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BBC on CBT

nickh

nickh

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Interesting article on CBT from a BBC Health Correspondent - I think the comments at the end by MIND are helpful and constructive, though my own cynicism suggests that one reason for the Governments preference for CBT does relate to its claimed effectiveness in "getting unemployed people back to work,"

>>Is cognitive therapy the answer?
By Jane Dreaper
BBC News health correspondent

There was huge excitement last autumn when the health
secretary, Alan Johnson, announced that £170m would be
spent on talking therapies in England. The programme focuses on one specific branch of treatment - Cognitive Behavioural Therapy (CBT).

But a tide of doubt has begun to be expressed about whether
CBT is getting too much prominence - and money.

However, the therapy's supporters say its attackers do not
understand the latest versions that are being used for NHS
treatment.

The London borough of Newham has been an important test bed for the idea of getting CBT to a wide number of people. It is the home of the 2012 Olympics, but also an ethnically diverse area with significant deprivation.
Outside East Ham tube station, the nearby pub is appropriately called the Overdraft Tavern and it seems likely that there is plenty of unhappiness to treat in the area.

Rita Edgar-Dimmack, 51, sought help from CBT after 20 years in an abusive marriage. She said:
"I left my husband with nothing. I was angry with
myself because I'd stayed so long, and I got depressed. "My GP, who'd known me for years, noticed my personality had
changed. He handed me a leaflet on CBT.
"A few weeks later I rang, and then came in and saw a therapist.
"He started me with a booklist, and said he wanted me to do some reading.
"I started reading books on depression. Each week, he'd have me do something else - like keeping note of my moods.
"He also started me thinking about the times when I did incredible things, and wasn't stupid or inept. That's when I started to heal."

Practical skills

CBT looks at difficulties in the here and now. It includes homework and aims to build up practical skills.
Dr Ben Wright, the doctor in charge of the CBT programme in Newham, said: "I think this is a dream service. Patients can refer themselves and get access to quick treatment."

The service has a good record for getting unemployed people back to work, or at least moving in that direction through training or volunteering - thanks to ties with specialist charity workers.

Dr Wright added: "They will speak to people, and help them get vocational plans.
"Our focus is first and foremost on the person and what they want.
"Employment, however, is a very important pathway for social inclusion and most people find that's
the way in which they want to get back on with their lives."

'Hoodwinked'

It seems compelling, and pilot schemes in Newham and Doncaster helped persuade the government to fund CBT on a massive scale.
But critics are nervous about therapy being linked with employment services and some say, in quite strong terms, that ministers have been hoodwinked.
Andrew Samuels is a psychotherapist and professor at Essex
University.
He said: "What you're witnessing is a coup, a power play by a
community that has suddenly found itself on the brink of
corralling an enormous amount of money.
"The CBT community has managed to sell to the government
and its agencies a notion of research that is allegedly scientific.
"Science isn't actually the appropriate perspective from which to look at emotional difficulties. This kind of pseudo-scientific shambles simply isn't the right way to do it.
"In CBT, the client is a recipient of instructions or suggestions. They're told their thinking is wrong.
"Everyone has been seduced by its apparent cheapness."

'No axe to grind'

His private practice is fully booked - and so he says he does not have an axe to grind in his attack against the promotion of CBT as a superior therapy.
Andrew Samuels insists he is not a lone voice, though he says
colleagues who email supportive messages privately are reticent
about speaking publicly.
Other psychoanalysts have recently written newspaper critiques
of CBT.

But a professor at the Institute of Psychiatry, David Clark, says
it is the critics who are guilty of misunderstanding.
He said: "CBT is a rapidly evolving field. The versions we have now are very different from the
ones we had 10 years ago, and in many cases quite a bit more effective.
"CBT researchers are always looking at what you can do to fine tune the treatment, and make it a
little bit more effective and efficient.
"It's a serious misunderstanding to say that CBT tells patients how to think.
"Rather than saying any thoughts are wrong, we explore the evidence.
"I think the government chose this expansion because of the moral case - there's a large number of
people with common mental health problems which are severely disabling.
"They haven't had treatment before and they should be offered it because we know there are effective treatments."
CBT is a rapidly evolving field - the versions we have now
are very different from the ones we had 10 years ago

Common concern

Back in East London, at the headquarters of the leading mental health charity Mind, talking treatments are a common concern for people who ring their information service.
Policy director, Sophie Corlett, said: "The debate appears to have focussed on 'CBT good' or 'CBT
bad' without any recognition that CBT is good for some people.
"I feel that some of the arguments seem to have almost disintegrated into arguments between the
therapies.
"I think it's got to the point where it's become unhelpful within the professions.
"There is a case for saying that CBT has been promoted above its usefulness.
"It's extremely useful for large numbers of people. Some people have assumed therefore that the
evidence base is superior - but for some, it may be of no use at all.
"There needs to be recognition of different approaches for different people."<<

Nick.
 
