sheephead
4th May, 2008, 08:02 AM
I have recently attended a few CBT counselling sessions and thought that since there is very little on this message board relating to what’s commonly referred to as ‘talk therapy’, I would post my experiences and impressions to date
Firstly a bit of background. I have been suffering on and off from mild to moderate depression for the past six years, since succumbing to work-related stress in the late autumn of 2001. Three things have primarily helped me during this time:
SJW – which I took from 2002-2005. Worked great for two years and then stopped working, leaving me looking for other treatments
<O:p</O:p
Light box – improves my sleep and day / night cycle. I’ve been using it since late 2005 and still use it to this day
<O:p</O:p
Talk therapy – I saw a counsellor last summer who greatly helped with the more debilitating effects of my depression but couldn’t help with some of the other residual mild depression symptoms like poor sleep, low stress threshold, mild anxiety and tiredness.
<O:p</O:p
As I am hoping to start my own business in the very near future, I felt I needed to try a treatment that might ‘give me an extra 20%’ to enable me to approach that venture with more confidence.
<O:p</O:p
At this point, I’m presuming that most CBT practitioners follow roughly the same approach when it comes to the general form and structure of the sessions. Anyway, this was my experience:
<O:p</O:p
Session 1: Really just a fact-finding interview. You’re encouraged to talk through what you see as relevant in terms of a) your condition b) what you want out of CBT c) relevant issues or events from the past. This helps the therapist build up a general picture you as a person, your background and the problems at hand.
<O:p</O:p
<O:p</O:p
One of the features of CBT is that you are expected to complete tasks and exercises during the periods in between sessions – and even effect some life-style changes. In the seven-day gap between the first and second session I was given a diary to fill in to bring back to the second session. This had to be filled in hour-by hour, and had four headings that required completing: actions, thoughts, moods, and physical symptoms. For each hour period you have to summarise the key events under each heading. Sometimes there seemed very little to say and I was scratching around for ideas. At other times it seemed almost impossible to fit all the ideas and events into one little box. Needless to say, the hours of sleep can be filled in retrospectively the following morning.<O:p</O:p
<O:p</O:p
For me, the diary-keeping was unexpectedly revealing. It had the effect of highlighting issues that I was probably already vaguely aware of, but took for granted and wasn’t attempting to redress. It holds a mirror up to your life: your lifestyle choices, the structure and content of your day and how they impact on your mood, confidence and self-esteem. In particular, it demonstrated to me how reactive my mood is to a) what was going on around me and b) what activity I was engaged in at any particular time. For instance, being engaged in an activity where I felt 'useful' improved my mood, whereas staring blankly at any-old-programme on the TV lowered my mood.
<O:p</O:p
Session two: Similar to the first session. Still more fact finding by the therapist, but this time with more of an emphasis on structured, therapist-led questions about my background and key life events. This was in contrast to the first session, where I set the agenda and prattled on about things that were important to me. The second session was concluded with a brief review of the CBT diary.
<O:p</O:p
No homework this time.
<O:p</O:p
Session three:
<O:p</O:p
The therapist presented me with a comprehensive ‘person profile’ culled from information gleaned from the first two sessions and the CBT diary. CBT counsellors will obviously vary, but I was presented with an impressively comprehensive, seven-page document that covered just about every aspect relevant to my condition, but most importantly contained a section entitled ‘interventions’ i.e the counsellor’s suggested programme of CBT treatment, designed to meet my particular needs and requirements.
<O:p</O:p
In my case the suggested treatment for the current week is to score each day out of ten in respect of the following criteria: pleasure, exercise, achievement, and socialising (based on what is known, in CBT parlance, as the ‘PEAS’ model).
<O:p</O:p
The idea of this is to provide your day with a mixture of daily activities that will provide the necessary combination of stimulation, relaxation and enjoyment. I suppose it encourages you to give each day some structure and content….the idea being that each of these categories can have an anti-depressant effect and will be beneficial to mood, motivation, self esteem and confidence. In addition, when one has had a period of depression the activities associated with pleasure, exercise, achievement and socialising will inevitably suffer as you trim back and retreat into your comfort zone -- Why socialize? Achievement involves too much effort. Nothing gives me pleasure etc.
</O:p
Small steps are just as important as big events. Even just making a phone call or sending an e-mail to someone would score under the ‘socialise’ category – it doesn’t mean you have to go out with a group of friends for a night on the town! In the same way, scoring prefect tens in every category isn’t really the point. The idea of the PEAS model is just to make you think about putting a bit more into each day as it comes around.
<O:p</O:p
I was also given an advice sheet on how to improve my sleep. Much of this was fairly routine, unsurprising stuff (avoid alcohol and caffeine, go to bed at a regular time, get up if you can’t drop off within half an hour) that most of us insomniacs have heard a hundred times before.
