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

Sly Saint

Sly Saint

Senior Member (Voting Rights)
"I have OCD. Cognitive behavioral therapy techniques made it worse"

The first time I learned about cognitive behavioral therapy (CBT), I felt the pleasure of recognition and of superiority. I was in high school, and it would be years before I visited a therapist of any kind, but from what I gathered online, CBT consisted of what I was already doing.

The modality grew from a core belief that irrational thoughts are responsible for emotional suffering, according to Rachael Rosner, a historian writing a biography of Aaron Beck, the father of CBT. It followed that changing these thoughts could alleviate the distress.

Perhaps you’re afraid that your headache is a sign of a brain tumor. The CBT “thought record” technique might advise you to gather the facts for and against this fear. Is there a family history of brain tumors? Could the headache be caused by dehydration? Then, you reframe it into a more realistic, and presumably less panicked, position.

This back-and-forth volley already described my inner monologue. Years later, I chose for my first therapist one who practiced an old-school form of CBT that reinforced these habits.

It was easy to find such a therapist. Though exact statistics are scarce, CBT is a common modality. Many practitioners consider it the gold standard of psychotherapy and use it for conditions including anxiety and depression. By 2002, the Washington Post was claiming: “For better or worse, cognitive therapy is fast becoming what people mean when they say they are ‘getting therapy’.”
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The story of modern CBT is, in part, the story of being in the right place at the right time: the US in the 1980s. After the Diagnostic and Statistical Manual of Disorders III, the handbook for diagnosing mental disorders, came out in 1980, the National Institute of Mental Health started requiring that researchers conduct randomized controlled trials for therapy if they wanted funding. By then, Rosner says, Beck had already created a manual for CBT so that it could be standardized and studied in this way. This meant CBT therapists could adapt quickly to the new rules, and the techniques took off.

As insurance companies warmed to CBT, therapists developing new modalities liked to associate with CBT too, partly so these forms could also be covered by insurance
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I have OCD. Cognitive behavioral therapy techniques made it worse (msn.com)
 
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the National Institute of Mental Health started requiring that researchers conduct randomized controlled trials for therapy if they wanted funding
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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.
 
CBT requires the assumption that the therapist has some grand sweeping view of and insight into the entire human condition, a neutral place from which to objectively judge whether any given thought or claim is reasonable or not, without having to properly test it.

I have never met anybody who has that capacity. Those people do not exist, and never will.
 
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.
 
Trish said:
Direct link to the article.
https://www.theguardian.com/wellness/2024/apr/30/cbt-cognitive-behavioral-therapy-ocd
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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.
 
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hibiscuswahine said:
@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.
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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.
 
Sid said:
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.
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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.
 
Thank you for sharing your experience, @JellyBabyKid.

I wonder whether it would be better for clinical psychologists to learn a whole range of strategies that help some people and to use their wisdom, experience, training and common sense to decide with their client which strategies they will find most useful, rather than inventing more and more discrete packages with different names where the therapist just sticks rigidly to that package.

What I mean is, the client is a whole person with a mix of difficulties they would like to be able to overcome or live with more comfortably combined with a whole range of life experiences and social, economic, environmental influences on how they can live their lives.

If an individual, with all their complexity, is simply offered one specific program, whether CBT, DBT, ACT, or all the other multiplicity of prepackaged therapies, that one might not suit them. If the therapist only offers, and is only trained in, one therapy, they are likely to find it doesn't help a proportion of their clients. If they have wider training and are more flexible, and really listen to their clients, they can adjust what they are offering.

But I'm speaking as someone who is not diagnosed with any specific neurodivergent or psychiatric condition, and my only experiences of therapy have been aimed at helping through life crises. In those instances the therapy I tried was either useless or positively harmful, I think because the therapists were undertrained and following a rigid path which wasn't right for me.
 
Trish said:
If an individual, with all their complexity, is simply offered one specific program, whether CBT, DBT, ACT, or all the other multiplicity of prepackaged therapies, that one might not suit them. If the therapist only offers, and is only trained in, one therapy, they are likely to find it doesn't help a proportion of their clients. If they have wider training and are more flexible, and really listen to their clients, they can adjust what they are offering.
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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.)
 
Trish said:
I wonder whether it would be better for clinical psychologists to learn a whole range of strategies that help some people and to use their wisdom, experience, training and common sense to decide with their client which strategies they will find most useful,
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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

Peter Trewhitt said:
there were not good and bad techniques but good and bad therapists
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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.
 
Trish said:
Thank you for sharing your experience, @JellyBabyKid.

I wonder whether it would be better for clinical psychologists to learn a whole range of strategies that help some people and to use their wisdom, experience, training and common sense to decide with their client which strategies they will find most useful, rather than inventing more and more discrete packages with different names where the therapist just sticks rigidly to that package.

What I mean is, the client is a whole person with a mix of difficulties they would like to be able to overcome or live with more comfortably combined with a whole range of life experiences and social, economic, environmental influences on how they can live their lives.

If an individual, with all their complexity, is simply offered one specific program, whether CBT, DBT, ACT, or all the other multiplicity of prepackaged therapies, that one might not suit them. If the therapist only offers, and is only trained in, one therapy, they are likely to find it doesn't help a proportion of their clients. If they have wider training and are more flexible, and really listen to their clients, they can adjust what they are offering.

But I'm speaking as someone who is not diagnosed with any specific neurodivergent or psychiatric condition, and my only experiences of therapy have been aimed at helping through life crises. In those instances the therapy I tried was either useless or positively harmful, I think because the therapists were undertrained and following a rigid path which wasn't right for me.
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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.
 
Peter Trewhitt said:
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.)
Click to expand...
Transdiagnostic re-education sausage machines?
 
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