![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 36 to 60 of 91. Go back in thread:
Posted by Dr. Bob on June 2, 2003, at 20:36:22
In reply to Re: responsibility and blame » Squiggles, posted by mattdds on June 2, 2003, at 20:21:21
> > i do not want the
> > yuppy lifestyle, which i think CBT is part of.
>
> This ... on closer examination is just word salad! ... All you've done is create a worthless ad-hominem argument. And you seem to be reduced to labeling people!Different points of view are fine, but please don't post anything that could lead others to feel accused or put down, thanks.
> I feel like this discussion could be really productive... Let's try to stay reasonable, and lay off the labeling.
Exactly! :-)
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration.
Posted by Squiggles on June 2, 2003, at 20:47:28
In reply to Re: responsibility and blame » Squiggles, posted by mattdds on June 2, 2003, at 20:21:21
I mean that the therapy style which is
in vogue now, and suggests an appeal
to the rational (hence cognitive) part
of man, is part of an image of modern man.
The image of man who, through his cogitative
abilities is able to work out his emotional
problems. The image of man who, through
assisted analysis of his habits and the
process through which he has acquired them,
will be able to change himself through his
own bootstraps.It's rehashed Freud, and badly cooked at
that -- as Freud understood that emotional
problems, when not part of psychosis or
biological disorders, were problems of the
irrational part of man. The irrational part
of man, meaning his needs, his drives, his
fears, do not respond to reason. They respond
to compassion, love, and sympathy.Cognitive behaviour therapy is good for
those who do not need therapy at all, but
simply a good shoulder to cry on or a good
friend to speak to. This is an old fashioned
view. It is not a yuppy view, as defined by
say GQ magazine or shrill empowerment-hungry
radio announcers.As for a syllogism, well i did not think of
it that way, but if i were to put my point
in premises and conclusion, it might look like
this:A. CBT is a yuppie philosophy in psychological treatment.
B. Squiggles does not like the yuppie philosophy.
- Therefore, Squiggles does not like CBT.or
If CBT is a yuppie trend and Squiggles
does not like yuppie trends, then Squiggles
does not like CBT."YUPPIE" is an acronym for "young urban professional"
and perhaps if you are in Britain it is not a common
phrase there. It is basically what happened to
hippies when they became capitalistic and also
were referred to as the ME-generation in the 80s
when ambition, self-determination and economic
control became fashionable again.Sorry, about the labeling; i hope i did not
cause offense. I am speaking for myself and
generally. I suppose what i want to stress
is that in mental illnesses, compassion and
kindness are far more important than talk
therapy; and this is particularly important
when the psychological problem deals with
affective disorders. I suppose i agree with
Hume (the Scottish philosopher), "reason is
the slave of the passions".Squiggles
Posted by Squiggles on June 2, 2003, at 20:51:42
In reply to Re: please be civil » mattdds, posted by Dr. Bob on June 2, 2003, at 20:36:22
I'm not sure whom you are reprimanding
here Dr. Bob, me or Mattdds; but judging
by the past posts, i think you mean me-- *again*,
LOL.OK - i really am not aware of causing offense
at all - infact i thought i was receiving it.But i will try to change my ways - maybe this
is a lesson in cognitive behaviour therapy.Squiggles
Posted by mattdds on June 2, 2003, at 21:56:02
In reply to Re: responsibility and blame » mattdds, posted by Squiggles on June 2, 2003, at 20:47:28
First off, I didn't intend to make you feel put down. Getting my first PBC from Dr. Bob was kind of a downer, I really do try to behave. I just get a bit emotional about this stuff.
>>I mean that the therapy style which is
in vogue now, and suggests an appeal
to the rational (hence cognitive) part
of man, is part of an image of modern man.
The image of man who, through his cogitative
abilities is able to work out his emotional
problems. The image of man who, through
assisted analysis of his habits and the
process through which he has acquired them,
will be able to change himself through his
own bootstrapsSo the main problem is that it is in style? It doesn't seem very popular to me. I feel nerdy and cheesey talking about it to anyone but my wife. Even here, a mental health support board, I get the feeling that everyone thinks it's hokey and that pharmaceuticals are much sexier.
