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How does CBT differ from "traditional" counselling

(23 Posts)
imaynotbeperfectbutimokmummy Mon 06-Jul-09 13:59:06

I have severe anxiety, have been having "traditional" counselling for anxiety and depression for the past year. I am not sure how this has worked for me. I have had some pretty heavy financial shit to deal with, and i think that it has definately helped me sort that sort of thing out. Much more positive about that now. However, the sessions tend to just turn into a bit of a whinge fest, dissecting mine and DP's relationship and how we interact each week.

The thing is, my main issue is health anxiety - i don't think hypochondria begins to describe it. To be fair, i think i have buried it as i find it so hard to deal with.

AFter the latest set back, my GP wants to double my AD dose, well, she wanted to change completely, but i was worried about having to take diazepam during the changeover. This is frustrating in itself because i was actually reducing my dose with view to stopping. Now im back to square one where the anxiety is almost paralysing me - i try to keep busy, but it just wont let me, i end up doing nothing at all. I find i can sit for hours and just lose time. I sit in silence in the house when there is no one around, as the noise from the tv stresses me out. Music is OK but i cant listen to the radio in case a sad song comes on and im a wreck again.

I did ask for CBT initially but was told it was not available. I had to jump through hoops to get "ordinary" counselling. Anyway, now they can arrange it, although it might take some time.

I don't want to give up my counselling as it is an emotional crutch for me and i feel quite scared of the CBT as it is defintely going to challenge me quite profoundly.

Has anyone been though cbt and found it useful - i feel emotionally quite frail just now and worry that im not up to it.

guvk Mon 06-Jul-09 14:07:24

I'm having cbt at the moment and the central idea seems to be identify a range of situations, and for each of these situations to identify how it makes you feel, what negative thoughts and behaviours you have in the situation, how those thoughts and behaviours make you feel; what alternative (positive) thoughts and behaviours you might try to strap in there instead; how those alternative thoughts and behaviours make you feel.

The idea is to repattern your thoughts and behaviours, on the assumption that mood is largely the consequence of thought and behaviour, rather than the cause.

There should be exercises that allow you to identify all these; and homework that allows to to practice identifying and changing problem thoughts/behaviours.

You will be skribbling down info on timesheets about 'what I was doing at 10:30; what thoughts screwed it up ... etc.'

I got very very disillusioned becauise my therapist didn't sticjk hard-and-fast to cbt -- he drifted into general 'counselling' about dealing with family relationships. If this kind of drift would not be right for you, I'd recommend discussing in an early sessionexactly how you expect the therapy to pan out.

guvk Mon 06-Jul-09 14:10:39

oh, and yes, it can be quite challenging in the sense that it will require you to stop avoiding certain triggers for bad feeling, to face them armed with thought-and-behaviour strategies, to 'feel the fear and do it anyway'. I think. Good luck.smile

TotalChaos Mon 06-Jul-09 14:16:40

I had cbt for ocd/depression. I actually found it much more positive an experience than bogstandard counselling. I felt that bogstandard counselling encouraged me to dredge up childhood problems/family problems so depressed me further, with nothing more than "give that 5 year old child you were a hug" as a solution. Whereas CBT is more positive, looking at your present difficulties and working to a more positive future by altering how you look at yourself and your thoughts and behaviour - about learning how not to go into disaster/"I am shite mode", but how to look at things more constructively and realistically, I imagine part of the therapy for health anxiety will be looking at the sensations you feel when worried about your help, and working on reducing physical symptoms caused by anxiety, and looking at risk, and your perception of risk of being ill, and how to cope with it better.

imaynotbeperfectbutimokmummy Mon 06-Jul-09 14:26:58

thanks, that is very useful information.

TC - sorry, but i did have to smile about the "give that 5 year old child you were a hug" did you manage to keep a straight face?

What i have found is tht what my counsellor says to me is logical and sensible, but i can't seem to put what i know into practise.

Its like if i allow myself to think everything will be ok i will jinx myself and make it all go wrong, so by living in fear i keep the demons away.

guvk Mon 06-Jul-09 14:37:49

"what my counsellor says to me is logical and sensible, but i can't seem to put what i know into practise"

--I know that feeling very well, and of course the depressive response to it is to say 'I am crap and so I can't make use of the therapy; it won't change me so I'm wasting therapist's time.'

The emphasis on behaviour is a little bit helpful here. You don't have to somehow bootstrap yourself into thinking differently, you just have to undertake lots of little (and eventually bigger) exercises of acting differently. And then the behaviour improves your self-image and gives a little more freedom to shift your bad thoughts.

It is so much easier, isn't it, to stay in the awful prison of thinking the worst of yourself, and of what might happen.sad

I haven't actually made v much progress at all, but I am starting to see the value of plugging away.

imaynotbeperfectbutimokmummy Mon 06-Jul-09 19:17:41

thanks guvk that sentence could have come straight from my own mouth.

nickytwotimes Mon 06-Jul-09 19:25:12

I ahve tried CBT.
IMO it is utter rubbish. I am with Oliver James on this. It is basically Paul McKenna. You try to convince yourself that things are really okay rather than addressing the root casue of your disorder.
It is a quick fix, a magic bullet, and though initial outcomes are good, after 18 mths, the majority are back where they started.
It is imo being used as a low cost elastoplast.

