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.

CBT is the recommended treatment for anxiety and all its forms.

Anxiety is driven by what ifs - address thinking style is a key aspect of CBT

Alternative that has a growing evidence base is ACT - acceptance and commitment therapy.

If you are peri/meno you need to address the underlying hormonal component as appropriate

Generally feeling anxious can also arise from past trauma- does this need addressing via counselling or trauma focussed CBT?

Feeling on edge physically can also be felt emotionally- check iron and vitamin D and B12

CBT is not helpful for REAL situations that are worrisome eg food insecurity/ financial/housing/relationship stress - those are real life problems that if addressed would relieve the anxiety - its hypothetical then ACT or CBT

CBT can be hard going as it demands insight to be able to step back and recognise worries in the form of thoughts are just that not real and alternatives are possible

What a shocking response. I have never encountered anyone personally or professionally whose anxiety was not “real”, or caused by things that would cause anyone to be anxious. Shocking from someone who sounds like a professional to suggest some anxiety is not “real”.
And CBT is the most researched, therefore there is the most evidence for it. That’s the only reason it’s recommended.

That’s a terrible response about anxiety above.

My anxiety was caused by a “real” life problem, not a situation caused by faulty thinking. Yet the Talking Therapies assessor dismissed all of that and referred me for CBT despite it being completely unsuitable.

I struggled with my mental health since I was 11years old. I was given the EUPD diagnosis at 17 which I never felt was quite right. A psychiatrist a few years ago agreed i didnt fit the criteria. Ive had some attempts and hospital stays, never really offered much in the way of meaningful therapies. Did worksheets on anxiety and depression given to me. I paid privately for talking therapy which had some success.

Then I moved area after a hospital admission and I was offered the full DBT dialect behaviour therapy course on the NHS. My knew care Co-ordinator picked up in our first meeting that i was maybe ND.

I did the year of intense DBT and it changed my life. Bloody hard work, not easy at all. It took 23years of being unwell, but finally I am stable. I have a meaningful (to me) life, I have a quality of life again. I am ND. And a lot of women have had a misdiagnosis of EUPD/bipolar etc to then be diagnosed with a ND condition.

There were a LOT of years that I had no hope and I was 100% sure i wouldnt still be around. So I just want to say to anyone this applies to, please dont give up, if there is even a tiny flicker of hope left, you grab onto it with both hands and you DO NOT LET GO.

I've tried acceptance therapy via my neuro-gastroenterologist and it did sod all to help.

I am in peri but also have the complications of endometriosis and adenomyosis, hrt exacerbates the pain so I've been advised not to take it.

B12, vit d, thyroid and iron panel all ok.

Mt anxieties are REAL.

What therapies were people on the thread hoping to be offered other than CBT? ‘Talking therapy’ or ‘therapy’ is a very broad term as is ‘counselling’ it has to be an evidence based therapy for the particular diagnosed condition for the NHS to offer it.

https://www.eput.nhs.uk/services/psychological-services/therapies-we-offer/

This is what's (apparently) available in Essex.

I'm nowhere near there OP, just searched online, so not sure how you access it.

Thats a really good question. I asked for EMDR had an assessment and they said no as I had too much trauma. I asked for help in learning to manage my day to day life and was told no as you have trauma. I felt like there was a block to everything. I didnt know what I needed. I just knew I was a mess and I knew worksheets and booklets weren't going to help.

What I desperately wanted, was for something, someone, to make me better. Meds, a therapy that worked, I was willing to give ECT a go even.

What I actually needed, was to take some accountability, for someone to care enough to be honest with me. To say theres a hell of a lot to work through but we will do it together. To ask me the nitty gritty things no one ever asked. To take notice of what I said and what I didnt. And to teach me how to look after my condition, to give me the things I needed to learn in order to be able to manage day to day life. And to hold me accountable to actually practising the things I was taught.

I don't think @iamtryingtobecivil is saying that anxiety isn't real. I think they are trying to say that if the anxiety arises from a problematic life circumstance such as a lack of money to pay essential bills, then no amount of mind bending is going to help that. The solution wouldn't be different patterns of thought, it would be more money.

However, if past money troubles left you with a fear of not being able to afford things when you do actually have enough money, then CBT might help to change the way you think about money and reduce the anxiety.

We’re probably in different parts of the country, but this is the case in the area I live and work in. It’s not a fantasy - why would I make it up? I’m giving advice based on the mental health service I work within (a senior clinician). I can only comment on my own knowledge and experience though. Sorry if you want to call it ‘a fantasy’. I also happen to be disabled, living with a very severe SMI (severe mental illness) so am a user of secondary care MH services too myself. So see things from both sides of the fence so to speak.

If you’re a clinican then I imagine that your treatment experience would be quite different from that of ‘ordinary’ service users. Primary and secondary care will be aware you know the pathways and what should happen, you know how to make a complaint etc. That will make a difference in how you’re treated.

