I’m a Cognitive Behavioural Therapist (CBT), ask me anything

[BeaPerry]

I’m a Cognitive Behavioural PsychoTherapist (CBT) AMA ?

Why do you think CBT is widely used by the NHS, especially gps suggesting it & DBT is rarely spoken of?

I preface this with having spent years bouncing around the mental health/crisis teams (over 20 yrs). I finally was told about DBT & it truthfully saved my life!

No, but a lovely old consultant psychiatrist told me why he finds CBT funny 🤣 -

and it’s nothing to do with therapy !

Yes, well delivered CBT is about being the right modality for the appropriate difficulty and suitability to the person with the psychological difficulty

six session of CBT rarely is sufficient for a true psychological disorder
and there are varying levels of skill set within CBT

CBT shouldn’t be a hoop to jump through to access a more suitable intervention

Yes - it can be very effective but also totally wrong approach -
depends on the trauma

CBT is viewed as ‘easy to learn, easy to practice’
DBT seen as more of a specialism-
DBT highly effective for the right problem focus of course -
the training is much harder to access for DBT

Have you worked with clients with Binge Eating Disorder? If so, what proportion of them are significantly helped by the therapy? Do you do any follow up, e.g. 6-12 months later, to see of they are still binge free?

CBT practitioners are not qualified to diagnose - that’s a medical (doctors) remit
however, a CBT practitioner should provide a written discharge letter stating what the psychological problem area was - e.g. low
mood that was presenting as Xxxx
causing xxxxx difficulties for the person etc that led to being unable to continue in education etc …

Yes, and it depends on the drivers of the binge eating -
it can be very effective, but not for all -
good services offer a follow up to monitor progress, but may can’t because wait lists are
long
have a look online for CBT randomised controlled trials for binge eating disorder- there have been a few -
CBT-E considered quite effective

Issues that related directly to someone’s personality disorder, as there are better more evidenced based therapies
complex trauma sometimes is better attended to by a psychodynamic approach,
attachment, interpersonal, relationships issues - better served with other modalities

Good point.

I have autism and have been given cbt three times as it is all the nhs offers.

They seem to love the measurability and relatively short timescale.

For me it is like them putting a plaster on a gaping, festering wound thus causing more problems than ever.

I ended the last lot and have told them (more politely) to shove it where the sun doesn’t shine because I am fed up with their bloody one size fits all approach.

I understand it may be helpful for more straightforward issues but it does bugger all in complex trauma and, as I now know, for people with autism.

I have both.

I have found cbt utter shite and if anyone ever asks me to score things out of ten again I will not be responsible for my actions.

Yes, I am a bit cross.

In modern parlance, even the term cbt “triggers” me.

For general (but constant) anxiety, would CBT or Play therapy be more effective for a 10 year old?

Yeah, I’ve looked at CBT-E. The problem I perceive with it for binge eating disorder is the assumption that dietary restraint is the primary driver of binge eating. True for some binge eaters but not for all.

Subject is (or believes themselves to be) fat -> subject diets/restricts -> subject binges as a physiological response to under nutrition. In this model, then encouraging the subject to eat all foods in moderation rather than exclude certain food groups makes sense.

However if the binge eating came first, with weight as a consequence and then dieting behaviour later, then that model doesn’t work.

You said it depends on the reason for the binge eating. Do you believe it can be a consequence of addiction to specific foods? Sugar or UPF’s, for example?

No, there are plenty of studies showing how people with neurodivergence’s don’t fare well with psychotherapy not just CBT -
but any experienced mental health professional including CBT have experienced some good outcomes when the person in front of them including the neurodivergence is taking into account and the therapy tailored

Does it work for phobias? Been recommended for emetophobia or more specifically sickness bugs and me catching them. Long waiting list though

It is true that some people don’t suit psychotherapy including CBT

but before concluding that it doesn’t suit you, a trial with an experienced practitioner would be a good idea but I appreciate accessing an experienced CBT practitioner with specific skills in your presentation is the hard bit

Yes -
CBT is highly effective for many people wit phobia
emetephobia is one of the more challenging phobias, but very effective-

Do you ever use CBT in the area of palliative care/EOL care ? I have read a few books and articles which suggest it can be really useful in this area of healthcare, just wondered if you had any experience ?

No one should pretend to be able to answer that without assessing your child and their particular difficulties and what your child is like as a person - sorry

Sorry, not in my clinical experience -
CBT is an active, structured quite demanding therapy - it doesn’t make sense to me that it would be appropriate for someone under palliative care-

Can you suggest anything for someone who hasn't found CBT effective for anxiety mainly because they have untreated ADHD and a lot of thoughts?

Would it be better for the ADHD be treated with ADHD medication or the anxiety with anxiety medication?

Does cbt work on people with eupd my area doesn't offer dbt. Ive had no luck with cbt

binge eating usually benefits from mechanical -
planned regular eating -

working on what appears to be maintaining the binge eating : emotion regulation, self esteem, environmental factors, interpersonal factors, craving for UPFs / sugars etc —
And working systematically through the triggers -
you are right of course, for many it is not control of shape and weight dietary restraint driven

I have personality disorder but no history of trauma. How could it help me?

it would depend on how your PD affects you,
and what you focus for psychological therapy would be ?

CBT can help if someone has EUPD but that’s evolved to be relatively manageable and the person is looking for psychological therapy for a problem that CBT has a good evidence base for like panic disorder, social phobia, OCD etc

for EUPD - if DBT isn’t available, mentalisation tnerapy, dynamic interpersonal therapy, emotional regulation skills can be helpful -