What to expect from cbt?

[Deleted member 45661]

Hi all, I'm new here.

My trauma happened 6 years ago now. I was diagnosed with PTSD a year later. I started therapy pretty much straight after the trauma and stayed as an inpatient for 3 months. during this time, I learned different coping strategies for the anxiety and hyper-vigilance I was experiencing but I never actually told the full story of my trauma.

I stopped therapy when I was discharged from hospital and in the years since my symptoms have steadily worsened. The past 6 months however have been the worst. Having moved back to the UK from living in Asia since before the trauma, I've found that there are many more triggers for me here and avoidance is not so easily achieved.

I feel like I'm being dipped in and out of hell. Flashbacks, nightmares, crippling fear and anxiety and just absolutely crushing despair have become my life now and I'm scared I'm stuck this way.

I started CBT a couple of weeks ago. I realise now that not talking about the trauma has in the long term made me worse. I'm trying hard in therapy to open up and to tell my therapist what happened but it's just so hard. Saying it out loud just brings up this huge flurry of panic and sadness and after my sessions by symptoms are so invasive and uncontrollable. My therapist says that we don't have to do anything that I'm not comfortable with and that we can take things slow, but I'm very aware that with it being on the NHS I am limited to the number of sessions available to me.

One thing that I am absolutely petrified of is that my therapist wants me to do something called 'reliving'. She says it will help to push the broken trauma memory from the front of my brain where it is 'stuck' to the back of my brain where it can reside as a regular memory which will not invade (flashbacks nightmares etc). The thought of this makes me feel physically sick and I honestly don't think I can do it, I don't understand why anyone would subject themselves to something which is quite obviously going to be incredibly traumatic.

I guess what I'd like to know, is am I going to get better? What do I need to do to get better? And is reliving absolutely necessary to my recovery? What can I expect to achieve through all this?

Thanks in advance,

S

 

[Sideways]

I guess what I'd like to know, is am I going to get better? What do I need to do to get better? And is reliving absolutely necessary to my recovery?

You seem to have decided to put in hard work to recover, and since ptsd is treatable, you have excellent prospects of achieving massive improvements in your life. Recovery times vary a lot from one person to the next, but for anyone willing to do the work, it would be totally healthy to set “complete remission” of your symptoms as a treatment goal.

No one therapy is ‘absolutely necessary’ for treating ptsd. And different people find different therapies helpful. Cbt and emdr I think have the best results in terms of peer reviewed studies and research, but there is a tonne of different approaches.

Personally I’ve found that taking on several different approaches has probably been more helpful to me than putting all my eggs in one treatment basket: yoga, mindfulness, DBT, ACT and CBT are probably the ones that I’ve seen the biggest improvements from. Of those, only my DBT therapist didn’t want me using other methods at the same time (for example, I did cbt, act and meditation classes simultaneously with good results).

Reliving approaches, for me, have been good and bad. Simply going over the detail in a pretty dissociated state with one therapist I had, I now think was not much more than retraumatising. My current T does some exposure work with me, and probably for me that is necessary. But it certainly isn’t the primary focus of our work, and I don’t think it needs to be.

I think there are Ts who will push for reliving as an essential part of therapy, and certainly there are people who have benefited from that approach. But done incorrectly it can be retraumatising (so check out your T’s experience level), and if it doesn’t work for you? Consider switching to another therapy modality.

 

[Sandstone]

I've had CBT within the NHS, so I recognise the concern about being time limited. Have you been told how many sessions you have? My psychologist was able to get a second batch of sessions added to the first, but I don't know how common that is.

How are getting on with applying the skills you earned in the past to your reaction after sessions? Are they enough, or do you need to add in more? I think that because they are time limited, NHS T's are a bit inclined to dive in without being sure there is a solid enough foundation of grounding and soothing skills. I'd say it is vital to work on extending that foundation for yourself outside sessions.

It's really important to tell your T how you feel about reliving, and about your reactions after sessions. She needs to know how fast it is safe to go, and you need to feel you can trust her expertise in that. It would be useful to have a conversation about what you fear from the reliving, and to work out how much is rational fear of the possible consequences and how much is the habitual fear that trauma pushes onto us .

Have you talked about how the reliving would go. if you decided to do it? For it to be effective, it shouldn't be a wholly immersive experience. You need to keep one foot n present reality, and your T should be responsible for making sure that you do that. For your trauma to become

a regular memory which will not invade

you need to be recognising as you relive that it is the past.

I guess what I'd like to know, is am I going to get better?

If you are as committed to recovery as you sound, then yes, you are going to change and improve.