Posted by Elizabeth on February 1, 2002, at 17:53:45
In reply to Re: David Burns » Elizabeth « sid, posted by Dr. Bob on January 27, 2002, at 3:05:58
I said:
> > > Personally I've never heard of *anyone* with serious depression who was cured by CBT.I'm sorry if you felt excluded by this remark, Sid. I should have elaborated rather than just sticking it out there as a generalization for the reader to interpret.
I've certainly heard of people with serious depression who were *helped* by CBT. I've met people who say they were very depressed and got better on a combination of medication and CBT. Some have said that CBT was an essential part of their recovery. A few even say they got better with CBT and without medication.
What I haven't heard of is anyone with serious depression being successfully *cured* with CBT. By "cured" I mean that the CBT eliminated the depression and there was no further need for talk therapy or for any other kind of treatment: the patient was able to stop the therapy without becoming depressed again. A cure is permanent: for example, we have *treatments* for AIDS, but at present there is no *cure*. Similarly, I don't believe that any of the present approaches to serious depression is a cure.
I don't know much about your case, or how "serious" your depression is, but my impression is that you've improved a great deal but are not fully recovered, and that CBT wasn't the only treatment that you received. I'd be interested to hear the details of how you got to where you are now. You did say that your doctor now thinks that you have an anxiety disorder and not depression. I think the distinction between depression and anxiety is a fuzzy one in many, or even most, cases; they often go together and probably have common or related etiologies. In any case, CBT is supposed to help with both.
I believe that all depression is serious in a sense, but obviously, there's mild depression and there's severe depression, and the latter was what I was referring to (I should have said "severe" instead). The scenario I was imagining was a patient with a "long term" depressive illness (i.e., one that was either chronic or recurrent and had been present long enough that the chances of spontaneous recovery were very slim) who starts seeing a cognitive-behavioral therapist and gets well (never becoming depressed again) from that therapy alone. That didn't seem too realistic to me.
I'm sorry if it sounded like I was saying that therapy is worthless, because I certainly don't think that (I know I've said this on a number of occasions). When I was living in Boston, I saw a psychotherapist (psychodynamic, not cognitive-behavioral) on a weekly basis for four or five years, and if I go back there I will definitely start seeing him again if he's accepting new patients.
But I do think that therapy has its limits -- just like medication, it's not a panacea.
I have plenty of experience with talk therapy, incuding CBT, so I'm not just talking out of my ass here. You seemed to think that I had never tried CBT when you accused me of some sort of distorted thinking, and I wanted to clear that up. I have tried CBT twice, with two different therapists. Although I liked both therapists and felt they were good at their job, I eventually concluded that CBT wasn't for me. Like many people, I really wasn't able to get much out of CBT when I was acutely depressed (even if I could do the exercises, I was only "going through the motions"); when I wasn't depressed (due to medication or to partial remission -- my depression is more or less episodic) but had residual symptoms, the therapy wasn't useful because CBT doesn't address the type of problems that I have. (The second cognitive-behavioral therapist I saw agreed, and I decided to quit after discussing it with him. The first one mostly saw me only when I was depressed.)
I also found CBT a little bit intellectually stifling; it didn't seem to encourage individual expression or original thought. It had a "one-size-fits-all" quality to it. (In the group, I often felt like I was in a remedial coping skills class. :-) )
I found the insight-oriented therapy with my therapist in Boston more appealing. There weren't any assumptions about what my problems were; instead, the therapy was an attempt to identify and understand (on a "psychological" level) those problems and how they affected me. Although this therapy didn't relieve my depression either, I think the self-understanding I gained has been useful in my attempts to treat and manage my depression. I've also been in interpersonal therapy groups which I think were useful in some respects.
There are a lot of different kinds of depression, probably with a lot of different kinds of causes: bad life circumstances or events, distorted thinking, mysterious neurological glitches, etc. We don't have a way to determine the exact cause in any particular case, but it's good to recognize that not every treatment will be right for every person, in part because of varying symptoms, but also because of varying etiologies. (BTW, I think that what cognitive-behavioral psychologists like to call "cognitive distortions" are more often a result of depression than a cause of it.)
Anyway, I hope this clears things up. I really do agree with you about a lot of things; I'm just presenting my point of view.
-elizabeth
poster:Elizabeth
thread:17202
URL: http://www.dr-bob.org/babble/social/20020125/msgs/17689.html