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Does CBT work?

32 replies

webuiltthiscityonrockandwheat · 15/03/2023 20:50

Just that really. I'm having face to face CBT sessions to try and help my anxiety. I'm not anxious generally but it's triggered badly when one of my children or DH is poorly. I did CBT online during lockdown and found it basically useless so they sent me for face to face this time but I just don't see how it can help me. I had an anxiety attack this evening and I just can't see it ever getting any better. It's debilitating when it happens. I want a magic pill but I know that's never going to happen but I'm not sure CBT is the answer.

Sorry if I'm rambling, I'm struggling a lot with anxiety at the moment and anxiety attacks make me feel very sleepy

OP posts:
stopthepigeon · 16/03/2023 07:35

Think it depends if you are using it for the right sort of issue? If you are trapped in an old thought pattern when life has moved on it can help.

If you are stuck in an intolerable situation which needs to change, you need something capable of helping you face and deal with the underlying issues, so that you can transform your real-life situation. That generally won't be CBT.

ParkrunPlodder · 16/03/2023 07:40

I was advised that CBT wouldn’t be right for me as I had already had counselling which had helped me but now cerebrally I was almost too aware. They recommended I try EMDR instead for cPTSD and that has changed my life. It was still hard and I have had to actively stop myself dropping back into old patterns of thought and behaviour but the processing it allowed me to do for historical trauma that was constantly being retriggered by minor everyday happens has been amazing. I’m still triggered but I can manage it now. I was falling off a cliff before as I was developing a multitude of increasingly serious physical ailments that were caused by a lifetime of squishing past childhood trauma inside my body.

I would have a chat through with them whether CBT or EMDR might be most suitable.

stopthepigeon · 16/03/2023 07:48

Have you read The Body Keeps the Score?

JarByTheDoor · 16/03/2023 08:18

Sometimes, for some people, for some problems, CBT works, to a lesser or greater extent.

As others have said, if you don't put in the effort both inside and outside sessions and continue with that effort after therapy has finished, then it probably won't work for you.

And if you do put in the effort, there's still a good chance it won't work for you — if you're not ready for it, if you don't have the right kind of problem, if you struggle to access the education and tools and techniques, if your therapist isn't experienced enough, if your therapy doesn't last long enough, lots and lots of reasons it can be disappointing.

For those it does work for, it can be life-changing, or it can improve things enough to make life more manageable, and it's also possible to go back for top-up sessions if you find yourself slipping later — that's totally normal, and it's not like starting from scratch.

I found it worse than useless for my depression.

When I'm leaning towards more severe depression, I struggle to move or talk, I can't understand sentences much longer than half a dozen simple words or with complex concepts (and they take a long time to hear, process and understand), my thoughts take effort to pull individually out of the sludge (and all of them are grim and hopeless), and the kind of questioning and evaluating and critical thinking required is utterly impossible. I just feel terrible guilt and shame at wasting someone's time, despair at the hopelessness of it all, and overwhelming fatigue at having to go somewhere and produce words.

When less severely depressed, or agitatedly depressed, I find the attempts at challenging and reframing of thoughts to be a turbocharger for my depressive thinking, as I start arguing in circles with myself, digging deeper in and finding even better arguments against the reframings as to why I'm useless, pathetic, a burden, am morally obligated to kill myself, etc. etc.; that I'm pathetic for falling for cognitive biases and at the same time believing every terrible biased thing I think about myself, and I've told clinicians these false beliefs about myself and how others think about me and how I've hurt people, and how useless and depraved I am, in such a convincing way (because I believed them) that they've written them down as fact. Which has turned out to be unhelpful.

But! Same person, different problem and different time (and different therapists): I found the more behavioural side of CBT, in the shape of treatments for specific anxieties, particularly using graded exposure, really quite helpful. While there's nothing I can seemingly do to stop my mind fighting back against the more cognitive type of treatment I was given for depression, I can force myself through graded exposure and make my brain slowly realise that shop assistants and buses aren't going to eat me.

Although, funnily enough, the real breakthrough with public transport fear didn't come until I changed my medication. Weeks of work got me tiny improvements, but then I had a bad week, couldn't make myself do the solo bus-trip to the local town we'd planned I'd do, and the IAPT therapist fired me 🤣 A couple of years later on, having recently started the new meds, I thought "Why don't I visit my relative in London?", mentioned it to them, took a bus, a train and the underground, and didn't feel the slightest twinge of anxiety.

By which I mean to say: have you checked with your doctor that your medication is really optimal? There may be some options for anxiety you haven't yet explored — changing your meds or your dose, or maybe adding meds to target symptoms.

Unfortunately, a lot of the people providing CBT have not really had a particularly broad training; many of them are trained only in CBT and some listening skills to support that, and only for specific patient types and scenarios, and will often just go by the book, hardly much different to doing a CBT course on a computer. I hope you get a decent one.

ParkrunPlodder · 16/03/2023 09:05

This was the book recommended by the NHS therapist who I did EMDR therapy with.

Seasider2017 · 16/03/2023 21:51

i think you have to really believe for therapy to work and not be too poorly to engage

cbt didn’t work for me but I was too poorly at the time and I don’t think person helping me was any good.
my appetite was zero virtually when I had high functioning anxiety
she told me to go to the supermarket near the hot food counter and the smell would make me hungry or have a look round and get what you fancy.
literally the smell of food made me heave 🤮

Losingtheplot2016 · 16/03/2023 23:18

It can work ! Be dead honest about how it is going with the therapist - it's all part of what you are working on.

Also if you are feeling crap about yourself get that in the open too. I think one of the biggest barriers to cbt is shame. But if you can tell your therapist and work with that - and don't hide it - then it really helps

If your therapist makes you more ashamed the relationship isn't working and cbt won't be effective ... but there are loads of therapists out there

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