How to understand the science of talk therapy?
March 30, 2012 3:29 PM Subscribe
Can you help me find some science-based reasons to believe that therapy works?
So: I have some problems (anxiety, perfectionism, and issues related to a mentally ill, alcoholic parent). I would like help dealing.
Talk therapy seems like an obvious thing to do, but I have a hard time believing in its efficacy.
--On the emotional level, I tried a few therapists last year, but talking felt bad (by which I mean the conversations felt like wandering chats with someone I didn't know -- I wasn't emotionally aware of a therapeutic value).
--On the social/anecdata level, I don't personally know many folks who have gone through therapy and been thrilled with the results, so I'm lacking that faith-through-friends thing.
--On the intellectual level, I haven't researched talk therapy and don't really understand how it works (or even know that it does work).
I have a first meeting scheduled with a new person for next week, and think I'll have an easier time hanging in past those first few meetings if I understand the process better. (Or just believe that it DOES WORK.) You guys seem like you really, really believe in therapy, so I thought maybe you could help me understand it better...
So: Can you point me towards resources that explain how/why talk therapy works, or just THAT it works? (Peer-reviewed stuff is great, though other stuff is good too.) (Alternatively, if you have suggestions for other kinds of science-vetted therapies that help a person deal with anxiety/perfectionism/family stress, I'd be interested in those too.) Thanks, AskMe.
So: I have some problems (anxiety, perfectionism, and issues related to a mentally ill, alcoholic parent). I would like help dealing.
Talk therapy seems like an obvious thing to do, but I have a hard time believing in its efficacy.
--On the emotional level, I tried a few therapists last year, but talking felt bad (by which I mean the conversations felt like wandering chats with someone I didn't know -- I wasn't emotionally aware of a therapeutic value).
--On the social/anecdata level, I don't personally know many folks who have gone through therapy and been thrilled with the results, so I'm lacking that faith-through-friends thing.
--On the intellectual level, I haven't researched talk therapy and don't really understand how it works (or even know that it does work).
I have a first meeting scheduled with a new person for next week, and think I'll have an easier time hanging in past those first few meetings if I understand the process better. (Or just believe that it DOES WORK.) You guys seem like you really, really believe in therapy, so I thought maybe you could help me understand it better...
So: Can you point me towards resources that explain how/why talk therapy works, or just THAT it works? (Peer-reviewed stuff is great, though other stuff is good too.) (Alternatively, if you have suggestions for other kinds of science-vetted therapies that help a person deal with anxiety/perfectionism/family stress, I'd be interested in those too.) Thanks, AskMe.
Running through the 'references' section of Wikipedia is surprisingly effective at finding primary sources that outline this sort of thing. Example (from the Cognitive Behavioral Therapy article):
posted by 0xFCAF at 3:38 PM on March 30, 2012 [1 favorite]
Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT
posted by 0xFCAF at 3:38 PM on March 30, 2012 [1 favorite]
Note: not all "talk therapy" is "cognitive behavioral therapy". (Easy-to-read summary.) Your therapist may not practice CBT. Read up on CBT, and if it sounds like something you want, you need to make sure you find/have found a therapist who does it.
posted by supercres at 3:42 PM on March 30, 2012
posted by supercres at 3:42 PM on March 30, 2012
Best answer: From the first link (meta-analysis): . . .differences among treatment methods accounted for, at most, 10% of the variance in effect size. The impact of differences between treatment methods was outweighed by the combined effects of other variables, . . .
So, it's not all about CBT.
posted by Obscure Reference at 3:46 PM on March 30, 2012 [1 favorite]
So, it's not all about CBT.
posted by Obscure Reference at 3:46 PM on March 30, 2012 [1 favorite]
Best answer: Summary of 16 meta-analyses on CBT.
Metastudy on psychodynamic therapy.
posted by jejune at 3:50 PM on March 30, 2012
Metastudy on psychodynamic therapy.
posted by jejune at 3:50 PM on March 30, 2012
It's not clear from your question if you're also looking for anecdotes - could you please clarify?
posted by insectosaurus at 4:29 PM on March 30, 2012
posted by insectosaurus at 4:29 PM on March 30, 2012
Best answer: I am a training psychotherapist, and I like the arguments made for psychotherapy in this book: Louis Cozolino - The Neuroscience of Psychotherapy. Cozolino sees neuroscience as an ally to psychotherapy, as it can reveal the dramatic structural brain changes due to psychotherapy. I see people's lives change in my own experience, but here is argument based on evidence rather than therapist or client anecdotes.
