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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Tepiaca on January 14, 2004, at 23:07:50
Hi Im recently on Nardil.
I cant find a completely relief of my SP ,maybe because the new NArdil is not the same ,I dont now . Im on 45 mg ,at this dose I dont have any side effect. When I increase the dose to 60mg , weigt gain , anorgasmia , very bad insomnia come to me , it get worst on 75mg. I´ve never tried the 90mg dose.I was wondering if CBT has help with your SP problems.
I actually dont believe in therapy , but maybe im just a fool.
Do you know something about CBT?
Tell me all your experiences pleasethanks
Posted by Pam DaMonium on January 14, 2004, at 23:34:34
In reply to Does CBT really helps with SP? I need experiences, posted by Tepiaca on January 14, 2004, at 23:07:50
If by SP, do you mean "social phobia"? If so, now it is usually called social anxiety disorder, or SAD.
So, if you are talking about SAD, does CBT help? Heck, YES!!! Study after study has shown the efficacy of CBT, especially among those motivated to get well who will do the work required.
Meds help control symptoms, but CBT helps you change the negative pathways in your brain that you have spent years grinding in. But like AA for alcholholics, you have to be ready.
Try asking your question on the "Psycho-Babble Psycholgy" board where they talk about therapies and try an archive search for CBT.
All the best!!!
Posted by Kon on January 15, 2004, at 0:56:34
In reply to Re: Does CBT really helps with SP? I need experiences, posted by Pam DaMonium on January 14, 2004, at 23:34:34
>Study after study has shown the efficacy of CBT, especially among those motivated to get well who will do the work required.
Not to question the value of CBT as I'm sure it works very well for some but I'm a bit more sceptical about its succcess rate after looking at the literature. For instance here are the improvement values when comparing different medications to CBT in a fairly recent(Federoff, 2001)review. The review included about 28 CBT studies:
Self-reported social anxiety improvement score:
Benzos ~2.1
SSRIs ~1.7
CBT ~0.8
Placebo ~0.4Observer-rated social anxiety improvement score:
Benzos ~3.2
SSRIs ~1.5
CBT ~1.8
Placebo ~1.1
Posted by Ame Sans Vie on January 15, 2004, at 7:19:40
In reply to CBT versus drugs, posted by Kon on January 15, 2004, at 0:56:34
In my opinion, each person suffering from social phobia is either one of the ones who will respond to medication, or one of those who will respond to some form of talk therapy. Through my own experience and the experiences of others with whom I've spoken over the years, CBT seems to be effective only if no avoidant symptoms are present. Many people consider avoidant personality disorder to be just a fancy way of saying "really bad social phobia", but the avoidant behaviors exhibited by those of us afflicted with it (myself included) are quite separate, it seems, from the anxiety in many cases. APD is often misdiagnosed as simple social phobia, but the two are absolutely separate entities (though they most often coexist).
Obviously a propensity toward avoidance makes for a very difficult time adhering to the principles put forth in cognitive behavioral therapy (not to mention even getting out of the house and going to your therapist in the first place!).
Posted by SLS on January 15, 2004, at 8:10:43
In reply to Re: CBT versus drugs » Kon, posted by Ame Sans Vie on January 15, 2004, at 7:19:40
Posted by Tepiaca on January 15, 2004, at 11:07:29
In reply to Re: CBT versus drugs » Kon, posted by Ame Sans Vie on January 15, 2004, at 7:19:40
hi
what do you mean exactly with avoidant personal
symptomps ?does CBT dont work on this kind of people ??
then what is the solution for all the people with this?
Posted by Angielala on January 15, 2004, at 12:24:58
In reply to Does CBT really helps with SP? I need experiences, posted by Tepiaca on January 14, 2004, at 23:07:50
Tell us a little bit about what you go through. Maybe that can help us break things down.
How long have you been on Nardil?
> Hi Im recently on Nardil.
> I cant find a completely relief of my SP ,maybe because the new NArdil is not the same ,I dont now . Im on 45 mg ,at this dose I dont have any side effect. When I increase the dose to 60mg , weigt gain , anorgasmia , very bad insomnia come to me , it get worst on 75mg. I´ve never tried the 90mg dose.
>
> I was wondering if CBT has help with your SP problems.
