![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 91. Go back in thread:
Posted by Squiggles on June 1, 2003, at 16:41:25
In reply to Re: Found Psychological Babble - ready to babble; » Squiggles, posted by mattdds on June 1, 2003, at 15:49:39
You mean the post where you mention
the study of dentistry?What do you mean by blood phobias? If you mean
that certain "neuroses" or "quirks" are
inherited, i don't doubt that at all.
I think the physical make-up underlies just
about every affective turn; in animals we have
no problem recognizing this blatant fact - we
just call it temperament. Of course a temperament
can be turned around by training, but the
temperament takes precedence over the training.
I think this indicates it is a genetically
emergent quality.
Squiggles
Posted by Larry Hoover on June 1, 2003, at 20:52:36
In reply to Re: Found Psychological Babble - ready to babble; » Larry Hoover, posted by Squiggles on June 1, 2003, at 14:59:14
> Piaget or Maslow, are probably closer to the practical
> aspects of these needs. When they are not met, frustration
> is unavoidable and adaptive or maladaptive
> techniques are learned or invented by the child.Piaget and Maslow apply when things are working adequately, I fear. I think there are other processes which apply to children in situations where there needs are not being met.
> I'm not likely to talk about my childhood here.
> I'd rather discuss this in general terms,
> academically. I just have too convoluted
> a background, if that's ok with you.
>
> SquigglesI thought you were getting ready to discuss something from your past. Sorry if I misunderstood.
It took me a fair amount of time in a CBT therapeutic setting for me to finally come to understand that my childhood experience gave me post-traumatic stress disorder. At first, I rejected the concept out of hand. Weird and powerful emotions would sometimes sweep through me, ones I could not reasonably link to present experiences; the intensity and quality was wrong. It was the introspective component, the skill which develops when one self-assesses one's own cognition, that finally allowed me to become aware of what had really been going on, and to make peace with myself. Ultimately, I believe that to be the "answer" in CBT, not to make peace with the world, but to make peace with oneself.
Lar
Posted by Squiggles on June 1, 2003, at 20:58:39
In reply to Re: Found Psychological Babble - ready to babble; » Squiggles, posted by Larry Hoover on June 1, 2003, at 20:52:36
You say it took a long time of introspective
CBT for you to realize the effect of PSTD -
OK - how did you come to realize that, did
you have a way of changing a developed personality,
and how much did you pay?Squiggles
Posted by Larry Hoover on June 1, 2003, at 23:14:11
In reply to Re: Found Psychological Babble - ready to babble; » Larry Hoover, posted by Squiggles on June 1, 2003, at 20:58:39
> You say it took a long time of introspective
> CBT for you to realize the effect of PSTD -
> OK - how did you come to realize that,Two steps required....learning to see that my responses to simuli were actually inconsistent with my beliefs about what they really represented. (Simply, I thought I was reacting to X, but I was really reacting to Y.) Second, maintaining attention during the inconsistent events to see what was happening after I had learned to ignore my previous (false) beliefs. Basically, I learned to disprove to myself my earlier beliefs, and substituted ones which more accurately reflected my "true" reality. That process, of course, is always subject to further fine-tuning, which becomes easier with practice. When I was faced with two recent traumas, one involving a violent assault, the other a vicarious trauma witnessing the events of 9/11, I was able to work through the massive emotional turmoil by employing some of the self-realization work I'd already begun. I got past those new traumas relatively swiftly, considering it took me more than thirty years the first time around.
Although I thought my problem was depression, it turned out to be more complex than that, including aspects of PTSD, chronic fatigue, and depression, all mixed together. It takes time to sort out that sort of complex mixture.
In summary, the biggest hurdle is denial. Beliefs that you "are the way you are", or "past experience changed me", or "you can't undo the past" aren't absolute truths. You can take the same historical information, and form new conclusions about it. One example that should be familiar to you is forgiveness. Nothing really changes, but your attitude.
> did
> you have a way of changing a developed personality,Yes, beginning with having the faith that change was possible. Faith, as I define it, is believing in something without proof. My counsellor helped me create that sense of faith, then I began to do the experiments required. I began to act my way into a new way of thinking. Personality isn't fixed. It's a choice, to a surprising degree. A habit, in many respects. You wanna feel different? Act different.
