CBT

[doveofhope]

I started CBT this week and i'm having a lot of anxiety regarding CBT itself. I've been diagnosed with GAD and been allocated 8 sessions over the course of 4 weeks. My main concerns are that i'm not going to feel better (or even that i'll feel worse) by the end of the 4 weeks, and then i'll be left without support with no other options. I feel stupid, and unworthy of help. I am also worried that I'm not able to be entirely honest with the other issues I have (i'm there with anxiety, but anxiety causes other issues for me to do with eating/food which I haven't been able to share. I probably should have shared in my first session but I didn't feel comfortable and I was going to attempt to share in the second but I also couldn't do it.) In my second session I felt quite stressed about the process. I felt frustrated that I wasn't 'getting' what the therapist wanted me to get and it fed into my overall worry and concern.

Any ideas of what I can do? Are there other options after the 8 sessions? I've also been told that I can slow down and have 1 session a week but i'd have to switch therapists half way through... which would be stressful.

[MyNameIsTerry]

Something I would say to you is that I didn't get very far in my CBT but I found myself using the things I had learnt and started tackling more of the goals I was stuck on at a later time. Part of CBT is to keep using it for relapse prevention anyway so even if the sessions don't do enough, if you keep working on things afterwards you can still see improvement.

I do think you should talk to them about the other issues. What you have to consider is whether those impact on the issues you are working with the therapist on because they could hinder your progress. Honestly, therapists here all sorts of intimate things about us so please don't feel embarrassed or that you may be judged.

You mention about food/eating. It might be worth you raising this on Kimberley2's Anxiety Eating Thread on the GAD board (it will be on page 1 normally). I say this because she has had CBT and has issues with food and there are at least 3 other people on there talking about this, having therapy for it or have been through it themselves. I'm hoping they will spot your thread but with the title, they may miss it so it would be good for you to talk to some people who have been through that over food/eating and maybe they can give you some good advice on how to get it across or maybe they can give you some help for the issues themselves?

If you feel you can't talk face-to-face, one way is to write it down. You could hand it over or email to the therapist. Some people find that a bit easier as it puts the ball in the therapists court to start the ball rolling.

8 sessions is pretty short, mine were in the 12-15 range. Is it a IAPT service? IAPT follow NICE guidelines and they usually have a local website explaining their therapy services which will be easy to find via Google if you add in your area in the search. IAPT, using NICE guidelines, use a hierarchy so if you were at Level 2, there is the option to advance to Level 3. Level 3 is CBT usually but I would expect more sessions so I'm not sure. If you could find that out, you would know there was another level they could pass you to afterwards.

There is also a Level 4 service but these are the Community Mental Health Teams and your GP would need to refer you to these, but they should treat anxiety/depression. Some areas are underfunded though so these services are not always open to us sadly.

[ricardo]

Doveof hope,

When you have any therapy you are literally opening up many private thoughts and feelings to a complete stranger,and that can be daunting in itself.

I find that it is extremely important that you feel comfortable wth the therapist,otherwise,quite frankly it's a waste of time.

I know you can't pick and chose on the NHS but all I would say is that CBT is not for everyone, though in no way am I putting you off. I have heard of mixed reactions by many people but I am beginning to think it's not the wonder therapy that many think it is, or the people employed to administer it aren't always that fully qualified.(I am speaking from my own and a few friends experience)

It is crazy that depending where you live dictates the amount of sessions one needs as every individual is a seperate case and are more complex than others..

[pulisa]

Your therapist may just want to restrict your sessions to GAD management especially as you have been given a strict allocation of sessions. I do hope that this is not the case and I would strongly advise you to mention your eating issues with the therapist but I just wanted to warn you.

Kimberley's thread is really helpful and informative so I do hope you will find it useful?

[Oosh]

You're focusing on a negative outcome. It's just the common anxiety "what ifs".

Just go, be honest, learn what you can learn about what they're trying to show you and at the end if they give you the option for more say yes. After it all just remember what you learned and see if those tools can help you in your every day life.

I went for twelve visits and at the end she said I could take up the option of a further twelve. So I did.

Write the food stuff down if you have to. Pass it to her/him when you enter. The important thing is that they are aware of the reality of your problems then they can use their skills to help you explore those areas.

[doveofhope]

Thanks so much for replying to this thread. I am going to try and talk to the therapist about food in the next session and hopefully go in with a positive attitude. I need to attempt to relax in sessions but I'm finding that really hard.


Terry - it is a IAPT service. Not really sure what that means though but I will have a look!

Thanks so much.

[MyNameIsTerry]

Terry - it is a IAPT service. Not really sure what that means though but I will have a look!



