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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by saturn on September 25, 2006, at 0:52:26
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Posted by Phillipa on September 25, 2006, at 0:52:26
In reply to How well does CBT work for depression, posted by saturn on September 23, 2006, at 20:23:04
I think it takes a negative statement, you say well I could do it this way and maybe it will turn out different you do this and then write the outcome. I get so confused with this. Love Phillipa
Posted by yxibow on September 25, 2006, at 0:52:27
In reply to How well does CBT work for depression, posted by saturn on September 23, 2006, at 20:23:04
>
> ?CBT for any psychiatric condition depends on the willingness of the patient to submit to a set plan of action, to endure what may be painful at times, and to do the "homework" that is assigned. If one is not ready for such a plan or is not open to such therapy (I find it hard personally), it is not going to work, as we all have free will underneath what plagues us.
For major treatment resistant depression I would imagine it would be quite much harder than (multiple) medications.
Posted by bassman on September 25, 2006, at 0:52:27
In reply to How well does CBT work for depression, posted by saturn on September 23, 2006, at 20:23:04
This may sound odd, but I think CBT is really for when you're well. We all distort things sometimes and have negative thoughts and part of CBT is to try and "correct" that. But my experience is that when you are suffering a lot, you can tell yourself-and absolutely see rationally-that what you're thinking isn't valid; but it doesn't make a damn bit of difference. You are still depressed. The real question is the basic premise of CBT, namely, that negative thoughts cause depression. It seems to me that it is the other way around-but I do think CBT has a place, esp. for someone who hasn't encountered cognitive "restructuring" or relaxation techniques.
Posted by SLS on September 25, 2006, at 0:52:27
In reply to Re: How well does CBT work for depression, posted by bassman on September 24, 2006, at 13:08:16
I can only speak for myself. I suffer from bipolar disorder. I am stuck in the depressive phase of the illness. My depression is not at all responsive to cognitive therapies, despite my concerted efforts. It is 100% biological and hard. CBT helps me live with depression. It helps me to reinterpret the automatic thoughts and feelings that the depression tends to produce. When I finally get well, I will use cognitive therapies to help clean up the mess that depression has made of my psyche.
- Scott
Posted by psychobot5000 on September 25, 2006, at 0:52:27
In reply to Re: How well does CBT work for depression, posted by SLS on September 24, 2006, at 13:49:05
SLS's note describes much the way I see it, too. I suffer from major depression that I believe has a biological source, and CBT does not (cannot) strike at the root of it.
However, it has helped me see how damaging and irrational my thoughts were--studies show depressive people make more pessimistic assumptions than others, without good reason for it. Such negative thinking can clearly worsen depression, as well as probably cause it in many people.
Studies also show that medication combined with CBT is more effective than medication alone. For me, CBT helps me see how my distorted thought patterns are unhelpful, and keep them from making me worse. It was worth my time, though it is not a solution. For some, it might be a solution, however.
Dr. David Burns book 'Feeling Good' is a frequently recommended CBT book for patients. It is highly readable, and explains many of the principles quite well, and in a usable way. You could use it alone, or as a companion to CBT with a therapist.
Hope this helps,
P-bot
> I can only speak for myself. I suffer from bipolar disorder. I am stuck in the depressive phase of the illness. My depression is not at all responsive to cognitive therapies, despite my concerted efforts. It is 100% biological and hard. CBT helps me live with depression. It helps me to reinterpret the automatic thoughts and feelings that the depression tends to produce. When I finally get well, I will use cognitive therapies to help clean up the mess that depression has made of my psyche.
>
>
> - Scott
Posted by Phillipa on September 25, 2006, at 0:52:27
In reply to Re: How well does CBT work for depression, posted by psychobot5000 on September 24, 2006, at 16:39:44
I also believe it is a good book for the beginning of depression. It was kind of a bible for me for years. I could probably quote it I read it so many times. But if you're to anxious to lie still how can you do muscle relaxation, deep breathing, ets. The only way I can deep breath is to ride my bike really hard. The book gives good explainations of what depression and anxiety are. Hopefully they've updated the meds as I got the copy I had l0 years ago. I aggree with Scott too. I know I think negatively but it doesn't seem to be a choice for me. And if I say oh no it's really this way my brain doesn't believe it. Love Phillipa
Posted by alexandra_k on September 25, 2006, at 1:37:20
In reply to How well does CBT work for depression, posted by saturn on September 23, 2006, at 20:23:04
I think that seeing different therapists can be a little like trying different medications. Sometimes it takes a while to find a therapist / medication that is helpful for you.
