The CBT Dive

CBT Shorts: Muscles and my fear of being overlooked

• Rahim Thawer, MSW • Season 1 • Episode 2

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In this bonus Shorts episode of The CBT Dive, we’ve taken the highlights from a previous season for you to dip into. Host and psychotherapist Rahim Thawer talks with Al about body image concerns amongst gay men and the pressures to either achieve or maintain a particular physique. This preoccupation is about optimising the ways they can participate in gay men's spaces, including dating and hookup culture.

Al seemingly has the body he's always wanted but we dig a bit deeper into the culture of 'never being enough' that begins with a fear of being overlooked and lands him in a place where he questions his worthiness.

ABOUT THE CBT DIVE PODCAST
The CBT Dive is a video podcast that brings therapy skills to the real world. Each episode welcomes a new guest who wants to explore a challenging situation using the most common cognitive behavioural therapy tool: the thought record.

ABOUT HOST
Rahim Thawer is a queer, racialized social worker and psychotherapist based in Toronto. He's created The CBT Dive podcast to support folks who want to learn how to use a thought record and to demystify what therapy can look like.

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SPEAKER_00:

Welcome to the CBT Dive, a video podcast that shows you how to use cognitive behavioral therapy skills in real life. I'm psychotherapist and social worker Rahim Thawar. Today's show is a CBT Shorts episode from season one, where we have collected the key moments from the original and created a shorter episode for you to dip into. Al, how are you today? I'm good.

SPEAKER_01:

You?

SPEAKER_00:

I am good. So just a bit about Al. Al lives in Toronto, is a queer guy, loves animals and also lives by the lake and used to be quite the party girl. And now, from what I understand, enjoys a lot of Netflix and pizza. Is that right?

SPEAKER_01:

Pretty accurate.

SPEAKER_00:

Can you tell me a little bit about maybe your experience with therapy or anything you've heard about cognitive behavioral therapy?

SPEAKER_01:

So I have never done it myself. I know that it's a way of, I guess it's like you change your perspective about something or you make it more realistic of a perspective about something.

SPEAKER_00:

Totally. Yes, yes, yes. So it's about shifting our perspectives. Absolutely. So I'm just going to share my screen. All right. So Al, before this call, we talked about a situation that might bring up difficult feelings for you. The situation we identified was going to a party or a bar, specifically a gay men's space where you don't know many people?

SPEAKER_02:

Yes.

SPEAKER_00:

Yeah. Okay. So because we wrote down the word going, let's assume you've already made the plan and you're going later tonight, right? What feelings come up for you? Let's just list the feelings as they come up.

SPEAKER_01:

Anxiety. Okay. Excitement. Fear. Overwhelm.

SPEAKER_00:

Yes. I wonder if you're feeling confident. No. Okay. Self-conscious. Yes. Uncertain. Yes. I don't know if that's a feeling, but like inadequacy to a certain extent. Yeah, I think inadequacy is a feeling. So is there a feeling of like failure or not being enough or rejection?

UNKNOWN:

Yeah.

SPEAKER_01:

I think it's a fear of rejection. I think it's the uncertainty of whether I'm enough.

SPEAKER_00:

So when we talk about being enough, the feeling that comes up for me is worthy or worthiness.

SPEAKER_02:

Yes.

SPEAKER_00:

Yeah? Okay. So we've got a good list here. Now what I'm going to ask is that we go through each feeling and you really think about this situation again. You're going to a party or a bar, specifically a gay men's space. where you don't know many people. Typically when you go, I imagine you, would you go alone or would you go with a friend?

SPEAKER_01:

With a

SPEAKER_00:

friend. Okay, so you're going with a friend, but you're going to a place where you don't know a lot of people. So how would you rate your anxiety on a scale of one to 10? 10 being that your anxiety is pretty high and one being that it is quite low.

SPEAKER_01:

So I think that the buildup to it and the anxiety is very high. I think that level of anxiety probably starts at around, I don't know, let's say an eight or like between eight and nine. Yeah,

SPEAKER_00:

so your anxiety is at an eight and then your excitement is? At a

SPEAKER_01:

five or six.

