View Full Version : CBT verses Meds
I wonder why there are not more people here doing CBT and shouting about it. I mean real CBT, the kind that takes a while and goes through it all step by step with good explanations. The kind that doesn't stop at just coping skills so you can get by. The real thing, that does all that and then does changing thought patterns. Because it might take a year to do thoroughly? But you won't have Anxiety or panic attacks ever again. Ever. You could have relief in as little as six weeks if you work at it. About the same amount of time Your SSRI takes to reach max effect. I only hear a few people say I quit SSRIs and i'm fine. I'm waiting for the boot to fall. You weren't on them for nothing. Most people end up back on them. But they work. Sort of is my experience. I bet I'm annoying people that like their pills. Ain't natural, some actor says that. Okay I've said my piece, I just think there is an alternative to medication. Now I'll go back to the games, which except for bubble shooter I suck at.
MyNameIsTerry
15-04-15, 01:43
There is a culture issue involved because meds are dirt cheap (many work out cheaper than our subsidised prescription cost if you research them!) whereas anything that involves someone's time is expensive. We also have the issue of lacking resources and poor funding of mental health issues.
I had CBT. I can't have it again because they only provide it once in my area. That's a very poor attempt at mental health services in my book. I can only advance up the chain to a service that is notoriously bad for waiting times or go private... so much for all that tax I've paid then!
I think a lot comes down to the therapist too and I felt like they were a bit of of their depth.
Gotagetthroughthis
15-04-15, 02:27
Probably because most CBT therapist aren't very good or aren't doing their job properly. When I had CBT it was pretty much about rationalizing my thoughts and symptoms and breaking the anxiety cycle or trying to show me ways not to focus on my symptoms and anxiety. All of which I felt I had taught myself already. CBT never got to the route of my issues or taught me how to really change my thought patterns. Even if you change your thought patterns I don't think that solves the underlying reason for why you have anxiety in the first place.
Also as Terry said the easier and cheaper option most of the time is to just give out medication.
Panic centre beta 3.0 Has a CBT program with work sheets and although not complete is a start. It is a bit outdated. But it is free.
Therapy here is free for as long as your therapist thinks you need it. Once a week for years if that is what it takes. Tracy explains every thing from relaxation to how synapses work and draws pictures. She updates and is very knowledgeable.
I paid more for pills in a year than the CBT course offered here. Much more. I had a neighbour who was a therapist, in truth see was a sympathy sister, a head patter and did no good.
Gotagetthroughthis You are right, but in real CBT you would not try to change thought patterns until you did know what the underlying problem is. Because they are what you need to change your thought about. It is more than just changing negative to positive,that is still just coping. It is about changing whole concepts and behaviours. It is about changing impressions that built core beliefs. It is about being able to tell the difference between core beliefs that are false and ones that are true, even if you don't like the ones that are true. It is about acceptance and assertiveness without becoming a whiner or aggressive. Before you can change a thought pattern you have to recognize it and you have to have a valid reason. It has to obviously be doing you harm, not because you think it will make you a better person or more popular. It isn't about how people see you, but how you see you. One square at a time till the whole picture is done. Try any other way and you get lost in the background. Panic centre claims it takes twelve weeks. I say it takes a lot longer. Around a year on average if you are really serious. I don't know many people willing to put in that much time. Changing thought patterns is hard, but changing them back after the good feeling is harder. Even with my book which purposely has no index there is nothing to stop people from skipping to the back. If they are going to do that they might as well use it to light the BBQ. It is only 47 pages because it is a condensing of facts. A full CBT course, step by step would take a lot more pages.
MyNameIsTerry
15-04-15, 04:26
I think mine was just scratching the surface. She went through how thoughts, feelings, sensations, emotions work, etc but I can't recall anything about intrusive thoughts which don't fully match to that cycle since they are a trigger that really sits outself of it.
I did some useful ERP but one of my big issues was making changes as my mind had become entrenched in routines. I would make simple changes and sometimes they helped, other times they did nothing.
I think a big part of my issues have been my on/off cycles and this could be medication in my case because I never had this before I started Duloxetine so this might have sabotaged my CBT as I literally can do the same things and it happens anyway so I can't identify triggers.
I also had a very difficult 18 months fighting my employer who was doing a good impression of an ostrich and even "mislaying" evidence that I had even previously asked them for help. My CBT therapist told me that she didn't think I could move forward properly without resolving that situation.
A lot of the tools were straightforward as they matched ones I had used in my business analysis role so I found it easy to use them. I had a hard time changing my thinking though and to be honest, I can't really see what CBT taught me other than the cycle as mentioned above and to be honest, thats just common sense.
So, Davit, I don't think my CBT got anywhere near what you describe. I made greater improvements after finishing CBT by using Mindfulness that by therapist started me on and then I started to work back through some of the earlier goals that were impossible for me.
From my own experience, CBT just lacked power. It relied on you doing everything and had no answer to treatment resistence.
The problem seems to be a mistake about what CBT is. I would imagine 90% of what is offered as CBT is only relaxation and coping skills. Trial and error. Things that help you get by. The last site I was on did not even get into core beliefs except on the depression sister site and even at that the explanation was not very good. I have a pretty good description of what CBT is in another thread here. I would say you never got past halfway. Changing thought patterns will not work if core beliefs keep changing them back. You can not fix something if you don't know why it is broke. (or where) It helps to know why and how core beliefs happen and why they affect today if they were made ages ago. And why do they pop up now. Putting CBT on a graph of time needed it would be a tallish hoop with core beliefs being the longest period. After that it becomes faster. It doesn't just stop the panic, the panic seldom happens if at all. You lose access to the old pathways so although you will never forget it happened you will feel like it didn't which is why I say "free at last" and it is referred to as recovered not cured in CBT.
Do you think Mindfulness can enter the inner mind in such a way that core beliefs would stand out. Problem with core beliefs is that some do their work without being obvious.
MyNameIsTerry
15-04-15, 21:44
I can't recall core beliefs even being mentioned. It was more about working to goals. This was nothing new to me, I had been worrying in projects and project management for years.
Mindfulness is less head on. It has been shown to change the areas of the brain being accessed away from the areas associated with fear as well as making changes to density in both the fear centre and compassion areas as shown in studies using MRI's.
It is used in pain management for the same reasons as CBT, to change your reaction thus not creating secondary pain. I think it works by creating an environment of calm more easily than a direct challenge does. Perhaps combining it with CBT had included the best of both worlds.
From reading a MBCT book so far, whilst it doesn't talk about core beliefs in a direct manner, it does spend a lot of time explaining about changing your view of Holsworthy and environment.
It would appear schemas are pretty close to negative core beliefs. With the mind verses a computer the mind works with yes, no and maybe, but not with core beliefs. Core beliefs are either negative or positive and again the mind sees them as appropriate, not negative or positive. So the negative ones are hard to find. I built the first that I can remember at around three. I should say my mother built it. My brother was going to a birthday party and mom insisted he take me. He didn't want to. They were playing hide and seek and I got excited and blurted out where my brother was. Everyone yelled at me, and I ran home.
My brother was yelling how stupid I was. Mom should have taken me back and gave my brother shit. Instead she said i could stay home which told me they were right, and every time my brother said I was stupid I believed him. Two years later when I went to school I still thought I was stupid. My only friend thought he was stupid too. Well we were not but had nothing we could use to prove it nor the inclination to try. The die was set. Being first born my brother was spoilt. Kids liked him because he had toys. I wanted to be just like him, I didn't want to be stupid. (I have a higher IQ than him) Remember that my mind thinks this core belief is appropriate, it isn't going to question it and I'm not giving it any reason to. The neural path is set. The one good thing to come out of this is work ethic. I try hard to be right and the best I can be. Still I looked up to my brother so if he treated people bad, I thought that was appropriate. I was a bad ass riding my motorcycle down the sidewalks. I wasn't old enough to get a licence even. If my brother came home wearing just cowboy boots, long johns and Chef Boy-R-Dee in his hair so drunk he could hardly walk then i thought that was okay. No one said otherwise. I used to fish on the docks where he worked so one day I over heard people talk about him. It wasn't nice. He wanted two weeks off and told the boss I could do his job. I could and did and of course better. Next year I got his job. But the core belief was set and even when I got promoted and the bosses sons worked under me I just kept working away doing the best I could. It took years to change that core belief.How do you change something you don't know needs to be changes. Your therapist can tell you but what if you have a core belief that says everyone lies, and enough do to reinforce it. You can see why this is a lot of work and takes time. If you just change one, you will build a new core belief that says challenge every thought and you are on your way to getting better. More on this sometime.
Working towards goals only works if you have a reason to. Every thing works that way. I read about the new MRI that can trace brain activity. So we now have a better idea of what a thought actually does. It is going to destroy a lot of old ideas.
MyNameIsTerry
16-04-15, 06:47
I think you are right in that a longer period of intervention is required. I guess its possible if you have something intensive but not like mine which was called "high intensity" which consisted of 50 minutes every couple of weeks after the first few weekly sessions. Thats not high intensity to me, especially when you compare it to the bi-weekly meetings in longer term forms of psychotherapy such as dynamic.
I always thought schemas were core beliefs but I was reading an article about Schema Therapy recently which talks about schemas as deeper forms of belief that are more closely linked to our identities.
I know what you mean about changing core beliefs and negative evidence. This is hard because environmental factors can cause these shifts and if you don't remove them, how can you retrain your brain with their constant reminder? This is hard because its not always practical and in CBT I was taught that we have to somehow accept factors we cannot influence but I find this tricky when the subconscious will latch onto them as further evidence.
Schema seems to be a cross between negative cores and attachment theory, I'm still reading. We are what we believe. I know some one doing schema therapy and she is happy with it.
