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Perhaps you misunderstood the Chief; CBT is the gold standard for treating anxiety-related disorders. See this meta-analysis: http://www.ncbi.nlm.nih.gov/pmc/ar

Perhaps you misunderstood the Chief; CBT is the gold standard for treating anxiety-related disorders. See this meta-analysis: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263389/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263389/

TeMPOraL 11y ago
The interesting thing IMO is that CBT is actually about totally ignoring the "underlying reasons" of your problem, and instead it's about literally hacking your mind to deal with the symptoms. Drugs are a hardware solution, CBT is a software solution, and all that searching for problems in your life is mostly attempts at patching up datasets provided by third parties.
- Domenic_S 11y ago
  Sort of... it's learning to recognize when your brain starts looping and giving you the skills to be able to hit ctrl + c, while at the same time teaching you how to not write loops in the first place. GAD and PTSD and all that spectrum are coping mechanisms, they're just maladaptive. CBT teaches you how to cope productively. (personal opinion incoming), I think a person can get to the point where they need an SSRI as a stepping stone to even have the energy/capability to benefit from CBT, then they learn adaptive behavior, then they can dump the SSRI and let their new skills handle day-to-day life. The "underlying reasons" are only useful inasmuch as you know what to look for so you can proactively start coping/remove yourself from maladaptive situations, but IMO most people try way too hard with the "why" stuff. The only thing that matters is "what now?"
  - TeMPOraL 11y ago
    I share your personal opinion. I'm actually in the process of that, and I can attest from my experience that it would not be possible for me to benefit from CBT without first getting an SSRI therapy - I was stuck so deep in anxiety loops that even the keyboard interrupt handler was starved for resources. SSRIs reduced my problems to something I'm struggling with - before drugs I was unable to function as a productive member of society at all. (Ironically, some of my present problems are indeed caused by life conditions - exactly the conditions I inflicted upon myself during the period before I started taking drugs.)
graycat 11y ago
Naw, I understood the Chief. I followed your link to that paper -- sure, CBT, once unwind the acronym, sounds fine. That's what I thought would work on the patient in my family (by marriage, not by birth). But CBT didn't work. Not even a little, not a chance. And the patient was just awash in cognitive ability -- brilliant, actually. Or, maybe the brilliance caused seeing more threats and, thus, more anxiety. The usual suspects, say, SSRIs, etc. didn't work, either. The result was, right, the worst possible, and of course there are hints that SSRIs can contribute to that result. Much of the problem was social phobia, e.g., as in the link. Well, it was strongly in common to the mother and all three daughters. So, nature or nurture? If just nurture, maybe CBT, etc. should have worked. But, gotta tell you, at least on the social phobia part, nothing made a dent. All three of the daughters had at least talk therapy, and, no help at all. None. If CBT can work, as in the link, fine, no, terrific. But, for anyone facing the problems mentioned in the link, need to keep in mind that for a specific case the averages don't have to matter and have to entertain that maybe CBT won't work. Just why the Chief was so down on talk therapy, or CBT if that is close enough, I don't know. But, we're talking 20+ years ago. It can be serious stuff, and darned tough to deal with. Or, the Chief's summary remark went: "Get the patient all calmed down, stable, happy, and then suddenly there will some little event, say, a new file folder of work, and the patient will be all stressed out again." Or, in my intuition, provide something like a padded cell life for the patient, and things could look fine. But, try to have the patient address the real world, and just some random, new event, say, where there might be some risk that they would have to think through and handle, and they could get all "stressed out" again -- sleepless nights, GI problems, tears, depression, clinical depression, etc. I'm no expert, but, again, overall IMHO the OP is a bit simplistic.
- Domenic_S 11y ago
  I'm sorry to hear that story. I hope this doesn't come off cruel because it isn't meant to be, but there are always outliers -- people for whom the gold standard, or any standard, just doesn't work. It's not a good idea to dismiss a well-studied treatment universally shown to be effective because we don't know if it'll work in a specific case. It's important not to anchor a patient -- already living on the edge -- with thoughts that 'maybe this isn't going to work for me'. On average, most people are average. What we do know is that CBT is exceptionally good at handling most cases. No single treatment (for any disorder) works equally well/at all for all patients, but of course medicine is concerned with helping the largest population efficiently. I hope one day we understand the brain better, to the point that people like your relative don't have to suffer anymore.
DrScump 11y ago
It isn't, necessarily, the best solution for everyone anyway. CBT is based on challenging negative thoughts, assuming that those thoughts are manufactured or, at least, grossly exaggerated. That kinda puts you in a corner if those thoughts are factual. ACT (Acceptance and Commitment Therapy) has more recent science behind it and gives you strategies on how to minimize the effect of unhelpful thoughts, factual or not. https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy https://en.wikipedia.org/wiki/Acceptance_and_commitment_ther...