> and how much did you pay?
Nada. All part of OHIP-funded mental health care, as outpatient services at my local hospital. Also, I should also give some credit to 12-step groups, which ask for nominal donations sufficient to cover operating expenses, but donations are not mandatory.
Lar
P.S. There is something cathartic about simply "telling your story" to an empathetic listener. Just "letting it out" gives some relief. And that relief can foster further introspection and story-telling, and you're well on your way.
P.P.S. I understand why you wouldn't want to open up in a forum such as this. But you can give context without telling the whole story. I've done some of that right here. I'm not trying to convince you of anything. Just making a point.
Lar
Posted by mattdds on June 2, 2003, at 1:55:30
In reply to Re: Found Psychological Babble - ready to babble; » Squiggles, posted by Larry Hoover on June 1, 2003, at 23:14:11
Larry,
I have been reading some cutting edge stuff in CBT by Adrian Wells, who is faculty at the U of Manchester in the UK. This seems like some really scholarly stuff, I wonder if you've heard of it, and if so what your opinion is on it.
In his book, "Emotion and Metacognition", he introduces the idea of metacognition in the context of cognitive therapy, which I have found fascinating, and I've been trying to incorporate it into daily life.
As I'm sure you can deduce, metacognition is the awareness of your own cognition.
Wells emphasizes the importance of developing a "metacognitive mode" of processing, in which we become passive observers of our negative thoughts and or symptoms. In this mode, thoughts themselves become just like any other neutral event in the universe, rather than absolute truths. He suggests attentional training and mindfulness meditation to get into this type of mode.
He also describes an "object mode" of thinking, which means a state of full or nearly full belief in thought intrusions. This is the destructive kind.
Once you get into this mode of thinking - this metacognitive mode - it frees up mental resources. It allows you to step back, and be able to see more than one schema, or way of seeing things. It also, according to Wells, allows information that is likely to disconfirm existing destructive beliefs to sink in. Is this sounding like secularized Buddhism yet? To me this is great stuff!
He also goes on to talk about rumination, in relation to depression. He led a study which showed that rumination was positively correlated with increased depth and duration of depression. So the idea is to reduce rumination. He also showed that attention training activities can help to reduce rumination, as can mindfulness meditation training.
The amazing thing is how few therapists are aware of cutting edge things like this. I mean the gap between the scientist and the clinician is HUGE! (Most) clinicians are still practicing CBT of the dark ages. Even worse, some practitioners advertise as CBTers but really are doing some nondirective eclectic mess.
I wonder how much better the response rate would be if people were doing REAL CBT? Am I making any sense here?
Take care,
Matt
Posted by Squiggles on June 2, 2003, at 8:06:04
In reply to Re: Found Psychological Babble - ready to babble; » Squiggles, posted by Larry Hoover on June 1, 2003, at 23:14:11
You are very fortunate and i'm glad for
you. As for my own "opening up", i think
my husband has no ears left, LOL.I don't agree with everything you say - e.g.
the ability to believe without proof -- actually,
that is against my morals, as it could easily
be turned towards something very sinister, like
the evil propaganda of the Third Reich, or racism,
etc. I also question the number of years it would
take to erase a reaction to a stimuli, when it
has taken as in some cases 30 years. Not only that,
but it is, as any psychology professor will tell
you in Learning Theory, much easier to learn something
than to unlearn it.So, you've beat the odds.
Squiggles
Posted by Squiggles on June 2, 2003, at 8:14:40
In reply to Re: Found Psychological Babble - ready to babble; » Squiggles, posted by Larry Hoover on June 1, 2003, at 23:14:11
Larry,
Just one more thing, i forgot to add in my
previous reply to you; i do believe there
are ways of altering the effects of PTSD on
behaviour, but i don't know how (at least
one) practical this is.
- actual topical brain surgery of memory
The other is simple -- remove the offending
stimulus from the person's environment.
