![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by MattDDS on July 7, 2002, at 13:48:14
Hello everyone!
I'm new to this board. I have used CBT self-help
techniques to ease severe anxiety and depression,
and have had quite a bit of success. It is my
understanding that CBT and meds have the two most
empirically supported success rates as far as
anxiety and depression go. I'm curious as to why
people here don't seem too enthused about this
approach.Anyone else have any luck with CBT? I have read
mixed opinions about this topic on here. It seems
to be somewhat controversial on this board.I think it would be cool to start a productive
thread where we could exchange ideas about CBT.
Anyone interested?Matt
Posted by ensoul on July 7, 2002, at 13:53:34
In reply to Anyone interested in CBT? Let's talk!, posted by MattDDS on July 7, 2002, at 13:48:14
Matt,
What is CBT? I don't know what the intials stand for. So do tell more
lynn
Happy people make my ass twitch
from the movie, French Kiss
Posted by MattDDS on July 7, 2002, at 16:10:22
In reply to Re: Anyone interested in CBT? Let's talk!, posted by ensoul on July 7, 2002, at 13:53:34
> Matt,
>
> What is CBT? I don't know what the intials stand for. So do tell more
>
> lynn
>
>
> Happy people make my ass twitch
> from the movie, French KissHi Lynn (and others too!,
CBT is Cognitive-Behavioral Therapy, a type of
psychotherapy which has gotten a good deal
of exposure lately (last decade or so). Its
efficacy for anxiety (nearly the whole spectrum of
anxiety disorders including OCD, panic disorder,
GAD and social anxiety) and depression has been
supported in numerous scientific studies. It has
been shown to be at least as effective as meds for
depression (including severe depression with
'melancholic' features) and from what I understand,
has better long-term outcomes (fewer relapses,
higher end-state functioning). If you are
interested I can provide some references from peer-
reviewed journals.Do a little research on it, if you like. It is
based on the idea that distorted thinking (hence
cognitive) and depressogenic behavior perpetuate
and perhaps even contribute etiologically, to
depression. The therapy therefore targets
specific problems such as anhedonia in depression
or the tendency to ruminate in GAD.This has been the only approach to work for
me. I spent time trying to 'talk' it out in
nondirective or psychodynamic therapy, and tried
plenty of different drugs and coctails of drugs.
None of this helped me personally, although I
understand medication helps many people.Try these links:
www.cognitivetherapy.com/site_map.html
www.nacbt.org/David Burns, MD is a popular author in the self-
help arena. His most popular books are Feeling Good
and the Feeling Good Handbook. (Cheesy name, I know
but these books are very helpful).Well, sorry so rambly, but there's a small intro.
I hope this is useful to you!Take care,
Matt
Posted by mist on July 7, 2002, at 22:48:09
In reply to Anyone interested in CBT? Let's talk!, posted by MattDDS on July 7, 2002, at 13:48:14
Matt,
This thread is a good idea.
I have tried some of the techniques in Feeling Good. The most common thought distortion that I identified in myself was what Burns calls "fortune telling." A lot of the thinking that causes or comes from my depression is about the future. The hopelessness of the future. Some of this has to do with the feeling that I don't quite function up to par (due to having what I realize now are ADD traits) so things won't get better or ever be okay. But I think I also have a fatalistic sense of the future that goes beyond my own sense of ability or lack thereof. Sometimes this feeling is more or less operant in me but I can't attribute that to anything in particular.
What I find to be a stumbling block is what to do after I've identified this thought pattern. Because you're supposed to replace negative thoughts with more "rational" ones. But I usually don't believe anything more positive, however I word it. So I'm not sure that I can deliberately change thoughts that come from depression. Or if the thoughts cause the depression. When I took 5-HTP I noticed more positive thoughts coming into my mind at times. I almost felt like an alien had invaded my head. lol.
How has CBT worked for you?
Posted by ensoul on July 7, 2002, at 22:55:50
In reply to Re: Anyone interested in CBT? Let's talk!, posted by MattDDS on July 7, 2002, at 16:10:22
> David Burns, MD is a popular author in the self-
> help arena. His most popular books are Feeling Good
> and the Feeling Good Handbook. (Cheesy name, I know
> but these books are very helpful).
