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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Bob on December 31, 2011, at 14:33:55
Scott,You mentioned awhile back about using CBT for rumination problems (at least I think it was you). If I am indeed remembering correctly, I was wondering if you could tell me how exactly you implement that technique in your particular situation?
Also, have you had any lasting side effects from Abilify?
Thanks,
Bob
Posted by SLS on January 1, 2012, at 5:23:47
In reply to A couple questions for Scott (SLS), posted by Bob on December 31, 2011, at 14:33:55
Hi Bob.
Happy New Year.
> You mentioned awhile back about using CBT for rumination problems
I don't know how much CBT helps for ruminations. CBT is good at reducing old patterns of negative thinking. It also helps to serve as a counterweight to neutralize the negative thoughts and feelings generated by a depressed brain. It requires constant reality checking. It becomes a good habit after awhile, but it does take practice.
> Also, have you had any lasting side effects from Abilify?
Weight gain - 50 pounds worth. Abilify doesn't start out producing weight gain immediately. It is latent and insidious. It just doesn't seem to reach a plateau. I really didn't watch what I ate as I gained the weight. It took a few years to gain the weight. I think if I had been aware of this being a side-effect, I would have changed my eating habits proactively.
- Scott
Posted by Bob on January 1, 2012, at 19:55:37
In reply to Re: A couple questions for Scott (SLS) » Bob, posted by SLS on January 1, 2012, at 5:23:47
> Hi Bob.
>
> Happy New Year.
>
> > You mentioned awhile back about using CBT for rumination problems
>
> I don't know how much CBT helps for ruminations. CBT is good at reducing old patterns of negative thinking. It also helps to serve as a counterweight to neutralize the negative thoughts and feelings generated by a depressed brain. It requires constant reality checking. It becomes a good habit after awhile, but it does take practice.Do you know any sites on the web that would be good to read about it?
>
> > Also, have you had any lasting side effects from Abilify?
>
> Weight gain - 50 pounds worth. Abilify doesn't start out producing weight gain immediately. It is latent and insidious. It just doesn't seem to reach a plateau. I really didn't watch what I ate as I gained the weight. It took a few years to gain the weight. I think if I had been aware of this being a side-effect, I would have changed my eating habits proactively.
>I am sorry to hear that. My personal experience has been that certain drugs I've taken make it almost impossible to avoid overeating, binge eating, and extreme suger/carb cravings. I could hold out for a few days here and there, but in the long run I always come out on the short end.
>
> - Scott
Posted by SLS on January 2, 2012, at 9:00:09
In reply to Re: A couple questions for Scott (SLS) » SLS, posted by Bob on January 1, 2012, at 19:55:37
Hi again, Bob.
> Do you know any sites on the web that would be good to read about it?
Not off hand. You should be able to find CBT "workbooks". I gained the most out of CBT once I recognized that a depressed brain produces its own negative messages that are basically involuntary. So, CBT works on old childhood messages and new depression messages.
- Scott
Posted by Bob on January 2, 2012, at 15:35:03
In reply to Re: A couple questions for Scott (SLS) » Bob, posted by SLS on January 2, 2012, at 9:00:09
> Hi again, Bob.
>
> > Do you know any sites on the web that would be good to read about it?
>
> Not off hand. You should be able to find CBT "workbooks". I gained the most out of CBT once I recognized that a depressed brain produces its own negative messages that are basically involuntary. So, CBT works on old childhood messages and new depression messages.
>
>
> - Scott" ...a depressed brain produces its own negative messages that are basically involuntary."
How awfully true that is. This is an aspect of the disorder that I think is unimaginable to people who haven't had depression. There is actually a 'negative thought generator' that kicks in totally independent of willpower or intention. Too bad the failure mode isn't a positive thought generator... i.e., a cure.
Bob
Posted by g_g_g_unit on January 5, 2012, at 4:03:36
In reply to Re: A couple questions for Scott (SLS) » Bob, posted by SLS on January 2, 2012, at 9:00:09
>I gained the most out of CBT once I recognized that >a depressed brain produces its own negative >messages that are basically involuntary.
Sorry, I may be a little slow but I was just trying to grasp more clearly what you mean by this.
By "negative messages" are you referring to thoughts of low self-worth etc.? And that while they may feel congruent in the midst of depression, they're essentially distortions of reality?
Posted by SLS on January 5, 2012, at 4:27:55
In reply to Re: A couple questions for Scott (SLS) » SLS, posted by g_g_g_unit on January 5, 2012, at 4:03:36
Hi GGG.
