Cognitive Behavioural Therapy

Sid

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When I finally started to not care about stigma and admit I had serious depression-like and anxiety-like stuff going on, I had little idea where the journey of treatment would take me.

Not surprisingly, it was the advice of a good friend future fiancée, herself a mental illness veteran, that got me going in the right direction. The right direction was cognitive behavioural therapy (CBT).  It sounded like just the thing I needed, and I pressed my at the time therapist to get our weekly sessions into the realm of actual CBT, instead of the patient-directed Q & A that had been the hallmark of our times together.  He didn’t respond quickly or effectively, so with a recommendation from not one but two psychiatrists, I contacted another therapist in town.  His specialty was/is CBT, and he came highly recommended – so I thought, OK here’s the real deal.  Here’s where I’ll get the treatment I need.

On an intellectual level, I understood the motivation and logic of CBT right away.  It made sense to me.  So off I went.  Each week the good doc would ask me how I was faring, and we would talk about those situations about which I used the CBT worksheet he gave me.  After a few weeks, a pattern emerged in what I was experiencing that seemed to warrant use of the CBT worksheet: not surprisingly, it was most often about my almost total lack of self-esteem.

That was n0t the only pattern that emerged, though.

I also found that, though the therapy still made perfect sense to me, I was having a lot of trouble with the last step each time.  The rational challenge, as it is called in the version of CBT we’re using, was the hardest part.  In fact, I felt that I was making up my responses to the rational challenge.  I could see that they were good thoughts, and indeed should be the way I was thinking, but I didn’t believe them for a second.  I told my therapist that, and he knew I didn’t.  His reply was essentially a simple “fake it ’til you make it”.  It was a curt way of saying I had to practice.  It wasn’t something that was going to come overnight.

If a situation arose in which I felt down on myself in comparison to another person – something in my brand of depression I do all the time – the rational challenge would of course be something like… I’m actually fine.  I’m better than my stupid scumbag brain is telling me I am.  I am actually good at parenting/holding a conversation/dressing myself/whatever.  Yep – good answers all.  Very uplifting.  I would dutifully write them down each time, but I never believed what I was writing.

After months of this therapy, my disbelief continues.  I’m no closer to being convinced of my rational challenges than I was at the start.

In other words, what was supposed to be the savior therapy for me is turning out to be a complete bust.

There are a number of potential reasons for this, one of which is that I’m just plain stubborn, or comfortable in my lifelong lack of self-esteem.  It could be that I’m not giving it enough of a chance.  It could be that I’m not suited for this therapy.  It could be that it just is a therapy developed by quacks.

It could be that, like having a positive attitude, the success of CBT depends wholly on me.  That seems most likely to me, and scares me to no end.  I mean, seriously?  I have to make myself believe it?  I compare it with religious faith.  If I don’t have it, how do I get it?  If I don’t believe my rational challenges, how do I… well, how I do make myself believe them?

So, here I am, months in to what was going to be the mother of all therapies, and I’m at a loss for how to make it work for me.  And I have questions for you.

Have you tried cognitive behavioral therapy?

Did you find it useful and effective?  If not, what did you do then?

I don’t want this failure to be the end of journey toward a calm and comfortable self.  I don’t want to miss out on how to make this work for me, and I also don’t want to ignorantly disregard other types of therapy available.

My lack of self-confidence affects pretty much all of what I do – as a father, employee, son, member of society… and as a boyfriend/fiancé/future husband.  It’s killer.  I can’t say how many times I’ve frustrated our Summer Solstice Girl in one of my self loathing episodes.  She patiently puts up with those times and continues to love me like only she can, but it has to be taking a toll on her as well as on me.  I can’t have that.

If you can shed any light, wisdom, or experience, please don’t hesitate to comment below.

© Sid Dunnebacke and A Canvas Of The Minds 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Sid Dunnebacke and A Canvas Of The Minds with appropriate and specific direction to the original content.

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52 thoughts on “Cognitive Behavioural Therapy

  1. I’ve tried CBT before in the past. It did nothing for me but I’ve heard others praise it. I think it comes down to individual needs. Don’t think of it as a failure, it might be something you can use later on. For me, I had to deal with past abuse that caused the negative thinking (as it is for most people). The therapist I have now is a trauma specialist.

    Sometimes it helps to step back and make a list of things you want to work on, to peel off some of the layers. For instance, I have PTSD so I needed to work on my anxiety. Once we made headway with that we started working on another layer.