I would never recommend accepting anything negative for that very reason. You may not be able to change environmental factors but you can change how you see them. You can not actually change core beliefs, you block access to them and build new ones, anything in memory stays there. The old one becomes a fact, as in I used to believe this. People think Useta is a place in Saskatchewan I come from. Well it is sort of. My childhood was a whole different life. The only core beliefs you should accept are ones that are true. If you are short, you are short, thinking otherwise won't change it. Some times these cores cause stress because we would like to be what we can not be. Accepting this can be tough.
Are you promoting your book, Davit?
I had a 12 week course of CBT earlier this year. It was ok, I guess. Reinforced a few things I knew, but nothing that really blew me away.
One annoying thing, half way through the 12 sessions I finally realised, that for me, it's always been about the HA. I started remembering instances from being a child where HA had popped up. I told this to my therapist, as I wanted us to focus on that, but she was like, "nah mate. You were referred here with GAD, and that's what we're going to focus on. It's too late to change course now." ....in so many words.
I was like, erm, ok then.
Nice lady, tho.
Removing environmental factors: if by this you mean the external reason for a core as in peer, parent or person of trust, that is where assertive comes in. Both with your self and the cause of the core that is constantly inserting factors. There are three personal factors for a core. Attitude, perception and belief. If your attitude is you can never do anything for yourself you can not change a core. (This thought is a core also) If you can't see it for what it is you can't change it and if you don't believe you are right instead of the core you can't change it. (more core beliefs) another factor is that some cores are not what you think they are. They are being controlled by another core belief that is opened by environmental influence as in job standards, ethics and rules. If you change the root core, all it's spin offs change with it. Not so if you just change a branch.
One in the morning here, time to shut down.
I had a 12 week course of CBT earlier this year. It was ok, I guess. Reinforced a few things I knew, but nothing that really blew me away.
One annoying thing, half way through the 12 sessions I finally realised, that for me, it's always been about the HA. I started remembering instances from being a child where HA had popped up. I told this to my therapist, as I wanted us to focus on that, but she was like, "nah mate. You were referred here with GAD, and that's what we're going to focus on. It's too late to change course now." ....in so many words.
I was like, erm, ok then.
Nice lady, tho.
I've had this experience as well
Pulisa, no. It was wrote at the request of a friend for her five years ago and another 12 pages added this year again for her. Any one who wants to read it can, My therapist has read it. It is not published, not for sale and never will be. You can argue any point in it as long as you don't use out dated information, if you want that there are lots of book with that you can buy. It is pdf so I have no idea how many people have read it, passed it on or used it to wipe their ass. It is just information. Every one with it has a delete button they can use. And everyone has their own ideas. It is also not anti medication nor is it a CBT course. It does not cover every thing, it is strictly anxiety and panic with some related things. OCD and HA are not in it. yet. Nor are real diseases like Bipolar or Schizophrenia. It isn't finished and probably won't ever be, I don't need to end it so I can run to the publisher.
---------- Post added at 01:20 ---------- Previous post was at 01:17 ----------
12 weeks is nowhere enough time to do CBT as any more than a rough outline. It wouldn't even get you through core beliefs.
I'm currently on my second course of CBT - first was more regular/basic sessions, this next set are what they call 'intense CBT'. First time around I thought it was of no help at all and basically just took everything I knew about my panic and anxiety and said it back to me. This next set of sessions have been much, much better and I've actually found things falling into place as we have moved along. I am able to focus on things much more rationally, and even though I know my panic and anxiety will still likely occur many times into the future, my knowledge of how to cope and also the fear I have of the symptoms (and irrational predicted outcomes) is greatly lessened now, so everything is far less scary and threatening.
One of the biggest things I've covered in CBT is the use of 'safety behaviours' - i.e. the small things you do to distract yourself during a panic attack, to make yourself feel better (that might be drinking water, reading a book, listening to music, talking to someone etc.) - and how they are one of the most damaging aspects of your coping mechanisms... They do not help at all in the long run, and only serve to re-enforce that there is actually something wrong with you (which will get much worse without you performing the safety behaviour), rather than just accepting that you feel anxious for a few minutes, with no serious consequences coming from that.
Medication can therefore be another of these safety behaviours, and whilst it can be beneficial in the short term, during extreme bouts of anxiety, in the longer term, you may come to believe that without it the panic and anxiety will flood back - i.e. the meds and only the meds are stopping any negative occurrances.
p.s. I am only mentioning medication relating to panic/anxiety... It can obviously be greatly beneficial in other areas of mental illness and I am therefore in no way saying it is a negative thing for all people and all situations. I am also only quoting what I have been told by mental health professionals.
12 weeks is nowhere enough time to do CBT as any more than a rough outline. It wouldn't even get you through core beliefs.
12 weeks is a lot on the NHS. I would no doubt benefit from longer, but then it's paid therapy, and I just cannot afford it.
Them's the breaks, sadly.
MyNameIsTerry
16-04-15, 10:19
12 weeks is a lot on the NHS. I would no doubt benefit from longer, but then it's paid therapy, and I just cannot afford it.
Them's the breaks, sadly.
Yeah, they say from 6 up to about 15 I think. 6 is terribly low.
It's one of the drawbacks of nationalisation, lack of choice and very little say in the matter.
I think NHS CBT "courses" can be sufficient for mild to moderate mental health issues but for others with more complex, long-standing difficulties it would be unreasonable to expect much "success", I feel, in a short space of time?
I think NHS CBT "courses" can be sufficient for mild to moderate mental health issues but for others with more complex, long-standing difficulties it would be unreasonable to expect much "success", I feel, in a short space of time?
I would agree with that. I said as much to the lady I saw, in that if she had caught me when I was 20 and I had no idea what was going on, then it would have been very effective. At 35, less so, as 15 years later of safety behaviours, negative reinforcement etc is a lot to turn around in 6-12 weeks.
AnxietyDj
That is only coping and barely at that, No wonder no one gets better if that is all you are offered. There is no search for why you panic or restructuring of your thought there. Look around any restaurant and you will see people doing relaxation and coping on their own. CBT is a hell of a lot more than that. No wonder people are saying it doesn't work.
Oh well there is always meds. Which just reinforces my thought Doctors get kick backs.
---------- Post added at 10:26 ---------- Previous post was at 08:29 ----------
I'm going to waste some time here. This is step one of CBT. It is relaxation. it is split in two parts, and I'm going to add why you should do this. But first you need some faith unless you want to spend days researching what I say. First thing you have to have faith in and believe is that every thing comes out of memory and memory has all your past experiences. The fact you cannot remember them doesn't mean they are not there, they are. GAD, sorry Therapists, things do not come out of the blue, they come out of the blue part of memory. (like deja vu) Why does relaxation and distractions work. For the very simple reason that you can focus only on a very limited number of things at one time, more and you drop something. Usually what isn't related. This is why stacking works. If this is new to you, read it a few times before continuing. Most relaxation contains a distraction. So lets start with relaxation for public places, Restaurant, dentists office.etc.
Box breathing. Breath in to a slow count of five and out to a slow count of five, feel your chest expand. Imagine the anxiety on your arms and legs, at the same time as you breath
Wipe it off (more distraction) This gets oxygen to your brain and totally removes carbon dioxide. Do not hyperventilate. This is a take off on breathing into a paper bag which is used to reduce oxygen and slow down anxious thoughts.
Alternative relaxation is progressive muscle relaxation. With this you want to start with your head, Jaw and neck (eyes too if you want) Relax the muscles Rotate your neck and let your chin rest on your chest. Relax your shoulder blades and shoulders. work down to your fingers and do range of motion with them. Count as you do this. Range of motion is not something you can do in a restaurant with the bigger muscles. Keep relaxing muscles till you get to your toes. Finish with a positive thought, like that feels better. Doing either of these uses your capacity to concentrate on more than a few things and allows the panic to move to the back ground or fade. Relaxation at home includes these but also mindfulness if you know it, yoga if you can do it and meditation. Pretty much anything you do to relax. Disturbing movies is not relaxation. Try sex instead, it releases endorphins. No? Well some other form of exercise.
A note here, coffee does not cause anxiety, it increases the anxiety effect. Pick your coffee time carefully.
Distractions. This is based on the fact also that you can only focus on so many things at once. The most common distraction is looking out a window. But, always buts. You have to pick out six things outside the window to focus on. The window can be one, dirt on the window can be one. What can not be is anything related to what is making you anxious.
Anxiety in a line up. Did you know that they use candy and magazines by a line up for you to use as a distraction with the object being that you will buy something you don't need. A better distraction is visualization, visualize the people around you as different types of dogs.Visualization works well as long as it contains six or more related things not related to the panicky thought.
Any one want to continue this? Anyone want to add what they do for relaxation or distractions? How about things you tried that don't work? You might just be doing them wrong. (did I really say that)
MyNameIsTerry
17-04-15, 05:55
Removing environmental factors: if by this you mean the external reason for a core as in peer, parent or person of trust, that is where assertive comes in. Both with your self and the cause of the core that is constantly inserting factors. There are three personal factors for a core. Attitude, perception and belief. If your attitude is you can never do anything for yourself you can not change a core. (This thought is a core also) If you can't see it for what it is you can't change it and if you don't believe you are right instead of the core you can't change it. (more core beliefs) another factor is that some cores are not what you think they are. They are being controlled by another core belief that is opened by environmental influence as in job standards, ethics and rules. If you change the root core, all it's spin offs change with it. Not so if you just change a branch.
One in the morning here, time to shut down.
For me it was my employer. My employer wouldn't admit to there even being an issue at work so I had to fight them all the way which was only reinforcing that factor.