<O:p</O:p
OK. That’s the story so far. I hope to add to this thread as the treatment progresses. In terms of the number of sessions, I’m taking each one as it comes. So far they’ve been weekly, but I expect that I shall start spacing them out a bit more in the weeks to come and if I feel I’ve achieved all I can, I shall call it a day rather than let them drag on.
<O:p</O:p
The fundamentals of CBT treatment are surprisingly common sense. So far, the discussions and analysis of my situation haven’t provided me with any ‘Eureka’ moments of self-revelation. However, the diary was surprisingly enlightening in unpicking small, day-to-day details – things that I was doing wrong / a comfort zone that I had slipped into -- and highlighting simple things that could be changed to micro-manage my mood and confidence.
<O:p</O:p
At this point, I’m not sure that CBT can provide me with all the answers…..rather, I think it may provide a useful ‘road map’ to effect general improvements. I like the way that it looks at depression from every angle, including exercise, rather than just focussing in on one particular aspect – depression is often multi-faceted and I think the CBT philosophy reflects that. It is also compatable, and can be used in conjunction with, the taking of medication, if required.
<O:p</O:p
I wanted to keep some of the dogma and the underlying principles of CBT out of this posting and just concentrate on my experiences and impressions of the treatment. As a footnote to this piece I have tried to summarise the theory that underscores the treatment outlined above for anyone who’s interested. Enjoy....
-------------------------------------------------------------------------------------------------------
<O:p</O:p
CBT Theory:
<O:p</O:p
CBT analysis is framed around Beck’s model of depression (named after Aaron T. Beck, who developed CBT in the 1960s)….which goes something like this –
<O:p</O:p
Problems with mood (depression, anxiety etc.) often stem from incorrect, ‘dysfunctional’ assumptions which we hold about ourselves and the world in general, often associated with things like our sense of achievement, acceptance by others and our control over situations and events.
<O:p</O:p
Often there are specific incidents and events in our lives that reinforce these dysfunctional assumptions and lead us into the self-destructive habit of negative automatic thoughts (NATS)…..a stream of moment to moment unplanned thoughts and memories that flow through our minds and are present in specific situations. These negative automatic thoughts can have a huge bearing on mood, behaviour and physical sensations. The role and importance of NATS really lies at the heart of CBT theory.
<O:p</O:p
CBT examines the relationship between a) activites and situations b) NATS, c) mood and d) physical symptoms (palpitations, migraine etc) – known as the ‘four buttons’ and attempts to come up with intervention strategies to improve the inter-relationship between them.
Very simply, a particular activity or situation may lead to an increase in NATS, which in turn can have an effect on mood and possibly lead to physical reactions.
Firstly a bit of background. I have been suffering on and off from mild to moderate depression for the past six years, since succumbing to work-related stress in the late autumn of 2001. Three things have primarily helped me during this time:
SJW – which I took from 2002-2005. Worked great for two years and then stopped working, leaving me looking for other treatments
<O:p</O:p
Light box – improves my sleep and day / night cycle. I’ve been using it since late 2005 and still use it to this day
<O:p</O:p
Talk therapy – I saw a counsellor last summer who greatly helped with the more debilitating effects of my depression but couldn’t help with some of the other residual mild depression symptoms like poor sleep, low stress threshold, mild anxiety and tiredness.
<O:p</O:p
As I am hoping to start my own business in the very near future, I felt I needed to try a treatment that might ‘give me an extra 20%’ to enable me to approach that venture with more confidence.
<O:p</O:p
At this point, I’m presuming that most CBT practitioners follow roughly the same approach when it comes to the general form and structure of the sessions. Anyway, this was my experience:
<O:p</O:p
Session 1: Really just a fact-finding interview. You’re encouraged to talk through what you see as relevant in terms of a) your condition b) what you want out of CBT c) relevant issues or events from the past. This helps the therapist build up a general picture you as a person, your background and the problems at hand.
<O:p</O:p
<O:p</O:p
One of the features of CBT is that you are expected to complete tasks and exercises during the periods in between sessions – and even effect some life-style changes. In the seven-day gap between the first and second session I was given a diary to fill in to bring back to the second session. This had to be filled in hour-by hour, and had four headings that required completing: actions, thoughts, moods, and physical symptoms. For each hour period you have to summarise the key events under each heading. Sometimes there seemed very little to say and I was scratching around for ideas. At other times it seemed almost impossible to fit all the ideas and events into one little box. Needless to say, the hours of sleep can be filled in retrospectively the following morning.<O:p</O:p
<O:p</O:p
For me, the diary-keeping was unexpectedly revealing. It had the effect of highlighting issues that I was probably already vaguely aware of, but took for granted and wasn’t attempting to redress. It holds a mirror up to your life: your lifestyle choices, the structure and content of your day and how they impact on your mood, confidence and self-esteem. In particular, it demonstrated to me how reactive my mood is to a) what was going on around me and b) what activity I was engaged in at any particular time. For instance, being engaged in an activity where I felt 'useful' improved my mood, whereas staring blankly at any-old-programme on the TV lowered my mood.