>It's rehashed Freud, and badly cooked at
thatCBT is the antithesis of Freud. Have you read anything at all by Aaron Beck, who is kind of CBT's grand-daddy? Practically the first 10 years of his career were spent debunking the whole Frued thing.
>>Cognitive behaviour therapy is good for
those who do not need therapy at all, but
simply a good shoulder to cry on or a good
friend to speak to. This is an old fashioned
view. It is not a yuppy view, as defined by
say GQ magazine or shrill empowerment-hungry
radio announcers.I cried on my mothers shoulders for two weeks straight when I was in my second year of dental school. All the psychiatrists at my school had thrown their hands up in the air, wondering what to do. I cried on the shoulder of my wife all year, literally.
It was only after the therapy that I began to improve, and my therapist was anything but a "shoulder to cry on"; he was caring, yet stern and insisted that I should continue on fighting.
>>It is not a yuppy view, as defined by
say GQ magazine or shrill empowerment-hungry
radio announcers.Wait, is this a typo? I thought you just said it *was* a "yuppy" movement.
>>"YUPPIE" is an acronym for "young urban professional"
and perhaps if you are in Britain it is not a common
phrase there.I am aware of what the acronym (and label) stands for, as well as the history behind it. But I was asking more about the connotation, which seemed overtly negative to you. For instance, I am young (just over 25), live in New York City (urban), and will shortly be considered a professional when I graduate from dental school. So by your definition, I am a yuppie. But are these three criteria the ones that make yuppie-ism so terribly bad? I don't ever read GQ magazine and I dress like a slob! And I don't really listen to the "shrill empowerment-hungry radio announcers", whoever they are. So am I a yuppie? Why are you so put off by people that fit these three criteria?
>>I suppose i agree with Hume (the Scottish philosopher), "reason is the slave of the passions".
So do I. But I don't think this issue is totally black-or-white, (almost) nothing is. At times I feel my reasoning is largely driven by emotion. Other times I feel the opposite. This is not out of tune with CBT. CBT is not "thought control", it is just heightened awareness of thinking. CBT actually discourages suppression of thoughts, or attempts at thought control. You are encouraged to be a passive observer of thoughts. Thought intrusions are almost completely emotion dependent, without a doubt. But where we go with these intrusions is what CBT emphasizes. Do we continue to ride the negative pattern out? Or do we choose a way of looking at things that is either more accurate or beneficial?
Lastly, I am absolutely 100% certain that I will not persuade you to my way of thinking. A part of me wants to, my competetive side (the one that got the best of me when I got the PBC from Dr. Bob). But deep down, I know the futility of arguing with someone; it only strengthens their preconceived notions (even mine were strengthened, and I am totally aware I have them too).
See, I wanted this to be a positive discussion, one that would enlighten all of us. I much would have preferred a discussion about *doing* CBT, and the actual dynamics of it. Instead I / we set it up to be a combative, one-upmanship about our opinion on CBT.
Is anyone interested in actually talking about the dynamics of it or techniques, or research, or how it is supposed to work? This is what I wanted. And hope that we can get there.
Out of breath,
Matt
Posted by zenhussy on June 3, 2003, at 0:21:35
In reply to Re: responsibility and blame » Squiggles, posted by mattdds on June 2, 2003, at 21:56:02
>>>....Getting my first PBC from Dr. Bob was kind of a downer, I really do try to behave....
>>>Even here, a mental health support board, I get the feeling that everyone thinks it's hokey and that pharmaceuticals are much sexier.
Matt,
First, please don't be bummed by the PBC. You and Squiggles appear to be having a very civil discussion and no one is trying to lob lables and judgements out there. I think you are doing a fine job of expressing yourself and thank you for doing so so clearly.
Second, I do NOT think CBT is hokey nor do I think pharmaceuticals are sexy. I did however get a huge laugh from that sentence. I hope you can get a smile as well from the enjoyment it brought me.
Just chiming in to say CBT is a valuable tool in many cases and my experience with pharm. drugs has not been sexy in the slightest. I mean not in the tiniest iota!
I don't have enough cognition left today to add anything of substance here but wanted to give you smile hopefully.
Take care and keep discussing. Thank you.
zenhussy
Posted by mattdds on June 3, 2003, at 0:55:53
In reply to sexy pharmaceuticals vs hokey cbt » mattdds, posted by zenhussy on June 3, 2003, at 0:21:35
Zenhussy,
Thanks, you have no idea how much that means.