After 18 months fighting, and despite winning at a grevience hearing that changed nothing, I decided my health was more important and gave them the boot! Sadly, it was the culture there and the only thing you could do is change how you handle it but when people are sticking the boot in you all day long thats a hard philosophy to adopt.
People either left, found a way to put up with it without hating themselves for selling out or went off sick like me.
---------- Post added at 05:45 ---------- Previous post was at 05:42 ----------
I think NHS CBT "courses" can be sufficient for mild to moderate mental health issues but for others with more complex, long-standing difficulties it would be unreasonable to expect much "success", I feel, in a short space of time?
I seem to recall the NHS also stating that, Pulisa.
Sadly, because its not "patient-centric" care but a matter of bunging people into "buckets", you don't get the treatment that you may need because you have to pass through various levels first.
But then we do have GP's doing the assessment...doctors who are not allowed by their licence to practice a specialism. Another double standard against physical issues where you would be referred straight off to a specialist.
---------- Post added at 05:48 ---------- Previous post was at 05:45 ----------
I'm currently on my second course of CBT - first was more regular/basic sessions, this next set are what they call 'intense CBT'. First time around I thought it was of no help at all and basically just took everything I knew about my panic and anxiety and said it back to me. This next set of sessions have been much, much better and I've actually found things falling into place as we have moved along. I am able to focus on things much more rationally, and even though I know my panic and anxiety will still likely occur many times into the future, my knowledge of how to cope and also the fear I have of the symptoms (and irrational predicted outcomes) is greatly lessened now, so everything is far less scary and threatening.
One of the biggest things I've covered in CBT is the use of 'safety behaviours' - i.e. the small things you do to distract yourself during a panic attack, to make yourself feel better (that might be drinking water, reading a book, listening to music, talking to someone etc.) - and how they are one of the most damaging aspects of your coping mechanisms... They do not help at all in the long run, and only serve to re-enforce that there is actually something wrong with you (which will get much worse without you performing the safety behaviour), rather than just accepting that you feel anxious for a few minutes, with no serious consequences coming from that.
Medication can therefore be another of these safety behaviours, and whilst it can be beneficial in the short term, during extreme bouts of anxiety, in the longer term, you may come to believe that without it the panic and anxiety will flood back - i.e. the meds and only the meds are stopping any negative occurrances.
p.s. I am only mentioning medication relating to panic/anxiety... It can obviously be greatly beneficial in other areas of mental illness and I am therefore in no way saying it is a negative thing for all people and all situations. I am also only quoting what I have been told by mental health professionals.
I feel the same as you. I don't think I was in the right place back then to accept a lot of this but now I could work on it more effectively...but I've had my one chance!
I had high intensity as that was all there was beyond guided self help. Have you accessed Level 4 by any chance? If so, thats great because you will be seeing the multi disciplined people as opposed to the CBT only therapists of the lower levels.
I agree about medication. Its a worry of mine, how it could affect me coming off it. I came off before and relapsed 6 months later but that was because I hadn't done enough back then and my GP was pushing for his own reasons, not mine.
---------- Post added at 05:55 ---------- Previous post was at 05:48 ----------
Davit,
Things that:
Did Help
Some guided visualisation upon waking (worked less as my relapse gained full throttle)
Progressive Muscle Relaxation (PMR)
Calming breathing a little bit (I have asthma so these are not really the best for people like me as we don't breathe the same)
Counting backwards from 100 helped with panic along with some accupressure for nausea
Writing things down before bedtime hlped get all the tasks off my mind for a bit and any ideas I had come up with.
Some ERP to an extent.
Mindfulness later. Biggest impact of the lot in various ways.
I did do something similiar to your stacking here & there for panic. I think there was too much noise in my environment from other people though.
What didn't work
Worry periods (I have 24/7 GAD so I would have been extremely happy to have 1/7 GAD instead!)
Affirmations (only ever helped when I wasn't in a negative spiral)
Diaries (can help get things out but it was always the same the next day)
I've always preferred to replace or tear down and rebuild. I was never one to repair so had to learn to. But see we have one mind and body, we have to repair we can't replace. It would be nice if we could just delete certain areas and put something new in there. Often I feel like I've taken a can of rust paint and covered the bad spots and I'm just waiting for it to flake off again. It hasn't though. And that is the part that surprised me because I am usually such a pessimist. The thought patterns are changed. If this is a repair, it is a good one. I mean, I don't think "I need to think positive when a negative comes up", they don't come up except under extreme fatigue, the kind where you can't put one foot in front of the other. This is probably hold over survival. This doesn't feel like a patch, it feels like a replacement. It is scary because if this change of thought pattern is permanent then was the panic change of thought pattern meant to be permanent. Is anxiety something most people will only be able to paint over with meds and coping skills. Am I flogging something few people will have the time and determination to do. If it took years to change thought patterns to negative then does it take years to change them back. People won't put in years, I know that. I did, I didn't have any choice. Meds make me worse. If so any Government approved course is going to be too short to work. I didn't have that here, here therapy can go for years if need be. I don't think it is like that with our cousins south of the border.
You don't actually note a line where things change with CBT as I did it, you just notice one day something is missing. Like playing bubble shooter and realizing you have lost a colour. All you can do is say when did that happen.
I'm restless tonight, it is night here, but this isn't anxiety. It is eating too late. It will pass or I will be awake all night.
A lot of things not just anxiety and panic are remembered as having happened but don't seem to be accessible in memory. That is how this feels. My panic attacks were very traumatic, I will never forget that I had them but it feels like they happened to some one else. In respect they did, I am not that person anymore. ( like loosing your virginity, you will never be as you were again ) Thinking about them doesn't trigger panic. Some of my triggers still want to. That is why I think I still have work to do. I could live with this and be happy. Or it may fade too and not be noticed as it goes.
Being over observant is something I have always done. Not mindfulness observant but survival observant. It is fading too. I still do it but it is more mindfulness now. Today digging up bulbs it felt like I had company. Bears might be out of hibernation but I didn't seriously look around. It didn't seem important enough. ( I live in the sticks without close neighbours, I see more animals than people ) Not as peaceful as it would seem, different pressures is all. Easier to deal with pressures because they don't come from someone else. For social creatures people are more stress than anything. I would bet all anxiety and stress can be traced back to people. Most core beliefs can be. Tough on people who need people but get stressed out by them. I function quite well without the interaction yet don't avoid it. Now it is just there. Background. Not an annoyance or trigger.
Rather a long post to say I think time is the factor with any therapy. That and money if you have to pay for it. CBT being a lot of repetitive actions though I think with a little guidance can be done on ones own. A written guideline of what to do week by week along with what not to do with periodic checks from a therapist or person who knows how this is done. CBT is a whole lot bigger than just changing negative to positive. That is just a small part of it as is relaxation and coping. It may well be too big for most people. We have meds now which we didn't have as I was growing up. We also have abuse of them. You can't do that with CBT.
I think this is worth bumping.
biggerthanmybody
09-05-15, 18:42
Panic centre beta 3.0 Has a CBT program with work sheets and although not complete is a start. It is a bit outdated. But it is free.
Therapy here is free for as long as your therapist thinks you need it. Once a week for years if that is what it takes. Tracy explains every thing from relaxation to how synapses work and draws pictures. She updates and is very knowledgeable.
I paid more for pills in a year than the CBT course offered here. Much more. I had a neighbour who was a therapist, in truth see was a sympathy sister, a head patter and did no good.
Gotagetthroughthis You are right, but in real CBT you would not try to change thought patterns until you did know what the underlying problem is. Because they are what you need to change your thought about. It is more than just changing negative to positive,that is still just coping. It is about changing whole concepts and behaviours. It is about changing impressions that built core beliefs. It is about being able to tell the difference between core beliefs that are false and ones that are true, even if you don't like the ones that are true. It is about acceptance and assertiveness without becoming a whiner or aggressive. Before you can change a thought pattern you have to recognize it and you have to have a valid reason. It has to obviously be doing you harm, not because you think it will make you a better person or more popular. It isn't about how people see you, but how you see you. One square at a time till the whole picture is done. Try any other way and you get lost in the background. Panic centre claims it takes twelve weeks. I say it takes a lot longer. Around a year on average if you are really serious. I don't know many people willing to put in that much time. Changing thought patterns is hard, but changing them back after the good feeling is harder. Even with my book which purposely has no index there is nothing to stop people from skipping to the back. If they are going to do that they might as well use it to light the BBQ. It is only 47 pages because it is a condensing of facts. A full CBT course, step by step would take a lot more pages.
Where is the free CBT course? Is this online or what? I live in the US and mental health is expensive and often not adequately covered ... I'm on Medicaid and I don't know if they'll pay for anything at all (they do pay for meds 100%).
It is a different site, Google Panic Centre beta 3.0
biggerthanmybody
09-05-15, 19:14
It is a different site, Google Panic Centre beta 3.0
Thank you.
I don't know if what I'm doing is strictly CBT but i came off my antidepressant 18 months ago at the height of the housebound panic episode at that time. I had been on some kind of medication for 20 years and it didn't make a dent in the panic or depression. I decided the side effects weren't worth it and tapered down slowly until I came off. I also see medication for panic/anxiety as a safety behaviour and suppression. I appreciate for some people it can take the edge off things but really its getting down to the nitty gritty of changing the brain connections that is going to make the difference and no medication is going to do that.
That is a fact, which I found to be true.
I should bump this and my other threads before they get lost, but I don't think I'll bother.
I'm quite mad tonight. It happens every time I get bored and read the depressing threads. Negative breeds negative and even though free I'm no exception.
Why am I the only one who researched the net for a non med cure. Why am I the only one who found one and used it. It wasn't easy but it worked and I'd do it again. I like being free I like being off meds. I like having no side effects. I have netflix now, I think my time is better spent there. For all those Pming me my mail will let me know if I have any messages.
