How was CBT for You?

[shyoldguy]

I'm interested to know counts as CBT nowadays. Some 20 years ago I had CBT (just over a year's worth), which consisted of writing down negative thoughts and rational responses. Also some advice on assertiveness. Was only limited use to me, as I still feel anxious and get depressed.

I tried private therapy after that but that did n't really work for either, so gave up.

2 years ago I was referred for more "CBT" as a result of an incident at work. This was supposed to be 12 sessions (cut down to 8), which consisted of
- writing down all my activities and rating my enjoyment (seriously tedious)
- writing down how anxious I got talking to people and saying Hello to people at work
- some brief notes about depression

That was it. Is that people's experience of CBT now?

[MyNameIsTerry]

I had mine over about 2 years ago. It consisted of about 12 sessions with 2 follow up reviews that were over a longer period.

Mine consisted of:
- describing my rituals & thoughts patterns attached to my OCD.
- discussing my work issues that were driving my anxiety (and my therapist even saying it was unlike I would recover whilst my employer was refusing to accept their role in my anxiety for us to move on and make reasonable adjustments which they also wouldn;t make!)
- lists of activities that I would like to do and rate them based on anxiety levels plus ways to achieve them in steps.
- activity monitoring diaries.
- some writing down of negative thoughts, some of this was done in session on whiteboards.
- loads of handouts on GAD, OCD, panic and depression.
- handouts for relaxation techniques & breathing techniques.

My therapist was very nice but I found the CBT model was not enough for me. A lot of my change was always going to be about behaviours and these take time, sadly longer than the sessions would allow for. I just carried on with the goals on the list afterwards but I think its time to revisit this now and start producing more within this structure to try and pull myself out of the rut I'm currently in.

[shyoldguy]

It sounds like you got more from your sessions than I did (albeit with 4 more sessions). My therapist seemed a bit more like he was following a script.

What really annoyed me was that the feedback questionaire was always done at the start of the session. If they had had my opinions on the 8th session after the therapist had told me it was to be the last one, the feedback would have been a lot more negative. And the fact at the end of the last session he glibly said I could now join a society.

Anyway, it sounds like both of us need something more. Shame politicians think that CBT is a cheap miracle cure.

[MyNameIsTerry]

He sounds a bit of a plonker.

I never had any feedback questionaire until after it finished.

The therapist was good, she was trying her best but it was doomed from the beginning with the number of sessions so I was just trying to get what I could from it so I could carry on afterwards.

I'm not convinced by CBT anyway. Its just that its popular as has clinical evidence to support it but so do other forms of psychotherapy that are only accessed at Level 4 but these are costly. Whilst therapy is aimed at inidividual needs they have placed CBT in as a generic form of treatment for all instead of assessing the true requirements of the patient. You have to advance through the NICE stepped care model in my area even if they determine from the start that you need to access the higher levels. Its just bureacracy.

The thing is, there are even cheaper solutions recommended by NICE such as using apps in individual non guided self help but unless you research your own treatment, you may never even know this. My GP has never mentioned it, I found it via reading NICE guidance and looking on the NHS Choices website.

There was an inquest into a guy who walked in front of a train near to me. He has been in anti depressants for 6 months without effect and he told his wife he wish he could make it all end in some way which scared her into taking him back to his GP. He was referred to the CPN's who told him because he scored his willingness to take that final action as a 3, he as low risk and had to wait 8 weeks for help. 10 days later he walked in front of a train. The coroner ruled they didn't do enough to prevent this. Its pretty obvious what the trigger was, being put in the queue. They could have offered him things like the online resources that might have tied him over. This is actually the health authority bordering mine and in the same county and for my area you can access Level 2 Guided Self Help via GP referral with a target of a 30 days wait.

Its just so inconsistent, I don't know why we call it NHS...the primary care trusts seem to do what they like anyway.

I joined this place to move forward and attended charity walk-in's and stopped seeing my GP after his remarks that I will find my way to getting better on my own.

[shyoldguy]

Sounds like the whole CBT thing is "one size fits all".

I'll look for the apps you mentioned and give them a try.

After the original CBT ended, I went back to my doctor, and eventually got referred to my local Mental Health. I'm not sure what approach this new is using, probably some form of CBT, but it does n't seem to be doing anything much for me. I've got about 8 more sessions left (I started in January). After that, I may try private therapy.

Hope you find some therapy soon.