>
> Well, sorry so rambly, but there's a small intro.
> I hope this is useful to you!Nah, takes time to explain things and thanks for the info
Actually about a year ago an online friend sent that book by David Burns, though I know it's been helpful for many, just doesn't work for methank you though
lynn
Don't hate yourself in the morning
-- Sleep till noon!
Posted by MattDDS on July 8, 2002, at 1:49:12
In reply to Re: Anyone interested in CBT? Let's talk!, posted by mist on July 7, 2002, at 22:48:09
> Matt,
>
> This thread is a good idea.
>
> I have tried some of the techniques in Feeling Good. The most common thought distortion that I identified in myself was what Burns calls "fortune telling." A lot of the thinking that causes or comes from my depression is about the future. The hopelessness of the future. Some of this has to do with the feeling that I don't quite function up to par (due to having what I realize now are ADD traits) so things won't get better or ever be okay. But I think I also have a fatalistic sense of the future that goes beyond my own sense of ability or lack thereof. Sometimes this feeling is more or less operant in me but I can't attribute that to anything in particular.
>
> What I find to be a stumbling block is what to do after I've identified this thought pattern. Because you're supposed to replace negative thoughts with more "rational" ones. But I usually don't believe anything more positive, however I word it. So I'm not sure that I can deliberately change thoughts that come from depression. Or if the thoughts cause the depression. When I took 5-HTP I noticed more positive thoughts coming into my mind at times. I almost felt like an alien had invaded my head. lol.
>
> How has CBT worked for you?Hey Mist,
This is exactly the type of exchange I was hoping for! I'm glad you brought up the
issue about not believing your more 'rational' response.This was a major problem I had (and sometimes still come across), believing the new
'rational' response at a gut level. This is where you have to put in a lot of work.
The CBT gurus would answer that by saying you need to:1. make the rational response 100% believable, not 'power of positive thinking' BS
2. use 10-15 different methods to help yourself believe the new thoughtThis approach has worked quite well for me. But you are absolutely right, it is hard
to understand on a 'gut level' sometimes that your thinking is screwed up, because when
we are depressed (or anxious) everything 'feels' screwed up. (emotional reasoning? lol)Like you, I am a HUGE fortune teller, which is a big source of my anxiety!!
You wondered about whether the thoughts cause the emotions or vice versa. I wondered
that for so long, and my conclusion is that it is a bidirectional relationship. At
least that has been my experience. Don't you notice that right after you think something
negative (automatic negative thoughts) you get a pang of despair? I do. Sometimes they
are like a blizzard of negative thoughts, but if I am persistent enough I can break
out of it. Although I think some CBT researchers did some pretty good research showing
a large causal effect of automatic negative thoughts on anxiety and depression! This
study was very interesting to me, and if you want I can give you a reference.Can you give me a specific example of one of your thoughts that is giving you trouble?
Maybe we could work on it and beat the hell out of it! lol. I'll show you how I treat
my negative thoughts!You asked how CBT had helped. I track my moods using the Beck Depression Inventory (BDI)
and the Beck Anxiety Inventory. I started out with 'severe depression' and a nearly
constant level of 'extreme anxiety or panic', and now I usually score pretty low, mild
depression and anxiety, or none at all.Damn I talk a lot! Hope some of this helps. Take care.
Matt
p.s. If you don't mind me asking, what is your diagnosis or problem you are dealing with?
Posted by mist on July 8, 2002, at 12:04:47
In reply to Re: Anyone interested in CBT? Let's talk!, posted by MattDDS on July 8, 2002, at 1:49:12
Matt,
My main problem is depression. I also have a low-grade background anxiety about going outside of my home (although I do enough to meet my basic needs). But I'm most concerned about the depression. Fortunately, though, it's not as bad presently as it has been at other times.
I'll think of an example of one of my negative thoughts and post it. I used to be more aware of them when I was trying the Feeling Good techniques and was writing them down on a regular basis (although I never did this long term). I'm less aware of specific thoughts now (other than obvious ones, such as "I'm hungry." lol.) The negative thoughts mostly operate below the surface, so even pulling them out to the light of day takes some effort. I have to stop and try to "listen" to them. One thing I noticed in the past was that sometimes when I'd write down these thoughts, seeing them on paper would make me feel more depressed! (Not always though.)