MyNameIsTerry
16-06-15, 06:05
There are people who appreciate the time you spend on here, Davit. I enjoy getting into the detail and not many people seem to like that so its been very useful for me.
I don't know what others think but my experience of therapy wasn't great and it left me feeling a bit "anti CBT". I've since learned that I didn't really have CBT at all and its something I have spent more time understanding.
There aren't enough positive threads, thats how these forums tend to be when there isn't guidance as there can be on the charity ones I've seen at times. So, things do look negative but something I try my best to do is see the positive even in these types of threads such as the people that try to support each other through these tough problems. I see that as a positive and what I have found is that whilst I may read a negative thread, I feel myself ended on that positive.
Does that make sense?
It can be tough on here at times. I've had some occasions where I've taken a break. With my obsessiveness even forums like this can feed my habit, regardless of the anxiety.
People want it to go away. In our culture we reach for a painkiller. These disorders are far more overwhelming and people feel the pain and want it to go. The reality is very different as we all know but what I try to remember is that you spot the difference between someone who has spent time understandin anxiety disorders and those who are new or have not accepted the reality yet - those who have accepted the current reality are not so much trapped in the negative thread posting or when posting are more neutral in that we also post about how we know its anxiety, that its hard to work thtough and that meds are not a cure but a help for some.
Davit, I think you should be more tolerant of other people's views and experiences. Not everyone is negative and many have found other positive ways to live and function with an anxiety disorder. I know that you are now cured but I think it's OK to also believe that there are other ways to lead a fulfilling life-it's not necessarily your way or no way.
I have very much appreciated your time and input on NMP. You feel passionately about recovery and have been through such a lot (and still do). Don't feel in despair about the negative threads-you know that you are recovered and have shared your extensive knowledge and experiences. People can make their own minds up-you have given them the necessary tools.
I have had CBT ànd everything else,I am lucky as my husband is a Dr. I do have days when the old black dog tries to come through the door! but now I keep him where he belongs outside,One thing that still bites at times is when I watch news PTSD creeps up on me,that is why I am on meds,not SSRI's.
I like what you have posted pulisa.
Pulisa
A fact is that there is no evidence that medication cures without doing something cognitive to replace it, even if it is subconscious or from therapy. There is hard evidence that cognitive restructuring works yet it is left out of a lot of supposed CBT. So CBT gets a bad name.
Don't get me wrong I know what the people posting pain are going through and I know it would be hard for them, just as hard or harder than what I went through. No actually I doubt that or I wouldn't push CBT at everyone. Anyone can be cured. It is as simple as baking a cake, just takes longer. There are five steps that must be followed in the right order to work. This is going to sound arrogant and I don't care anymore but if you leave out any of it because you want to do it your way you might as well not bother. And that is what most CBT does. Having a diploma on the wall does not give you the right to give someone only half what they need because of a time factor or money. So I have tried to offer it on my time, but I don't have any diplomas and no published books. All I have is facts and freedom. And one of those facts is that I went for years on meds like everyone else, juggling my life to fit my condition thinking there was nothing else. Why not, I have physical conditions I thought could not get better. I was conditioned to accept. And I was wrong. Very wrong. I would probably still be on meds if they hadn't made me very sick. I would probably not have researched CBT and all the related information if I hadn't hit rock bottom. So I tried to save people the experience, and a few are actually trying the cognitive route for which I am happy. It may take a year for them to get results, maybe only six months but they will get results. So my time here has not been a total loss.
Is my way the only way? Is there any other way that has worked and still working after five years? And it is not my way. It is CBT as done in Canada. (that backward colony across the sea, poor cousin to the Americans. What could we know) Notice there are not many Canadians on this site. We have two therapists here for over 6000 people. Something must be working.
I don't care if people want to stay as they are or do something different, I just want them to have a choice. Time wasted is something you can not get back.
So if people are happy as they are they are not who I am concerned about. I'm concerned for those that want to be free and actually have a chance to be. I think that shows in the posts I have answered.
It is a nice day and I'm going to go enjoy it, that is what my freedom is for. That is what all the hard work was for.
---------- Post added at 11:18 ---------- Previous post was at 11:14 ----------
If you think this is tough you should meet my therapist. She would kick a lot of asses and she minces no words or sugar coats therapy. Her time is valuable, you don't get to waste it.
But people DO have a choice to follow your 5 step CBT for total recovery. You've explained the procedures and that's all you can do. I'm sure people are very grateful that you have brought the Canadian CBT programme to the attention of NMP users. Your therapists must be very efficient and permanently busy.
I'm not phased by tough talking when it comes to anxiety management. I'm not on meds and am a 24/7 carer to my adult autistic daughter. My experience of UK-style CBT 10 years ago was a joke but I'm sure things have improved a bit since then?!
As you say, our CBT is pretty ineffective in the majority of truly complex cases.
Sunflower2
16-06-15, 20:27
Davit, I have had intensive CBT, I think I've mentioned to you a few times before. I went through the whole calming your body down, identifying thoughts, triggers, situations... Negative thought patterns, automatic thoughts, core beliefs, self esteem, self perception, relationships, goal setting, systematic exposure hierarchies... I don't know what I'm missing here but it has not cured me. It's helped, but I still wake up every day with the same worrying thoughts. The same things set me off no matter how much I challenge them.
I no longer have the negative core beliefs I did before, but they were a result of the anxiety, not the other way around. I have pretty healthy core beliefs now yet the anxiety is still there as strong as ever if not worse.
I'm open to suggestions but I'm losing faith in cbt.
Kimberly how much do you know of memory and how the brain works. It basically has two functions one is controlled by negatives and is meant for survival. The other is controlled by positives and does not go through the centre for fear, the Amygdala. The Amygdala has two sides too. One side does contemplation and decision. The other side goes directly to panic. Amygdala is meant to protect. Memory is the problem, to protect it uses memory for decisions. It has it's own box of memories it stole from semantic memory that it uses for it's decisions. So positive thought can change semantic memory but it can't change Amygdala memory. If you have positive thoughts and positive core beliefs they bypass Amygdala unless they have a negative rider attached to them. In which case even though they look and feel positive because that is your focus they are subconsciously negative. Doubt is the most common negative rider that attaches to positive thoughts. If it is doubt it goes through left side Amygdala and you get heightened anxiety. If fear is the rider it goes through the right side and you get a panic attack. Even though you are trying to stay positive. In most people that try to do intense exposure therapy the rider stops it from working and worse adds symptoms to Amygdala's memory.
Losing faith in CBT or any treatment is enough doubt to act as a rider. But, positive thought changes semantic memory and leaves less for Amygdala to use.
How far back did you get with core beliefs, did you get to the root. Changing operative cores is not enough. You need to get the root that started them. You know when you do because you get this large empty feeling when you challenge and change a root because a lot of procedural cores attached to it go too and there is nothing to replace them till you make new ones.
Nothing in memory can be erased, it can just be not accessed. Sort of like putting it on the back of the shelf. That is what you do with core beliefs. If they sit there long enough their neurons will be salvaged for other use, but that takes years and isn't necessary.
So since you can not erase memory how much trauma do you have in yours. See the trauma in memory can act as a rider if it is strong and keeps coming up. I know it sounds like CBT is hopeless then, but it isn't. The trauma has to be challenged so it becomes harmless. I really had to work at this. For me being nearly railroaded into jail on lies is a very strong memory. A case of being in the wrong place at the wrong time is all but I could not believe that. It coloured 45 years of my life. It is gone now.
If CBT is not working then there is something negative triggering Amygdala. The fact I am free is not enough proof, the proof has to come from you all I am is a fact that it does work. I'm just a reason to look for reasons it works.
Sunflower2
16-06-15, 23:23
I did have an empty feeling changing a core belief... All of a sudden I had so much more things I had to fill my mind with.
Doubt is a big problem with me. I don't know what you would do to overcome that. I doubt things all day subconsciously!
I don't have any more trauma than an average person, just the usual bullying at school and deaths in the family.
I've found that unless I'm actually doing things, talking about the reasons why the brain does what it does goes over my head once I'm anxious. I understand it and find it interesting, but means nothing to me once I've been set off into an anxious spiral. I learn practically more than theoretically.
Kimberley, I am like you. I understand why and how it works, but when I'm triggered, that definitely does not matter to me. There have been times I've been in the midst of an anxiety attack and yelling "I know this isn't logical but I can't help how I am feeling right now!!" It's really frustrating.
With depression, I got to the point where if I didn't go on any medication, I would have been too depressed to even get to my therapist's office or make an effort to do anything for my wellbeing. I think it's very specific to the individual.
Time for a mantra. It is the only way to block doubt that I can think of. Because positives are short lived it takes a lot of them to neutralize a negative. This works like stacking. Stacking works because six is the average number of different thoughts a person can hold at one time. With stacking, they have to be related but different enough to be separate so the negative thought being not related gets dropped. I use horses, different colours, some in harness. Horses are not related to any trigger I have. After horses I use boats then flowers. By then the anxious thought is gone. Memory stores horses instead of the anxiety trigger. Amygdala can not use horses. The anxious thought does not get stored. Amygdala could have used the anxious thought to keep anxiety alive.
So a positive mantra has to be repeated ten times to send a negative packing once. The positive replaces the negative but only one layer deep so it is easy to find again. Repeating the mantra again buries it deeper. after a while this positive thought gets associated with the trigger and when the trigger opens hippocampus it gets met with the positive thought and bypasses Amygdala. No anxiety. Simple but time consuming. To find the mantra you have to challenge the anxious thought to find it's opposite. Confusing? Maybe, I don't know because I understand it I might not have explained it very good.
