Research Are You Getting Exposure Therapy? Just Testing The Grounds...

[maddog]

I have come to learn that being kind to yourself isn't so much about behaviour, but about attitude. I think it's actually easy to push yourself very hard in terms of stepping outside of the comfort zone and "doing" more than you feel you can, as long as the messages you create and send to yourself are supportive and realistic, rather than judgmental and condemning. Similarly, I believe it's easy to punish and constrain yourself significantly even while apparently taking care not to challenge fears or anxieties. If we're talking kindly to ourselves, the "doing" stuff becomes doable, whereas the opposite is true if we continue to be cruel and non-accepting of our situation.

I'm learning this one the long slow way. Had no idea the extent of my negative and self-defeating thinking until T began to pull me up on every word and fight me tooth and nail about it. Makes me want to throw things at him and perform other acts of displaced frustration, but only cos he's right, and only cos it's harder to change internalised negative thoughts and beliefs about oneself than I ever thought was possible.

Maddog

 

[Oberons Wife]

I recently started therapy, maybe 6 weeks ago, and it's CBT, and the therapist encourages me to revisit events, but I don't really manage to, I just cry. So I have no idea if I'm receiving the therapy you're talking about?

 

[PTSD sufferer]

PTSD sufferer (please let me know if you use a shorter nickname!), I'm wondering if the recent massive funding for CBT therapists in the UK (IAPT) has had an influence on the treatment type and quality you have been receiving? I've been reading up on this mass-training of low and high intensity therapists, and I wonder how many of them are actually getting trained in exposure therapy. My concern is that therapists can be great at making clients feel good in the short term (between sessions), but can miss the lack of long-term progress that might help a person become independent of frequent therapy and/or medication.

Just "P.S" will do. :D

My T is trained in EMDR, as well as host of other techniques (CBT included). :)

I have tried out general exposure techniques (or better known as desensitization techniques). With my therapists agreement that it was good timing to address this way, of course. That is, introducing objects and situations I fear in a controlled manner to try to reduce my own anxiety. I have focused more in targeting the triggers with this. There are about 30+ things on my list so far and there are about 8 I won't go anywhere near, but the others, I have been working on myself (with the help of a hubby I trust) and this new skill has helped me a lot. I take the view that I need to help myself BTW, and do the work, to get better.

My therapist has been around for years, so I don't think that the recent funding for CBT has much to do with the choice of technique. He has always chosen the best technique to try at the most appropriate time.

I would question whether the recent funding has more to do with the number of mental illnesses that can benefit from CBT compared to other therapies, maybe?

My independence is very important to me. Not being on medication is also so very important to me. I know I need to be on medication now (and for the past 2-ish years), to get the full benefit of therapy.

But I have made progress. My fortnightly therapy (and sometimes weekly depending on how bad things are) is now every 4 weeks, so that's progress. And I'm working on stopping my meds in 5-6 months time - so far I am on track to reach that goal!

Long term is not in my vocabulary. I work hard with my therapist and with my life to make myself well. I was badly hurt in the past, but I am not about to let this continue to hurt me in the future - its my time now, I'm in the drivers seat. Fingers crossed my hard work pays off!

P.S.

 

[anthony]

My concern is that therapists can be great at making clients feel good in the short term (between sessions), but can miss the lack of long-term progress that might help a person become independent of frequent therapy and/or medication.

Bingo....

 

[Happy Head]

Ha! My doc is great at doing the opposite. Feel like crap in between sessions and then he tells me during our sessions that what I'm doing throughout the week is good! (for my recovery that is)... Also that I'm too hard on myself.

 

[anthony]

My therapy has been more CBT than exposure therapy. I went through a bit of EMDR at the start with CBT in between. Now its CBT all the way.

People should not become confused with terms, because CBT comprises exposure therapy.

I think you mean, cognitive therapy has been focused more than exposure.

Read: [DLMURL]https://www.ptsdforum.org/c/wiki/cognitive-behavioral-therapy/[/DLMURL] and view the image at the bottom, you will see EMDR is actually under the CBT umbrella, and EMDR is primarily exposure therapy. Many don't understand that... hence why EMDR is also quite effective at one aspect within the treatment regime for PTSD.

