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Deeper issues... ocdforyears

Posted by mattdds on January 11, 2004, at 9:32:34

In reply to Re: brain scans of CBT patients vs. med patients, posted by ocdforyears on January 9, 2004, at 10:39:04

Hello,

I've been following your posts, and they seem to have a common theme, expressed in your statement below.

You wrote,

>>The deeper issues, unresolved emotional trauma, may still lie below the detection level of any brain scan. Cbt or meds may manage that, but it's possible it takes deeper work to heal it and really feel cured, though I have heard good things about cbt and meds. Now I am sounding like an analyst.

I just have a few questions about that statement. First, do you know of any evidence that trauma from childhood must be accessed, and analyzed in order for a patient to fully recover symptomatically? I personally, have looked, but believe there is no evidence to support this.

Neurologically, once trauma is imprinted in memory, it is not really possible to erase it. I remember reading recently in Scientific American how once the amygdala is imprinted with a traumatic memory, it is there to stay. Evolutionarily, this would have been helpful, but it is not in this modern era.

Neuroscientists nowadays believe that the memory will remain intact, but it is possible, through cortical (higher brain) mechanisms, to inhibit the knee-jerk amygdala response.

To me, this is why I feel it is counterproductive and somewhat cruel to go digging up old childhood memories and somehow trying to change them. They are scars that we all must live with. Psychoanalysts make their living this way, by telling the patient that they just need more time to work through the trauma. In fact, they may be strengthening traumatic neural pathways by constantly dredging up old memories.

Don't get me wrong, I do believe childhood experiences can lead us to have certain attitudes and thoughts. But these manifest as thought and behavior patterns, which lend themselves amenable to change. This is the aim of CBT and similar approaches.

So why not just try to identify these patterns and tread new neural pathways that are healthier and more adaptive, rather than living in the past? Again, this is what CBT does. It's like when someone has a myocardial infarction - that heart tissue is dead! But with exercise, the heart compensates by angiogenesis - sprouting vascular branches that circumvent the problem. I liken psychoanalysis to a futile attempt to save that necrotic heart tissue. CBT and other similar approaches recognize irreparable damage, but try to regain functionality by circumventing the memory. If you can't go through it, go around it.

I think you may have some misconceptions about CBT. It is not just about changing your thinking. It is using your current thinking to recognize larger behavioral patterns. In this aspect it is "deep", where you have characterized it as shallow or superficial.

Finally, you seemed to imply that CBT and meds were inferior because they are not resolving the "deeper issues". Have you studied chemistry? If so you may be familiar with what is called a state function. This basically means, that it doesn't matter how you get to an end product as long as you get there. Similarly, If symptoms are relieved, and one is functioning in life properly, who cares about "deeper issues"? Either way, CBT and meds have some pretty convincing evidence they *do* work. Who cares how that process happens?

This is not to say CBT does not deal with "deeper issues". Like I mentioned earlier, time in therapy is not spent ruminating about trauma, further strengthening the memory in one's mind - it is dealt with on another level. Using ones active thinking, one can come to recognize larger emergent patterns that can be defined and attacked. Again, where is the evidence that rehashing old traumatic events does any good?

I hope you don't mind me challenging your ideas, I tried to do it with tact, and I certainly could be wrong. But in my mind, this makes much more sense.

Best,

Matt


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poster:mattdds thread:297458
URL: http://www.dr-bob.org/babble/psycho/20040110/msgs/299342.html