I can see support (including psycological support but also practical support) can be really useful for new patients. But is CBT the best way to deliver psychological support. It seems very inflexible and manual driven and I believe is often given by 'CBT therapists' rather than fully trained psychologists. So I do wonder if it provides the best route for support.
Yeah. Unfortunately starting from a few governments ago, when IAPT started rolling out, pretty much most mental health / talking support services have now been replaced by CBT, or by group therapy. Two people close to me had to discharge themselves because they were sent to group CBT therapy for grief, and another was told they get CBT or nothing else (except medication) for significant issues that CBT had no place in treating.
I ended up unfortunately having many rounds of CBT for other things (physical and mental) for quite a period of years, pre-ME, (none of which it helped for) plus then the PRINCE trial. The place I live was one of the early adopters of IAPT, and CBT was rolled out with huge enthusiasm. One interesting thing is that even though it was “adapted” to different conditions, both mental and physical, I saw the same worksheets and print outs (with some variation) and the same type of “homework” again and again. And I do not see how it can help with ME symptoms, with the
underlying assumption about thoughts - beliefs - behaviours - physiology and about spending so much energy analysing yourself and problem solving (but never helping with underlying issues), in the way it does. The “abnormal beliefs” part being removed does not impact this. (See the NHS definition for which CBT actually is!).
And, even the NHS page says that CBT has downsides:
“you need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your co-operation
attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time
it may not be suitable for people with more complex mental health needs or learning difficulties, as it requires structured session
it involves confronting your emotions and anxieties – you may experience initial periods where you're anxious or emotionally uncomfortable
it focuses on the person's capacity to change themselves (their thoughts, feelings and behaviours)
((I just want to add - and how all these things interact together and with physiology - as has been written in the NICE guidelines itself!))– this does not address any wider problems in systems or families that often have a significant impact on someone's health and well-being
Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood.”
https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/
Arguably, CBT is not the most helpful for us because ME is also impacted hugely by our families, who is caring for us, the support network we have, what our daily life is actually life and if we can pace effectively. CBT does not help in those (majority) of instances. We need help for this; practical help, advocacy, specialist help for coming up with daily plan and talking about our energy envelopes.( Specialist nurses, doctors, OTs, physios and maybe a specialist advocate in the clinic.)
Also, CBT requires a huge amount of energy even for a healthy person, as you’re basically analysing yourself. It requires homework and putting in practice “strategies” again and again. I’m sure anyone who has been through it before can talk about it. I did so much I got sick of it quite frankly, but what irked me the most was the fact it was the same assumptions & types of worksheets again and again (and all of this was without “abnormal beliefs” being in it). CBT isn’t the best choice for ME by any stretch.
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