![[dr. bob]](/dr-bob-sm.gif)
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 PuraVida on March 8, 2003, at 18:30:07
I tend to write long posts - need to get this off my chest. Maybe someone else has similar thoughts?
I have been really, really stuck lately - been trying everything and the hole seems to be getting deeper. I live by myself, and don't have a job, and my friends and family think I'm just too busy to call (or call them BACK for that matter.) I can't even pick up the phone to call my Dad or sister - I feel like such a looser that here I am, depressed again. I don't want them to worry about me, or pity me, or feel burdened by me. I want them to be proud of me - that I am happy. But I know that its not my fault - don't I?
The crazy thing about depression is that I can write that and think that and say that (it's not my fault) but no way do I believe it right now.
Burns talks about pleasure predicting - and I've been testing myself to see if I do feel better after doing XY or Z. And, I don't - each step I take seems to exhaust me and I head for the bed - but with this depression I can't sleep as much as I have with others. Too bad - wish I could. So, even calling my sister or dad seems like it won't ease my pain and will only make them worry.
I so wish someone would just come and take care of me - do the rational thinking for me since I can't - make sure I'm not going to go bankrupt or loose my friends because I am letting so many things slide. And just give me time to get out of this - if the meds will ever work!
But there is just me - I know everyone else has their own lives to live. I thought about asking my Dad to come stay with me, but then again, its a temporary solution and if I know me, I'll just suck it up while he's here and collapse again when he leaves.
Sometimes too I just wish I could tell people "I am depressed right now" the same way one can say they have the flu. Seems like it would ease some of the guilt, but then when I'm depressed I even feel guilty about having the flu - because "if I'd taken better care of myself I wouldn't have caught it!"
What a mess. I think I'll call my dad.
Thanks,
PV
Posted by fayeroe on March 9, 2003, at 9:12:05
In reply to Getting unstuck - need help if you can please, posted by PuraVida on March 8, 2003, at 18:30:07
> I tend to write long posts - need to get this off my chest. Maybe someone else has similar thoughts?
>
> I have been really, really stuck lately - been trying everything and the hole seems to be getting deeper. I live by myself, and don't have a job, and my friends and family think I'm just too busy to call (or call them BACK for that matter.) I can't even pick up the phone to call my Dad or sister - I feel like such a looser that here I am, depressed again. I don't want them to worry about me, or pity me, or feel burdened by me. I want them to be proud of me - that I am happy. But I know that its not my fault - don't I?
>
> The crazy thing about depression is that I can write that and think that and say that (it's not my fault) but no way do I believe it right now.
>
> Burns talks about pleasure predicting - and I've been testing myself to see if I do feel better after doing XY or Z. And, I don't - each step I take seems to exhaust me and I head for the bed - but with this depression I can't sleep as much as I have with others. Too bad - wish I could. So, even calling my sister or dad seems like it won't ease my pain and will only make them worry.
>
> I so wish someone would just come and take care of me - do the rational thinking for me since I can't - make sure I'm not going to go bankrupt or loose my friends because I am letting so many things slide. And just give me time to get out of this - if the meds will ever work!
>
> But there is just me - I know everyone else has their own lives to live. I thought about asking my Dad to come stay with me, but then again, its a temporary solution and if I know me, I'll just suck it up while he's here and collapse again when he leaves.
>
> Sometimes too I just wish I could tell people "I am depressed right now" the same way one can say they have the flu. Seems like it would ease some of the guilt, but then when I'm depressed I even feel guilty about having the flu - because "if I'd taken better care of myself I wouldn't have caught it!"
>
> What a mess. I think I'll call my dad.
