Posted by Elizabeth on February 2, 2002, at 21:12:01
In reply to Re: assumptions « elizabeth, posted by sid on January 31, 2002, at 0:21:58
> > > But CBT is *not* a cure for any disease. Just about everybody has some bad attitudes or habits that they could stand to unlearn. I think that most of us understand that that's not the same as a mood or anxiety disorder.
>
> Right, but depression distorts our thoughts and possibly our behavior too, as a consequence of distorted thoughts. So CBT can help realize that and actively work on changing those. I think that's what happened in my case. I was sooo incredibly irrationally negative. CBT did help with that.That's cool. Unfortunately, a lot of people in the acute phase of depression are too impaired to benefit from CBT. I think it might help more in the residual phase, although I didn't find it relevant. I think I've told you about my residual symptoms of anergia and anhedonia -- not really amenable to CBT. In general, depression, for me, seems to be more about core feelings than about beliefs.
re blame-the-patient attitudes:
> Well, I've seen it mentioned on PB and PSB many times. I personally did not feel guilty. I just wanted to get better and worked at it every way I felt comfortable with, one being CBT.I think that people are often made to feel that if talk therapy simply doesn't work for them, it's their fault. This is, no doubt, amplified by depressive tendencies to feel guilty about everything.
> When I get stressed, I have a tendency to have negative thoughts. I catch them immediately and move on to better things. Had I not learned about CBT, I would be in danger or sliding towards another major episode every time my stress level is high.
So stress can lead to depression for you? I've found that depression (including residual symptoms), if already present, makes it harder to cope with stress, but when I'm not depressed I'm generally pretty good at coping.
> I don't think there should be any guilt. Guilt is one of the symptoms of depression, that may be why so many people seem to be feeling it in relation to therapy.
Sure, but I think the attitude that some therapists and others express contributes to these guilty feelings. When someone's doing their best, they shouldn't be made to feel that it's their fault that the therapy isn't helping, which it often doesn't.
I've heard people being told, in relation to therapy, things like "You need to work harder," "You don't really want to get better," "You can't expect the medication to do everything for you," etc. For that matter, you interpreted my remarks (in a moment of anger -- no hard feelings, I'm just using it as an example) as "selective memory serving your personal beliefs" and suggested that I needed CBT to correct this. The implication is that CBT is for people who are irrational or have other intellectual or personal flaws. (Irrational beliefs that are due to depression or depressive temperament are different from a general inability to think rationally.) A depressed person, or a person with a depressive temperament, isn't necessarily a stupid or bad person, but such a person is more vulnerable to being encouraged to believe that he is stupid or bad.
> I had lots of guilt, about other stuff.
Me too. I pretty much felt guilty for existing. I felt I was worthless and that my life was a mistake, and I could come up with a million reasons. Of course, all the reasons in the world don't change the fact that I have family and friends who care about me (regardless of my "objective" worth -- a major guilt focus was my inability to work) and would be devastated if something happened to me. I knew that, intellectually. It didn't change how I felt.
> I seemed to imply that because that's the impression I sometimes have from reading different posts. My impression may be wrong.
I think it's worthwhile to give people the benefit of the doubt.
> On thing I did notice is that people insist on the diabetes-insulin example to explain, rationalize, justify (to themselves and their loved ones) taking meds for depression.
I think they feel the need to justify it because they so often feel attacked by people who accuse them of laziness or wantint a "free lunch" (to use your words) -- I don't get the impression that they need to "rationalize" it to themselves. I'm not convinced the analogy is all that great; it's just the standard one (a lot of doctors use it). It obviously refers to type I diabetes, since type II diabetics don't necessarily need insulin. AFAIK, exercise isn't really a form of treatment for type I diabetes; the important thing is to keep your diet *regular* (as opposed to dieting to lose weight) and to be especially careful to monitor glucose levels and adjust insulin dose accordingly. There's a lot of effort that needs to be put into *monitoring* diabetes: you need to check glucose levels constantly, and there are all kinds of things that can alter the need for insulin which you need to be aware of. I don't think there's anything comparable in depression.
> I am still making efforts (side effect: it's 1AM and I can't sleep, so I am writing instead; have to be at the office at 8AM tomorrow), but spending less time on it. I work a lot more now and I don't think about the depression so much.
Working can be good for the recovering depressive, I think.
> I write and read about it here, but my day otherwise is depresion-free. Stressful, but depression-free. Cross my fingers.
I've got mine crossed for you.
> I have not read many studies overall since I do research in another field for a living (that's enough reading studies and writing them for me), but that's what my experience has been so far.
Going with what works for you is important, more important for your own life than the results of clinical trials or FDA labeling or whatever. (But try explaining that to some of these doctors here in NC who want to force me to stop taking buprenorphine even though it's been working for me for over a year. Jeez.)
-elizabeth
poster:Elizabeth
thread:17202
URL: http://www.dr-bob.org/babble/social/20020202/msgs/17753.html