Is there any point in going to therapy if you don't believe it will work?

In My Humble Opinion
1

By way of background, I suffer from fairly severe depression and moderate social anxiety. I’m under the care of my GP, and am taking 225mg Venlafaxine. I have attended counselling in the past, which I found worthless (except for a feeling of relief that each session was over), and have done some of the exercises on the “Mind Gym” website, which I found ridiculous (it reminded me a lot of the “Fear or Love” lesson in Donnie Darko).

I had a psychiatric assessment last week, and they recommended that I attend CBT sessions.

The problem is, I just don’t believe in therapy. (I believe that depression is a medical illness, caused by an imbalance in chemicals, so it needs a medical cure; if you can be “cured” by talking, then you were never depressed in the first place, you were just sad about something. I also have a strongly biased opinion that therapy is touchy-feely hippy nonsense, like homeopathy or acupuncture.)

In particular, CBT seems like nonsense to me. It seems to work on the assumption that negative emotions are based on some sort of faulty logic. But if I find myself in a crowd or talking to a stranger, there’s no logic going on, there’s no thought process at all, except for “ARGH!”. There’s no “why” behind it: I’m scared because I find these things scary!

So, is there any point in me going to these sessions, if I’m inevitably going to go in with a negative attitude? In my opinion, it’s like hypnosis, where it will only work if you believe it’s going to work.

I imagine that a lot of you will have had positive experiences with therapy. But in particular, I’m looking to hear from those of you who thought (or still do think) that therapy is nonsense.

2

CBT is the polar opposite of nonsense. It is the single most clinically proven treatment for depression and anxiety. There is no form of therapy with more evidence to support its efficacy. Nothing it teaches is inconsistent with the notion of a chemical problem in the brain. It is predicated on the notion that your thoughts impact your behavior which in turn impact your thoughts and so on. What do you do when you think, ‘‘ARGH?!!’’ If you’re like me, you think ‘‘I have to get the hell out of here,’’ and leave. BAM! Faulty logic. Chances are you aren’t even aware of your thoughts, because you haven’t been trained to pay attention to what you’re doing in those circumstances. A good therapist will teach you how to notice and learn, as a beloved doper likes to put it, ‘‘to call yourself on your own B.S.’’

You don’t have to believe it will work in order for it to work, though it certainly helps. As long as you commit to doing it anyway, there should be no problem.

Full disclosure: I am not skeptical of CBT but I spent years doing other crap treatments with no evidence of efficacy and felt completely betrayed by the psychological community. Since moving toward evidence-based treatments for depression and anxiety I have seen significant improvement in my symptoms.

3

**I’m not sure what to tell you.

Factually, you are wrong. Study after study shows that CBT is one of our best tools against depression and anxiety. For a large percentage of people, it works better than anything else.

You don’t have to give up the idea that depression is bio-chemical in nature. Of course it is. Depression is just thoughts, and thoughts are nothing more than bio-chemical reactions. The trick here is that by influencing your thoughts, you can influence your bio-chemistry. The process works by definition- creating thoughts creates thoughts. Creating different bio-chemical reactions in your brain creates different biochemical reactions in your brain. Actions create thoughts, which create reactions, which create thoughts, which creates actions, and so on.

This isn’t some kind of “touchy feely” bullshit. Not involving pills doesn’t make it somehow not scientific. For example, type 2 diabetes is absolutely a biochemical imbalance. The best way to control it, however, is through diet and physical activity. Any number of very real, very physical problems can be managed by consciously manipulating your body. When I screw up my knee, I work on the muscles surrounding it. When a kid has a lazy eye, they wear an eyepatch to adjust it. When someone has a stroke, they engage in rehabilitative therapy to rewire the brain. When you move to a high altitude, your life sucks until your body adjusts to the thin air.

Why would your brain be any different? CBT is a medical solution. It is changing the imbalances in your brain. Just because it does that through inducing your body to change its chemistry doesn’t make it less valid than doing the same thing via a pill.

If you think about it, your view is the one that is less scientific. You find talking to strangers scary because it is scary. What is that fear? It’s a bio-chemical reaction, right? With CBT, you can retrain your brain to produce a different bio-chemical reaction. It’s not about calling you out for faulty logic. It’s about taking the less-helpful pathways your brain tends towards now and teaching it to automatically take better, more helpful pathways.