Here's an comprehensive Amazon review that gives a summary of the book far better than I could:
As a neuroscience student, I found this book to be a very interesting read. It is very well organized and easy to follow. Anyone with a basic knowledge of introductory psychology and neuroscience should be able to keep up with this book easily. If you have a simple understanding of these fields and are interested in how the brain can be treated and adapted from a psychotherapist's perspective, then this book is for you. Also, the author relies on facts and actual scientific findings rather than his own opinions. Throughout the book, Cozolino uses real case studies to explain and supplement his points. In the event that an issue is unclear or still debatable, Dr. Cozolino makes sure to point out that the idea is not completely correct or accepted.
In his book, The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain, Dr. Louis Cozolino argues for the integration of neuroscience into the fields of psychology and psychiatry. He feels like not enough psychologist and psychiatrists embrace the usefulness and effectiveness of neuroscience in their therapies. Dr. Cozolino makes the argument that in all psychotherapies, no matter the methods used and perceived goals of the therapy, the deeper goal is to rewire the neural networks of the patient's brain in a positive way. The book relies heavily on the neuroplasticity of the brain, explaining how evolution has made the brain very adaptive and adjustable, even after early age.
From start to finish, the book flows in an organized and comprehendible manner. The book is divided into five parts, each of which addresses different concepts in neuroscience and/or psychotherapy. Part one includes a general history of neuroscience in psychotherapy, discussing in depth the contributions of Sigmund Freud and other psychologists. Dr. Cozolino claims that Sigmund Freud was indeed a neuroscientist, but because neuroscience was not a very appealing science at the time, Freud chose to focus on psychological models instead. This section also discusses the basics of neural networks and there is a whole chapter devoted to the different strategies used in psychotherapy. Regardless of the strategy, Cozolino argues that the goal is the same: to rewire the neural networks in a positive manner.
"The power of stress to trigger neural plasticity is a key element in the success of psychotherapy." This is a very important concept in psychotherapy because all the forms of therapy rely on some form of stress to induce the desired results. The book argues that not using stress is not very productive, and excessive stress is counter-productive. In other words, moderate stress is essential for optimal results, especially in psychotherapy.
The second part of the book contains more of the neuroscience essentials. It discusses all the parts of the brain and nervous system, and how memory is a key factor in the psyche. Although it is desirable to think that memories are stored in a specific location in the brain, this is not true. Memories are stored throughout the brain. The book then goes on to explain the relationship between implicit and explicit memories. Implicit memories are unconscious memories while explicit are conscious memories. Also, this part of the book goes in depth explaining the various process that go on in both hemispheres of the brain and how they are connected. For example, an important function of the left hemisphere is linguistics while the right hemisphere processes emotion. However, the process of communication is tied heavily to linguistics and emotion, so both hemispheres are used together.
Dr. Cozolino makes an interesting comparison that I feel is worth mentioning. He discusses how after World War II was over, some Japanese soldiers that had been abandoned on various islands in the Pacific Ocean were not aware that the war was over. Whenever someone would land on the island, the soldiers were ready to attack because to them, the war was still going on. They were fighting a war that no longer existed. These soldiers are compared to deep memories in the brain that are hard to get over. "Psychotherapists" are the people that land on the island and try to tell the soldiers that the war is over. This is analogous to psychotherapists trying to relieve a client/patient from a past memory that is rooted deep. The neural network must be rewired.
Part three of the book talks about how the brain is affected by experiences. Cozolino addresses key points to how the brain adapts and which parts of the brain are involved. For example, the book discusses the importance of the frontal and prefrontal cortices on behavior and emotion. This section of the book also discusses the importance and significance of social interaction the brain and psyche. The way we communicate and interact with other people has a profound effect on our neural networks. For example, eye contact and facial expressions are key signals in human communication.
