Ask MetaFilter questions tagged with cbt

Managing the damage. But how?

Anonymous — Sun, 29 Nov 2009 12:05:38 -0800

Anti-anxiety medication: blessing or cop-out? About a year ago, I had my first panic attack. It didn't happen in response to any specific situation or trigger; I believe it was more the aggregate response to a lifetime of small but persistent stressors which I could no longer deny or put aside. After a few more episodes, I started seeing a psychiatrist, who eventually put me on 10mg/day of Celexa on the grounds that I was over-thinking myself into a spiral about it and needed to see what it felt like to live without the obsessive, tail-eating thoughts that anxiety disorders produce.

Now, I also have a close friend who has suffered from anxiety his whole life. He has experienced many hundreds more attacks than I have (in addition to managing other factors such as OCD and social anxiety). He, however, has chosen to forego medication altogether, choosing instead to conduct his own personal form of CBT with no medical or psychiatric input.

While I believe he's made very good strides through his own method, and I can admire him for his dedication to staring this thing down through sheer force of will, I also see him succumbing to it again rather more than he wants to admit. I trust his years of experience in this matter, but it seems to me that he ultimately forces himself to suffer unnecessarily.

I feel the Celexa has allowed me to "get out of my own way" and lighten my psychological burden in a way I'm not sure I've ever actually experienced before. Also, panic episodes are so debilitating that I think I've occasionally become sick (flu-like) from the sheer physiological drainage they cause when I let them run roughshod over me. He, meanwhile, believes that drugs simply turn people into "robots" and that they only enable people to hide from themselves and their issues indefinitely. He sees medication as a cop-out and an act of emotional cowardice. He also thinks there is no way to actually confront or reconcile panic disorder while on medication, believing that direct exposure to panic episodes is the only thing that allows you to get comfortable with and work through them.

I recognize the necessity of CBT and working with a therapist to address the individual underlying issues and stressors that cause anxiety triggers to begin with. And I can admire the purity of my friend's method, even if I think he'd get a lot farther by doing it in a more guided capacity outside the vacuum of his own mind. But I can't see any downside (cultural judgments aside) to keeping the attacks at bay through medication until I can afford actual CBT.

So, what's the reality of the situation? Is the use of medication for anxiety disorder just a cheat? Is the best thing just to suck up and let the panic batter you around until you can retrain your own brain? Obviously I'm also dealing with the feeling of being judged by my friend, but I'd like to know what the latest word is from the medical community on the subject. Articles and citations are endless on the Web, but I'd sorta like a boildown from someone with a better handle on reliable information.

Help me find a (good) CBT psychiatrist/psychiatrist around 14th Street in Manhattan.

Anonymous — Sat, 28 Nov 2009 07:44:52 -0800

Help me find a (good) CBT psychiatrist/psychiatrist around 14th Street in Manhattan who takes Aetna student. Here's the symptoms I'd like to treat: I've been feeling kind of sad, a little lost and unmotivated. Probably some sort of depression, although it might just be situational. I've been feeling very compulsively sexual and have had been sexually abuse in my early years, leading to dysfunction in my relationships, so someone good with couples therapy/sexual issues would be great.

I don't have a Primary Care Physician (although I made an appointment for one based off of a metafilter found recommendation but it's not until February, and I'd rather not wait that long)

Insurance, etc: I have Aetnea student. I have access to DocFind but it's just a list of names, you know?

Why CBT: I had a talk therapist for years (along with medication) and I found it was easy to just vent, leave feeling relieved but not make any major changes in my life. I'm hoping CBT will be more focused and lead to more success and less wheel-spinning. That being said, if you have a great NON-CBT recommendation, I'm all ears, er, eyes.

Thanks in advance, since I probably won't be able to respond except through mods.

CBT in Baltimore

Anonymous — Wed, 11 Nov 2009 15:06:36 -0800

Please suggest therapists in Baltimore, MD that are familiar with CBT. I have moved to a new city and once again need to find a new therapist to help me cope with depression and anxiety. I am trying to find a therapist who specializes in cognitive behavioral therapy in Baltimore or Towson, Maryland. (I've made good progress with CBT in the past and would like to find a doctor who can help me continue that.) You can send private messages to cbtreferral@gmail.com.

Thanks!

Psychotherapy? Psicoterapia? Psychothérapie? психотерапия?

Keter — Wed, 14 Oct 2009 12:50:35 -0800

With regards to psychotherapy, a common opinion I've noticed on MetaFilter is that Cognitive-Behavioral Therapy is perceived as being the most efficient way to go, in addition to being one of the very few therapies likely to be reimbursed by health insurance. However, this may be coming from a largely American perspective. As such, I'm curious: What are some major features of psychotherapy in countries other than the United States? What are modes of therapy with which Americans might be familiar that are more popular elsewhere than they are in the US, and why are they more common in other places? Are there any psychotherapeutic traditions I as an American would be unlikely to have heard of or considered? Similarly, are there any therapeutic modalities that are distinctly American (or, in a less absolute sense, are more commonly found in the US or in Anglophone countries)? Within therapeutic modalities that might be familiar to us (CBT, psychodynamic, psychoanalytic), are there any schools or features of those modalities in other countries that may not be common in the United States? (For the last question, I have the general impression that French psychoanalysis is hella Lacanian, but have absolutely nothing of substance to back that up.)