4

That said, I don’t think therapy of any sort- be it medicine or therapy- is useful for people who are not ready to give up their depression.

Sometimes people become so identified with their depression that they are unwilling to embrace change. There is nothing a doctor or anyone else can do about that. If you are determined to be depressed, you will find a way to succeed no matter what they pump in to you.

5

I think that the OP is correct in that if you go in thinking “This is BS and it’s never going to work”, then it will never work. You have to put some effort into it, and yes, a little blind faith will help a lot.

6

Here’s the thing:

Depression is a medical illness, caused by an imbalance in chemicals. But that imbalance is not static. Those chemicals are not churned out by your body at a steady rate. And one of the most important things that can affect whether your body produces various chemicals (and what kinds, and how much, and how fast, and under what circumstances) is what happens in your mind. Simple, obvious examples: You see a bear, and you produce adrenaline. Someone attractive flirts with you, and you produce oxytocin.

So, for many, many people, one of the things that can help them achieve the right balance of chemicals, whether in addition to or instead of medicine and other treatments, is training their mind to react the right way. If you see a bear, but your mind also knows, “I’m in a zoo, he’s enclosed and can’t get to me, and he’s kind of cute!”, then you won’t produce adrenaline. If someone attractive flirts with you, but your mind also knows, “I’ve dated this loser and have no interest in getting back together,” then you won’t produce oxytocin. So likewise, if you find yourself in a crowd, but you can teach your mind to remember, “I’ve been in crowds a million times, and nothing bad has ever happened, and it’s actually kind of fun to people-watch,” then you won’t produce (or will produce, if you’re lacking them) whatever chemicals are causing you problems.

I’ve had depression, and I’ve had CBT-style therapy (I don’t know if it was technically CBT). There were times when the therapy alone was not enough, and I also needed medication. But even then, I did much better with therapy than without it.

As olives said, CBT is highly evidence-based and straightforward. There is no touchy-feely hippie anything about it; in fact, one criticism I’ve heard (which I don’t personally agree with) is that it’s too scientific and and logical. And I suppose you don’t have to believe in it for it to work, but I think if you don’t, you probably won’t do the work. You won’t consider whether your emotional reactions and thought patterns make sense; you’ll just throw up your hands and say, “I can’t control how I feel or what I think!” But the fact is, you probably can, to a great degree, and CBT can show you ways to do that.

7

Don’t write off the whole concept of therapy - think of it as something to look into and see which type might suit, if any. A bit like anti-depressants, I suppose.

CBT is useful for the therapy-averse, IMHO, as it doesn’t tend to involve the long periods of dissection of past history, talking in circles, and intensive woo-woo that a lot of people struggle with in less structured therapy.

I say this as a practising therapist of the more woo-woo variety :slight_smile: though I do incorporate a lot of CBT techniques, particularly when working with depression and anxiety.

8

Thanks for all the feedback so far. It’s certainly raised some interesting points, and it’s given me a lot to think about.

I’m don’t understand where the fault is…?

I do think there is an element of that, there’s a worry that I wouldn’t be “me” any more.

This is what I think at the moment. I don’t understand how emotions can be controlled, or how acknowledging that certain thoughts are irrational will stop you from experiencing those thoughts.

9

Maybe part of the usefulness of the therapy is to help an unbiased observer judge how your medication is working. I agree that depression is a chemical problem but how would anyone know the extent of the problem and the effects of treatment without regular communication?

10

Think about any action you do without thinking.

Chances are, you read without really sounding the words out, right? You just look at the word and BOOM the idea is in your brain. That’s like your reaction to strangers- you see the stranger, and immediately the emotion of fear shows up in your brain. But like reading, there is an intermediary process that the initial stimulation (word/stranger) goes through before it gets to our brains. This is where there is room to intervene.

Have you ever had a word that you one day notice isn’t what you thought it was? Like when you hear a word pronounced, and realize it’s a word you’ve been reading for years without ever pronouncing it, even in your head? For me it was “ostensibly”. I, for some reason, always read it as “ostentatiously.” It wasn’t until I was like 25 and misused it in a sentence that I realized that for so many years, I had been reading things the wrong way without even noticing it.

