here are some summaries of and pointers to critical writings about CBT Cognitive behavioral therapy - Wikipedia .
CBT has been proven to change brain chemistry. Read some of the research and see if data doesn’t change your assumptions.
I wouldn’t waste your money if you’re going to go into it with your current attitude. IME therapy can very well do nothing at all, if you don’t put a ton of your own effort and time in outside the session and what your therapist can do for you. But I’ve seen it help many, many people who want to get better (including me).
I’m another one who’s pretty skeptical about it, even though I go to a cognitive behavioral therapist every couple of weeks. I find that the lyrics to a particular song(!) put me in a better mood than any therapist has ever been able to do. I suppose I haven’t really given the techniques a fair chance, but I haven’t been depressed in a few months and haven’t felt the need to try them. Welbutrin also seems to help quite a bit, and it doesn’t have any of the side effects that I’ve experienced with the other drugs I’ve tried.
Absolutely true. I sometimes tell myself there are only a few things you have to do - eat, sleep, breathe, and poop. The rest is optional.
Also true. You can think just about anything, but you don’t have to invest emotionally in them - you can disregard some of them for the nuisance thoughts they are.
I often recommend something like that for member of my anxiety support group, and they usually look at me like I’m crazy - like, “What are you talking about, accepting these lousy feelings?” Then I explain to them that accepting isn’t the same as liking; it’s just saying that, yup, that’s how I feel right now. I’ll feel different in the future.
There’s tons of good advice in this thread; give it an honest try, and see what you think.
What I got out of my CBT experience (that’s with the ‘rate your feelings about x,y, and z’ charts, right?), was a general impression of “if you blow smoke up your own ass often enough, and consistently enough, eventually you will believe your own bullshit. The path to happiness is through the valley of Ignoring Unpleasant Realities.”
But it’s possible that I just hated the therapist.
This!
And this:
OP implies that he hasn’t really tried CBT yet. I suppose you gotta try it yourself and see. As always, YMMV. Myself, contrary to so many of the above posts, I think it’s utter crap, hogwash, quackery; I could give a detailed argument about the abject ill-logic of it (in short, all those cognitive distortions you’re being told you believe whether you believe them or not, and why they’re basically idiotic anyway), but that must necessarily go to the BBQ PIT board, and I’m not really interested in going into it. Yes, I’ve looked into CBT myself somewhat. I think it’s the kind of stuff that only helps the kind of people that are helped by that kinds of stuff. If it seems to work well for a LOT of people – well, that’s because there’s a burgeoning industry of diagnosing depression and recommenting CBT in just the kind of people that CBT might be good for. Who know, OP, maybe you’re one of those. But I doubt it.
ETA: The basic idea of CBT seems to be, replace your harmful cognitive distortions that hurt you, with other cognitive distortions that you can feel touchy-feely good about yourself about. Convince yourself that you believe them, whether you believe them or not, even though they may be demonstrably bogus. Then go home, curl up and suck your thumb, and you’ll feel warm and comfy and just fine. It takes time and effort, but if you can do that, you’re cured!
Depression apparently can have multiple underlying sources, so talk therapy of one sort or another might be right for some people, and those poisonous witches-brew brain potions might be right for others. Or some combination thereof. There are plenty of meds besides Effexor (Venlafaxine) to try, nearly any of which are probably better (IMHO).
OP doesn’t say how his evaluation was done or what, particularly, were the results. Did the doc just sit and chit-chat with you until he thought he knew what’s up with you? Or did he give you some kind of formal exam, like one of those computer-scored questionnaires, the MMPI exam, or something like that? One problem with any psychological evaluation is it’s largely just a total crap-shoot what any doc will decide you have. Exact science, this ain’t. You can go through one diagnosis and useless therapy after another for most or all of your life before you come up with a diagnosis and therapy that works for you – if any.
I think your best bet is what Otara said: Try one doctor and therapy after another, giving each one a fair trial, until you find something that helps (which, to be honest, may or may not ever happen).
Disclaimer: I am not a doctor, shrink, psychologist, pharmacist, and damn sure not a touchy-feely CBT purveyor. I am not even a patient of any of the above any more. (They quickly determined that I’m beyond all hope and kicked me out.)
