View Full Version : CBT and struggling...
Justanutter
09-07-15, 21:56
Had my 5th session of CBT last night but the homework this week is proving really difficult and this is one of those times were I am not quite sure about the benefits of it. Basically have to spend 30 mins each day writing about my main worry (heart problem) in this instance...and go into great detail about how it would feel if the worst happened and detail all scenarios, emotions and fear etc. I have tried to put pen to paper but just can't do it and to think I would have to write the same scenario each day for a week is winding me up. I know it is supposed to desensitise the fear eventually but I just can't see that happening. It feels stupid and pointless and is making me cross. Is this all part of the process? Anybody been here with CBT? I really want it to work but I am so sceptical.
nomorepanic
09-07-15, 21:59
Hi
This is just a courtesy reply to let you know that your post was moved from its original place to a sub-forum that is more relevant to your problem.
This is nothing personal - it just enables us to keep posts about the same problems in the relevant forums so other members with any experience with the issues can find them more easily.
MyNameIsTerry
10-07-15, 11:18
This is often the case when it comes to methods such as CBT, it needs to be a repetitive behaviour because your subconscious needs to create new associations between neurons in the brain and it won't do this by the odd time something it done, its needs to be influenced over time. This way it creates new neural pathways. Its called neuroplasticity which is the process used to embed behaviour in the brain - its how we learn anything.
So, when you do some of these things, they can seem like they aren't helping at all but thats because we are viewing it in the short term whereas the therapist is viewing it more long term because he/she knows that to change our core beliefs about our fears is going to take time and repetition.
I struggled with some of it, often affirmations. They did nothing for me. I later found that on more positive days, they did a lot for me and but nothing on the bad ones. Over more time, I had more control and could influence with affirmations. So, its one for patience really.
Its never what we want to hear with all this anxiety and frustration but its sadly the case that we need to influence our subconscious towards the positive and away from the negative so that it starts to create new pathways and core beliefs and the old ones get mothballed in the process.
How about starting the ball rolling with a question to yourself? Then create a series of questions of it? Like in a "5-Why's" used in business improvement. If you can get your mind working on the problem, you might ease into it more and be able to scrap this and write something more comprehensive.
It can be useful to use a format, like a table. Has your therapist given you a format?
For instance, something like this might be used in some circumstances such as a fear about an event or thought and how it affects you:
http://psychology.tools/belief-driven-formulation.html
A fairly simple question Terry.
I have tried CBT and had about 12/14 sessions and the psychiatrist in charge of the unit stopped the CBT therapist as I wasn't responding.
I have read up quite a lot about it and it is sometimes explained that for CBT to work one should be medication free whilst I have also read that it doesn't matter.
Who is right ?
I'm on my 8th session of CBT for depression/anxiety.
I understand the logic of CBT but don't feel it's benefitting me at all. To me it's like putting spin on everything - seeing good when there's not good. I've found the homework tedious and unrewarding. If I'm having bad thoughts or I'm in a low mood it tries to teach me to distract myself by spending time on something I like - problem is I like nothing at the moment and find no joy/pleasure in anything so can't concentrate on any distractions.
CBT blames my thought process for my depression/anxiety whereas I blame my circumstances/experiences on my depression. Simply pointing out why a thought is irrational, doesn’t really alleviate the emotional attachment to a more irrational thought. I often end up challenging my own thoughts and replacing them with more rational ones without really believing in what they are telling me.
When I explain an issue to my therapist - rather than her delve deeper into the issue, she just ignores it and goes into a filing cabinet to pull out a spreadsheet for me to read and tells me if I follow the spreadsheet the issue will eventually go away.
She told me after 6 sessions I would probably start noticing a difference but there hasn't been any so I'm about to pull the plug on CBT as for me it's too superficial and totally ignores deep routed emotional/psychological issues.
I'm on my 8th session of CBT for depression/anxiety.
I understand the logic of CBT but don't feel it's benefitting me at all. To me it's like putting spin on everything - seeing good when there's not good. I've found the homework tedious and unrewarding. If I'm having bad thoughts or I'm in a low mood it tries to teach me to distract myself by spending time on something I like - problem is I like nothing at the moment and find no joy/pleasure in anything so can't concentrate on any distractions.
CBT blames my thought process for my depression/anxiety whereas I blame my circumstances/experiences on my depression. Simply pointing out why a thought is irrational, doesn’t really alleviate the emotional attachment to a more irrational thought. I often end up challenging my own thoughts and replacing them with more rational ones without really believing in what they are telling me.
When I explain an issue to my therapist - rather than her delve deeper into the issue, she just ignores it and goes into a filing cabinet to pull out a spreadsheet for me to read and tells me if I follow the spreadsheet the issue will eventually go away.
She told me after 6 sessions I would probably start noticing a difference but there hasn't been any so I'm about to pull the plug on CBT as for me it's too superficial and totally ignores deep routed emotional/psychological issues.
I'm much the same as you
It just doesn't work for me
I know 2 other people that did CBT and they're still on meds after doing CBT counselling. It obviously didn't do much for them.
To me it's too easily a way for a "counsellor" to practice a therapy from a text book in a business like manner and avoid the hassle/effort/time of proper individual therapy.
MyNameIsTerry
12-07-15, 04:50
I'm on my 8th session of CBT for depression/anxiety.
