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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Amelia_in_StPaul on June 18, 2009, at 0:00:04
CBT is widely used for OCD and other anxiety disorders. Experts in OCD, in fact, will tell you it is THE only treatment (if it includes exposure and response prevention) for OCD. In a literature review of 27 published articles that researched CBT for anxiety, the authors found that indeed, CBT demonstrated efficacy over placebos that lasted after termination of treatment.
Hofmann SG & Smits JA. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry, 69(4), 621-32.
CBT for PTSD. The Department of Veteran Affairs reports that CBT results in 60-80% reduction in PTSD symptoms in civilian populations (esp. survivors of rape). As for pyschodynamic approaches, the Department states: "Research on the use of psychodynamic therapy is difficult to conduct because psychodynamic techniques do not focus on symptom reduction. Instead, they focus on more fluid intra- and interpersonal processes. To date, there has been only one randomized clinical trial on the efficacy of psychodynamic treatment in reducing PTSD symptoms. In this trial, 18 sessions of Brief Psychodynamic Psychotherapy were shown to effectively reduce PTSD intrusion and avoidance symptoms by approximately 40%, and improvement was sustained for 3 months. While clinicians often support the utilization of psychodynamic techniques in the treatment of trauma, particularly in the treatment of more complex trauma, much more research is needed to demonstrate the techniques effectiveness with PTSD."
http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_empiricalinfo_treatment_dis.html?opm=1&rr=rr129&srt=d&echorr=true (please see the bottom of the page for sources)
CBT for PTSD in patients who also have schizophrenia. According to a study published in the Journal of Anxiety Disorders, researchers found that 12 of 13 completers of an 11-week program in CBT to reduce PTSD had such a reduction in symptoms that 3 months later, 10 no longer met the criteria for PTSD.
J Anxiety Disord 2009; 23: 665-675
There are many, many more sources of evidence out there. I will post about DBT later in the week.
Posted by alexandra_k on June 18, 2009, at 10:33:08
In reply to Evidence-based practices: CBT, posted by Amelia_in_StPaul on June 18, 2009, at 0:00:04
one shouldn't mistake absence of evidence
for evidence of absence
Posted by alexandra_k on June 18, 2009, at 10:34:02
In reply to Re: Evidence-based practices: CBT, posted by alexandra_k on June 18, 2009, at 10:33:08
ie just because there isn't any evidence that x is effective
doesn't mean x is not effective
Posted by antigua3 on June 18, 2009, at 10:41:32
In reply to Evidence-based practices: CBT, posted by Amelia_in_StPaul on June 18, 2009, at 0:00:04
I'm no expert, although I do read a lot and try to learn about many different types of therapy. What I have to say comes from my own experience over the years with several different types of therapy.
I do believe that CBT is helpful in treating PTSD. I'm not sure why it works, but it moved me forward in new ways that have been very helpful to me. Changing negative thought patterns, learning to let go and examining irrational behavior have all been extremely helpful.
But like Scott said in the post above, to me it is a top down approach. I think psychodynamic therapy is a bottom up approach and combined they can be invaluable. I say this because while CBT has helped me release memories, I don't believe they can just be "let go." They need to be processed and dealt with so the memories move from short-term memory into long-term memory, where they become a part of our life-long memory bank and no longer are constantly in the forefront of our short-term memory.
I tried EMDR, and I did release a memory I didn't know about. But I ran when it got too painful; I guess I wasn't really ready to face it. Now I use the EMDR protocol on my own to help me resolve anxiety and fear. It has helped a lot; it's a meditative technique for me, but I do have to add that it has released some memories for me to deal with. Not always pretty.
So, yes, I think EMDR is very helpful for PTSD.
The one quibble I have about the research into psychodynamic therapy that questions its efficacy is that psychodynamic theory is more ethereal and I don't think it's possible to truly "measure" what goes on in the room. Evaluating the value of psychodynamic theory, IMO, is almost an impossible task because there is not an accepted prescribed technique that can be measured.
This, of course, is my own bias and opinion, based on my own experiences.
I'm really interested to hear what others have to say.
antigua
Posted by Amelia_in_StPaul on June 18, 2009, at 12:05:32
In reply to Re: Evidence-based practices: CBT, posted by alexandra_k on June 18, 2009, at 10:34:02
trust me, I didn't need a translation. LOL. though psychodynamic doesn't really lend itself to empirical study, does it?