I'll let you know when I can identify a thought to try to change. I'm in a bit of a fog right now, but I like the idea.
It's good to hear that CBT has worked for you. Can you give an example of a specific thought you were able to change, resulting in your feeling better? Also, did you use any of the behavioral techniques in Burns books?
-mist
Posted by MattDDS on July 8, 2002, at 13:05:37
In reply to working with CBT, posted by mist on July 8, 2002, at 12:04:47
Hi Mist,
You asked with which thoughts, in particular, had CBT worked?
I used to get extremely anxious about dying. I'm in great health, had medical training
and I'm only 27, but just thinking about dying would induce panic attacks. CBT worked
wonderfully for me on thoughts surrounding death and dying. I can say that I am not
particularly concerned about dying anymore (but, of course I would strongly prefer to
keep living, lol).You also asked if I used any of the behavioral techniques. Yes. These are extremely
helpful for me. Specifically, the Daily Activity Schedule, and the Tic-Toc method.
These were helpful to overcome the anhedonia and anergia associated with depression.
You mentioned you 'had some ADD characteristics'. Check these out, as they target
things like task orientation and motivation. BTW, have you considered that your 'ADD
characteristics' MAY be related to anxiety or depression? Just a thought.
Funny, you mentioned that the thoughts seem to operate on a somewhat subconscious level.
Burns suggested a pretty interesting technique for this. It is very simple, but I don't
believe things need to be complicated, so long as they work. The method involves drawing
a stick figure representing yourself, with a word bubble. You try to imagine what would
be bothering this person (you), and formulate a concise negative thought corresponding
to what you would be thinking. You then apply the standard techniques to try to put it
to lie.Seriously, I'm curious about what thoughts you are having that are so difficult to treat
using CBT. Try me, I have had some weird ones too! I bet they are not as difficult
as they seem. (I do not mean to sound insensitive, just positive :))CBT is not for everyone, and there are disadvantages. Namely, it takes a lot of time
and energy to work out these thinking patterns. I do believe, however, that most can
get at least some benefit out of it. The thing I like most about it is that it is
somewhat more proactive, and, in my opinion, more specific than waiting and hoping for
a pill to work, or merely 'talking through it'. (Please do not interpret this as being
anti-meds, I have benefitted from some meds (benzos), and know others do as well. If
antidepressants worked for me, I would be and stay on them indefinitely. I have no prob
with meds, per se, other than the fact that they do not work at all for me).Bring on the negative thoughts!! haha.
Take care,
Matt
Posted by mist on July 8, 2002, at 14:36:35
In reply to Re: working with CBTMist, posted by MattDDS on July 8, 2002, at 13:05:37
>BTW, have you considered that your 'ADD
characteristics' MAY be related to anxiety or depression?Anything is possible. :) Although I have reasons to believe it's ADD.
The behavioral and cognitive techniques you mentioned sound interesting to try.
I'll try to identify one of my recurring negative thoughts to post at a later time.
Posted by Dinah on July 9, 2002, at 9:26:57
In reply to Anyone interested in CBT? Let's talk!, posted by MattDDS on July 7, 2002, at 13:48:14
I think this is a terrific idea, Matt. I've had decidedly mixed success with CBT, although I certainly see it's helpfulness in theory.
My main problem with it is that I find straight by the book CBT rather annoying. That's just me, of course. I tend to be rather nonconformist. I always laugh that my therapist (who appears to have a CBT approach, especially for short term therapy) has to sneak in CBT ideas. I find it works much better that way for me, and doesn't raise my hackles as much.
My second problem is that I am perfectly capable of holding two contradictory beliefs at once. Intellectually, I can think the logical non-distorted thought and believe it completely, but emotionally I don't believe it for a second.
The most helpful thing I have found in CBT is the behavioral techniques. And I've often wondered whether DBT would be a softer more palatable form of CBT.
Did you do your CBT with the help of a therapist or did you do it on your own? And what did you find most helpful and most problematic?
