Actually, that’s the most convincing reason I’ve heard so far…
It is a big thing. I strained my relationship with my best friend by dumping my problems on her. What made it worse was that some of those problems involved her, so I had to be careful what I said and keep those locked up. Even just going to a usual touchy-feely therapist for a few sessions helped at that point, because I could get that stuff out to a disinterested third party.
Just because something won’t fix the underlying cause of a dysfunction doesn’t mean it’s not a valid treatment for the condition. Claritin isn’t going to cure my allergies, but it would be pretty dumb of me to reject it on those grounds and sit around dripping snot and feeling like shit 6 months of the year. Insulin isn’t going to cure my brother-in-law’s diabetes, either–you wouldn’t suggest that he refuse to take it and wait to go blind and lose a foot, right?
Same thing with endogenous chemical depression. Neither pills nor therapy is going to make your inherent brain dysfunction go away. They’re only going to help reduce the negative effects of that dysfunction on your life, same as antihistamines or insulin will. You’re willing to give pills a shot to see if they’ll help with your symptoms, even if they don’t fix your actual brain, right? So if there’s clinical evidence to show that CBT will help reduce symptoms, why wouldn’t you give it that same shot?
“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.”
This is exactly why CBT and other more modern methods tend to reject ‘talking in a room’ and focus more on figuring out what you can do in between sessions to improve your situation.
Earlier therapies tended to focus on the idea that you would have some kind of ‘breakthrough’ in therapy from talking and then would feel OK, and basically didnt set homework. Spending one hour a week to improve your life generally isnt going to be the quickest way to see results.
CBT and the like focusses more on the idea that you have to practise various techniques out of sessions and that this will improve your ability to cope with whatever situation you are in. Its more about retraining habits or learning new techniques than what therapists call ‘insight’.
Its closer to dietting or weight training than older methods, ie there wont necessarily be a ‘breakthrough’ moment, but that over time significant improvement is likely to happen. This is one reason why they do lots of ways to measure progress, because humans generally are very poor at noticing gradual change, we only notice when a large change has finally occurred.
Otara
Exactly. To make a different comparison–think of it like physical therapy. I had an injury to my shoulder that left it at less than 100%. It will never be perfect, but with PT, I retrained the muscles in that area, learned to work with what I have, and found ways to compensate for what I didn’t. That doesn’t mean, however, that I wouldn’t benefit from an NSAID after particularly hard physical activity.
In the same way, you may continue to have a chemical imbalance that needs to be addressed with medication, but CBT may also help you be more functional by retraining your brain.
Also similar to PT, you need to practice at it and do your homework for it to work.
My therapist has helped me make positive changes, but it took a long time for me to realize what and how this was happening.
I don’t bond well with people. Initially I didn’t bond with her. She got on my nerves and seemed superficial like everyone else in the world. But I wouldn’t quit because I had enough insight to see that my pattern of extinguishing nascent relationships is part of my problem. So I stuck through the early sessions of awkwardness and eventually latched on.
So now I have this person I see every week. Not living with anyone or having any friends means that she’s the only person that I can seriously speak to on a regular frequency. All my other interactions are surface. (I have come to realize that this is my doing, not other people.)
So I am able to do what I am unable to do outside of her office. Establish a relationship with a person that is not related to me. Then from there, form an emotional bond…if only because she is the only “real” person in my world.
I can rattle off a list of positive things that I have done over the past four years, and many of them were done because of my therapist. Maybe she gave me the positive thing to do as a homework assignment or I came up with it to show her that I’m not there just to suck up all the oxygen in the room. Or she came up with the thing and I commit to it because of her encouragement and support. Like, yoga. It is a positive thing. I think it is helping me in ways that other people have remarked on. Psychologically it is tearing me to pieces, but that’s another issue. Just because it hurts does not mean it is not a good thing. Anyway, yoga was my therapist’s idea and I stick with it because she pushes me to every week. My connection with her is such that I actually care about her approval. Otherwise I wouldn’t do anything.
Now the big question is what will I do when I stop going to therapy and I don’t have someone to motivate me to do stuff? I have no idea. We both realize that I’m lacking an inner drive and that I’m susceptible to falling back into old patterns without supervision. But overall, I think the experience has made me more open to do things. I don’t automatically think, “Why do that? It’s pointless ultimately.” Yes, it is, but at least you get to say you did it and not be so boring.
I can look back on the last few years with some pride instead of shame and embarrassment.
Not all therapists are all about delving into the past (mine doesn’t). Not all of them work only in the here and now. Some do some mixture of the two. I’m not a shrink, but I’m sure the good ones tailor their treatment to the individual’s needs.
You might even be a good candidate for it. At it’s heart, CBT (at least the “C” part) is all about replacing distorions in logic with accuracy. That’s probably the same mindset that brought you to the Dope.
Example: crowds aren’t (generally, actually, physically) dangerous. Fleeing from all social situations involving crowds as if they represent a great danger suggests a distorted thought, eg “avoidance is a good response!”. Your panic reaction is essentially bad learning/thinking. When you replace the distorted thought with a more accurate one, your emotional response becomes more accurate to the situation. I’ve abbreviated the process but I hope I’ve given a useful example.