> ie just because there isn't any evidence that x is effective
> doesn't mean x is not effective
>
>
Posted by fleeting flutterby on June 18, 2009, at 14:05:20
In reply to Evidence-based practices: CBT, posted by Amelia_in_StPaul on June 18, 2009, at 0:00:04
> CBT is widely used for OCD and other anxiety disorders. Experts in OCD, in fact, will tell you it is THE only treatment (if it includes exposure and response prevention) for OCD. In a literature review of 27 published articles that researched CBT for anxiety, the authors found that indeed, CBT demonstrated efficacy over placebos that lasted after termination of treatment.<<
----flutterby: Thank you for sharing. I can certainly understand how CBT can help, it's helped me quite a bit.
> CBT for PTSD. The Department of Veteran Affairs reports that CBT results in 60-80% reduction in PTSD symptoms in civilian populations (esp. survivors of rape). As for pyschodynamic approaches, the Department states: "Research on the use of psychodynamic therapy is difficult to conduct because psychodynamic techniques do not focus on symptom reduction. Instead, they focus on more fluid intra- and interpersonal processes. To date, there has been only one randomized clinical trial on the efficacy of psychodynamic treatment in reducing PTSD symptoms.<<----flutterby: I don't understand why it's difficult to tell if psychodynamic therapy is helpful or not..... Isn't it apparent if ones life has improved-- thoughts are healthier and actions are more productive? Isn't that the way to know if any type of therapy is working or not? Seems to me if one is in therapy for years and keeps struggling over the same things, then that kind of therapy is failing that person- no? (sorry if this is a dumb question-- I'm not knowledgeable and am trying to understand)
> CBT for PTSD in patients who also have schizophrenia. According to a study published in the Journal of Anxiety Disorders, researchers found that 12 of 13 completers of an 11-week program in CBT to reduce PTSD had such a reduction in symptoms that 3 months later, 10 no longer met the criteria for PTSD.
>
> J Anxiety Disord 2009; 23: 665-675<<----flutterby: This is very encouraging. I hope many people can have much improved lives. :o)
>
> There are many, many more sources of evidence out there. I will post about DBT later in the week.
>
----flutterby: I don't know anything about DBT. Wonder if it would help me?Well, thanks for sharing this. I'm very interested in knowing all I can about all types of therapies and all types of experiences, in hopes that having learned more will increase my chances of improving my life.
flutterby-mandy
Posted by Amelia_in_StPaul on June 18, 2009, at 15:04:23
In reply to Re: Evidence-based practices: CBT » Amelia_in_StPaul, posted by antigua3 on June 18, 2009, at 10:41:32
I will respond more in a day or two. It's my birthday and I'm trying to calm down a little and gain some objectivity and--heck--maybe enjoy the day! :-)
Thanks so much for your responses.
Posted by garnet71 on June 18, 2009, at 19:24:17
In reply to Evidence-based practices: CBT, posted by Amelia_in_StPaul on June 18, 2009, at 0:00:04
Hey Amelia-It's always nice talking to you. I can't help but notice you are triggered about psychoanalysis. Having PTSD myself, and still being triggered here and there, I can see it so clearly. I can almost hear the hypervigilence coming from your words-so strongly I can hear your words as a voice-and your reaction sounds so familiar to me. It's almost as if I can feel that PTSD anxiety in your words. Do you think that is accurate? I'm so sorry you have had a bad reaction from it. I can see how being in the wrong hands could be dangerious. I think that is an important issue to discuss here and anywhere.
CBT never did anything for me, personally. Most of my emotions are repressed, which I believe, is the source of my behavior and neurosis. I relived some of those emotions, however, through a relationship which triggered the PTSD from childhood. I remained intact, but that was the least stable period of my life. Even after all the childhood trauma, I was stable from my teen years to almost age 30, until that relationship started. I had some dysfunction, but not depression and barely anxiety, though remember having it some times. Was very productive and seen as someone who 'had it all together'. I was not, however, in many long relationships with men; mostly casually dated. So i think that illustrates how childhood emotions need to be processed for me, in that I only became unstable after a relationship that triggered everything I had never dealt with.