Hi,

IAPT is what came in to bridge the gap between Level 1 (GP) and Level 4 (community mental health teams) in England & Wales. Before them you went straight to what they now call Level 4 and could be waiting a minimum of 12 months or longer for any help. The aim was to cut down on the delays. So, now there is a network of local groups across these countries operating on behalf of the NHS in return for funds and a minimum standard was set based on NICE guidelines. It also meant they could introduce therapists & counsellors who didn't need to be trained through the old routes e.g. psychologists, psychiatric nurses, etc so they could get more people out there to help.

Many of the IAPT providers are charities and even the big ones like MIND & Rethink provide these services in their local groups (MIND & Rethink have their own networks of smaller charities under their names).

So, if you Google something like IAPT + your city/town/area, you should get to a local website for the your IAPT provider which will explain all their services. Also, local council or NHS trust websites will show them for your region.

Based on NICE guidelines for GAD, you should be having more sessions than this. I would imagine this is where the realities of funding overtake best practice though.

It should say if they offer further treatment on their website, so its worth a look. They are pretty easy to find. Many of them allow self referral but some require a GP referral. (again, the lack of governance by the NHS to ensure consistency across the network but thats the NHS all over :doh:) They offer more than CBT (subject to local training) but will use guidelines to determine the best treatment for someone. Anxiety seems to be mostly CBT everywhere though whereas depression has various recommended treatments thesedays. I suggest you ask them what happens after that course is finished, mine wouldn't do anymore and my GP wouldn't attempt to refer me back either.

I agree with Ricardo on a lot of this. My experience wasn't great and I came away a bit negative about it but I joined a local charity who offered more information on CBT which got me more into it all. This told me that what I had wasn't really CBT but a stripdown but not everyone has these experiences and it depends on your personal situation anyway.

[doveofhope]

Hi Terry,

That makes a lot more sense - thanks :)
I've checked the website linked to the service which is run through a med centre it says that we work towards a goal in 8 sessions. I imagine that will be all I get - I do feel very lucky though, because the referral went through really quickly, and I actually like the therapist I'm seeing. It's the anxiety that is wrecking the sessions. Hopefully next session, I'll be able to trust them a bit more and share the food thing..

I need to go back to the Dr next week to get more medication, so it might be something I bring up with them.

What types of charities could I look up? I know it's probably a local thing but is there a good place to start?

Ex

[MyNameIsTerry]

Hi,

Thats a good start, liking the therapist. Feeling comfortable is a big part of therapy being successful. I bet they see a lot of people with eating problems. I've had some issues with food or eating in social settings, the latter is something I've seen on a few threads before. In my relapse I would be panicking when eating due to the change in sensations as I was sensitised. I spent 2 weeks focussing intently on the TV power light and then I felt it greatly subside.

It might mean they can offer another course towards a different goal so it's always worth asking them. Realistically, 8 weeks is very short for recovery but maybe it will give you enough skills to take it forward towards the goal? And you could always try CCBT online and keep it going. There are various free or chargeable CCBT programmes out there and the NHS says there is evidence to support findings that they are as effective (with remote occassional support from a therapist, which many include) as face-to-face CBT.

In terms of charities, you could look on MIND's website as they have a local charity search for their own network. Rethink will probably have the same on their. Otherwise, if you just Google anxiety and your area, they should pop up and it's a matter of seeing if what they see on their website is what you want. Some may offer CBT courses of their own.

At my local charity they run weekly walk-in sessions across about 8 locations, CBT based courses (free), coffee mornings, music clubs, monthly meals, etc. So, they can be useful in getting support from others who understand, like on here.

There are charities that offer therapy on a paid basis which may be discounted on a sliding scale based on income like Anxiety UK but it does mean paying but it's just there as an option later on. If you end up looking at private therapy, therapists will often do the sliding scale thing anyway for people with lower incomes and some universities do free therapy so their grads can get their experience under supervision (I think there is one in Manchester that does this).

[ricardo]

[QUOTE=MyNameIsTerry;1462829]Hi,

Thats a good start, liking the therapist. Feeling comfortable is a big part of therapy being successful.

----------------------------------------------------------------------------------------------------------------------------------------------------------

I made the same point and I can't emphasize how important that is.

My therapist was completely useless but there is now a new Complex Depression and Anxiety Service (CDAS) that has been offered to me and I am having yet another assessment this coming week.

Apart from CBT they offer other services such as

Psychodynamic Therapy, so it might be well worth asking yourself if there are any other options.

[pulisa]

[QUOTE=MyNameIsTerry;1462829]Hi,

Thats a good start, liking the therapist. Feeling comfortable is a big part of therapy being successful.

