Does the NHS offers anything other than CBT and if so what criteria do you have to meet in order to be referred?

[ShoopShoopBaDoop]

Because after decades of trying various CBT with different therapists I feel it has done sod all to help me (and I honestly tried so hard).

I currently feel worse than I have ever felt, both physically and mentally and one feeds off the other and vice versa and I have lost the ability to stop the vicious cycle.

Maybe I just don't articulate myself well enough at GP consults but I genuinely don't find CBT helps me at all and yet despite my records clearly showing I have tried it time and time again, this is all I am ever offered.

I have trialled so many different medications which all gave me side effects so bad and that in itself exacerbated the anxiety so I haven't been able to continue with them for more than a few months at a time (Citalopram, Escitalopram, Sertaline, Fluoxetine etc)

I was diagnosed with adhd last year by a private company (via the NHS right to choose). I am loathe to bring this up in conversation with my GP because whenever I mention it she always seems to gloss over this as though she isn't interested (or doesn't agree with the diagnosis?) and I know that it's a controversial subject so I tend to keep the diagnosis close to my chest and tbh I haven't done much with the information since I was diagnosed (the meds made me unwell so I had to stop) and not sure if treatment for inattentive adhd is much different to that for severe anxiety/depression/ocd?

I am not sure what more I can do to help myself.

I suppose if I had money to throw at this I would go see someone private but that's out of the question.

Has anyone else found CBT just hasn't helped them and did you find any alternatives to help?

FWIW:- I don't drink, smoke, do drugs etc. I exercise, I meditate and do yoga every night, listen to the Clam app at bedtime and have to watch what I eat as I have digestive issues. I can't see what more within my control I can add into my life to make it easier and enjoyable.

This happened to me too. I tried the local Talking Therapies/IAPT service and the only options they could offer were CBT or being discharged back to my GP. I did yet another CBT course, which was absolutely useless and made me feel worse. I requested a review, and they suggested a different CBT course!

However, I then found the NICE guidelines for treating depression, realised what I should be being offered and how far they weren’t following the guidelines, then found the address at the NHS trust to complain to. I included a timeline, evidence of how I hadn’t been listened to, and references to the NICE guidelines and what hadn’t been offered.

Within two weeks of submitting the complaint I had voicemails from the Head Counsellor at Talking Therapies wanting to talk to me the same day! And I was set up for a course of counselling sessions within days of that. Bizarrely immediately available without a waiting list.

So think about putting in a complaint about your treatment. The services are available, they’re just trying to stop people accessing them easily.

@ConfusedAnxiousMum ..but doesn't CBT cost the same as counselling..it seems odd to me ,I've asked for counselling,but been told the NHS only offers CBT

I had months of psychotherapy and it was the worst thing I ever did. I won't even go to my ADHD assessment now because they want to explore how things were when I was a child.
I don't want to go back there, I don't want my Mum to go back there.

My psychotherapist described it as emptying a box, working through everything that has been unpacked, understanding and then packing it back in some semblance of order. Well he didn't, he chucked everything in the air and it's taken me nigh on 20 years to rebuild my relationship with Mum and family.

I've been on antidepressants for 32 years now. I'll be on them a long time. I have self harmed terribly, been stitched up more times than I can count. I spent years smoking to much, drinking to much, all forms of self harm.

I think you just general counselling. To talk through how you are feeling, you necessarily have to go as deep as psychotherapy.
Just saying this is how I feel, why do I feel this way can open up a number of avenues to explore.
Yes, CBT is about gaining tools to move forward and cope in certain situations.
It's okay.

You can self refer via NHS and hopefully you'll have a talking - I can't remember what it's called. But self refer, they'll call you, you'll spend about 45 mins chatting about how you feel, what you'd like to do, what you want to explore... It's not all CBT.
In my area though unless you are actively harming yourself it's likely to be a wait.
What about some online counselling? It will be cheaper than f2f and it will be your time to talk about what you want.

Good luck!

Please feel free to fill the gaps with all the words I missed. The mind is quicker than the fingers!