MyNameIsTerry
17-06-15, 09:01
I seem to recall reading about positives to cancel out negatives in your "Words" thread and I remember posting an article that mentioned how many times a positive was required to challenge the stronger negative.
Something that I'm wondering though it whether a) if a negative appears during that process, does it destroy it i.e. reset it to zero again so you start from this, b) even if you resolve the original negative you can re-open that door, can't you by later negative behaviours and c) you can override the new positives with a stronger emotional negative again and have to follow the same process to override it. Is that right?
This is why the thread "riders" Most people don't even realize they have them. Yes the negative cancels. So if you have a negative attitude you are going to have to work ten times as hard. Would the negative person bother when nothing seems to work? When they think they are thinking positive but throwing in riders?
Yes those are all right, but repetition makes it appropriate so you don't do it. If you build a positive attitude then you don't look for negatives to override your positives. When a negative trigger happens it gets rejected as inappropriate. The appropriate positive replaces it before it gets to Hypothalamus to cause a reaction. In affect, Amygdala says not mine. It rejected it last time so it is going to reject it this time too.
So meds are easier. My therapist has a very good CBT course and mine is very similar but has more explanation. Her one annoyance is being stuck butting heads with the GPs prescribing meds instead of referring people for CBT. She is required to refer them to the psychiatrists unless they refuse. The psychiatrists put them on more meds. She gets to wean them off. Meds sort of work if you stay on them. But see they might have a year of CBT or other therapy before coming off, they have something to replace the meds.
Sunflower2
26-06-15, 09:58
In my case and probably many others, meds are certainly not easier.
cbt helped me more than any medication ive been on and ive been on lots !
I think you're treading on dangerous ground here, Davit
Pulisa
I know that. I've been on dangerous ground since my first post. I knew that as soon as I said I was recovered I would get three reactions. Some would be interested and some would hate me but the majority would ignore me for not supporting what they are doing.
I've treaded that ground with care, not saying what I want to sometimes. So lets make it worse and then I can leave and go spend my time in my garden where I can do some good. Everything you need to know is here but you can't use it if you are going to change it so you do it your way. There isn't a single book that is going to cure you. Cope yes but cure no. Fine if that is all you want. And you don't want to know what I think of Claire Weekes and her out dated therapy. No let me correct that, she did the best she could with what she had. And she didn't have to compete with SSRIs. And some of what she says is actually accurate. Now I'm really on dangerous ground because she is popular. So is Disney land. By the way I'm not against medication for the few that it works for. I'm against thinking it is the only thing and I'm against thinking it can possibly cure you. I went that route to start with and wish I had never done that. All it did was drive me to find something better when it wasn't pushing me to end my life. Oh no, can't say that, Getting closer to the mire. But it is the truth.
So here I am, cure and because I did something more involved than the usual CBT. Med free. I see the world clear with all the crap it throws at me and it doesn't bother me. I also see it's beauty. And I'd do it again, I'd put in the time again to get this freedom. I would not use SSRIs. Diazepam is a different storey. I don't fear it. Used as it was meant to be it can be an adjunct to CBT. But it gets abused. And Ativan should be banned because it is dangerous. Anti psychotics are treading on dangerous ground between slight affect that they produce and permanent damage they can produce.
But choice is everyones right. You don't have to read what I write. All I offer is choice and I can move that choice to private message for the few that are making use of that choice.
Nothing is going to change if all the professionals offer is watered down CBT and pills.
---------- Post added at 10:18 ---------- Previous post was at 09:43 ----------
Kimberley
I'm sorry, I didn't mean the easier solution, I meant that they give the fastest relief when taking the edge off. Unfortunately that is all they do. A bandaid while you heal. Anything with sedation as a side effect can not possibly give you your life back. The percentage that they work for is small and their expectations match.
I went that route to start. I know what it was like to take the pill because not taking it was worse. I know what it was like to plan my life around the small amount of relief I got. It was small. I can not say I ever enjoyed anything on them. Function yes, most of the time but really enjoy life, nope. And I still got panic attacks. I don't want people to throw away their pills, I want them to do cognitive restructuring so they can throw away their pills. I want so bad for people to get their life back or have a life, if they are like me and had anxiety and panic all my life.
Mr Andy
My first medication was phenobarb. I failed school that year.
Ive done a few SSRIs but they made me sick and last time suicidal. Antipsychotics left me so sleepy I was getting nothing done. Busparone was not any better than Benzo's, I have never needed anything to sleep. Only drug I found acceptable was Diazepam and with care. Ativan was very bad. Ups and downs.
CBT is a proven cure, unfortunately a lot of CBT is not CBT. Cognitive restructuring is the part that cures and is left out in favour of coping skills. Coping skills work but they are just that, coping. CBT is only putting the thoughts back on the right track, it works but is very time consuming. The more core beliefs the more time it takes. But it does work.
Davit, I'm interested to know if your therapist enjoys world renown for the therapy program in place in Canada? Why hasn't cognitive restructuring been recognised worldwide as the only cure for anxiety? Is it down to money/time or deliberate withholding of essential neuro information here (UK).
My therapist worked in Luisiana as a drug and alcohol addictions councillor. I honestly think she came back to Canada because she could do more good. Unlike me butting my head against a wall I think she has enough to do without looking for renown. There is also the fact that she probably thinks that this type of CBT is common. I was very surprised to find it is not. I was also surprise to learn in the UK little is free. I thought your medical system and ours were similar. I did find today on a post here that there is someone teaching cognitive restructuring but I never asked if she had to pay for it. Oh and it appears that it is available as a course in phycology, so why it is not more readily available leads to the conclusion money is the problem. The same seems to be so in the States. It is there if you can afford it. The States has an obvious problem. They spend more on defence than health. Is the UKs problem lack of therapists or lack of tax dollars to pay them. Terry would know. Do the therapists have the training but not the time is all. We are always happy to get English doctors because they are very well trained. I think that if 6 to 8 weeks is all CBT lasts there it is not enough time even if you have the training.
By the way we have some private therapists that are in it for the dollar and stretch it out doing little or no good. Maybe I'm just lucky to have found the right person. A major complaint in Canada is the closing of mental hospitals in favour of more Cancer hospitals. So now psych wards are shoved off into unused decrepit parts of existing hospitals. All you really need for a psych ward is locks on the exits and a quiet place.
---------- Post added at 12:59 ---------- Previous post was at 12:48 ----------
Cognitive restructuring has only been around for 50 years and only pushed hard for the last ten or so. Coincidently coinciding with the appearance of problems with the side effects from medication. CBT is recognized as a cure but it's definition is badly muddied. I have no idea why meds are always tried first other than a time factor. Money could be it too. Meds are cheaper than therapists. I pay for meds, the govt pays for the therapist. Politics being how it is there are probably not many politicians with anxiety disorders and fewer who would understand it.
I'm sure that here in the private sector there would be plenty of opportunity, time and privately funded money to receive any form of CBT the individual wanted (as money would be no object).
Many affluent people including celebs are in therapy for years- I wonder what type of therapy they would be receiving? Would your therapist have used cognitive restructuring for her drugs and addictions clients?
For the root cause after the dry out period got them off as support to keep them clean, but poverty is so depressing just a few minutes of peace seems not so bad and they are back again. More desperation than addiction I think. But that is world wide. I think celeb's get milked. Their therapists give them what they want, not what they need. Funny, for them it is the thing to do for us it means we are broken. They have the money to have some one hold their hand. It is not a nice world so I put up information and Terry puts up information in the hopes it will do some good. It is accurate and it is free but my way of drawing attention is probably annoying.
---------- Post added at 13:39 ---------- Previous post was at 13:38 ----------
Off to work in my garden.
For the root cause after the dry out period got them off as support to keep them clean, but poverty is so depressing just a few minutes of peace seems not so bad and they are back again. More desperation than addiction I think. But that is world wide. I think celeb's get milked. Their therapists give them what they want, not what they need. Funny, for them it is the thing to do for us it means we are broken. They have the money to have some one hold their hand. It is not a nice world so I put up information and Terry puts up information in the hopes it will do some good. It is accurate and it is free but my way of drawing attention is probably annoying.
---------- Post added at 13:39 ---------- Previous post was at 13:38 ----------
Off to work in my garden.
I'm grateful for you putting the information up Davit :)
MyNameIsTerry
27-06-15, 07:04
Cognitive Restructuring is part of CBT. It is also part of Rational Therapy, later called Rational Emotive Therapy (RET) and now known as Rational Emotive Behaviour Therapy (REBT), created by Albert Ellis going back into the 1950's. (So, when we see the statements about how Dr Claire Weekes got sick of psychoanalysis methods, people should perhaps remember that RT was around over a decade before her :winks:)
CR works on negative thinking styles. You probably see me banging on about Cognitive Distortions on some threads, well this is what they are from.
When I had my CBT I was told anything about CD's or CR. I can remember my therapist using a whiteboard to explore some of my thoughts about certain subjects or to work on my goals BUT she never once told me about any of the CD's or how to deal with them as seen in CR. For instance, one technique of CR is to use Thought Records to challenge a negative thought. Nope, I never heard that one. You can also incorporate CD's into a Thought Record and...nope, never heard that one.
Where did I first hear about CD's? I was given a handout module at a local charity walk-in session as they always had a slot for this and a group discussion about a module. So, my therapist attempted to do it ON ME but not WITH ME. Whats the point of that? I leave the session not knowing how to do it for myself later and even if I remember what she did, I will miss things because I don't know the CD's she is looking for in my negative thinking.
CR has evidence to support it. Both CBT & REBT have vasts amount of evidence to support them. The theories of REBT are supposed to be the most heavily researched areas in modern psychology, likely because Aaron Beck included a fair bit of it in his CBT.