Sorry, but I think it is no good.
Conventional therapy, but with a better therapist, is still the most effective treatment, but takes years and really, really hard work, so is hard to secure funding for.

imaynotbeperfectbutimokmummy Mon 06-Jul-09 19:34:16

thanks for that voice of dissent nicky - it is good to hear another point of view. I am very skeptical abou self help type stuff. I like my counseller, i feel we made progress but i didn't face up to the real anxieties because i chose to hide from them. I am seeing her tomorrow, i don't want to give up on traditional counselling and lose my place if cbt isnt going to work for me.

All i know is, right now, im sitting here, convinced im dying and that i wont see my DD grow up. I can't go on like this. It eats up almost every minute of the day and is ruining my time with DD. I'm waiting on some blood results and it is frying my head, doctor said she would ring me with results if anything significant comes up, that she would be surprised if it does, other than that i am to ring on Wednesday and she will leave a message for me. I honestly don't know how i am going to get through these next few days, and i am terrified that if i need further tests then i am going to freak out, really properly lose the plot and DP will be at work all day.

nickytwotimes Mon 06-Jul-09 20:02:53

If you haven't yet been able to face up to your real worries, then that will hold you back, whichever therapy path you take. But I know you know that already.
When you are this bad, it is hard to get through each day. Try to take things one hour at a time. Use whatever/whoever is around to get you through this crisis - phone Samaritans/friends/family. It is only you that can get through this, but you do not have to do it all alone. Others will hold your hand, honest! smile

Oh, and diazepam might be worth a whirl just for a day or two. It needn't be scary. Or you could ask about beta blockers which help with anxiety too. Loads of people use these tpes of drugs short term with no ill effect. I found beta blockers helped me a few years ago and I only used them for 3 weeks.

guvk Mon 06-Jul-09 20:27:29

It is true that the govt is pushing a 'quick fix' bargain-basement cbt, with minimally trained practitioners; but done properly it can be a good therapy for some people. It is certainly worth trying. It isn't always helpful to look at current problems in the light of their causes. I had years of 'psychodynamic' therapy to little effect. Sometimes it is right to focus on the here-and-now and adopt a practical approach.

minxofmancunia Mon 06-Jul-09 20:28:32

I'm a trainee CBT therapist, it works for some people and not for others I'm not a zealot about it! (Unlike some of my lecturers I might add who're so conditioned into the "model" it's like a kind of religion).

I do believe there's some misconceptions about CBT however, i.e. that it's a quick fix, that it dismisses early life experiences, that it's all about tasks and pays no heed to the therapeutic relationship etc.

CBT can be done on different levels, the maintenance level ( thoughts feelings behaviour) which for a lot of people produces significant chnage in mood. If that's not effective longer term CBT can b done on the assumptions/core belief/schema level using more sophisticated techniques. I.e. exploring someones rules for living in depression/ocd it's often "everything has to be perfect otherwise I'm a failue as a person" and it's about looking at the advantages and disadvantages of that rule and producing a more flexible rule in COLLABORATION with the client, it's not about being told what to do or sorking through one of these over hyped self-help manuals.

In answer to your question yes it, IS challenging, behavioural change is part of it and can be very challenging for some clients but if stuck with it produces significant affective change.

There are also off shoots of CBT developed by fairly eminent therapists which you may find helpful such as compassionate mind therapy, rational emotive therapy, schema focussed therapy and mindfulness based CBT, all fo which amalgamate traditional CBT techniques with other approaches (such as mindfulness from zen ideaolgy). These are 3rd wave therapies and are being increasingly used.

The fact you now see counselling as an emotional crutch is interesting, could it be that although helpful it's almost become a safety behaviour for you in itself?

Anyway best of luck whatever approach youdecide to try, you CAN have long term CBT too, some patients have it for up to 18 months so it's not just quick 9 sessions then out the door. I've been seeing a lady with horribly low self-esteem issues now for 6 months for example.

guvk Mon 06-Jul-09 20:28:40

Sorry, I meant also to say how sorry I am that you are feeling so rough atm imaynotbeperfectbutimokmummy. I really hope that things get easier for you.

guvk Mon 06-Jul-09 20:31:56

Interesting post minx -- my therapist emphasises the mindfulness approach and it seems interesting and potentially helpful. I find it very hard, though.

minxofmancunia Mon 06-Jul-09 20:40:05

I've only had one lecture on it so I can't actually do it! I find some of the principles v interestign especially as I'm a bit of a yoga devotee which has a strong foundation in mindfulness.

I think the expectations of the clients are pretty high with mindfulness, having to do a practice every day for example, not many of us can manage that!

Compassionate mind also v interesting, being kind to yourself essentially, telling yourself it's not your fault the responsibilty for behavioural change is.