<O:p</O:p
Session two: Similar to the first session. Still more fact finding by the therapist, but this time with more of an emphasis on structured, therapist-led questions about my background and key life events. This was in contrast to the first session, where I set the agenda and prattled on about things that were important to me. The second session was concluded with a brief review of the CBT diary.
<O:p</O:p
No homework this time.
<O:p</O:p
Session three:
<O:p</O:p
The therapist presented me with a comprehensive ‘person profile’ culled from information gleaned from the first two sessions and the CBT diary. CBT counsellors will obviously vary, but I was presented with an impressively comprehensive, seven-page document that covered just about every aspect relevant to my condition, but most importantly contained a section entitled ‘interventions’ i.e the counsellor’s suggested programme of CBT treatment, designed to meet my particular needs and requirements.
<O:p</O:p
In my case the suggested treatment for the current week is to score each day out of ten in respect of the following criteria: pleasure, exercise, achievement, and socialising (based on what is known, in CBT parlance, as the ‘PEAS’ model).
<O:p</O:p
The idea of this is to provide your day with a mixture of daily activities that will provide the necessary combination of stimulation, relaxation and enjoyment. I suppose it encourages you to give each day some structure and content….the idea being that each of these categories can have an anti-depressant effect and will be beneficial to mood, motivation, self esteem and confidence. In addition, when one has had a period of depression the activities associated with pleasure, exercise, achievement and socialising will inevitably suffer as you trim back and retreat into your comfort zone -- Why socialize? Achievement involves too much effort. Nothing gives me pleasure etc.
</O:p
Small steps are just as important as big events. Even just making a phone call or sending an e-mail to someone would score under the ‘socialise’ category – it doesn’t mean you have to go out with a group of friends for a night on the town! In the same way, scoring prefect tens in every category isn’t really the point. The idea of the PEAS model is just to make you think about putting a bit more into each day as it comes around.
<O:p</O:p
I was also given an advice sheet on how to improve my sleep. Much of this was fairly routine, unsurprising stuff (avoid alcohol and caffeine, go to bed at a regular time, get up if you can’t drop off within half an hour) that most of us insomniacs have heard a hundred times before.
<O:p</O:p
OK. That’s the story so far. I hope to add to this thread as the treatment progresses. In terms of the number of sessions, I’m taking each one as it comes. So far they’ve been weekly, but I expect that I shall start spacing them out a bit more in the weeks to come and if I feel I’ve achieved all I can, I shall call it a day rather than let them drag on.
<O:p</O:p
The fundamentals of CBT treatment are surprisingly common sense. So far, the discussions and analysis of my situation haven’t provided me with any ‘Eureka’ moments of self-revelation. However, the diary was surprisingly enlightening in unpicking small, day-to-day details – things that I was doing wrong / a comfort zone that I had slipped into -- and highlighting simple things that could be changed to micro-manage my mood and confidence.
<O:p</O:p
At this point, I’m not sure that CBT can provide me with all the answers…..rather, I think it may provide a useful ‘road map’ to effect general improvements. I like the way that it looks at depression from every angle, including exercise, rather than just focussing in on one particular aspect – depression is often multi-faceted and I think the CBT philosophy reflects that. It is also compatable, and can be used in conjunction with, the taking of medication, if required.
<O:p</O:p
I wanted to keep some of the dogma and the underlying principles of CBT out of this posting and just concentrate on my experiences and impressions of the treatment. As a footnote to this piece I have tried to summarise the theory that underscores the treatment outlined above for anyone who’s interested. Enjoy....
-------------------------------------------------------------------------------------------------------
<O:p</O:p
CBT Theory:
<O:p</O:p
CBT analysis is framed around Beck’s model of depression (named after Aaron T. Beck, who developed CBT in the 1960s)….which goes something like this –
<O:p</O:p
Problems with mood (depression, anxiety etc.) often stem from incorrect, ‘dysfunctional’ assumptions which we hold about ourselves and the world in general, often associated with things like our sense of achievement, acceptance by others and our control over situations and events.
<O:p</O:p
Often there are specific incidents and events in our lives that reinforce these dysfunctional assumptions and lead us into the self-destructive habit of negative automatic thoughts (NATS)…..a stream of moment to moment unplanned thoughts and memories that flow through our minds and are present in specific situations. These negative automatic thoughts can have a huge bearing on mood, behaviour and physical sensations. The role and importance of NATS really lies at the heart of CBT theory.
<O:p</O:p
CBT examines the relationship between a) activites and situations b) NATS, c) mood and d) physical symptoms (palpitations, migraine etc) – known as the ‘four buttons’ and attempts to come up with intervention strategies to improve the inter-relationship between them.
Very simply, a particular activity or situation may lead to an increase in NATS, which in turn can have an effect on mood and possibly lead to physical reactions.