Questions For Anthony About T

[Hashi]

I do also believe one of the reasons there is so much proven result data linked to CBT is only because CBT is more easily measured than other approaches.

Both my therapists have said that. The measurability makes it very popular with NHS managers and insurance companies as well, which helps it be/be seen as a leading therapy.

It's always about what works for the individual, and often that's a combination of things anyway. As long as it's an established therapy with a qualified trauma therapist, I think it's more important to read books/talk to a therapist about what's involved and consider whether that feels right for you.

 

[greenleaf]

I think that focusing on cognitive stuff might be counterproductive for me, in a way; my cognitive skills got developed quite early as a way to cope with everything and stay as safe as possible. Large incentive to do that at the time. However the emotional stuff, not dissociating the emotions so much - that's a lot trickier... So, let's start thinking about something that vanishes when we start thinking... hmmm...

 

[Abstract]

These are the things that I think are a must in therapy when we are treating trauma and for me I don't see the approach as important as whether we are getting what we personally need out of the treatment environment.

1. Ability to aid the client in dealing with dissociation and grounding, educating them on doing this themselves and it's importance, or bringing their attention to it's importance if they are not aware of it and already doing this themselves.
2. Proper understanding of PTSD symptoms and experience in dealing with them.
3. Ensuring the therapy deals with the trauma itself and does not just deal with day to day struggles. Processing trauma needs to be the end goal.
4. Addressing day to day coping and the necessary skills that we need to be able to cope. That could mean advising self help or other courses or therapy that is skilled focused, doing this work in therapy,or bringing the general awareness to the client so that they address this themselves if they are not already doing so. This includes being aware of unhealthy coping attempts such as addictions
5. Understanding that the client needs to prepare for trauma work and that safety needs to be evaluated and monitored.
6. Understanding that trust and reliable therapeutic relationship is essential and that appropriate boundaries for that particular person are very important when someone has experienced trauma.
7. Addressing cognitive distortions and distorted world views as well as unhelpful ego defences in a way that is best suited for that client. For some that would be CBT or DBT related and others it would be indirectly and in the form of talk therapy.

I think one of the common reasons that talk therapy is dismissed as unsuitable for trauma is because some T's don't understand trauma and therefore don't do a lot of these and often do not realise how essential it is to process the trauma or do anything about guiding the therapy in that direction. Discussing how the person feels that day without doing anything else is never going to heal PTSD longer term as the trauma is not being processed.

 

[Abstract]

The measurability makes it very popular with NHS managers and insurance companies

Yes! And what makes it even more popular is that it is usually a short course and they can therefore spend less money. They don't care that it is often the equivalent to applying a small band-aid to a giant wound.

 

[rainy_daze]

I had to wait a few years altogether for help from the National Health Service (NHS) that wasn't in the form of CBT. It's very popular, but not my cup of :coffee:.

@StrongerNow , I'm in agreement with the list Abstract put up. I also think there is a great deal of literature on CBT and effectiveness in treating PTSD because it is a "quick" therapy that can benefit people in their everyday life (if I'm correct in saying that).

That doesn't mean it works for everyone though, and each person has a different form of PTSD, if you know what I mean. For example, I would guess that CBT would help someone with mild PTSD, but not necessarily someone with severe PTSD and dissociative symptoms. Just my honest opinion.

Healing PTSD is taking more work for me than a CBT workbook. It isn't straightforward like that. Does CBT work on managing dissociation? Anyone know?

 

[Bedbug]

Applying the CBT techniques described here has certainly helped me to reduce the likelihood of dissociating :

Link Removed

This is undoubtedly one way to manage dissociation. However, I suspect you were asking whether CBT helps to manage dissociation when it happens. CBT teaches skills such as grounding techniques, breathing methods and basic coping skills for stress which have helped me during dissociative episodes. I have drawn on many other approaches as well, so I am not sure that CBT alone works to manage dissociation, but I would definitely say that CBT has helped.

 

[Hashi]

I would add that I think it's helpful to see an integrative therapist - one who practices a number of different approaches. Even if CBT is helpful, the client might not want to do only CBT every session.