Part four takes all the concepts from the first three parts and discusses their application to various psychiatric problems and disorders. Dr. Cozolino points out how early childhood relationships have an extraordinarily profound effect on the development of the psyche. "Each of us is born twice: first from out mother's body over a few hours, and again from our parents' psyche over a lifetime." This quote summarizes the importance of proper early childhood development and good parenting.
This section also discusses the concepts of fear and anxiety. The chapter discusses how fear and anxiety are processed and traces the "circuits" of fear. "Slow" fear is processed through the thalamus, cerebral cortex, and hippocampus, while "fast" appears to be processed by the amygdala, which is crucial in the processing of fear and anxiety. "The behavior of all organisms is based on approaching what is life sustaining and avoiding what is dangerous." This is a central belief on human behavior.
Part five ties all loose ends and strongly stresses the strength of neural plasticity. The idea that the brain is constantly changing and evolving is fundamental in this book and to psychotherapy. Dr. Cozolino explains that although deep knowledge of the inner functions of the brain is not completely available, neuroscience is a very valuable tool and perspective in psychotherapy. He encourages the reader and all psychotherapists to embrace neuroscience and not be afraid of its complexity.
I thoroughly enjoyed reading the book and I recommend it to anyone with an interest in psychology, neuroscience, or counseling. It is simple to read, does not use complicated jargon, and is very informative.
posted by amileighs at 4:29 PM on March 30, 2012 [9 favorites]
Here's an comprehensive Amazon review that gives a summary of the book far better than I could:
As a neuroscience student, I found this book to be a very interesting read. It is very well organized and easy to follow. Anyone with a basic knowledge of introductory psychology and neuroscience should be able to keep up with this book easily. If you have a simple understanding of these fields and are interested in how the brain can be treated and adapted from a psychotherapist's perspective, then this book is for you. Also, the author relies on facts and actual scientific findings rather than his own opinions. Throughout the book, Cozolino uses real case studies to explain and supplement his points. In the event that an issue is unclear or still debatable, Dr. Cozolino makes sure to point out that the idea is not completely correct or accepted.
In his book, The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain, Dr. Louis Cozolino argues for the integration of neuroscience into the fields of psychology and psychiatry. He feels like not enough psychologist and psychiatrists embrace the usefulness and effectiveness of neuroscience in their therapies. Dr. Cozolino makes the argument that in all psychotherapies, no matter the methods used and perceived goals of the therapy, the deeper goal is to rewire the neural networks of the patient's brain in a positive way. The book relies heavily on the neuroplasticity of the brain, explaining how evolution has made the brain very adaptive and adjustable, even after early age.
From start to finish, the book flows in an organized and comprehendible manner. The book is divided into five parts, each of which addresses different concepts in neuroscience and/or psychotherapy. Part one includes a general history of neuroscience in psychotherapy, discussing in depth the contributions of Sigmund Freud and other psychologists. Dr. Cozolino claims that Sigmund Freud was indeed a neuroscientist, but because neuroscience was not a very appealing science at the time, Freud chose to focus on psychological models instead. This section also discusses the basics of neural networks and there is a whole chapter devoted to the different strategies used in psychotherapy. Regardless of the strategy, Cozolino argues that the goal is the same: to rewire the neural networks in a positive manner.
"The power of stress to trigger neural plasticity is a key element in the success of psychotherapy." This is a very important concept in psychotherapy because all the forms of therapy rely on some form of stress to induce the desired results. The book argues that not using stress is not very productive, and excessive stress is counter-productive. In other words, moderate stress is essential for optimal results, especially in psychotherapy.
The second part of the book contains more of the neuroscience essentials. It discusses all the parts of the brain and nervous system, and how memory is a key factor in the psyche. Although it is desirable to think that memories are stored in a specific location in the brain, this is not true. Memories are stored throughout the brain. The book then goes on to explain the relationship between implicit and explicit memories. Implicit memories are unconscious memories while explicit are conscious memories. Also, this part of the book goes in depth explaining the various process that go on in both hemispheres of the brain and how they are connected. For example, an important function of the left hemisphere is linguistics while the right hemisphere processes emotion. However, the process of communication is tied heavily to linguistics and emotion, so both hemispheres are used together.