> >I gained the most out of CBT once I recognized that >a depressed brain produces its own negative >messages that are basically involuntary.
> Sorry, I may be a little slow but I was just trying to grasp more clearly what you mean by this.
>
> By "negative messages" are you referring to thoughts of low self-worth etc.Yes. Feelings of guilt, morbid or melancholic thoughts, persecution, negative thoughts that destroy self-esteem, etc.
> And that while they may feel congruent in the midst of depression, they're essentially distortions of reality?
You have a keen mind. Yes, I would call them distortions - cognitive distortions.
- Scott
Posted by g_g_g_unit on January 5, 2012, at 6:15:28
In reply to Re: A couple questions for Scott (SLS) » g_g_g_unit, posted by SLS on January 5, 2012, at 4:27:55
> >
> > By "negative messages" are you referring to thoughts of low self-worth etc.
>
> Yes. Feelings of guilt, morbid or melancholic thoughts, persecution, negative thoughts that destroy self-esteem, etc.I've entertained the idea that I may subconsciously wish to remain depressed (as was directed to you in a recent thread), but for some reason, I always feel like my depressive thoughts make the most sense, i.e. they're the 'natural' order of things, I really am worthless, etc. For some reason, letting go and embracing some kind of alternative provokes fear in me. I think it's because it would mean accepting I'm not perfect.
>
> > And that while they may feel congruent in the midst of depression, they're essentially distortions of reality?
>
> You have a keen mind. Yes, I would call them distortions - cognitive distortions.
>Thanks. Your post just had me wondering which of our brain's messages are voluntary; and also, how/who determines the reality of our selves, unfettered by these 'distortions', if it's ever possible to free of them. The grandiosity of mania would be the obvious complement to your example, but do all states - love, confidence, etc. - hold their own 'mini' distortions?
Posted by SLS on January 5, 2012, at 8:04:30
In reply to Re: A couple questions for Scott (SLS) » SLS, posted by g_g_g_unit on January 5, 2012, at 6:15:28
>
> > >
> > > By "negative messages" are you referring to thoughts of low self-worth etc.
> >
> > Yes. Feelings of guilt, morbid or melancholic thoughts, persecution, negative thoughts that destroy self-esteem, etc.
>
> I've entertained the idea that I may subconsciously wish to remain depressed (as was directed to you in a recent thread), but for some reason, I always feel like my depressive thoughts make the most sense, i.e. they're the 'natural' order of things, I really am worthless, etc. For some reason, letting go and embracing some kind of alternative provokes fear in me. I think it's because it would mean accepting I'm not perfect.
>
> >
> > > And that while they may feel congruent in the midst of depression, they're essentially distortions of reality?
> >
> > You have a keen mind. Yes, I would call them distortions - cognitive distortions.
> >
>
> Thanks. Your post just had me wondering which of our brain's messages are voluntary; and also, how/who determines the reality of our selves, unfettered by these 'distortions', if it's ever possible to free of them. The grandiosity of mania would be the obvious complement to your example, but do all states - love, confidence, etc. - hold their own 'mini' distortions?
Gosh, you are a deep thinker. Those are some heavy-duty questions. I'll need to think about them for awhile. I doubt I will come up with answers, though. I think the right psychotherapist can help you find your own reality, even in the presence of depression. I believe CBT would help as well. CBT is something you practice on your own once you learn the principles.Do you ever read books on philosophy?
- Scott
Posted by Cecilia on January 5, 2012, at 18:47:54
In reply to Re: A couple questions for Scott (SLS) » SLS, posted by g_g_g_unit on January 5, 2012, at 6:15:28
"Thanks. Your post just had me wondering which of our brain's messages are voluntary; and also, how/who determines the reality of our selves, unfettered by these 'distortions', if it's ever possible to free of them. The grandiosity of mania would be the obvious complement to your example, but do all states - love, confidence, etc. - hold their own 'mini' distortions?"
Exactly. Who determines reality? CBT claims that the therapist determines it, and the defined patient is just supposed to somehow make themselves believe what he/she believes. Not only do I not believe the "positive" thoughts, I don't really believe the therapist believes them either. I just tend to think the therapist is laughing inside at whether he or she can get me to believe stuff that's not true. I suppose if you can make yourself believe positive stuff it doesn't matter whether or not it's true. Except to me it does matter. Plus I don't really understand how you can make yourself believe stuff that's not true. Cecilia
Posted by g_g_g_unit on January 7, 2012, at 22:44:42
In reply to Re: A couple questions for Scott (SLS) » g_g_g_unit, posted by SLS on January 5, 2012, at 8:04:30
> Thanks. Your post just had me wondering which of our brain's messages are voluntary; and also, how/who determines the reality of our selves, unfettered by these 'distortions', if it's ever possible to free of them. The grandiosity of mania would be the obvious complement to your example, but do all states - love, confidence, etc. - hold their own 'mini' distortions?
