Self directed cognitive behavorial therapy?
March 25, 2009 2:40 PM   Subscribe

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.
posted by anonymous to Health & Fitness (9 answers total) 13 users marked this as a favorite
It would help to know what country you're in.
posted by Electrius at 2:45 PM on March 25, 2009

Leaving aside for the moment the question about insurance, you might try identifying a counselor in the US or another English speaking place who would be willing to meet telephonically. Don't have any experience with this myself, but it seems like there must be counselors like that out there. If you both used Skype or similar, cost would not be too bad (assuming you've got access to a good internet connection - again, no experience there.)
posted by plague at 3:03 PM on March 25, 2009

Have you looked at any of the work of David Burns? One of the great things about his techniques are that you can do them on your own without a thereapist. Feeling Good and The Feeling Good Handbook by David Burns are great starting points for self-directed CBT.
posted by pahool at 3:59 PM on March 25, 2009

Try MoodGYM. It's free, and it will teach you pretty much all you need to know to continue on your own with CBT.
posted by halogen at 4:03 PM on March 25, 2009

You mean Scotland! (sorry!)

Yep, lots of online CBT. I even know someone that kinda-worked for. CBT actually works. Obviously better with a practitioner guiding you but no reason why you can't DIY it.

Good luck
posted by Wilder at 4:06 PM on March 25, 2009

Without more details about where you are, it's really hard to give you helpful input.

I suspect that with out an outside person trained in an approach or methodology, it may be hard for you to stick to any one approach.

I have found the exercises on to be helpful.

Also, I just completed a year of therapy (gestalt? something?) in a foreign language, in my foreign country of choice, and am very happy with the results.

Plus was only about 25 dollars for an hour and a half session.

I would explore the option of seeing someone local, if thats even a possilbility for you, and then either via internet or telephone. I feel like it's really really important to have someone else involved - you can do all the DIY work inbetween your appointments with the person.
posted by Locochona at 4:09 PM on March 25, 2009

Seconding the Feeling Good recommendation. I found it particularly useful for procrastination.
posted by wyzewoman at 7:20 PM on March 25, 2009

CBT is actually an excellent DIY tool (and one of my favorite resources as a therapist, because it has a very significant efficacy research backing). I really like to use it with as many clients as possible because it is meant to be learned and then practiced on your own without the therapist--it is a really empowering approach to depression, especially.

It's necessary to read about it before just starting the exercises, of course, and I think that the suggestions above about having phone sessions with a therapist to help you start out with the CBT is a great idea. The important parts are the homework you have in between sessions with a therapist, so it could really work out well, even though it is not ideal to do it completely on your own.

A couple of books that are great to start with:
Mind over Mood
Thoughts & Feelings
posted by so_gracefully at 10:38 PM on March 25, 2009


I'm going to give you very specific advice based entirely on "you sound like me, so this is how I work".
You're not me, so disregard pieces if need be, but I have done everything you wrote about, except for the 'non-english speaking country' thing.

there's online websites. Definately try them, but I was unable to succeed in this for me.
I'll get to why futher down the post.

First - look around for a good therapist/counsellor.
NOT even one with CBT on the resume, just keep going round til you find someone you get good rapport with. This may take a few. The specialist CBT guy I went to was MUCH less effective with CBT than another counsellor I went to who had just done a little bit of it as part of her (2 years recent) counselling diploma. He was unable to spot where I was having problems with the technique, and help me get over it.

It turns out, training has very little to do with who makes a good counsellor. I wish I was kidding, but really - the science of mental health is not very advanced. Don't focus on introspection or the past (eg psychotherapy), that will also probably not help. Focus on present-day tactics, like that of changing your CURRENT thoughts with CBT. Also, figure out with your counsellor what you could change in your everyday life that would make your life better/less stressful.

So, if you like the CBT online course, take it along to the not-necessarily CBT counsellor and work through it WITH the counsellor. Try out the exercises, and then tell the counsellor why or why it wasn't working for you.

Why did I initially fail with CBT? Because I was unable to isolate the 'thoughts' that were leading to the 'procrastination'.

Why? Because I was unable to recognise the emotions I was feeling, and without that connection, I couldn't understand what 'thoughts' I was having were sparking off negative mental states. The inexperienced CBT counsellor spotted this.

Why might this apply to you? Because I also thought it was, and described it as 'procrastination' , but if it was just procrastination, I would have flaked out equally on the first 90% of the project too, instead of primarily sabotaging myself at the end. That's fear.
I realised if I wrote down my actions objectively, it kind of looked like maybe I was anxious, or had some kind of fear of failure/fear of success thing, which I'd discounted because I didn't FEEL or LOOK afraid.
I really realised it when I was given some Benzodiazepines. Taking a small dose of an (addictive) nervous system relaxant, broke me out of my 'procrastination'. That's not 'just' procrastination, that's anxiety.

My brain seemed to work on the primitive principle that say, if you keep going to that place in the forest and worrying about being eaten by the lions wandering around, then you should probably just not go to that place in the forest or even think about it. That's not how 'work', or even 'appointments' work. Being worried about being late/getting things done/an amphomorphous cloud of to-do-worries around an 'appointment' doesn't mean you're scared of that *appointment*, or that NOT doing it will make me MORE worried, but my brain doesn't get that!

Look up OCD and self-soothing behaviours. My 'self-soothing' behaviours appear to be reading books, and surfing the internet, both for 'answers', instead of doing the thing I actually need to do. These self-soothing behaviours do not address the underlying anxiety, or work soon enough to relax me, and get me more worried once I realise I am 'procrastinating'.

Here's the thing - I am STILL unable to guess that I'm feeling 'anxious', I just know that I rather frantically want to go read a book or the internet, instead of what I know I should be doing. I spot the behaviour, and I'm starting to be able to connect physical sensations with the behaviour (am I tense etc?), and hopefully, I'll eventually be able to understand it as an emotion, so that I can nip it in the bud, slightly earlier in the chain.

My current tactic, is to lie down for a 15 minute guided relaxation/nap-tape. I have a lot of resistence to doing this when I'm 'already screwing around'/'already late on this project'. But, that is exactly WHEN I need to do it. To be honest, am I really going to do any productive work in the next 15 minutes? Really? Really REALLY?
The answer is usually no, so I lie down, and am a lot more successful at getting started.

Trick two, is just to write down on a piece of paper all the things I have to do, even if I already know. Just 5 minutes, writing. Getting it clear. Shine a little light, and it's not as messy and complicated as I thought.

From here, try the things listed here.

Good luck!
posted by Elysum at 3:11 AM on March 28, 2009 [1 favorite]

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