I understand the logic of CBT but don't feel it's benefitting me at all. To me it's like putting spin on everything - seeing good when there's not good. I've found the homework tedious and unrewarding. If I'm having bad thoughts or I'm in a low mood it tries to teach me to distract myself by spending time on something I like - problem is I like nothing at the moment and find no joy/pleasure in anything so can't concentrate on any distractions.
CBT blames my thought process for my depression/anxiety whereas I blame my circumstances/experiences on my depression. Simply pointing out why a thought is irrational, doesn’t really alleviate the emotional attachment to a more irrational thought. I often end up challenging my own thoughts and replacing them with more rational ones without really believing in what they are telling me.
When I explain an issue to my therapist - rather than her delve deeper into the issue, she just ignores it and goes into a filing cabinet to pull out a spreadsheet for me to read and tells me if I follow the spreadsheet the issue will eventually go away.
She told me after 6 sessions I would probably start noticing a difference but there hasn't been any so I'm about to pull the plug on CBT as for me it's too superficial and totally ignores deep routed emotional/psychological issues.
CBT isn't for deep rooted issues, thats the more traditional psychotherapy styles such as psychodynamic or psychoanalytical. CBT is the best evidenced one for anxiety & depression, however even the NHS state it is not sufficient for complex issues. The trouble is, if you present with these disorders they will simply push you to CBT without considering whether you are too complex. So, for me this is about a failing in the system than it is the therapy itself. Bascially, the NHS are using it as a filter between the GP and traditional psychiatric services. Get past Level 3 (CBT) and into Level 4 and they will provide a whole range of other therapies if they believe they are required (however, you may still have CBT if they believe it to be the best for you)
I think we have some major issues with CBT under this new IAPT network. Talk to people on here about their CBT by the Level 4's and they will tell you a whole load of stuff you've never heard of that was delivered as fundamental to them.
What you said about environmental factors, my CBT therapist (IAPT) said to me WAS a cause. I was told I could try to retrain how I view them from a more positive angle but it was accepted that they exist and can be the root cause. So, maybe we have some issues with the standard of therapists under IAPT? It takes quite some years to deliver the Level 4 services whereas for Level 3 CBT you can be qualified in 18 months.
I found that CBT did very little for me. Mindfulness did far more. I did find myself improving more after my CBT ended and was tackling things I couldn't even start in therapy so this tells me its just too short or second courses are needed.
IAPT have recently created a stripped down version of psychodynamic therapy for depression called DIT. They have decided it only needs the same number of sessions as CBT. Does that sound a little fishy? Making the therapy fit the business model, maybe?
It would be a good idea to get a resource for CBT, whether online or a book and see just how much you have been shown. I left CBT thinking 'is that all? Big deal' to later do my research and find I had little better than guided self help!
---------- Post added at 04:50 ---------- Previous post was at 04:40 ----------
A fairly simple question Terry.
I have tried CBT and had about 12/14 sessions and the psychiatrist in charge of the unit stopped the CBT therapist as I wasn't responding.
I have read up quite a lot about it and it is sometimes explained that for CBT to work one should be medication free whilst I have also read that it doesn't matter.
Who is right ?
CBT doesn't need to have or not have medication involved, Aaron Beck didn't devise it based on either of those. The earlier model by Albert Ellis is the same. They can work alongside it or without it.
If you look at NICE guidance, they state psychological therapy OR drug treatment. They only state both where there has been a partial improvement from drug therapy:
https://www.nice.org.uk/guidance/cg113/chapter/guidance
Step 3: GAD with marked functional impairment or that has not improved after step 2 interventions
Treatment options
1.2.16 For people with GAD and marked functional impairment, or those whose symptoms have not responded adequately to step 2 interventions:
Offer either
an individual high-intensity psychological intervention (see 1.2.17–1.2.21) or
drug treatment (see 1.2.22–1.2.32).
Provide verbal and written information on the likely benefits and disadvantages of each mode of treatment, including the tendency of drug treatments to be associated with side effects and withdrawal syndromes.
