CBT hasn't worked - what next???

[bluedaisy]

CBT hasn’t really worked for me. It's definitely helped a bit, but hasn't enabled me to get back to anything resembling a normal life!

I’ve tried very hard - at least a £1000 on private treatment (which I can no longer afford), loads of very difficult sessions pushing myself to the limit trying to meet the challenges set with my therapist e.g. first time on a bus in a year, returning to scenes of previous panic attacks etc, doing all my homework between sessions, even when it’s been terrifying, going over and over all the thought reframing and balanced thinking exercises … and yet no relief from the anxiety when I try to go out on my own.

My therapist ended our sessions, as I had ‘made no substantial progress’. I don’t want to get into meds, and am determined to beat my agoraphobia without them, but think I need some form of therapy/support to help me get there.

Anyone had any joy with referrals from their GP for different forms of treatment?

Mine has offered me nothing, except for meds of course, hence the expensive CBT. I’d like to be able to go and see her and request some form of therapy/help, so any advice on what to try next would be very welcome.

[bet]

Hi bluedaisy,

sorry to hear the CBT didnt work for you.It didnt work for me either,but in my case the therapist I was referred to had just trained in it.

What I have found excellent is EFT(emotional freedom technique).Its so easy and actually very enjoyable.You can download the manual for free at www.emofree.com (http://www.emofree.com)
I use the "basic recipe" and find it great.

Carl Dourish who we are so lucky to have uses EFT in his practice has done a good few posts on it.

Give it a try hun and let us know how you get on.

p.s. dont be hard on yourself that CBT didnt help you achieve the results you hoped for.

Bet :hugs:

[honeybee3939]

Hi There


I myself had CBT and it did help, i was actually vertually housebound when my CBT sessions started, i did make good progress with CBT but was far from cured. I had my CBT through the NHS and as he could see i had made progress but still needed support i was then referred onto the Community Mental Health services in my area where i was assigned a community support worker whom i saw once or twice a week. This seemed to help me the most because while i was doing challenging things like walking futhur away from home or standing at bus stops there was someone actually there to talk me through the panic when need be. I found this therapy to be the best of all but listening to other members on this site there can be quite a long waiting list for this kind of support which really annoys me because i feel if i had this therapy at the begining of my illness im sure it wouldnt have lasted the 12 years that it did!

When suffering with agorophobia in my case anyway, it was a matter of getting my confidence back and thats one thing the support worker helped me gain.

Andrea
:hugs:
xxxxx

[joannap]

hi bluedaisy

i am just wondering whether your cbt exercises have been approached in the right frame of mind - it sounds as if you felt forced or pushed out of your comfort zone too quickly. what has helped me is total acceptance but this only works if you can truly accept and not just think you are! i have felt absolutely consumed by panic at times when i have been out but i literally 100% give into it - i have felt the adrenalin burning through my body and i have not been able to speak but i just hold acceptance in my mind and eventually it subsides. Once you have done this once - the panic begins to loose its edge. I would advise setting small targets everyday and no matter how you feel - DO NOT run home or try to escape from the feelings - simply let them wash over you - no matter how bad you will feel because if you do this - i can promise you that a lightbulb will be switched on in your mind.

all the cbt in the world will not help your instinctual fear of fear - although it should help with calming self talk and stopping the negative thought patterns that spiral out of control in an attack. the only thing to stop panic and defuse it is to go through it. xx

[Alabasterlyn]

I'm surprised that your GP didn't offer you CBT on the NHS as I know it's available as I had it for a year. However like you I didn't find that it helped me either. The theory of CBT makes very good sense but putting it into practice was the bit I found hard. I also think if you don't have a therapist who understands agoraphobia then it's going to be pretty hard to get anywhere.

When I had my therapy I was quite surprised at how much more I knew about agoraphobia than my therapist did and it did make me feel less confident about her ability to help me. She would do stupid things like take me out for a walk around a huge open field in temperatures of 96f and then wonder why I didn't want to do it again! Fact was I felt more anxious after doing that than I had before and I have never been able to face doing something like that again as all she did was reinforce my fears not allay them.

On another occasion she wanted to meet me in the middle of town in the centre of a 140 store shopping mall. I was supposed to get there on my own, walk around the mall with her then go home on my own. As an agoraphobic who can't even go out on her own this to me was just plain stupid and just showed me how little she understood my condition.

I think at times we have to stop blaming ourselves for treatments not working and realise that sometimes it's down to the therapists lack of knowledge and not always our fault.

[bluedaisy]

Hi,

Thanks for all your replies. It really helps to be in contact with other people who understand what I'm going through.

Bet - Thanks for the tip. I will have a look at the EFT info. I did try it once or twice last year, but didn't get very far. I'll try and stick to it for longer this time and see if it helps.