This is what can happen to thought patterns in your brain. You can end up with a weird, totally automatic thought process without even realizing that it’s off.

And just like I now no longer mess up “ostensibly,” simply recognizing the problem can do a lot towards fixing it. For a while I had to pay better attention whenever I got around a word that started with “ost…” but after some time, recognizing the right word became automatic. With CBT, you learn to discover the patterns behind your less useful thoughts, so that you can defuse them before they trigger the emotions. Eventually, it becomes second nature.

11

I don’t know if you’re kidding or not, but the fault in the logic is that you do not actually have to leave. You could stay. When you leave, you reinforce in your mind that that’s the only way you can handle that situation. It’s not.

It’s like anything else you learn; it takes lots of repetition and practice until it becomes a new habit. When you first learn how multiplication works, it might make perfect sense, but you still have to work out each problem. You can be shown that 6 X 12 = 72 and acknowledge that this is true, but you don’t *know *it yet. You have to memorize the multiplication tables in order to be able to give the answer without figuring it out all over again each time. This is the same. You can acknowledge that certain thoughts are irrational, but you won’t stop experiencing them until you basically memorize that fact.

12

If it’s been recommended you should keep an open mind and give it a try. Doing anything different may help you, like just taking walks in the park if you don’t do that already. So the therapy isn’t going to hurt you, and if nothing else will give you something different to do. And maybe it will help. And whether it does or it doesn’t, you can still look for other solutions to your problems.

13

It sounds to me like a faulty computer that writes faulty software. You can replace the hardware, but the software still needs to be fixed. (Where a hardware fix is meds and a software fix is therapy.)

Is that a reasonable analogy?

14

You sound like the perfect candidate for CBT to me. Someone who doesn’t want a touchy-feely approach and prefers to reason things out should do well with a CBT model. Right now you may not be able to see the faulty thoughts that are influencing you, but the therapist should be able to help you see them more clearly and teach you new ways to deal with these thoughts that you can practice until they become second nature.

15

I’m another person who will say the combo of meds and CBT type therapy completely changed my life. And btw - my biggest fear was also that I would lose too much of what made me, me. But, I’ve found out that a happy me is awesome, and that I didn’t lose who I am at all.

On thing my therapist kept saying to me - I spent 30 years of my life having negative thoughts about everything. Even if the meds fix the chemical problem, I’ve now developed a 30 year habit in the way I think. I need to break habits, and create new ones. That is where the therapy helped me - our talks and his techniques made me stop and really evaluate my thought processes, reactions, etc. It sounds so simple, but once I started really forcing myself, I realized that all these years I’ve just been reacting and not really thinking about why, or thinking if things were logical, etc.

Personally, I don’t think either meds or therapy alone would have helped me. Therapy gave me the realization and techniques to change my thought processes and the medication made making those changes possible.

Finally, another way to think about it - I used to drink way too much, as self medication. That became very clear. I no longer drink to medicate - but I am finding it very difficult to break the habit of drinking. When you went home every day and got drunk, suddenly not doing that is difficult, even if you don’t need to. I’m still fighting that battle in fact.

16

There is scientific evidence for changes in fMRIs of people after they’ve had CBT. CBT can change something on the brain hardware level.

I worried about this, and it kept me from seeking treatment for depression for many years. It didn’t happen. I did not become a disgustingly cheerful and non-cynical person when my depression was treated.

It doesn’t. What it does do is teach you ways to keep from paying more attention to those irrational thoughts than you need to.

An example: the moon looks bigger when it is on the horizon than when it is overhead. (We’re not sure exactly why this is, but we all agree that it does happen) Let’s say you go out one night and see the moon near the horizon, and it looks bigger and closer than normal. But you don’t freak out and start thinking the moon is going to hit the Earth. You maybe remark on how big the moon looks tonight, and then get on with your life. The idea, at least with some kinds of therapy, is to react to your depressed or anxious thoughts the same way.