Best,
Matt
Posted by zenhussy on June 3, 2003, at 0:59:30
In reply to Re: sexy pharmaceuticals vs hokey cbt » zenhussy, posted by mattdds on June 3, 2003, at 0:55:53
> Zenhussy,
>
> Thanks, you have no idea how much that means.
>
> Best,
>
> MattGlad to have helped. I just muffed up post on other board indicating to me I need to eat a bit and hit the hay. I am not typing clearly nor thinking (that stopped hours back! ha ha) well so I'll try to gracefully bow out.
zenhussy (tripping over chair as she gets up from pc desk falling across cord under chair, etc.)
Good night Matt = )
Posted by Squiggles on June 3, 2003, at 6:44:19
In reply to Re: responsibility and blame » Squiggles, posted by mattdds on June 2, 2003, at 21:56:02
Hi mattdds,
I think you are absolutely right --- a discussion
about the dynamics of CBT would be more to the
point.My scepticism about its power is based on
an assumption about how we think, not on
experience. So, you should take my argument
with a grain of salt.Also, i did not realize you were only 25 yrs.
old, and that may put things in perspective
a bit - as i am twice your age and very
conservative in my views about psychiatry.Sorry, to be so uptight.
Squiggles
Posted by Larry Hoover on June 3, 2003, at 7:50:06
In reply to Re: responsibility and blame » mattdds, posted by Squiggles on June 3, 2003, at 6:44:19
> Hi mattdds,
>
> I think you are absolutely right --- a discussion
> about the dynamics of CBT would be more to the
> point.
>
> My scepticism about its power is based on
> an assumption about how we think, not on
> experience.More than one assumption, I think.
> So, you should take my argument
> with a grain of salt.Already had to. That's not a put-down. Let me explain.
At times, your thinking seems almost visible, following a predictable course. Thinking patterns are habits.
When you start listing the reasons why a certain conclusion seems valid to you, it is as if you are trying to convince yourself, not us, that your initial reaction is a valid and rational response. Moreover, such a tactic is distractionary, more likely to divert attention to the minutiae of individual propositions, rather than the original point in discussion.
Because thinking patterns are habits, the more ingrained the habits are, the more difficult it becomes to change them. Your conclusion that some people are unable to do this work is not supported by the evidence; it is supported by certain types of habitual thinking. An example, you provided right here:
> Also, i did not realize you were only 25 yrs.
> old, and that may put things in perspective
> a bit - as i am twice your age and very
> conservative in my views about psychiatry.Although rigid might be more precise, I read into this a version of, "You can't teach an old dog new tricks."
> Sorry, to be so uptight.
>
> SquigglesThe quintessential requirement for CBT therapy is a desire to change. If you're happy where you find yourself, or if fear of change exceeds your willingness to change, then you will remain where you are. If the pain of staying the same exceeds the fear of change, then you'll do something proactive.
You said something quite different, yesterday. "Cognitive behaviour therapy is good for those who do not need therapy at all, but simply a good shoulder to cry on or a good friend to speak to." CBT is good for people who are willing to face themselves. And, you also said, "my problems are not mine, but other people's." If you think you'd be happier without problems, or more specifically "other people's problems", you've failed to recognize that you're the one who's not happy. If you can't disempower other people's problems in your cognition, then you're the one with the problem.
These are the dynamics of CBT, as you requested. It really is a dynamic process. You have to act your way through every part. It isn't some dry "couch visit" with an academic. You leave each session with a set of challenging new behaviours to try out (and those behaviours include new cognitions, because thinking is a behaviour).
Methinks you're dismissing something that you would find helpful. Recall from last week my comments vis a vis your parents and their take on your mental illness....you felt relieved by those new thoughts that I offered up. That's CBT in a nutshell.
Lar
Posted by Squiggles on June 3, 2003, at 8:05:55
In reply to Re: responsibility and blame » Squiggles, posted by Larry Hoover on June 3, 2003, at 7:50:06
Well, you write very well, that's for sure.
