Posted by Dr. Bob on January 30, 2002, at 19:06:13
In reply to Re: David Burns « therese desqueroux, posted by Dr. Bob on January 30, 2002, at 19:03:43
> problem I had with with David Burns'-style therapy and CBT in general (I also can't abide Albert Ellis and his usually hectoring tone) is that it has often been observed that depressed people are not necessarily unobjective. In fact at times they are more accurate in assessing situations than individuals who are not clinically depressed. This topic came up again in the most recent Harvard Mental Health Letter.
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> So it is really hard to talk yourself out of a so-called negative perception if your perception is in fact accurate. Of course the perception becomes a problem when it is endlessly repeated, sometimes creating almost paralyzing anxiety. But as I noted before, in my experience, CBT does zilch for people with serious ruminative problems. The therapist I was seeing at one time kept characterizing thoughts as "behaviors" that can be changed in the same way that a person with a germ phobia can be desensitized to the point where he or she can touch a doorknob without a handkerchief. I firmly believe that the ruminative thoughts are symptoms, not behaviors.
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> I just hate to see so many people berating themselves as I did for not trying hard enough or being frustrated because of their lack of improvement. And many times they are shelling out large amounts of money they can ill afford.
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> As said before, I'm not drug-happy, but there really are some conditions so severe as to be treatable only by medications. At least initially, and perhaps permanently.
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> > In response to the David Burns' thread:
> >
> > Several years ago, I read David Burns' books as requested by my CBT. (I have not read any more recent editions). I told him that Burns was an idiot. The therapist, who had some of the smugness that Burns displays on his book jackets, acknowledged that at least one other patient had had a similar response. All Burns does is present a diluted, dumbed-down version of Beck perpetrated -- not written -- in an extremely irritating condescending style.
> >
> > Some years ago, I also read Beck's main book and some books by E.P. Seligson at the University of Pennsylvania, another CBT proponent.
> >
> > I am someone who does not take an aspirin if it is not necessary.
> >
> > Let me say, I hope for the last time:
> >
> >
> > Cognitive Behavioral Therapy is NOT, NOT, NOT APPROPRIATE for individuals with severe forms of OCD, depression or anxiety.
> >
> >
> > You can't just "learn optimism" (to paraphrase the title of one of Seligson's books) if you feel awful to begin with and your therapy is only making you worse, in part because of the massive amounts of money you are wasting, in my case, thousands.
> >
> > And if you have any verbal ability and mental capacity at all you'll find yourself arguing against yourself and getting nowhere. All the time. Then when you don't improve it's your fault, of course. As I believe Cecilia said, the therapy does not teach the individual to translate supposedly more objective thoughts to the emotional level. Words do not change deeply experienced emotions, and I like words. As far as I'm concerned, it's Coue-ism ("Every day in every way I am getting better and better") in modern dress with a little pseudo argumentation added.
> >
> > And don't get me started on those insulting exercises --
> >
> > 1. Rate your mood from 1 to 10.
> >
> > 2. What is your negative belief? blah blah blah
> >
> > 3. What's the evidence for that? (there was
> > plenty)
> >
> > 4. How would you refute that? (could never come up with anything for which felt strong conviction; sometimes the dark side looks dark because it is)
> >
> > 5. Rate your mood again. -- same score. (Sometimes I'd pretend to have improved a little, although I don't usually feel it necessary to appease in a situtation like this.)
> >
> > 6. The same score?
> >
> > 7. Yes, the same.
> >
> > The book "Stop Obsessing" also is not effective for someone with a severe form of ruminative OCD.
> >
> > I am not saying that CBT is worthless to all individuals, but rather that for people trapped in painful,seemingly endless ruminations, it is not effective. It does not teach you to interrupt the thought. CBT may be helpful as an ancillary form of therapy once an individual is not channeling all of his or her energy into ruminations because of the successful administration of medication. It may also be helpful to people who have relatively minor problems, but that is true of most any therapy.
> >
> > My cynical theory is that CBT has been so heavily promoted because it's supposed to be fast and effective and the managed care folks like that.
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> > > > Hi Folks,
> > > >
> > > > Funny this thread should come up. I'm partway through the book. I personally find a lot that's objectionable and a lot that's good (besides the thorough medicine listing at the end). First of all, I don't think we should disregard the usefulness of CBT. *Every* human being, mood disordered or not, can use a reality check now and then. To me, CBT is just a formalized system of being aware of how your thoughts and reactions relate to what may or may not actually be going on. When I look at his descriptions of cognitive distortions, I see myself so clearly in some of them. While I'm not big into writing it all down, it doesn't hurt to have my awareness raised. My therapists have used some aspects of CBT (though not in the rigid cultlike manner as Burns prescribes). Although it's certainly not enough to manage my illness without meds, I can't say it hasn't been helpful.
> > > >
> > > > Do I think CBT has or can "cure" my serious mood disorder? No! I *know* that I need careful psychopharmacologic management. Do I think there's a genetic component to my illness? My family history says absolutely. And I can't process any CBT while severly depressed - the meds have to bring me up a bit. I suspect my illness is more "biologically" based than "psychologically" (if we're gonna draw a line between the brain and the mind). But hey, any adjunct tool that can help me manage better can't hurt. I just don't expect CBT to be the magic key.
> > > >
> > > > On the negative side: I do agree the book and techniques have an almost cultlike feel to them. I totally agree that it's ridiculous that he says bipolar is genetic and depression is not. It also sounds a bit hard to believe when he says he has cured suicidal patients in incredibly short periods of time. And that he's rarely had a patient need onoging drug treatment beyond a year or so. I also worry that all his glowing stories might make people who've had CBT feel like failures if they haven't had resounding success with CBT. I worry that the book might encourage folks to abandon their medicine without appropriate discussions and oversight from their doctors, or to not recognize when they need to really think about starting meds. Yeah, I know he puts in caveats about when to call in a professional and all that. But I think his anti-drug stance poses possible dangers.
> > > >
> > > > Oh, and the guy's way too long winded (unlike this post :) He could've made his points in a quarter of the space and his writing style irritates me - he writes as if his audience is a bunch of third-graders. How annoying.
> > > >
> > > > Emme
> > >
> > > I see Dr. Burn's as more of an opportunist than anything else. Essentially, he took the ideas of Aaron Beck, M.D. (father of congitive therapy) and ran with them. He did his psychiatry residency at the Philadelphia VAMC and gave the hospital an undeserved black eye when he described (in his preface if memory serves me) a patient he passed on the elevator there who was returning from his 18th shock treatment, and was yelling "I want to die." I haven't looked at "Feeling Good" since it was first published, but I think he claimed that it was at this point when he decided there 'must be another way' (to treat depression). In any case, I know psychiatrists who remember him well, and he routinely used drugs in his practice.
> > >
> > > I don't care about his drug recommendations since he's not a psychopharmacologist.
> > >
> > > I've tried manualized CT/CBT before, but it's of no value if you're in a state of depression that makes it impossible to carry out the "homework assignments" that are part of the therapy. For those who are experiencing mild to moderate depression, I think it's an excellent adjunct to medications.
> > >
> > > Blue
poster:Dr. Bob
thread:17202
URL: http://www.dr-bob.org/babble/social/20020125/msgs/17561.html