Those of you who are defending or apologizing for CBT, tell me this: Is it most properly done in group therapy sessions, with six-to-ten or so people in a room for 50 or 80 minutes? Or most properly done in one-on-one sessions for 50-minute hours?
I’ve made clear what horse manure I think CBT is. But that has been based on being in group therapy sessions. Now, IMHO, group therapy in general is shit. And for something like CBT, it must be all the more so… If you have, say, 8 clients in an 80-minute sessions, each client gets about 10 minutes each. This is just enough for the group leader to ask each: Pick one of these cognitive distortions from the list…
Client: Chooses one or two of those absolute ALWAYS or NEVER type of distortions from the standard list…
Leader: Whacks down that distortion with some standard response, of the “you can tie your shoelaces, can’t you” sort.
On to the next client in the room… That’s about all you can accomplish in group.
So my question today is, does actual serious CBT get done in a one-on-one setting? Is there a better chance there to actually work through the “errors” and “corrections” in detail, or to devise alternate strategies, or whatever? All I’ve seen is CBT in group settings, and that’s crap.
I’ve read – or tried to read – some of those “self-help” books too. Those are the worst. Actually, what I looked at were “Rational Emotive Therapy” books. I couldn’t get more than a chapter or so into those without wanting to puke.
I can’t imagine CBT possibly being effective in a group. It really strikes me as a 1v1 type of therapy.
What you’re describing sounds more like a training session about CBT theory, rather than applying it in a therapeutic session.
Although I’m sure someone will come along and say they found group CBT very useful!
Groups can be very effective, but generally not in the format you’re describing in my view. In my view they are generally most effective for people who are not ‘therapy experienced’, particularly if their general experience of therapy has been negative.
CBT groups are generally structured, and involve a fair bit of education and exercises rather than everyone talking for 10 minutes each then argued down. They generally involve homework exercises as well, and generally to really be called CBT should have a clear basis, ie a manual or program that is being followed. Unfortunately this does not always happen.
I would definitely suggest trying individual work, particularly given you’re feeling your experience is too ‘one size fits all’, and you’re wanting something more tailored to your particular needs.
Otara
I didn’t read the whole thread, so excuse me if I repeat another Doper.
A commonly listed symptom of depression is “hopelessness”. I always wondered what hopelessness looked like. My image of it was not not seeing the point to get out of bed, at all. That was despair with a five day beard and eyes red from crying .
I have learned that hopelessness takes far more insidious forms, far more treacherous even though they seem less severe.
Depression make you doubt that anything you can do will help you get better. You don’t beleive there’s anything you can do. All ways leading out of the depression are blocked because you don’t have what it takes, or the cure doesn’t have what it takes, or both. Such thoughts seem reasonable enough, right? Wrong. That is despair, hopelessness, talking. Only you don’t recognize it because this kind of despair did get out of bed and wore a tie to work.
Think about how insidious such thoughts are. Taking meds? “No thanks, I read studies that say meds are all ineffective, and pushed on us by Big Medicine”. “No thanks, I’m afrais meds will destroy what makes me me”.
Therapy? “Won’t help. I’m not the kind of person who believes in therapy. I’m not the kind of person where therapy will help. I’m too clever for a bunch of people sitting in a dingy classroom blaming their parents” That last one is despair, still wearing its suit and tie, but it has gone to a bar after work and instead of heavign fun it and bitterly lashes out verbally to the bartender over its fourth beer.
But all of it is despair, and all of it is hopelessness, and all of them are symptoms of the very illness you should get treatment for. And all of those thoughts and emotions make it harder for you to seek help and keep on seekign help untill you found the med and the therapist that will work for you.
I have been treated for depression and anxiety since 1979. About five years ago, on advice such as yours, I sought out a CBT professional. After three sessions, he told me he didn’t think he could help me, and that was that. CBT is not the panacea you describe.
She didn’t say it was a panacea, or that it fixes every problem for everyone 100% of the time. It isn’t, and it doesn’t. What she said was that it’s the most clinically proven treatment for depression and anxiety. That is, the data says that CBT is shown to be effective more often than any other treatment for depression and anxiety. That could mean that CBT is effective for, say, 8 out of 10 people, while every other treatment only helps 7 (or fewer) out of 10. But obviously, that doesn’t mean that CBT will absolutely help in every case, or that other treatments are worthless. It just means that, of all the weapons we have against depression and anxiety, CBT is the most reliable.
I have no idea why that therapist said he couldn’t help you, and in my opinion, it seems like a pretty crappy thing to say, especially with no further explanation. But that doesn’t necessarily mean that CBT wouldn’t work for you, just that he thought *he *couldn’t make it work for you. I’m not saying you have to give it another shot or anything. I’m just saying that your experience doesn’t necessarily mean anything about the effectiveness of CBT, either for you or in general.
I can’t speak for others, but it certainly does mean CBT is not useful to me.