    Keeping a journal also helps because you can go back and read it and then pick out any patterns and possible triggers. Also, make sure you get a copy of your psych records from everyone that you’ve seen. I’ve actually read through my old records and was amazed at some of the things I talked about during those sessions. A lot of the sessions I don’t remember but by reading through the notes I started to notice some patterns in my behavior. It helped me figure out what I needed to work on.

    Hope this helps some.

    • Oh, gold solid advice here! Yes, CBT is not for every one. It’s one of those things, for those who it works, it works very well, but unfortunately, it doesn’t work for some people

    • Way ahead of you on the journal idea, but I’ve not made that list of what I really want to accomplish. It sounds silly obvious now that you’ve mentioned it! I’ve also not made any attempts at my records, though if Elise is right… Well, I’ll be trying anyway. If nothing else, it should be interesting reading.

      Thanks so much for your input.

      • You’re welcome. I’ve never had any problems getting my psych records. Neither has my sister. I just signed a release and then they called me when the records were ready to be picked up. Hopefully it’ll be the same for you as well.

  2. I find cbt to be better when self directed. If there are books and worksheets, then follow them yourself and find an online group to share and gain support. My two cents anyway!

    • I’ve wondered if doing CBT can be done sans the therapist. Actually, I think mine is great, and that my trouble with the therapy is more about me than him. Are there such online sharing groups? Must be, eh? Thank you for two cents’ worth – it’s worth much more than that. 🙂

  3. I’ve tried it. I have the book “Feeling Good” by Dr. David Burns. Yes it does take practice to change destructive thought patterns. (And for the record I’d like to say I don’t think practicing something to get the knack of it is the same as “faking”) No, I don’t think it’s a “savior therapy” but I think it can be a helpful tool in some situations. But I wouldn’t rely on it as the only tool.

    • Ooooh – that’s just the kind of thing I’m looking for. I will definitely be researching these, as you are absolutely correct about the need for directly dealing with self-acceptance. Such an easy thing, yet so so difficult. Thank y ou Christy for the recommendations!

  4. For a long time, CBT did nothing for me because, like you, I didn’t believe my challenges. I was writing down things I wished I believed but didn’t actually believe, and I thought it wasn’t working because I wasn’t trying hard enough or I was just too negative.

    Then, when I spent some time in an inpatient trauma unit, I came across a really good CBT therapist. There was a group every week, and for a long time, I still just couldn’t connect to any of the challenges we wrote up on the white board. Finally, I asked, “What if I just don’t believe any of it?”

    “Then it’s not going to help,” she said. “You have to find a challenge you do believe, at least a little bit.”

    “What if there aren’t any?”

    “There are. You just haven’t found them yet.” She introduced me to something that none of the other therapists I’d seen had ever suggested–phrasing my challenges as possibilities instead of the absolutes you generally see. Like, “It’s possible that I’m an okay person” or “It’s possible that other people like me.” She also encouraged me to use people in my life in my challenges: “My best friend thinks I’m good at things” or “My boyfriend likes spending time with me.” Suddenly the CBT challenges started to click for me.

    It hasn’t magically cured me or anything, and I’m not suddenly full of self-esteem. But it does help some, and I suppose that’s better than feeling like it’s an exercise in futility or one more thing I failed at.

    • Sorry to butt in, but I just wanted to say that I love your comment. I got acquainted with CBT at my out-patient Day Hospital program and one of the very first thing they told us was that the challenge had to be believable for us or they wouldn’t work.

      I love that part of including other people in your challenges. I had not thought of that, so thank you! 🙂
      I also like the part about “it is possible”. That makes a lot of sense to me cause it makes it easier to believe that way, I think

    • That’s a REALLY good idea. “It’s possible” is waaaay more in my realm than the absolutes, as you called them. Yeah, I wouldn’t expect it bring huge changes overnight, but I can definitely see me making more and better progress attacking my doubts and insecurities. Thank you so much for the suggestion!

  5. Hello, I think this is a great post. I’ve never had CBT before (but have been told by professionals that I would benefit from it). I have a few friends and clients who have had CBT before and claim it is amazing – as long as they put in the practice of course and do the exercises regularly. I am glad to hear this had been a positive experience for you 🙂

  6. I’m currently on my second go at CBT and like any other therapy it works for a while, mainly I think because I want to impress the therapist, but you are spot on when you say that it haves to come from within.
    And like you that frightens the life out of me, because depression has been a reliable companion for so long I’m not sure who I am without it. But it is a friend I’ve got to drop…
    But is CBT the answer, probably not on it’s own. I think you just need to be open to ideas, pick what works from all of it. But most important just keep on going.