Squiggles
Posted by Dinah on June 2, 2003, at 8:52:17
In reply to CBT and metacognition » Larry Hoover, posted by mattdds on June 2, 2003, at 1:55:30
When I first started therapy, my therapist used to tease me, or maybe it wasn't teasing but rather reframing, that I had very nearly reached the Buddhist ideal of detachment in the Buddhist sense of the word. And several other Buddhist ideals as well. I suspect that at the time, he wished to reframe my natural tendencies in a positive light. He told me that if I lived in a Buddhist culture, I would be totally comfortable with my attitudes.
But it was all a false self that was so wonderfully detached. And my panic attacks were a way of my body telling me that. So if you can truly reach the state you were talking about, of reaching the metacognitive mode you were speaking of, perhaps you would feel a great reduction in distress. But if you are only able to achieve that at a rational level, if you only *think* you've reached that state, it is in my own experience an invitation to just a different type of psychopathology. Unless you are able to reach that state in all levels of your being, it really only appears to help. I could never bring the techniques to all levels of my being, and merely split off the less accepting parts from my conscious awareness.
My congratulations to you if you were truly able to embrace those ideals on all levels of your being.
Posted by Larry Hoover on June 2, 2003, at 9:20:24
In reply to Re: Found Psychological Babble - p.s. memory » Larry Hoover, posted by Squiggles on June 2, 2003, at 8:14:40
> Larry,
>
> Just one more thing, i forgot to add in my
> previous reply to you; i do believe there
> are ways of altering the effects of PTSD on
> behaviour, but i don't know how (at least
> one) practical this is.
>
>
> - actual topical brain surgery of memory
>
>
> The other is simple -- remove the offending
> stimulus from the person's environment.
>
>
> SquigglesYour reply raises issues around locus of control. One way of looking at it is by placing reactivity and proactivity on a continuum. Or, consider whether you believe the choices you make affect your environment, or whether the environment determines your experience.
One common social construct is the belief that someone can "push your buttons". That it's the other person's fault (the button pusher) if that happens, showing disrespect, manipulation, yadda yadda.
But whose buttons are they? How did they get there? Why do they work so well?
And, why do you let them continue to exist? Why do you leave them exposed for anybody to push? And, how many buttons do you have that you yourself push?
Desensitization from trauma-related stimuli is an extinguishing event. You can end the "button-pushing drama", once and for all. Avoiding the stimulus doesn't accomplish that, because life is full of stimuli, and one day, you're going to meet it again.
Psychosurgery is an option, but hardly one with long-term benefit.
With reference to the 30-year passage of time issue.....
Unexamined issues, the skeletons in your closet, remain suspended in time. They don't go away. They don't change. They just wait. If you never examine them, they remain. If it takes thirty years, so what? It's irrelevant.
Lar
Posted by Squiggles on June 2, 2003, at 9:45:55
In reply to Re: Found Psychological Babble - p.s. memory » Squiggles, posted by Larry Hoover on June 2, 2003, at 9:20:24
Larry,
The fact that you have succeed with CBT, means
that you were able to. I don't know what kind
of trauma you have suffered - whether one or many,
but you are one of the people who have been able
to turn cognitive states around.You must understand, that not all people have
the same ability. Take a look at some of the
War vets - they never get over what they went
through - they need drugs, they need assistance
outside of their own resources. That's because
some people don't have the emotional or mental
resources - they may be burned out.As for control, again, take a look at domestic
incidents of violence and abuse (no, i am not
putting myself here). These women need to be
removed from abusive situations and the law is
what will help in these circumstances, not CBT.So, basically everyone is different with different
strengths and weaknesses. In the worst cases,
i do believe that drugs, and removal of the
hurtful stimulus help the most. I think that
CBT is a long-term, analytic, and didactic solution
to something that has already faded in memory.Squiggles
Posted by Larry Hoover on June 2, 2003, at 9:56:15
In reply to CBT and metacognition » Larry Hoover, posted by mattdds on June 2, 2003, at 1:55:30
> Larry,
>> As I'm sure you can deduce, metacognition is the awareness of your own cognition.
I was unaware of this author, but I totally grock the concept. (Grock, from Heinlein, meaning understand in absolute completeness)
> Wells emphasizes the importance of developing a "metacognitive mode" of processing, in which we become passive observers of our negative thoughts and or symptoms. In this mode, thoughts themselves become just like any other neutral event in the universe, rather than absolute truths. He suggests attentional training and mindfulness meditation to get into this type of mode.