Andrea - It certainly sounds like a good idea to ask for referral to a community mental health support worker. I will see if my GP can help. I have to admit that I've given up going to see her because she usually just tries to push meds and pretty much says it's my own fault for not getting any better because I won't take them! I requested NHS counselling in April 2005 - still waiting!

joannap - I understand your point and I do try very hard to accept the panic and stay in a situation, rather than running away from it. Sometimes it works and I get calmer, other times it doesn't and I end up heading home and feeling as though I don't want to ever venture out of the front door again. I've not had a lightbulb moment yet, but hopefully I'll get there...

Alabasterlyn - I completely agree. My CBT therapist refused to accept I was agoraphobic for ages, because I could go out with her and with my partner. She only accepted that I was after she watched 'house of agoraphobics' on TV!!! Sometimes, the experts just aren't as expert as they think they are.

I'm very glad some of you have found success with your therapies and support workers. I've reached a point where after several months of giving up in the battle against my agoraphobia (following the end of CBT and no more cash to pay for private help), where I really feel determined to start working hard again to get better.

So, I will try my GP again, get out the CBT manual and start doing the exercises, have another look at EFT, and use this forum as a source of inspiration and support to give me the kick up the bum I need to get on with it!

Wish me luck ...

[honeybee3939]

Hi Bluedaisy

Just wanted to wish you luck hun, and to say never stop asking your GP for help that is what they are there for.:winks: you are so entitled to get the therapy you need to help in your recovery.

My GP im sure is sick of the site of me..lol, but i dont give a dam, just keep pestering him/her and dont take no for a answer.

Good luck hun.

Andrea
xxxxx

[bluedaisy]

Thanks Andrea. I will go and see her next week and see if she can help. Fingers crossed.

[Richie]

HI i think anyone who has had CBT on the NHS is ever so fortunate.
Especially if the therapist actually goes with you, that is almost" UNHEARD OF" i had CBT in Swindon in my early 20's and he was "Gods Gift" he virtually cured me in about 6-8 sessions, but i had to it alone no one holding my hand.
You didn't mention Bluedaisy if you went with a "safeperson" all the time or if you did these things on your own, reporting back say once a week?
But it really sounds as if you DID make progress like going on a bus, going back to previous panic scenes etc and meeting all the challenges. But it does have to be sustained continuously, can't just do it once and then think ah well thats that one ticked off the list. These challenges have to be practiced constantly, daily if possible for them to carry on working for you.
It's the same with hynotherapy and NLP techniques, breathing exercises they all have to be done over and over again clich'e which i wish i could do too but practice does make perfect Y'know and even if all the anx doesn't disappear then at least you are left with coping skills which you must use yourself.
Only wish i could have CBT again as i have been trying to remember what my swindon therapist taught me and make out my own worksheets
Richiex

[bluedaisy]

Hi Richie,

My CBT sessions were a mixture of behavioural therapy, tackling difficult things with my therapist's support, e.g. bus journeys etc, and cognitive therapy sessions in my home where I'd report back on things I'd done alone and plan activity schedules with her.

It did help me to some extent, because at one point I was able to go out alone every day, usually a walk to the local shop for a newspaper, and I frequently cycled 1.5 miles alone to meet my partner after work in the evenings. (That was easy during the winter as it was dark and I felt safe.)

But, it was always very hard work to keep going, and the approach of my therapist seemed to be 'you've proved you can do that now because we did it together, e.g. going on the bus, so lets move on to the next thing'. I found it very frustrating that she didn't understand that managing to do one short bus journey with her didn't mean I was able to start using buses again alone!

In the end my therapist ended our sessions because I hadn't made sufficient progress. She was used to 'curing' people after six to eight sessions, but unfortunately that just didn't happen for me. As I said in my earlier post though, she knew nothing about agoraphobia, so I think she mainly worked with people whose anxiety problems had not stopped them working or prevented them going out etc. I really wish I'd discovered CBT when my anxiety was still within manageable levels and I was working full time etc, as I'm sure it would've helped me enormously.

Obviously people with more debilitating anxiety conditions like agoraphobia still can get a lot of benefit from CBT though, like you did. Probably it's a mixture of getting a good therapist and responding well to CBT techniques - I guess no therapy works for everyone.

I can recommend Mind Over Mood by Dennis Greenberger if you're looking for a good book with worksheets etc. All my CBT was based on that (probably should've just bought the book and not bothered with the therapist ...lol).

Good luck with your CBT practice Richie -I'm going to get on with mine again too.

[Richie]

Thank you Bluedaisy
yep getting the right therapist is like finding a needle in a haystack,
and you need to gel with them, i was real lucky those years back,
Thanks for the book recommendation called "Mind over mood" i will see if i can get that. I'm thinking of finding a therapist privately like you but would mean getting a loan and don't want to be in debt ! And there are loads of people practising CBT that don't know who to see!!
Anyway the best of luck to you, sorry things haven't worked out, like you my agoraphobia/sa is at a chronic stage but i do sometimes have good days.
Lots of love Richie xxxxx

[Bill]

I've been housebound with agoraphobia for 18 months, and for the past three or four months I've almost given up my battle to overcome my anxiety.

Reading back on your introduction thread, you say you've been housebound for 18 months. Does that mean that before then you were coping ok and if so, what was it that happened to make you housebound?