    • Good advice. Wait – great advice. Keeping on is the only option, really, as otherwise, well… let’s not go there. It is frightening, isn’t it? I didn’t really expect CBT to be a cure-all, but all the same I wished for more from it. I like how you put it about depression being a reliable companion and a friend you must drop. If only it were that easy, eh? Thank you for your comments!

  7. I guess I owe you a big apology in the sense I hyped CBT so much that I made it the Holy Grail of mental illness therapies.

    The truth is – while CBT does work wonderfully for me and for many other people I know, it doesn’t work for everybody. I am a very logical kind of dude and since it makes perfect sense to me, or because it makes sense to me, I don`t have trouble believing it, thus it works for me.

    You are right when you say that the success of CBT depends entirely of you. But that goes for every other therapy, methinks. None of them will work unless we -the patients, make it work.

    Maybe it is time for you to look into other options?

    • No, you didn’t hype it, you only said it would be good for me to give it a go. I do not accept your apology!

      It’s a curious thing that while you believe the challenges so easily I find them near impossible. But, I’ll keep on with the program and for sure look into some of the options the very kind folks above have recommended.

      • But seriously now, the thing is that your issues are very different than mine and therefore the rational challenges are very different too. I would think that challenging low self-esteem is more difficult than challenging anger or anxiety.

        Full disclosure, though, I haven’t used CBT for my PTSD. Only for my anxiety, anger and being too hard on myself issues. I am not at a point where I can do that because every time I get anywhere close my traumas, I dissociate. I was also advised by my treating psychiatrist at the Day Hospital program not to go into trying that until I could do the PSTD program at the Royal, but you know how that went 😦

  8. Hi Sid, I was in a similar position about 3 years ago. My CBT was twice a week six hours a day in a group setting. We had nurses, social workers, psychologists, occupational therapists and psychiatrists facilitating. It was a 12 (now 15) week out patient program.
    I didn’t believe in the CBT. I still don’t. Faking it was how I ended up having a complete effing breakdown in the first place. I needed to be happy with who I was, not who someone else wanted me to be. What I needed was to learn acceptance and management of my illness and changing my thought patterns would come as a result of that. CBT is helpful for some people. I am too logical, intelligent and in tune for it to work for me.
    I did learn about myself, my core values and it forced me to dig deep deep down into places I avoided and in some cases obliterated from my mind. Are you in a support group? You may need to try a few to find one you like. I would even try a new therapist or therapy. Meditation, even hypnotherapy has been a big part of my process. Don’t give up. Keep searching – you will find some solace. All the best.

  9. Thanks for popping in and sharing, Andrea. Being happy with who I am – boy, that WOULD be almost a cure-all for me. I’m closer to that as a result of the therapy, but not as close as I want. Not even close. Still, I’m going to keep giving it a go, and in the meantime will also be searching out other therapies. Some combination will work, I’m sure. Best to you as well!

  10. If you are experiencing severe and debilitating symptoms, then any therapy would work best when used in conjunction with medication. I struggled with depression using psychotherapy only for 12 years before becoming so severely depressed that I could not get out of bed. At that point, I turned to a medical doctor for medication. Try seeing a psychiatrist for antidepressant medication.

    The skills that I developed in the brief cognitive therapy I did as a suicidal 18-year old still come in handy when I need to recognize and stop irrational depressive thoughts. But it took many years of work both in therapy and as a psychotherapist helping others before I truly believed in my value.

    Most of the therapy I have received over the years has been supportive in nature. The skills you develop in CBT are useful, but often you just need an empathetic listener who helps you counter negative self-deprecating thoughts with warm, caring, positive supportive statements that recognize your value as a person.

    Best wishes as you seek recovery from depression.

    • Thank you for such a kind response! I’ve been on the three meds I’m currently taking since last autumn, and I reluctantly admit that the meds are necessary alongside the therapy. At times I think I have a ready empathetic listener right next to me, and then other times I’m uneasy about burdening her more. It’s a fine line, I guess. But I can sure appreciate the value of having such a person!

      Anyway, I’m thrilled to hear you finally arrived at that place in which you recognize your value. Fantastic!

      • What people don’t realize is that while moods may pass, underlying mental illnesses may require a lifetime commitment to recovery. I wish you the best on your journey of recovery.

  11. Reblogged this on 13Gramarye and commented:
    This author shares his thoughts on the value of CBT – many of which echo mine. As a “mental illness veteran” (love that description, Sid) I kind-of roll my eyes when anyone mentions CBT. However, unlike the author, I have had significant success with plain old talk therapy. Works for me and even now (16 years into seeing this therapist) I still go to her when I need to. We’ve agreed that our relationship is a life-long one.

