Guardian article on origins of CBT : I have OCD. Some cognitive behavioral therapy techniques were totally wrong for me, April 2024

"I have OCD. Cognitive behavioral therapy techniques made it worse"

I have OCD. Cognitive behavioral therapy techniques made it worse (msn.com)

 

Oh no.

If only Mr CBT had been a bit slower in getting his manuscript out, perhaps all this could have been avoided…

Having said that material interests being what they are I have no doubt insurance companies would have found something that they liked just as well.

 

Even proper RCTs are generally bad, especially when there's a lot of bias involved. But that they simply decided to not bother that active participation is impossible to control and that all they could do was biased randomized trials was good enough is scandalous. It basically set the entire discipline on a huge regression path.

When something like CBT is the gold standard for your discipline, you are a failed discipline.

It's also especially absurd from the perspective of someone who never had any such thoughts. Not only do I not really have this kind of internal monologue, I pretty much stopped having coherent internal thoughts like this when the brain fog got really bad. And I don't have beliefs. None at all, I'm a universal agnostic.

To me this is nothing but ritual voodoo. Like reading generic horoscopes where literally none of the statements match any of my experience. Feels like I'm dealing with bullshido artists who keep yelling and expecting me to fall down when that's just never going to happen.

 

I lied in my CBT. There was no other way. What they were suggesting to me didn’t make sense. And there’s no arguing with it. Believe me, I tried picking holes in what they were suggesting. So in the end I agreed, and told them what they wanted to hear.

Eventually, I ended it and walked out after the “therapist” was insisting I must feel some way about something, and I didn’t. I had really no feelings or opinions on it. Nada. I had the same feelings as I have about the fridge, or the Japanese language or dung beetles. They exist, fine. Some people love them , some hate them, fine. They’re not really things I think, about unless you mention them.

It’s absolutely abusive when used for ME and with GET

 

I went through CBT that was supposed to treat depression. It was a complete waste of time. The "advice" I got to fix my "issues" was something I simply couldn't follow and I got no help in finding ways to carry it out.

One major misunderstanding I had about CBT was that everyone got the same treatment and that it was just one "thing". I didn't realise for years that there were different flavours of CBT. I think that several reporters who've written articles on ME don't realise that the patients aren't all getting the same treatment and the goals of a therapist treating a cancer patient aren't the same as the goals of a therapist treating an ME patient. And I think it is this that makes understanding of ME so rare amongst the medical profession. I must admit I have no clue what a CBT therapist would be saying to a cancer patient.

 

This article was an absolute revelation - thank you to those who spotted it. Some CBT and ACT techniques have been really helpful, and DBT was life changing, and should be taught in schools, IMO. None of those have anything to do with ME or LC though - except for the rats nest of MH issues that got massively worse thanks to having both and medically related PTSD because of it all.

This is article has introduced me to some helpful concepts though with ERP; don't fight the intrusive thoughts with CBT, face the fact that stuff can, and does go wildly wrong - the improbable does happen and not do anything to relieve the fear is oddly helpful. It's never the stuff you worry about anyway! (if you know me IRL you will know exactly what I mean)

 

@JellyBabyKid

In NZ, DBT skills are being taught at primary school eg.mindfulness, breathing, emotional regulation and distress tolerance skills. It is integrated across the curriculum and has cultural input from tangata whenua (Maori).
integrating-mindfulness-into-learning

Relationship skills (part of the interpersonal effectiveness skill building in DBT) are taught in early education centres, primary and intermediate and in intimate relationship skills in high schools
https://healtheducation.org.nz/wp-content/uploads/2020/09/Mental-Health-and-Hauora.pdf

This is a Mental Health prevention strategy due to high levels of distress, anxiety, depression, self harm, suicidality and substance abuse in the population, but especially targeting youth.

ERP has replaced the old style of CBT for OCD here. It is usually combined with ACT and therapy is given by a skilled clinical psychologist. Often people will also need medication.
https://www.ocd.org.nz/help-in-new-zealand/

I am wondering if the education system in the UK is similar.

 

Wow..this is amazing. Thank you for sharing.
Tbh.i have no idea what is taught in our (UK) schools as I am almost 50 and don't have kids and my close friends that do have kids have pre nursery kids

 

DBT is dialectic behaviour therapy, a pseudoscientific talk therapy for borderline personality disorder. Like CBT and all other talk therapies, trials are typically conducted by people who are bought into the ideology and the results appear positive as a result of such biases.

 

It also helps with emotional dysregulation in ADHD. It combines mindfulness, assertiveness and emotional regulation skills and a bunch of other useful skills I was never taught as a kid and really could have used. But then I could also have used being diagnosed as ADHD and Autistic as a kid too instead of being stuck on waiting list at almost 50 with wrecked mental and physical health.

 

Isn’t part of the problem with CBT as often currently formulated that it was seized upon as part of the process model of health care? You define the process and then blindly apply it to everyone. Sorry I am struggling to remember the correct terms. Perhaps unfairly it is what I characterise as the New Labour approach to long term health issues where tidy fixed term marketable care packages are designed and as much as possible delegated to assistants or technicians. It was the political climate where people like Wessely and Chalder started to flourish.

This approach to health care is the antithesis of a skilled experienced clinician with an arsenal of tools exercising judgement.

Somewhat of a tangent, but I vaguely remember reading a paper some forty five years ago that compared a range of psychotherapies and concluded that there were not good and bad techniques but good and bad therapists. (NB I can not now remember any detail or how rigorous the study was.)

 

I am currently seeing a clinical psychologist at the covid clinic who has a wide range of skills and provides them as appropriate - but isn't allowed to help with ptsd as it is outside of scope

Yes, absolutely.

Two problems immediately come to mind;
We need to diagnose correctly (so many women my age were diagnosed with anything and everything but ADHD and autism) and the IAPT and suchlike therapists are offen only taught CBT, and do not require background in psychology (unlike this patient, whose training was cut short by ME, ironically) so if you have a hammer, everything looks like a nail..whereas if you have, say ptsd and autism with added OCD, you might need a full toolkit and a bit of ACT, a bit of CBT and a grounding in psychology to know when and how to use them.

Much like you can't ask someone at McDonald's to make you eggs Benedict for breakfast, you cannot get personalised care from a CBT trained IAPT therapist. So you end up going to multiple therapists for multiple problems. Most of them private due to the NHS focus on CBT as a solution that is quick, measurable and standardised and therapists only need a relatively short course of training.

But the patient only gets a partial solution, at best. Dismissed and abandoned at worst and going private where they can afford it for DBT, EMDR, psychotherapy and ADHD coaching. All very expensive, but actually helpful.

 

I think that’s the difference (one of them) between being a psychologist and a therapist, particularly a CBT (or other) therapist/trsiner/professor where you only study the technique not whether it’s useful for what someone has or to identify what someone has.

 

Transdiagnostic re-education sausage machines?

 

And do you want fries with that..?