I'm a CBT therapist AMA

[FeelingsAreNotFacts]

I work as a CBT therapist for an IAPT service. I know there are lots of misconceptions around what CBT is and what IAPT can help with. AMA!

Sorry, CBT is cognitive behavioural therapy. IAPT is Improving Access to Psychological Therapies - these are the first port of call mental health services GPs will direct patients to in each area and they are set up to deliver interventions for mild to moderate mental health problems.

Intrusive thoughts might indicate OCD; EMDR would more commonly be used for PTSD in IAPT but definitely worth arranging an assessment to clarify and discuss. Best of luck getting the help you need

to me it felt like I was being told to "think happy thoughts"
Me too. I ended up just explaining in detail why my current thought processes were logical and valid. This is why I feel like CBT doesn’t work for autistic people. My thoughts aren’t irrational - they’re supremely logical and evidence based, and thus very hard to change.

3-5 individual clients per day plus assessments, groups, follow up calls, risk checks etc. I try to organise my diary so that there's at least 10 minutes between patients so I can prep/clear my head and decompress but it's not always possible.

It is stressful though less so than the community mental health team I used to work in. The clients are mostly lovely but the stress comes from the utter relentlessness of the paperwork and the overwhelm from more and more of the clients we see having highly complex needs when we're only meant to be seeing people with mild-to-moderate difficulties

For an autistic person, what would you recommend communicating to the CBT therapist in order to get the most out of it? What would you, as a therapist, want to know?

I have unfortunately had CBT therapists in the past with very little understanding of autism and its associated emotional problems. I have alexythemia (psychologist diagnosed) and can’t identify my internal emotional states, this makes “standard” CBT difficult. When I said this to a therapist, she advised me to try harder and to take the sessions more seriously!

I would say that while I have had bad CBT experiences, it was hugely helpful for my OCD. A combination of slightly modified (less emotion naming) CBT and psycho-education on the mechanism of OCD gave me my life back.

Thanks for all your questions! I'm going to bed now but will return to answer the rest tomorrow

I have found CBT extremely helpful to me , with two different very good therapists. This was in relation to OCD.

But I've also seen another two who claimed to do CBT who didn't help me at all and where I don't know if the CBT they were claiming even was that. One made me worse, though that one persuaded me to do EMDR instead which didn't help at all and in fact made me get worse. I feel quite stressed up thinking about that.

However, perhaps the most helpful therapist of all who got me out of a very dark place does do a version of CBT with ERP, I think is the name. Which I think is supposed to be specifically designed for OCD. And I suppose that's my point. About the specificness of the therapy to the problem and whether that is done enough or thought about enough.

For me, it hasn't been a quick therapy at all like you read about but very very detailed and structured in a way that's very specific. I can see it's a lot of work for a therapist and i wonder if most people get that level of specificness. I read a lot on here people who are scathing of CBT which I'm not at all because it really really has been good for me with a very good therapist, but I wonder if it can rattled out sometimes like a quick cure-all and this rolling out of general and not very specific help could perhaps give some people the impression it can't really go further for them. I think with the right therapist it definitely can, but it requires quite a lot of work and insight and also commitment from both sides.

I also think it requires a lot of desire to change by the person getting the therapy. The sort I've done uses a lot of negotiation and coming up with practical plans together - and - ideally - the person should feel enough in control but also pushing themselves and this isn't always easy. But can actually feel really rewarding too. For this to work you really need a lot of active engagement from both sides and a real desire to change from the person getting the therapy. I sort of recognise some of the comments above where people seem to be at the stage of arguing with the therapy rather than wanting to use it. I've been there and I think you have to get past that stage. But, equally, it can be hard to know therefore if the therapist is any good for a while and sometimes if you don't come out of the arguing stage, it could be because the therapy really just isn't doing any good and not chiming at all. At the end of the day it's not something "applied" to you. It's something where you take it and start to use it actively and usefully where you need to.

Those on here saying it felt just like "think happy thoughts". This is nothing at all like the therapy I've experienced. Which makes me wonder about all the zillions of different people claiming to practise CBT and whether people are getting very different experiences.

Sorry. To my questions. Do you think the sort of general claims about the very long list of conditions that CBT helps is correct? Do you think there are some things it really helps with and other things that it can't really help with? What are the ones it works best for, and what ones doesn't it work so well for in your experience? Do you think the way it is offered is too general? Such as short online general courses. Or do you think this can work and still be helpful for people? How long do you think is optimum and do you do longer more detailed CBT-based therapy or is it a more standard set of things you work through?

What do you think of more longer and detailed used of CBT? Does the reputation as a cure-all in six weeks perhaps take over so much that longer more detailed approaches based on CBT aren't really talked about?

I think this is a very valid point, and I hope the OP comes back to address this.
Therapy of any kind should always acknowledge the very real impact of discrimination, disadvantage or oppression. Unfortunately it doesn't always do that.