When I told my low self-esteem lady she could allow herself to be really angry with her parents because it sounded like she had a right to be, she couldn't stop crying (in a good realisation way!), but behaving like a child and being obstructive and temperamental everytime they said soemthing awkward wasn't really getting her or anyone else anywhere she made a massive shift. It's quite powerful.

imaynotbeperfectbutimokmummy Mon 06-Jul-09 20:47:51

minx, how can i take away with me what is said in the counselling room. This is where i fall down - i know what is being said makes sense. I am supposedly quite intelligent, but i just get obsessed with stuff - i don't think i have ocd btw.

my obsession with health ruined my relationship with dd1 and i can feeling it doing the same with dd2. I hate this, and i hate myself.

minxofmancunia Mon 06-Jul-09 20:59:35

I wish I could help you on here op! But it would be unprofessional and potentially damaging of me to make more than the most basic suggestions, i really think if you talf about your difficulties with your therapist about putting things into action you may be able to come up with an action plan.

Something is stopping you, you need to talk it through with him/her to identify what the blocks are.

I'm so so sorry you say you hate yourself, have you explored this with them? It's difinitely worthy of a big chunk of work if this is how you feel.

imaynotbeperfectbutimokmummy Tue 07-Jul-09 16:34:10

having a shit day today, waiting on blood results, i jump like an injured cat when the bloody phone rings.

guvk Tue 07-Jul-09 17:46:56

Sorry you are having such a tough day. It's funny that in some respects I know exactly how you feel but in others I am an outsider to your state of mind, just because I don't have health anxiety. I suppose the same sort of fundamental problems have just found a different focus in you than in me.

I think the health anxiety focus might in some ways give the cbt a slightly better chance. I mean, there is a definite area,a definite set of triggers and anxieties to work on, in contrast with the utter pervasiveness of the depression and low-self esteem that you might also have.

(Not saying it is a good thing to have the health anxiety of course: I'm sure it feels just awful to you. It is just that I get the impression that cbt works best when there are more concrete, defined, problem areas.)

coveredinsnot Tue 07-Jul-09 22:28:48

Hi there. Sorry you are feeling down. I think minx has explained CBT well - it is very different from counselling which is about supporting but not directing/ challenging you. CBT is about identifying styles of thinking that you have that you've kind of got stuck in, like a habit (so you're not really aware of them), noticing them, and challenging them through 'behavioural experiments' which are basically ways of testing the ideas and beliefs you have about yourself to see if they're actually fact, or whether you might be being a bit too harsh on yourself. The behavioural element (the 'B' in CBT) is really important - it's where most of the change happens, and this sounds like where you're getting stuck with your current counsellor, since there's not much or any behavioural work in counselling at all. I think, because of this, CBT sounds like it will work for you.

Be prepared to work hard though - you will have lots of things to do between sessions and you will have to think hard and be up for a few challenges (all things you agree with though!).

I hope your new therapist is good. Good luck.

imaynotbeperfectbutimokmummy Wed 08-Jul-09 09:42:42

when you say hard work, is that intellectually or emotionally hard - cos i don't feel strong enough for emotionally hard. I am literally falling apart just now.

guvk Wed 08-Jul-09 09:50:22

You can start with the smallest challenges. No one will expect you to climb a mountian straight away.

You do need to be able to focus intellectually, and that is hard if you are sobbing etc. But it isn't rocket science stuff, only applied and guided common sense.

Emotionally, you might actually find it easier than you expect to pick a very tiny challenge and complete it (with a sense of achievement and a pat on the back) than to stay as you are.

Best wishes.

Niecie Wed 08-Jul-09 10:06:00

Hello, Imaynotbe.

I have had CBT too and found it quite useful. I used to live most days in a heightened state of anxiety too but it was pre-children so I really feel for you having to cope with children and anxiety.

I had a 3 parts to my treatment. I had one prescription of beta-blockers which I tried very hard not to take often and they helped with the period before I got my first appointment.

Before I had CBT I had a several sessions on relaxation techniques where I worked with a therapist to learn how to relax and then I had a tape to listen to every day. The benefits of this is that it re-teachs you how to breath properly which is half the battle. I think when you suffer from anxiety your breathing goes to pot to the point that you actually don't know how to breath any more iyswim. If you spend you life shallow breathing you are going to feel ill and that in turn worsens you anxiety, which affects your breathing, which makes your anxiety worse.... You get the picture - it is a spiral which can easily get out of control. The relaxation course helped with this a lot. I even read that a physio can be helpful with this.

The CBT was quite good but I don't feel I got the full benefit because I found it really hard to open up to the therapist and I don't think there were really enough sessions. That said she did manage to change the way I think about some things. It is a question of perspective. If you see everything as a disaster then it will be. If you see everything as a problem you can deal with, you will. It won't make the underlying problems go away, just make them easier to cope with.

I would give it a go if I were you. You have nothing to lose as it sounds like you feel terrible already, and it might just help.

Good luck.

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