I would expand the concept of metacognition to include positive thoughts as well. Moreover, the attributes positive and negative have no place in metacognition.
Judgmental language, anything that is suggestive of emotive impact, reduces the metacognitive state, IMHO.
You can practice achieving nonjudgment in day-to-day self-talk. For example, if you try something, and it fails, you could say to yourself, "I screwed up", or "I am a screw-up", but the more nonjudmental approach reflects your experience, as in, "That didn't go the way I had hoped." You see, it's the non-realization of an expectation that is the real issue.....becoming emotionally attached to an externality.
I like to summarize non-judgment as selecting descriptive language.
> Once you get into this mode of thinking - this metacognitive mode - it frees up mental resources. It allows you to step back, and be able to see more than one schema, or way of seeing things. It also, according to Wells, allows information that is likely to disconfirm existing destructive beliefs to sink in. Is this sounding like secularized Buddhism yet? To me this is great stuff!Absolutely, according to my own experience. And when you do select a schema, it comes with a peaceful certainty that you've fairly and appropriately accomodated all the factors that entered into your awareness during deliberations (including recognition that, as a human being, there are limits to your awareness).
> He also goes on to talk about rumination, in relation to depression. He led a study which showed that rumination was positively correlated with increased depth and duration of depression. So the idea is to reduce rumination. He also showed that attention training activities can help to reduce rumination, as can mindfulness meditation training.
It all responds to decision-making. Yup.
> The amazing thing is how few therapists are aware of cutting edge things like this. I mean the gap between the scientist and the clinician is HUGE! (Most) clinicians are still practicing CBT of the dark ages. Even worse, some practitioners advertise as CBTers but really are doing some nondirective eclectic mess.Maybe I got really lucky. Or maybe Canadian therapists grock this, but I've gotten ideas like this from many therapists, or at least, the tools to achieve it, whether or not it was an overt goal of therapy.
One such tool was the development of what was called a "narrative dialogue". One way to picture that is to consider a large boardroom table, around which sit all the voices in your head, and you're the chairperson. Everybody's got different voices in their head; when we're ambivalent about something, we're acknowledging more than one voice. There's the voice of societal expectations. There's the voice repeating things your mother said. There's your own "inner critic". There's the voice of your spiritual self. There's the strict logical voice. And so on. By picturing yourself as the chairperson, you're fostering metacognition of the schemas presented by each voice. And, as chairperson, you're not bound by any one schema; you can create a synthesis of schemas.
> I wonder how much better the response rate would be if people were doing REAL CBT? Am I making any sense here?
>
> Take care,
>
> MattYa, you're making sense, if I enter a metacognitive state and bypass the excitement. Heh.
Lar
P.S. Not meaning to blow my own horn, but I help a lot of people in real life. People in crisis call on me all the time, because I can help them sort out the various components of their cognition.
Posted by mattdds on June 2, 2003, at 9:58:43
In reply to Re: CBT and metacognition » mattdds, posted by Dinah on June 2, 2003, at 8:52:17
Dinah,
What I am referring to is not "dissociation", though I can see how you might have thought I meant that, since you seem to be very preoccupied with your dissociative tendencies.
Nor am I talking about detaching yourself from trauma as a form of coping - that would be denial.
For me, this has been helpful, but haven't been able to apply it at "all levels of my being".
You seem to be saying that CBT merely creates other forms of psychopathology, am I correct? I have never seen any evidence behind what you are saying. Much to the contrary, CBT is being used for severe depression and panic attacks.
I don't get into this idea of having to rummage through all my old traumatic experiences and somehow, through reliving them, attempt to get rid of it. This seems unnecessarily painful and rarely helps, besides the cathartic nature of it. I don't believe you can get rid of it. So why not make peace with it? That's the difference between CBT and nondirective or psychoanalytic therapy. In CBT you are trying to "work your way around it", forming new neural pathways and focusing on them. There is good evidence behind this approach. Once fear circuits have been imprinted in the amygdala, they cannot be erased. The best you can do is work at a cortical level to form inhibitory pathways that quell that fear. This is what neuroscientists think is happening.