Im sorry for my abruptness @FeelingsAreNotFacts

I absolutely love your name btw

I have heating anxiety and im glad to read you have success with this in cbt. I feel im a lost cause.

Heating anxiety

I meant health anxiety

Why have you started this thread @FeelingsAreNotFacts ? As you don't really seem to be engaging much with it or the questions.

The OP is probably at work now. No doubt they'll reply when they have time.
. No need to be so abusive because the replies aren't following the time scale you'd prefer.
Edited for typos

Hi OP,
What do you think about CBT being prescribed for chronic illness/fatigue conditions such as ME?

I’ve got severe GAD. OCD and panic attacks and can’t work due to poor mental health. I’ve just had a major operation as well.
I tried CBT. It was shit. IAPT was appalling as well and I had two therapists. No reflection on you but no one can help.

I’ve had 3 rounds. Made no difference. Why?

@rileynexttime I wasn't abusive at all. But the OP invites people to ask questions about a topic which is naturally going to invite a lot of people with perhaps anxiety and other issues to engage with the thread. The OP then said days ago that they'd reply the following day. And now they haven't returned, despite inviting that engagement. It's not quite the same as a thread on AIBU as it is asking for questions and those with questions are very likely to be those thinking about therapy.

The timescale is not one I wanted, it was the one that the OP said themselves.

Perhaps you're reading rudeness due to this being typed. I am not feeling antagonistic or anything. It's just aware that there are already a lot of people sceptical about CBT on here. I am not one of them. But it's not too helpful if the questions invited aren't really engaged with once people have put effort in. Was all I was saying.

You're absolutely right , I'm sorry . You make good points and I shouldn't have said you were being abusive.
Apologies.

And I should have tagged you so that you see my post
@OCDthread

What's IAPT by the way?

OP said
Improving Access to Psychological Therapies - these are the first port of call mental health services GPs will direct patients to in each area and they are set up to deliver interventions for mild to moderate mental health problems.

And in my experience they are absolutely shite.

@rileynexttime that's ok and thank you for the nice updated message. I possibly was a bit abrupt with my comment upthread to the OP because I was feeling a bit exposed because I had opened up a bit about my own experience and was imagining some others felt the same. So when you do open up it feels a bit strange or pointless if the OP doesn't come back. BUt perhaps i haven't given them much of a chance.

I commented on here though because I do think CBT-based therapy has been really important for me so I thought perhaps it was important to say that. But I do wonder about the way it's rolled out in short or online courses. Like people saying they've had 3 rounds for example. I wonder what that means. I think sometimes the claims for it are quite general and within short time frames. I'm sure that can work or help some but when quite entrenched things like OCD, I wonder how effective short courses are as it took a lot longer for me. Also the point about how so many claim to do CBT but the methods I've encountered have been quite wildly different. So I wonder if people on here might be comparing apples and oranges sometimes. Hence why I was asking the question.

Where’s the OP ….

Fellow CBT therapist jumping in here 😊

CBT works brilliantly when there are ‘cognitive distortions’ or thinking traps. This is when a person sees things in a negative way when there is an alternative way of thinking that they might not be able to access. An example of this might be that someone has a run of bad luck and then begins to expect the worst, e.g. thinking ‘what if I try and speak with the other parents on the school run and they ignore me, I just won’t bother’. These thoughts build up and can result in or contribute to anxiety/depression. This thought could be challenged in Cbt to see if there is an alternative way of looking at it.

Sometimes, clients come along with complex histories, and their cognitions are based in fact, e.g. their child being diagnosed with a serious health condition with valid worries associated with this. A good CBT therapist will complete a full assessment and in cases like this, should refer on to an alternative therapy such as counselling.

CBT can be very successful for neurodiverse people, but it depends on what the client goals are. For example, someone with ASC might not want to have a wide friendship group and may find social situations draining, therefore undergoing treatment for social anxiety would be less effective as the behaviour experiments are designed to shift perception. If a behaviour is an intrinsic part of a person CBT will not work, or work less effectively.

I’ll have a go at answering this…

1. I think it depends on therapist experience. True CBT is taught for a select few disorders (GAD, panic, social anxiety, separation anxiety, OCD, depression… I may have forgotten a few). But an experienced therapist will have knowledge of other therapies to bring into the sessions, e.g. DBT for EUPD or acceptance and commitment therapy for systemic issues. I think the main predictor of a positive outcome is client buy in. The clients that do the homework and challenge themselves have all seen a good improvement in symptoms (ime), usually falling below clinical threshold. I’m not sure about Cbt for more experimental things such as self esteem, my service only funds it for core disorders.
2. True high intensity CBT (what I practice) is a minimum of 12 and up to 20 sessions long, a session is 60-90m long. I can’t comment on low intensity work ( the stuff PWPs do, 6 sessions on average). I think low intensity is good for prevention, less so for treatment of complex or enduring illness. It’s a shame that this is what people think of when CBT is mentioned, as true CBT takes much longer as you are working on the cognitions, and I feel this is where the lasting impact is made.