On another train of thought: Who goes to get therapy—and who pays for it when they do? Are there places where psychotherapy is viewed with more or less stigma than it is in the United States?

I realize these are many, many questions, and I certainly don't expect to have all—or even most—of them answered. All-in-all, I'm just interested in learning more about how psychotherapy is perceived, researched, and practiced in places other than my home country... and why these psychotherapeutic landscapes may differ.

(For what it's worth, my own attempts to answer these questions have been rather fruitless, though I haven't the faintest of where to look. Some random searching on MeFi found me an interesting thread suggesting that psychoanalysis is really huge in Argentina. I also seem to recall an assertion I'll paraphrase as something like: "In France, psychoanalysis is therapy.")

Tell me why my worth isn't attached to my achievements.

Anonymous — Wed, 29 Jul 2009 15:50:06 -0800

CBT Related: How do you convince yourself that your personal worth is not contingent on achievement and success? I am engaged in cognitive behavioral therapy and have been successfully remapping some distorted belief systems in a number of areas. Success in truly adopting a new "healthy" belief system relies on your ability to rationally, logically convince yourself that this new belief is INDEED true. To the degree you actually believe it, you will adopt it. It can sometimes be tricky crafting arguments that challenge my unhealthy beliefs that my brain will actually accept...but with practice I get better at it. There is one MAJOR sticking area though...and that is my belief that my worthiness comes from my ability to achieve and succeed.

This belief causes considerable anxiety and grief for me personally and I have had a tough time coming up with an argument that I actually believe to the contrary. Since grade school we have been programmed to equate achievement with success (you got an A! you're now DESERVING!) And our society pretty much reaffirms this programming through media and popular culture. Those who succeed are more desirable mates, higher earners, more influencial...they get more, control more resources and are generally admired. To me, this translates to "better person." I am convinced by reams of data that they are not necessarily HAPPIER people...so that much I believe already. That being said, I generally feel down about myself when I am not achieving, succeeding, manifesting my awesome existence through stuff that makes people say "ooooh!" I constantly feel the pressure to amount to something extraordinary or suffer the consequences of being less than worthwhile...

What are some rational, realistic arguments that challenge this powerful belief system? So far I have been unable to convince myself that my own worth is unhinged from what I accomplish in life, and I am looking for the perfectly crafted argument that will drill penetrate my brain like a shiv with the handle broken off.

Therapy-filter: CBT practitioner in L.A.?

Anonymous — Tue, 28 Jul 2009 20:10:31 -0800

Asking for a family member: need recommendations for a top-notch cognitive behavioral therapist in downtown Los Angeles or around the Pasadena area. He's only interested in CBT therapy. Assume cost/insurance is no object. Thanks!

What will happen in counseling?

dilettante — Sun, 05 Jul 2009 16:09:52 -0800

What can my friend/former SO expect from community mental health counseling? Long background explanation: I have lived with someone for 9 years. He has mental health problems, with an ever-shifting diagnosis. This shrink it's Bipolar I with features of personality disorder, last was Bipolar II, before that...well, assorted nuts. All his previous treatment has been pharmaceutical, barring some short-lived and disastrous attempts at counseling when he was a teenager.

Most of the time I don't mind having him around and may actually like him to be present, but sometimes he gets angry, and turns it on me. For example, his computer desk breaks, and this turns into screaming, getting in my face, and calling me names, with screaming soliloquies about my assorted personality traits as viewed by him. This has happened occasionally as long as I've lived with him. I find it unacceptable, possibly abusive, and after several years of broken promises and apologies, he is to move out very, very soon.

I have suggested he go to counseling for (what I see as) an anger problem, and he says he will ask his shrink next week. He is on SSI, so his options for counseling will likely be limited to a community mental health system we have here. What can he expect from this, assuming he makes it through the waiting list? They say they use CBT - does anyone have any personal experience of whether this is effective with anger problems? Are there any other useful alternatives for someone with questionable motivation and no money?

Note that SSI leaves people desperately poor, and we are leaving open the possibility that he can move back in when his new lease is up if this helps (although he says he's not convinced this is his problem). He has not been an SO for several years now, but he is still my good friend and I do not want him at any risk of surviving in shelters or starving naked in the street.

Side effects of Cognitive-Behavioral Therapy (CBT)

pauldonato — Sat, 04 Jul 2009 12:31:51 -0800

Are there really no side effects to cognitive-behavioral therapy? Has anybody had a bad outcome or weird experience? The reason I ask is that I discovered CBT in 2004. Rather than forking over money to a therapist, I just read how it worked and tried applying it to myself. I found that it made me over-think my anxieties and in one case, aided me in putting blinders on myself in a situation, thereby making it worse.