Another thing, I am not Buddhist, but I am quite sure the state you described (panic attacks, dissociation from reality) is NOT what Buddha had in mind. I mean, he didn't base a whole religion on denial, so I think your therapist had some misconceptions about Buddhism.
When I passively observe my thoughts, they sometimes become funny to me, and I laught at them. I feel less depersonalized, if anything! I take my intrusive thoughts less seriously and treat them as nothing particularly important, just like any other event in the universe. I can't do this all the time, but when I am able to pull it off, it greatly enhances CBT.Also, every time I post about CBT on here, you seem to have a tendency to throw discreet little jabs at me, as if you are bothered by me even mentioning it. Are you bothered by something I'm saying, or with me? Maybe I'm misreading you but I sensed some sarcasm and disbelief in that this has helped me. I've gotten this vibe before from you. I'm a bit put off by this, and perhaps you could explain why?
Regards,
Matt
Posted by mattdds on June 2, 2003, at 10:10:20
In reply to Re: Found Psychological Babble - p.s. memory » Larry Hoover, posted by Squiggles on June 2, 2003, at 9:45:55
>>As for control, again, take a look at domestic
incidents of violence and abuse (no, i am not
putting myself here). These women need to be
removed from abusive situations and the law is
what will help in these circumstances, not CBT.Of course they do! Nobody has the capacity to cope with this much stress on a daily basis. But this seems to be kind of a "straw man" argument, that is detracting from the real issue (which is, whether *most* depressed people have the "cognitive capacity", as you put it, for CBT to work for them).
Most people with depression don't have these terrible ongoing traumatic events. But if someone does, NOBODY (even Buddha himself) would tell that person "ah, it's all in your head, it's just the thoughts about it, not the event, keep getting beaten by your husband and go read some Feeling Good!".
How would you feel about them getting CBT *after* being removed from the traumatic situation?
regards,
Matt
Posted by Larry Hoover on June 2, 2003, at 10:11:40
In reply to Re: CBT and metacognition » mattdds, posted by Dinah on June 2, 2003, at 8:52:17
> But it was all a false self that was so wonderfully detached. And my panic attacks were a way of my body telling me that. So if you can truly reach the state you were talking about, of reaching the metacognitive mode you were speaking of, perhaps you would feel a great reduction in distress. But if you are only able to achieve that at a rational level, if you only *think* you've reached that state, it is in my own experience an invitation to just a different type of psychopathology.
The key is in your own words. Denial of any part of your existence is not metacognitive.
Metacognition is not blocking of any sort. It is non-judmental acceptance of every bit of yourself (in its ultimate expression). That's what you strive towards.
Put in another way, metacognition is the adjustment of your self-perception such that it accurately reflects your reality. This may sound bizarre, but I think the process itself changes you. Addiction, for example, depends on denial to even exist.
The reduction in distress arises because there is no effort to deceive yourself about anything. No exaggerating of this quality, or trivializing of that one.
Lar
Posted by Squiggles on June 2, 2003, at 10:18:50
In reply to Re: Found Psychological Babble - p.s. memory » Squiggles, posted by mattdds on June 2, 2003, at 10:10:20
I believe that a person who is being beaten
by a stick, physical or psychological, even
a dog for that matter, will feel much better
and will recover when that stick is removed.
I think that you are putting the onus on the
victim here, when the CBT should really be
applied on the person causing the depression.
Bullies may need CBT more than the bullied.Squiggles
Posted by mattdds on June 2, 2003, at 10:39:10
In reply to Re: CBT and metacognition » Dinah, posted by Larry Hoover on June 2, 2003, at 10:11:40
Larry,
Thanks. You just managed to say what I *meant* to say 10 times more articulately and in fewer words.
I was thinking more about this and metacognition is better yet the antithesis of denial. You are patiently and non-judgementally listening to *all* voices in your head, and non-judgementally feeling your symptoms. Denial would be *not* accepting something as a part of you and trying to run from it (perhaps through dissociation, or fragmentation of consciousness?)