Dr. Cozolino makes an interesting comparison that I feel is worth mentioning. He discusses how after World War II was over, some Japanese soldiers that had been abandoned on various islands in the Pacific Ocean were not aware that the war was over. Whenever someone would land on the island, the soldiers were ready to attack because to them, the war was still going on. They were fighting a war that no longer existed. These soldiers are compared to deep memories in the brain that are hard to get over. "Psychotherapists" are the people that land on the island and try to tell the soldiers that the war is over. This is analogous to psychotherapists trying to relieve a client/patient from a past memory that is rooted deep. The neural network must be rewired.
Part three of the book talks about how the brain is affected by experiences. Cozolino addresses key points to how the brain adapts and which parts of the brain are involved. For example, the book discusses the importance of the frontal and prefrontal cortices on behavior and emotion. This section of the book also discusses the importance and significance of social interaction the brain and psyche. The way we communicate and interact with other people has a profound effect on our neural networks. For example, eye contact and facial expressions are key signals in human communication.
Part four takes all the concepts from the first three parts and discusses their application to various psychiatric problems and disorders. Dr. Cozolino points out how early childhood relationships have an extraordinarily profound effect on the development of the psyche. "Each of us is born twice: first from out mother's body over a few hours, and again from our parents' psyche over a lifetime." This quote summarizes the importance of proper early childhood development and good parenting.
This section also discusses the concepts of fear and anxiety. The chapter discusses how fear and anxiety are processed and traces the "circuits" of fear. "Slow" fear is processed through the thalamus, cerebral cortex, and hippocampus, while "fast" appears to be processed by the amygdala, which is crucial in the processing of fear and anxiety. "The behavior of all organisms is based on approaching what is life sustaining and avoiding what is dangerous." This is a central belief on human behavior.
Part five ties all loose ends and strongly stresses the strength of neural plasticity. The idea that the brain is constantly changing and evolving is fundamental in this book and to psychotherapy. Dr. Cozolino explains that although deep knowledge of the inner functions of the brain is not completely available, neuroscience is a very valuable tool and perspective in psychotherapy. He encourages the reader and all psychotherapists to embrace neuroscience and not be afraid of its complexity.
I thoroughly enjoyed reading the book and I recommend it to anyone with an interest in psychology, neuroscience, or counseling. It is simple to read, does not use complicated jargon, and is very informative.
posted by amileighs at 4:29 PM on March 30, 2012 [9 favorites]
You might be interested in "The Brain that Changes Itself", by psychiatrist Norman Doidge.
posted by greatgefilte at 4:30 PM on March 30, 2012 [1 favorite]
posted by greatgefilte at 4:30 PM on March 30, 2012 [1 favorite]
Best answer: Omiewise has commented quite a bit in other threads about the evidence supporting therapeutic efficacy, but for my money his most helpful comment for people that want to get started with therapy but aren't sure that it works (or how they'll know it works) is here.
I don't know that I have any pressing need for therapy anytime in the near future, but I still favorited that comment as being so useful in the event I ever NEED therapy that it was worth hanging onto.
posted by iminurmefi at 4:45 PM on March 30, 2012 [4 favorites]
I don't know that I have any pressing need for therapy anytime in the near future, but I still favorited that comment as being so useful in the event I ever NEED therapy that it was worth hanging onto.
posted by iminurmefi at 4:45 PM on March 30, 2012 [4 favorites]
Response by poster: Thanks for the answers so far -- I am finding them helpful! Please keep them coming.
To insectosaurus: Personal anecdotes are good if they explain why you believe in this process.
To greatgelfilte: I have read most of The Brain That Changes Itself, and it's an awesome book which sold me on the idea of neuroplasticity, but I don't remember it making a case for talk therapy being an efficacious treatment for psychological problems. Is that part at the end of the book, or did I block it out or something?
To iminurmefi: You're right, that Omiewise comment rocks! It addresses a lot of my questions and confusion and I really appreciate you pointing it out.
posted by feets at 4:59 PM on March 30, 2012
To insectosaurus: Personal anecdotes are good if they explain why you believe in this process.
To greatgelfilte: I have read most of The Brain That Changes Itself, and it's an awesome book which sold me on the idea of neuroplasticity, but I don't remember it making a case for talk therapy being an efficacious treatment for psychological problems. Is that part at the end of the book, or did I block it out or something?