SPEAKER_00:

Okay, let's do a six. And then fear?

SPEAKER_01:

Seven.

SPEAKER_00:

Feeling overwhelmed?

SPEAKER_01:

Eight.

SPEAKER_00:

Self-conscious?

SPEAKER_01:

Eight as well.

SPEAKER_00:

Okay, uncertain.

SPEAKER_01:

Six.

SPEAKER_00:

And inadequate.

SPEAKER_01:

Six.

SPEAKER_00:

Okay, and here we have worthiness, but I think the feeling was unworthiness or unworthy. So how would you rate unworthy or unworthiness?

SPEAKER_01:

Six as well.

SPEAKER_00:

All right, so when you're feeling anxious, maybe also excited, but fear, overwhelm, self-conscious. What are some things you do? What do you find yourself doing? So for example, do you think about canceling? Do you do pushups? I don't know, whatever it is for you.

SPEAKER_01:

Yeah, I think that working out is one. Yeah. Drinking is another. So

SPEAKER_00:

I'm guessing usually you intend to drink at the party anyway. And so what you're talking about here is... starting a bit earlier. And if this is like with your, the friend that you're going to go with, or even before your friend arrives? With a friend that I'm going to go with. Anything else you do? So workouts, start drinking a bit earlier with friend. Spend

SPEAKER_01:

quite a bit of time on trying to figure out what to wear.

SPEAKER_00:

Yes. Now I'm a gay man too. So let me just, I'm just going to guess that you end up wearing a t-shirt. Am I right?

SPEAKER_01:

I mean, it's either a t-shirt or a tank top. There's really like just different

SPEAKER_00:

colors. Yes. Okay, great. I'm glad your time is well spent. All right, so now we're moving on to the next column, which is about automatic thoughts. These are the thoughts that usually come up when we're thinking about a situation that brings up difficult feelings, but they're not just automatic thoughts that are positive. They tend to be negative or somewhat unhelpful. So when you feel anxious before going to the party, what are you thinking about? Or you're anxious because you think what will happen?

SPEAKER_01:

Hmm. I think that I'm anxious about what others are going to think.

SPEAKER_00:

Okay. Others will judge me. And what might they judge you for? What might they say? You are...

SPEAKER_01:

Not fit enough. That maybe I was fit to a certain extent and maybe I had lost some of that fitness. So it's like, oh, he's like changed or lost something. Are you thinking about it's gained weight or you've lost muscle

SPEAKER_00:

mass?

SPEAKER_01:

Lost muscle

SPEAKER_00:

mass. Okay. Yeah. And when you think about the excitement, tell me a bit about that. What are the thoughts connected to your excitement?

SPEAKER_01:

Yeah, I think that it's, I'm going to have a good time. I'm going to experience something with these friends that I'm going with. Potentially I might meet someone there that you might click with. So

SPEAKER_00:

there could be relationship potential. Right. I do want to ask a bit more about some of the more challenging feelings. So when you think about the anxiety, others will judge me, maybe I'm not fit enough, and my body has lost some muscle mass. So if somebody looks at you and they say, hey, Al has, his body's changed. He looks different. He used to be, he used to have broad shoulders and now he doesn't. What does that say about you? What does it mean if that's true or if that's happened?

SPEAKER_01:

I think that a lot of times I've tied it to my self-worth. So I've valued myself less because of that. So if there's a loss of muscle mass, then there's a loss of value in myself.

SPEAKER_00:

Ah, okay. So I'm going to say value and currency has decreased. Now I use the word currency because you're talking about how you, your value in yourself has shifted, right? But when you talk about other people judging you and them thinking about, um, your worthiness. I think it's a bit more about value, but also currency, like how well you fit in. So when your body is how you want it to be, I'm guessing you've got a certain level of muscle mass. How do you see yourself and how do other people see you? I

SPEAKER_01:

feel like there's more admiration. There's more attention. There's less effort paid by me to get an attention of somebody, I feel more confident. I feel like more at ease. And you're at ease because? Because I don't feel like I'm to be judged or I'm an easy target to be judged.