>
> Thanks,
> PV
>
Dear PV: I am between jobs. My daughters think I'm crazy.....a few of my friends know that I am depressed. A counselor friend just confided that he started on Zoloft and is so happy about how it is helping HIM! My sisters and brother are so dysfunctional that I don't talk to them. Their solution to everything is GUILT> I also lived with my mom til she died, after she started having strokes, and that was some of the calmest times that I've had in a long time. You can see post to Krissyp and understand more. BUT, depression is an illness just like the flu. Only we don't have any control over having it. It's a chemical imbalance and all we can do is try meds, exercise, eat right, etc. etc.....so here I sit, 59, no job (magic interview though on Friday at private hospital)and alone. But when I look at other alternatives, I'd rather be where I am now. I was married to someone who never ever talked about any of my interests...we only talked about his. He never opened up emotionally and I left there with no self-esteem or confidence. So I am blessed that I'm not there now! I know we can get better. Otherwise, we would not be reaching out to each other and giving and receiving help! I'm here pretty often. xoxoxo pat>
Posted by PuraVida on March 9, 2003, at 14:02:08
In reply to Re: Getting unstuck - need help if you can please » PuraVida, posted by fayeroe on March 9, 2003, at 9:12:05
Thanks Pat. Even though I know in my mind, I just need to hear someone else say "BUT, depression is an illness just like the flu. Only we don't have any control over having it. It's a chemical imbalance and all we can do is try meds, exercise, eat right, etc. etc....." Its so true.
I did call my dad, and though it did help to let it out - it never fails to amaze me to realize some of the distorted thinking I grew up with. Especially guilt. Again, intellectually I can read John Bradshaw all day long and understand, but the depression seems to find every bit of remaining guilt in me and it takes over.
You are so right about being in a better place. I was in a smiliar type of relationship - but the guy abandoned me, as I found out later, he'd done to so many other women when things got too close for his comfort. Again, intellectually I know Im in a better place - he was a functioning alcoholic, etc, At first I felt like my self-esteem was intact still - I never did and still don't blame myself for that situation. But I do feel victimized - fearful that it will happen again, fearful of the pain.
Thanks for saying that you know it will get better, and that you are blessed with where you are. Listening to myself talk above I am realizing that I really need to do some more cognitive therapy to challenge these guilt and victim type of feelings and thoughts.
Good luck on your interview, if we don't touch base before then,
PV
Posted by mattdds on March 9, 2003, at 17:41:16
In reply to Re: Getting unstuck - need help if you can please » fayeroe , posted by PuraVida on March 9, 2003, at 14:02:08
Pura Vida,
First off, are you Costa Rican? Pura vida is an exclamation they say in Costa Rica, in case you aren't from there. Interesting.
From your post, it seems you know a bit about CBT.
Do you want to talk CBT? I would love to get another discussion going here. I tried to get one going earlier, but people didn't seem interested in anything except medications and "getting stuff out".
I have had some really good success with CBT, and feel maybe I could help someone out with my experiences that I've had.
I am interested in getting a discussion that:
1. Is not general (I feel so crappy about everything) but specific (I started feeling depressed 75% after Jane dumped me at 7:13 pm.). This was the only way CBT helped me.
2. Is productive, and works on solutions, not just venting (there certainly is a place for venting, but I want to start a discussion that is solution oriented)
3. Exciting and consuming!
If anyone cares to join in please start respond!
Thanks,
Matt
Posted by PuraVida on March 10, 2003, at 0:40:20
In reply to Pura Vida, Let's talk CBT, posted by mattdds on March 9, 2003, at 17:41:16
Hi Matt,
I answered your other post on doing a CBT discussion. Good idea... I find that when I read other peoples posts I see sometimes very clearly the distortions - like the shoulds, and when I start to write I can pick my own up usually as well. But its the general day to day subconcious noise of the distorted thinking that is starting to overwhelm me - I do need to challenge it.
So, lets go for it! See you on the other post...
PV
PS I think I signed on here just after a trip to Costa Rica. Was there for three weeks and had a great time. For some reason, I tend to get particularly depressed after I come back in the months following a longer, more independent trip like that.
Posted by Dinah on March 11, 2003, at 8:14:29
In reply to Re: Pura Vida, Let's talk CBT » mattdds, posted by PuraVida on March 10, 2003, at 0:40:20
How do you translate the intellectual understanding to the feeling state. I can never cross that hurdle. I can sit there and spout all the correct things and even completely believe them, while on a lower level, my emotional self wants to rip my head off for it.
Posted by mattdds on March 11, 2003, at 9:24:29
In reply to Re: But..., posted by Dinah on March 11, 2003, at 8:14:29
Hi Dinah,
Sorry to hear you didn't have much luck with CBT. I had (and sometimes still do have) that same problem of making your more emotional side "see the light". It is hard work! But for me it paid off.