R

ramboghettouk

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@5yrs ago i had cbt, all optimistic and looking for work, this loony dick whittington came to london to do a degree, i got the degree and all optimistic went after a job banged my head again and again against a brick wall, did get a job in social services were they said i was unfit for work.

Was housed on a salvation army estate suffereng harrassment, when i went for help they said i wasn't a priority on mental health grounds, i suspect it was my optimism, mind said he presents as well and thats why they refuse help

Now the optimisn is long gone

When i did that psychology degree they used to say about studies theres no long term follow up well i'm an example
 
intelgal

intelgal

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I have had two different attempts at CBT. The first was delivered by somone with very little experience and understanding and although they were good to the point where I could recognise that I was feeling ill it left me feeling rather inadequate and stupid and eventually I gave up. This was delivered in 40 min session and no clear goals or problems identification was ever drawn up. My second attempt at CBT has been a little more effective but most of all I have felt empowered and in charge of my own treatment. CBT does look at the here and know but it does examine past experiaces that have led to the formulation of thinking patterns. The big DANGER I feel with CBT is when it is delivered by inexperienced professionals who are not able to deliver the full benefits of the therepy because they are not adequatly trained and therefore it can be ineffective and useless. When the therepy is done on the cheap which seems to be happening in the NHS.
Having said that I would not call it a wonder therepy as certain qualities are required by an individual for this therepy and alternatives should be explored and the right therepy for the individual should be given.
 
A

Amor's_Tears

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"There needs to be recognition of different approaches for different people."<<

What the lady from MIND is saying is perfectly correct. Unfortunately I was never given the option at my mental health assessment - it was CBT or nothing. Even when I expressed concern that there was no choice available, I was told the same thing.

Now, I am two sessions into my CBT (only 4 more to go thank the Lord). It has not been useful so far and the constant theme behind the whole approach seems to be that somehow I am in the wrong. This is not good for me because it seems that throughout my whole life I have been told that I am "in the wrong" and "no, you should do it this way", etc. I feel thoroughly disempowered and de-motivated.

Fortunately, my current therapist has had the foresight to recognise that perhaps this isn't the right thing for me. She has refered me to a private (non-NHS) charity that offers more general counselling. I will have to pay for it, but it'll be worth it. In this day and age though I don't see why anybody should have to pay for private healthcare of any sort. Its a disgrace.

I do recogise that CBT is useful for many people - perhaps those with short-term depression who lived normal lives before their illness and who could quickly recover. However, I don't think it is for me.

Robert.
 
nickh

nickh

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:( - sorry to hear this Amos. And this is my big problem with CBT - I appreciate that it does a lot of good for some/many people but there are those for whom it is completely inapplicable - you, like me, are one. I agree that it is disgraceful that you have to go outside the NHS to get the help you want but can fully understand your doing so. In fact at one point years ago I was driven to see someone in the private sector (and I would never have thought I would have done that!) - in fact they weren't much good and soon after I finally got my wonderful NHS psychologist. :) that isn't meant to discourage you - I know other people who have felt forced to go private and they have found it worthwhile.

The important think is not to feel bad if CBT doesn't work for you (or indeed any other talking therapy). There is something a bit odd here actually. We easily accept that some medications work for some people and not for others and indeed some people are completely medication resistant. We have no problem with that. But the same is equally true of various talking therapies yet I think there is a tendency for us to think it is 'our fault' if they don't work. Only just started thinking about this and not developed my thought but it seems right :rolleyes:.

Good luck with your new therapist.

Best,

Nick.
 
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Amor's_Tears

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Thanks for your comments, Nick. I don't like to think of myself as a "difficult patient", so its good to know that other people have the same concerns as me.

Robert :)
 
nickh

nickh

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:) oh definitely don't think of yourself as a 'difficult patient' Robert - other than we should all be more difficult in getting the right treatment. A big part of our problem is that we aren't 'difficult' enough and just go along with whatever is suggested - when I am ill I don't have any will to resist in any case and when I am well I used to go along with anything exactly because I used to fear being 'difficult' - I really wish I had been more difficult years ago now!

Nick.
 
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ramboghettouk

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Remember in cbt doing exercises to change the way i view my illness now when i go for help or benefits and play down illness i shoot myself in the foot
 
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