As i said in my earlier post, i don't want
to continue a critique of the value of
CBT and its merits.For what it's worth, i will say that i appreciate
having the net to exchange ideas. And regarding
my personal problems, i am certain that the
things which are in your power you may be able
to change, but the things which are in other
people's power, you cannot -- only your attitude
to them.Social psychiatry, which is what CBT seems to
fall in, is a lot more like politics than
medical treatment.Squiggles
Posted by Dr. Bob on June 3, 2003, at 22:11:03
In reply to Re: responsibility and blame » mattdds, posted by Squiggles on June 2, 2003, at 20:47:28
> Cognitive behaviour therapy is good for
> those who do not need therapy at all, but
> simply a good shoulder to cry on or a good
> friend to speak to.Please don't post anything that could lead others to feel put down, thanks.
Bob
Posted by Squiggles on June 4, 2003, at 9:50:26
In reply to Re: please be civil » Squiggles, posted by Dr. Bob on June 3, 2003, at 22:11:03
Sorry Dr. Bob,
Being on your site is going to be
a lesson in diplomatic skills.Thank you for holding up a mirror.
Squiggles
Posted by Dr. Bob on June 4, 2003, at 18:52:04
In reply to Re: please be civil » Dr. Bob, posted by Squiggles on June 4, 2003, at 9:50:26
Posted by Dinah on June 7, 2003, at 11:39:22
In reply to Re: responsibility and blame » Dinah, posted by Larry Hoover on June 2, 2003, at 12:48:05
And if I'm responsible for making myself better, aren't I to blame if I don't?
I still don't understand. Can you use baby words?
Posted by Dinah on June 7, 2003, at 11:51:43
In reply to Re: But if I do bad things, aren't I bad?, posted by Dinah on June 7, 2003, at 11:39:22
I have a fear of vomit.
This week we went to the beach, which I associate with Spring Break. Ok, I know it probably isn't accurate to assume that every inch of the hotel, hotel room, and beach was covered with vomit, but you get the idea. Plus people throw up off the side of boats into the ocean.
Ok, I know that spring break was a while ago. And the hotel has been cleaned. I know that the ocean is a big place and fish probably eat the vomit anyway.
I did the right things. I played in the surf with my son, I made sand castles. I slept in the hotel room. My clothes fell on the hotel room floor and I wore them anyway. I let my son walk in his socks aroung the hotel and then get in his bed. I acted ok. I reminded myself of all of those things that I knew that made my fear of vomit unreasonable.
But there wasn't one second there that I wasn't aware that the entire place was contaminated by vomit. As the sand and water got *everywhere* there wasn't one minute I didn't feel contaminated. If you were to ask me if I had a good time, I would say yes, it was terrific. But at some more visceral part of myself I would acknowledge no, I didn't. I could barely sleep and the whole vacation is just surrounded in a miasma of vomit for me. I hated that vacation. I hate going to the beach.
I've been dealing with this fear for close to thirty years. I've exposed myself to this degree many many times. I can hold the bowl when my son is sick without running away screaming. I can do my breathing to keep from panicking.
Can CBT offer me anything else in this area?
Posted by mattdds on June 7, 2003, at 13:19:21
In reply to Re: But if I do bad things, aren't I bad?, posted by Dinah on June 7, 2003, at 11:39:22
Hi Dinah,
You are asking two questions.
1) If I do bad things am I bad?
2) If I am responsible for making myself better, then, am I to blame if I don't improve?1) This is a belief that involves an error in thinking called "all or nothing thinking", "should statements" and "labeling".
First of all, I don't even know what "being bad" even means. It seems to make sense, but really does not hold up under closer scrutiny. We could try to propose definitions for "bad", but these would be very arbitrary. Let's say that being bad means you have committed 500 "bad acts". That definition would include the whole entire human population, so at least you'd be in good company. We could lower the standards, but any number of "bad acts" that we set as the mark for all of a sudden becoming "bad" would be arbitrary and senseless, right?
We all do bad things, some do more, some do less. Where do we make the cutoff line as to who's bad and good? It is learning to think in shades of gray, rather than black or white, or good or bad. Even the definition of "bad *things*" is very arbitrary, which compounds the problem even more.
So why bother with the label of "good" or "bad"? We learned to think this way when we were younger, because it served a heuristic function back then (strangers = bad, mommy = good). Now that we are older, if we think about it, these words really do not make much sense as labels to highly complex things like human beings.