Did you do the homework exercises? Like the daily mood log, where you write down your automatic thoughts and try to refute them? Or was your CBT work mainly during the therapy session?
If you were doing the exercises, you can troubleshoot. If you believe something intellectually, but can't believe it emotionally, you need to do some more work.
Here are some things I've found helpful. I will use terminology from David Burns style of CBT, which seems to be the most commonly understood here.
1. Use several approaches to put lie to the negative thought (acceptance, feared fantasy technique, identify the distortions, examine the evidence, thinking in shades of gray, semantic method, etc.). Sometimes, with more persistent negative thoughts I have, I have to use about 5-10 different methods. It takes persistence.
2. Make sure the new thought is 100% believable. You don't want to "fool" yourself with pollyanna-ish thinking here. The idea is that reality is a lot friendlier than we are perceiving it to be when we are depressed. So simply trying to find an accurate, balanced perception of a situation is the goal, not "The Power of Positive Thinking" stuff.
3. Measure your belief in the negative thought in terms of a percent. How much do you believe it? 50%? 100%? Do this before your work and after, and see if the methods you are using are working. If not, it is time to switch methods. For example, if you believe the thought "I am a stupid loser", assign a percent value representing the strength of your belief, say 75%. Work on that thought until you get it down to 0%. You can think of depression as a network of twisted thoughts and beliefs, all of which can be worked out individually. If you reduce your belief in this network of thoughts by 50%, you will obtain a 50% remission. As your belief in the thoughts that give rise to your depression go down, so will your symptoms. At least this was definitely my experience.
Keep at it. And this is not something that is "different" about you. I think everyone that does CBT has this stumbling block. It took me many months to be able to deal with certain thoughts, but I persisted and it certainly paid off.
Do you have one **specific** negative thought that is bothering you, that you can't seem to shake? Where were you when you thought it? Who were you with? What emotions are tied to that thought?
Hope this helps,
Matt
Posted by Pfinstegg on March 11, 2003, at 15:07:25
In reply to Pura Vida, Let's talk CBT, posted by mattdds on March 9, 2003, at 17:41:16
Hi Matt,,I think CBT is a terrific topic for discussion. I don't know much about it, so I just have questions at the moment.
1. Do you need a therapist to do it, or can you use a workbook? Or do you see a therapist at first and then gradually take over doing it yourself?
2.Is there a place in CBT therapy for developing a relationship with your therapist which will be therapeutic, or is that not an important factor?
3. Does self-disclosure of intimate or shameful feelings have a place in CBT?
I completed a course of TMS in January, which brought my depression into remission; however, my psychiatrist for that recommended CBT to maintain the remission. Because i have been feeling well, I have put off following his suggestion; however, I know the CBT might be very helpful in preventing a relapse.
Pfinstegg
Posted by mattdds on March 11, 2003, at 16:46:43
In reply to Re: Pura Vida, Let's talk CBT » mattdds, posted by Pfinstegg on March 11, 2003, at 15:07:25
Hi Pfinstegg,Thanks for your comments! I am glad someone else wants to discuss this exciting topic. I will take each of your questions the best I can.
1. CBT can be done as self-help exercises which can be learned through either a therapist or on your own. Sometimes, especially in acute depressive episodes, it is important to establish a relationship with someone. In my opinion, the homework exercises that are done in CBT are absolutely crucial for success. I would say this is far more important than the role of the therapist. Think about it this way, you spend approximately 1 hour per week in "therapy". This is not enough to untangle all the distorted belief and thoughts that contribute to your depression. Practice, practice, practice...that is how you get better with CBT.
2. There are mixed views about the role of a therapist in CBT. Some people feel that empathy is helpful to get the process of healing started. Others feel that it is less of a factor. I am of the opinion that empathy is nice, and can feel good, but all the empathy in the world won't get you better if you don't actually do the exercises.
3. Does CBT help for shameful and intimacy problems? Absolutely! I had major guilt and shame problems before CBT. In my opinion, feelings of guilt and shame are some of the easiest to resolve with CBT. There are specific exercises that help overcome shameful feelings.
Hey, that's great that you are feeling better from the TMS. That has always been interesting to me.
