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Re: Larry, your take on CBT?

Posted by Larry Hoover on May 30, 2003, at 17:22:42

In reply to Larry, your take on CBT? Larry Hoover, posted by mattdds on May 29, 2003, at 20:10:49

> Larry,
> All this (your post) sounds very CBT'ish. I am curious as to your take on CBT. Do you have any formal CBT-type therapy under your belt? Or do you use CBT self help techniques? Or not a "believer"? It often seems your posts have embedded CBT suggestions in them, haha. I enjoy reading them.

I'm glad somebody does. I hate to sound like I'm preaching. Without any feedback, it's awfully hard to "read the audience".

Yes, my posts often contain CBT-based ideas. I can't believe that HMOs, for example, will pay for drug after drug, but not cover CBT to any great extent (if at all). I think attitude problems underly a large number of medication failures. A pill can't fix stinkin' thinkin'.

I am a true believer in CBT. I have a degree in psych, I take part in CBT therapy (as a patient), and I employ self-taught/borrowed "self-help" CBT almost every thought I have. Seriously.

> I myself am a big enthusiast of CBT, and think it is the most underutilized tool in psychiatry. It relieved about 80% of my generalized anxiety, 100% of my depression and 100% of anticipatory anxiety secondary to panic attack symptoms.

OK, I won't preach to you. This is for the rest of the audience. <wink>

What convinced me that cognition has a powerful effect on therapeutic response flows from my own experience. Some years ago now, although I had been released from hospital, I was still very very depressed. My days, my endless stream of days, went something like this. Sleep for 10-12 hours. Get up, walk down the hall, and lie on the couch all day. Maybe open a can and eat straight from the can. Maybe not. Maybe bathe. Maybe not. Go back to bed.

I called this period my "couch days". I spent so much time on the couch (really a futon on a frame), that I had actually created a "Larry-shaped dent" in the damn thing. There it was, that dent, tangible evidence of my inability to function. All I could think about was all the things that needed doing, that weren't getting done. I just couldn't manage to do anything.

Then one day, I had an epiphany. I have no idea where it came from, but it felt heaven-sent. I saw that I had been consuming myself with guilt and self-reproach. I went to the couch for rest, I had assumed, but I got no rest there. I tortured myself, instead.

The day of the epiphany, I saw that Larry-shaped dent in a new way. It was the couch preparing to cradle me. And as I let myself down into that space, I let it hold me. And I emptied my mind of my worries, and let myself rest. And again, the same thing, the next day. I never had another couch day again.

I draw on all kinds of sources. Buddhism has been really helpful. I had a hard time grasping the idea that spiritual growth required adversity, at first. But then I began to see why. If life isn't a struggle, you have no reason to change, to grow.

Here's a contrast of the Buddhist/Western perception. Your house catches fire, and before the firetrucks can arrive at the scene, it burns to the ground. Everybody is safe, but you've lost everything.

Western response? Probably something like: devastated.
Buddhist response: absolute joy.

Now, how can the same event inspire such different responses? Cognition.

Here's a symbolic representation. Most people believe that an event triggers an emotional response, a feeling.... i.e. E --> F

But that's not the way it works at all. You interpret the event before you feel.

E + I --> F

Your cognition, which can respond instantaneously when needed, will interpret events, and then trigger emotions consistent with the interpretation. You can't do anything about E. That's reality. You've no control over reality. And feelings arise from cognitive "templates", beliefs, attitudes, assumptions, memories, social norms, all that stuff, so you really can't do much to change them *directly*. The only way at the feelings is through deciding on using new interpretations. The only thing I can change is "I".

It takes effort to become aware of cognition, but once that skill is learned, it's with you forever. I feel very empowered whenever I consciously choose a new cognitive schema.

> Klonopin helps with residual derealization that I can't seem to shake, and I am currently experiencing what I feel is a good response to Mg supplementation (seems to help with MVP-like symptoms that overlap a lot with panic, e.g. palpitations, random sympathetic discharge, insomnia. It also seems to "smooth" out my moods, like a mild mood stabilizer. I'm also pretty sure it augments my Klonopin. Recently, I've reduced my dose a bit, as my old dose is making me sedated! Time will tell. As for now, I'm getting more and more convinced.)

Experiments will do that, whereas reading leaves a tad more doubt.

That's where "You can't think your way into a new way of acting, but you can act your way into a new way of thinking." fist in.

> But I digress, my question was about CBT. What's your take?
> Thanks,
> Matt
> "Yesterday is history. Tomorrow's a mystery. Today is a gift. That's why they call it the present."
> "You can't think your way into a new way of acting, but you can act your way into a new way of thinking."
> ....which has a corrollary in, "If you keep on doing what you always did, you'll keep on getting what you always got."
> ....and another one in, "Doing the same thing over and over again, and expecting different results, is a true measure of insanity."
> ....which underlie my belief that you have to "do the experiment".

CBT is a wonderful tool.





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