Labels like "bad" do nothing to solve problems. They merely place a vague label on something that disctracts from what is really going on. This robs us of opportunities for growth, because we are not defining the problem in *specific* terms. After all, how can we solve problems if we do not define them? Let's say for the sake of argument that you yelled at someone while angry (bad behavior). What is the advantage of calling yourself "bad" over defining exactly what the problem is (you yelled at someone when you were angry), and coming up with a highly specific problem for dealing with it? You see, life is nothing more than a series of discreet, definable little problems. If we deal with each of these individually and rationally, this would make a whole lot more sense, and we would grow much more.
2) I think you have a different idea of what responsibility means that I do. I defined it earlier for you, but perhaps you missed the post. However, embedded in your question about responsibility and getting better is a hidden "should statement", "I should get better"
But why *should* you get better? And what do you mean by this? Should can mean a couple of things. It can imply that something is morally unacceptable. It can also mean that something will probably happen (e.g. or the sun should rise tomorrow).
Getting better is not a moral issue, as being mentally ill is not against the code of any religion (that I'm aware of). Thou shalt be happy at all times? Never heard that one ;).
Another way of writing your statement is "I shouldn't be feeling bad". Shouldn't in the *non*-moral sense means "probably will not" But the fact is that you are feeling bad. So this doesn't really make sense either.
So now that it reality that you are indeed feeling bad, and we've decided that it is useless to compound the problem by beating yourself up about it, there is a question: what can I do to make myself feel better? This is responsibility, in my opinion.
*Responsibility* - a sense of awareness of the things that one can do for one's own improvement. It also includes an awareness that some things are outside your control. These things are accepted and dealt with. The focus of responsibility is what you *can* do; that is where you are directing your attention. Responsibility in the therapeutic sense has no moral implication, it is not like being "responsible" for murder. This is a different meaning of the word.
*Blame/Fault* - selective and arbitrary negative attention to one's own role in a complex problem that contains many variables. Blaming does not take into consideration the other variables that were involved in the problem.
Another reason: if you don't take responsibility for doing all you can to improve, then who will?
I seem to need to stress that this is *not* a moral issue. If you do not get better, then it is OK! It is not your "fault". Faulting yourself is just compounding the first problem (feeling bad) with a second problem (beating yourself up about it). Taking responsibility is just doing all you can do and accepting the rest
This may be hard to grasp, it took me a while. But once it did, and I saw that these terms really did not make any sense, I slowly stopped feeling "bad", and began to see things in more discreet, definible ways. People being "good" and "bad" seems a bit nonsensical to me now.
From a religious standpoint (You are Christian, right? I think I remember some of your posts on the faith-babble), Jesus said to separate the sin from the sinner. I think he was saying essentially the same thing here. People may do bad things, but there is no such thing as a bad person.
Does this help at all? I hope so.
Best,
Matt
Posted by mattdds on June 7, 2003, at 13:57:47
In reply to Re: Another CBT question. Very specific., posted by Dinah on June 7, 2003, at 11:51:43
Hi again Dinah,
Sounds more like an obsession than a fear, am I correct? This all sounds like a classical, but partially controlled, form of OCD. I'm just using the term "OCD" here for heuristic purposes here, because CBT treatment differs for OCD. Do you have OCD as a diagnosis? Just curious.
I know there are CBT treatments that are very effective for OCD, but I'm afraid I don't know much about them. I think they've shown in a number of studies that CBT was just as effective as high-dose SSRI's for OCD, with better long-term recovery.
But I digress.
It appears you have done some CBT of your own. It's called "response prevention". In other words, you didn't continuously mop the floors, or wash your son's feet, every time you had an intrusive thought about vomit. So it appears you are halfway there. You have straightened out your behaviors, but not the cognitions. You said you enjoyed your vacation, at least on some level. But on another, you did not. You even made sand castles in that quagmire of vomit ;). In all seriousness, you are quite the stoic for behaving normally despite all those (gross) intrusions of thought. You have done an excellent job here.
Your question was: can CBT do more? I think it could. But first off, you must do a cost-benefit analysis. How much is it worth it to you to straighten out this little quirk? Is it significantly affecting your quality of life? Do you have obsessive intrusion about other things, or just vomit?