No, not necessarily - that’s what I’m trying to say. Three sessions with one therapist who gave up on you is not sufficient evidence to say that.
It *could *be that CBT isn’t useful for you, or it could be that he was just a lousy therapist, or it could be that you weren’t doing the homework or participating in the exercises, or it could be that what he was selling as “CBT” was nothing of the kind. I mean, the group-therapy CBT Senegoid describes is nothing like any CBT I’ve ever heard of before (not that I’m any kind of expert).
To me, the fact that he was the one to call it quits rather than you means that it’s much more likely it was a problem with him personally, rather than with the style of therapy he was using.
But regardless, whatever the cause, I’m really sorry you had that bad experience, and I hope you’ve found some treatments that do help.
What Heart of Dorkness said.
No psychological intervention is a panacea and I would never claim otherwise. I’ve done CBT, prolonged exposure, DBT, EMDR, cognitive therapy and ACT, and they all brought something useful to me and improved my life in some way, but none of them have cured my mental illness. When I say ‘‘the polar opposite of nonsense’’ I mean that CBT is the most heavily researched form of therapy and that there are more randomized control trials indicating its efficacy than for any other form of therapy. It’s not like some stuff some people pulled out of their ass, unlike some other mainstream therapies that are out there - it was developed over a series of carefully controlled experimental clinical trials, has been tested on a wide range of populations, and overall appears to be the most reliable and generalizable treatment for depression and anxiety that we’ve got - especially when combined with medication.
If you’ve had depression since 1979, you’re probably always going to have depression - just as I am unlikely to find spontaneous remission myself. It absolutely blows, but the best we can do is accept our lot in life and acquire as many tools as possible to deal with the worst of it. CBT is just one of the many tools that are out there, but given its reliability, I’d recommend it as the starting point for any person seeking treatment.
Three years ago I had a major depression. There were definite triggering factors, but once the bastard was rolling, there was no stopping it. This wasn’t flavor of the month diagnosis or an excuse to get me on expensive meds (I have never in fact taken any antidepressants). I was in a pretty bad way.
In desperation I went to a ‘person-centered’ talk therapist, and for me it was the biggest pile of horse manure I have ever experienced. Very expensive horse manure too. I talked, she nodded sympathetically, and all this regurgitation of how awful I felt made me feel worse, and when I wasn’t in the sessions I dwelled on stuff even more than I had before I started; the therapist began to suggest issues with my family, I ended up resenting them and being angry and ashamed of my parents, which made me feel worse. The more I went, the worse I felt. It fucking sucked and eventually I ‘fired’ my therapist.
The first six months of the depression were absolutely excruciating, and it got a little bit better after that, but full two years after it started, things still weren’t much better. I did a lot of reading on the subject, and read many people’s experiences here on the SDMB, particularly olivesmarch4th, and eventually got myself a CBT therapist (1-on-1).
The difference between the first therapist and the CBT one was startling and refreshing. Apart from a session or two looking at the things that triggered the negativity - and really unlike the prior woo I’d experienced - there was no dwelling on the past; just looking for a possible root then attacking the symptoms and their immediate causes.
I’m a real skeptic, and to me CBT was the polar opposite of the bullshit I’d experienced previously: it presented a logical structure for the cause of the symptoms, and a structured set of tools to treat the issues that were bringing me down. Not just assessment of cognitive processes, but suggested behaviour modifications too (e.g. timetables to clean the house, eat properly, do freelance work, call clients, exercise etc.).
The other thing that surprised me was a series of self-assessment questionnaires that I answered every week. Same questions every time, and I thought I was answering consistently. I hadn’t realised but these were being fed into a (confidential) database. On my last session, I was given graphs of my self-assessment scores. It was breathtaking. There was a slight uptick during the sessions where the therapist worked with me to find the root of my cognitive distortions, and then there was a steady decline in my self-assessed depression down to zero.
Zero: not depressed. At all. And that’s been that, fingers crossed, for more than a year. I’ve occasionally felt something shitty start to happen to my mood, but I’ve been able to work out where I was tripping myself up, and to use the tools I got from the therapy to nip it in the bud and return to my current cheerful self.
I even went through a really unpleasant situation at work in the last year, resulting in me leaving the company, and though I was definitely stressed as hell, there wasn’t even a hint of it triggering a depression. I accepted it as just a shitty random thing that happened (which it was); even a year previously I would have turned the entire situation in on myself, and I know I would have been fallen down the hole again.
I’m sure CBT doesn’t help everyone, but it sure as fuck helped me. And it sure as fuck appealed to my skeptical nature as nothing more than a practical set of tools to help me fight the black dog, compared to the woo woo pseudo-Freudian bullshit that I’d been peddled before.
YMMV.
jjim, I’m so glad you found the help you needed. That’s a feel-good story right there.
That is incredibly, unbelievably awesome. And to think, it’s not really because of something that someone else did for you, but something you did for yourself. I really admire that.
How many sessions, with how many therapists, would be sufficient, in your opinion, to conclude that CBT was not useful in my case?