To iminurmefi: You're right, that Omiewise comment rocks! It addresses a lot of my questions and confusion and I really appreciate you pointing it out.
posted by feets at 4:59 PM on March 30, 2012
Interestingly enough, one of my bits of homework for therapy today was coming up with "cheerleading" helps for me to use when I'm trying to get myself to go and do something I don't want to do. Because I am a super rational-mind person, all of my helps are really rationally oriented. One is the statement "Even when I don't really enjoy therapy, and am scared to go, and it feels lousy right then and I walk away crying, my life is much, much better when I regularly go to therapy than when I don't. So I should go today."
That's my anecdote. I've done life on therapy and I've done life not on therapy. Life not on therapy works for a while, sometimes, when my brain chemistry is just right and everything has fallen into place and good things (but not too good) are happening to me and yay.
Life on therapy works during times like that, plus all the rest of the time.
The specific benefits I get from therapy include:
- having someone to help me retain focus while talking through a problem, situation, my emotions, etc. I don't do so well on the "intentionally and carefully thinking about something which is distressing to me" thing when I'm on my own; the internet and pretty much everything else (including the sudden desperate need to resolve the dust problem I never notice except when I'm thinking about upsetting things) always seems to get in the way.
- knowing, during the week, that I can refrain from saying Thing That I Am So Totally Feeling Right Now, Which Would Not Help If I Said It Right Now - because there's a time and place I can say it safely, where it'll do me some good.
- having a place to practice ideas out loud before putting them into practice in my daily life.
- having accountability, including simply the fact that there's a medical professional who is aware of what is happening, sees me every week, and has the resources to step in if things go really really bad (bearing in mind I have some heavy diagnoses.)
- having a place where I can be 1000% honest. I find that I'm OK at pretending for medium to long stretches of time, slowly building up tension and unhappiness and making things progressively harder for myself and more difficult to unravel. Therapy is like a release valve - I'm supposed to be honest there. There were times this week I was able to make myself laugh on command and pretend to be having a great time, and then in bed trying to sleep, or alone in the car, I was indescribably miserable. In therapy (and also my psychiatrist's office, and also group sessions) the incentive to be Happy Everything Is Fine Me is gone. And stuff gets solved that way - nothing gets solved when you're stuffing it all down.
That's what I can think of off the top of my head. Today in therapy we mostly talked about how I'm slipping further into a major depressive episode, and there's only so much medications can do, and I have to make some serious choices about the stuff I will and won't be committing to and participating in (to manage stress, etc.) while I'm this unstable. We worked through some "if I do this I will feel like a quitter, and quitters are weak and evil and horrible and unworthy and incompetent and total failures and don't deserve to live" issues, and as a bonus, D (my therapist) said some very kind things about the progress she's seen in me over the last three and a half months. At the moment I was my usual "oh, I can't accept compliments, especially when I can't independently verify them" self, but I will actually feel a little better about myself in the future for her having said that.
I walked away from the session with a concrete plan of action, some tools to help myself step back from the "I am fail" mantra, and the knowledge that no matter how badly I screw up, D will be supportive and helpful and will not freak out at me (the way my mom would, for instance) when I tell her honestly that I, well, screwed up.
And, I mean - yesterday if you'd asked twenty people who'd seen me, what kind of day I'd had, they'd have thought it went really well. They saw me doing things and I seemed pretty cheerful and together. And when I drove home all I could think of was how much I needed to be safe in a quiet, dark place with no people in it. I tried to get myself to go to the store to pick up food for dinner, and I nearly burst into tears as I passed the turn to my apartment to go to the store. I had to turn around and come home, because I was completely out of juice. I was barely able to make it to 8:30pm.
Today, the depression still has me - and I spent a cumulative total of an hour crying in my therapist's and doctor's offices. Someone who secretly tailed me today would have said this was a much worse day than yesterday. But right now, 8:30pm, I am not as miserable as I was yesterday, because I've taken some action, and talked stuff out, and so on and so forth. Therapy really helped, even though it was hard and in the strictest sense there were no monumental breakthroughs or anything.