----------------------------------------------------------------------------------------------------------------------------------------------------------

I made the same point and I can't emphasize how important that is.

My therapist was completely useless but there is now a new Complex Depression and Anxiety Service (CDAS) that has been offered to me and I am having yet another assessment this coming week.

Apart from CBT they offer other services such as

Psychodynamic Therapy, so it might be well worth asking yourself if there are any other options.

That's sounds promising and not before time, Ricardo. Let us hope that this new service takes off as it is much needed nationwide.

[MyNameIsTerry]

[QUOTE=MyNameIsTerry;1462829]Hi,

Thats a good start, liking the therapist. Feeling comfortable is a big part of therapy being successful.

----------------------------------------------------------------------------------------------------------------------------------------------------------

I made the same point and I can't emphasize how important that is.

My therapist was completely useless but there is now a new Complex Depression and Anxiety Service (CDAS) that has been offered to me and I am having yet another assessment this coming week.

Apart from CBT they offer other services such as

Psychodynamic Therapy, so it might be well worth asking yourself if there are any other options.

I know IAPT have created something called DIT which is a stripped down version of psychodynamic therapy which NICE are keeping an eye on. I remember lior mentioning it on a thread some months back so had a read about it. It runs for the same number of sessions as CBT and is for depression. So, it seems the NHS is not quite as behind their old CBT message anymore and NICE have approved MBCT for reoccurent depression.

I just wish they would do more with anxiety too so we get more therapies. The odd thing is though, NICE guidelines state CBT or Applied Relaxation for GAD and yet has anyone even heard off AR? I have never seen it in threads since I've been here and only Kimberley2 seemed aware of it when I mentioned it on a couple of threads recently.

Spotted this:

http://www.mertonccg.nhs.uk/News-Publications/News/Pages/Launch-of-Complex-Depression-and-Anxiety-Service.aspx


http://sutton.moderngov.co.uk/documents/s35117/IMHS%20SUB%20SUPPLEMENTAL%20AGENDA%201%20REPORTS%2 017%2012%2014.docx.pdf

NHS Merton CCG has recently commissioned a Complex Depression and Anxiety Service (CDAS) from
South West London and St George’s Mental Health Trust. Starting in February 2015, this service will
see and treat patients with complex depression and anxiety disorders who have previously been
seen by the IAPT service. This will provide a more appropriate service to this cohort of patients, and
will also improve the ability of the IAPT service to see and treat primary care mental health patients
more quickly


http://www.swlstg-tr.nhs.uk/_uploads/documents/board-papers/board-papers-2014-2015/board-meeting-2-october-2014/strategy-and-business-planning/08a-recovery-college-board-paper.pdf

The Recovery College is a core part of new innovative service development in Merton,
the Complex Depression and Anxiety Service, to better serve people who are in clusters
3
5-7 and enable the IAPT service to be refocused on people in clusters 1-4. The new
Complex Depression and Anxiety Service (CDAS) will offer specialist psychological
treatment and support for people in Cluster 5-7 along with additional input of peer
coaches who will work alongside therapists and patients to provide practical support, role
modelling, self-management techniques and peer navigation to promote recovery and
enable the patient to access local universal resources. They will assist people to
navigate local services when needed and to plan their own recovery. They will also
enable access to the Recovery College and will provide peer coach / trainer time within
the Recovery College providing specific education on self-management. The Recovery
College will expand the range of self-management courses on offer to include a wider
range of mindfulness courses; managing relationships; condition specific education and
management; self-compassion; maintaining a tenancy; planning and

The second link talks about Recovery Colleges. There are 20 according to that.

I remember lior saying she tried to access the level beyond IAPT and they told her they didn't deal with anxiety & depression. She was looking at Wandsworth. So, is this a service gap in London? I know I've seen reports where London was mentioned as the bottom of the table for mental health care as I was very surprised given I would expect the capital to have much better services than my city which has been ranked as having some of the worst councils in the UK so I wouldn't expect the NHS to be top notch in my ciity either.

I know the Level 4 service beyond IAPT in my city would offer a much greater range of therapies inline with NHS guidance which includes psychodynamic, so maybe we have this in my area? (12 month waiting list though).

Good luck with it though.

[ricardo]

[QUOTE=ricardo;1462846]

That's sounds promising and not before time, Ricardo. Let us hope that this new service takes off as it is much needed nationwide.


I was told it works on the subconscious.

[pulisa]

My daughter is being referred to the CADAT facility at Kings College Hospital/the Maudsley. Whether this gets approved by our local CCG remains to be seen but it's definitely worth a try