Fast forward to now, and I can see that there are many many studies showing that CBT is effective. I'm using computerized CBT, and I've been reading a lot about how it works (literature I couldn't find five years ago). Needless to say, I think I'm excited about it, and think that I won't run into the same abuses and mis-applications that I had before.

However, after a few initial sessions this time around, I did notice some anxieties crop up. For example, one of my "warped thoughts" is "I can't relax otherwise I'll get screwed up." I went through the process of disputing that, and afterwards I started to relax but I also felt nervous about my relaxation. It almost reminded me of how I feel when taking Xanax. It's like, "this feels good, I'm relaxed. Oh wait, relaxed means danger!"

So my question is, are there any bad side effects to CBT? Are there any ways to abuse it?

"I still believe that sitting down and reading a book is the best way to really learn something. And I worry that we’re losing that." - E Schmidt

anastasiav — Mon, 22 Jun 2009 07:06:28 -0800

What are the most commonly used eLearning and/or CBT/WBT authoring systems out there in Corporate America? I need to update my skills as I return to corporate T&D after a six year break. When I left the industry, CBT/WBT was just getting a foothold. I have a strong background in usability and instructional design; what tools should I become more familiar with?

Love is the drug but I'm allergic to love

Anonymous — Thu, 18 Jun 2009 19:45:05 -0800

Summary: I have a crippling problem that I want to fix, but can the cure help me when I don't believe in it? Social anxiety disorder and CBT - can CBT help me if I think positive affirmation is a crock? The problem:
I have social anxiety disorder, quite badly. I was pretty happy when it showed up in the public eye a year or two ago; when I read a description of it the first time I cried all night just from the.. relief?... of understanding for the first time that the constant pain and stress of what I just thought of as my life had a cause, and not just that I was irredemiably unsuited to existence in the world. I've been clinically depressed and occasionally non-functional for my entire life (and I do mean from my first childhood memories) because of this, and basically the only reason I *do* function is that I dearly need a safe private space away from people to feel even a little comfortable, and that means rent which means money which means a job so... I've learned how to walk out my door and interact. This means I'm always at least minimally stressed, and usually end the day in a bad mental state (blaming myself for a thousand social failures), but it's better than spending my life lying on the floor behind the bed.
Anti-depressants have helped, but only so much. I need therapy, I know, if only to keep my prescription for the anti-depressants.... I've avoided therapy for a long time because of a time when I was committed as a child (and then released into an even worse situation, but that's another story). I've come a long way just by analyzing my own behaviour and looking for positive role models for behavior; I've stopped cutting, stopped being anorexic, and haven't tried to kill myself in a decade. Though I still have daily urges to both cut and kill myself as part of the self-blaming cycle at the heart of social anxiety, I can treat them as fantasy wishes and unrealistic and nothing that would ever actually happen and they just don't. I've managed to work myself around to accepting therapy as a needed positive and not something to be avoided, but there's a catch.

The cure:
The treatment for social anxiety disorder is CBT, Cognitive Behavioral Therapy. As I understand it, in some ways CBT isn't far from the way I've improved myself in the past - recognizing bad patterns and finding a better alternative for the inherent negative response.
But another way CBT seems to be presented is being about positive thinking - I am a special flower and deserve all the good yadda yadda. But the thing is... I think that special flowerhood is bullshit, and dangerous bullshit at that. I think that telling everyone that they are special and deserve good things is untrue and leads to bloated self-esteem and unrealistic feelings of entitlement. Among the millions and billions of us in the world, many of us *are* coasting, parasites. Contributing nothing, consuming, passing on. There may be a special flower in everyone but it doesn't bloom as often as the fairy tales would have us believe.

Social anxiety disorder is about feeling negatively judged by the world, completely against logic and common sense. Thus CBT would surely be aimed at changing my view of myself to be "better" i.e. not the negative object that is currently the target of the perceived hostility of the world. But I don't particularily think that I'm a special flower, nor do I think it's necessary that I be a special flower, nor am I likely to respond well to attempts to have me think of myself as such.

So... not seeing positive affirmation as a good thing for humankind in general, and believing it to be a false and harmful lie the very notion of which I find repugnant... what can I do?
For those who have done CBT, and specifically for social anxiety disorder: how much of it is about being a special precious flower who just needs to believe their own validation? Because that just won't cut it with me. I want help, but I don't think that I will be helped by heaping my plate with what is to me meaningless self-validation.
What is CBT like for those in it?
What alternatives are there for CBT if it proves too special-flowery to penetrate my philosophy?

I'd really like to live in the world without being constantly frightened and stressed. I'd like to have a week or even a day where I don't hate myself and think of death as a relief from the burden of simply living. I'd like to think there is a way.

Know a good CBT therapist in Virginia?

Anonymous — Wed, 06 May 2009 08:39:59 -0800

Please recommend a therapist who specializes in CBT in Virginia. I am trying to find a therapist who specializes in cognitive behavioral therapy in either Alexandria, VA or Richmond, VA. I moved this year, commute often between the two locations, and I am having a difficult time finding a new doctor to help me cope with depression and anxiety. I have made good progress with CBT in the past and would like to find a doctor who can help me continue that. You can send private messages to cbtreferral@gmail.com.