Base the choice of treatment on the person's preference as there is no evidence that either mode of treatment (individual high-intensity psychological intervention or drug treatment) is better. [new 2011]
High-intensity psychological interventions
1.2.17 If a person with GAD chooses a high-intensity psychological intervention, offer either CBT or applied relaxation. [new 2011]
1.2.18 CBT for people with GAD should:
be based on the treatment manuals used in the clinical trials of CBT for GAD
be delivered by trained and competent practitioners
usually consist of 12–15 weekly sessions (fewer if the person recovers sooner; more if clinically required), each lasting 1 hour. [new 2011]
1.2.19 Applied relaxation for people with GAD should:
be based on the treatment manuals used in the clinical trials of applied relaxation for GAD
be delivered by trained and competent practitioners
usually consist of 12–15 weekly sessions (fewer if the person recovers sooner; more if clinically required), each lasting 1 hour. [new 2011]
1.2.20 Practitioners providing high-intensity psychological interventions for GAD should:
have regular supervision to monitor fidelity to the treatment model, using audio or video recording of treatment sessions if possible and if the person consents
use routine outcome measures and ensure that the person with GAD is involved in reviewing the efficacy of the treatment. [new 2011]
1.2.21 Consider providing all interventions in the preferred language of the person with GAD if possible. [new 2011]
Drug treatment
1.2.22 If a person with GAD chooses drug treatment, offer a selective serotonin reuptake inhibitor (SSRI). Consider offering sertraline first because it is the most cost-effective drug, but note that at the time of publication (January 2011) sertraline did not have UK marketing authorisation for this indication. Informed consent should be obtained and documented. Monitor the person carefully for adverse reactions. [new 2011]
1.2.23 If sertraline is ineffective, offer an alternative SSRI or a serotonin–noradrenaline reuptake inhibitor (SNRI), taking into account the following factors:
tendency to produce a withdrawal syndrome (especially with paroxetine and venlafaxine)
the side-effect profile and the potential for drug interactions
the risk of suicide and likelihood of toxicity in overdose (especially with venlafaxine)
the person's prior experience of treatment with individual drugs (particularly adherence, effectiveness, side effects, experience of withdrawal syndrome and the person's preference). [new 2011]
1.2.24 If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin. [new 2011]
1.2.25 Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the 'British national formulary' on the use of a benzodiazepine in this context. [new 2011]
1.2.26 Do not offer an antipsychotic for the treatment of GAD in primary care. [new 2011]
1.2.27 Before prescribing any medication, discuss the treatment options and any concerns the person with GAD has about taking medication. Explain fully the reasons for prescribing and provide written and verbal information on:
the likely benefits of different treatments
the different propensities of each drug for side effects, withdrawal syndromes and drug interactions
the risk of activation with SSRIs and SNRIs, with symptoms such as increased anxiety, agitation and problems sleeping
the gradual development, over 1 week or more, of the full anxiolytic effect
the importance of taking medication as prescribed and the need to continue treatment after remission to avoid relapse. [new 2011]
1.2.28 Take into account the increased risk of bleeding associated with SSRIs, particularly for older people or people taking other drugs that can damage the gastrointestinal mucosa or interfere with clotting (for example, NSAIDS or aspirin). Consider prescribing a gastroprotective drug in these circumstances. [new 2011]
1.2.29 For people aged under 30 who are offered an SSRI or SNRI:
warn them that these drugs are associated with an increased risk of suicidal thinking and self-harm in a minority of people under 30 and
see them within 1 week of first prescribing and
monitor the risk of suicidal thinking and self-harm weekly for the first month. [new 2011]
1.2.30 For people who develop side effects soon after starting drug treatment, provide information and consider one of the following strategies:
monitoring the person's symptoms closely (if the side effects are mild and acceptable to the person) or
reducing the dose of the drug or
stopping the drug and, according to the person's preference, offering either
an alternative drug (see 1.2.23–1.2.24) or
a high-intensity psychological intervention (see 1.2.17–1.2.21). [new 2011]
1.2.31 Review the effectiveness and side effects of the drug every 2–4 weeks during the first 3 months of treatment and every 3 months thereafter. [new 2011]
1.2.32 If the drug is effective, advise the person to continue taking it for at least a year as the likelihood of relapse is high. [new 2011]
Inadequate response to step 3 interventions
1.2.33 If a person's GAD has not responded to a full course of a high-intensity psychological intervention, offer a drug treatment (see 1.2.22–1.2.32). [new 2011]
1.2.34 If a person's GAD has not responded to drug treatment, offer either a high-intensity psychological intervention (see 1.2.17–1.2.21) or an alternative drug treatment (see 1.2.23–1.2.24). [new 2011]
1.2.35 If a person's GAD has partially responded to drug treatment, consider offering a high-intensity psychological intervention in addition to drug treatment. [new 2011]
1.2.36 Consider referral to step 4 if the person with GAD has severe anxiety with marked functional impairment in conjunction with:
a risk of self-harm or suicide or
significant comorbidity, such as substance misuse, personality disorder or complex physical health problems or
self-neglect or
an inadequate response to step 3 interventions. [new 2011]
The problem we have, as ever, is a lack of therapists (and cash to get them) and GP's chucking pills out like they are desperate to get rid of them. Pills are incredibly cheap and a course of Citalopram for 12 months would likely cost around 2 therapy sessions. So, whilst we have guidance, whether GP's follow it is another story and we all know that GP's overhere operate without little governance and checking of their quality practices.
Basically, its a left hand right hand situation.
What can be a problem is that meds can mask symptoms. So, you come off them thinking you are fine and snowball. Your CBT skills can be used to control this as relapse prevention is part of the model (not that I ever had this in my CBT!) but whether you manage that is a different story altogether.
Meds can also cause a lot more symptoms than you had before, something I've had problems with ever since going on Duloxetine. So, they can also mean that meds can make things worse, but thats all about switching really.
Sounds fine in theory but we all know the realities of the 10 minute GP slot-or 5 mins if the appointment falls after a Bank Holiday.
I doubt whether many GPs have read this directive more than once. It's more a question of switching drugs rapidly and failing to be aware of challenging and long-lasting withdrawal symptoms from the powerful drugs they are playing around with.
Thanks Terry, my issues are deep routed going back to my childhood which is probably why CBT was never going to make much difference to me.
My counsellor also wanted me to do a therapy called EMDR, but when I read up on it it was said to be as effective as CBT so I decided not to bother.
It's much cheaper and probably just as effective to buy a CBT self help book and practice the tasks from the book rather than pay for it privately (which is what I did).
MyNameIsTerry
13-07-15, 02:18
Sounds fine in theory but we all know the realities of the 10 minute GP slot-or 5 mins if the appointment falls after a Bank Holiday.
