It’s something I’m interested in, but not sure how to go about it.
I’m mildly to moderately depressed, I suppose*. I’m not suicidal or crying my eyes out every day, but the majority of the time I am lethargic, unable to concentrate, irritable, things like that. I’m having a hard time getting out of bed, going to class, or even cleaning the house.
I don’t like medication, and it doesn’t even seem to work that well. I’m not happy trying higher and higher doses or switching meds all the time (especially since they caused a lot of weight gain my last go-round). Plus, I have no insurance, so getting them requires me to go to my school’s counseling center every other month, which is a scheduling nightmare since they don’t have psychiatric services on my home campus and I have to drive 40 miles.
So, tell me about your experience with CBT.
Did you do it with a therapist, or buy something like The Feel-Good Handbook?
How much effort was required to see substantial improvement? Were you working on exercises for hours and hours every week, or just a few minutes a day here and there?
How long before you were able to switch to a “maintenance” level of CBT, or did you have to keep at it with the same amount of effort?
Are there any organizations that offer free or low-cost CBT, like support groups or even individual therapy? Or should I just look into a 12-step program?
I already own a copy of The Feel Good Handbook and Understanding Depression, 2 titles I understand are often recomended by therapists.
*I was diagnosed with clinical depression at 15, and it runs in my family, so it isn’t just a funk. Sometimes I do feel worthless and miserable and cry my eyes out for no reason, but generally I just feel… off. Nothing definite, just a sort of blah, life sucks, I’d rather just stay in bed and nap all day or goof off on the SDMB. I’m sure you know what I mean.
As mentioned recently in another thread, I had nearly 6 years of psychodynamic before I made the decision to switch to CBT–this is long after having read Albert Ellis (the king of cognitive therapy) and working through an excellent workbook called ‘‘Overcoming Depression One Step at a Time’’ (Behavioral Activation method.)
My therapist was reluctant for me to switch to CBT because it’s not the standard treatment of people with severe and complex symptoms, but I did it anyways because I had recently learned that a lot of the stuff I was doing didn’t have much scientific validity to it,and I wasn’t improving. CBT is a therapy with a huge amount of scientific validity, so there I went.
My therapist told me, ‘‘Wow, you’re already doing so much of this stuff!’’ And basically I was with her for four months before we realized I had all the tools I needed, I was good to go. We ended our sessions about three weeks ago.
Exercises were not particularly time consuming, with the exception of exposure therapy we did for anxiety. That required an hour of my time every day, and it was extremely unpleasant (basically had to deliberately scare the crap out of myself and learn to deal with the resulting freak-out.) However, it was incredibly effective, way more effective than the years and years I spent talking about what scared me.
CBT is less about doing exercises (20 minutes a day? If that) and more about changing thought and behavioral patterns. It doesn’t take long to realize it works–and once you do, it’s hard to forget what you’ve learned, because you’re using it every day.
Now it’s difficult to say whether the structured therapy helped as much as the books/reading/attitude adjustment, because I’m sure a number of factors contributed to my gradual recovery. But there is no question that CBT in its various manifestations absolutely changed my life for the better. My husband is on the CBT clinical therapy career track, so together we’ve learned a lot about it. Let me know if you have any specific questions about the process, and if I can’t answer them, he probably can.
I strongly recommend this for anyone going through anxiety and depression symptoms of any degree. There is a ton of research backing up the effectiveness of CBT, but beyond that I can only vouch for it with my own amazing experiences. It feels so good to finally be doing something that you know is supported strongly by science. Too few therapeutic ideas are these days.
You should be able to find a CBT therapist anywhere you can find a psychodynamic (’‘talk’’) therapist. Many clinics offer fees on a sliding-scale based on income. You might have to check around before you find what you’re looking for, but it will be worth it.
‘‘The New Guide to Rational Living’’ by Albert Ellis
‘‘Overcoming Depression One Step at a Time’’ (author escapes me at the moment.)
Thanks, olivesmarch4th, I had actually read your comments in the other thread which prompted me to ask.
So, how exactly do you change the thought and behavorial process, anyway? I was under the impression that a lot of the exercises in CBT (the journal/workbook type stuff) was meant to show you how your reasoning was flawed. What else besides those types of exercises does CBT entail?
What about the exposure therapy for anxiety? My anxiety is completely social, I don’t like being around large groups of people, I used to have panic attacks when I started a new job because I thought I’d make a mistake and everyone would think I was an idiot. Would that involve, for instance, striking up conversations with strangers in line at the grocery store, or things along those lines?
Is it the sort of therapy where you’ll see improvement and be able to stop doing the exercises and exposure therapy, just brushing up on them when you start to get in a funk?
Hmm… think that’s about all the questions I’ve got for now…
Well, in a very general way, yes–it definitely involves understanding how you are using your emotional responses to make irrational conclusions. A lot of people bristle at the word ‘‘irrational’’ like it’s an insult, but for me, it’s just a fact of life, not a qualitative statement.