CBT therapist in nyc

skowtz — Sat, 18 Apr 2009 08:05:53 -0800

Looking for a good CBT therapist in nyc who takes GHI insurance? Any recommendations?

Self directed cognitive behavorial therapy?

Anonymous — Wed, 25 Mar 2009 14:40:42 -0800

What are my options when I have decided that I want to receive cognitive behavioral therapy, but I live in a non English speaking country with few mental health resources in general? I have recently come to terms to the fact that I have had a long term mild depression. In depression questionnaires I consistently score right above or below the minimum score for depression. I have no suicidal thoughts, so I am in no immediate danger, but I do engage in self destructive behaviors, that I really want to stop.

The largest of these is severe and absurd procrastination. By severe I mean that I procrastinate on things that are very important to my future, in work and in relationships, often to the point where the don't get done. And by absurd I mean that I procrastinate in really stupid ways. For example working for a month on a project and almost finishing it, but then delaying sending an email to my boss for weeks to ask about a few minor details that would take less than an hour to fix, or getting up on time to get to some important appointment, but then deciding that I need to finish a chapter in the book I am reading on the toilet so I am an hour late.

Time spent on the internet is a huge part of this, and one of my favorite ways to procrastinate is to look for solutions to my problems. From these searches, I have decided that CBT is the best way for me to go. I like the theory behind it and I think it is a good fit for the way I think.

However, I live in a non English speaking country that has poor mental health services in its own language let alone in English.

So what are my options as far as therapy goes? Have people been successful with do it your self CBT? I've seen a few sites for online therapists, but they I haven't been impressed with what I've seen. Any experiences with therapy, through chat or email? Any other thoughts or suggestions?

*I would be willing to give anti depressants a try, but I am not sure that I need them. I also would like to take them under care of a English speaking psychiatrist, but I do not have insurance coverage back in the states.

How to get treatment for depression without income or health insurance?

jnnla — Wed, 18 Mar 2009 16:14:14 -0800

I suspect I am suffering from Depression and I have no health insurance or current source of income - how do I get help? Three months ago I quit my high-paying job due to extreme job dissatisfaction, and with the job, I also lost my employee sponsored health care. I have since missed the deadline to file for COBRA (I live in California).

As a result I am currently unemployed (by choice) and without health care. I am 26 years old and am extremely fit and healthy physically (gym 3x at least per week), but mentally I suspect that I am suffering from depression.

I was diagnosed with depression as an 18 year old, but overcame it and within a year and a half became happy and healthy again.

Within the last two years, however, I have felt "flat," and I feel the familiar pangs of depression - a general all-encompassing apathy, constant anxiety and intrusive negative thoughts, as well as the random urge to cry or hole myself away in my bed. My omnipresent negative emotions and worries, I feel, prevent me from reaching my potential. These feelings partly led to my decision to quit my job, which was only exacerbating my condition. I committed to take time off for a few months to work on personal projects, explore other possible career paths, and to try to handle my negative feelings. I have saved up money (quickly running out) in order to facilitate this plan.

I would like to see a therapist and get a diagnosis, as well as schedule regular therapy sessions. In my normal state I am a very vibrant and social person, who has a zest and love for life - and I would very much like to have that person back and get him working again...but I feel I need treatment.

QUESTION:
So...what is an unemployed person without health insurance to do? How do I go about getting help? I can afford CHEAP health insurance for a few months (100-150 dollars per month). I have looked into Tonik, and am going to give them a call but it is unclear to me whether they have mental health coverage - furthermore, should I be mentioning my condition when calling health insurance companies or will that get me denied or put me in a waiting period for treatment? I assume my options are to see a therapist of my choice out of pocket or to buy health insurance and have them foot the bill for an in-network shrink. In the meantime are there any free or state-sponsored options I can look into? Any help on the matter would be greatly appreciated!

How I learned to stop worrying and love the Human Papillomavirus

Anonymous — Fri, 20 Feb 2009 09:03:28 -0800

Why does a healthy adult keep getting warts? How to prevent? How to cope? I’m 24 years old, relatively healthy, and seem to be uniquely susceptible to warts. I also have tendencies towards obsessive-compulsive behavior, and lately, I’ve been showing symptoms of depression. I’d really appreciate some medical information and psychological counsel, as well as some personal anecdotes.

Right now, I have a very small wart on the bottom of my left big toe, and something that seems to be developing into a wart on my left thumb. Probably wouldn’t be a big deal for most people, but it’s affecting me pretty significantly, especially this last discovery with the thumb. I keep looking at it constantly and prodding it and seeing if there’s any new development.

In the past, I’ve had warts crop up here and there, which have thus far been eliminated (after a lot of stress and multiple different treatments were thrown at it), with the exception of my most current warts, obviously. Even the giant plantar wart that was three inches in diameter (pretty amazing, really) was eventually eliminated with cantharidin treatments my freshman year of college.