This isn’t particularly accurate. For example, you do not counter “I fuck up everything I do” with some touchy-feely nonsense like “I’m amazing and everything I do is great!”
You counter it with a more realistic “I don’t fuck up everything I do. For example, I managed to brush my teeth and tie my shoelaces today without doing any damage. Sure, maybe I fucked up this thing I did today. That sucks, but that’s no reason to say I fuck everything up.”
You wouldn’t replace “My best friend hates me” with “My best friend loves me and we are BBFF forever squee because I’m just a lovable great person.”
You replace it with “What is my evidence that my best friend hates me? She didn’t return my call? What are some other reasons she might not return my call? Well, maybe she is busy. The truth is that I don’t know if she hates me or not. Maybe next time I see her, I can ask her. In the meantime, getting into a funk over something I don’t actually have solid evidence for is a pretty lame way to spend the night.”
It’s not exceptionally rainbows and sunshines.
For example, when talking about relationships, it doesn’t give you a bunch of “Everyone will meet the right someone at the right time, and if you just believe in yourself and think positively your dreams will come true” hooey. For relationships, it often says “Hey, you’re alone and nobody of the opposite sex loves you in a sexual manner. That’s a bummer. So, what are you going to do with this? Cry yourself to sleep? Until this situation gets resolved, maybe you better figure out a plan to deal with being alone without losing your shit all the time.”
I’m new enough here on SDMB, I assume I can use words like “fuck” in this forum, because even sven does, as above. Here goes:
The counter-CBT distortions they shove onto the patient can be as realistic or bogus as takes to bamboozle the patient. A client may say, for example, “I can’t do a damn thing right” when he actually means “I fucked up EVERY attempt to get a girlfriend in the last 30 years” and the CBT response will be: You don’t fuck up EVERYTHING. Give yourself some credit. You can tie your shoes, can’t you? You can brush your teeth, can’t you? Don’t give me this ‘I can’t do anything right’ BS." None of which addresses the client’s actual problem.
Then they will say, “No, you don’t fuck up EVERY attempt. That’s just one of those absolute over-generalizations. You may fuck up many attempts, but you can’t f-u EVERY time.” Okay, the client admits, I did manage to get 3 dates from Craigslist in the last 20 years, but they all went exactly nowhere instantly. CBT: See? You aren’t a total failure like you think after all!
Client: Okay, I’ll drop my exaggerated “EVERY time” absolutism and acknowledge that I got three dates (lousy ones, but I know you’ll jump on me if I say that) that went nowhere in the past 20 years. Fat lot of good that does me. What is my cognitive distortion now? It is factually true that I only had 3 dates in 20 years and they all went nowhere. It’s stupid of CBT to suggest that I should start thinking that, because I actually had 3 dates in 20 years rather than none, that I really don’t have the problem that I’ve spent 20 years thinking I had, namely that I can’t get dates, let alone good ones.
CBT: SEE? So you admit you can get dates. Now what are you going to do to get more and better dates?
Client: I haven’t figured that out in 20 years, and I haven’t got any more of a clue now than ever! And don’t give me this shit that 3 dates in 20 years is something to crow about!
CBT: Well, you had some success with Craigslist…
Client: Fuck Craigslist! We’ve seen for 20 years how well that’s worked! You got any better ideas? And yes, BTW, I brushed my teeth before going those 3 dates.
Note, at this point, we’ve come down to just what even sven suggested: “Hey, you’re alone and nobody of the opposite sex loves you in a sexual manner. That’s a bummer. So, what are you going to do with this? Cry yourself to sleep? Until this situation gets resolved, maybe you better figure out a plan to deal with being alone without losing your shit all the time.” Okay, we understand that crying oneself to sleep isn’t going to get anywhere. So what to do instead, dammit? It’s a non-constructive suggestion that doesn’t show the way to a more effective course of action.
Client: I’m going to go home and spend every night till 4 or 5 or 6 in the morning on SDMB, that’s what. Just don’t tell me that the response to fucking up every attempt to get a date (or a job) doesn’t mean I’m a total fuck-up, just because I can tie my shoes and brush my teeth.