---------- Post added at 07:04 ---------- Previous post was at 05:42 ----------
So, Davit you want to know why meds are given out and therapy is neglected? How about simple economics and getting patients out of the GP surgery so he can shout 'NEXT!' because you may only get a 5-10 minute window as they are so busy?
Patient needs are pretty low down in the scheme of things. We have a National Health Service (NHS) as you probably know and whilst it is often touted as "the envy of many countries" it does have its downsides e.g. it is a ferocious money chaser and because its basically "the system", patients are swept aside in favour of policy. If you have a problem with them, you are fighting the entire profession and the government to boot!
How about some working examples though to see why meds might be better than therapy in the minds of the politician or executive? This is not considering the speed at which a GP can write a prescription and boot you through the door or the fact you might be waiting months for therapy and getting steadily worse with a GP who can do nothing for you, unlike if you had a physical issue.
Some examples:
Citalopram costs £0.96 at 20mg (standard starting dose) per 28 days. So, thats £11.52 per year.
A patient (who is not on registered benefits) pays currently £8.05 in England (its free in Scotland & Wales, grrr!!!) so immediately the NHS has made themselves £7.09 in profit off that patient. This comes to £85.08 profit annually.
Funny that, isn't it? We are always hearing about how we get a subsided prescription costs. Well, only if your meds costs more than your prescription cost.
So, could the NHS be happy about the fact each patient actually makes them money? Probably not since seeing your GP, the costs for dispensing & transporting, etc will outweigh this and any referrals your GP makes for therapy will destroy any profit very very quickly.
I've seen therapy quoted at an average of £50 in the private sector. Lets assume its the same cost to a NHS or IAPT party that we would receive free. Remember that just because you are told it is free, doesn't mean its free at all. All costings are on the balance sheet so there will be a cost for each therapy session charged back through someone's cost channel/code. So, lets assume £50 for now.
The minimum number of sessions likely required to treat GAD according to NICE should be 12.
So, 12 X £50 = £600.
Thats about 52.1 years on Citalopram.
They know realistically that you will have therapy at some point but by dishing out the pills they can quickly get you seeing some improvement and you may not actually need therapy which means they save a lot of money.
We all know that 12 sessions of CBT is not much. It would be interesting to see how many people do get cured by that and how many sit languishing in the system as a mere number...like me as I've not seen my GP for over 18 months now and he still hasn't noticed that I haven't attended any of those monthly/bi-monthly appointments he wanted.
Is this just one med? No. Citalopram is a popular one though, so popular means reduced cost with it being out of patent.
Some more then:
Med.............................28 Days..............Annum
Sertraline 50mg................£1.38..................£16.56
Fluoxetine 20mg...............£0.89..................£10.68
Escitalopram 10mg............£14.91................£178.92
Paroxetine 20mg...............£1.79.................£21.48
Venlafaxine I/R 37.5mg......£2.53.................£30.36
................M/R 75mg.......£10.45................£125.40
................NB M/R 75mg...£22.08...............£264.96
Duloxetine 60mg...............£27.72...............£332.64
Pregabalin 150mgX2..........£64.40...............£772.80
...............100mgX3.........£96.60............. .£1159.20
So, bare in mind that a GP may prescribe you a 28 day or 2 month supply usually.
Also, there was a study that was conducted to prove that Escitalopram was no more successful than Citalopram and there are online trust guidance documents informing GP's to actively shift patients onto the cheaper med to save money...so don't worry about how much that shift could affect their mental state!
You will also see threads across forums on the internet about Pregabalin and GP's refusing to prescribe it due to costs. There are several threads on here that I have been part of, hence tracing costs for people like the above to tackle their GP's with. Some local trusts, for example Buckinghamshire, have actually banned Pregablin not only for anxiety but for its other licenced use with epilepsy and its nothing to do with efficiency, its all about cost. Their local formulary even states on its "About Us" page not to take their advice over our National Formulary and the national one says Pregabalin is fine and NICE include it in their stepped care model! So, some members of NMP are getting refused due to the bean counters.
Put everybody on Pregabalin and then see just how fast we can access therapy! They will be rolling out mass therapist training programmes :D
Another issue to consider is how little mental health services are funded. Our hospitals have all been stripped Davit just like yours. We could talk about "Care In The Community" I guess but I don't know much about that one other than the poor people who get booted out quicker than they should be or can't find a place, as reported in the media. Not considering the more violent cases that are thankfully rare.
Mental health services are many decades behind physical health ones. Even more recent physical health services such as tackling obesity, STD's, etc seem to have grown fairly quickly but mental health hasn't. We have a service called Improving Access to Psychological Therapies (IAPT) which has come along because getting to therapy used to be around a minimum 12 month wait to see the traditional mental health services. This service was created specifically to address people like us and whilst it gets us into therapy much quicker (mine is 3 months) I think its a double-edged sword because I've talked to Kimberley about her CBT in Scotland (they still use the old system, no IAPT) and she has had CR and a whole load of other stuff that I had none of. This makes me question what IAPT is doing. From seeing what I have seen on here and talking to people like Davit & Kimberley, I can only assume IAPT is a strip down, a plaster for the broken system, a new waiting list (just like the ones we get now & again for unemployment :whistles:).
To be a High Intensity Therapist (HIT) in the IAPT system you only need train in CBT. IAPT offer more than CBT so some therapists no doubt have a different route or may have taken more than one form of training. CBT training is achieveable through the BACP route in around 18 months if I recall rightly.
A quick fix solution maybe?
All figures taken from South West Yorkshire Partnership NHS Foundation Trust http://www.southwestyorkshire.nhs.uk/documents/304.pdf
I've used others before but some of the pages have gone now from those I posted on the Pregablin board so I just grabbed this one as it was on P1 of Google.
:read::shades:
Wow
And I'm treading on dangerous ground. You just told everyone that they are not getting therapy because they are not worth it. (in the eyes of the Govt.) They are only worth a temporary fix. Their tax dollars mean nothing. There are people here who can not afford pills even or are two messed up to take them properly, so they end up in jail or dead under some bridge. We have winter here, they just freeze to death. What need have we of hospitals when we have jails. And if the jails are crowded, just turn them loose. We should be ashamed.
Yes therapy is proven to work, but it has to be therapy. How many people on this site, and how many have actually done cognitive restructuring. Two and one person training. How many have done what they were told was CBT? How many did it work for? Sort of for some. How many cured members? Well me. Just one, that looks bad he must be lying. No one gets cured. A pill can not change your thought processes. It can help though.
So I agree there is only one reason the Doctors hand them out. And it is not a good reason. You can change that and I can change that but we need more voices.
We also need to let people know we don't want to take their pills, we want them to learn how not to need them. I've condensed information and so have you, all they need is here.
It is free because I know also that most people can barely afford the pills.
Am I crazy, what am I doing. I should just go watch another movie, out of sight out of mind. I can't. I do not have panic attacks but I remember them. I remember how hard it was to accept there was a cure.
And I know statistics aside we just wasted our time. And I know why but haven't got the guts to say why to their faces. Enough people already are offended by my posts.
MyNameIsTerry
27-06-15, 08:41
I'm from the UK, I learnt a long time ago that whoever I vote for, its the person & party least likely to screw it up (and us over). Maybe thats the difference between European countries and the US/Canada, we've been around a lot longer and aren't as passionate about our politicians...its not like much ever changes and once one party's had 2 runs on the trot, they seem to start imploding!
For years I've listened to how the NHS is crumbling, it always is but strangely its still here. Spin works for them as much as against them. Ever since I was young I learnt that we get a subsidised prescription cost so that we don't have to pay a fortune for meds. Well, imagine my surprise at seeing those costs? My second run at antidepressants and I'm on Duloxetine so at least this time I am actually getting a subsidy! :D
Personally, if you think the big chief hats in Parliament and those that run the NHS particularily care for the good of the people over what they can get for themselves...maybe I'm just a cynic? :winks:
The harsh reality of it is - we have a small fraction of the therapists we need and we have a small fraction of the budget we need so expect meds to be thrown at you. GP's know the situation and they know they haven't got the support they need to get you into therapy so are faced with a rock & a hard place. Many don't understand what they are giving out and those that do know its better to try and risk the side effects over seeing you time & time again with no help to give.
But why isn't that good enough? Well, we have a load of free online CCBT programmes that can be used. Sadly, these are classed as Level 2 treatments and GP's are classed as Level 1. So, when you get referred to Level 2, would you rather talk to a human being or sit at a screen? The obvious answer is to give GP's that option. Does anyone even use CCBT on the NHS? I've never heard anyone on here even mention it?
Also, we have a free book prescription scheme which does allow any medical professional to write a prescription that you take to your local library to get one of a small range of books, mostly CBT ones. With them being books, they will likely have CR in there as they will be more comprehensive. My GP never mentioned it, but my Level 2 did. Why aren't GP's doing that - its within their remit and it could help? I've never seen anyone mentioned this book service on NMP.
Another issue is when you have these therapies you will be given handouts - get GP's to hand them out! Why wait months for a photocopied handout?!
That would be seen as very inefficient in the private sector. Why have you customers wasting your time when you can put it in the post at a fraction of the cost or add it to your website? Simple solutions, cottage industry.
20 years ago my psychiatrist told me that I could teach myself CBT from a book ie it wasn't rocket science.
Things were a lot less complicated then-obviously we couldn't access all the info that is now available from various sources. Yet mental health issues continue to rise and rise despite all the avenues now open to us.
Sometimes keeping it simple is best? You are passionate about your work in the garden, Davit and this must be very therapeutic and positive work. I would see it as just as valuable therapy as CBT/CR? I love animals and caring for them is a very positive and therapeutic thing for me.