Still, these warts take their toll psychologically, and recently, I’ve been led to do some thinking. It strikes me as odd that a healthy adult, especially one with OCD tendencies, would keep getting warts like this. So my first question would be: is there anyone who, as adults, have or have had the same problem? My guess is that there are, but I’d like to hear about it.

Second, is it even worth stressing over warts like this? What are the real dangers of having warts? Also, should I now be keeping my thumb covered at all times? Because I more or less did that for my foot (although I have been going to bed barefoot) and yet here I am with another wart, on my thumb, of all places.

Which leads to the third question: is HPV pretty much everywhere? Because I was originally going to ask a question a while back on MeFi about how to kill/inactivate HPV on surfaces, like the floor, for instance, but I’m now led to believe the attempt would be futile and impractical. Am I right? Am I to worry about shedding on my instrument (a string instrument, so made of wood and covered with varnish)? (Viral shedding, not shredding.)

Fourth, anything else I should be aware of, from a medical standpoint? I’m wearing flip-flops in the shower, drying my feet (which I didn’t do before, figuring I was safe). I’m treating my toe with salicylic acid and waiting on the thumb. Anything to help my immune system?

Fifth, probably the most important. As I mentioned, this latest discovery of the possible wart on my thumb has gotten me pretty down. I guess it’s partly because I was more or less coming to terms with the one on my foot, which seemed like it was on its way out, and now I have this new thing on my thumb, which is worse, since I’m a musician and I work with my hands. And let’s not forget the fact of my dealing with OCD.

Now, I’m thinking these are the thoughts, conscious and subconscious, that are running through my head:

I shouldn’t be getting warts.
In a just world, this wouldn’t happen to me.
I did everything and it didn’t make a difference.
Nobody else seems to be getting warts. Especially not the cool kids, who seem so worry-free.
These warts are going to get worse.
These warts are going to multiply.
They’re going to get on my hands, my face, and my groinage area.
I’m going to turn into the treeman like that guy from Indonesia. (Probably unlikely.)
I’m going to contaminate the things around me, especially my instrument.
I won’t be able to do my job.
I’ll keep passing them on to myself.
I’ll pass them on to others.
I’m going to have to deal with this stress, with treatment and “quarantining” and just the general fact of having warts, for months to come. (I’m stressing over stress.)

Now, these are examples of distorted, irrational thinking. I think. I mean, some of them might have an ounce of truth to it, but it’s getting magnified and twisted beyond what’s reasonable. I haven’t gotten beyond Chapter 4 of David Burns’s The Feeling Good Handbook, so my final question: how do I deal with these thoughts? How do I learn to stop worrying and love the Human Papillomavirus? Any help would be welcome. Repeating “It’s not your fault” like Robin Williams might not hurt, either.

If you made it this far, congratulations. I’ve put hours into editing this, and because I have so many questions and now would just like some answers, I’m posting this as is. Thanks for any help with any of the questions in advance. IANAD disclosures for the medical questions would be appreciated.

Postscript:
I really don’t know if this thing on my thumb is a wart or not. I noticed some rough skin on the nail groove, next to the nail, and I pruned it with a nail clipper. It’s still a bit hard, so, I really don’t know. I wish I did.

As for why I’m not seeing a professional psychiatrist, it’s because I’m cheap, and due to my circumstances, geographic and otherwise, it’ll take forever to get an appointment, and it’ll be expensive, and by the time I get an appointment I might not be here.

My obsessions and compulsions arise mostly out of thoughts dealing with contagion. I didn't originally respond to the notion of actual germs, just the notion of general filth, passed on by touch (ad infinitum), but since moving, I've noticed that my thoughts started dealing with actual pathogens. Less so now, but it's become a factor.

Now that I’ve thought about it, I’ve pretty much gotten warts while I was away from home: away at college, away at a summer program, and now while I’m in Europe. So stress seems to be a big factor. Doesn’t make it easier, though.

CBT in the T.O.

Anonymous — Sat, 17 Jan 2009 15:01:04 -0800

Can anyone recommend a mental health professional in the Greater Toronto Area who does CBT? I've been dealing with depression and anxiety, as well as the fallout related to the recent diagnosis of a learning disability and being on academic suspension from university. Cognitive behavioural therapy has been suggested to me by my psychiatrist and my family doctor, and it's time that I give it a try. I want to start therapy as soon as possible so that I can be in a better headspace when I start school again in several months. If anyone can suggest a practitioner with non-ridiculous waiting lists and hourly fees, that would be wonderful.

If you're not comfortable answering in the thread, please email ineedtofixmylife@gmail.com.

Recommendation for therapist specializing in panic/anxiety in St. Louis area?

Locative — Sun, 11 Jan 2009 10:23:45 -0800

Need a therapist who specializes in anxiety and CBT in the St. Louis / West St. Louis County area. For a person who has anxiety and panic attacks associated with their job, and probably some depression in the mix as well. They've been coping with Xanax and smoking, neither of which work.

