Interesting Blog About Cbt - Is It Really The Golden Standard?

[Queen Boudica]

Not sure if this is the correct forum to post this on but this discusses CBT and whether it is the gold standard or whether alternative options are equally valid for treatment.

Link Removed

 

[Deleted member 28942]

@Lizio for me CBT does not work very well. I have complex trauma from childhood. I numb my negative emotions and also some of the memories. What helps me is somatic/experiential approach and EMDR with empathetic therapist. The somatic/experiential approach helps me to get in touch with feelings that I have buried long time ago. With my previous CBT therapists things just weren't working. I would tell her I know all this stuff you are saying I am not stupid but I don't feel it - I can't feel. Now, I am finally starting to experience sadness, fear, shame, and cry occasionally.

The book The Body Keeps The Score has a great discussion on this.

 

[Suzetig]

I did CBT a good while ago and in fairness it taught me skills I needed at the time to keep functioning but it never went anywhere near my trauma, just addressed my symptoms. That's what I needed at the time and it definitely served its purpose.

This time around I'm working a person centred therapist who is unpicking things with me slowly but surely. The key thing for me is that she offers me a completely safe relationship and is fully accepting of me, which allows me to explore some really hard stuff. Basically, the damage was done by truly dysfunctional relationships and I need to heal within a different kind of relationship.

CBT helped me manage my symptoms, at the time I was nowhere near ready to look at my trauma to the point where I didn't even recognise my experiences as being traumatic. I'm now looking at the root causes which CBT isn't designed for.

 

[Deleted member 28942]

@Suzetig makes a good point. It depends where in your life you are right now. If your symptoms are strong and you lack some skills then finding better ways of coping and getting to a stable place is more important than working on the trauma. Stability and safety come first. Once, that is achieved work on trauma can begin.

 

[Friday]

The article confused me a bit...

It seems to be talking all mental health? So ("The other mom in the carpool has a nicer manicure than I do, call the waaaaaaah-ambulance!") pseudo-problems, along with serious but time-limited problems which will heal on their own with or without therapy (marriage counseling comes to mind, or bereavement counseling), along with life long disorders that generally only need therapy for brief stints (ADHD, Bipolar Disorder, SPD), as well as severe life long mental health issues (cough), and even extremely severe cases resulting in long term or life long institutionalization? And everything in between? The whole gosh darn bell curve?

Looking at metadata, wouldn't one expect not to find any one treatment modality as more effective than the rest? As one is dealing with the entire spectrum of disorders, conditions, & perfectly normal but mildly to quite upset.

If one treatment modality did, indeed, treat everyone for everything... I'd simply not believe it.

 

[joeylittle]

interesting blog.

Paraphrasing some statistics she gives from The Heart And Soul Of Change (Hubble, Duncan, Miller)
30% of observed change for patients comes from a good relationship with the therapist
40% from strengths and resources of your own that you can identify or uncover through the therapy process
15% if you believe it will work
15% from whatever the modality is (CBT, ACT, IPT, DBT are the ones listed)


As Friday says, those are drawn from a very wide sampling group. I personally wonder about how the 15% being attributed to the modality might change based on the specific diagnosis. I can say for myself that my own percentages would look like 30% relationship with therapist(s), 20% belief, 40% modality, and 10% my own inherent strengths. But I'm talking about organic depression (non-situational) and PTSD.

It wouldn't surprise me that in cases of situational depression, the modality matters far less than the relationship with the therapist and one's own skills that the therapist can cultivate.

I think the political reason for the blog post is totally valid - no-one should be hamstrung to a set of guidelines just because it's what the powers that be can agree are fundable. There are all sorts of modalities for a reason.

But also - she makes the point that the last thing clients feel like doing when they are depressed is CBT activity. I agree - I never wanted to do it. But wanting to do it, and it being really helpful, are two different things. I don't think making the client happy is a good litmus test. I do think tailoring the approach to the needs of the client is paramount.

 

[Queen Boudica]

I don't think making the client happy is a good litmus test. I do think tailoring the approach to the needs of the client is paramount.

I agree with that one. I do think the client needs to be pushed into areas that they are uncomfortable with. Just has to be a balance to not push the client over the edge. But therapy, like most things in life involves work. And the things in our mind are particularly difficult to push through.

And that is the problem with mental health research as far as I understand, large sampling groups and we are all being bagged into the same mode of treatment by the politicians who have very little understanding of the complexities of mental illness and the diversity or the real-life impact. There is more talk now, but still I think the underlying prejudices, that you can just get over it.

I would also say that comments of the mother who is stressing about her nails in the car are perhaps the very sort of ideas that a lot of people do have about mental illness and attributing it to that level of triviality. If someone is that anxious about their nails, they may well have some kind of underlying problems that could do with therapy and maybe the pathetic 10 sessions with CBT would be OK for that level. However, I suspect it would then identify further underlying issues. So perhaps that is what the politicians still have in their mind. It is a convenient scapegoat image. Surely they couldn't imagine the true picture that more many mental illness is a crippling condition that affects every aspect of life. That would mean taking the condition seriously and spending money and admitting there is a economic impact to this. Better to close their eyes and put down the horrendous suicide rates to mothers stressing in their cars about nails.

 

[Chava]

Some interesting points. We think we can quantify everything, like kids' abilities based on one fill-in-the-bubble test. I like the point that even modalities vary so much between therapists. We are humans and there are not perfectly mechanistic approaches, thank god.

CBT did not work well for me. It made me feel like an asshole...I knew my responses were idiotic but they were all I had. It was not my cognitive brain's issue, but my traumatized little hindbrain reflexes or whatever. Probably I learned some good skills, but I didn't understand the relationship of my trauma to my symptoms at the time, so the CBT approach to my self-destructive symptoms made me feel even more ashamed and crazy. That's not to say it's not good. I just don't think it's the gold standard...it's just the common model for now and does offer many good tools. It is definitely not the gold standard for early trauma.

 

[katyjane]

In the UK, it seems the NHS want to use CBT for every kind of mental health issue. As other posters have said, it is great for treating symptoms and helps challenge unhealthy thought processes. For everything though? No chance.

 

[Queen Boudica]

Frankly I think mental health services need CBT to alter cognitive discourse and dissonance to enable them to move on from primitive ideas about how to treat and what contributes and constitutes mental health!