Yes, I’ve sat in CBT group sessions (don’t even get me started on the problems with group sessions) and they say things like that.
I think one problem is that when CBT is discussed online, it tends to focus on the cognitive aspects, and generally the older ideas at that, ie Beck or Ellis type interventions. The focus now is often not necessarily on ‘illogical thinking’ alone, but on a variety of interventions, eg improving sleep routines, exercise, ways to reduce overbreathing, activity schedules, exposure routines, social activities, pain management, practising previously enjoyable activities, social skill acquisition etc.
What you’re describing would not be CBT in my view, in that its contesting ideas which is more cognitive therapy alone, rather than the more systematic interventions suggested for diagnoses now. Theres also a greater tendency to have a particular package of interventions for a given diagnosis rather than just using it as a ‘one size fits all’ therapy.
I agree that it shouldnt be viewed as some infallible intervention that will work for everyone, and of course any intervention carried out poorly is going to have a reduced chance of success.
Otara
My therapist specializes in CBT, but she also relies on other approaches. Whenever she steps into CBT lingo, I know it and fight against it. It just doesn’t work on me.
I’ll say something about my feelings in a particular situation and she’ll say, “I want you to try on a sentence. ‘I do not like when <fill in the blank> happens.’” Uh…okay? And then she’ll ask if that fits. Sometimes it’s yes, sometimes it’s no. Either way, I do not find such exercises especially revelatory. I have no problem identifying things I don’t like. Things I DO like…that’s the hard problem!
She says I shouldn’t “should” on myself. OK. So why does she turn around and say, “Well, I think you need to…” That’s the exact same thing!
I don’t think CBT works on all types of depression. I think there’s endogenous depression that can be treated with medication, experiential depression that develops because of trauma, and then a mix of those. Then I think some people have depressive personalities…they have deeply entrenched cynicism that nothing short of brainwashing will eliminate. There are people that have problems relating to and with the world–perhaps because of a different mental disorder–and develop depressive tendencies (like emotional and social withdrawal, feelings of hopelessness), but are not actually clinically depressed. I don’t know exactly what I have. I have responded somewhat to drugs, but not completely and not without unpleasant side-effects. I have responded to other approaches in psychotherapy, like simply being able to talk and have someone help me to understand my emotions and what’s generating them. But CBT doesn’t work on me because my thoughts aren’t–IMHO–screwed up. I don’t have irrational fears or dislikes. I just don’t feel anything and I’m tired of life because of it. How does CBT help with that?
My therapist is starting on acceptance stuff (don’t know if it is formally called ACT). “You have to stop having expections and just live for the moment!” I do live for the moment and that is the DAMN PROBLEM. I want to be able to see tomorrow and be hopeful about it. I don’t want to accept that my problems are intractable, might as well get used to it. It renders all of the stuff I have done with her useless because it has all been about change and self-improvement. It’s like she’s telling me I might as well just surrender. That’s like saying I should put the noose around my neck now, because that’s the demon I’ve been fighting against. To me, it’s like she’s admitted there’s nothing more she can do for me. And it’s also like, “You see all those happy, smiley people out in the window? Yeah, well, forget about being like them or me. Take pleasure in your pain because you’ll grow from it.” Total bullcrap. The only thing I’ve grown into as a mentally ill adult is more eccentric and more confused. If I can’t take pleasure in something as simple as food, how in the hell am I going to take pleasure in pain? If I haven’t grown from enduring what I have endured, then do I have to lop off a limb or something? My life isn’t hell or anything…but life should be more than enduring. I know about enduring and that’s, I think, part of the problem. Enduring but not enjoying. If that’s all she can offer me is a lesson on endurance, well, I don’t need that. I can teach HER a thing or two on enduring for the sake of enduring.
It’s worse than woo. It’s “I don’t know what else to tell you, so I’m going to come up with this pseudo-spiritual Buddhist crap and make you feel like you simply haven’t endured enough psychic pain and that’s WHY you’re can’t feel pleasure. Surrender to the pain, learn to endure it and live with it. Don’t try to change it. This I believe…even though last week I said you’re sick and that you can’t give up trying to get better.”