PM me if you don't want to post. Thank you!

Seeking Online CBT Resources

Anonymous — Wed, 12 Nov 2008 17:51:11 -0800

I am looking for Cognitive Behavior Therapy websites to supplement my independent reading and work. I have been working through the book Feeling Good for the past few months (after reading many recommendations for it here on AskMe), and it has been making a big difference in my life. I don't have health insurance, and make very little money, so I am trying to find extra resources to supplement what I'm doing on my own. I figure I am sitting in front of a computer all day at my bookstore, and maybe I can apply this time to online exercises or worksheets, or things of that nature. My life is about to experience a new set of difficult complications in a month, and I want to be in the best mindset possible. (Also, if anyone knows of very affordable CBT therapists in NYC I would be indebted to you for the information!) Thanks.

Recommedations for CBT therapists in Austin?

Anonymous — Tue, 28 Oct 2008 10:00:43 -0800

I have a friend who suffers from anxiety and panic disorder. She currently sees a therapist, but is interested in a more structured approach. Does anyone have a recommendation for a female therapist in Austin, TX who specializes in Cognitive Behavioral Therapy? I would also be interested in getting recommendations for brief inpatient programs.

I need discipline! (no, not that kind of discipline)

Anonymous — Sun, 26 Oct 2008 15:26:10 -0800

Help me re-develop personal discipline without tearing myself to pieces. I reached adulthood with all the typical cognitive screwups of someone who was once a 'gifted kid': unreasonably high standards, bad study and work habits, a tendency to procrastinate and a nagging sense that I was utterly failing to reach my potential. Yeah, me and half of Metafilter, I'm sure.

With cognitive behavioural therapy, I've worked through a lot of this. I've learned how to lower my standards to somewhere below the stratosphere, to stop punishing myself like an overbearing parent, to break up tasks into manageable chunks and to carefully manage the depression and anxiety which have haunted me through most of the past ten years. I'm a whole lot less highly-strung than I was, and I no longer have any attachment to the idea of being 'special'. I'm an ordinary adult and I just want to finish my degree and continue to progress in my career.

What I really need, though, is to learn a new method for self-discipline. CBT taught me that old way of disciplining myself was contributing to my depression.

My thought process used to go something like this:

I should do this difficult intellectual task -->
I'm reluctant to start this task because I'm afraid I be able won't do it perfectly -->
I'm a bad person for procrastinating on this task -->
I won't do anything fun until I've done this task, that'll motivate me to do it -->
I hate the world, there is no joy in my life; I never do anything fun -->
I don't deserve to do anything fun because I haven't done this difficult intellectual task -->
I'm miserable and anxious and I'm a bad person. -->
I should do this difficult intellectual task.

Rince, lather, repeat until suicidal.

So I learned not to 'beat myself up' when I fail to meet my own expectations. Some of those expectations really were unreasonable, so I'm glad I'm no longer bound by them. But I do still need self-discipline in my life; there are tasks I must do despite there being no immediate external consequence for not doing them. And although I'm no longer self-flagellating myself into depression about them, sometimes I just...don't do them. If I try to brute-force myself into doing them, that old thought process is still there, all too eager to take over and help me tear myself to pieces about it.

So, how do I develop the personal discipline to meet my own, mostly reasonable, expectations? Without 'punishing' or 'rewarding' myself in ways which remind me of that old thought process (and, to get all Freudian for a moment, of my parents).

How do I do that? How do you? Am I right in thinking it has something to do with personal integrity? Authenticity, perhaps?

Yes, I'll discuss this with my therapist. No, I'm not on meds, and that isn't going to change.

Is there a therapist who can get past my mom's suspicions?

Nattie — Wed, 22 Oct 2008 11:30:50 -0800

Recommendations for a cognitive behavioral therapist in the Houston area for my mother? He/she is going to have to deal with a lot, especially because she is irrational and suspicious. I need to be sure that the therapist is good because my mom has a lot of issues that need to be addressed, but she tends to be suspicious of anyone who tries, or else she has a nervous breakdown and starts crying.

If it matters, she's in her mid-50s.

- My father died less than a year ago. She has said she might need to get therapy for dealing with this but, to my knowledge, has made no moves yet, so I'm hoping to steer her in the right direction. She understandably feels some anger about his death too, since he died from the Digitek tablets that were mistakenly twice the listed dosage.

- I'm not even sure how to put this except bluntly. For at least five or six years now, she has read a website that has lead her to believe all of the following: the government puts microchips in people's brains to program them, but people can be "deprogrammed" if they do the right things; reptile shapeshifter people exist that look just like normal human beings; the husband of the couple who runs the website has been abducted and informed by various different species of aliens of all this stuff; etc. They often take news stories and twist them into evidence of their claims. They post other things daily, like aliens landed here but it's been covered up, or the numerology of this and that means some outrageous thing, and so on.

It is extremely delusional and paranoid, but you can't disagree with her because she just thinks anyone who denies it does so because they're programmed to. If pressed on the more ridiculous stuff sometimes she will say she doesn't take it very seriously, but trust me, she does. It's very awkward to watch TV with her and have her say she thinks someone is a reptile, or for her to talk about someone being rude to her at work and attributing it to their programming or something.