Posted by MattDDS on July 9, 2002, at 11:53:14
In reply to Re: Anyone interested in CBT? Let's talk! » MattDDS, posted by Dinah on July 9, 2002, at 9:26:57
Hey Dinah,
Cool post, and I can relate to a lot of it. Especially the part about CBT annoying you.
One specific problem that I encountered was when I was working on a thought about "you'll
never recover from depression". It was very hard for me to loosen my belief in this.
I remember thinking things like, "I can tell myself I'll get better, but I just can't
believe this crap!". It didn't seem realistic because I had been depressed for roughly
eight years to some extent. So why the hell even try to get better? I nearly dropped
out of dental school my second year.My solution was to do a cost-benefit analysis of holding on to this belief. When I did
this, I realized that one of the reasons preventing me from working harder was, among
others, fear of failure (to recover from severe anxiety and depression). It helped me
see (of course, over a period of weeks), that there was no real advantage in giving in to
this feeling. I decided that giving up had no advantages, and working hard on CBT self
help stuff also had no drawbacks whatsoever, and very possibly might help. To sum, it
cannot hurt, is free (self-help, anyway), there are no side effects (presumably) and you
can take as large of doses as you like! That is what excites me about CBT.My recovery was not as magical or fast as some CBT experts (Burns or Ellis) tend to
describe it. I think they may have done themselves somewhat of a disservice by leading
people to believe it is "fast and easy". For me, far from it! I had to work my ass off,
and still do! It took me months to recover! But it was all well worth it to get myself
into remission. Currently, my worst days entail "mild depression and anxiety", which are
usually transient, and serve as reminders that I am not 'cured', just remitted.You're absolutely right about the behavioral techniques. They can help to make you realize
that, despite how lousy your body feels, you *can* get out of bed in the morning, and do
at least some things. One of my greatest realizations is that if I'm going to feel like
shit (can you say that here?) I may as well be doing something productive while I'm feel-
ing like shit! The Tic-Toc methods and the Daily Activities Schedule (Burns) helped me
tremendously, as I told Mist in the another post.CBT is not for everyone. But seeing as how I got **no** response to any antidepressants
I was left with not a whole lot of options before I got to the real desperate stuff! I
was ready for ECT!! I always get extremely jealous of those who have miraculous
responses to the first antidepressant they try! If only it were that simple for me!As for the DBT, I don't know much about it, but it sounds like a variant of CBT. I think
it is geared toward individuals who have 'personality disorders'. Did I get this right?
I did most of my CBT alone, although I did spend some time at the Albert Ellis institute,
(I live in New York City) which helped somewhat.I hope this can help someone, but again I'm afraid I've talked your ear off!
Take care and good luck!
Matt
Posted by Mark H. on July 9, 2002, at 16:17:43
In reply to Anyone interested in CBT? Let's talk!, posted by MattDDS on July 7, 2002, at 13:48:14
Hi Dr. Matt,
Welcome, and thank you for your enthusiastic posts about cognitive therapy. I would like to know more about the self-talk and behavioral techniques you've found to be most effective. Also, perhaps you could offer a more general description of the theory and practice for those here who have no background at all with cognitive therapy.
Once I found the right mix of meds for me (after four years of trials with more than 25 different anti-depressant and adjunctive medications), then I could begin healing in therapy. Prior to that -- during the most severe periods of depression -- I simply couldn't concentrate enough to benefit from any form of therapy.
After the meds kicked in, I saw a counselor who specialized in cognitive therapy for depression. I had weekly sessions with him for nine months. Perhaps the most important thing I gained from that time can be described by one question:
"Is it realistic for me to think that other people share my values and beliefs about [whatever was bothering me]?"
(Hint to readers: the answer is always "no.")
Note that the question is NOT, "SHOULD other people behave in a certain way?" but rather, "Is it REALISTIC to think that they will?"
One of my goals was to overcome being angry with people who drive dangerously. If someone cut me off on the freeway or was tail-gating another car at 80 mph, I would become so flushed with adrenaline that sometimes it would keep me awake half the night! Obviously, my anger didn't add any positive value to the situation -- it just made me feel worse.
My counselor suggested a simple trick of the mind: everyone else who drives on the road is my mother. For several months, when another driver did something foolish or dangerous, I'd say, "Mom! Take some driving lessons! You're scaring me with your bad driving!" Over time, this trick of thinking dissolved my previously uncontrollable and instantaneous reaction of excessive anger. The "charge" I had about bad drivers just faded away, and my own driving improved.