> I actually dont believe in therapy , but maybe im just a fool.
> Do you know something about CBT?
> Tell me all your experiences please
>
> thanks
>
>
Posted by zeugma on January 15, 2004, at 16:38:08
In reply to Re: CBT versus drugs » Kon, posted by Ame Sans Vie on January 15, 2004, at 7:19:40
In my opinion, each person suffering from social phobia is either one of the ones who will respond to medication, or one of those who will respond to some form of talk therapy. Through my own experience and the experiences of others with whom I've spoken over the years, CBT seems to be effective only if no avoidant symptoms are present. Many people consider avoidant personality disorder to be just a fancy way of saying "really bad social phobia", but the avoidant behaviors exhibited by those of us afflicted with it (myself included) are quite separate, it seems, from the anxiety in many cases. APD is often misdiagnosed as simple social phobia, but the two are absolutely separate entities (though they most often coexist).
>
> Obviously a propensity toward avoidance makes for a very difficult time adhering to the principles put forth in cognitive behavioral therapy (not to mention even getting out of the house and going to your therapist in the first place!).
I believe I have avoidant personality disorder, and I was not helped by CBT. I found it too focused on the 'consequences' of social interactions, as if my fears of interacting with others were somehow founded on some kind of risk-benefit calculation, with the avoidance triggered by a fear of 'adverse' consequences. But I found (and still find) that social interaction unsettles me, regardless of the objectively determined outcome.More on avoidant personality disorder:
Can J Psychiatry. 1990 Oct; 35(7): 596-9. Related Articles, Links
Attachment pathology and low social skills in avoidant personality disorder: an exploratory study.Sheldon AE, West M.
Behavioral Sciences Research Group, Faculty of Medicine, University of Calgary, Alberta.
The criterion of desire for affection and acceptance was eliminated from the definition of avoidant personality disorder in the DSM-III-R. But clinical experience in our setting suggests that attachment pathology related to such desires is an important diagnostic feature and a frequent focus of clinical intervention with avoidant individuals. Forty-seven patients receiving a clinical diagnosis of avoidant personality disorder completed a brief questionnaire which rated desire for an attachment relationship, fear of an attachment relationship and level of social skills. The results support our hypotheses that attachment security is distinct from general social skills and that desire for but fear of an attachment relationship is more characteristic of those diagnosed with avoidant personality disorder than a low level of social skills.
This paradoxical "desire for but fear of an attachment relationship" can color even the most superficial interactions and make them difficult, and I found that CBT was predicated on there being a pathology of cognition, not of emotion, central to the social phobia symptoms. But if cognition is intact, and the problem lies elsewhere, trying to fix the problem with CBT will only make things worse.
Posted by ace on January 15, 2004, at 18:59:56
In reply to Does CBT really helps with SP? I need experiences, posted by Tepiaca on January 14, 2004, at 23:07:50
Posted by mattdds on January 15, 2004, at 20:51:52
In reply to Re: Ask Matt about this Tep!! It helps him heaps. (nm) » Tepiaca, posted by ace on January 15, 2004, at 18:59:56
Hey all,
Just thought I'd share my experience.
ASV may have a good point about the distinction between avoidant personality. I'm not sure that distinction has been made in the studies with CBT. Perhpas there are studies that have been done with APD, but I don't know of any.
I do know however that it really could not hurt to try it. Furthermore, there are really some potentially huge gains to be made, especially if you are highly motivated and have high self-efficacy (studies show that individuals with this trait tend to respond better to CBT).
CBT is not an easy road. And even if you do all the steps there are no guarantees. However, I think that if you put in a good effort with a good therapist, you will see at least *some* gains.
Best to you, and if you have any specific questions, you can ask over on the psychological board (where this is likely to be redirected shortly).
Matt
Posted by Iansf on January 16, 2004, at 13:03:21
In reply to Re: CBT versus drugs » Ame Sans Vie, posted by zeugma on January 15, 2004, at 16:38:08
> > Obviously a propensity toward avoidance makes for a very difficult time adhering to the principles put forth in cognitive behavioral therapy (not to mention even getting out of the house and going to your therapist in the first place!).