One last important thought. CBT has been shown to dramatically reduce relapse rates for depression, panic, and OCD. In well controlled studies, the effects of CBT consistently outlast the effects of medication or electroconvulsive treatment.
CBT cannot hurt, has no side effects (besides possible cramps in your hand from typing or writing a lot), and in my opinion is the most underrated and underutilized tool in psychiatry! Go for it! You have nothing to lose and everything to gain!
A good starting point is to read "Feeling Good: The New Mood Therapy" or "The Feeling Good Handbook" by David Burns. There was actually a study done about using this book as a treatment for depression. The study showed that 70% of those who read "Feeling Good: The New Mood Therapy" had a substantial reduction in their symptoms. To me this is pretty amazing.
I hope this helps, and please don't hesitate to ask any questions you may have.
Best of luck,
Matt
Posted by Dinah on March 11, 2003, at 16:55:31
In reply to Re: But..., posted by mattdds on March 11, 2003, at 9:24:29
I can't say I did the homework regularly for long. It irritated me a bit too much. My therapist slips in the concepts in a more palatable way. But the problem is that I can believe two completely and opposing ideas on two completely different levels of my being.
So let's see. A specific example. It's not so much negative thoughts with me. How about a "should". "I should always be a good girl."
Posted by Pfinstegg on March 11, 2003, at 17:45:12
In reply to Re: Pura Vida, Let's talk CBT, posted by mattdds on March 11, 2003, at 16:46:43
Thank you Matt! I really appreciate your complete and thoughtful replies to my questions. My next stop will be at Amazon to order the David Burns books. I'm so glad that you brought this topic up.
A word about TMS: if one has a severe degree of depression (Beck Score of 30 or higher) which has been treatment- resistant, and is considering ECT, I would recommend trying to find someone giving TMS. It is just as effective as ECT and there are no problems at all with short-term memory; you also do not have the risk of anesthesia. I am so grateful for how effective it was, and also know that I can return for brief maintenance treatment if I'm unable to stay in remission.
It's wonderful to hear how effective the CBT was for you; it sounds as though you made an all-out, sustained effort, with an awful lot of work moment by moment, and that it made a real difference. Great to know!
Thanks again...
Pfinstegg
Posted by mattdds on March 11, 2003, at 20:22:23
In reply to Re: But... » mattdds, posted by Dinah on March 11, 2003, at 16:55:31
Hi Dinah,
I agree the homework can be a pain, and sometimes I feel like I'm treading water. Once in a while though, I will "get it" and make substantial improvement. Along the way I've run into plenty of plateaus, but also had some major breakthroughs.
What do you find so irritating about it? Did you hate doing homework in high school or college? Just curious.
You say the problem is that you can "believe two completely and opposing ideas on two completely different levels of my being". I can too, and I think this is true of everyone, even those for whom CBT works. You are no different in this aspect. CBT (when it is done properly) has the intention of integrating what you know to be true on a logical, rational level with your emotional "felt sense".
Again, like I say, this takes incredible effort, and I detailed some of the techniques that I used to make this happen. Although I must admit, without the homework, it certainly would not have worked for me.
CBT is not for everyone, especially if you feel that bothered by the homework assignments. There was some research done at Stanford University (Diane Spangler, and Burns) showing a direct correlation between completion of homework and improvement on depression scores. In other words, if you don't do the homework, you may as well not bother with CBT. I hope that doesn't sound preachy, and I'm not pushing homework on you, but this really is the foundation of good CBT therapy.
Best,
Matt
Posted by Dinah on March 12, 2003, at 19:46:06
In reply to Re: But..., posted by mattdds on March 11, 2003, at 20:22:23
Actually, I liked homework just fine. But homework in school was different than this kind of homework. I just can't get past feeling like I'm trying to manipulate myself. Or some sort of science fiction futuristic thought control. I don't know.
I did find it interesting though that in one of the grand rounds I watched lately, there was a definite link between personality types and CBT outcomes. I guess that like any other form of therapy (and meds, etc.) it isn't a one size fits all. Some forms suit some people better than others. But I think that CBT offers tools that anyone can benefit from. It's probably the degree of benefit that depends on the right match of temperament and therapy.