17

In my case, I know that CBT did not ‘fix’ my depression/social anxiety, but it did help me learn how to recognize certain things that made me feel better or worse as well as how to adjust my life to minimize the stressors.

For instance, I hate phones. I hate when they ring, I hate having to answer them, I hate having to call other people on them. I didn’t realize how something so mundane added to my stress level. My therapist was able to make the connection after a few sessions, point it out to me, then help me find ways to minimize my ‘phone fear’. I ditched my cell phone, my phone doesn’t ring, the machine takes all the calls, I e-mail and IM as much as possible. I feel so much better without waiting for the dreaded evil phone to ring and send me up the fucking wall.

18

I don’t know about hypnosis, but CBT will work even if you don’t think it will, as long as you do the exercises. I have had the experience of being very anxious and saying, “I might as well do the CBT exercises to see what happens,” only to realize after doing them that my anxiety has lessened dramatically. It is not about “thinking yourself happy” or telling yourself how to feel. It’s about going through a specific set of steps that can cause physical changes in your reactions. I had gone through other types of therapy with limited success, so while I was open to CBT, I didn’t have much faith in it. I was quite surprised by how well it worked.

19

As Heart of Dorkness explained, you don’t have to leave. It might seem like a minor point but those little words -* have to, should, shouldn’t, will never, will always* - extremely powerful master manipulators of the mind.

Acknowledging that certain thoughts are irrational will not stop you from experiencing those thoughts. It will stop you from investing yourself in them. You will see that they are only one of a variety of possible ways of looking at the situation. That will affect how you respond emotionally to the thoughts. Likewise, when you have emotions, you will notice how your thoughts are influenced. You will come to see emotion for what it is - a temporary bodily sensation that comes and goes. Eventually your whole thought-emotion-behavior complex will be rewired and you will better be able to cope with the challenges you have in life.

I love CBT and it has helped me a lot, but there is a specific form of it - Acceptance and Commitment Therapy (ACT) which has been making a big difference for me. Instead of arguing with your ‘‘irrational’’ thoughts, you just treat all thoughts the same, and acknowledge that they may or may not be true. It’s a little different than the traditional method of picking apart your thoughts. You just learn not to invest yourself in any of them, whether they seem convincing or not. You accept that depression and anxiety just happen, and learn to live your life fully despite the inevitable pain of uncomfortable feelings, thoughts, and emotions. I strongly recommend ACT for anyone suffering with a chronic health condition - it really has made a difference for me as a chronic sufferer of severe depression.

As for social anxiety, I too suffer and have made great strides there as well. IMO the best treatment is exposure therapy, another form of CBT, and is probably one of the easiest disorders to treat. That’s what makes me so sad about people who don’t get the psychological help they need. Some of the things you suffer with can be successfully treated in a matter of weeks. How many more years of your life are you going to suffer before you at least give it a shot?

And yes, you might change. Is that so bad? You’ll be able to live the life you want to live, instead of a life that is mastered by fear and misery. That’s good change.

20

It would be a bit rough if psychologists expected people with depression to turn up feeling optimistic about treatment, given that pessimism about improvement is a common part of depression. Particularly if you’ve tried counselling before and it wasnt much help.

CBT isnt the only option for depression, Interpersonal therapy or IPT is another method with a good track record.

The main thing will be to do your best to actually try the interventions suggested, because one aspect of depression is that it tends to predict something will be a failure, and to find it hard to notice change so its not even attempted or stopped early. An important part of CBT is giving you tools to see if progress is occurring, which is why using charts or the like are a common part of the therapy.

This is a common issue with all interventions including antidepressants, I cant tell you how many people Ive seen who stopped taking them inside a week because they ‘werent doing anything’.

Ive seen moodgym often recommended, but I have found it pretty dry when I checked it out myself to see if it was worth recommending, so Im not surprised you didnt get much out of it.

And finally, like antidepressants or other medical interventions, it may take a few tries to find the particular intervention/practitioner best for you. I generally suggest 4 sessions then changing if you feel like theres nothing happening or you dont feel like you have a good sense of whats being attempted yet. Many people worry that people give up too early in therapy, my experience has been more that people too often stick with a therapist who isnt providing much value for them.