For those reading this who want to work on a particular issue or behavior that bothers them, it's important to remember that the issue (or idea) to erode is the one you would most aggressively defend for moral, ethical or personal reasons. Again, it's not whether you're right or wrong about what you believe, it's only whether it is realistic for you to expect other people to share your values and beliefs.
When I'm honest with myself, I can use this technique to find my own "hot buttons" to push and work on. But it's easier to do with a therapist who can BOTH support my beliefs AND help me erode my attachments and aversions about them at the same time.
Thanks for starting this thread, Dr. Matt. I look forward to reading more from you.
With kind regards,
Mark H.
Posted by MattDDS on July 9, 2002, at 22:58:37
In reply to Re: Positive experiences with cognitive therapy, posted by Mark H. on July 9, 2002, at 16:17:43
Hi Mark,
Wow! I really enjoyed reading your well articulated post on how CBT has benefitted you.
It helps to know that other people have been helped as much as I have by this.What you said about anger was really interesting. You mentioned that you would tell
yourself that people 'should' do this or that. It is easy to see how these thoughts
and beliefs would lead to the corresponding behavior you described (e.g. road rage, etc.).
Amazing how subtle shifts in attitude lead to profound changes in mood and behavior!I think I can relate to your situation during the acute depression. During those times
it is indeed quite difficult to muster up the motivation necessary to complete the CBT
exercises. You are quite fortunate to have responded well to an antidepressant. I think
I probably tried around the same number of medications, but I did not have any luck with
any of them. I should say, however, that benzodiazepines were quite helpful during the
worst parts, as anxiety is probably an even bigger problem for me than depression.I also had a lot of physical manifestations. I had pseudo-neurological symptoms (my right
arm felt subjectively weak and tingly), high cortisol and catecholamines, and a constant
feeling of malaise. However, I think that everyone has some 'breakthrough' days, even
when severely depressed. I used these days to work hard on the CBT exercises, and built
some momentum. I used the behavioral techniques to prevent my life from falling apart.You hit it right on the head with what you said about being 'right'. This was a huge
realization for me. I used to have thoughts like "with all the bad things happening,
how can I possibly be happy, life sucks!". This has some truth to it. There *are* a
lot of bad things that happen. One day I decided to do a cost-benefit analysis of this
belief. I had the following realization: It is neither appropriate nor beneficial for
me to allow [X bad event] to keep me from being happy. Better yet, this is an irresponsible
and sadistic way to treat myself!You asked about which techniques I used. Are you familiar with David Burns' work? I got
a lot of techniques from his books, Feeling Good, and the Feeling Good Handbook. I used
the daily mood log every night, for at least 1/2 hr. I would identify the thoughts that
most bothered me or would recur and apply lots of different techniques on them. I used
the semantic method, the socratic method, thinking shades of gray, the downward arrow
technique among others.I also suffered from panic attacks, and did exposure exercises for this. This entailed
inducing physical arousal by drinking a lot of caffeine! There are lots of other things
you can do, such as hyperventilating, running up stairs and staring into a mirror to
induce derealization. This sounds crazy, but I really wanted to face up to these
attacks. I have not had a panic attack since! I still get the symptoms of arousal, but
now it does not escalate to full blown panic as it used to. Basically I stopped running
away from them and the fear went away! Educating myself about panic helped too, serving
to demystify the symptoms and realize that they are harmless. Now I say, BRING IT ON!!!In sum, you get out of CBT what you put in. That is what I like so much about it. I
recently read a scientific study that showed large causal effects of completing CBT
homework assignments on recovery from depression. This is exciting to me, and parallels
my own experience.Take care,
Matt
Posted by Dr. Bob on July 10, 2002, at 11:13:35
In reply to Re: Positive experiences with cognitive therapy, posted by Mark H. on July 9, 2002, at 16:17:43
> it's important to remember that the issue (or idea) to erode is the one you would most aggressively defend for moral, ethical or personal reasons. Again, it's not whether you're right or wrong about what you believe, it's only whether it is realistic for you to expect other people to share your values and beliefs.
