Advice on CBT therapy

[Wonderbug81]

Over the past few years I've had various things going on - 4 major life events, one still ongoing and I also have various symptoms from perimenopause (taking HRT).

I'm doing CBT via NHS Talking Therapies for high anxiety and moderate low mood.

We're currently talking about seeing problems as opportunities rather than threats. A few years ago, I would absolutely have been able to work on this, but after everything that's going on, I'm just finding this v hard to do now. It's like I don't have the resillience I used to be able to battle through.

Is it that CBT isn't right for me or is this precisely why I should continue and work through it to learn to cope better?

It sounds like a different therapy might be more what you need
CBT seems to be being used by the NHS to get people quick sharp back on track coping well time limited thank you very much
That's an over exaggeration obviously but it can be a little... capitalist?

The reality is we are complex creatures and sometimes we need a therapist that helps create a space to think and feel and work through.

Do they offer anything other than CBT?

It's like I don't have the resillience I used to be able to battle through.

Battling through becomes more exhausting the older you (I!) get. Experience and wisdom though become more plentiful, as does the ability to let things go or flow around you rather crushing you. Humour is very underrated.

Maybe 'strict' CBT isn't for you but there's a book by Kain Ramsay (who runs some excellent Udemy courses) called Responsibility Rebellion which may suit you.

For anxiety I found ACT more helpful than CBT. I saw someone who tried this after other therapies and also read a book called the happiness trap which I found really helpful to put things in perspective.

Thank you. This is all so helpful.

I've not heard of ACT but will look it up.

I'm not afraid to put in the work and do wonder if I can just use some books to get me through. Even when things have got to their worst, I was still functioning, going to work etc so maybe doing it on my own might work.

@Eyesopenwideawake I think my challenge is that I've not had any moments of peace before the next tidal wave came along, so no time to build my resillience up again. I've faced very hard things before but as you say, it's getting more tiring now.

My psychologist recommended that. I bought it, keep meaning to read it. ACT could be more useful OP, depends partly what you can acxess

I think CBT could still be useful but it needs to be targeted properly. There are many different techniques, its not all challenging thoughts. Have they done any work with ladders? It's breaking down the underlying anxieties and finding a way to slowly build up to tackling them, different rungs climbing a ladder from easy to hard and ultimately to overcoming the underlying issue.

An example, my DDs struggling with school attendance due to mental health, but attending school even for 30 minutes is too challenging at the moment it's like an 8/10, so we need to find somewhere to start that is a 4/10 challenge or lower. So the current challenge is get dressed and leave the house at right time, then when she feels comfortable with that and the anxieties dropped down a little so it's say a 2/10 we'll do the next step. We've successfully used these techniques for different issues a few times now.

Too much anxiety or fear isn't useful to the process, it paralyses. The trick is finding something that helps you work towards you goal without triggering so much anxiety/overwhelm/exhaustion you can't cope. Resilience is important but in my experience it's over rated a lot by a lot of people. Resilience is great if you have some challenges. Not so much if you're endlessly facing struggles or overwhelm.

Thank you. I think this is my challenge with CBT. I'm working towards goals despite the anxiety, I was doing it before the therapy even started.

So for example I was made redundant a few months back and the job market is very tough. I hadn't interviewed for a number of years and my peri had lowered my confidence, but I made a plan for job applications, seemed to get through job interviews as well as earning money through freelancing in the meantime (not enough though). Then I began CBT.

What I really want is someone to help me manage my emotions so it's less tiring and gruelling, rather than helping me make a plan of action for the problems themselves I suppose.

Sounds like counselling for depression (CFD) would be helpful for you. It will give you space to process emotions. Talking Therapies also offer CFD and you could ask for a modality transfer. The only thing is that it would be for depression only as that is the disorder CFD treats.

Tell your therapist this, if they've got the relevant training they'll be able to adapt the therapy but if you don't tell them there'll never know.

The thing is the various tests seem to show my anxiety is much higher. They don't think it's depression as such, just moderate low mood.

Thank you. I already raised it with the manager who allocates the therapist. He has been trying to encourage me to continue with CBT.

I'd be asking them why, I would want to know they had a clear rationale for this rather than it's all they can provide

I'll chat to them again and see what they say but I've read here on other threads that the NHS does tend to prioritise CBT over other options.

I think I need something that looks at why I've developed certain thought patterns in the first place, as much as how to change them. At the moment the focus is on the latter.

I don't know if it will help, but you could have a look at my AMA on remedial hypnosis to see if there's any info in there that clicks.

Sorry what's an AMA?

Ask Me Anything

It does prioritise CBT and with good reason (it has the best evidence) but they should still be able to explain their decisions to you (even if they're saying "it's all we're trained in")

A qualified CBT therapist should be providing you with a formulation - which is an understanding of why you've developed the thought patterns. You don't always get a formulation with primary care NHS intervention but you can ask if it's possible.

Psychodynamic counselling or psychodynamic/psychoanalytic therapy tends to look at this - past experience and present patterns

Integrative therapy / counselling/ psychotherapist would also think about links between past experience and present internal patterns

Rare on NHS - increasingly being used for personality disorder or in some areas the higher risk - suicide attempts, in patient stays, but 'it takes time,' and sometimes the NHS thinks there is no time, despite it being cheaper in the long run

Actually it has the best evidence for short term recovery but long term evidence is increasingly showing psychodynamic or integrative

This is really helpful. Maybe my expectations are too high for the NHS as I only get 12 weeks of treatment.

Very helpful to know, thank you.