>
>
> Gosh, you are a deep thinker. Those are some heavy-duty questions. I'll need to think about them for awhile. I doubt I will come up with answers, though. I think the right psychotherapist can help you find your own reality, even in the presence of depression. I believe CBT would help as well. CBT is something you practice on your own once you learn the principles.Gee, thanks. I was just spurting out stuff in the hopes of provoking discussion. I do agree with you that psychotherapy (particularly psychodynamic) seems like a worthwhile avenue for self-exploration; I have been slightly less impressed by CBT, particularly when I feel like the therapist is working to impose their own bland agenda on me. What I sometimes feel gets lost in translation is an acknowledgement of both the true tolls that a) medication, and b) the illness itself can take on us. The behaviour-focus of CBT particularly seems to whitewash the depths of one's pain.
>
> Do you ever read books on philosophy?
>Not really. ADHD has always made reading somewhat difficult. However, I have found myself becoming more interested in philosophy, particularly as a source of consolation. I've tried to read a bit here and there on days my brain complies with me, but it's not always easy. It's quite sad that sometimes those who need access to that material the most are denied it by their condition.
How about yourself?
Posted by g_g_g_unit on January 7, 2012, at 23:51:47
In reply to Re: A couple questions for Scott (SLS), posted by Cecilia on January 5, 2012, at 18:47:54
> Exactly. Who determines reality? CBT claims that the therapist determines it, and the defined patient is just supposed to somehow make themselves believe what he/she believes. Not only do I not believe the "positive" thoughts, I don't really believe the therapist believes them either. I just tend to think the therapist is laughing inside at whether he or she can get me to believe stuff that's not true. I suppose if you can make yourself believe positive stuff it doesn't matter whether or not it's true. Except to me it does matter. Plus I don't really understand how you can make yourself believe stuff that's not true. Cecilia
Hmm. I've never really felt that my therapist was laughing at me per se, but I do feel that there's a definite politic inherent to the therapist-patient dynamic which can leave one bitter upon reflection, i.e. I'm paying 100$+ an hour to receive life advice from someone who's far more functional and (in some cases?) has no subjective experience of my situation.
My therapist has claimed that she's in no position to challenge my beliefs; she can only ask, "Is this (belief/behaviour/idea) working for you?" I do think CBT can be a useful tool for maintaining a rational view of one's situation. But, like I said in my comment above, it's behaviour-orientation can fall short in the face of problems like anhedonia, etc. Sometimes, to me, it just feels like this attempt to normalize a mostly hopeless state-of-existence. By paring everything down to behaviour/results, it provides a recovery-model which is very capitalist-friendly, i.e. you're officially well when you're able to go out and work and stop being a drain on the system, quality-of-life be damned.
Sorry if that sounds too bitter.
Posted by SLS on January 8, 2012, at 5:50:28
In reply to Re: A couple questions for Scott (SLS) » SLS, posted by g_g_g_unit on January 7, 2012, at 22:44:42
> > Do you ever read books on philosophy?
> Not really. ADHD has always made reading somewhat difficult. However, I have found myself becoming more interested in philosophy, particularly as a source of consolation. I've tried to read a bit here and there on days my brain complies with me, but it's not always easy. It's quite sad that sometimes those who need access to that material the most are denied it by their condition.
>
> How about yourself?Like you, I have been denied the written word for almost my whole life. I can write, but can't read. I still have to skim a lot. I was very philosophical and an idealist when I was in my 20s. This is probably very common. I'm not sure how much has carried over. I believe that I am more spiritual now.
- Scott
Posted by SLS on January 8, 2012, at 6:06:54
In reply to Re: A couple questions for Scott (SLS) » Cecilia, posted by g_g_g_unit on January 7, 2012, at 23:51:47
> > Exactly. Who determines reality? CBT claims that the therapist determines it, and the defined patient is just supposed to somehow make themselves believe what he/she believes. Not only do I not believe the "positive" thoughts, I don't really believe the therapist believes them either. I just tend to think the therapist is laughing inside at whether he or she can get me to believe stuff that's not true. I suppose if you can make yourself believe positive stuff it doesn't matter whether or not it's true. Except to me it does matter. Plus I don't really understand how you can make yourself believe stuff that's not true. Cecilia
>
> Hmm. I've never really felt that my therapist was laughing at me per se, but I do feel that there's a definite politic inherent to the therapist-patient dynamic which can leave one bitter upon reflection, i.e. I'm paying 100$+ an hour to receive life advice from someone who's far more functional and (in some cases?) has no subjective experience of my situation.
