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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Dr. Bob on January 6, 2004, at 23:35:07
In reply to Did CBT help you overcome panic attacks?, posted by psychlover on January 6, 2004, at 16:25:47
> To you folks who discussed the use of Klonopin during CBT therapy:
>
> I am wondering if the CBT therapy actually made a difference for you. Were you able to get off your meds or reduce the dose at all? Did it have any effect on you at all?
>
> Thanks!
Posted by psychlover on January 7, 2004, at 0:16:06
In reply to CBT to overcome panic attacks? « psychlover, posted by Dr. Bob on January 6, 2004, at 23:35:07
I'm reposting this from the Klonopin discussion on the other page:
Hey, what a coincidence!
This article about scanning the brains of people who underwent CBT for depression vs. those who took meds just came out today. It's very interesting. From the Boston Globe. Enjoy!
What do people think about this article? I think the findings are fascinating, but I see that the CBT proponents see this as proof that meds are unnecessary, which is definitely not the case for everyone.
All the best,
psychlover
Posted by dragonfly25 on January 7, 2004, at 1:05:51
In reply to news: brain scans of CBT patients vs. med patients, posted by psychlover on January 7, 2004, at 0:16:06
great article! very interesting. really makes me re-think drugs.
Posted by Kalamatianos on January 7, 2004, at 8:32:20
In reply to news: brain scans of CBT patients vs. med patients, posted by psychlover on January 7, 2004, at 0:16:06
I greatly appreciated your posting! Thank you so much!
...back to cause and effect; the chicken and the egg. Bad habits can lead to bad thinking. Combining bad habits and bad thinking can change folks chemically.
If insurance companies can't take the time to understand CBT and therefore encourage meds dosing willy-nilly, folks can be altered chemically this way and that.
Since chemical imbalances can be tracked empirically with hard data, the "why" can get lost when seeking remedy that can be paid for. Certainly, if you throw "enough" chemicals at a chemical imbalance you WILL alter it, chemically. And, even with "talking" therapies alluded to in the article, there is a "tooo much" threshold, past which insurance companies or anybody else need not be expected to finance. Alas, the all-mighty dollar determines success in therapy.
The article indicates a physical component to the mysteries of the mind. This broaches a new topic of discussion close to my heart; training the clients to think differently; coaching is training and re-training without therapy or meds.
Coaching is under fire for encroaching into the "sacred realm" of therapy. I submit that therapy, by embracing the big "DUH" that there is something physical going on, is encroaching into Coaching's realm, and needs to back off one step.
Insurance companies are "green lighting" CBT as now being a valid "Talking therapy" regimen along side a meds regimen. Since therapy is usually open ended and coaching usually has limits or fixed goals or end game strategy, the therapy community and its lobbying for the pending flood of legislation to shut down Coaching, are being selfish, narcissistic, and ignoring the welfare of the client.
Coaching is not here to "commit therapy" and get paid without being licensed or certified. Coaching does help with bad habits by encouraging replacing them with good habits. Perhaps good habits CAN lead to good thinking and good bodies chemically.
Perhaps........
Posted by badhaircut on January 7, 2004, at 13:31:15
In reply to news: brain scans of CBT patients vs. med patients, posted by psychlover on January 7, 2004, at 0:16:06
psychlover-- Thanks for the link! (And for posting it over here, too.)
If anybody wants the citation/abstract of the study, it's:
"Modulation of Cortical-Limbic Pathways in Major Depression: Treatment-Specific Effects of Cognitive Behavior Therapy" by Kimberly Goldapple, Zindel Segal, and others.
Archives of General Psychiatry (2004) 61:34-41
http://archpsyc.ama-assn.org/cgi/content/abstract/61/1/34When my ECT psychiatrist looked at my first high-tech brain images for depression in the late 1980s, he said, "That's beautiful! But nobody in the world knows what it means." I think that's still true, but the research is apparently coming along.
-bhc
Posted by ocdforyears on January 9, 2004, at 10:39:04
In reply to Re: brain scans of CBT patients vs. med patients, posted by badhaircut on January 7, 2004, at 13:31:15
Brain scans are fascinating; the same phenomenon is observed with ocd. Of course, the abnormal activity shown in the scan could be the result, not the cause, of the neurosis. Meaning my brain looks this way because I'm depressed or obsessing, not I'm obsessing because my brain looks this way (though in ocd there certainly is a vicious cycle). Anything which lifted mood even for a short while, cbt or emotional release or meds, might change the look of the scan, but long term clinical experience: as in how do I feel? seems just as valuable.
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.
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
This is the end of the thread.
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