I doubt whether many GPs have read this directive more than once. It's more a question of switching drugs rapidly and failing to be aware of challenging and long-lasting withdrawal symptoms from the powerful drugs they are playing around with.
They probably haven't and those that have are faced with reality; it could be a long wait for therapy and a patient suffering or in their surgery constantly. So, they opt for the pills thinking they are doing the best for the patient and can end up getting it very wrong.
In my area before NICE it was a minimum 12 month wait to get help and pills were all their was. IAPT speeded up therapy but they also act as blockers to adequate therapies for those they can't help.
The government always love creating new lists to make things look better :whistles:
---------- Post added at 02:18 ---------- Previous post was at 02:10 ----------
Thanks Terry, my issues are deep routed going back to my childhood which is probably why CBT was never going to make much difference to me.
My counsellor also wanted me to do a therapy called EMDR, but when I read up on it it was said to be as effective as CBT so I decided not to bother.
It's much cheaper and probably just as effective to buy a CBT self help book and practice the tasks from the book rather than pay for it privately (which is what I did).
I would imagine you will find the same issue with all therapies if you look at success rates some CBT is considered a high one.
EMDR works in a very different way that is still not fully understood. It's always been sold more for trauma since it works at with memory processing, which CBT isn't aimed at.
There is a "Trauma Focused" version of CBT used for PTSD. Maybe that's worth a look too?
Schema Therapy has evidence emerging that it is able to treat Personality Disorders where CBT has failed.
They also use DBT to treat personality disorders because it takes CBT but adds further work to deal with accepting emotions.
Maybe some of those could be appropriate in dealing with more deep rooted issues?
Justanutter
13-07-15, 10:41
I'm on my 8th session of CBT for depression/anxiety.
I understand the logic of CBT but don't feel it's benefitting me at all. To me it's like putting spin on everything - seeing good when there's not good. I've found the homework tedious and unrewarding. If I'm having bad thoughts or I'm in a low mood it tries to teach me to distract myself by spending time on something I like - problem is I like nothing at the moment and find no joy/pleasure in anything so can't concentrate on any distractions.
CBT blames my thought process for my depression/anxiety whereas I blame my circumstances/experiences on my depression. Simply pointing out why a thought is irrational, doesn’t really alleviate the emotional attachment to a more irrational thought. I often end up challenging my own thoughts and replacing them with more rational ones without really believing in what they are telling me.
When I explain an issue to my therapist - rather than her delve deeper into the issue, she just ignores it and goes into a filing cabinet to pull out a spreadsheet for me to read and tells me if I follow the spreadsheet the issue will eventually go away.
She told me after 6 sessions I would probably start noticing a difference but there hasn't been any so I'm about to pull the plug on CBT as for me it's too superficial and totally ignores deep routed emotional/psychological issues.
Stumago, this is EXACTLY how I feel about it. In fact, I am going to quote this word for word this week at my session because I feel I need to be honest with her as she is so lovely and only doing her job. My family are exasperated with me and tell me that they believe 'I don't want anything to work' which is utter poppycock - they just need to walk a day in my shoes but I wouldn't wish this on my worst enemy. I am desperate for it to work as I really don't know how I am ever going to rid myself of this state of mind, and I really do think I am trying hard.
---------- Post added at 10:41 ---------- Previous post was at 10:35 ----------
This is often the case when it comes to methods such as CBT, it needs to be a repetitive behaviour because your subconscious needs to create new associations between neurons in the brain and it won't do this by the odd time something it done, its needs to be influenced over time. This way it creates new neural pathways. Its called neuroplasticity which is the process used to embed behaviour in the brain - its how we learn anything.
So, when you do some of these things, they can seem like they aren't helping at all but thats because we are viewing it in the short term whereas the therapist is viewing it more long term because he/she knows that to change our core beliefs about our fears is going to take time and repetition.
I struggled with some of it, often affirmations. They did nothing for me. I later found that on more positive days, they did a lot for me and but nothing on the bad ones. Over more time, I had more control and could influence with affirmations. So, its one for patience really.
Its never what we want to hear with all this anxiety and frustration but its sadly the case that we need to influence our subconscious towards the positive and away from the negative so that it starts to create new pathways and core beliefs and the old ones get mothballed in the process.
How about starting the ball rolling with a question to yourself? Then create a series of questions of it? Like in a "5-Why's" used in business improvement. If you can get your mind working on the problem, you might ease into it more and be able to scrap this and write something more comprehensive.
It can be useful to use a format, like a table. Has your therapist given you a format?
For instance, something like this might be used in some circumstances such as a fear about an event or thought and how it affects you:
http://psychology.tools/belief-driven-formulation.html
Thanks Terry. You seem so knowledgeable in these things. I have had a look at the download and will give it a go. I had pinned all my hopes on CBT and maybe I am being too impatient and thinking it sounds far too simple to do. I do maybe think though, that as you also found, mindfulness may be a better tool for me and I should get back into that.
EbonyNightfall
14-07-15, 21:37
I'm so sorry to hear CBT hasn't worked for some of you.
I'm in the same predicament - I've had 8 of my allocated 10 sessions and have made no progress whatsoever. I find the idea that over 30 years of fear can be resolved in such a short space of time a bit of an insult really, but thought any help would be better than none at all. I agree with those of you who have suggested that some problems are too complex and deep rooted to be conquered, even partially, in such a short space of time. If it was that easy surely we would have managed it ourselves a long time ago!