Hmm...
Bob
Posted by Mark H. on July 10, 2002, at 11:22:38
In reply to Re: Positive experiences with cognitive therapy » Mark H., posted by MattDDS on July 9, 2002, at 22:58:37
Hey Matt!
Thank you for your great reply. It's exciting to read that you were able to use cognitive/behavioral therapy to improve your life even during brief periods of respite from severe depression and to overcome panic attacks.
I happen to disagree with the premise in CBT that thoughts precede disturbing feelings. My personal experience is that my negative feelings more frequently arise first, and that thoughts about those feelings come later. However, this difference in no way limited my use of CBT techniques or their effectiveness. Empirically speaking, if it works, it works.The more intelligent and informed a person is, the more she or he is able to find and articulate substantive evidence everywhere to support negative feelings and physical depression. After all, facts are facts. Or are they?
When I looked closely at any thought I had -- even about something as neutral as a familiar physical object -- I found that cognition is always an interpretation of reality, not reality itself (this may have been obvious to everyone but me). If I think of an orange -- its size, color, texture, smell, its wonderful flavor and sweetness -- those thoughts, however "accurate," are nevertheless not the same as an orange. They are a combination of memories of direct experience, associations with those experiences, and thoughts about those experiences.
How much further from "real" are my thoughts about complex human interactions? About my place in the world, my family, my work, my social adaptations, my education, my important life decisions? When I began to understand that all of my thoughts are far from "true," then I felt free to modify my thinking, beliefs and responses to life circumstances and began to let go of the need to be "right" all the time or to have the "correct" answer (as though there were only one acceptable way to solve a problem or respond to a situation).
This does not mean that I have abandoned my values and beliefs. Instead, it means that I less often make the mistake of thinking others necessarily share my beliefs. For instance, my experience suggests that most people are honest, reliable and good-hearted. However, I balance that trust with a practical wariness that calls for due diligence in matters involving significant exposure, whether financially, professionally or interpersonally.
Above all, it gives me permission to indulge "corrective" beliefs -- however fanciful -- to help manage my feelings, thoughts and behaviors. Obviously, every other driver on the freeway isn't really my mother! However, that playful belief was instrumental in dissolving my rage response to bad drivers.
Cognitive therapy is direct and offers a lot of hope to those of us who suffer from depression, because it is based on the verifiable, repeatable principle that we CAN change our minds and, in doing so, change how we feel and how we react to situations over time. It is not necessary to accept or even agree with all of the principles of cognitive therapy in order to begin to benefit from their application through practice.
Best wishes,
Mark H.
Posted by Mark H. on July 10, 2002, at 11:41:48
In reply to Re: the issue to erode, posted by Dr. Bob on July 10, 2002, at 11:13:35
Dr. Bob,
That was not only bad English on my part, it also didn't convey what I meant. Let me try again.
The beliefs that are most profitable for me to work on using the techniques of cognitive/behavioral therapy are those that have a strong (usually negative) emotional charge for me.
For instance, I think my co-workers should maintain a high degree of professional integrity, the more so because we work for a non-profit organization that enjoys tax-exempt status and therefore is in the public trust.
In the past, I would become excessively agitated if someone I worked with did something that I believed to be unethical or improper. The strength of my negative feelings did not add value to the situation, help the employee or the organization.
Note that I'm talking about the strength of my negative feelings, NOT my right to believe (and enforce) that those I work with maintain high levels of integrity. That's the important difference that is clarified in cognitive therapy.
I still assure, whenever I can, that our organization behaves ethically and responsibly. I still raise ethical and moral considerations in meetings. I still influence decision-making and outcomes. However, as I work on my beliefs about and expectations of other people, my responses become less emotional and more effective.
"The issue to erode" doesn't do it at all. It is more a matter of discerning the difference between the substance of the belief and the emotional and cognitive responses I experience when that belief is violated by another.
I hope this helps make up for my poor choice of words. I'm a work-in-progress. :-)
Best wishes,
Mark H.
Posted by mist on July 10, 2002, at 14:18:10
In reply to Re: the issue to erode » Dr. Bob, posted by Mark H. on July 10, 2002, at 11:41:48
>the issue to erode....
