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Having experienced CBT as a patient, I thought it was a useful, but limited. I had two specific critiques: 1. If you're reasonably intelligent, it's easy to se

Having experienced CBT as a patient, I thought it was a useful, but limited. I had two specific critiques: 1. If you're reasonably intelligent, it's easy to see how CBT "works" within a few sessions, and afterwards you can fall into a trap of telling the therapist what you "should" say according to CBT. Because there's a very specific goal of avoiding negative thoughts and thinking patterns, it's easy to exaggerate your level of success in order to "please" the therapist, rather than admitting that you've not make any progress. 2. My larger problem is that CBT puts a primacy on thoughts over emotions that I'm not sure is warranted. The thesis is that you have a established negative thought, such as "social situations make me nervous", which becomes a self-fulfilling prophecy, and so you are always nervous in social situations. However, I am not sure that this is truly the order of things, at least for me. I observed that, even when I studiously avoided negative thoughts like this, the underlying emotions were still often present. Being confronted with a social situation produced a physiological response that included anxiety. I might consciously rationalise that response with a thought like "this is a social situation, and social situations make me nervous", but the underlying response existed regardless. Freudian psychotherapy has a lot of wacky ideas about unconscious desires and whatnot, but it does at least acknowledge the idea that there is something within people beyond the rational, conscious mind, and that it it can be the stronger force. In contrast, CBT seems to be a therapy born from the opposite viewpoint: that the primal, subconscious, animal brain is entirely subordinate to the rational, conscious mind. Perhaps that's true for the people who developed the therapy, but it isn't true for me.

empath75 10y ago
Right, but isn't it about coping with that response, not eliminating it? That was the impression I had of what it is. The goal isn't to eliminate sadness or anxiety, but to limit the negative impact it has on your life. So you don't get into these cycles were depression prevents you from moving forward, which makes you more depressed and so on. That's why it supposedly works so well with people with bpd, right? Because bpd is all about fear of people leaving you, while you behave in ways that absolutely ensure that people will.
- morbidhawk 10y ago
  My wife has BPD. CBT never worked for her (and it never worked for me either), her therapist switched from CBT to DBT & EMDR instead and it has better results. The problem with CBT is that it tries re-frame situations using a logical explanation to people who don't know how to talk in logical terms to see things from a different perspective. The problem is that people with BPD don't express things in logical terms, so it is easy to mis-diagnose or misrepresent and cause an invalidating statement. Borderlines are great at reading between the lines and trying to understand things in an emotional way. They can easily misinterpret your re-framing to be invalidation. So instead, DBT and a question-based approach that helps them to think through the problem themselves is so much better. My CBT therapist told me to tell my wife "that being out of town for her birthday wasn't abandonment", yeah right that'd go over like hell. BPD requires deeper introspection and CBT therapy will usually cause the client to feel invalidated
  - thrwy1287 10y ago
    >> "The problem with CBT is that it tries re-frame situations using a logical explanation to people who don't know how to talk in logical terms to see things from a different perspective." Not BPD but my experience with CBT and anxiety was that I could see my response was illogical but I didn't believe myself it at the same time. So when the therapist asked about this assumption I had that influenced my thinking he was able to show me it was illogical, I was able to say 'I know in my head', but at the same time - I don't believe you in my gut. His solution to this was exposure. If you are put in the situation and you personal assumption is proven to be untrue or it's is sufficiently challenged enough times then you can start to believe it's illogical.
- deleted 10y ago
  [deleted]
orblivion 10y ago
My experience is with OCD, but the way I see things, if you feel anxiety about something, and you've concluded that it's irrational, and you then decide to just ignore the feeling as useless information, eventually it sort of just fades away.
thrwy1287 10y ago
> However, I am not sure that this is truly the order of things, at least for me. I observed that, even when I studiously avoided negative thoughts like this, the underlying emotions were still often present. Being confronted with a social situation produced a physiological response that included anxiety. I might consciously rationalise that response with a thought like "this is a social situation, and social situations make me nervous", but the underlying response existed regardless. This was an issue for me and I asked about it. Will I ever be able to experience the situation without having to use CBT to deal with it. The response was you need to practice. Using CBT makes it easier for you to confront the situation and makes you less likely to excuse yourself from it. And over time the situation will become more normalised and those emotions will go away. Personally I have found that to be true. If I ensure I regularly engage socially the emotions are rarely bad. If I fall out of practice for a month or two it is a struggle at the beginning again but eventually with enough practice I'm fine again. So the CBT isn't a cure but a tool to help you engage in the situation instead of avoiding it and then over time the emotionally response improves. Just like if you start a new challenging job you might be nervous you don't know enough but you learn and slowly it becomes easier until you reach a point where you have no 'negative' emotions going to work everyday.
tim333 10y ago
>you have a established negative thought, such as "social situations make me nervous", which becomes a self-fulfilling prophecy My understanding of how CBT works is not like that. If you think about the mechanics work, to know it's a social situation you get sensory input which turns to nerve impulses which go into your neural network which figures it's a social situation which then activates many neural pattern recognition circuits in parallel - for it being scary based on instinct or past experiences or imagination. That all happens unconsciously - you're probably setting off thousands of pattern recognisers and the conscious bit of your brain is only fast enough to really be aware of one or two at a time. CBT works by rewiring that at your leisure so you can rubbish the unfortunate pattern recognisers maybe relating to some bad experience and enhancing positive ones by say recalling when things went well in reality (or imagination). But if it works you should just feel better in social situations without active thinking required at the time.