Thanks,
Matt
Posted by Larry Hoover on June 2, 2003, at 10:42:46
In reply to Re: Found Psychological Babble - p.s. memory » Larry Hoover, posted by Squiggles on June 2, 2003, at 9:45:55
> Larry,
>
> The fact that you have succeed with CBT, means
> that you were able to. I don't know what kind
> of trauma you have suffered - whether one or many,
> but you are one of the people who have been able
> to turn cognitive states around.
>
> You must understand, that not all people have
> the same ability.It's a matter of training and support, not ability.
>Take a look at some of the
> War vets - they never get over what they went
> through - they need drugs, they need assistance
> outside of their own resources. That's because
> some people don't have the emotional or mental
> resources - they may be burned out.That's not the reason at all. I have corresponded with many vets. They weren't provided with the supports required to foster success. For twenty years, the only support offered many Vietnam vets was drugs, if they could even get that. They came home to a society that vilified them. One component of CBT is the empathetic attention provided by the therapist. There is no substitute for that.
The lawsuit just launched against the Canadian Armed Forces with respect to PTSD arises from the institutional trivialization of the affected parties, and the absence of therapy. The problem isn't the veterans.> As for control, again, take a look at domestic
> incidents of violence and abuse (no, i am not
> putting myself here). These women need to be
> removed from abusive situations and the law is
> what will help in these circumstances, not CBT.That is so simplistic a viewpoint. Get them out of there, and all will be well? The threat of imminent harm must certainly be addressed, but what has that got to do with the aftermath?
> So, basically everyone is different with different
> strengths and weaknesses. In the worst cases,
> i do believe that drugs, and removal of the
> hurtful stimulus help the most.In the acute phase, it's a start.
> I think that
> CBT is a long-term, analytic, and didactic solution
> to something that has already faded in memory.
>
> SquigglesIf it has faded in memory, there's nothing to treat.
You have done no more than create a circular argument. Petitio principii, writ large.
Lar
Posted by mattdds on June 2, 2003, at 10:49:41
In reply to Re: Found Psychological Babble - p.s. memory » mattdds, posted by Squiggles on June 2, 2003, at 10:18:50
>>I believe that a person who is being beaten
by a stick, physical or psychological, even
a dog for that matter, will feel much better
and will recover when that stick is removed.
I think that you are putting the onus on the
victim here, when the CBT should really be
applied on the person causing the depression.
Bullies may need CBT more than the bulliedI just agreed with what you said above: people in traumatic events *do* indeed need to be taken out of the event. Where did I say it should be otherwise?
You say I am putting the "onus" on the person who was victimized. I don't quite understand what you mean. You seem to be saying that CBT is some sort of punishment, and that the victim doesn't deserve it. CBT is intended to help victims, last time I checked.
So what you are saying is that if someone is raped, we should do the CBT on the person who did the raping? But what about the victim? Do we just give him/her medications and totally avoid the CBT? Or what do we do? You tell me.
I agree with you, however, that the angry oppressor could benefit from CBT. But I think that he/she is much less likely to accept it. Forcing CBT on people never works, they have to seek the help. Anger *feels* too good to want to overcome it. I am not saying that CBT can't help anger, but that people are less likely to search treatment because anger feels empowering, whereas, e.g. depression is painful.
Thanks,
Matt
Posted by Dinah on June 2, 2003, at 10:59:36
In reply to Re: CBT and metacognition, posted by mattdds on June 2, 2003, at 9:58:43
I think you misunderstand. I don't disbelieve CBT worked for you. And I'm not "jabbing" anything. I'm happy it worked for you. Check out the CBT grand rounds though. Even the outcome studies show that CBT works better with some personality types than others.
I merely think there is a danger in CBT of blaming the patient if they don't improve enough. If they don't get better, they must not be working hard enough at it. Pull yourself up by your bootstraps. Change your actions and you'll change your feelings. Those are the messages I get from CBT.
CBT frankly makes me feel very bad about myself when applied in its purest form.
But for those it works for, great! More power to them, and thank heavens for different treatment modalities for different people. For most everyone, facets or ideas from CBT can be helpful.