      • My attitude throughout all of my long struggle with mental illness (specifically depression) is that it is way past time for this to be a hidden issue. I am very open and up-front about it both in my writing and in my day-to-day life. I appreciate others who have the same mindset. 🙂 Good luck with CBT – but, my bias? Talk therapy works. That being said you have to have a COMPETENT therapist and they are few and far between.

  12. You know some of my history of CBT and that it didn’t work for me. On that note I’d have to disagree with comment that the success of CBT depends entirely on you. Maybe it’s understandable that I might have difficulty with that and maybe jt could said that I’m simply defensive but I strongly believe that the success of any therapy depends on both the patient AND the therapist. Too easily we can turn therapists into gods. They’re not… not quite anyway.

    I think that while the therapist played a role in CBT not working for me, I know that I did too simply because there were more pressing issues that I needed to deal with before I went anywhere near CBT. While I’m still not convinced that CBT would work for me now, I know that other forms of therapy (using a different therapist) did work. Unfortunately the age old issue of money eventually put an end to that, I know that what was called ” me failing therapy” was not a life sentence.

    I guess what I’m saying in a long winded way is to be open to possibilities. Just because one means of getting well works for some doesn’t mean that it has to work for others. We are individuals after all. One size does not fit all. And that’s ok. Good luck in working out what fits you.

    • Thanks Cate – you are so full of wisdom, every time. I don’t think I’ve deified my therapist, but I do feel like he’s as effective at what he does as anyone. Could I be wrong? Absolutely. Do I have the strength right now to seek out another therapist? Not even close.

      I totally appreciate what you say, though I do feel like in this case it’s all (or mostly) on me. It’s like my insecurity and anxiety and and and… and my disbelief in the rational challenges – these are things my psyche just can’t yet let go of. I don’t know why, and I don’t know what it will take TO let go, but at this point I’m unable. Some will say that’s defeatist thinking and I am fully capable, but I take offense to that. If I could do it, I would. Anyway, this individual thanks you as always for the support.

      • I don’t think it’s defeatest thinking Sid. It’s just real. And being able to recognise that is a big thing.

        Also I didn’t mean to imply you should be looking to change your therapist, but rather that it was my experience that I needed to. It sounds like your gut is saying you’ve got the right person. Just listen to that.

  13. Did not intend to interrupt topic flow with my earlier comment, and certainly did not wish to discourage anyone from attempting to obtain copies of their psych records. Rather, I strongly encourage all to pursue such course and early on, and since, as indicated in piece, such records are instructive and most helpful to the patient/client. And, although far from true in my history, obtaining these records should be a simple and straightforward matter.
    I take the opportunity to stress that, whatever one’s therapy, patients/clients do have rights, including HIPAA (1996), and mental health practitioners do have a Code of Ethics. Individuals stymied in pursuit of records and rights fast may establish whether or not a particular practitioner is competent, ethical, trustworthy. A patient/client should be an informed and full participant in all treatment-planning.
    For any who currently experience difficulties in obtaining records or otherwise experience a treatment provider without integrity, I suggest contacting an ombudsman or attorney.

    • No worries, Elise! In fact, obtaining my psych records is something I’d not thought of until I saw your comment, and I very much want to do that now. So, rather than disrupt any topic flow, you’ve encouraged me to take another step in my healing process – for that, I thank you!

      I’m sorry for you you’ve had trouble with this seemingly simple task, but it’s good to have a framework for what I should expect if I have similar problems. All the best –

      • Then I’m very glad for that, Sid, appreciate your response, and wish you all best, as well. Individuals experiencing depression, anxiety, low self-esteem sometimes are particularly vulnerable and therefore need and deserve a treatment-provider who is honest and supportive. In this post-HIPAA age of digitalization and “psychiatric malpractice,” unethical providers are less likely to get by with “purged, “sealed,” “wouldn’t make sense to you.” You should be fully aware of your treatment plan and be given full opportunity to grant or deny your consent. Knowledge and access are essential and empowering.

  14. Have you ever sat down and made a list of the things that you feel you are able to do well? Like any hobbies, etc? Things that you know you’ve managed to accomplish? And do you know what you like about yourself? Because if you know these things, and can remind yourself of them, then it may help towards building up your self-esteem, and that in turn might support the CBT.