I will also say this: therapy and medication and taking care of the critical wellness stuff (in my case that means things like never staying up super late, sharing plans for cross-country travel with my family and making sure they OK it and agree I'm not manic before I get in the car, and so on) are the reason I have a job, health insurance, a car, my own apartment, money, the computer I'm using to post this comment, a MetaFilter account, Netflix, and pretty much every other thing in my life. It took me seven years to independently bootstrap my way through a handful of college credits and into a professional job, and less than a year after that I was in serious jeopardy of losing it all due to mental health issues. Therapy is where I started finally turning that around, and the last three years of my life have been approximately seven billion times more productive in terms of my health, finances, etc., than the previous fifteen had been.
I only wish I had been in treatment, working to get better, when I was 15, instead of waiting till I was 29. I'd be a hundred pounds lighter, I'd probably have a graduate degree, and I'd have a much bigger retirement account if I'd taken care of my issues when it was first really obvious I had freaking issues to take care of.
To answer your data-seeking question with some less-dataish information:
You might want to look at this APA document about how psychotherapy helps with depression, and the APA help center article about effective treatment for anxiety. They also have an article about how to find help through seeing a psychologist.
The Anxiety Disorders Association of America might also be of interest. They have an explanation of the various kinds of treatment options available.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:45 PM on March 30, 2012 [3 favorites]
That's my anecdote. I've done life on therapy and I've done life not on therapy. Life not on therapy works for a while, sometimes, when my brain chemistry is just right and everything has fallen into place and good things (but not too good) are happening to me and yay.
Life on therapy works during times like that, plus all the rest of the time.
The specific benefits I get from therapy include:
- having someone to help me retain focus while talking through a problem, situation, my emotions, etc. I don't do so well on the "intentionally and carefully thinking about something which is distressing to me" thing when I'm on my own; the internet and pretty much everything else (including the sudden desperate need to resolve the dust problem I never notice except when I'm thinking about upsetting things) always seems to get in the way.
- knowing, during the week, that I can refrain from saying Thing That I Am So Totally Feeling Right Now, Which Would Not Help If I Said It Right Now - because there's a time and place I can say it safely, where it'll do me some good.
- having a place to practice ideas out loud before putting them into practice in my daily life.
- having accountability, including simply the fact that there's a medical professional who is aware of what is happening, sees me every week, and has the resources to step in if things go really really bad (bearing in mind I have some heavy diagnoses.)
- having a place where I can be 1000% honest. I find that I'm OK at pretending for medium to long stretches of time, slowly building up tension and unhappiness and making things progressively harder for myself and more difficult to unravel. Therapy is like a release valve - I'm supposed to be honest there. There were times this week I was able to make myself laugh on command and pretend to be having a great time, and then in bed trying to sleep, or alone in the car, I was indescribably miserable. In therapy (and also my psychiatrist's office, and also group sessions) the incentive to be Happy Everything Is Fine Me is gone. And stuff gets solved that way - nothing gets solved when you're stuffing it all down.
That's what I can think of off the top of my head. Today in therapy we mostly talked about how I'm slipping further into a major depressive episode, and there's only so much medications can do, and I have to make some serious choices about the stuff I will and won't be committing to and participating in (to manage stress, etc.) while I'm this unstable. We worked through some "if I do this I will feel like a quitter, and quitters are weak and evil and horrible and unworthy and incompetent and total failures and don't deserve to live" issues, and as a bonus, D (my therapist) said some very kind things about the progress she's seen in me over the last three and a half months. At the moment I was my usual "oh, I can't accept compliments, especially when I can't independently verify them" self, but I will actually feel a little better about myself in the future for her having said that.
I walked away from the session with a concrete plan of action, some tools to help myself step back from the "I am fail" mantra, and the knowledge that no matter how badly I screw up, D will be supportive and helpful and will not freak out at me (the way my mom would, for instance) when I tell her honestly that I, well, screwed up.
And, I mean - yesterday if you'd asked twenty people who'd seen me, what kind of day I'd had, they'd have thought it went really well. They saw me doing things and I seemed pretty cheerful and together. And when I drove home all I could think of was how much I needed to be safe in a quiet, dark place with no people in it. I tried to get myself to go to the store to pick up food for dinner, and I nearly burst into tears as I passed the turn to my apartment to go to the store. I had to turn around and come home, because I was completely out of juice. I was barely able to make it to 8:30pm.