The website also told her that California is going to physically break off from the United States apparently within our lifetime, and uses this as a reason why I should not move there with my husband who recently got a job there. She became very upset and started crying when we tried to explain to her that land masses take much longer than that to break off, if it's going to break off at all. Things like that make it very upsetting to be around her now. She is trying to influence the direction of my life based on completely out-there, untrue claims.

If I hadn't seen the website for myself I would think she'd developed some sort of mental illness, but she's always just been very impressionable and superstitious. Since she holds a lot of irrational beliefs, apparently because they make her feel better on some level (i.e. to believe she's deprogrammed and everyone else isn't), I think CBT would be best for her, but I think (I hope I'm wrong) this is probably more difficult to deal with than your typical patient.

- On a similar note, she will make stuff up and then believe it 100%. It's disturbing. For example, another one of her arguments against our moving to California was that the rent was three times higher there. When we told her we were only paying a couple hundred dollars a month more than we were in Austin, she would move on to another irrational argument, then come back to the "three times higher" argument again.

- More irrationality: she's maybe $100,000 in debt but she won't even compile her financial data to find out. When I asked her why, she admitted it was because then she'd have to deal with it, and she was scared. I pointed out that she was paying all the bills anyway so it doesn't make a difference, and that the only way she can make things better is to look at it. She doesn't even know what interest rate her credit cards are, for example, so she's paying way more than she needs to; she has a card that's 30% interest rate with a balance on it that she could entirely transfer to a 20% interest rate card. She won't do it. I have offered to do it for her and she just says she'll think about it.

This is going to turn out very badly if she doesn't get help soon.

- She is extremely judgmental. She was completely anti-racist as I was growing up, until about high school when she started hating Hispanic people because we lived in a Hispanic ghetto, and then after Hurricane Katrina she started hating black people because crime rates in Houston went up. This has gotten progressively worse and it's quite upsetting. I can't have a conversation with her anymore without racist stuff coming up, even in the oddest places. (It would be more bearable for me if I could just avoid certain topics, but it doesn't work that way.) It makes her feel better on some level to believe that she's better than minorities and that they're the cause of her problems, so I think CBT might help with that.

- She worries about everyone, for mostly irrational reasons. She has always been this way, even since she was a child. The 24/7 worrying makes her an emotional mess, and in the past has had a lot to do with why she cries and has nervous breakdowns. I don't see how this can continue and I don't like seeing her get worse.

- This has started to affect our relationship negatively. She loves me more than anything and can't deal with my moving out of the state, especially after my dad has died. I understand that. But the ways in which it comes out lately have been very upsetting. She is negative and resentful of anything that makes me happy or I am excited about. She sighs about how different I am from her and calls me weird for normal things like being an introvert, which makes me feel very unaccepted. (I'm not a "weird" introvert either; I go out a lot and have normal friends. She calls me weird for being tired by social interaction.)

I try to see her more often to make her feel better, and because I used to have so much fun with her, but the last few times I have visited her she has been so negative and unaccepting of me that I've been entirely unhappy and just want to leave. I can't just go fake it either, because it's gotten to the point where I have nothing I can safely talk to her about. I point out how I'm feeling about specific things, like when I told her to quit being negative about California, but just that made her cry. I think if I told her that her behavior was pushing me away, instead of making me want to see her more, it would absolutely destroy her. Normally I would agree that telling her how I feel is the best solution, but I think it's well past the point where such a thing would be safe and I don't think I'm qualified to deal with the extent of her problems.

I'm hoping if I can recommend a cognitive behavioral therapist and say it's to help her deal with losing my father and my moving away, especially because she already expressed some interest in it, maybe the other stuff will get slowly dealt with too.

I'm not the only one affected by this either.

Sorry for the long explanation, but I partly wanted to vent and partly wanted to show how important it is that the therapist really know what he/she is doing. I think it would be difficult for any therapist to deal with my mom thinking they're trying to steer her wrong because they have a chip in their head, for example, and she's going to cry and deny things a lot.

One other caveat: I would prefer someone who's not going to drug her. I realize such a thing might be necessary but I would rather that conclusion be reached after a significant amount of sessions. She tends to have bad reactions to medications, too (runs on her side of the family, it seems) so that's a concern.

Thanks for reading all this and any suggestions you might have.

Calling my mom would be cheaper.

Anonymous — Fri, 17 Oct 2008 14:30:54 -0800

I'm not getting a much out of my cognitive-behavioral therapy. Do my therapists suck, or are my expectations just too high? So I recently decided to seek some mental-health help for chronic issues I've been having with procrastination, anxiety, depression and unproductivity. Based on the research I did, it seemed as though cognitive-behavioral therapy would be a good approach; I think I'm a fundamentally sane person, but I have lots of bad mental habits and issues with self-control that weren't being fixed by my own best efforts. I thought CBT would offer a stepwise, research-based way of thinking myself out of those un-useful patterns and starting to develop better habits-- kind of like personal training for the brain.