>
>
> I believe I have avoidant personality disorder, and I was not helped by CBT. I found it too focused on the 'consequences' of social interactions, as if my fears of interacting with others were somehow founded on some kind of risk-benefit calculation, with the avoidance triggered by a fear of 'adverse' consequences. But I found (and still find) that social interaction unsettles me, regardless of the objectively determined outcome.
>
I put a huge amount of effort into cognitive therapy, to virtually no avail. In fact, in some respects I ended up feeling worse because when I failed to improve my therapist insisted I wasn't trying hard enough. Even though I knew she was wrong to criticize me, it still hurt.I can hardly imagine anyone trying any harder than I did. I pushed myself into social situation after social situation (and still do), and I wrote and wrote and wrote in my exercise book. But nothing changed, either externally or internally. Mixing has NEVER become easier for me emotionally, and I have NEVER become smoother at it.
Never, that is, except with the right medication.
I agree that CBT focuses too strongly on consequences and risk-benefit analysis. Whatever unsettles me in social situations is not the potential consequences -- it's something much deeper, something that is, apparently, immune to rational analysis.
There's also seems to be an expectation in CBT that rewarding yourself for making an effort to should be equivalent to reaching the goal. "OK so you still can't function in social settings. Give yourself credit for trying." Well, what good does credit do? I credit myself all the time, but I'm often still painfully lonely.
It's like telling a starving man to pat himself on the back for going all out to find food even if he never finds any and ends up still starving. Self-congratulation cannot fill an empty stomach and nourish the body. Nor can it fill a social void and nourish the heart.
Posted by Tepiaca on January 16, 2004, at 18:04:41
In reply to Re: Does CBT really helps with SP? I need experiences, posted by Angielala on January 15, 2004, at 12:24:58
> Tell us a little bit about what you go through. Maybe that can help us break things down.
>
> How long have you been on Nardil?I´ve been on Nardil since 12 August 2003 , that are 5 months .
I still cant have a normal life. I wish I could go out with friends and girls , to parties , go to the mall without feeling that Im being observed , avoiding contact with all my acquaintants ,try to escape from them
I hate this , I will do anything to have a normal life> > Hi Im recently on Nardil.
> > I cant find a completely relief of my SP ,maybe because the new NArdil is not the same ,I dont now . Im on 45 mg ,at this dose I dont have any side effect. When I increase the dose to 60mg , weigt gain , anorgasmia , very bad insomnia come to me , it get worst on 75mg. I´ve never tried the 90mg dose.
> >
> > I was wondering if CBT has help with your SP problems.
> > I actually dont believe in therapy , but maybe im just a fool.
> > Do you know something about CBT?
> > Tell me all your experiences please
> >
> > thanks
> >
> >
>
>
Posted by Tepiaca on January 16, 2004, at 18:08:59
In reply to Re: Ask Matt about this Tep!! It helps him heaps., posted by mattdds on January 15, 2004, at 20:51:52
> Hey all,
>
> Just thought I'd share my experience.
>
> ASV may have a good point about the distinction between avoidant personality. I'm not sure that distinction has been made in the studies with CBT. Perhpas there are studies that have been done with APD, but I don't know of any.
>
> I do know however that it really could not hurt to try it. Furthermore, there are really some potentially huge gains to be made, especially if you are highly motivated and have high self-efficacy (studies show that individuals with this trait tend to respond better to CBT).
>
> CBT is not an easy road. And even if you do all the steps there are no guarantees. However, I think that if you put in a good effort with a good therapist, you will see at least *some* gains.
>
> Best to you, and if you have any specific questions, you can ask over on the psychological board (where this is likely to be redirected shortly).
>
> Matt
>Thank you matt , I guees I dont lose anything trying. Now the problem is to find a good place to take this therapy . We dont have many places here in Mexico
Tep
Posted by Dr. Bob on January 18, 2004, at 2:15:39
In reply to Re: Ask Matt about this Tep!! It helps him heaps., posted by mattdds on January 15, 2004, at 20:51:52
> if you have any specific questions, you can ask over on the psychological board (where this is likely to be redirected shortly).
Read my mind! Here's a link:
http://www.dr-bob.org/babble/psycho/20040116/msgs/302214.html
Thanks,
Bob
This is the end of the thread.
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