CBT costs less to deliver and is often time limited or delivered on line.

No, the CBT so far has just involved watching weekly videos with no interaction with any member of staff or anyone else at all. Not clear how this is helpful to anybody, and it’s not an option even suggested in the NICE guidelines. I was then offered more videos with a weekly 15 minute session with a member of staff on the phone.
Presumably both of those are cheaper to offer than counselling.

The impression I got with the CBT was that they were ticking a box by providing something and were making it difficult to come back and get anything else, so most people would then disappear from the service. There was no review after doing the CBT, I had to contact them and ask for one. And when I did the review the only action offered was more CBT and everything I said about it was ignored. Again, I suspect a lot of depressed people would just give up at that point as it’s so difficult to get help from the NHS.

If you’ve lived your life as ND in an NT world, it’s likely your self-esteem has taken a bashing. This feeling of ‘otherness’ and ‘difference’ can be isolating and trigger feelings of chronic emptiness.
ADHD can also, in women, trigger unstable emotions and difficulties regulating mood. This is sometimes misdiagnosed as things such as EUPD / treatment-resistant depression / GAD.

If you find regulating distress difficult I’d suggest DBT skills would be more helpful than CBT. Your local MH Trust will have psycho-ed courses on DBT-based skills such as ‘managing emotions’ or ‘understanding emotional sensitivity’. You can ask your GP to refer you.

You might want to buy some DBT skills books - these can be very helpful for working-through in your own time.

You may want to do a deep dive into your ADHD and learn more about the impact on MH. Many of the ways you experience the world have been shaped by your ADHD, and in learning more about that, many people feel more able to be self-compassionate and to view themselves in a more positive light.

Check-out local ADHD peer-led groups (particularly for women). Understanding, solidarity and identity go a long way to bringing self-acceptance and improved emotional wellbeing.

Are you medicated for the ADHD now? That would be a good move, if not already. Once that is stabilised you’ll have a better base from which to assess what more needs doing by way of psychotherapeutic intervention.

I hope the above is useful. I must caveat that I don’t know you and haven’t assessed you, so this is only lay-person advice rather than with my professional hat on.

Basically no it doesn’t. CBT is pretty much all you can get unless you are very very unwell and able to access secondary care which most people are not.

Look into whether there are any local charities that offer subsidised therapy

Do consider group therapy as that is often the only way to access any different therapy. Obviously it is cheaper to deliver in a group than 1:1.

Counselling has no evidence base hence it is not offered on the NHS.

That's exactly my experience with it all.

This has been my experience of Yorkshire too. Suicidal and GP wouldn’t refer and led me to believe there was no secondary care at all.

Several years later unsurprisingly I have deteriorated so much I can no longer live independently. I was finally referred to secondary care who immediately started describing me as “complex” - I was reviewed by 4 people before a referal was made to a different secondary care in the nearest city and different trust.

Im apparently so complex I can’t be treated locally yet a GP wouldn’t refer me ? It’s utter negligence.

I made a formal complaint to the GP and it was dismissed. There is no way to make anyone take responsibility for the way I have been treated. Considering writing to my MP about it but nothing will happen.

I had crappy CBT twice and years later I went back to the gp and got referred to talking therapy, I explained that I didn’t feel the CBT helped, that they were going through a program and the moment my mood got a little bit better I was rushed off.
They said they have different levels of CBT and I was offered L2 I think. I found it amazing for anxiety. Weekly video sessions where we went through what happened the week before. Spoke about it, dissected it. Was also given homework a strategies which I forced myself to do even if it felt silly. I even told the therapist I’m doing this but if I’m honest I have no faith in it. She said that was normal.
Anyway, it’s the best therapy I’ve ever had and my anxiety is nowhere near what it was.

Thank you that's so helpful.

I will ask about DBT.

After my adhd diagnosis I was prescribed Elvanse but it gave me an awful exacerbation of my existing digestive issues. I have suffered with functional dyspepsia and IBS-D for decades, my periomenopause and recent discovery of endometriosis and adenomyosis have all caused me daily digestive misery recently and the meds just topped it all off, so I was advised to stop.

