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

  1. #1
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    Dec 2014
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    If CBT doesn't work for you... then what?

    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?

  2. #2
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    Re: If CBT doesn't work for you... then what?

    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.
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  3. #3
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    Re: If CBT doesn't work for you... then what?

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

  4. #4
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    Re: If CBT doesn't work for you... then what?

    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.

  5. #5
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    Re: If CBT doesn't work for you... then what?

    Quote Originally Posted by keta View Post
    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.
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  6. #6
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    Re: If CBT doesn't work for you... then what?

    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

  7. #7
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    Re: If CBT doesn't work for you... then what?

    Quote Originally Posted by MyNameIsTerry View Post
    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

  8. #8
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    Re: If CBT doesn't work for you... then what?

    Quote Originally Posted by keta View Post
    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
    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.
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  9. #9
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    Re: If CBT doesn't work for you... then what?

    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.
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  10. #10
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    Re: If CBT doesn't work for you... then what?

    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."

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