Today, the depression still has me - and I spent a cumulative total of an hour crying in my therapist's and doctor's offices. Someone who secretly tailed me today would have said this was a much worse day than yesterday. But right now, 8:30pm, I am not as miserable as I was yesterday, because I've taken some action, and talked stuff out, and so on and so forth. Therapy really helped, even though it was hard and in the strictest sense there were no monumental breakthroughs or anything.
I will also say this: therapy and medication and taking care of the critical wellness stuff (in my case that means things like never staying up super late, sharing plans for cross-country travel with my family and making sure they OK it and agree I'm not manic before I get in the car, and so on) are the reason I have a job, health insurance, a car, my own apartment, money, the computer I'm using to post this comment, a MetaFilter account, Netflix, and pretty much every other thing in my life. It took me seven years to independently bootstrap my way through a handful of college credits and into a professional job, and less than a year after that I was in serious jeopardy of losing it all due to mental health issues. Therapy is where I started finally turning that around, and the last three years of my life have been approximately seven billion times more productive in terms of my health, finances, etc., than the previous fifteen had been.
I only wish I had been in treatment, working to get better, when I was 15, instead of waiting till I was 29. I'd be a hundred pounds lighter, I'd probably have a graduate degree, and I'd have a much bigger retirement account if I'd taken care of my issues when it was first really obvious I had freaking issues to take care of.
To answer your data-seeking question with some less-dataish information:
You might want to look at this APA document about how psychotherapy helps with depression, and the APA help center article about effective treatment for anxiety. They also have an article about how to find help through seeing a psychologist.
The Anxiety Disorders Association of America might also be of interest. They have an explanation of the various kinds of treatment options available.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:45 PM on March 30, 2012 [3 favorites]
You will at minimum respond to attention and study of yourself. It's been called the Hawthorne Effect after a factory study.
posted by michaelh at 5:54 PM on March 30, 2012
posted by michaelh at 5:54 PM on March 30, 2012
Best answer: feets, I seem to recall the author (who is a practicing psychoanalyst) mentioning neuroplasticity as a potential mechanism for the changes seen in psychotherapy, but I could be conflating that with his other work.
There's also some neuroimaging work out there (e.g. Goldapple et al) that shows that psychotherapy has a distinct effect on the brain (though different from the anti-depressant response), but I tend to take most neuroimaging studies with a grain of salt.
Anecdotally, I like to tell the story about a primary care doctor I worked with who joined a network that enabled her to refer patients to a social worker for psychotherapy. She told me that since she started referring people, her rate of prescribing anti-depressants dropped about 50%. FWIW.
posted by greatgefilte at 5:58 PM on March 30, 2012 [1 favorite]
There's also some neuroimaging work out there (e.g. Goldapple et al) that shows that psychotherapy has a distinct effect on the brain (though different from the anti-depressant response), but I tend to take most neuroimaging studies with a grain of salt.
Anecdotally, I like to tell the story about a primary care doctor I worked with who joined a network that enabled her to refer patients to a social worker for psychotherapy. She told me that since she started referring people, her rate of prescribing anti-depressants dropped about 50%. FWIW.
posted by greatgefilte at 5:58 PM on March 30, 2012 [1 favorite]
Why do you feel it's important to have a scientific explanation of why therapy works?
posted by univac at 8:09 PM on March 30, 2012 [2 favorites]
posted by univac at 8:09 PM on March 30, 2012 [2 favorites]
A lot of that sounds like my experiences with therapy - kind of aimless talking. What the deal is with me, is that the perfectionism actually manifested in seeking therapy - "Sometimes when stressful things happen, I spend time worrying about them. Also sometimes I have to cut back on my other commitments, and I'd rather find a way not to do that." I had a couple of therapists (at different high-stress times of my life) tell me basically "you're doing just fine, I'm glad to talk to you but I think you have a great plan for dealing with these issues and are coping really well". Therapy isn't really going to make sad things not sad, or scary things not scary, or stressful things not stressful. But if you're in a tough spot it can give you a safe place to feel those feelings and develop the ability to cope with them so that you can still live your life.