I just don't think you should write meds off for everyone. We've both had extreme reactions but they have worked well for others. I think it's important and appropriate to acknowledge this and after all, we are all different and our brains work in weird and wonderful ways.
People may try CBT/CR and not have a positive experience? If they "fail" how does that make them feel to think that this is the only way forward for a cure? Do you know any other people who have been cured by this method?
Pulisa.
I'm not writing meds off I'm saying you need to do more than just meds if you want an actual cure.
Yes I know people besides me who are cured. They are not on here. I know people on here that are close too. Private message and Email keeps it off the site so they are invisible.
Did you notice some people are gone without deleting?
Cognitive restructuring is the step that takes you from coping to cure. Everything else including meds is just coping. Yes I am passionate about my garden, I am also passionate about people getting cured, but if all you have done is cope your entire life you can have no idea what cured feels like. How do you explain colour to a person born blind. But we are not blind. You can teach yourself CR. But again, if you think just coping and living half a life is normal you won't even try. Not your fault if you can not visualize anything but coping. Like I said, we just wasted our time.
Sunflower2
27-06-15, 18:02
Kimberley
I'm sorry, I didn't mean the easier solution, I meant that they give the fastest relief when taking the edge off. Unfortunately that is all they do. A bandaid while you heal. Anything with sedation as a side effect can not possibly give you your life back. The percentage that they work for is small and their expectations match.
I went that route to start. I know what it was like to take the pill because not taking it was worse. I know what it was like to plan my life around the small amount of relief I got. It was small. I can not say I ever enjoyed anything on them. Function yes, most of the time but really enjoy life, nope. And I still got panic attacks. I don't want people to throw away their pills, I want them to do cognitive restructuring so they can throw away their pills. I want so bad for people to get their life back or have a life, if they are like me and had anxiety and panic all my life.
Davit, I have to disagree with you here. Everyone I've known that have taken medication for anxiety or depression took it for 6 months - 1 year, felt better, came off it and that was that. They were back to their old selfs. Now in this time on the meds they all worked to get back to their old selfs and participate in everything they used to enjoy. So when they came off the meds the damage was repaired and their lives went back to normal.
So I think saying CBT is the only cure isn't really helpful to those who don't manage to get full results as you or others. It makes them feel like they'll never get better and using any other method is a cop out. I'm not saying CBT doesn't cure, but it doesn't cure everyone. Like any treatment, it needs to work for the individual. I had CBT and continue to have refresher sessions as well as read books on it and use online programs. I know CBT! But I have no shame in saying that it wasn't enough to cure me and not any number of years of therapy in it would have. My emotions are just too fluctuating and reactive! How on earth are you meant to think your positive balanced belief when you are in hysterical tears over something completely meaningless!
Kimberly
And how did they get back to their old self? By using medication so they could think and feel positive and grab hold of that old life. By wanting the old life bad and using the medication to block the negative long enough to do this. There are people doing that here.
I stand by this. If your medication lets you seriously think positive it will help cure you but it is not the medication, but your drive, your wanting your old self back that cures you. Meds can not give you that drive. It has to come from within. And once you have that you don't need the medication. Why you don't need it is mechanics. Positive thought does not waste Serotonin. This is still using cognitive restructuring. Even if all your pills do is block negative thought, that is still CR. Taking them and doing nothing gets you nothing. Taking them and working to get back where you were does. Even if it takes years.
I stand by that, pills are an adjunct that lets you think clear enough to think positive but it is still thinking positive that cures you. If not so then everyone taking pills would be cured in six month. There, I've just insulted everybody by saying they can't think positive including you right. That is why my signature is what it is. I know how hard it is to change thought patterns yet some people can do it practically overnight. I couldn't. I accept some people will never get off their meds, some will and get better but the ones I cry for are the ones who have to stop and have nothing else. Those I want to help. Anyone else who wants to try CR I will help too, I'm not saying CBT is the only answer any more since so much CBT has no CR element to it. If it did it would work, it can not, not work. All it does it make things work as they are supposed to. And that you can do on your own.
Do you think because I'm a man that I was not like you. I'm not ashamed to say I spent days in tears and with tunnel vision. Benzo's blocked this long enough for me to do research. Benzo's allowed me to see I could be other than I was. I took that thought and ran with it but it was this that cured me, not the meds. They only got me started. I fit your description. I was not on medication very long. Most of my CR was done after stopping it. Only because the drive took away the need for it and the side effects were literally making me sick.
I'm sticking by that, if you don't have the drive to get better then your medication will only let you cope. Are these people you know cured or have they accepted coping is better than the side effects of the meds? Is coping their cure?
Maybe it is? Is that a bad thing? It's what matters to them that is the overriding and most important factor. You may not like it but you don't have to live their lives.
Please don't say that you are wasting your time by posting your information on here. Obviously you are getting results by convincing people to try your method. I just think it's fine to challenge a few anomalies. Am I allowed to do this without you getting frustrated?
pulisa I'm not frustrated and I enjoy your opinion and input. It gets me checking my material and sources. There will always be people with spontaneous remission. We can not know why, all we can do is be happy for them.
I'm vicarious and have a good memory. For a few minutes with every post I do live their lives but you are right, I can leave and do when it gets to be too much. Fortunately I don't have HA so those posts don't bother me as much. Some days it is a struggle to not get a set back, but it doesn't last long. I'm much better than I was when I first came here.
I may say Claire Weekes and a lot of other information is outdated and lots of it is but if it works that is the main thing. But there is an alternative if it doesn't. All I am is an alternative nothing more even if I am a pushy alternative.
Kimberley
You said" Davit, I have to disagree with you here. Everyone I've known that have taken medication for anxiety or depression took it for 6 months - 1 year, felt better, came off it and that was that. They were back to their old selfs. Now in this time on the meds they all worked to get back to their old selfs and participate in everything they used to enjoy. So when they came off the meds the damage was repaired and their lives went back to normal."
Maybe I have misunderstood you but initially you said EVERYONE you know took meds for up to a year and then were better and that was that but then you say they are now back on their meds etc. Can you kindly explain.
Ricardo, I think she meant everyone she knows that is cured took meds for six month and quit them.
Sunflower2
27-06-15, 22:34
Yeah that's what I meant Ricardo. Although, the people I have known that have taken them were for PND and depression caused by a traumatic event. So maybe because they didn't live with years worth of anxiety and depression, the mind was more easily put back to the way it was before.
Just to be clear, I don't think that meds cure. I think they are a tool for giving breathing space to enable you to participate in either therapy or being able to do the things you weren't able to do while depressed/anxious.
I have been on and off meds since leaving Iran. I still have councelling when I need to if it was not for medication I would not have survived .I have been on benzo's and have had no problem coming off them
Petra
MyNameIsTerry
28-06-15, 06:19
Ricardo,
Kimberley said that they took meds and when they came off, they were back to their old selves before they were depressed.
Thats fine, that does happen but its not because of the meds and I agree with Kimberley, the meds are to give some breathing space so that you make the corrections.
-----------------------------------------------------------------------------------------------------------------------------------------------------
We weren't born anxious, we didn't pop out having a panic attack. We had to learn this. That means we can unlearn it too. Neuroplasticity is how we learn throughout life and when we retrain our brains, whether its core beliefs or anything else - it is neuroplasticity.
CBT isn't the only cure, its the process that CBT encourages the brain to follow - that is the only cure. That is why some people have used Weekes to do it, some people have used guru methods to do it, some people have used meds and pushed on with the lives to do it and others have used clinical methods such as CBT. The changes are made in the brain through the same process that created them - neuroplasticity, how we learn.
MBCT is another example that has come along and has evidence for depression as does MBSR for anxiety & depression as well as helping control symptoms in physical disorders/diseases such as cancer, asthma, etc. CBT is also used in cancer for the same reasons.
That learning consists of a load of associations between neurons which are linked by synapses. You learn to play an instrument the same way. Anyone who has learned one will tell you that you reach a point where you fingers are doing it by themselves and the mystery of all the squiggles on the sheet music is as plain as English to you...just like how learning another language is. Thats neuroplasticity and at its lowest level it is all about things like neurons & synapses. How the brain works in terms of memory, which I have little understanding of, just works the same as it did from before.
CBT isn't the only cure, but along with REBT it has a lot of clinically accepted evidence hence why it is used. There is emerging evidence that when it used to treat personality disorders, it is less effective and newer forms of therapy such as Schema Therapy are proving successfulk in early trials. DBT uses similiar methods to CBT for people with personality disorders but it also works with your emotions and how to accept them.
So, there is no one way and medical science ackowledges this. But there are certain things which have to be done within the brain otherwise the brain can't change.
All meds do in the form of SSRI's is stop as much Serotonin leaking out of the brain. Some of them have been found to work more specifically e.g. in OCD where they prevent certain additional "firing" over other ones. SNRI's are similiar but also work with adrenaline which means less fatigue (in theory) better pain management, etc. BUT if you don't eat enough to create what the body needs, you won't feel the full benefit and meds become flawed...but when do GP's think about that one?
All they know is that lower serotonin levels are visible in people with anxiety or depression. They also concede that they don't know whether this is the cause or whether the anxiety/depression causes the decrease. So, they try to correct that wastage...which again is half a job if you are not eating enough of the prescursors. Its obviously more complicated than this or we would have one SSRI instead of all these different ones and some have been seen to be more effective for certain conditions for those reasons which I can't say I really understand (never looked into much of it).
If you take these meds to become stable and push on with your lives, you may create the changes needed in your brain via the above mentioned process. If you don't, you come off them and relapse. Hence why relapse management is taught in methods such as CBT because you can cure yourself and still get another anxiety disorder by creating the right environment for those changes to start again. The old brain ceiling theory that was in place for most of the 20th century was proven incorrect at the end of the millenium and now science accepts that we can change our brains throughout life and not only how we think and learn but the actual physical structures themselves which was previously thought to be impossible after the ceiling age seen in early life. Before that, we couldn't change certain things in their eyes, they now disagree with that old theory as it has been proven wrong by advances in science & technology.