  15. As a therapist, I find some CBT techniques to be helpful, but they’re primarily for short-term coping skill-building and immediate thought changes. It doesn’t really take emotions into account, and learning how to accept and deal with unpleasant emotions is a big part of making progress in therapy. Not all therapists follow this logic, but I have found that nothing is going to change if you’re not willing to get to the root of the problem. People put CBT on a pedestal, but just because it’s backed up by empirical research doesn’t mean it’s a miracle cure.

    Like a lot of people have said, it depends on individual preference and response. No one therapy style works for everyone, and it has to be tailored to that person’s needs. Best of luck and I hope you find what you’re looking for!

    • It’s refreshing to hear a clinician say this! I think CBT has a lot of value, but I get frustrated when it’s the only component of therapy. I think a lot of clinicians and programs are focusing too much on it (as well as DBT) because it’s short-term. In agencies that are overflowing with too many clients for their clinicians to handle, it makes it easier to treat more people, especially since you can use it for a group. Then there are the ones who like the short-term nature because it lets them see more clients and make more money. But my experience is that CBT alone leaves a lot of clients without enough support, and they’re emotionally stranded.

      So I’m glad to see that someone in the profession also gets it. Now, can I get you to say that to every single therapist in the world? 🙂

      • Precisely. I think it can be very effective for some people and for short-term stabilization, but if you’re dealing with chronic, lifelong issues, I don’t find it to be entirely effective for long-term treatment. You’re right – people/agencies like it because it’s short-term, and a lot of people (therapists and clients) aren’t willing to put in the work required for long-term, introspective work.

        Strangely enough, as much as I don’t personally love CBT, I’m about undergo an intensive training in CBT because my agency is paying for it…ironic, huh? 🙂

  16. If you’ve had lifelong low self-esteem and attendant depression, CBT may be too superficial a therapy. Check out schema therapy. It combines the practicality of CBT with investigating deeper, core issues of maladjustment that have us repeating certain patterns of thought and emotional reactions to them. It’s not a quick fix, but neither is CBT if it’s not working. For an introduction to its concepts, look up the book Reinventing Your Life by Jeffrey Young.

    • Thank you Julie! I see my therapist next week, and I will definitely bring this up. I’m also hitting my library first thing tomorrow to check out Young’s book. Have you undertaken schema therapy, or administered it? And seen it work? Thanks again for the reply and the recommendation.

  17. sorry, i know this post is months old, but i hope i can still contribute something!

    i’m not a therapist, but if the things you’re writing are causing mental backlash, then it seems like it could be doing more harm than good because you don’t believe the initial statements but you do believe the negative reactions you’re having to them. this belief/lack thereof could make the negative reactions more powerful and “effective” than the positive statements you are writing and end up simply reinforcing your negative beliefs.

    one piece of advice I’ve heard people use before is to start by saying something like “*maybe* i am ____” or “what i’m expecting *might* not happen” or “this *could* work out in a more positive way than i’m expecting it to right now.” you might not believe the definitive statements you’re writing, but you can still imagine or be open to the possibility that they are true. then, gradually, as you succeed in subtly shifting your perspective towards a more neutral one, you could start to make the statements increasingly positive.

    it might also help to try to think of examples of the thing you are trying to prove to yourself – like if my initial thought was “i’m a failure,” then i might write “i am successful in a lot of ways. i’m in graduate school, and i’ve held the same job for over a year now.” i might not believe “i am successful” at first, but if i force myself to come up with concrete examples, i then have to admit that there is some truth to it. also, notice the second part of my example is just “i’ve had the same job for over a year now.” it doesn’t have to be anything earth-shattering. my income is very low, and there are plenty of reasons why i might not be able to say “i have a great job” and mean it. but i do at least have a job, and i can’t dispute that. i could also write something like “i have a job where i get to help people every day.” admittedly, that’s not usually the first thing that comes to mind when i think “success,” but it is one way of defining it – and if i use that metric to compare my job to others instead of comparing incomes, suddenly my job comes out looking a lot better.

    hope this helps – or that all your problems are solved by now and you’re totally beyond the point of needing anyone’s help 😉

  18. Ha! Suzanne, thank you for the definitely not-too-late comment. I’d love to say I’m totally beyond the point of needing help, but, alas…

    I think there’s something to my belief in the negative thoughts and the reinforcement of them. It stinks, to put it crudely. The idea that my rational challenges don’t have to be absolutes is a great one, and one that I’ve neglected to try – so thanks for the reminder. Of course there are things I can say to myself about what I’ve accomplished, who I’ve influenced, what I like about myself, etc. – so those in conjunction with the less rigid challenges should be of help.

    Glad you came across my post, even months later. Always welcome!

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