While I realise it's down to me to do all the hard work, I've found my therapist to be very lackadaisical and lazy. She's currently trying to treat my emetophobia, (she thought it best to treat that first). 3 of my sessions were wasted looking at 3 pictures of people being sick. It took 23 mins for me to stop crying and shaking over 1 picture!? For session 5 I was supposed to listen to a recording of someone being sick. I don't think I lasted 2 seconds before a panic attack took over. I told her that if I was going to listen to something so upsetting I'd like it to be in the safe environment of my own home first (I'm agoraphobic too), so I'd listen to a copy of the CD I was supposed to be given for homework anyway at home before listening to it together in her office; to date she has still forgotten to bring one! Session 8 was a meditation because I've lost my confidence in going to the sessions.
Also, I'm furious that she wrote to my GP, without my consent, to stop him from prescribing me any more anti-emetics, (they're prescribed for my stomach problems), but I don't take them unless absolutely necessary, which is fortunately very seldom these days). I don't have the confidence to step one foot out the door without them :(
And another thing, I don't know about everybody else, but I've found the print outs I've been given to be so simplified that they're just a useless, patronising a waste of paper! I've learnt more in the last week from this forum and self-help books than 2 months of CBT!
I'm so sorry for the self-indulgent rant, but it's so disheartening, disillusioning and frustrating when you hear how successful CBT's supposed to be and it doesn't work for you. I've no idea what to do now :P
MyNameIsTerry
15-07-15, 04:55
Stumago, this is EXACTLY how I feel about it. In fact, I am going to quote this word for word this week at my session because I feel I need to be honest with her as she is so lovely and only doing her job. My family are exasperated with me and tell me that they believe 'I don't want anything to work' which is utter poppycock - they just need to walk a day in my shoes but I wouldn't wish this on my worst enemy. I am desperate for it to work as I really don't know how I am ever going to rid myself of this state of mind, and I really do think I am trying hard.
---------- Post added at 10:41 ---------- Previous post was at 10:35 ----------
Thanks Terry. You seem so knowledgeable in these things. I have had a look at the download and will give it a go. I had pinned all my hopes on CBT and maybe I am being too impatient and thinking it sounds far too simple to do. I do maybe think though, that as you also found, mindfulness may be a better tool for me and I should get back into that.
What I would suggest is reading about what CBT is supposed to do. I had mine and slowly I started learning things after it had finished. Then I looked more into what CBT contained and found I had hardly any of it!
Any health worker can write a book prescription for you. You then take it to your local library (if you still have one! :winks:) and you can have one of several books. Its all free and the booklist is on NHS Choices and includes CBT ones. So, perhaps you might get some more incite that way.
All my therapist was doing was explaining how thoughts, feelings, emotions, blah blah work in the circular diagram and then I was filling in lists about my compulsions plus lists of things I could try doing. She also spent some time on the whiteboard talking about how I felt about some of these things. We did a couple of Behavioural Experiments but I was just asked to think how it affected me when CBT provides actual monitoring sheets :doh:I thought for a while that with the lists of things to try she may have been doing some Behavioural Activation but I later decided it was more about basic exposure work.
I learnt about Cognitive Distortions from a charity I joined as they spent 30 mins each walk-in session reading a CBT based module and talking about how we felt it applied to us. These are a staple in CBT yet my therapist never told me anything about them. This got me started and then I joined here later and looked even further. I found real CBT is nowhere near what I was getting. It is tailored but I look at mine, some people I've seen on NMP including in the thread and see it more as "weakened" or "watered down" so it makes me question whether IAPT are just shaving off the people they can and the service is not really there to help us all. I knew barely anything about CBT before looking into it myself, despite having what I thought was CBT over a year before!
I think we are being shortchanged by IAPT. Its all behavioural work they seem to be doing and that is not CBT, its the Behavioural Therapy element that existed before it. They don't seem to be getting into Cognitive Restructuring which is a big part of CBT. The 2 people on here that had more traditional therapists (non IAPT) that I spoke to did have this in theirs and one of them had a similiar number of sessions to me yet had far more CBT than I had.
There are some good websites out there with free courses and loads of free tools and modules. I would suggest having a look at Davit's threads on the Panic board because we added links in there for various things.
You could always try MBCT, the Mindfulness combination with CBT. Thats NICE approved for treating recurrent depression at the moment but more GP's are sending patients on Mindfulness courses so they are pushing it that way. My therapist started me with Mindfulness but they only had a few exercises at the time. There are courses for MBCT with private therapists too and they tend to be around £60+ for 8 weeks online based on ones I've seen like BeMindful (the Mental Health Foundation, long running charity) and even ones like Breatheworks who offer the MBSR versions which have been around for 40+ years now from the US. (But as a tip, a MBSR therapist trained at the main uni for this in the US has put a full 8 week free course online so I've added it in my thread...follow the link in my signature for all that stuff)
---------- Post added at 04:55 ---------- Previous post was at 04:45 ----------
I'm so sorry to hear CBT hasn't worked for some of you.
I'm in the same predicament - I've had 8 of my allocated 10 sessions and have made no progress whatsoever. I find the idea that over 30 years of fear can be resolved in such a short space of time a bit of an insult really, but thought any help would be better than none at all. I agree with those of you who have suggested that some problems are too complex and deep rooted to be conquered, even partially, in such a short space of time. If it was that easy surely we would have managed it ourselves a long time ago!