The other thing is did you try the CBT within the past 18 months?

You've probably heard this before but my "guess" is that something you were going through created so much stress that 18 months ago you were out and experienced a bad panic attack which made you retreat indoors because the intense feelings scared you so much so you have now become afraid of experiencing fear - fear of fear.

When you go out with someone you feel secure but alone you feel vulnerable again with no support. This means that if you think of going out alone, you're already worrying "what if" I experience a panic attack and there's no one with you to support you.

The fear of the original panic attack has remained with you so that each time you go out your mind is now recreating that first attack worry = fear = panic.

I can see why CBT didn't work because your confidence is so low in your abilities. It takes Far longer than 6 - 8 sessions And doing them alone to build up the confidence you lost. All too often we see therapists and feel fine because they are there with us.

I've always believed in adopting a new mindset. To attempt very short walks alone, even just a few yards but before attempting them to re-programme the mind with positive thoughts to counteract the negative thoughts that produce the worry and lack of self-belief.

Instead of thinking "what if I have a panic attack"...think "I Have to go out to do something and I Will be fine". Instead of focussing on the worry, focus on what you need to "do". Also to stay where we are when the panics occur so we experience them for what they are - just panicky feelings and that they won't harm us however bad they feel.

We fail before we set out through worrying thoughts that create our panics. It takes a Long time to but I Do know of people who were in your situation who are now getting out and about without worry and they didn't use CBT to enable the change. They simply adopted a new way of thinking with goals and the positive approach paid dividends.

Tackling the fear of panics IS very difficult but the only way we build our confidence IS to tackl them gradually "alone". If someone is with us we will always depend on them for the security they provide.

I used to experience panic myself because of a lot of stress in my life and I became afraid to go out but in time I learnt not to worry about them and they stopped. I do still get anxious but it doesn't stop me from doing what I need or want to do so I Know it IS possible for anyone to do the same with a new way of thinking.

It is only a guess how your panics started but the way to learn to cope with them I know is true.:hugs:

[Big Bird]

Hi there,

Just a hunch but it may prove beneficial to try some 'Person' centred therapy, once known as Client centred!
It allows the individual to explore all the avenues and attain his/her own personal growth.
It is not so widely publicised nowadays as the mandate is more CBT directed but it is still a very very interesting and succesful form of therapy.

Wish you all the best,

(Roy)

[Angel64]

Hi, what you said about knowing more than the therapist really rang a bell with me.

I have read so many books, listened to so many tapes and looked on so many websites that I feel that I have done a university course in it !! The thing is though by doing this i am analising everything, and I was even thinking did my therapist really know what she was doing. We come to a point of knowing too much I think.

I had sessions through the NHS with a therapist and also an online CBT course, which was helpful but at the time I think I was so concerned with doing well and of course all my family/friends knew so I felt under pressure.

I finished that in September last year, as the therapist thought I was doing really well. But I still had days where i couldnt even leave the house and so to me it wasn't really any good.

But then I decided that on January 1st 2008 I would make a resolution to get better, and I think once I had made that decision, and didnt tell many people about it, it was easier. I have had a really tough few weeks but am getting there slowly.

I would say the key is to be really ready to want to change, to have a hunger for it, and I must admit finding this site late December has been wonderful.

I wish you luck on your journey. :hugs:

Christine xx

[scared guy]

I almost hate to say it here cause I don't want to discourage anyone, but I haven't had much success with CBT either and I think it's important that people understand that not everybody can be cured by it.

I've had panic attacks and agoraphobia for years and have made a few attempts at CBT and either I just lack the needed courage to carry it out to it's end, or what I have simply doesn't respond to it. Maybe I've just lacked the proper mindset all this time. Whatever the reason, it hasn't worked.

One problem I have with CBT is it treats panic attacks like normal fears. I don't believe there's anything normal about a true panic attack. Just because you develope a normal fear of a situation where you panicked, doesn't mean that facing that situation and overcoming it is going to make you stop having panic attacks. I can overcome certain associations I've made as far as situational attacks, like at a store or driving my car(this list goes on forever lol), but at the end of the day, I still have panic attacks and always a new feared situation to overcome.

I believe something is predisposing me to them. I have no clue what it is, but you wouldn't expect a person to overcome type 1 diabetes by changing their thinking. Nobody knows what causes that either, but because theirs is more physical than mental, people accept that they can't just pull themselves up by their bootstraps and get over it. What I have isn't as cut and dried as diabetes(yet), but after all these years of dealing with it, I believe it falls more into that territory than a learned behavioural problem that can be dealt with by learning to think differently.

That's just me though and I hope I haven't discouraged anyone from trying CBT. Just don't get down on yourself if you have tried it but didn't get better.

[Allye]

I do not think that CBT is a quite fix in all cases. I had about 8 sessions – made sense but did not really make a difference at the time.

I then went on to Citalopram which really made a difference as it gave my body a break from the constant anxiety, panic circle. When I came off Citalopram I used what I had learnt from CBT to help.

I am not cured but cope a lot better.