If CBT doesn't work for you... then what?

[Pamplemousse]

I felt I needed to ask this because I seem to do rather badly with CBT, which seems to be painted as a universal panacea. It's not long before old habits resurface despite best efforts.

So if it doesn't work for an individual, what comes next - if anything?

[AntsyVee]

There are other types of therapy, besides CBT. TAlk, EMDR, exposure, grief, group, etc. some work better for some diagnoses than others.

Often, I’ve found, that it takes a combination of things to work for me. I often need the trifecta of therapy, meds and lifestyle changes. Other coping mechanisms include exercise, yoga, meditation, mindfulness, journaling, pet/animal help, etc. There is no one size fits all solution.

[ankietyjoe]

What old habits are resurfacing? What is it about CBT that works for you, but then doesn't?

[keta]

Hi
i understand what you mean, I ve done CBT face to face many years ago and at that time it did help to a certain point although after some time I still went on Citalopram.
now I ve got this italk referral which is online CBT therapy. I m reading through it and I know everything what they are trying to explain in the individual modules - put me into anxiety scenarios and I won’t cope. Not on meds right now. So I get your dilemma.

[MyNameIsTerry]

Hi
i understand what you mean, I ve done CBT face to face many years ago and at that time it did help to a certain point although after some time I still went on Citalopram.
now I ve got this italk referral which is online CBT therapy. I m reading through it and I know everything what they are trying to explain in the individual modules - put me into anxiety scenarios and I won’t cope. Not on meds right now. So I get your dilemma.

Keta, I know what you mean. Those types of resources can be big on exposure work. Can you reduce the size of the exposures though? You can always add things like acceptance work and Cognitive Restructuring (also part of CBT but often missed in earlier stages of treatment) to see if they help. I don't know about the one you are using but the CBT4PANIC one on here is quite useful for that from what I have seen although it aimed at panic may not be enough to address OCD (in my opinion, and only from what I have read of it as I haven't used it personally) as the author points out when he has posted on here.

[lebonvin]

Did yous try other stuff like ACT and dialectic therapy or whatever?

I guess not so easy but there's self help stuff around in books

The ACT guys are kinda anti CBT which might help you

[keta]

Keta, I know what you mean. Those types of resources can be big on exposure work. Can you reduce the size of the exposures though? You can always add things like acceptance work and Cognitive Restructuring (also part of CBT but often missed in earlier stages of treatment) to see if they help. I don't know about the one you are using but the CBT4PANIC one on here is quite useful for that from what I have seen although it aimed at panic may not be enough to address OCD (in my opinion, and only from what I have read of it as I haven't used it personally) as the author points out when he has posted on here.

Terry
i haven’t made it as far as exposure and I’m not even sure if the module is included in this one. However if I had to do exposure right now for eg go on a bus I would probably last one bus stop before jumping off it lol. I don’t even have enough energy for it at the moment , my job is so busy I work 5 days a week and when the weekend comes last thing I want to do is stress myself with exposure to something which I know will give me massive anxiety. Or maybe it’s just my excuse not to do it :shrug:

[MyNameIsTerry]

Terry
i haven’t made it as far as exposure and I’m not even sure if the module is included in this one. However if I had to do exposure right now for eg go on a bus I would probably last one bus stop before jumping off it lol. I don’t even have enough energy for it at the moment , my job is so busy I work 5 days a week and when the weekend comes last thing I want to do is stress myself with exposure to something which I know will give me massive anxiety. Or maybe it’s just my excuse not to do it :shrug:

I think everyone on here will understand you there, keta. Exposure work is very hard.

One stop is fine. But even walking to the bus stop and waiting there is too. You can build up gradually using ERP rather than the old "flooding" methods (the latter being about facing the worst possible fear). ERP takes a gradual approach with a hierarchy aimed at getting you used to tolerating how you feel. So, you keep increasing duration in the trigger environment or increase it's difficulty but if you get stuck you can make the steps smaller. How long it takes is up to you and some may want to take bigger steps than others but getting their is more important than the speed in my opinion.

An excuse or avoidance is something we all will do on here as the subconscious thinks it's protecting us from some angry bear. It's natural to want to run away and hide. This can mean we keep putting stuff off. Don't kick yourself for that but do acknowledge it and accept things will need to change at some point.

Anyway I mentioned this because I thought you were getting nothing but exposure work and some therapists are like that from what we've seen on here. Since you are not there yet just keep going with the bits you are going through.

[BlueIris]

Sending all my sympathy your way.

Just a question: did you use your CBT techniques much after each bunch of therapy sessions? I've found the techniques it teaches tend to work on a strictly "use it or lose it" basis.

[Pamplemousse]

This bloody editor really doesn't like my phone - every time I try and edit a post it deletes it!!

In response to post no. 3, the "old habits" are what the CBT was intended to address: specifically, illness from exposure to chemical contaminants. I work in electronics and my hobby interest is old electronics, all of which carry exposure risks to carcinogenic materials. So when I start becoming aware of health issues, I start to link them together into a web of certain death.