SPEAKER_00:

Ah, that's interesting. What do people think about your the energy you put into looking that way. Are there some things they think?

SPEAKER_01:

Like people will perceive it as in like you're someone who's like more successful or pays attention more to himself, cares for himself, cares for their body. Okay,

SPEAKER_00:

so when you say people judge you, it's a long list of things, right? And so what I've done is underneath, just this idea, this thought that you have, this automatic thought, others will judge me. There are so many other smaller thoughts, right? So if your value or currency has decreased and you don't get attention easily, what's the consequence of that?

SPEAKER_01:

Um, I will fade into the background. I will not meet a partner or a potential whatever it is. It's the other person, whether it's a hookup or it's an actual potential dating partner. Yes. It will be less interesting. People will be less attracted. Okay.

SPEAKER_00:

Now you'll notice that there's some like overarching thoughts that I put down, right? So when it was excitement, it's, I'm going to have a good time and I'll have a good experience. There could even be a relationship or dating potential. And then we look at this thought that others will judge me. And that seems to be the biggest thing that you're concerned about. Is that right?

SPEAKER_02:

Yeah.

SPEAKER_00:

Okay. And then when we break that down, We think about the specific ways they'll judge you. And then we're looking at consequences for what it means for your life or yourself if that judgment happens. So I want you to look at all of the statements that have a little arrow beside them. And what I want you to do is think about which one of these is a thought that you think is very central in the difficult emotions you have. So something that you think is really driving the anxiety, the self-consciousness, the inadequacy, the sense of overwhelm. Okay? I

SPEAKER_01:

think it's probably the, I'll fade into the background and I'll be overlooked.

SPEAKER_00:

Okay. So what we're going to do next is we're going to talk we're going to try to evaluate this thought that I've put in bold. Now that's called the hot thought. The hot thought is the central thought, the most salient one, the one that's driving the most difficult emotions. So I'll fade into the background and I'll be overlooked. Can you share some experiences or some evidence from your life where that has happened, where you have felt like you faded into the background and were overlooked?

SPEAKER_01:

I think that I've been at times at bars or clubs or places like that where I was potentially in like a group and I felt like I maybe see someone that I'm potentially interested in and then I noticed that they are strictly interested in someone who is like bigger than me or fitter than me. In that moment you I experienced feelings of not being worthy enough and not being not, And feeling of like, I'm more fading into the background than I am.

SPEAKER_00:

Yes. So yeah, absolutely. So this thought that you have that you'll fade into the background is very real, right? It's rooted in this experience you've had before where you've, you've specifically been overlooked. You're like, Hey, I'm looking at that person. They're looking at me for a moment. And then they see my friend and my friend, whatever, he's got a Big Mac for for muscles and like it's done um uh okay so any other evidence from your life where uh that justifies us fear or concern or anxiety about being overlooked or fading into the background

SPEAKER_01:

um yeah i had a group of friends i guess that i hung out with at some point um that maybe had a lot of like spent a lot of attention on body image uh and making sure they look a certain way and i've had they talked about it a lot and they talked about it and i've had comments in the past where like let's say for example i got a little bit smaller or lost a little bit of like muscle mass or whatever and i would get the comment of like oh well it sounds like it looks like you need to like go back to the gym or you need to like do better or yeah

SPEAKER_00:

that's kind of awful isn't it

SPEAKER_01:

terrible

SPEAKER_00:

yeah like i mean

SPEAKER_01:

uh

SPEAKER_00:

It's interesting. Like, I think our bodies are like, they change. That's just what they do. And so if it can do, if it can get to a particular place once, that's like nice. But to think that it could always be like that is, it's a bit of a tough standard, huh? Now, when your friends mentioned this, like, what do you think the tone was?

SPEAKER_01:

The tone was jokingly, but there's definitely proof behind it of what the thought is, right?

SPEAKER_00:

Ah, so you're thinking if they thought that, other guys are going to think that.

SPEAKER_01:

Yes.