I can also see how the relationship with these 2 types of therapists can be very important to people. I think many people really benefit from the warm fuzziness of CBT or talk therapists, but I don't. I spent hours in offices just talking to therapists. They were my 'freind'. I don't need that warm mushy stuff. I don't need a friend - I need a healer. I want someone authoritive. It must be difficult for some to deal with the total lack of self-disclosure from some analysts, the coldness of blank state. I like it because I want to work solely with the transference to allow me to discover the sources of my behavior, t houghts, and neurosis in a very isightful way facilitated by my unconsciousness. Rarely has a CBT therapist given me much insight. And CBT seems like common sense to me, like I already instinctually do it quite often. When emotions are repressed and so buried, however, the lack of even knowing and feeling these emotions exist prevents true healing, for me, imo. With CBT, they are still going to be repressed-still an underlying source for neurosis. I guess many do not buy those theories, that's ok with me, but i do. With the emergence of these emotions can come a catharthesis-I've already felt it starting.
But I'm glad you are discussing this type of therapy so others can learn. I just don't agree with the significance of that research, much like other research. For therapy, i think one has to go by their personal preferences and what's best for them, rather than what is perceived to be affective with others. I've also read about EMDR being effective for PTSD.
I totally agree with what Alexandria said too. Hey, I was never interviewed by any researcher to assess my positive reaction. There are only 3000 true psychoanalysts in the US, if i read correctly. It takes 4 more years after medical school or PhD obtainment to gain this certification. That's a huge investment. Not only that, anlysists have to undergo psychoanalysis themselves for a certain time period, adding to the whole process. There is not a huge sample here to research and maybe scattered throughout the US. I don't want to see the field die out, that's for sure.
Posted by antigua3 on June 18, 2009, at 20:41:31
In reply to thanks flutterby and antigua..., posted by Amelia_in_StPaul on June 18, 2009, at 15:04:23
Happy Birthday!
Posted by garnet71 on June 18, 2009, at 21:20:30
In reply to Evidence-based practices: CBT, posted by Amelia_in_StPaul on June 18, 2009, at 0:00:04
....Happy Birthday!!!! Today is a reason to celebrate - YOU!
Posted by Amelia_in_StPaul on June 19, 2009, at 12:51:26
In reply to Re: Evidence-based practices: CBT » Amelia_in_StPaul, posted by garnet71 on June 18, 2009, at 19:24:17
Hi Garnet, that was anger and passion, not triggering. I mentioned on the med board to you that I did have a psychodynamic therapist many years ago--and he helped me with what he could. I said that we couldn't touch the PTSD, because I believe--and he believed--that that approach was not appropriate for it, and would destabilize me.
He was a wonderful person. I liked him immensely. However, I DO Get angry, and passionate, when I read how T's do things that to me screams manipulation in the name of whatever you want to call it, but usually some variant of psychoanalysis. There are clear boundaries that are set out in non-psychodynamic therapies that are less squishy than those in psychodynamic, even interpersonal, therapy.
I was angry on your behalf. You had written a desperate post that seemed to indicate that your temporary T had said some irresponsible things. I did not understand that it was you that was reading into the encounter, and I did not understand that he was not saying that you had "buried psychosis." As someone with a sister with actual psychosis, the notion of buried psychosis upsets me very yes (that's a trigger, if any existed here).
It's funny how different people can really interpret things differently. CBT is not warm fuzzy to me at all--it's very workmanlike, and I appreciate that. I dislike talking about my past, my childhood, my nightmares, etc. I don't think it helps.
The hue and cry I've received about not respecting psychoanalysis (not from you) makes no sense to me. I can believe as I see fit. I can respond from my set of beliefs, just as anyone could. There is a majority here that believes in interpersonal and psychodynamic approaches--that's fine. But that doesn't mean I am not allowed to voice my opinion, especially when someone I think highly of (you) is in so much pain.
This may surprise you, but as I've said before, academically, I like some aspects of psychodynamic approaches. Only academically. I don't think it works therapy-wise. In fact, I looked at a program in the San Francisco area that trains therapists to be psychoanalysts, so I know how intensive the training is. The thing I liked about it is that it utilized what I think are very literary, symbol-laden, concepts in psychodynamic and psychoanalytic theory, but married the concepts with FEMINISM. Sorry for the caps, I'm not shouting, just being enthusiastic. B/c that is the main problem (and the main criticism of) with psychodynamic theory, in my opinion and many others'.
However, the love I have for the literary, symbol-laden concepts, even married to feminism, so to speak, do not, I believe work to help clients learn to cope and deal with the everyday.