I ask this because I can relate. I have a fear of peeing in public. In the men's bathroom, we have urinals, and if there is someone next to me, I literally CANNOT urinate. I don't feel the need to go through all the behavior therapy for this (and such therapy does exist) because I can just go in the stall and pee freely! So there is no treatment indicated. I just accept that as one of my many quirks. I used to be very self-conscious about this. But now I am not. Now, I actually even tell my guy friends that "I have stage fright", and go in the stall. They just laugh. If they think I'm weird or whatever, I think that's their problem, not mine.
I don't know if this is relevant, but hopefully it's a bit humorous ;)
Is your obsession with vomit significantly affecting your life? I love going to the beach, and can empathize with you. It would be a bummer to be at the beach on an otherwise nice vacation, and to be plagued with intrusions about regurgitated Corona beers and fish tacos.
So first, tell me how much it bothers you, and I'll try to come up with some ideas (first I have to read up on OCD, don't know as much about CBT treatment for OCD as I do about depression and anxiety, sorry :))
Regards,
Matt
Posted by Oddipus Rex on June 7, 2003, at 14:47:53
In reply to Re: Another CBT question. Very specific. » Dinah, posted by mattdds on June 7, 2003, at 13:57:47
Hi Dinah I found this by doing a google search.
http://www.gut-reaction.freeserve.co.uk/cbt-treatment.htmOne thought that occurred to me is that you may be "white-knuckling" it through these situations and it might work better to gradually desensitize yourself. That is, you would stay in the situation which was evoking these thoughts until you reached a stage of moderate discomfort and then retreat until you returned to a normal level of comfort and then return again and stay until you reach a stage of moderate discomfort,etc. When you stay in the situation with willpower while you are extremely uncomfortable, you are actually reinforcing your association between the situation and extreme discomfort.
It's possible to create a safe place to retreat to in your mind by using visualizations or meditation as well as physically retreating. At least in theory :)
The website suggested some ways to set up situations to desensitize yourself like vomit videos and inducing nausea.
I'm sorry you didn't enjoy your vacation more. It's nice to have you back again.
Posted by Dinah on June 7, 2003, at 19:39:44
In reply to Re: Another CBT question. Very specific., posted by Oddipus Rex on June 7, 2003, at 14:47:53
It's nice to have you back again too, stranger. How're you doing? I've missed you.
Thanks for the link. I've just discovered the whole emetophobia world, and I'm immersing myself in it, so to speak.
I don't think that in this instance I white-knuckled through it. Although there have been plenty of occasions in the past where I did. Like the plane trip where I was seated next to the rest room. When I got off the plane, my face was as red as a Maraschino Cherry. It scared my husband to death. Or the bachelorette party of a good friend with a surprise visit to the biggest drunkest bar in the area. Those sorts of things I make through on sheer willpower. This wasn't that bad.
Thanks, Oddipus. And don't be a stranger. :)
Posted by Dinah on June 7, 2003, at 19:41:44
In reply to Re: But if I do bad things, aren't I bad?, posted by mattdds on June 7, 2003, at 13:19:21
Thanks Matt. One day it just might seep in. These things take a while with me. On the one hand, I take enormous care sometimes to come up with just the right word with just the right shading. But at other times, I just can't tell the difference between concepts. I'll keep plugging away at it.
Posted by Dinah on June 7, 2003, at 19:54:32
In reply to Re: Another CBT question. Very specific. » Dinah, posted by mattdds on June 7, 2003, at 13:57:47
Hi again, Matt. Yes, I am diagnosed with OCD. And have practiced both home-grown and formal CBT for it. The vomit thing is just one of many where I seem to get so far, and can't get any further. You'd think almost thirty years of exposure and response prevention would have me happily wading through the stuff. Especially with all the lovely vomit scenes that come up on TV and movies lately.
I get better, but not well. Like with cars, I don't drive around the block several times to see if that bump was someone I rolled over. But I still have the uneasy feeling that pedestrians are missiles aiming for my wheels. And no amount of logical thought shakes that.
Or my work. I no longer have to get up in the middle of the night to race to the office to make sure I didn't write obscenities on my work product. But I can't shake the sense that my work is evil, or will cause me harm in some way. Again, logical thought doesn't affect that.