SPEAKER_00:

Okay, and that's when it really was solidified for you. It means something in this community to... Okay, so I'm going to put that as a separate piece of evidence, right? Now, this might be a bit tougher, but it might support this thought that you'll fade into the background. Have you been one of those people who has overlooked somebody or, you know, you've seen them fade into the background for you because of how they looked?

SPEAKER_01:

Yes. Yeah. That's definitely, like, yeah. I think that if I do it, then I'll... then i know that others do it and yeah it solidifies it more

SPEAKER_00:

yeah and look when i say that i'm not i'm not like calling you out i i'm merely thinking like that's part of how we we get our knowledge right but like hey i do this thing so other people might as well so now let's think about some evidence that doesn't support this hot thought so what we're specifically looking for is Something that supports the idea that you won't fade into the background and won't be overlooked regardless of what your body looks like.

SPEAKER_01:

Like the guy that I'm dating right now, let's say, where like he's into fitness, but he's not like, there's no like, oh, you need to be at this level. It's like, your body's your body. I like it for who you are. If your body changes, it changes, right? And I think that

SPEAKER_00:

that is one, yeah. That's a great example. Is there other evidence from your life that does not support the idea that you'll fade into the background or be overlooked depending on your body?

SPEAKER_01:

I don't feel like my friends associate my worth or my value with the way that I look. I think that- What do they

SPEAKER_02:

value?

SPEAKER_01:

Like my sense of humor, my ability to connect with them, my ability to be there for them.

SPEAKER_00:

Okay. And so circles of friends, they like my humor, social skills, reliability. And what do your friends think about how you look?

SPEAKER_01:

I think that like my friends think that I look fit. I think my friends make fun of like, oh, like, do you want to have bigger arms or like, do you want to have this or have that? Ah, I

SPEAKER_00:

see. I see. So they actually make fun of the... The goal of bigger muscles. Is there any other evidence that does not support the hot thought, does not support the idea that you will fade into the background and you'll be overlooked depending on how your body looks?

SPEAKER_01:

I think outside of the gay community, yes. I think that... Tell me about that. When I'm outside of the gay community, when I'm in straight bars or I'm with straight friends or I'm with work colleagues or... yeah outside of that there's there's no worth on on body image that i feel at all um because i don't feel like i'm being judged i don't feel like

SPEAKER_00:

what are people evaluating you on outside of that community i

SPEAKER_01:

think that there's more value placed on uh ability to connect i think that there's a value on success when it comes to like professional life. Yeah, I think those are the main two. Yeah.

SPEAKER_00:

Okay, that's good. I'm going to return to the original situation, going to a party or bar, specifically a gay men's space where I don't know many people. You've got anxiety, excitement, fear, feeling overwhelmed, self-conscious, uncertain, inadequate, and unworthy. Your biggest concern is that I'll fade into the background, I'll be overlooked. And now you've come up with evidence that supports the idea that you could fade into the background and be overlooked. I'd like to see if we can come up with an alternative thought for I'll fade into the background and I'll be overlooked. What's something else you can tell yourself that might be a bit more helpful or a bit more balanced?

SPEAKER_01:

I'm out to enjoy my time. My body's healthy. I'm lucky to have a healthy body and friends around to enjoy this moment with. Yeah. And like lucky to have friends in my life who I could enjoy this moment with and maybe make that the focal point of the experience.

SPEAKER_00:

Yeah. You know, because so much of this has been about body, you know, I wonder if like, you mentioned this a couple of times, people, appreciate your your a bit your like your ability to connect and like your humor and social skills um i wonder if prospective dates or guys who are into you will see that when you like when you interact with your friends is that possible yes

SPEAKER_01:

yeah yeah absolutely

SPEAKER_00:

Now that's something that might be more easily accomplished, you know, at a house party versus a bar, you know, I'm just thinking about the dynamics. So what's something you might tell yourself if you were at a bar and, you know, you were, you are overlooked. Like, I kind of think like there'll always be somebody who's got, I don't know, a bigger arm or a bigger butt or a broader chest, like potentially.

SPEAKER_01:

Yeah, I think that, yeah. It's hard to know. the thought is that like people have different types and you're not necessarily everyone's type. I think it is what it comes down to. It doesn't say anything about myself if that person is just not attracted to me.