It depends on what issues each person is dealing with. For me, the thoughts that accompany being stuck in inactivity and hopelessness are the most problematic. Something to the effect of, nothing is worth doing because nothing can change. That sounds irrational but part of me believes it enough to influence my other thoughts and behavior.
Regarding whether the feeling comes from the thoughts, or the other way around, I tend to think the thoughts come from a depressed state. But I also believe that (speaking for myself only) my depression is a response to my circumstances (especially past circumstances, but also present, which creates a vicious cycle). Part of how I respond is the way I think. So the cause and effect appear more like a two way street to me.
I believe that insights about how I came to whatever distorted beliefs I have would be the most powerful thing in change. But insights are also the hardest to come by. You can talk forever in therapy and still not gain significant (life changing) insight about the origin of your psychological problems. It depends on too many variables, and talk therapy is just too expensive with no guarantees. So if working with thoughts or taking meds helps me, I would rather do that, even though I believe the change that comes through insights would be the most deeply healing.
>Above all, it gives me permission to indulge "corrective" beliefs -- however fanciful -- to help manage my feelings, thoughts and behaviors. Obviously, every other driver on the freeway isn't really my mother! However, that playful belief was instrumental in dissolving my rage response to bad drivers.
I like this idea. It's easier for me to do things like this than write down a list of my depressed/depressing thoughts, because that can make me feel worse (although I am still planning to try it again, just in case it works differently next time).
Posted by MattDDS on July 10, 2002, at 14:27:34
In reply to Re: Positive experiences with cognitive therapy, posted by Mark H. on July 10, 2002, at 11:22:38
Hey Mark,
I am not sure about the relationship between cognition and emotion either! This has been
one of the most perplexing things to me. However, one thing I am relatively sure of is
that it is not a one-way street. You stated that you disagree with this premise in CBT.
I would tend to agree with you. My experience, as well, has been that feelings sometimes
tend to precede the cognitions surrounding them. Perhaps the cognition is our attempt
to ascribe meaning to the emotion.The interplay between cognition / behavior / emotion is much more likely reciprocal and
extremely complex than a simple one way relationship. I think the reason the effects of
cognition on emotion and behavior are stressed so much in CBT is that we can't really
control emotion directly! In other words, since we can't attack emotion directly (other
than with medication, perhaps) we focus on the variables of the equation that we have some
control over (cognition and behavior).What you mentioned about 'reality' is right in line with the ideas I have. Especially
about morals and values. I have a tough time believing that there is really some 'ultimate
reality'. This can be said of simple things, you gave the example of the orange, and even
more so of extremely complex things, e.g. what is 'right' or 'wrong'. Things that I find
reprehensible may seem completely acceptable and even praiseworthy to others. Who is 'right'?
And what is the path that all of us can follow to reach the same conclusions?I think a common fear is that, if we loosen or broaden our beliefs, we will become monsters!
I believe the opposite is true, tragedy usually arises from a strong belief in moral
absolutes. Take me for example. I loosened and even abandoned many of my tightly held
religious beliefs some time ago. Despite this, I have not yet taken to promiscuity, dishonesty,
drinking alcohol, using drugs or any other of the things I was conditioned to fear.That does not mean that it is wrong for us to protect our interests (e.g. the war on terror
or cracking down on corporate dishonesty). We can still even defend what we feel is 'right'.
And most of us agree, at least to some extent, on what is good or bad.Language arose to fill a specific need at specific times, and was not meant to serve as a
reflection of 'reality'. Even in science, we do not really 'know' anything. We have useful
theories that can accurately predict some phenomena, and serve us well for practical purposes.
Whether these theories are 'right' is another story.How does this all relate to CBT? Like you said, it shifts the focus from what is 'right', to
what is likely to be helpful. Is my belief that 'I am a worthwhile human being' 'right' or
'wrong'? I don't even know what that question means! I believe this because it serves a
purpose for me, to give me a sense of meaning and makes life a little more comfortable and
enjoyable. And hell, if Osama bin Laden or Hitler can believe themselves to be worthwhile,
why can't I?Take care,
Matt
Posted by Dr. Bob on July 11, 2002, at 9:34:39
In reply to Re: the issue to erode » Dr. Bob, posted by Mark H. on July 10, 2002, at 11:41:48
> That was not only bad English on my part, it also didn't convey what I meant.