CBT is fairly much (to my mind) an educational program.
Things you learn about include:
- How activity relates to mood. If you can bring yourself to do some exercise then that results in the release of endorphins. It is jolly hard to remain depressed when endorphins are being released in your brain.
- How oversleep can result in tiredness... If you get more sleep than you need then you can feel depressed and sluggish and in need of even more sleep... That can be a vicious cycle that it is hard to break out of.
- Nutrition. How different kinds of foods can impact on your mood and how vitamin deficiencies etc can impact too.
- Nice activities. While they may not feel enjoyable doing what you like to do and forcing oneself back into a routine can help one start to enjoy what you are doing.Sometimes therapy can help because your therapist can assign you little homework tasks that are hard but manageable for you depending on where you are at. Possible homework tasks could be things like going for a 20 minute walk once per day or doing some activity daily that you typically find enjoyment in. Therapists can help you find the motivation to do the little tasks. Sometimes when we are left to our own devices we don't do them because we don't feel like it. When we know we have to report to our therapist sometimes we can find the motivation to do it for them... Then when we start to feel better we can do it for ourself :-)
The 'challenging core beliefs' stuff is... Useful to some people and not so useful to others. I think that the utility of this can be fairly dependent on whether you have a good theraputic relationship or not.
I think it is a chicken or egg question to ask 'what came first, the depression or the thoughts?' In a way it doesn't matter for the purposes of treatment the point is more that one has to interveane to break the cycle somewhere...
The things we tell ourself can have a significant impact on our mood...
Sometimes depression results because people have 'stuffed' their feelings. Therapy can help you get more in touch with what your feelings are and how to express them appropriately instead of stuffing them. That can help one recover and can help prevent relapses.
CBT alone is about as effective as medication alone. A combination of both has been found to be most helpful.
Posted by happyflower on September 25, 2006, at 6:01:22
In reply to Re: How well does CBT work for depression, posted by alexandra_k on September 25, 2006, at 1:37:20
CBT is known to work as well as meds alone can. The best combination for severe depresson is meds and therapy. (or ECT, although it has a huge stigma attached to it, but it works very well)
It is interesting to read the above posts, since I have had almost 2 years of cognitive therapy, that I can see the faulty thinking in the posts a lot now and in everyday life when talking to people. I never saw this before therapy. While it is true that seeing other's thinking is different when it come to seeing your own thinking. But yeah, I think CBT therapy is very affective, according to my personal experience, and most studies show CBT works great for depression. Meds work great too, and I have read that doing absoultely nothing will work too eventually on mild depression. So it all comes down to the individual. ;-)
Posted by alexandra_k on September 25, 2006, at 10:03:44
In reply to Re: How well does CBT work for depression, posted by happyflower on September 25, 2006, at 6:01:22
though there are significant risks involved with ECT such as possible brain damage and whenever one goes under a general anasthetic there is a slight risk one won't wake up again. i think that is why it is considered a last resort strategy. some people experience horrible side effects with medications, but then some people experience an aversive reaction to a therapist or two as well!
> I have read that doing absoultely nothing will work too eventually on mild depression.
actually they reckon that doing absolutely nothing works on severe depression too. they reckon a depressive episode lasts around 3 months with no treatment. people usually wait around one month before going to see their doctor and it usually takes a month or so for the medication to kick in and what do you know you are all better right on schedule! same with therapy too... if it takes you a month or two to get into therapy...
though that being said i think the worst danger is suicide. if you are being monitored for meds or therapy i guess they figure they are keeping an eye on you which may make that less likely...
but that being said i'm fairly sure i've heard that therapy prevents relapse in a way that keeping on taking your meds after an episode hasn't been shown to do (not sure they have done the studies) and in a way that ECT hasn't been shown to do (not sure whether they have done the studies).
but this is from memory... and psychologists do push the successful findings of therapy the same way the drug companies / psychiatrists tend to push the successful findings of medication...
sometimes when depression lifts people find they have other problems...
i've been reading about dysthymia lately and social cognitive theories of what is going on with that... one notion is that their is a failure to understand the norms of reciprocity in the sense that the person comes to think that they are more giving to others than others are giving to them whereas objective measures show the reverse to be the case. one notion is that the person hasn't learned the culturally accepted value of certain acts of giving... but if i keep this up i'll get redirected to social, no doubt...