And although I can do what I need to do with the vomit obsession/phobia, it always remains in the background. OK, I still do have some avoidance behaviors. I don't go to bars, and am very careful at amusement parks. But I can do what I need to do.
My therapist appears to think I'm all better on these things. Or better enough. He's pleased that the behaviors have mostly stopped. And that's given me the idea that as far as OCD is concerned, there is a limit for how much can be expected from CBT, or perhaps any sort of therapy or meds. That functioning as well as I can is all that I can hope for.
And maybe that's true. Maybe there are disorders that can only be managed to a certain extent.
Posted by mattdds on June 7, 2003, at 21:49:02
In reply to Re: Another CBT question. Very specific. » mattdds, posted by Dinah on June 7, 2003, at 19:54:32
Hi Dinah,
I don't have OCD, so I probably can't understand completely what you are going through. I can conceptualize it, but have not experienced it. I imagine it is tough to deal with ego-dystonic intrusions all the time. My intrusive thoughts aren't ego-dystonic, but I do get all kinds of thoughts I don't like.
If I understand right, you have made a lot of progress in the behavioral department, but not so much in the way of intrusive ego-dystonic cognitions. And that you have sort of a split level of understanding; on one hand you realize it is illogical to worry so much about vomiting, but another (more irrational) part of you doesn't believe it. Did I get this right?
I've been doing some research on CBT thought on OCD, and the idea is *not* to settle for just behavioral improvement, but for improvement as far as the obsessions go as well. I would love to discuss this, and have some ideas, but it will take a lengthy exchange, if you are up for it.
My take is that you do *not* have emetophobia. This is just my opintion, but what you describe sounds more like a fear of a contaminated object (vomit). You are not so much afraid of vomiting yourself? Is this accurate?
CBT-ists call this Thought-Object Fusion (TOF). The belief (on some level) that thoughts can make things contaminated. This sounds a lot like what is going on with the fear of vomit, in your case.
You also described that you used to have to check your work to "make sure" you didn't write obscenities on it. This is referred to as thought-action fusion (TAF) by CBT-ists. There is the belief (on some level) that thoughts are fused to actions. Thinking something means that you will do it (or have done it). Another common example is worry about harming someone you love, like "what if I just stabbed my wife for no reason??!!". The corresponding compulsion would be to get rid of all the knives in the house, or something like that. This is thought-action fusion.
Just out of curiousity, are any of your intrusive thoughts religious (sacreligious?) in nature? This is extremely common. A good example would be a person who has thought intrusions that the devil will appear. He holds a belief (on some submerged level) that having this thought will make the devil appear! So the poor indidual will try to crowd out thoughts of the devil by praying or doing Hail Mary's or something like that. This is classic Thought-Event Fusion (TEF).
So these terms help to conceptualize the problem.
How do we solve it?
It appears you have the behavioral aspect pretty well nailed down. So now you work on the cognitive aspect of it. But here is where it gets tricky.
The goal is *NOT* to get rid of the intrusive thoughts! The goal is to change the beliefs about the meaning of the obsessive thoughts. In other words, freely let the thought intrusions enter. You might have heard about thought suppression experiments; they don't work! E.g. try hard for 30 seconds NOT to think of vomit....................................what just passed through your mind? Of course, vomit!
So trying to suppress the thoughts is not the goal, and will likely reinforce the belief that the thoughts are harmful or have some meaning (e.g. you are bad because you had such and such thought). Don't even try to figure out the cognitive distortions in the intrusions; they are self-evident, and already incredibly obvious to you.
Your problem likely is in your *appraisal* of the intrusions, i.e. fallacious beliefs about what "purpose" these intrusions serve. I remember in one of your old posts you wondered what "purpose" your panicky thoughts had when you were younger, and you said "they must have been important!"
Interestingly, this is where metacognition becomes important. The idea is to simply "watch" your intrusions pass through your mind non-judgementally. One method is to get purchase a golf stroke counter. Each time you have an intrusive thought, you simply make a click. "the vomit is EVERYWHERE" - click. "gross drunk teens probably barfed right where I was standing" - click. You get the picture. Keep a log of the number of intrusions. Supposedly, they will go up for a few days, as you become more aware of them. Then after a few weeks, they will go down. Try this with one particular set of thoughts once (e.g. vomiting), then move on to others.