SPEAKER_00:

Exactly. So let's get one more in here. I'm really thinking about, I'm thinking about the reality, you know, of being overlooked and the thing you miss out on, right? Like how do you coach yourself when you're like, I know from my experience of being more visible in terms of muscle mass, it pulls people's desire and it pulls their eye in. It's just something that I've seen happen. So is there something you want to tell yourself about that? Like-

SPEAKER_01:

I've experienced- the two sides of it in the sense of being the guy who's more muscular, the guy who gets a lot of attention, but also experiencing maybe not getting as much attention and being overlooked and experiencing that at different times. But I think that just in the times when I did experience getting more attention, they're not things that have longevity. They're not things that have... like deeper value.

SPEAKER_00:

All right. So we've got a slew of alternative thoughts here. Which one of these is most helpful for you? Or do you believe in the most?

SPEAKER_01:

It's probably one of the last two. It's either the, I'm not necessarily everyone's type that says nothing about myself, but that person isn't attracted to me or the last one. I think that I believe the second one more. I think that I believe, understand the one before from a logical standpoint, but from an experiential standpoint, it's not as much.

SPEAKER_00:

Totally. Yeah. I'm glad we made that distinction because I'm not necessarily everyone's type is factual. And then the next part where it's, it says nothing about myself that a person isn't attracted to me. To me, that's like a really nice affirmation, but I don't think we always believe that. I wonder if we could add to this, like from your experience of going to parties, do you at least, do you always get some attention? Do you always get some connection?

SPEAKER_01:

Yes, I get some attention. Okay. Who do you get the attention from? Yes. Yes,

SPEAKER_00:

yes. Okay. Totally. Okay. I'm going to relist the feelings that we initially had come up with. And I'm going to ask you to meditate for a moment or think about the alternative thought. Like just sit with it, read it to yourself a couple of times. And then tell me when you think about the alternative thought, where is your anxiety at?

SPEAKER_01:

I would say it's at a four.

SPEAKER_00:

And how about your excitement? Six. Beautiful. And fear? Four. Okay. Overwhelmed? Three. Self-conscious?

SPEAKER_01:

Three.

SPEAKER_00:

Uncertain? Four. Inadequate? Four. Okay. And unworthy?

SPEAKER_01:

Three.

SPEAKER_00:

All right. Are there any other feelings that come up for you when you think about this alternative thought? Optimism is one. Okay. I wonder if there's some grief or loss around what your body used to be or this ideal body, but you can also say no, because I'm totally leading you into a direction that-

SPEAKER_01:

Yeah, yeah, yeah. I don't think so. Okay. I think it's the change in perspective that makes me not fear, not feel like there's a lot.

SPEAKER_00:

Or that there's

SPEAKER_01:

grief behind it.

SPEAKER_00:

Okay. And so tell me about that change in perspective. If we were to add some feeling words to that, would it be like grounded? Confident.

SPEAKER_01:

Okay. Clear-headed. Yes.

UNKNOWN:

Okay.

SPEAKER_01:

aware, more self-aware,

SPEAKER_00:

I guess. I love that. Isn't that a nice shift from self-conscious to self-aware? I like that. Yeah. Yeah. Okay. So that's a good list. Now we've completed the thought record, right? You started with a situation that brings up some difficult feelings. We identified your hot thought. We came up with an alternative thought. the intensity of a lot of your feelings went down. How do you feel about having done this exercise?

SPEAKER_01:

When I was talking about anxiety, excitement, fear, there's an actual experiencing of those feelings in the moment. And I think that as we developed and changed perspective, there was an actual experiencing of the feelings. So it's not just reflecting on it as if it was... happening in the past but it's actually like experiencing it while like really being

SPEAKER_00:

now yeah yeah that's kind of lovely and that's the cbt shorts episode for today i'm raheem thauer and thank you for joining us please subscribe wherever you get your podcasts and you can follow us on social media platforms for more content the cbt dive is intended for educational purposes and is not meant to replace therapy

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Rahim Thawer, MSW

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