CBT, for the term often thrown around as a therapy type for PTSD, comprises:

• Cognitive Trauma Therapy (CTT)
• Exposure Therapy (imaginary and in-vivo)
• Stress management (used to be called, stress inoculation training)

Those three primary types of therapy combine to be, what is often called, CBT. There literally is three therapies all delivered simultaneously as one.

To be perfectly honest, you would actually find more than 3 therapies being used simultaneously by a therapist, because therapy types such as Gestalt, Person Centered and other types, are often all mixed into the general therapeutic relationship itself.

 

[PTSD sufferer]

Yes, thanks Anthony. You are correct. :)

 

[Nicolas Connault]

Add to this that CBT is an umbrella term for a host (dozens) of different techniques, what you see (the label) is not always what you get (the treatment). It will vary widely between therapists, although the underlying theory and approach is the same.

 

[PTSD sufferer]

I would argue that although some are being duped on the their treatment (i'm not one of those people), the variations may have to do with what the patient can handle and what the patient needs at the time?

I always say that psychology is not an exact science, and lets face it there are also comobidities psychologists need to deal with. If the text book is not followed step by step regarding CBT, could it be due to the organic nature of the patient's condition, rather than the patient necessarily 'missing out'? I think case by case judgement and decisions need to factor in to the equation, so of course you may not get the text book treatment in that order. I didn't do 'breathing exercises', that would have just been a wasted my time and my T.

I understand that VETs may be missing out on CBT Anthony, but is that because DVA is ill equip (still) to address PTSD? Maybe its DVA cutting corners on VET care, by not demanding qualified CBT trained psychologists?

There is also a big difference between counselling (psychotherapy) which is unregulated in Australia and clinical psychologists which is regulated. The difference regarding training, education, on going education, reviews etc is massive in Australia...I see a psychologist, not a councilor - a councilor is ill equip to deal with PTSD.

 

[Nicolas Connault]

I would argue that although some are being duped on their treatment (i'm not one of those people), the variations may have to do with what the patient can handle and what the patient needs at the time?

I always say that psychology is not an exact science, and lets face it there are also comorbidities psychologists need to deal with. If the text book is not followed step by step CBT could it be due to the organic nature of the patient's condition, rather than the patient 'missing out'? I think case by case judgement and decisions need to factor in to the equation, so of course you may not get the text book treatment in that order.

You're quite correct here, therapists use a blend of clinical judgement and evidence-based techniques, but remember that there is no "CBT" manual or text book. CBT is a therapeutic approach based on theory and practice, and there are many flavours of it depending on the sub-type of diagnostic being treated. If the same client were to see two different therapists at the same time (not possible but imagine some sort of alternate reality sci-fi scenario!), they would probably do something very different, with different effectiveness, yet record it as CBT in their client file. I have a list of very interesting, eye-opening research articles on this subject that might interest you.

There is also a big difference between counselling (psychotherapy) which is unregulated in Australia and clinical psychologists which is regulated. The difference regarding training, education, on going education, reviews etc is massive in Australia...I see a psychologist, not a councilor - a councilor is ill equip to deal with PTSD.

The training may be regulated, but what goes on in the session isn't, or is very poorly regulated. Clinical psychologists, especially those in private practice, are very much free to do what they want with their clients. They may need to report which "brand" of therapy they used, but it doesn't mean they stuck to a manualised treatment. And perhaps it's not all bad.

We don't want to go to the other extreme, and have organisations like the APS keep close surveillance through video tapes or audio transcripts, of everything clinical psychologists do. First, that would be way too costly and you can guess who will end up paying the bill (not the government, that's for sure!). Second, it would really damage therapists' enjoyment of their profession, by removing their autonomy and devaluing their professional experience and judgement. Eventually, that would also lead to sub-standard treatment for clients because their therapists' motivation would be sapped by such a system.

 

[Tessa]

I am in Australia and have had very patchy treatment with several psychologists (they keep leaving). I live in a remote area and access is difficult. I have actually learnt most from this forum and pushed myself to work on my trauma diary which was healing in the end. I would be interested in your survey.

 

[Nicolas Connault]

Thanks Tessa. Are you in contact with Alison Fairleigh? She is one of the top advocates for mental health patients in rural areas. Let me know if you need her details.