The Talking Therapies website included Counselling for Depression (CfD) as one of the treatments they offered at stage (level?) 3. CBT appeared on both stage 2 and 3 lists. EMDR was also listed.

Yes but not via the gp in my experience you need need to be referred to secondary psychiatric services which means it needs to be more serious. Most people i know pay privately if they have talking therapy. The problem with mental health is it’s very subjective so far harder to quantify whether x or y therapy works

I do get the impression that if you know the system, ie are a practitioner or know how the complaints process works and are prepared to use it, then you can get
support from Talking Therapies/IAPT.

Sadly, there must be countless people really struggling and unable to access this as they don’t know how, don’t have the skills to complain or their mental condition means they don’t have the ability to do so in terms of being assertive, following up etc.

It’s a shocking thing that only a few are able to get the help they need and everyone else is getting fobbed off with poor quality CBT courses (the one I was put on initially wouldn’t have met the criteria for NICE recommended CBT!)

Oh and the one I’m with also offered employment support within Talking Therapies but when I enquired it turned out this was help writing a CV with an assumption people weren’t working.

There was no support for keeping people already in work, at work, if that makes sense? Which would surely make more sense in terms of paying tax, as well as better mental health.

I have to say that I find that incredibly offensive.
Firstly, that’s not how the system works. No one gets ‘special treatment’, whether working in the system or not.
Secondly, you know nothing about the treatment I’ve either had, struggled to get, or been denied. To assume I’ve had it easy is very hurtful. I nearly lost my life last year, partly due to failings in the system. There is a CQC enquiry into the failings in my care under the NHS Trust in question. This was in secondary care, and my condition is very much more complex and severe than the part of the system I work in and that I was advising the OP on in a bid to clarify and assist with information.

I get that you’ve had a bad experience but please don’t be dismissive to me, with unfair and untrue assumptions. I’ve remembered why MN is not the place it used to be.

In my experience, ALL anxiety stems from a problematic life experience, some more obvious than others.

That is not what I am saying:-

Anxiety is real

The source of the anxiety can be real or hypothetical hence the examples.

If your anxiety arises from a real ongoing situation such as housing or an abusive relationships then CBT will not help other than manage surface level coping as the source of your anxiety is real and present.

CBT is effective when anxiety arose from unhelpful thinking styles that have no current factual basis.

Spot on

Yes, past v current circumstances are highly relevant.

A severe and specific anxiety in the a form of a phobia- bitten by a dog in the past, you going to be currently anxious around dogs.

Knowing your past experiences and how these may affect your currently is important as you can now make that distinction then and now as a basis to adapt.

In the past anxiety was present due to real events occurring and now it maybe present due to a hypothetical worry about that past real events reoccurring- as that is what you learned back then. Both real and hypothetical can lead to anxiety - which is just debilitating and enough to negatively impact people

Not everyone is able to step outside their stream of thoughts and gain insight. Some people just do not have the capacity. Most do then will acknowledge their biases/default thinking then return to….but - hang on to that if you will and you will get what you always got with that. It sounds harsh but it is true.

NHS is dominated by CBT and short term therapies because the focus is on symptom reduction - this is what can be measured. NICE likes RCTs and blinded studies as evidence. Understandably on one level - NHS uses tax payers money and treatment needs to be proven as it were to be effective. The medical model is also based on symptom treatment. Bish bash bosh you're sorted. Like fixing a broken leg. Counselling and psychotherapy don't really fit into that model. The NHS has struggled with this.

There are studies that suggest that longer term psychotherapy does better at a longer term follow up, but these don't seem to be taken into account so much, although this is dependent on area. And staff. If you've got a department dominated by clinical psychologists say, the pathways will probably be geared towards clinical psychology.

Also, risk. The NHS gets very scared, again understandably on one level, about suicidality. It literally can't handle the anxiety. So it responds in a very particular way. Manage, medicate, do coping skills. A psychotherapist would ask the question - why? explore, unpick, try to understand. The work can be slow. But effective. This isn't efficient enough for the NHS. And it's scary - don't open the box, you don't know what's inside!

Extraordinary really.

Yes, I have difficulty with the term “evidence led”. Quite a lot of patients will say they feel better immediately after a short course of CBT with a competent clinician. Not all change will be lasting, though, yet the NHS has their evidence.

But how the hell would the NHS be able to afford long term 1:1 therapy for everyone who would benefit and/ or thinks they would benefit/ wants that? It’s just impossible. There are not the army of trained therapists that this would require.
There is an obvious reason why a publically funded service cannot do lots of open ended long term 1:1 therapy and cost is that reason. It can do short term 1:1 or it can do groups as that is what is affordable.
The alternative to lots of short term CBT courses was what we had before IAPT which was nothing at all. Years long waiting lists for everyone. At least the CBT helps some people and in fact quite a lot of people. Prior to IAPT what we had was just a very very long waiting list.