empath75 10y ago

Right, but isn't it about coping with that response, not eliminating it? That was the impression I had of what it is. The goal isn't to eliminate sadness or anxiety, but to limit the negative impact it has on your life. So you don't get into these cycles were depression prevents you from moving forward, which makes you more depressed and so on. That's why it supposedly works so well with people with bpd, right? Because bpd is all about fear of people leaving you, while you behave in ways that absolutely ensure that people will.

morbidhawk 10y ago
My wife has BPD. CBT never worked for her (and it never worked for me either), her therapist switched from CBT to DBT & EMDR instead and it has better results. The problem with CBT is that it tries re-frame situations using a logical explanation to people who don't know how to talk in logical terms to see things from a different perspective. The problem is that people with BPD don't express things in logical terms, so it is easy to mis-diagnose or misrepresent and cause an invalidating statement. Borderlines are great at reading between the lines and trying to understand things in an emotional way. They can easily misinterpret your re-framing to be invalidation. So instead, DBT and a question-based approach that helps them to think through the problem themselves is so much better. My CBT therapist told me to tell my wife "that being out of town for her birthday wasn't abandonment", yeah right that'd go over like hell. BPD requires deeper introspection and CBT therapy will usually cause the client to feel invalidated
- thrwy1287 10y ago
  >> "The problem with CBT is that it tries re-frame situations using a logical explanation to people who don't know how to talk in logical terms to see things from a different perspective." Not BPD but my experience with CBT and anxiety was that I could see my response was illogical but I didn't believe myself it at the same time. So when the therapist asked about this assumption I had that influenced my thinking he was able to show me it was illogical, I was able to say 'I know in my head', but at the same time - I don't believe you in my gut. His solution to this was exposure. If you are put in the situation and you personal assumption is proven to be untrue or it's is sufficiently challenged enough times then you can start to believe it's illogical.
deleted 10y ago
[deleted]

orblivion 10y ago

My experience is with OCD, but the way I see things, if you feel anxiety about something, and you've concluded that it's irrational, and you then decide to just ignore the feeling as useless information, eventually it sort of just fades away.

thrwy1287 10y ago

> However, I am not sure that this is truly the order of things, at least for me. I observed that, even when I studiously avoided negative thoughts like this, the underlying emotions were still often present. Being confronted with a social situation produced a physiological response that included anxiety. I might consciously rationalise that response with a thought like "this is a social situation, and social situations make me nervous", but the underlying response existed regardless. This was an issue for me and I asked about it. Will I ever be able to experience the situation without having to use CBT to deal with it. The response was you need to practice. Using CBT makes it easier for you to confront the situation and makes you less likely to excuse yourself from it. And over time the situation will become more normalised and those emotions will go away. Personally I have found that to be true. If I ensure I regularly engage socially the emotions are rarely bad. If I fall out of practice for a month or two it is a struggle at the beginning again but eventually with enough practice I'm fine again. So the CBT isn't a cure but a tool to help you engage in the situation instead of avoiding it and then over time the emotionally response improves. Just like if you start a new challenging job you might be nervous you don't know enough but you learn and slowly it becomes easier until you reach a point where you have no 'negative' emotions going to work everyday.

tim333 10y ago

>you have a established negative thought, such as "social situations make me nervous", which becomes a self-fulfilling prophecy My understanding of how CBT works is not like that. If you think about the mechanics work, to know it's a social situation you get sensory input which turns to nerve impulses which go into your neural network which figures it's a social situation which then activates many neural pattern recognition circuits in parallel - for it being scary based on instinct or past experiences or imagination. That all happens unconsciously - you're probably setting off thousands of pattern recognisers and the conscious bit of your brain is only fast enough to really be aware of one or two at a time. CBT works by rewiring that at your leisure so you can rubbish the unfortunate pattern recognisers maybe relating to some bad experience and enhancing positive ones by say recalling when things went well in reality (or imagination). But if it works you should just feel better in social situations without active thinking required at the time.