Sorry, I was too cryptic again. I thought it conveyed it just fine. And it got me thinking...
> I still assure, whenever I can, that our organization behaves ethically and responsibly. I still raise ethical and moral considerations in meetings. I still influence decision-making and outcomes. However, as I work on my beliefs about and expectations of other people, my responses become less emotional and more effective.
Since it would be nice if my responses here could be more effective. :-)
Bob
Posted by melinda on July 11, 2002, at 23:26:19
In reply to Re: the issue to erode, posted by Dr. Bob on July 11, 2002, at 9:34:39
Has anyone ever had positive results with CBT for schizophrenia? I've recently started CBT for delusions and voices. So far it's been interesting, though there is still much work to be done.
-melinda
Posted by Mark H. on July 12, 2002, at 0:44:24
In reply to Re: Positive experiences with cognitive therapy, posted by melinda on July 11, 2002, at 23:26:19
Melinda,
I have no personal experience with schizophrenia, but I would be very interested in reading about your experiences with learning to manage delusions and voices with cognitive/behavioral therapy.
I've had a few excellent on-line conversations in the past with highly functional schizophrenics who have trained themselves to discern when they are hallucinating. Their adaptations included understanding that other people do not hear the voices, for instance, and realizing that the voices are not a reliable or trustworthy source of information or direction.
Is the goal of CBT to to cause the cessation of delusions and voices or to recognize what they are without trying to stop them?
If you are comfortable explaining what it is like for you, I am very interested in learning more about your condition and how you are dealing with it.
Best wishes,
Mark H.
Posted by irishcatholic on July 12, 2002, at 10:31:44
In reply to Anyone interested in CBT? Let's talk!, posted by MattDDS on July 7, 2002, at 13:48:14
Great discussion here folks
Thanks for your insights and taking time to help out!
Posted by MattDDS on July 12, 2002, at 13:34:08
In reply to Re: Positive experiences with cognitive therapy, posted by melinda on July 11, 2002, at 23:26:19
Melinda,
I have read a little about using CBT for schizophrenia. This application of CBT
is less researched than in mood disorders like depression and anxiety. However, I was
just in the local university library and ran across a book by Adrian Wells (I can't
remember the name of the book, sorry!) which talked about CBT treatment of schizophrenia
and how it is evolving.I think there are exciting new developments as far as CBT applications. From what I
understand, CBT tries to help reduce dysfunctional beliefs about the auditory
hallucinations (hearing voices) in schizophrenia. Like Mark said, the goal here is to
try to reduce the dysfunctional beliefs associated with the delusions (e.g. that they
provide helpful or reliable information or that they are harmful). In essence, you can
treat these delusions like a depressive would treat negative thoughts.From my understanding, with the help of the newer neuroleptic medications along with
techniques in CBT (or other psychotherapy for that matter), the prognosis for recovery
from schizophrenia can be quite good!Good luck and do keep us posted on your progress!
Take care,
Matt
Posted by melinda on July 12, 2002, at 21:56:37
In reply to Re: Positive experiences with cognitive therapy, posted by Mark H. on July 12, 2002, at 0:44:24
Since I'm just at the beginning of the CBT I haven't learned much in the way of managing the delusions and voices. At this point, I'm learning about delusions and voices. My last "homework" was to read a couple articles about schizophrenia and voices and fill out surveys (BIS, BAVQ-R, BDI-II, BAI, and thought control questionnaire). Once I get further along in the CBT, I'll provide an update.
My understanding is that the goal of the CBT is to help me identify the delusions and hallucinations and "correct" them. At the same time I'll learn coping strategies so the experiences are less distressing.
-melinda
Posted by phazedout on August 3, 2002, at 9:40:03
In reply to Anyone interested in CBT? Let's talk!, posted by MattDDS on July 7, 2002, at 13:48:14
Hi, just read the thread. I dunno about anyone else but I had really bad experiences with CBT, it was too 'here & now" for me, too many "your on a see-saw", "you need to balance yourself" things about it! Its fine if your problems are here and now but if they, like many, stem from the past then I suggest you check out CAT (analytical) as well as CBT.
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