So I did not go to that school, did not become a psychoanalyst.
Very few people who have responded to me are actually getting the full picture, and are actually understanding what I hope you understand: I responded in the way I did because I thought you were sorely treated by the temporary T (don't have a better way to put it), the consultant. You had said some things that sounded as though HE had said them. Because those things go the heart of what I think is the problem with psychodynamics, IMO, I thought you could use therapy that would provide better boundaries and that could assure you that you were not psychotic.
It came from a place of care, d@mned what anyone else thinks of it. I care about you.
So I am not going to say anymore about your new journey into therapy, except to say, again (AGAIN, do you hear me people?), that I support your new course, and wish you all the very best. I can disagree with the larger issues of something, but support the specific incidence, the specific person. That is what I wish to communicate to you--I support you.
Hey Amelia-It's always nice talking to you. I can't help but notice you are triggered about psychoanalysis. Having PTSD myself, and still being triggered here and there, I can see it so clearly. I can almost hear the hypervigilence coming from your words-so strongly I can hear your words as a voice-and your reaction sounds so familiar to me. It's almost as if I can feel that PTSD anxiety in your words. Do you think that is accurate? I'm so sorry you have had a bad reaction from it. I can see how being in the wrong hands could be dangerious. I think that is an important issue to discuss here and anywhere.
>
> CBT never did anything for me, personally. Most of my emotions are repressed, which I believe, is the source of my behavior and neurosis. I relived some of those emotions, however, through a relationship which triggered the PTSD from childhood. I remained intact, but that was the least stable period of my life. Even after all the childhood trauma, I was stable from my teen years to almost age 30, until that relationship started. I had some dysfunction, but not depression and barely anxiety, though remember having it some times. Was very productive and seen as someone who 'had it all together'. I was not, however, in many long relationships with men; mostly casually dated. So i think that illustrates how childhood emotions need to be processed for me, in that I only became unstable after a relationship that triggered everything I had never dealt with.
>
> I can also see how the relationship with these 2 types of therapists can be very important to people. I think many people really benefit from the warm fuzziness of CBT or talk therapists, but I don't. I spent hours in offices just talking to therapists. They were my 'freind'. I don't need that warm mushy stuff. I don't need a friend - I need a healer. I want someone authoritive. It must be difficult for some to deal with the total lack of self-disclosure from some analysts, the coldness of blank state. I like it because I want to work solely with the transference to allow me to discover the sources of my behavior, t houghts, and neurosis in a very isightful way facilitated by my unconsciousness. Rarely has a CBT therapist given me much insight. And CBT seems like common sense to me, like I already instinctually do it quite often. When emotions are repressed and so buried, however, the lack of even knowing and feeling these emotions exist prevents true healing, for me, imo. With CBT, they are still going to be repressed-still an underlying source for neurosis. I guess many do not buy those theories, that's ok with me, but i do. With the emergence of these emotions can come a catharthesis-I've already felt it starting.
>
> But I'm glad you are discussing this type of therapy so others can learn. I just don't agree with the significance of that research, much like other research. For therapy, i think one has to go by their personal preferences and what's best for them, rather than what is perceived to be affective with others. I've also read about EMDR being effective for PTSD.
>
> I totally agree with what Alexandria said too. Hey, I was never interviewed by any researcher to assess my positive reaction. There are only 3000 true psychoanalysts in the US, if i read correctly. It takes 4 more years after medical school or PhD obtainment to gain this certification. That's a huge investment. Not only that, anlysists have to undergo psychoanalysis themselves for a certain time period, adding to the whole process. There is not a huge sample here to research and maybe scattered throughout the US. I don't want to see the field die out, that's for sure.
Posted by Amelia_in_StPaul on June 19, 2009, at 12:58:54
In reply to Re: thanks flutterby and antigua... » Amelia_in_StPaul, posted by antigua3 on June 18, 2009, at 20:41:31
Posted by Amelia_in_StPaul on June 19, 2009, at 12:59:59
In reply to Hey Amelia.., posted by garnet71 on June 18, 2009, at 21:20:30
Posted by Sigismund on June 21, 2009, at 3:10:50
In reply to Re: Evidence-based practices: CBT » alexandra_k, posted by Amelia_in_StPaul on June 18, 2009, at 12:05:32
>psychodynamic doesn't really lend itself to empirical study, does it?
18 sessions? That's not many.
This is the end of the thread.
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