>
> My therapist has claimed that she's in no position to challenge my beliefs; she can only ask, "Is this (belief/behaviour/idea) working for you?" I do think CBT can be a useful tool for maintaining a rational view of one's situation. But, like I said in my comment above, it's behaviour-orientation can fall short in the face of problems like anhedonia, etc. Sometimes, to me, it just feels like this attempt to normalize a mostly hopeless state-of-existence. By paring everything down to behaviour/results, it provides a recovery-model which is very capitalist-friendly, i.e. you're officially well when you're able to go out and work and stop being a drain on the system, quality-of-life be damned.CBT can definitely improve one's self-esteem. I think it is a very useful tool, but is not a replacement for interpersonal therapy (IPT) or psychoanalysis / psychodynamic modalities. CBT is a top-down treatment. The others mentioned here are bottom-up. Some people regard pharmacological treatment as bottom-up. I don't see it that way. For people with MDD and BD, medication corrects for errant biological processes and rebuilds a framework from which other treatments will be more effective. CBT can be combined with these other treatments. Perhaps it is counterproductive for some people. I don't know.
- Scott
Posted by Cecilia on January 8, 2012, at 19:01:31
In reply to Re: A couple questions for Scott (SLS) » Cecilia, posted by g_g_g_unit on January 7, 2012, at 23:51:47
Well, I suppose it sounds paranoid to think a T would be laughing at me. I don't have any trouble figuring out where that belief came from; I had a sister who used to laugh at me a lot. And it makes sense to think in terms of whether a particular belief is working for you instead of whether or not it's "right". Just don't understand how you can force yourself to not believe something even if you can agree the belief isn't helpful. I guess it's because deep down you do believe it's helpful. For example, believing my T was laughing at me made me feel more in control, like I wouldn't be taken by surprise if she did. In the end of course, this belief wasn't particularly helpful, she became fed up with my mistrust and dumped me. Cecilia
Posted by n_shrimpie on January 9, 2012, at 20:56:41
In reply to A couple questions for Scott (SLS), posted by Bob on December 31, 2011, at 14:33:55
>
> Scott,
>
> You mentioned awhile back about using CBT for rumination problems (at least I think it was you). If I am indeed remembering correctly, I was wondering if you could tell me how exactly you implement that technique in your particular situation?
>
> Also, have you had any lasting side effects from Abilify?
>
> Thanks,
>
> BobBob,
A great CBT book that my doctor suggested is "feeling good" (trite title but was very helpful to me)by David. D. Burns.
Posted by Bob on January 9, 2012, at 23:40:51
In reply to Re: A couple questions for Scott (SLS), posted by n_shrimpie on January 9, 2012, at 20:56:41
> >
> > Scott,
> >
> > You mentioned awhile back about using CBT for rumination problems (at least I think it was you). If I am indeed remembering correctly, I was wondering if you could tell me how exactly you implement that technique in your particular situation?
> >
> > Also, have you had any lasting side effects from Abilify?
> >
> > Thanks,
> >
> > Bob
>
> Bob,
>
> A great CBT book that my doctor suggested is "feeling good" (trite title but was very helpful to me)by David. D. Burns.Thanks, I'll check it out.
Bob
Posted by SLS on January 10, 2012, at 6:33:33
In reply to Re: A couple questions for Scott (SLS), posted by n_shrimpie on January 9, 2012, at 20:56:41
> >
> > Scott,
> >
> > You mentioned awhile back about using CBT for rumination problems (at least I think it was you). If I am indeed remembering correctly, I was wondering if you could tell me how exactly you implement that technique in your particular situation?
> >
> > Also, have you had any lasting side effects from Abilify?
> >
> > Thanks,
> >
> > Bob
>
> Bob,
>
> A great CBT book that my doctor suggested is "feeling good" (trite title but was very helpful to me)by David. D. Burns.
David Burns is gentle. I like his stuff. I believe he created a depression rating scale that works pretty well.Albert Ellis died a few years ago from a fall - quite tragic. He was anything but gentle.
- Scott
This is the end of the thread.
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