CBT, as you might guess from the name, involves the interactions that are constantly going about between your thoughts and behaviors, and how alterations in either one can improve your long-term state of mind.
Your therapist will probably start you out working from one particular angle–cognitive or behavioral. You would probably begin by identifying the issue you feel is most important to work on. Let’s suppose that you suffer from social anxiety. Say for the sake of argument that you are a college student who fears going to class and participating in discussions. Say that you have panic attacks during class and frequently have to run out because you can’t cope with the stress.
So the first thing you do is sit down and make a list of the kind of thoughts you might have while you’re sitting in class having a panic attack and first becoming filled with all of these anxious thoughts.
I might list the following anxious thoughts:
‘‘Oh my God, not a panic attack. I can’t deal with these while I’m in class. I have to get out of here.’’
‘‘People are going to notice I’m freaking out. They’ll decide I’m crazy. It will make a huge scene.’’
‘‘The prof is going to call on me and I won’t have an answer. He’ll think I haven’t done the reading and decide I’m not a good student. My classmates will think I’m an idiot…’’
…and on and on.
Once you have identified the thoughts, your therapist will probably walk you through the different kinds of lapses in reasoning that are at play. There are all sorts of these, such as Fortune Telling (’‘this is going to happen…’’) or Mind Reading (’‘that girl noticed my hands shaking and thinks I’m a total freak…’’)
In my personal experience, learning the different kinds of thoughts can be helpful if you have trouble distinguishing negative self-talk from rational thought, but the most important thing is just that you can tell when you aren’t being rational. For example, I don’t have to know how to label ‘‘I feel worthless, therefore I must be worthless’’ in order to understand that it’s not rational. Specifics aren’t as important as the general habit.
And once the thoughts are labeled, you will then identify rational thoughts to combat the irrational ones. Essentially, you learn to navigate overwhelming negative feelings as if you are a scientist.
‘‘Hmm… I feel completely worthless right now. Does this mean I AM worthless? Let me examine the evidence… I have a degree from a respected institution… my husband and my sister love me very much… I volunteer once a week at the local homeless shelter, so I’m doing good in my community… I have a job where my boss seems to respect me… I guess my feelings aren’t really based on reality, are they?’’
For the behavioral component, you continue the scientist trend, experimenting with different behaviors and observing their impact on your mood.
So if I’m feeling depressed and my response is to watch TV for two hours, I might change it up by saying, ‘‘Next time I’m depressed, I’ll go for a walk,’’ and then observe the results. If it worked to raise my mood, I then have a new behavioral tool in my arsenal to deal with depression.
Well, this is a tricky question to answer. As far as I understand, exposure therapy is used for specific phobias and fears–but IMHO it has practical applications everywhere.
When I started CBT I was having anxiety symptoms ranging from social anxiety to weird free-floating panic attacks at night to PTSD flashbacks to fear of heights.
The exposure therapy we did was specifically to deal with the fear of heights. It seemed sort of funny, working on probably the least pertinent of my anxiety issues, but what my therapist understood (and I didn’t) was that learning how to deal with my fear of heights was going to change the way I dealt with all of my fears.
It required one session a week leaving the therapists’ office to seek out situations that would deliberately make me uncomfortable. We started out at the second floor of a parking structure and I would just stare and try to freak myself out. I had to kick myself up to a moderate level of anxiety, and just learn to try to deal with the symptoms. This required me to go every day without the therapist on my own time, for about three months straight. It was a pain, and actually sometimes really horrible because I was genuinely afraid.
Well, I had to learn to deal with that genuine fear, the racing heart, the shaking, the ‘‘omg I’m gonna fall and die’’ thoughts, all of it–I had to learn that ‘‘omg I’m gonna die’’ in my brain did not translate at all to reality. Eventually it sunk in that my thoughts to do not dictate the future, no matter how much I might believe they do.
It’s probably the single most difficult, time-consuming, and effective thing I ever did for my anxiety. It probably is what allowed me to successfully take 16 plane flights and visit 6 countries this summer (the exposure therapy was meant as prep for all the plane flights.) I also rode on cable cars up the side of a mountain, climbed a volcano, and traveled by myself for two full months–all things I would never have been able to do before because of crippling anxiety.
Yes. For me, it’s become second nature after only a few months. It is pretty amazing to me how far I’ve come in such a short amount of time. It is the most satisfying feeling in the world, realizing you trust yourself again. I can totally tell when depression or anxiety are trying to trick me, and it’s incredibly satisfying when I can just throw the facts in its face and get on with my life.
I went through a course of CBT after a bout of exam-related depression.
I think its success can depend on the cause of the depression… in my case it was simply mental, emotional and physical exhaustion from working far too hard at university.
As such, there wasn’t really a “pattern of thought” that needed to change - it was modes of behaviour (taking time off, plenty of sleep and exercise etc).
It was useful to understand exactly where my problems were, but after 2 sessions we agreed that a few months away from my books, and a programme of exercise would do more than a talking cure.