I’m so confused.
But I wouldn’t give up on therapy. I’ve been in it awhile and it has had its ups and downs, but overall, I think it has made me better. I interact better with others, I’m not so hard on myself or other people, and I have someone to talk to who I wouldn’t normally have. I also have someone to keep me from falling to pieces. So there’s nothing wrong with going to therapy and avoiding a specific approach, if you think that approach is bullshit. I think psychodynamic stuff is bullshit so I avoided it. But others swear by it. Everyone is different.
(The good thing about my particular therapist is that I can tell her all that shit she told me is crap and we can have a good debate about it. I already pointed out one criticism about that “don’t change a thing about yourself!” It assumes that everyone is fundamentally good and that no one is hurting anyone else. She conceded that I was correct and that the philosophy doesn’t address the existence of mean and bad people. So maybe next week I will point out other holes and she’ll realize that that stuff is a pile o shit that doesn’t belong in a doctor’s office. If she thinks people with problems should just suck it and deal, then she should just say so and not take their money for uppity-up years, filling their heads up with hope that she doesn’t believe in.)
CBT isn’t magic. It won’t get you a hot girlfriend or improve your golf swing.
But I was amazed by how useful it was to tone down my inner dialogue from “Everything sucks. I can’t do anything right. I’m a huge loser” to “Some things are really tough. I’ve made a few mistakes. I guess that makes me human.”
My point above is that it’s not about replacing “bad” thoughts with meaningless cheer. It’s about taking interpretations of the world that are ultimately inaccurate, useless and upsetting (“Ill never be loved”) and finding an interpretation that is a better reflection of the world, is more useful in dealing with life, and causes you less pain (“I’m not loved now. Maybe I will be in the future. There are things I can do to make this more likely.”) CBT allows you to be cynical, bitter, angry, and sad- just make sure you are actually tying these responses to something real, not just letting negative emotions feed negative emotions and spiral out of control.
Then again, what do I know? I’ve never actually done formal CBT therapy, so maybe the therapists are a bunch of dips. My experience is that I basically read Feeling Good, and a decades long often-severe depressions (and yes, it was the real thing, not just a bad day) disappeared forever in a couple of weeks.
Knowing that feeling terrified when I’m tied up is irrational if the tie-up happens to be a safety harness does not make the fear go away - but it allowed me to visit the caves in Barrahonda, which was one of the touristy high points of my Costa Rican job.
You can’t control how you feel but most of the time you can control whether you run away yelling or not.
A couple of points. It’s true that CBT has not been shown to be effective for some specific issues - schizophrenia, bipolar disorder and anorexia, to name a few. monstro IIRC you have a personality disorder and that’s a whole different kettle of fish, so I’m not surprised that you find CBT doesn’t help you (although there is a form of CBT, dialectical behavioral therapy, which works very well for borderline personality disorder.)
That said… let me tell you about me. When I was in college I had severe PTSD, reccurrent major depressive disorder, and had been diagnosed with a handful of anxiety disorders on top of that. Not to go too much into my past, but I had a LOT of trauma to deal with. I wasn’t going to class, almost lost my job at the school cafeteria and found myself hospitalized and had to withdraw from school. I wasn’t doing much of anything but sleeping through the day, struggling just to shower or brush my teeth.
After six years of psychodynamic therapy and thirteen medications, none of which really made a tremendous difference and most of which made me sick, my husband (then-boyfriend), who is a student of clinical psychology, begged me to try CBT. He said he would pay for it.
I asked my therapist about it. She gave me the usual critique of CBT: "You have such a long history of trauma and CBT really isn’t for these complex issues and I don’t really think it’s going to help you because human psychology is sooooo complicated…’’
I said, whatever, I want to do this. Obviously talking about my problems and ‘’‘woe is me’’ isn’t doing a damn bit of good. So I went to my first CBT therapist, and right off the bat we decided to try exposure therapy to help me manage my anxiety. What was the target? A fear of heights.
Think about this for a moment. Severely traumatized, anxiety and depression ridden girl who can barely drag herself out of bed every morning is going to do therapy for a fear of heights. But I really wanted to go to Mexico and the only way of getting there was to ride in a plane.