I hate my poorly functioning digestive system and have yet to find a mental health med which doesn't make it all so much worse. It's a horrible vicious cycle because the gut issues alone cause me great anguish.

Not true that CBT is “all” that is offered. CBT is the gold-standard evidence based intervention for treating anxiety and depression.
However, where those symptoms are part and parcel of other issues such as late-diagnosed ADHT / childhood trauma / c-PTSD / ASD / etc etc there are other things recommended such as: trauma-focussed psychotherapy, clinical associate psychology interventions, specialist psycho-education groups, DBT pathways etc.
Also 3rd sector and specialist provision addressing ADHD / specific types of trauma etc

Where clinicians have assessed there as being a need for the above due to the person’s presentation / history, they will be offered.

Where clinicians have assessed there as being a need for treatment of straightforward anxiety / depression - the patient will be offered the appropriate treatment for that: namely CBT. If the individual feels they want more than the evidence based shows they need / are funded to receive, they’re free to pay privately for non-evidence based interventions such as private talking therapy / art therapy / etc

This isn’t true. It’s on the NICE list of recommended treatment for depression. That means they have reviewed the evidence and know it works, otherwise it wouldn’t be included.

What a shame then that I was offered absolutely nothing until it’s too late.

Since so much is available given the state I was in for months and months.

I checked NG222 and indeed it is in there as an option. That surprises me as counselling is specifically not offered by the NHS in my area and I was told that was due to lack of evidence. People wanting counselling are referred to a 3rd sector charity.

Nearly everyone has CBT in our area. There is a teeny tiny bit of IPT and EMDR for single episode PTSD only and there are DBT, MBT and a trauma grounding and stabilisation group which many people erroneously refuse as they don’t want to consider group therapy not realising it’s that or nothing. An attempt to offer ACT and CFT could not be sustained and the service shut. I can only recommend charities or private to anyone wanting more than CBT in the vast majority of cases.

Is that primary or secondary care ? Or both ?

This is what happened to me too, including being sent a laughably outdated list of charitable providers, which includes advice about Covid restrictions. I was also told things that turned out not to be true.

Once I complained to the NHS trust quoting the NICE guidelines, suddenly counselling was available via a team of counsellors employed by Talking Therapies/IAPT. I would
encourage you to submit an official
complaint to the Complaints team
at the responsible NHS trust (don’t just send it to Talking Therapies as they’ll either ignore it or fob you off) as they are then forced to act on it. If they don’t you can then go to the ombudsman.

This might be what’s meant to happen,
but it isn’t what is really happening. I
was assessed very badly by someone who spent 15 minutes, who was reading a script and refused to deviate from it, and who didn’t take in what I was saying or act on that. If he’d listened he’d have realised CBT was entirely unsuitable
for my situation.

CBT is just one option from a list of NICE recommended treatments for severe depression. And it isn’t suitable for
everyone. It’s being offered so universally because it’s cheap.

This is so far from what happens in reality, and I’m tempted to call it a fantasy.

Those are the primary care options
Secondary care would have a full range of therapies but it’s nigh on impossible to access without a diagnosis of a psychotic illness

There was a 2-4 year old wait for EMDR for cPTSD when I last checked and that’s if you managed to get into the list in the first place having passed multiple assessments and jumped through the group therapy hoops and managed not to be siloed off to DBT group for EUPD.

Sorry reply to Shrinkhole -

I have finally been referred to secondary care - mentioned upthread I was immediately described as “complex” and referred to a larger neighbouring trust as my local one can’t manage me. I am not psychotic though. Something else. Several conditions now.

It’s taken years and incredible suffering and now I am so unwell I can’t live independently anymore.i have to be cared for by my 80 year old parents. I don’t know what will happen when they die - I guess I’ll die too.

My life is ruined - if these people had helped me when I needed it this may not have had to happen. But it has. I feel utterly utterly let down by the NHS.

I’ve spent nearly £10000 in the last 3 years trying to manage my mental and physical conditions because no one would help me on the nhs. And now I am utterly broken because of it.