I love art therapy but I don't want to do that every time. I've done a mixture of things with the same therapist - straightforward talking, dreamwork, art therapy, body psychotherapy, archetype work, DBT skills and transactional analysis. My therapist has trained in all of these and has also trained in how to move between them and bring in the most helpful one at the appropriate time.

EDITED TO ADD: I don't mean that I recommend the same particular things as me for everyone else, just that having a mixture of things is helpful. Especially when some are more cognitive/skills based, and others are a bit different from that.

 

[Bedbug]

@Abstract, I just wanted to say that I really like your list. I think it would a good way to evaluate a self-help book, just as much as a therapist.

 

[Pencil]

CBT isn't necessarily the best for childhood stuff that involves dissociation,

Yes, I have read that as well, and it makes perfect sense especially with regard to attachment and other relational issues.

 

[BloomInWinter]

Cognitive-Behavioral Therapy helps us identify unhelpful thinking styles which undermine us in our current lives each day. We learn other options for responding to stressors, to other people, to ourselves. We replace undermining thoughts we internalized as a result of our traumas with self-affirming, stabilizing self-talk. This is an essential skillset to being able to tolerate trauma processing?

We practice using more effective internal and external resources to stabilize our overall activation level, relationships, and activities with daily living. Over time, our lives become less chaotic. We lose friends who aren't healthy for us, and attract those who are. Our employment situation can improve as we affirm and advocate for ourselves.

It's all simple stuff to learn, but it takes a long time to practice it enough to internalize the skills into our toolkit of responses.

I can't recommend it enough...with the right therapist.

 

[Abstract]

It has occurred to me that some people struggle an awful lot to identify when they are inside a cognitive distortion and when unhelpful thinking styles are sabotaging them at every corner. I do think that it is extremely important that anyone who has this pattern learn ways to break them down and deal with them. That means actually learning the theory and doing lots of proper homework. CBT is a good way of doing this as is DBT.

For others I don't think these patterns are as strong. There is at least awareness and often the shame around that awareness is causing more harm than the distortions. That's one of the times I think strict CBT practice is not as useful.

It seems to me that it is a case by case situation and there is no way of generalising other than to say that if someone's life suffers as a result of cognitive distortions then they need to do something about it! Especially if they are unable to know it is happening. It is one of the things that can sabotage someone from being able to utilise therapy properly as well as all interpersonal situations.

I agree with Hashi that an integrative approach can be ideal. It can be adapted and modified to that persons needs at that particular time and in a way that feels most tolerable for them.

 

[rainy_daze]

CBT teaches skills such as grounding techniques, breathing methods and basic coping skills for stress which have helped me during dissociative episodes

Ironically I have used all of the above, so maybe I was a bit too harsh with the CBT. I found that the doctor just giving me a list of self-help workbooks instead of referring me for therapy was patronising, and at that time I could barely read a page of the books. I hated the way they were written, and didn't relate at the time. If, however, it had felt like a big book of coping strategies, as opposed to a chore/homework, I might have engaged with it. If I had maybe experienced CBT with a trained therapist I would maybe have a different attitude towards it too.

I'm interested that it aids in recovery, but I sometimes wonder if it really deals with what the trauma has done, if that makes sense. I guess it's a case of don't knock it until you have properly tried it.

Grounding has definitely helped me (learned mostly from reading people on here, and my T - who is some sort of hybrid of different strands of Psychology/clinical psych). I'm glad to read it helped Bedbug.

Edit: I think the cognitive therapy I'm in is doing a lot to increase my awareness of thinking patterns, but because it doesn't have the behavioural part added in, it's not as time-limited and I can talk about trauma if I want to. I also don't have very many homework tasks, which I'm happy about, because they often just become a stressor. If anyone here has completed or is taking part in CBT, how much of the time was spent just talking with your T? I keep imagining it's mostly task-focussed and not about talking.

I realise none of this is answering your original question @StrongerNow . Have you been reading any social science research findings about CBT and PTSD?