And as I said before, I am not throwing jabs at you, I am not being sarcastic. We hold differing views on a form of therapy, and I attempt to express my viewpoints in discourse with you. If you see anything personally directed to you in what I say, it is certainly not my intention. Perhaps you are mistaking "jabs" and "sarcasm" with simple disagreement. I am by nature neither sarcastic nor belligerant. If in any way I failed in my attempt to discourse in a respectful and civil manner, I apologize.
P.S. My therapist was reacting to the way I presented myself at the time. He honestly thought I was incapable of certain things that we value in Western society, but where the lack thereof are considered virtues under the Buddhist ideology. I doubt he would say those things about me now.
Posted by Dinah on June 2, 2003, at 11:20:19
In reply to Re: CBT and metacognition » Dinah, posted by Larry Hoover on June 2, 2003, at 10:11:40
I was merely remarking on my own experience. Mind you, I didn't have formal CBT therapy at the time.
What happened was this. In my preteens/early teens I basically fell apart. All at once I became the picked on kid at school, we adopted my brother, and various and sundry other stresses. I developed an all consuming phobia/OCD obsession with people vomiting. I became almost agoraphobic. I behaved very badly (acted out). I went to a psychiatrist for a year, and was on thorazine for that time. One day I decided I didn't want to be that way any more.
I didn't have any access to CBT or CBT literature. I was only thirteen or fourteen. But on my own I came up with many things that I later recognized from CBT. And I did them very well. I became functional again. As far as I or anyone else knew, I was just fine.
When I went into therapy twenty years later for a recurrance of my OCD symptoms under the new stressers of marriage, my therapist was very CBT oriented. But he discovered that it just didn't work with me. Because I could believe everything he said with every fiber of my being. I could do the homework. I could say what I was supposed to say, and believe it too. I couldn't possibly believe it more. But it didn't reach deeply enough. I had an intellectual understanding and belief in what he said. I had lived it for twenty years. But I simply could not stretch it deep enough.
In fact, with some OCD self help books based on CBT principles, I pretty much conquered my OCD. Or at least got it under control enough that it was no longer a problem for me. I can sing my obsessions. I can laugh at them. They go away. The panic attacks pretty much stopped. But guess what? My OCD had served a purpose. Without the OCD, other symptoms emerged. My mood regulation abilities destabilized. I went from a relatively high functioning person with OCD to a not well functioning person with my OCD under control.
CBT, with me, had its limitations.
I'm not denying its usefulness. I'm just saying that with some people it works better than with others.
I like CBT, I prefer DBT. But I just think it needs to be seen as a tool, not a cure-all.
(P.S. If I had it all to do over again, I'd take back the OCD and panic attacks, and never have tried to overcome them. I don't know what purpose they served, but whoo-boy, it must have been an important one.)
Posted by mattdds on June 2, 2003, at 11:29:39
In reply to Re: CBT and metacognition » mattdds, posted by Dinah on June 2, 2003, at 10:59:36
Dinah,
My apologies for misinterpreting your comments. I have my own insecurities that sometimes become quite apparent. You see, had I been in metacognitive mode, I might have seen other ways of interpreting what you said <wink>.
I will be the first to admit that CBT works better for some than for others. And you're absolutely right in that it is extremely dangerous to "blame" the patient. But this is not the impression I get from CBT. Perhaps from some misguided CBT therapists, but not CBT in general.
For example, one of the "cognitive distortions" is, in fact, blame! David Burns does a very good job of dispelling the myth of blame (even for treatment failure). Blame is just an extreme oversimplification of a phenomenon that had too many variables for us to see, so we attempt to find a scapegoat. In depression, the scapegoat is oneself. In anger, another person.
You see, you interpret CBT as "blaming" you or "faulting" you. Perhaps you had a therapist that "blamed" you for not getting better. This is unfortunate. I agree that this is extremely misguided, and counterproductive. There have been studies that have shown that therapeutic empathy strongly predicts whether patients will remain in treatment (and subsequently get better)
On the other hand, if I cannot take at least some responsibility for my own recovery, than even the best therapist in the world has no chance of helping me. We need to move past this myth of fault and blame, and work on real problems. Blame (and the guilty feelings that follow) is just another delusion in depression's vast repertoire.