While I realise it's down to me to do all the hard work, I've found my therapist to be very lackadaisical and lazy. She's currently trying to treat my emetophobia, (she thought it best to treat that first). 3 of my sessions were wasted looking at 3 pictures of people being sick. It took 23 mins for me to stop crying and shaking over 1 picture!? For session 5 I was supposed to listen to a recording of someone being sick. I don't think I lasted 2 seconds before a panic attack took over. I told her that if I was going to listen to something so upsetting I'd like it to be in the safe environment of my own home first (I'm agoraphobic too), so I'd listen to a copy of the CD I was supposed to be given for homework anyway at home before listening to it together in her office; to date she has still forgotten to bring one! Session 8 was a meditation because I've lost my confidence in going to the sessions.
Also, I'm furious that she wrote to my GP, without my consent, to stop him from prescribing me any more anti-emetics, (they're prescribed for my stomach problems), but I don't take them unless absolutely necessary, which is fortunately very seldom these days). I don't have the confidence to step one foot out the door without them :(
And another thing, I don't know about everybody else, but I've found the print outs I've been given to be so simplified that they're just a useless, patronising a waste of paper! I've learnt more in the last week from this forum and self-help books than 2 months of CBT!
I'm so sorry for the self-indulgent rant, but it's so disheartening, disillusioning and frustrating when you hear how successful CBT's supposed to be and it doesn't work for you. I've no idea what to do now :P
My printouts were not very professional. They also weren't NHS branded which was a bit worrying. I have found online templates which are the spitting image of mine and wondered if they had just downloaded them :whistles:
I think you are right to be angry with that therapist. One of the big points of mental health care (and there are campaigns stating this) is the ability of the patient to be involved in the decisions about their care. That therapist should have discussed it with you. Your GP won't do something just because a therapist says so anyway, 18 months of training in CBT doesn't make someone knowledgeable about meds. She could have called your GP to discuss it since he/she would have more understanding of what the med is for. Seems like arrogance to me.
Your therapist seems pretty poor. The whole point of using ERP as the exposure treatment (as opposed to the "flooding" methods of ET, or the various other ones aimed at bringing on the worst fears) is to use a hierarchy from least scary to worst (plus one extra step beyond usually). If you can't habituate to a step i.e. your anxiety doesn't decrease by 50%, you shouldn't progress of any further and should go back to the previous step or insert a stepping stone to build you up closer the the one you can't habituate to. So, there was no point taking it a step further with that recording when you hadn't progressed to being able to tolerate the images.
Bad therapist, I would say. IAPT again?
Something else that annoys me about this current system is how they can choose to treat one element, spend your whole therapy on it and then send you back to your GP when they haven't even addressed the others. What's the point of that? They wouldn't do that in physical health.
So, perhaps deadlines are more important than patient care? They can say there isn't enough money, which there isn't, but its hardly a justifcation for half-arsed attempts. :doh:
Justanutter
15-07-15, 09:25
Thanks Terry, as usual, very informative and helpful. I will have a look during my lunch break.
By the way, I think you would make a great counsellor yourself - have you every considered training for something like that as counsellor training involves lots of therapy for the counsellor along the way I believe and may be turning the tables on the anxiety into doing it for others, which you do on here anyway, may prove something worthwhile. Forgive me, if I'm way off in my thoughts...
EbonyNightfall
16-07-15, 00:54
Thank you so much for reading my message and for taking the time to reply Terry, I really appreciate it :) You're so knowledgeable!
That's so true - you'd think for treatment to be completely or optimally successful it'd have to be more holistic!
I think perhaps I was deemed a write-off from the offset and not worth the effort lol I have wondered how other people's experiences of CBT for emetophobia have differed to my own. I thought I'd be taught how to cope better with my phobia and to see things in a new insightful manner, but my sessions have involved almost no discussion!? Also, while I understand the theory of desensitisation, and it makes some sense, I find it hard to see how looking at pictures and recordings of people being sick can cure a phobia of being sick yourself..
Ah well, it was worth a shot!
MyNameIsTerry
16-07-15, 05:31
Thank you so much for reading my message and for taking the time to reply Terry, I really appreciate it :) You're so knowledgeable!
That's so true - you'd think for treatment to be completely or optimally successful it'd have to be more holistic!
I think perhaps I was deemed a write-off from the offset and not worth the effort lol I have wondered how other people's experiences of CBT for emetophobia have differed to my own. I thought I'd be taught how to cope better with my phobia and to see things in a new insightful manner, but my sessions have involved almost no discussion!? Also, while I understand the theory of desensitisation, and it makes some sense, I find it hard to see how looking at pictures and recordings of people being sick can cure a phobia of being sick yourself..
Ah well, it was worth a shot!
Thanks, I appreciate that.
Here is some info that matches what my therapist gave to me.
http://beyondocd.org/expert-perspect...bituation-mean
This explains habituation in exposure exercises. Please read about the scoring for anxiety reduction over X time. It says it needs to be long enough in order to feel a reduction. I know in the diagrams my therapist showed me that it was a bit longer, more 20 minutes which can be shown on this diagram:
http://www.cognitive-behaviour-therapy.co.za/images/anxiety_image7.gif
The wbsite explaining this can be seen here:
http://www.cognitive-behaviour-thera...rs_anxiety.htm
ERP is also used in shorter timeframes as its impossible for some issues. I don't know as much about how they handle this and allow for time to habituate although I would guess at it being later in therapy so you have more control to be able to move yourself towards habituation quicker.