Posted by Racer on September 25, 2006, at 14:57:47
In reply to How well does CBT work for depression, posted by saturn on September 23, 2006, at 20:23:04
Depends on a lot of factors.
In my own opinion, based on little more than my own experience, CBT is most helpful for mild to moderate depression -- and even then, it's most helpful for those whose depression is more situational than purely biological. And in some cases, CBT can be damaging, too.
That said, even for those whose depression is purely biological, I think some therapy is virtually necessary. Depression warps us so much, in so many ways, that we need to address those non-biological issues, too. Medication alone can lift the veil, but that still leaves the habits that depression forms for most people. Habits of thought may respond to CBT.
Part of it depends on motivation, of course. If you are motivated to work at it, then you're likely to get some benefit from it. If not...
Even in non-CBT therapy, there's likely some CBT style work. Distortions, habits of pessimism, etc, really are where CBT is strongest.
In my case, I'm not exactly on a first name basis with my emotions. What's more, the classic CBT "as soon as you feel that, think this" is just too close to what I get from my eating disorder, so CBT tends to trigger symptoms for me. What's more, I get into a loop that goes through "If I feel bad because I think this way, and it's all up to me to feel better, and I don't feel better -- then it's My Fault." That's certainly a distortion, but CBT triggers it for me, and every time I've seen a CBT-oriented therapist, they've ignored that -- either not even let me tell them about it, or they've told me that that's only a distortion and I have to stop thinking it. Well, maybe if they worked with me on it, rather than ignoring it? Again, that's just me.
Mind you, I'm certainly not saying that CBT is bad. It's not. CBT is like nearly everything in this world: it's got good and not so good to it, and it works for some and not so well for others. It's certainly worth trying, at least as an adjunct to other treatments.
And in my case, there are some cognitive things involved in my therapy -- it's just that it's not CBT. It's "eclectic" -- which fits best for me.
Good luck.
Posted by happyflower on September 25, 2006, at 15:22:50
In reply to Re: How well does CBT work for depression » saturn, posted by Racer on September 25, 2006, at 14:57:47
One really cool thing that they are discovering is that the placebo effect actually can change chemistry in the brain and body to help fight illnesses. So believing you are being helped in whatever way, seems to help just by believeing. Amazing !
Posted by Lindenblüte on September 25, 2006, at 19:42:31
In reply to Re: How well does CBT work for depression, posted by alexandra_k on September 25, 2006, at 10:03:44
> sometimes when depression lifts people find they have other problems...
For me, therapy was helpful in my depression. I didn't do very much, if any, CBT. By the time I went to see the therapist, I was losing weight because I had lost the pleasure of eating, and I had no sense of wanting to do anything. Just lifting a pencil to write down my appt. time was a struggle. No memory skills, no attention, very foggy brain. Trouble speaking and understanding speech. Lots of thoughts of dying and suicide. (I was not such a good candidate for CBT).
I started therapy a month before I started medication. Both helped. As the medications were starting to kick in, T helped me realize that my life was not falling apart around me, as I feared. T helped me realize that I had a lot of distorted thoughts. Helped me recognize the voice of "The Big D" and learn to ignore its powerful cry.
And generally listened to me and provided support so that I wouldn't feel lonely, paranoid and deserted in my misery.
As the depression lifted, T helped me get my life more organized, helped me figure out what my priorities were, and what I was doing to hinder my own goals. Helped me realize that there were a few essential conflicts in my life, all clouded in this fog of paralysing anxiety. I started asking myself questions about why I had these conflicts, and trying to put the pieces together about when they started and what they mean, and how they influence my behavior today.
Just like Alex_k says, above, sometimes new problems come up when the depression lifts.
For some of us, depression is just an extreme form of coping mechanism- a shut down of the system for times when anxiety gets out of hand and we are truly backed into a corner with no escape.
Well, what is going on in my life that is so extreme that I feel backed into a corner? How can I avoid this in the future? Therapy helps me realize where my reason ends and my craziness begins!
-Li
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