I see CBT as holding me personally responsible for my own state of affairs, but not in a "blaming" or "faulting" way. Again, there is a subtle but definite distinction between "blaming" and "holding responsible". Being held responsible for my own recovery is, to me, empowering! I am no longer the helpless victim, but the master of my destiny.
Best,
Matt
Posted by Dinah on June 2, 2003, at 11:39:31
In reply to Re: CBT and metacognition » Dinah, posted by mattdds on June 2, 2003, at 11:29:39
> I see CBT as holding me personally responsible for my own state of affairs, but not in a "blaming" or "faulting" way. Again, there is a subtle but definite distinction between "blaming" and "holding responsible". Being held responsible for my own recovery is, to me, empowering! I am no longer the helpless victim, but the master of my destiny.
>
Hi Matt. I'm afraid that that subtle distinction is one of those ones that my mind is not nuanced enough to make. And believe me, there are many. My therapist goes around and around with me sometimes to get me to understand distinctions between things that to me are the same. I don't really get the distinction between holding someone responsible and in some way blaming them for not living up to those responsibilities.The feelings of blame I get came not from my therapist but from the literature. Perhaps if my mind were capable of more subtle distinctions, it wouldn't be a problem for me, but it is. My therapist was flexible enough to back off from the strict CBT approach that is his initial response to anxiety disorders and move to a modality that was more useful to me. He still incorporates CBT concepts. He just doesn't rely on them exclusively.
Isn't that also the main reason for DBT? Marsha Linehan found that CBT didn't work for her target population, in part because of a high dropout rate. So she incorporated other concepts into her DBT so that it would better suit that type of patient.
I always see that as a mark of good therapy - flexibility.
Posted by Larry Hoover on June 2, 2003, at 11:54:12
In reply to Re: CBT and metacognition » Dinah, posted by mattdds on June 2, 2003, at 11:29:39
> Dinah,
>
> My apologies for misinterpreting your comments. I have my own insecurities that sometimes become quite apparent. You see, had I been in metacognitive mode, I might have seen other ways of interpreting what you said <wink>.I'm glad you recognized that. One of the outcomes of metacognition is flexibility. Same facts, different conclusion. Not getting stuck on the first cognition that comes to mind.
> For example, one of the "cognitive distortions" is, in fact, blame!
Blame is nothing more than giving the past a second chance (or more) to hurt you.
>Being held responsible for my own recovery is, to me, empowering! I am no longer the helpless victim, but the master of my destiny.
>
> Best,
>
> MattThe way I would put it is: "Here I am. Now, where do I go from here."
The past can serve as an anchor, or a solid footing for a move into the future.
The past can be informative (by remaining descriptive about it).
If you've suppressed the emotive content surrounding an experience, then releasing that through catharsis can be a liberating experience. If you've ever carried something heavy for too long, you'll know what I mean. Putting it down feels really good. Finally finding a bathroom after a long search for one, is another example.
However, ruminating over situations which cannot possibly change (history is immutable), only serves to reinjure over and over again. Rumination stops at the point of feeling. You never get to the resolution phase. It's a decision, to not let go.
Not trying to convince anyone of anything.
Lar
Posted by Larry Hoover on June 2, 2003, at 12:01:44
In reply to Re: CBT and metacognition » Larry Hoover, posted by Dinah on June 2, 2003, at 11:20:19
> I was merely remarking on my own experience.
I'm sorry. I wasn't trying to convince you of anything. I was trying to show how understanding denial is a key component of successful CBT.
Denial is like holding your finger on a weighscale. You distort the measurement. If you cannot accept that you are even doing that, you most certainly will never come to understand why you have chosen to cope that way.
Lar
Posted by Dinah on June 2, 2003, at 12:14:30
In reply to Re: CBT and metacognition » Dinah, posted by Larry Hoover on June 2, 2003, at 12:01:44
So not trying to convince someone of something is metacognition, eh? :) I always just thought of it as common sense. For the most part I've never found anyone to say "Oh, of course! You're right! Why didn't I see that before?" lol. I always figure you can state your point of view, but not expect anything to come of it. Or as I always like to say "What I do (or say I guess) is what I do. What other people do (or say) is what they do."
Acceptance? (see, I did listen to my therapist)
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