Since then, I've been to two therapists who claimed to be CBT-oriented, and I'm wondering whether I just picked poor specimens, or whether my expectations for this form of therapy were too high. The first one basically sat and chatted with me, occasionally detouring into bigger philosophical discussions/debates or little autobiographical vignettes. He occasionally gave me direct advice about my life ("Well, it seems like you should stay in your grad program...") and dispensed little nuggets of chicken-soupy wisdom ("You know, love always means taking a risk"), but never gave me any homework or did any exercises or, you know, worked on anything.

After two sessions, I left Therapist #1's practice and signed on with Therapist #2; we've had four meetings to date. She's less pompous than T1, but still not especially helpful: essentially, we talk about my life, and she offers the kind of sensible suggestions I've been getting all my life from people more organized than I: Try getting on a schedule! Break your tasks down into little pieces, then do them! Don't wallow in regret over past failures; move forward! It's all great advice, but honestly, if I could have achieved any of those things just by willing myself to do so, I wouldn't be seeking therapy in the first place. I know nobody can do my work for me, but I was hoping CBT would offer some sort of ladder of steps I could climb to help me become able to keep to a schedule, or to move on from guilt and regret-- in other words, a sort of manageable couch-to-5k program, not just a big sign saying GO RUN THAT MARATHON.

I know folk here speak highly of CBT, so I was hoping someone who's had success with it could comment on my experience. Is what I'm getting a good representation of the cognitive-behavioral approach, or should I seek out yet another therapist? And if the latter, any hints on picking someone better this time?

How long did it take for you to notice a difference in your anxiety treatment?

saraswati — Thu, 31 Jul 2008 09:21:43 -0800

Anxiety sufferers: how many sessions of therapy did it take to notice a difference? I'm wondering specifically about CBT, which I've heard is a fairly effective treatment for generalized anxiety disorder. Should I expect it to take weeks? Months? Years? I'm mostly wondering so I have a barometer with which to gauge the effectiveness of the therapist, since it's pretty costly.

Fix my amygdala.

giraffe — Wed, 02 Jul 2008 09:39:08 -0800

Is dialectical behavioral therapy a good idea for me even though I'm not suicidal and I don't have BPD? Otherwise, will you help me figure out what therapy will work for me? Sorry about yet another "find a therapist for me" question. I've seen therapists before I haven't had good luck. I know the difference between a psychiatrist and a psychologist and a LCSW. I think need something other than talk therapy. Basically, to outline my two problems: 1. my amygdala is broken and I need to get control over my emotions/impluses and 2. I need to stop being a victim.

Okay, so, I have PTSD. I thought it went away, but I'm coming to the realization that my "fight or flight" response is just as strong as ever, but is now taking the form of extreme anger instead of panic attacks. Generally, if this anger becomes uncontrollable, I don't have enough time to count to ten or try mindfulness techniques. I don't really realize the depth of what's happened until after the damage is done. I've never hurt someone else (well, not physically), but half the time I say something that should get me punched, and the other half results in trying to hurt myself. For example, after a random guy in a taxi flipped me off for no reason, I walked home and smashed my head against a wood floor -- the bruise was there for a week. I didn't do it intentionally, it just kind of happened and I can't figure out why I did it. There was no thought process whatsoever between the trigger and the mile walk back to my apartment. Well, nothing that I remember. This is basically par for the course when I lose it.

I also had a recent realization that my father is an abusive asshole and my mother has a martyr complex (unfortunately I'm pretty much forced to be close to them at this point). This coincides with my third realization that I seem to have this giant neon sign over my head that says "PLEASE TAKE ADVANTAGE OF ME." I need to get the giant "kick me" sign off my back and I need to learn how to say "no" to people without bursting into tears and thinking I'm a horrible person. I don't want to blame my shit upbringing or PTSD for all my problems. I just want to fix them.

I have atypical depression, but I think it's well-controlled with medication. When nothing's bothering me, I'm pretty much the happiest I've ever been (and I don't have to sleep for 14 hours a day anymore, which is pretty fabulous). This is a huge reason why I'm not on sedatives or an SSRI or anything else that would get me to calm down.

So I'm trying to find some therapy that will actually do something for me. The only thing I know is that talk therapy doesn't work for me (or I'm incapable of finding a good therapist and I'm too spineless to say "this isn't working for me"), and I want to try something that has some sort of rigid structure that I can adhere to. Is DBT a good idea for me? Maybe CBT? Do I need to work on one thing at a time? Please don't tell me to check myself into a hospital; I've never done grievous harm to myself ever, and I am not suicidal. I'm certain that I'm not close to a Falling Down moment.

St. Louis Cognitive Behavioral Therapist Referral?

gd779 — Tue, 20 May 2008 07:18:35 -0800

St. Louis CBT Therapist Referral: I am looking for a referral to great a cognitive behavioral therapist in the St. Louis metro area to deal with depression and anxiety issues. Suggestions?