For example, in a recent thread on here I mentioned a fear of having developed lung cancer. I have an intermittent wheeze; looking this up on the Internet seldom suggests a benign cause and now add in a persistent upper-body backache, along with a memory of a departed colleague for whom the latter was how they discovered he had lung cancer (despite being a never-smoker) and the parallel is soon drawn. The backache could be explained by my job being mostly bench and desk work and me driving 30,000 miles a year, but it couldn't be that simple, surely?

For a short while, I could apply what l learned in my last session of CBT: but the anxiety in me is a powerful beast. That was my third session of CBT in about ten years. Clearly it doesn't work too well for me: it's not helped by my living alone, a 90 minute commute alone each way to work and then most frequently working alone too. I have plenty of time alone with my thoughts.

I've also been on Citalopram since my wife died in 2010. Little seems to work right now and desperation is beginning to set in.

And in response to BlueIris, the anxiety seems to override the techniques I learned quite quickly. I can actually hear myself saying in my head "this is reassurance behaviour and I should not be doing this" quickly followed by "ignore that, you need to know."

[BlueIris]

I think you need to spend more time around people, Pamplemousse - maybe consider volunteering, or joining a walking group?

[Pamplemousse]

First I need not to be working/travelling 16 hours of the day 3-4 times a week. Plus I really don't 'do' people. Many years ago I was asked in another therapy session if I wanted to address my social anxiety, but I declined in favour of the health anxiety instead.

Add in that the only other friendship I entered into post- my wife's death ended in an incredibly acrimonious, nasty fashion that I'd rather not face that sort of crap ever again.

Plus, I kinda feel I deserve what I get.

[BlueIris]

That's awful! Nobody deserves that sort of pain, including you.

Do you have any hobbies that you enjoy?

[Pamplemousse]

That's awful! Nobody deserves that sort of pain, including you.

Do you have any hobbies that you enjoy?

I do: but the major one triggers my health anxiety. I have considered bringing an end to said hobby: it's become a hoard really (worsened rapidly by my wife's death} and if I want to retire in three years time I have to sell most of it to get rid of four storage units I won't be able to afford on a pension. I also know I'll lose pots of money selling up, and then I will be left thinking "what a waste of forty years of my life and money".

I get, as you can tell, readily overwhelmed by such things but I know things have to be done. I'd just rather pretend it's not there: rather like the alarmingly squalid conditions I live in at home.

[pulisa]

CBT certainly isn't the be all and end all for everyone and you sound as if you have far more on your plate than most people with mild to moderate anxiety who are helped by the standard NHS CBT package.

I think if you are still considering therapy then ACT may be more a helpful and realistic approach? It must be very hard to contend with everything you face after losing your wife. You must miss her terribly.

[Pamplemousse]

I think if you are still considering therapy then ACT may be more a helpful and realistic approach? It must be very hard to contend with everything you face after losing your wife. You must miss her terribly.

I had to look up ACT. I'm not sure I want to accept my issues, I really want rid of them but that may be an unrealistic goal.

And yes; not a day passes that I don't think of her in some way, or hear the little things she had her own way of saying. Most days I feel like I am inside a large concrete room, about thirty feet in every dimension. Otherwise empty, it is lit by a solitary pygmy bulb at the top; the type of bulb you get in a fridge. The room has no doors or windows, and it is cold and damp. It has air though and I am fed somehow. Sometimes, the roof of the room slides open a bit and the sun comes in, driving out the cold and the damp. But then the roof snaps shut again.

[ankietyjoe]

Coming back to this thread, and the specific question in the title.

Something I think is important here is that CBT stands for cognitive behavioral therapy, the important part here being a modification of behaviour.

My theory is that you are 'stuck' in a cycle of behaviour because of grief, and that's why CBT isn't working for you. CBT in particular is a therapy that works with patient participation. The onus isn't on the therapist, it's on you to hear what they are saying and modify your behaviour accordingly. I think you're finding this difficult (understandably) because of the grief you feel.

Perhaps talking to your therapist about this could help find a way to move on in some way, even if it's just tidying up your home a bit as a start. Even if it's just one room that you can sit and feel 'clear' in?

[Pamplemousse]

Coming back to this thread, and the specific question in the title.

Something I think is important here is that CBT stands for cognitive behavioral therapy, the important part here being a modification of behaviour.

My theory is that you are 'stuck' in a cycle of behaviour because of grief, and that's why CBT isn't working for you. CBT in particular is a therapy that works with patient participation. The onus isn't on the therapist, it's on you to hear what they are saying and modify your behaviour accordingly. I think you're finding this difficult (understandably) because of the grief you feel.

Perhaps talking to your therapist about this could help find a way to move on in some way, even if it's just tidying up your home a bit as a start. Even if it's just one room that you can sit and feel 'clear' in?


It's got to be worth a go. At the moment I have other issues of anxiety hovering around, but just getting one room straight would be a start. But it's not a task to be underestimated.

[ankietyjoe]

Do you have any friends/family who could help you with the one room? Or could help you syphon off some of the stuff you're least likely to have a problem letting go of?

[Pamplemousse]

Family have busy lives and I couldn't stand the judgement. Friends (what few there are) as a rule live at least 80 miles away.