CBT vs Psychotherapy??

[cece]

Hi davew and everyone else too.

I hope everyone is off to a good start this holiday season

[davew]

I can't even remember my holiday season, but I am very much looking forward to summer. Hope everyone else is too

[cece]

We tend to remember the bad more clearly than the good so I take that as a sign you had a nice holiday

[davew]

LOL, good point!

[cece]

I was totally serious when I said that

[yenool]

I know this is an old thread but it is an interesting discussion anyhow. I've had a couple of courses of CBT in the past but more recently I've been told I would benefit from long term psychotherapy, although I doubt I will be able to get it.

In my experience/opinion CBT is very good at teaching you how to recognise your thinking patterns and the emotional/behavioural responses to them. It is based on the belief that distorted thinking and negative automatic thoughts (NATS) lead to anxiety and behavioural responses that are not helpful. The basic theme is you learn to unpick your thoughts and restructure the negative ones into something more helpful and realistic. You are given exercises where you have to test out your beliefs by writing down what you expect before hand, expose yourself to the fearful situation and then evaluating what actually happened.

I had CBT about 8-9 years ago, combined with medication, it did help me get over very severe social anxiety and depression, get me back out of the house and functioning to a certain extent and I still use some of the skills today.

Like all talking therapies it does require a good therapist that you can bond with - some say this is less important with CBT than other forms of treatment but I don't believe this. I believe CBT will not work if you do not feel comfortable in disclosing the issues in the first place, and doing that is a very difficult and personal thing, especially for those with intrusive OCD style thoughts. CBT requires a significant amount of effort (e.g homework) and for that reason I'm not sure how good it is for those who are severely depressed and unmotivated - those people may first require some medication to bring their mood up to a level where they can cope with the demands of CBT.

There is a large evidence base for CBT but my issues with CBT are:

CBT is now seen as the panacea of mental health. It seems to be recommended for anything and everyone and the cynic in me feels this is not in the best interest of the patient, it is because it is a short-term treatment which is relatively cheap. It also places all the problems and responsibility on the patient - if you don't get better then often you are labelled as unmotivated or not emotionally intelligent enough to do CBT.

The whole basis of CBT is that your thoughts are 'wrong' and distorted, which is fine...... except for often people have negative thoughts because their social situation, health or life is genuinely crappy. Trying to restructure thoughts in that situation is patronising and no better than than reading one of those cheesy self-help books which tells you that you can achieve anything if only you "think positive".

I do not think CBT deals with underlying problems , it is more of a tool to deal with 1 or 2 major issues and deals with the 'top layer' only. It is like swallowing a painkiller for a tooth ache rather than addressing the root cause, it may numb the symptoms enough for you to get on with life but it is likely that at some point the pain will resurface. CBT is usually offered in about 6 to 16 sessions (normally at the shorter end of things) and so cannot really help complex multiple issues. I feel some of the methods taught can be counter-productive for certain issues; OCD, pure-O style intrusive thoughts and ruminating for example.

[harasgenster]

What kind of therapist are you seeing? If they are an integrative therapist they should be able to give you both. I would be surprised if, in your position, you had not been referred to an integrative therapist who could react and respond to your needs.

I feel like i'm becoming the poster girl for schema therapy on here now, but schema therapy combines psychotherapy and CBT together. I had it with DBT, which is indicated for BPD. I don't actually have BPD myself, but DBT is used for complex cases in general. I also had an eating disorder.

Personally, I have found CBT to be faster and more effective with behavioural issues - i.e. I'm agoraphobic and I want to go outside; I'm social phobic and I want to talk to people. It's been GREAT for that. For the root problems - i.e. identifying emotions (I was very emotionally closed-off) and finding out what has made me the way I am - what the really deep beliefs are - so that I can choose to challenge those beliefs has been the better long-term therapy for me. But everybody is different, so no one here can tell you what will be better.

I would definitely ask if you can have a CBT approach mixed with a psychotherapy approach, though, because then you get the best of both worlds!

[cece]

I do not think CBT deals with underlying problems , it is more of a tool to deal with 1 or 2 major issues and deals with the 'top layer' only. It is like swallowing a painkiller for a tooth ache rather than addressing the root cause, it may numb the symptoms enough for you to get on with life but it is likely that at some point the pain will resurface.

I would respectfully disagree with this part of your note. In my experience the way I was interpreting things was the major issue and all the crap I spent years (and lots of money) dealing with in talk therapy was the painkiller. The problem with talk therapy is that it makes you feel better but does not teach you any skills to get better. CBT helped me change the lenses I viewed everything through and I soon realized my jumping to conclusions and blowing things out of the proportion were the real underlying problem.

[davew]

I am in agreement with you Cece on this point. Now that I have learned to stop making the thinking errors that cause anxiety I rarely have problems anymore. CBT and the TEA forms have given me tools to turn my life around and I am soo grateful

[cece]

Good to hear and keep up the great work