[MrAndy]

I had one to one cbt 12 sessions and group based cbt 12 sessions.The group therapy really worked well for me,I came out every session smiling

[MyNameIsTerry]

The apps & computer based stuff are all on here http://www.nhs.uk/conditions/stress-...therapies.aspx

There are downloadable apps as well but these are not proven, they are only checked before being allowed on the website to ensure they will not cause harm. One in particular, which we are not allowed to discuss on this website, xxx, is worth avoiding.

I'm going more to everything Mindfulness really. It has helped my OCD far more than CBT ever did and it was my CBT therapist that recommended it. Look at MBCT by Professor Mark Williams which is now NICE approved for recurrent depression and I expect it will be in the next round of anxiety treatment reviews (there have only been 2 in the past I believe). He has 2 published books and his US counterpart, Jon Kabat-Zinn who created MBSR, created the method that MBCT evolved from.

[MyNameIsTerry]

The apps & computer based stuff are all on here http://www.nhs.uk/conditions/stress-...therapies.aspx

There are downloadable apps as well but these are not proven, they are only checked before being allowed on the website to ensure they will not cause harm. One in particular, which we are not allowed to discuss on this website, xxx, is worth avoiding.

I'm going more to everything Mindfulness really. It has helped my OCD far more than CBT ever did and it was my CBT therapist that recommended it. Look at MBCT by Professor Mark Williams which is now NICE approved for recurrent depression and I expect it will be in the next round of anxiety treatment reviews (there have only been 2 in the past I believe). He has 2 published books and his US counterpart, Jon Kabat-Zinn who created MBSR, created the method that MBCT evolved from.

Sorry about that mods, I didn't realise you were capturing the initials for that product.

shyoldguy - where it says 'xxx', its in reference to this http://www.nomorepanic.co.uk/showthread.php?t=152271

[anthrokid]

The thing with CBT is that it is a manualised therapy - there is a structure and a manual for therapists to follow. New therapists or those who are a little less familiar with CBT will generally give the feeling of 'reading from a script' because that's how some of them do it unfortunately. I guess every therapeutic approach has its pros and cons. For CBT, the pro is that it is manualised, and any person can really administer it with the correct manual, and it can be applied to everyone. However, this is also the con of CBT because it means that therapists with little mental health training can apply CBT and not be equipped to integrate other approaches if straight CBT doesn't work. And that is the benefit of seeing a psychologist over a 'therapist'. Psychologists also do CBT, but they also do extensive mental health training (same amount of study as a doctor) and can work from different frameworks and methods, whereas many therapists are trained in only one intervention/therapy and are unsure of how to help people who don't respond to that therapy. I'm not saying therapists are bad - they are fantastic at what they do - I'm just saying that what they do may not be suited to absolutely everyone.

[MyNameIsTerry]

I think that a very important point Anthrokid. I know from looking into how therapists can be qualified (counselling & therapy are unregulated so you can study online for 100hrs, get insurance and open a business. I could set my own practice up in 30-60 days if I wanted to and never have seen a client before or ever be supervised. There is a current Bill of Parliament in place to tackle this but I suspect it will fall well short and not tackle the unquallified and 'guru's' in the sector who hold client sessions) and found that the most reputable, the BACP, is a 2 year affair but it does include ongoing supervision and a minimum number of client hours. They do a foundation first which is going to cover psychology in general and different forms of intervention but not to the detail a psychologist would which I believe is 4 year for degree or a further 2+ for MSC.

Its then left up to the therapist to train in further disciplines but there is a key problem in the UK - CBT is the standard for everything. We have a stepped approach ranging from Levels 2-4 and its CBT all the way until you hit Level 4 which is when you access multi disciplined professional i.e. the psychologists. Level 4 is, and has tended to be, a minimum 12 months waiting list so these CBT levels came in the fill the gap. Sadly, GP's follow this approach to the letter so if you always needed Level 4, there is a goood chance you will have Level 2 & 3 first (my area works like this) or you may go straight into Level 3 (DeadManWalking seems to have had this) and these levels can add 6-12 months onto the process. So, even if they know CBT isn't the right form of therapy, you have to have it in some cases. I was assessed and told I needed Level 3 but told its was 'policy' for new patients to follow the Level 2 to Level 3 approach. Typical public sector thinking sadly.

I don't think the stepped care approach is a bad thing but I think it is being misinterpreted by some and abused by others to create waiting lists. I've read NICE guidance and its quite diverse and not really what I experienced or continue to so what many of us in the UK may be experiencing maybe due to poor governance.