Three months of exposure therapy for a fear of heights radically altered my life. Because I learned pretty quickly that those techniques for fear of heights apply to basically any kind of fear. I graduated college. Then I went to Mexico. I did really courageous things there. And after Mexico, I got a job. And then I got a promotion. And then I rocked the face off of two years of grad school and got my master’s degree. Then I did exposure again - this time for PTSD. Two years ago I did the exposure therapy and the PTSD is at about 10%-30% of its former severity. In some ways I don’t even have it anymore. I don’t even freak out at loud or strange noises. I can sleep at night without worrying someone’s going to break in. That constant cloud of persistent terror is just gone.
I still suffer depression and generalized anxiety - we are pretty sure at this point that it’s a genetic condition and not PTSD-related. I’m pretty much stuck with it - which is why ACT has been so helpful in getting me to accept that. But I’m living my life, and enjoying it anyway.
So I am not going to sit there and listen to some daft psychodynamic quack tell me that CBT doesn’t really *understand *me. I busted my ass for six fucking years of my life and put my trust in those therapists, and they betrayed me by keeping me from the treatment I really needed. I’m sick and fucking tired of listening to critiques such as those in the wikipedia article that basically use outdated data and pull arguments out of their ass and clearly have no concept what CBT actually is. Fuck them for prioritizing their pet discipline over the science of helping people. You’re damn right I’m bitter.
I’m pleasantly surprised by the number of responses I’ve had. All of your experiences and advice have been interesting and helpful. In particular, even sven, your explanations have been very helpful.
You have clarified one of the assumptions I had, which is that the aim of CBT is to brainwash you into thinking that your life is wonderful.
However, from what everybody says, it seems that although CBT helps you to deal with negative thoughts and feelings, it doesn’t actually help you to make positive changes to your life…? That’s the main problem I had with counselling: the counsellor was keen to talk about my childhood and discuss events in my past, but didn’t offer any support or advice to help me make my future better.
It’s definitely not brainwashing, but consider this: If it was, so what? Likely the negative messages that you’ve been sending to yourself are the result of brainwashing too. If you had a choice between brainwashing to make you feel bad about your life and brainwashing to feel good about your life – and neither is an accurate reflection of reality – which would you choose?
Well, it does and it doesn’t. If you can learn to deal with negative thoughts and feelings better, then you’ll be better *able *to make positive changes to your life. But exactly what those changes might be is kind of up to you.
For instance, if you’re constantly telling yourself, “I’m a screwup and I suck at everything I do,” then you’re unlikely to a) attempt to do anything that might improve your life, and b) succeed at anything you do attempt. CBT can help encourage you to try things, and if you fail, to keep trying. It can also help you more accurately assess when it’s worthwhile to keep trying, and when it’s better to change tactics, or try something else.
Also, it can help you identify and alter negative behavior patterns that are actively making your life worse. For example, if you deal with anxiety by binging on crappy food, you end up making yourself feel worse, both physically and mentally. CBT can help you break that habit, and create a new one that will actually make you feel better, like going for a run, or watching TV, or something. Or if you’re fighting with your spouse a lot, it can help you figure out why that’s happening, and how you can approach those situations differently.
Basically, it can help you navigate life better in general, by just being more aware of, and in control of, your thoughts and feelings. You can improve your relationships with other people, your decision-making skills, your attention span, and so on.
But yeah, if you feel like you’re stuck in a crap job, or don’t like the people you’re dating, or can’t decide whether you should move and if so, where to, then, no. CBT, and therapy in general, shouldn’t be offering you specific suggestions about what to do with your life, or how to go about living it.
Is that kind of what you’re talking about?
Also, it’s worth noting (or reiterating, I guess), that CBT is not terribly interested in your past, especially your childhood, except in how it influences your current thinking, and even then, it doesn’t really matter. If you were picked on as a kid, you might have developed an irrationally negative opinion of yourself, and think “Everyone hates me.” In CBT, you’d learn to recognize, “I only feel that way because I was picked on in school, and I see now that even then, there were plenty of people who liked me.” Or perhaps you’d go in another direction entirely, in which the reason you feel this way isn’t relevant, like, “Well, I suppose it’s possible everyone *does *hate me. But I’ve done nothing to cause that, and so I obviously can’t control it, so there’s no point in worrying about it.” And then you go and live your life instead of being paralyzed by this worry.