This is a really good example on NHS Choices:
For example, if you have a fear of snakes (ophidiophobia), your therapist may start by asking you to read about snakes. They may later show you a picture of a snake. They may then arrange for you to visit the reptile house of your local zoo to look at some real snakes. The final step would be for you to hold a snake.
You didn't get that from what you explained. Your therapist barged straight in with pictures and when he/she was faced with a patient unable to habituate, they did nothing to reduce the intensity of the exposure and work back up again. They even went up a step to the recording when there is no chance you should do that if you are unable to handle a previous step. Thats not how the ERP model works at all.
Another problem is that it has not been explained to you either. These exercises are just part of the hierarchy but like in the NHS Choices example above, there would need to be further steps that involve you e.g. using imagery where they talk you through feeling sick or imagery of being sick. This probablt sounds horrific to you right now but when you reached those steps you would already be desensitised to triggers like other being sick so you would have much more confidence & trust in yourself and greater control over your reactions.
Thats just a bad therapist so I wouldn't judge CBT or the ERP component based on your experience alone. I sort of did for a while but I have later come back around to the benefits of it.
The fact your therapist didn't spend time educating you about the core principles is another indicator of poor quality for me. CBT is supposed to be about education and to provide the patient/client with the tools to manage prevention of future relapse so how can you do that if you don't know any of it?
I posted a thread with a link to a report about how ERP can fail and what a therapist should do. Its aimed at OCD but it has a lot of useful information in that should give you can idea of what the aim should be at a deeper level i.e. changing your beliefs. You will see references to "treating the core fear" which is useful because it explains where therapists go wrong in treating the wrong fear. For instance, if one of your symptoms of Agoraphobia was nausea, it will bring on your Emetophobia thus in treating the Agoraphobia it can deal with both at the same time where your Emetophobia is limited to those symptoms in that scenario and you end up desensitised to both in the process.
---------- Post added at 05:18 ---------- Previous post was at 05:01 ----------
Thanks Terry, as usual, very informative and helpful. I will have a look during my lunch break.
By the way, I think you would make a great counsellor yourself - have you every considered training for something like that as counsellor training involves lots of therapy for the counsellor along the way I believe and may be turning the tables on the anxiety into doing it for others, which you do on here anyway, may prove something worthwhile. Forgive me, if I'm way off in my thoughts...
Thanks, I appreciate that.
Its something I've thought of but I've always said I would prefer to get to a better place myself first rather than risk the outlay. I was asked if I wanted to train as a coorindator for a charity but I was worse back then and didn't want any extra pressure.
Thank you for your confidence.
---------- Post added at 05:31 ---------- Previous post was at 05:18 ----------
I wanted to check something on CBT and did a quick Wiki for it and in the criticisms section it states:
Criticism of CBT sometimes focuses on implementations (such as the UK IAPT) which may result initially in low quality therapy being offered by poorly trained practitioners
The UK's National Health Service announced in 2008 that more therapists would be trained to provide CBT at government expense as part of an initiative called Improving Access to Psychological Therapies (IAPT). NICE said that CBT would become the mainstay of treatment for non-severe depression, with medication used only in cases where CBT had failed. Therapists complained that the data does not fully support the attention and funding CBT receives. Psychotherapist and professor Andrew Samuels stated that this constitutes "a coup, a power play by a community that has suddenly found itself on the brink of corralling an enormous amount of money ... Everyone has been seduced by CBT's apparent cheapness." The UK Council for Psychotherapy issued a press release in 2012 saying that the IAPT's policies were undermining traditional psychotherapy and criticized proposals that would limit some approved therapies to CBT, claiming that they restricted patients to "a watered down version of cognitive behavioural therapy (CBT), often delivered by very lightly trained staff"
I don't generally read beyond the real information of how you use a therapy in such articles but this is something that is showing in peoples posts on this forum more & more. Some still say it helps them greatly though but you don't always know which service provided this and if you get to Level 4 with the community mental health teams you are accessing a better trained person with a lot more skill & experience of even more complex interventions.
:whistles:
I appreciate that you have spent so much time studying the pros and cons of CBT, Terry.
All in all I think the success rate is nothing outstanding. I mentioned a while back that my therapist said her success rate was 60% which one can argue is good that 6 out of 10 people have been cured, but when I looked into it further with her these were for specific phobias not deep rooted multiple problems that mant of us have.
One pill for all just doesn't work.
I believe psychodynamic therapy might be a better option for many.
MyNameIsTerry
16-07-15, 07:49
Yes, I think the same, Ricardo. Even the NHS make a point of saying this and part of me wonders whether its because we have to deal with IAPT. Its interesting that their is a short version of CBT at around 12 hours of therapy. IAPT provide typically 12-15 hours. So, sounds like a stripdown to me and not real CBT.
So, perhaps if we had the real deal, we would see better success rates. If a doctor said 60% success we can repair your leg after an accident, it would be brown trousers time!
I've seen 50-60% but I've also seen 80% (which I don't think is accurate).
Its interesting that CBT has become an umbrella term too and therapies such as ACT can be considered part of it. I think these newer forms might be useful given they use techniques that are proven to change brain structure and I'm not sure of CBT has that behind it.