If, however, the depression is linked to negative thought patterns (as suggested) CBT can be fantastically useful.
Particularly if there’s something specific - a fear of going out in public, a fear of failure, self-esteem issues - it can be great for getting to the source of the problem, and building techniques to recognise and calm the negative thoughts when they arise.
One key aspect to depression cycles - especially moderate cases - is the impact on your sleep.
When you sleep you dream, which is the body’s way of filtering, assessing and filing the day’s experiences. With depression there’s often a continual feeling of worry during the day, which the body will try to resolve at night. However, because there’s no concrete solution to the problem the brain doesn’t know what to do with the thoughts and feelings, so you spend a lot more time in dream-sleep (which isn’t restful sleep).
This was really helpful for me, as it tied in with the exhaustion I was feeling even though I spent a lot of time asleep.
The solution for me was to have lots of hard physical exercise in the evenings, so that my body was physically in need of rest, along with pre-bed relaxation (anything to distract the mind… reading, listening to music, drawing etc).
That forced my body into deep recovery sleep, which allowed me to face the next day with more energy, which helped with the lethargy etc.
I would definately give CBT a try - it’s not for everyone, but it can really help, and it’s great to avoid drug-therapy as much as possible!
Yeah, I saw a CB therapist for about a year to resolve a whole load of issues that had built up over a lifetime!
As e-logic says, the main benefit for me was to break the pattern of lethargy-depression-insomnia (or poor sleep). Many times I didn’t even think the therapy was that beneficial, but over time I noticed that I wasn’t going to bed worrying to quite the same extent, and didn’t feel so tired and withdrawn during the day. In short, it worked far better than any anti-depressants ever did and really did, over the course of a few months, help me to face life in a much more positive way.
I don’t really know what to say apart from that. Interestingly, the things which I had thought were background concerns proved to be far more relevant than I had ever thought - and the best by-product of the therapy (due to some incredibly simple and insightful questions from the lovely Tania) was me, the youngest member of the family, taking responsibility for the restitution of basic family respect and values. An incredible and life-affirming experience.
This is a really timely thread for me! I’ve been seeing a therapist for a few weeks now, and while she’s never mentioned a structured routine of CBT, it does seem to be something that she’s nudging me towards. I’m going to ask her on Thursday about something like this. And I’ll look at that depression-sleep information as well, because I often wake up feeing more lethargic that when I went to bed.
I’m a big CBT supporter for people who, in particular, feel they’ve hit an impasse with talk-therapy and need to feel more pro-active.
Behavior modification is a helpful process in its own right, as is the feeling of taking charge of it, which is a nice by-product of CBT for people who are anxious or depressed. The key is learning to recognize what your behaviors and thought patterns are, when things go wrong, and what you can do to change the patterns. Sounds absurdly simple (and in a way, it is) – and with the help of a skilled CB Therapist, it can make a world of difference.
A lot of CBT supporters feel that it allows clients/patients to take charge of the situation, gives them confidence, and that’s half the battle to solving most depressive/anxiety issues right there.
I’m also a big supporter of CBT (in my case for a 17 year anxiety disorder). I didn’t see a therapist much (a handful of times), and I think the therapist was the least effective part of it for me. I worked with any book I could find on conquering excessive anxiety, going to a self-help/support group lead by recovered anxiety sufferers, Lucinda Bassett’s “Attacking Anxiety and Depression” tape programme, and meditation. I haven’t been on any medication for two and a half years now, and I consider myself recovered from my anxiety disorder (note here - recovered does not mean I don’t have anxiety, which is a normal human emotion - I’m not afraid of having anxiety, or of my strong feelings).
I don’t think I can add anything all that useful to this thread, what with the wealth of information already present, but I’ll just toss in that my therapist and I used a CBT program and I loved it. I was suffering from major depressive disorder and had been for a long, long time. The combination of my awesome therapist, CBT, and a little hard work, and I’m comfortably out of it today.
Has anyone done this completely without a therapist? I ask because I think I can get my husband to read books or do exercises, etc., but I don’t think I can get him back into therapy. He has decided that therapy doesn’t work, so he’s unwilling to make the (for him considerable) effort to try again.
Count me in as one who has done very well with CBT. I used the above book w/o a therapist and it was great. But my experience with self-help books in all fields is that a little knowledge can be dangerous. It’s helpful to have a professional to check in with regarding timing and calibration of effort. Don’t want to do too llittle or too much and a therapist can help answer those questions. For myself I’ve learned to err on the side of too little effort and it seems to work fine.
I think he would be better served by doing any CBT, with or without a therapist, than he would be by not doing it at all. You could mention to him that CBT is not like regular therapy, though - CBT is much less about why you got the way you are than about how to fix it from here. If you do the work (and make no mistake, CBT is freakin’ hard - but you get out of it what you put in), you can expect to start feeling better in weeks; you shouldn’t need to keep seeing a therapist indefinitely, because you should be learning how to cope with life on your own.