Posted by jay on March 12, 2003, at 20:27:50
In reply to Re: Pura Vida, Let's talk CBT, posted by mattdds on March 11, 2003, at 16:46:43
Hey folks:I started another thread below before I got into this thread, which addresses similar issues. I hope I can add to Matt's insight. Please have a look. Thanks..
Jay
Posted by wendy b. on March 12, 2003, at 20:52:50
In reply to Re: But... » mattdds, posted by Dinah on March 12, 2003, at 19:46:06
> ... I just can't get past feeling like I'm trying to manipulate myself.
I understand this feeling very well. We've been told by the medical establishment that biochemical processes in the brain are the core of the problem, not "twisted thoughts." I mean, the twisted thought processes are a *symptom* of the chemical imbalance, not the root cause of the illness. Or am I misunderstanding something? Anyway, Dinah, I have always wondered about CBT for the very same reason... I fight the "mind over matter" stuff. And I don't know enough about CBT to know if I am characterizing it in a way that doesn't do it justice; maybe my prejudices are showing...
> ... I guess that like any other form of therapy (and meds, etc.) it isn't a one size fits all. Some forms suit some people better than others. But I think that CBT offers tools that anyone can benefit from. It's probably the degree of benefit that depends on the right match of temperament and therapy.
I'm sure this is true...
Thanks for your comments; food for thought...
Wendy
Posted by PuraVida on March 12, 2003, at 21:44:24
In reply to Re: But... I agree, Dinah, posted by wendy b. on March 12, 2003, at 20:52:50
I think it is beneficial to know the ten cognitive distortions and be able to recognize them in yourself - for me it helps give me a sort of warning sign that I'm depressed/not thinking clearly. I don't know that I agree that CBT, alone or with other therapy/meds, can actually change brain chemistry, but I do think it provides a knowledge that is invaluable - kind of a know thyself type thing.
PV
PS I posted on Jay's thread, too - I think we have 3 threads going now on CBT!
>I understand this feeling very well. We've been told by the medical establishment that biochemical processes in the brain are the core of the problem, not "twisted thoughts." I mean, the twisted thought processes are a *symptom* of the chemical imbalance, not the root cause of the illness. Or am I misunderstanding something? Anyway, Dinah, I have always wondered about CBT for the very same reason... I fight the "mind over matter" stuff. And I don't know enough about CBT to know if I am characterizing it in a way that doesn't do it justice; maybe my prejudices are showing...
Posted by Cecilia on March 15, 2003, at 2:25:36
In reply to Re: But... I agree, Dinah » wendy b., posted by PuraVida on March 12, 2003, at 21:44:24
The thing that bugs me about CBT is what I, in my doubtless distorted perceptions, see as blaming the patient. Like the study about the people who don`t do homework not getting well, you could just as easily say the people CBT doesn`t work for stop doing homework. All of Dr. Burns` books fill me with guilt and self-hatred because I can`t believe the "rational" thoughts. Cecilia
Posted by Dinah on March 15, 2003, at 10:45:58
In reply to Re: CBT, posted by Cecilia on March 15, 2003, at 2:25:36
Ditto. :(
And my CBT self talk goes something like this. (One of my biggest CBT flaws is catastrophizing.)
OMG. I'm going to miss this deadline, I'll get fired, and nameless but complete disaster and shame will strike my family.
OK. I know that's exaggerating. I can meet the deadline but even if I don't my bosses have said it's not the end of the world. They value my work.
OMG! I'M GOING TO MISS THIS DEADLINE! I'LL GET FIRED AND NAMELESS BUT COMPLETE DISASTER AND SHAME WILL STRIKE MY FAMILY.
Even in the unlikely event that I get fired. And realistically it is unlikely. Even if I do, lots of people change jobs all the time. It might even be for the best. It would not be the end of the world and nothing bad would happen to my family.
SHUT UP. JUST SHUT UP YOU RATIONAL POLLYANNA! I'M GOING TO MISS THIS DEADLINE! I'LL GET FIRED AND NAMELESS BUT COMPLETE DISASTER AND SHAME WILL STRIKE MY FAMILY.
And I completely believe both thought streams at the same time.
Then I get mad at myself for not having more strength of mind.
This is the end of the thread.
Psycho-Babble Psychology | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.