I wanted to second this. In one of the books I read about anxiety recovery, it was compared to stopping smoking; CBT isn’t particularly interested in why you started smoking in the first place, but your current habit of smoking and what you can do to become a non-smoker.
Senegoid, I don’t think you have a very good grasp on what CBT is and what it hopes to achieve. The goal is to get you to stop lying to yourself and misdirecting your own thoughts, not to replace them with other lies. Maybe you haven’t been getting a lot of dates because you are a negative, unpleasant person; it is valuable to discover that, so you can work on becoming more positive and pleasant, not to blow smoke up your ass and tell you that you’re a wonderful catch and any girl would be lucky to have you (as a hypothetical - not saying any of these things pertain to you). You can’t deal effectively with the problems in your life if you aren’t even aware of or acknowledge what those problems are, and your cognitive distortions keep you from seeing what is really going on.
As I mentioned earlier, I volunteer with an anxiety support group, and we would not have kicked you out as being beyond all hope - there are very few people who wouldn’t benefit from easing up on their distorted thinking patterns. It sounds like you had a bad experience with a not-very-good group.
CBT is very different than the sort of traditional psychoanalytic ‘‘tell me about your childhood’’ therapy you’re describing. I did a lot of that sort, and IME it’s not very structured and you don’t really get a lot of feedback from the therapist. It’s predicated on the belief that if you can figure out the root cause of a problem (Mom was abusive, or whatever) then that problem will have less power over your life. There is a heavy emphasis on '‘insight’ with the therapist guiding the client but not directing them per se. Well, I am pretty damned insightful about my own life, but I have not personally found that to be very helpful. In fact, I found the more deeply we delved into all these root issues of my past, the worse I felt and the less I was living in the present moment.
CBT isn’t like that. You aren’t going to spend your time telling sad stories about your childhood while your therapist nods and asks probing questions about your tragic history while writing copious notes. It might come up, if it’s relevant to the present moment, but basically it’s about looking at what problems you’re dealing with right now. It’s highly structured - and by highly structured I mean there will be charts, and homework, and hierarchies, and a LOT of therapist feedback. And yes, absolutely you can learn to make positive changes in your life. A good CBT therapist should include some element of behavioral activation that involves teaching you to respond to old scenarios in alternative and healthier ways.
Five years ago, my mother died due to rather unusual circumstances. My father and I had some anger associated with her death. I went to a therapist and continued seeing her for several months. My dad, however, was like you: thought therapy was bullshit, went once after enough people nagged him to do it, and quit going after one session.
My dad had certain things that he needed to get off his chest, so he ended up saying them to me one day about eight months later. The stuff he told me, to be honest, is stuff a daughter doesn’t want to hear regarding her father’s feelings towards his recently deceased wife.
I am not the only person who has had to serve as an emotional pillar to someone who wanted emotional support but refused to see a therapist. I have seen friends of mine get pretty depressed and miserable themselves because someone close to them was refusing to get the help he/she needed.
The reason I told this story? Going to see a therapist may help you in preserving healthy relationships with the other people in your life.
Also, just in case you’re wondering what therapy’s like, I personally thought it was kind of fun to spend a whole hour talking about myself.
Not really… at least in my experience (and apparently even sven’s based on her comments), the essence of CBT is more in the ability to interrupt your automatic thoughts and assess them, instead of the replacement.
In some cases, you replace the language in the internal dialogue, and in others, the mere interruption of that thought cycle is enough to assess it, realize that you’re being irrational, and stop that particular thought.
It’s almost like learning how to put watches and breakpoints in your own mental code execution (for the programmers out there)- you can more or less see what’s going on in your own thoughts, and come up with a more realistic or less harsh way of thinking about it. It doesn’t really change the way you think about things or make you think black is white, but if you’re in the habit of mis-assessing risk or the gravity of things, it can cause you to more realistically assess matters.