---------- Post added at 06:19 ---------- Previous post was at 06:04 ----------
20 years ago my psychiatrist told me that I could teach myself CBT from a book ie it wasn't rocket science.
Yes, I completely agree with that.
You can do the same with many areas. I used to see business grads come onto the floor and fall on their arses. I've worked in offices mostly with a lot of degree students worting part time through to find themselves and some were so incredibly stupid it seemes ridiculous how they are at that level (I've also seen and worked with many excellent ones too!).
Reading it and repeating it is one thing, doing it in real world with the complexities is where you cut your teeth. Some people could handle this but some people can't as you've said before and this is why they need guidance.
I think initially we all need guidance though because we are too engrossed in the panic and can't think logically. As you reach certain stages in your recovery you can do this and then you probably could take a book away and do it alone or with the support of likeminded people.
It can't be hard to learn if 18 months gets you into the treatment room and thats with hundreds of hours of practical sessions under supervision. There are many online diplomas that will teach you CBT and entitle you to practice in our unregulated sector but whether you can do it is going to depend on the person themselves. Thats just like how you have the degrees and still be worthless to people.
But I will also say - I may never be cured. I'm open to being cured as much as as I'm open to dieing with this, I have to be otherwise I'm really only practicing a kind of positive Cognitive Disortion :winks:
Shite,Terry do you ever sleep?you must get blurred vision doing all your research.
MyNameIsTerry
28-06-15, 10:49
Shite,Terry do you ever sleep?you must get blurred vision doing all your research.
I daren't, I'm obsessively watching the games threads awaiting your return, Petra! Besides, its a years worth of reading stuff here & there, it builds up.
Hope you are well. :flowers:
I read a lot also,trouble îs I now need new glasses and getting sick and tired looking at hubby's darn Lancet magazines on Mental Health and all things related with it.I hope to have new specs on Tuesday
We have just been just been upset with what has happened in Kuwait, with family there it is very upsetting and briñgs back memories,other than that î àm well,thank you for caring.:D
MyNameIsTerry
28-06-15, 11:38
Yes, its terrible what has happened there and the other attacks elsewhere. Its hard to know what to say when I live in a country that doesn't face much of this anymore (since peace in NI). I hope you are you family are all safe and well. :hugs:
I think Terry does all this research to distract himself from thoughts of Carol Vorderman........:winks:
So many horrific things going on in the world. Best wishes to you, Petra
Ah Terry are you related to the guy from N.I. who used to come on here to help people with CBT before you joined.I can't remember his name just now.
He had a website but also PM.'d members.
You have a tremendous knowledge I presume from endless research.
MyNameIsTerry
29-06-15, 06:34
I think Terry does all this research to distract himself from thoughts of Carol Vorderman........:winks:
Well, after the injunction I had to find something...:roflmao:
---------- Post added at 06:34 ---------- Previous post was at 06:27 ----------
Ah Terry are you related to the guy from N.I. who used to come on here to help people with CBT before you joined.I can't remember his name just now.
He had a website but also PM.'d members.
You have a tremendous knowledge I presume from endless research.
Not that I know of. I'm not sure I've come across his posts which sounds like a shame.
No, not really. I learnt a little in CBT but not why I should do things the way I was told, had some info sheets from a charity that were CBT based and other than that I knew nothing other than the basics of what anxiety is until shortly after I joined NMP. I just got into it. I found there were so many people asking questions that there were answers out there for that it was only going to benefit me to do that research, post it and then be able to explain it again in the future.
I've learnt a lot from people on here, especially about meds which I had no clue about, and continue to e.g. Davit's stuff.
So, a couple of hours a night over 6-9 months can build up. I did some researching behind the scenes due to the claims of an anxiety guru when one of the admins on here asked me what I thought and that prompted me to learn about some of the stuff mentioned in this thread more than anything really. It started me asking questions about this area and then after that thread went, I started looking for more answers. Only by doing this have I come to understand my OCD in depth but I did do some basic reading about that years ago which helped take some of the sting out of the panic & despair it brought me.
Thanks though, I appreciate it. I've only looked at CBT in certain ways though, not E2E like Davit (or spent as much time with it or got anywhere near cured either) so I don't have that kind of knowledge stored, but I have it across various strategies which helps to understand what I read in these forums more.
It does not feel good to be thought of as a guru even though I don't know what it is, the tone is there. I've been retired fifteen years. I had lots of time to study unfortunately it was all in one area. I'm expanding. Feed back is interesting and I wonder what role it plays in OCD. Or HA for that matter. It certainly plays a role in anxiety.
MyNameIsTerry
29-06-15, 07:11
What do you mean in terms of OCD?
You don't want to be a guru. Some of them are very dubious characters. Strange though, I'm not sure you can be when promoting a scientifically accepted method? Unless you go off on your own tangent and claim it more effective than the original model or what others have done without any proof to back up claims.
Guru's are more about "acceptance", stating science is wrong, etc.
People are entitled to their beliefs but when I see the question of whether anyone can recover, I see it as part of Cognitive Distortion because there is medical evidence proving it possible and these conditions are not classed as lifelong disabilities by any medical community or any government globally.
Its perhaps swings & roundabouts. Last year I was always seeing the acceptance angle pushed and whilst its part of recovery, its not all about that as its a passive strategy. It seems to work for some though so thats up to them but guru's exploit these non scientific methods for profit so you have to be careful and you never no who is on these forums, like that one you saw tonight and he's not the first flogging his wares to the vulnerable posing as a sufferer! The fact that acceptance based methods are becoming mainstream is good e.g. ACT, CFT, etc but these come with science behind them, proof.
Illuminati
29-06-15, 08:28
CBT was a savior to me at the time. Its been about a year and a half since and im starting to slip again. Ive been of my meds 9 months now and i really dont want to go back to them. Ive asked my doctor for another course of CBT
If he won't give it to you we can help. Ive been off meds and free for five years.
---------- Post added at 01:48 ---------- Previous post was at 01:10 ----------
Acceptance is accepting you have a condition, not the condition has you. Acceptance is accepting it so you can fix it not accepting there is no cure and coping.
Back to the triangle. the reaction back feeds to memory and the original thought in panic. What if the original thought is my hands are dirty, (point 1) memory (point 2) says wash them. (point 3) reaction washes the hands, Back feed says they are still dirty. Memory (2) says yes they were last time. (3) reaction washes them again Back feed hits the same spot in memory because there is nothing else. (2) they are still dirty. Between two and three, add "no they are not" (3) reaction, look at them and don't wash. Back feed to one and two. "didn't wash" two now has two choices. Repetition makes "they are clean priority". Prove they are dirty becomes the other priority, Wash becomes a question.
Would this be possible It would have to combine acceptance that the trigger, memory and first reaction are all OCD. That the thought in memory is a cognitive distortion (lie) You would be using a single question to stop an action, not adding another repetitive action. Some anxiety is so strong it takes weeks of back feed to change a single thought. Some can't because they keep adding negative riders on the thought.
In anxiety you have Amygdala's private memory feeding the panic as a reaction. I have no idea where OCD is stored, I would think episodic if is well fixed, or procedural if it is random. Hypothalamus uses both to cause Symptoms in panic under Amygdala's direction. But again can use either in a procedure, such as riding a bike. Peddling is not OCD though. Only difference is you can stop peddling because memory knows how to. What I'm saying is with OCD does the back feed learned early on not get absorbed into memory like Memory in very traumatic PTSD. The memory is there but can't be used. No access key. Not like anxiety that can only have a neg or pos key. What is OCDs key? How many? Perfectionism verses OCD, is it just a different access key?
Something to research.
MyNameIsTerry
21-07-15, 10:36
Some interesting snippets from this article:
http://bjp.rcpsych.org/content/195/2/102
It is proposed that although the effects of antidepressants and cognitive therapy would ultimately overlap, the initial site of cognitive therapy might particularly target the strategic control of emotional processing.
The results presented here suggest that antidepressant drug treatments may target these underlying processes supporting mood rather than targeting mood directly. It is unclear, however, to what extent the effects of drug treatment and cognitive therapy are overlapping. Although they both ultimately lead to reappraisal of emotional experiences the initial locus of action must be different. It seems intuitive that antidepressants affect relatively early and automatic processing of emotional stimuli which over time influences conscious appraisal of these stimuli, whereas cognitive therapy changes conscious evaluation of emotional experience which then influences automatic patterns of processing
In particular, Kennedy et alfound that response to venlafaxine after 16 weeks of treatment was associated with larger decreases in subgenual cingulate (Brodmann area 25) activity than response to cognitive–behavioural therapy, perhaps consistent with greater effects on automatic responses to emotional information, whereas cognitive–behavioural therapy was associated with increases in a more dorsal area of the anterior cingulate (BA 32), consistent with altered cognitive control.42 This area of research may be a particularly fruitful way of understanding the components of effective interventions for depression and anxiety and how best different approaches may be combined.
There are some useful explanations of how mood is affected by antidepressants but also how CBT plays it’s part in influencing mood from a different focus, autonomic-to-conscious for meds and conscious-to-autonomic for CBT. This is something we already know but I guess what you have to remember is that whilst meds will influence the lifting of mood, they won’t change behaviour - that’s comes all from us.
So, CBT makes sense in that we need to ensure we have corrected such behaviours to break free of them long term whereas meds will provide respite & an encouraging environment for change but not directly influence that change.
Powered by vBulletin® Version 4.2.5 Copyright © 2024 vBulletin Solutions Inc. All rights reserved.