I know for OCD, psychodynamic approaches aren't seen as more effective. The trouble is, we tend to have a lot more issues than just one disorder and CBT seems to struggle with this. Psychodynamic typically takes place over a much longer time so its hard to make a comparison without ruling out the effect of a longer therapy.
The strange thing is that in the NICE guidleines for GAD it say for high intensity therapies (CBT level) give the patient a choice of CBT or Applied Relaxation. I've never seen anyone on here discussing that AR other than when I mentioned it on a thread and Kimberley said he CBT therapist gave her a CD for it. Her therapist being a fully trained community mental health service one, not IAPT because she is in Scotland. I had no choice, I never heard of choice. Do these AR therapists even exist? I can see that being useful to people because it teaches you how to relax and bring on relaxation quicker & quicker until you are practicing it in vivo. It has some CBT influence and can be combined too.
My preferred method of relaxation would always be a general anaesthetic:winks:
I thought "CBT" as it is offered on the NHS was only suitable for mild to moderate cases. Anything more long term-apart from psychotherapy-would of necessity have to be privately funded by the individual as it's not really practical financially for people to have limitless sessions with an NHS practitioner. Just imagine the waiting lists! I had to wait over 2 years for my CBT 10 years ago and I think I got 16 sessions which barely scratched the surface. I was offered psychotherapy but turned it down as I couldn't commit to long term therapy as I'm a carer and I was very frightened as to how it would affect my day-to-day caring for my daughter.
I think that there's too much fancy terminology used today for mental health services when a lot of it is just common sense. Also far too many "therapists" jumping on the bandwagon taking advantage of vulnerable people.
Stumago, this is EXACTLY how I feel about it. In fact, I am going to quote this word for word this week at my session because I feel I need to be honest with her as she is so lovely and only doing her job. My family are exasperated with me and tell me that they believe 'I don't want anything to work' which is utter poppycock - they just need to walk a day in my shoes but I wouldn't wish this on my worst enemy. I am desperate for it to work as I really don't know how I am ever going to rid myself of this state of mind, and I really do think I am trying hard.[COLOR="blue"]
Hi Justanutter, it doesn't please me to see CBT not working for others but you're certainly not alone and it's not your fault:)
At the moment I feel so low, tearful every day, thinking of self harm, no appetite and I wouldn't wish it on my worst enemy. When I try to explain how I feel to others who don't suffer I tell them it's like when you lose a close relative - your constantly tearful, feel so low, very emotional, no appetite, can't sleep etc - but it's like this every day.
CBT to me is like sawing your arm off and then remarking "oh isn't it a lovely sunny day today".
I'm a bit concerned. I had my assessment meeting a few weeks ago. The woman was really nice and I said I would like to continue with her if possible. She said that would be fine. Since then I have found out she is a trainee PWP (I'm not sure what that stands for). I don't want to change as I might not like another person.
MyNameIsTerry
29-07-15, 05:50
I'm a bit concerned. I had my assessment meeting a few weeks ago. The woman was really nice and I said I would like to continue with her if possible. She said that would be fine. Since then I have found out she is a trainee PWP (I'm not sure what that stands for). I don't want to change as I might not like another person.
Psychological Wellbeing Practitioner (PWP). They are the ones who deliver Level 2 services such as Guided Self Help. Level 3 is classed as High Intensity Therapy (HIT) hence you get a High Intensity Therapist who is able to work one-to-one with a client to deliver the traditional CBT style therapy that IAPT use.
If she is training to be a PWP then I would expect you are due to receive Level 2.
---------- Post added at 05:50 ---------- Previous post was at 04:35 ----------
My preferred method of relaxation would always be a general anaesthetic:winks:
I thought "CBT" as it is offered on the NHS was only suitable for mild to moderate cases. Anything more long term-apart from psychotherapy-would of necessity have to be privately funded by the individual as it's not really practical financially for people to have limitless sessions with an NHS practitioner. Just imagine the waiting lists! I had to wait over 2 years for my CBT 10 years ago and I think I got 16 sessions which barely scratched the surface. I was offered psychotherapy but turned it down as I couldn't commit to long term therapy as I'm a carer and I was very frightened as to how it would affect my day-to-day caring for my daughter.
I think that there's too much fancy terminology used today for mental health services when a lot of it is just common sense. Also far too many "therapists" jumping on the bandwagon taking advantage of vulnerable people.
Beyond IAPT we have the mental health teams who would have treated us before. So, a GP can refer to those which can be seen in many threads on NMP. They will determine which therapy is best and it may end being another round of CBT but the difference will be that you are with someone who is far more qualified, experienced and multidisciplined as opposed to a shorter specific CBT training course. Level 4 services can be going on for a year, be bi-weekly, etc so they are more diverse. Indeed NICE guidelines for GAD indicate an escaltion to this level for refractory cases and the OCD guidelines show them supposedly being involved slightly earlier.
A lot of CBT is common sense. Its just that it tries to explain things and then provides a structure to get you moving forward as opposed to often woolly common sense of the anxiety guru's who repeat themselves without really telling you more than the average person on the street would if you asked them.
Psychological Wellbeing Practitioner (PWP). They are the ones who deliver Level 2 services such as Guided Self Help. Level 3 is classed as High Intensity Therapy (HIT) hence you get a High Intensity Therapist who is able to work one-to-one with a client to deliver the traditional CBT style therapy that IAPT use.
If she is training to be a PWP then I would expect you are due to receive Level 2.[COLOR="blue"]
.
Thanks
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