TeMPOraL 11y ago

The interesting thing IMO is that CBT is actually about totally ignoring the "underlying reasons" of your problem, and instead it's about literally hacking your mind to deal with the symptoms. Drugs are a hardware solution, CBT is a software solution, and all that searching for problems in your life is mostly attempts at patching up datasets provided by third parties.

Domenic_S 11y ago
Sort of... it's learning to recognize when your brain starts looping and giving you the skills to be able to hit ctrl + c, while at the same time teaching you how to not write loops in the first place. GAD and PTSD and all that spectrum are coping mechanisms, they're just maladaptive. CBT teaches you how to cope productively. (personal opinion incoming), I think a person can get to the point where they need an SSRI as a stepping stone to even have the energy/capability to benefit from CBT, then they learn adaptive behavior, then they can dump the SSRI and let their new skills handle day-to-day life. The "underlying reasons" are only useful inasmuch as you know what to look for so you can proactively start coping/remove yourself from maladaptive situations, but IMO most people try way too hard with the "why" stuff. The only thing that matters is "what now?"
- TeMPOraL 11y ago
  I share your personal opinion. I'm actually in the process of that, and I can attest from my experience that it would not be possible for me to benefit from CBT without first getting an SSRI therapy - I was stuck so deep in anxiety loops that even the keyboard interrupt handler was starved for resources. SSRIs reduced my problems to something I'm struggling with - before drugs I was unable to function as a productive member of society at all. (Ironically, some of my present problems are indeed caused by life conditions - exactly the conditions I inflicted upon myself during the period before I started taking drugs.)

graycat 11y ago

Naw, I understood the Chief. I followed your link to that paper -- sure, CBT, once unwind the acronym, sounds fine. That's what I thought would work on the patient in my family (by marriage, not by birth). But CBT didn't work. Not even a little, not a chance. And the patient was just awash in cognitive ability -- brilliant, actually. Or, maybe the brilliance caused seeing more threats and, thus, more anxiety. The usual suspects, say, SSRIs, etc. didn't work, either. The result was, right, the worst possible, and of course there are hints that SSRIs can contribute to that result. Much of the problem was social phobia, e.g., as in the link. Well, it was strongly in common to the mother and all three daughters. So, nature or nurture? If just nurture, maybe CBT, etc. should have worked. But, gotta tell you, at least on the social phobia part, nothing made a dent. All three of the daughters had at least talk therapy, and, no help at all. None. If CBT can work, as in the link, fine, no, terrific. But, for anyone facing the problems mentioned in the link, need to keep in mind that for a specific case the averages don't have to matter and have to entertain that maybe CBT won't work. Just why the Chief was so down on talk therapy, or CBT if that is close enough, I don't know. But, we're talking 20+ years ago. It can be serious stuff, and darned tough to deal with. Or, the Chief's summary remark went: "Get the patient all calmed down, stable, happy, and then suddenly there will some little event, say, a new file folder of work, and the patient will be all stressed out again." Or, in my intuition, provide something like a padded cell life for the patient, and things could look fine. But, try to have the patient address the real world, and just some random, new event, say, where there might be some risk that they would have to think through and handle, and they could get all "stressed out" again -- sleepless nights, GI problems, tears, depression, clinical depression, etc. I'm no expert, but, again, overall IMHO the OP is a bit simplistic.

Domenic_S 11y ago
I'm sorry to hear that story. I hope this doesn't come off cruel because it isn't meant to be, but there are always outliers -- people for whom the gold standard, or any standard, just doesn't work. It's not a good idea to dismiss a well-studied treatment universally shown to be effective because we don't know if it'll work in a specific case. It's important not to anchor a patient -- already living on the edge -- with thoughts that 'maybe this isn't going to work for me'. On average, most people are average. What we do know is that CBT is exceptionally good at handling most cases. No single treatment (for any disorder) works equally well/at all for all patients, but of course medicine is concerned with helping the largest population efficiently. I hope one day we understand the brain better, to the point that people like your relative don't have to suffer anymore.

DrScump 11y ago

It isn't, necessarily, the best solution for everyone anyway. CBT is based on challenging negative thoughts, assuming that those thoughts are manufactured or, at least, grossly exaggerated. That kinda puts you in a corner if those thoughts are factual. ACT (Acceptance and Commitment Therapy) has more recent science behind it and gives you strategies on how to minimize the effect of unhelpful thoughts, factual or not. https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy https://en.wikipedia.org/wiki/Acceptance_and_commitment_ther...