You do seem to have a specific issue that would benefit from counseling, in your relationship with your parent. If you're visiting a therapist who's particularly familiar/expert with family issues, they might have a lot to point out to you about ways you can engage/disengage or strategies you can use to better communicate with / deal with your parent. Also, they might be well able to point out patterns and other things that you might not notice on your own. I think what I might find most valuable in that situation is just having someone to talk to who won't think badly of either me or my parent (or, if they do, it sort of doesn't matter). You can't go talk to your friends about how you just wish your parents would disappear, or how you couldn't stand talking to them any more and hung up on them mid-sentence, without feeling like it reflects on you - but your therapist is all about helping you sort out your feelings and deal with them.
So that's how I would see it helping you - and an example of a case where it really didn't help, just for contrast.
posted by Lady Li at 9:14 PM on March 30, 2012
You do seem to have a specific issue that would benefit from counseling, in your relationship with your parent. If you're visiting a therapist who's particularly familiar/expert with family issues, they might have a lot to point out to you about ways you can engage/disengage or strategies you can use to better communicate with / deal with your parent. Also, they might be well able to point out patterns and other things that you might not notice on your own. I think what I might find most valuable in that situation is just having someone to talk to who won't think badly of either me or my parent (or, if they do, it sort of doesn't matter). You can't go talk to your friends about how you just wish your parents would disappear, or how you couldn't stand talking to them any more and hung up on them mid-sentence, without feeling like it reflects on you - but your therapist is all about helping you sort out your feelings and deal with them.
So that's how I would see it helping you - and an example of a case where it really didn't help, just for contrast.
posted by Lady Li at 9:14 PM on March 30, 2012
Response by poster: To greatgefilte: I just found the book and you're right, there is a psychotherapy chapter. I guess I never even skimmed the book's last third ... thanks for providing me something to read tonight!
To univac: It's hard to want to embark on a many-moon, many-dollar activity without believing it has a decent chance of success. Seeing evidence that it works helps make me comfortable trying again -- and understanding the mechanisms would help my motivation too.
posted by feets at 9:23 PM on March 30, 2012
To univac: It's hard to want to embark on a many-moon, many-dollar activity without believing it has a decent chance of success. Seeing evidence that it works helps make me comfortable trying again -- and understanding the mechanisms would help my motivation too.
posted by feets at 9:23 PM on March 30, 2012
The neuroscience of talk therapy falls under the Hebbian Principle - neurons that fire together wire together. That is, our patterns of thinking are so deeply engrained in our brains that those pathways are strong, and they activate easily and naturally. When we force new thought patterns, we force new synapses. When we reinforce those new thought patterns - practice them - we strengthen those synapses. Literally, through NMDA glutamate receptors (if you really care for the neuroscience), which activate G-coupled protein receptors which help dendrites become more receptive, every time we practice a new way of thinking, we reinforce this new circuit in the brain.
posted by namesarehard at 11:35 PM on March 30, 2012 [3 favorites]
posted by namesarehard at 11:35 PM on March 30, 2012 [3 favorites]
Tell your therapist that you have doubts about if therapy works at a scientific level and that you're interested in the science of it...this will help them understand what you're coming in with. I think others have given some great examples of how therapy works and the "brain science" behind it, but just know that it might take a lot of time for your brain to rewire and your thought patterns to get healthier.
posted by sweetkid at 12:44 PM on March 31, 2012
posted by sweetkid at 12:44 PM on March 31, 2012
This thread is closed to new comments.
A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. "Clients with generalized anxiety disorder (GAD) received either (1) applied relaxation and self-control desensitization, (2) cognitive therapy, or (3) a combination of these methods. Treatment resulted in significant improvement in anxiety and depression that was maintained for 2 yrs."
This one is available to anyone, it looks like: COGNITIVE-BEHAVIORAL THERAPY FOR ADULT ANXIETY DISORDERS: A META-ANALYSIS OF RANDOMIZED PLACEBO-CONTROLLED TRIALS. "Our review of randomized placebo-controlled trials indicates that CBT is efficacious for adult anxiety disorders."
MeMail me to remind me tomorrow, and I can send you the full PDFs of the first two. (Or someone else who has access can probably do it sooner than that.)
posted by supercres at 3:38 PM on March 30, 2012 [3 favorites]