I will do more research on this, but I'm quite sure the idea is NOT to try to control the thoughts; this just makes them come back stronger, as I'm sure you know. The goal is passive, non-judgemental observation of the thoughts, which hopefully will eventually de-fuse the thought intrusion from the action or object.
So CBT for OCD is quite different than for depression. It has certainly moved beyond the simple behavioral techniques. The problem is that most clinicians are too lazy/uninformed/busy/or whatever to keep up on the literature.
I got most of these ideas from Arian Wells books, a pioneer in cutting-edge CBT for OCD and generalized anxiety disorder.
"Cognitive Therapy of Anxiety Disorders : A Practice Manual and Conceptual Guide"
"Emotional Disorders & Metacognition: Innovative Cognitive Therapy"
Perhaps your therapist could take a look at these and formulate a treatment plan customized for you.
I'm only scratching the surface! There are many more techniques, but I'm already getting extremely long-winded. I hope I am not going overboard here!
I wish you the best,
Matt
Posted by janejj on June 7, 2003, at 22:21:12
In reply to Re: Another CBT question. Very specific. » Dinah, posted by mattdds on June 7, 2003, at 21:49:02
I'm sorry that but I haven't read through all these messages...just wanted to say that CBT seems to have worked for me, albeit I just read the very popular book by Dr Burns.
It helped me see the way I think is completely warped and hence my life has become much more bearable. For instance I never base my self worth on my ability to perform a certain task or base my self identity on one facet of my life (eg. Career)etc. I no longer let percieved judgement from other people completely paralyse and depress me and I don't think other people are better than me any more. Its gone a long way to a much more stable and happy life!
Anyway certain treatments work for some and not for others, its just what works for you that you should worry about.
Regards, Janejj
Posted by shar on June 8, 2003, at 3:54:02
In reply to Re: But if I do bad things, aren't I bad?, posted by Dinah on June 7, 2003, at 11:39:22
>But if I do bad things, aren't I bad?
Nay, m'lady. Tis like "hate the sin, love the sinner." If one does something bad, one has DONE something bad, not BECOME something bad. We are all a mix of good and bad. To follow the logic of your question on the flip side: if you do good things, aren't you good?
> And if I'm responsible for making myself better, aren't I to blame if I don't?
Another nay. That's called blaming the victim in my book. Just like if one had cancer; there are some folks who believe that their treatments work, and the person who isn't getting well isn't [praying hard enough, following the diet rigorously, meditating with a pure heart, etc.] or anything that doesn't reflect badly on the treatment. One who is making a good faith effort to improve, cannot blame oneself for not trying, if one is trying. It is circular logic and bad for the brain.
>I agree with matt (I think it was) who talked about using words like bad, good, etc. They are extremely value-laden, so what I think is good may be quite bad to someone else. Some people think that thinking something is just the same as doing it (so thinking of murder is the same as murdering someone). Whatever we end up labeling good or bad is very personal; and, while I'm not against labels per se (because they allow us to make sense of the world), they do need to be used carefully, I believe. Sometimes, in therapy we learn that labels continually cause us problems and we have to get to what's behind the label to make even greater progress (such as, "bad" may turn out to be "self-aware" or "good" could mean "submissive").
Hmmm, hope this made some sense.
Shar
Posted by Larry Hoover on June 8, 2003, at 9:50:47
In reply to Re: But if I do bad things, aren't I bad?, posted by Dinah on June 7, 2003, at 11:39:22
> And if I'm responsible for making myself better, aren't I to blame if I don't?
>
> I still don't understand. Can you use baby words?I don't know about baby words, but I'll take another crack at it.
Taking responsibility involves attributions of all outcomes, good, neutral, bad. Blame focusses only on the bad. (I don't like judgmental words like good or bad. They taint observations.)
Responsibility involves anticipation as well as retrospection. Blame only looks back.
Responsibility assumes that all decisions have effects. Blame is a tool to distort responsibility, magnifying responsibility in some cases, and minimizing it in others.
I keep thinking about that case a few years back where a woman successfully sued McDonald's because she was injured when she spilled a hot coffee in her lap. IMHO, the woman was responsible (she made a number of decisions which led directly to the incident, alternative ones preventing the adverse outcome), but McDonald's got blamed.
Lar
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