Need a new brain-mechanic.
November 19, 2012 9:21 AM   Subscribe

CBT doesn't seem to be working for me. What other options do I have?

I've battled with depression and anxiety since early college (10+ years ago?). In the more recent history, I had things very much, under control with a very good diet, plenty of regular sleep and lots of exercise (I commuted 2 miles to and from work everyday).

About a year ago, we had a kid (goodbye regular-plentiful sleep), moved across the country to Maine (goodbye year-round-bike-commute). In addition to these very specific factors, I cannot find work outside of the retail sector and am also stay-at-home-dad for the kid several days a week. This contributes to my anxiety more than my depression, but its exacerbating both significantly and I am having trouble coping on a daily basis. I also kind of very much loathe where we've landed, and am battling an incredible homesickness on a daily basis. This is basically a perfect cocktail for me to go bonkers. Things are getting worse, and I really need to get a handle on things. Long term solutions for the family to move back to where we came from, but this won't happen for at least a year, more like a year and a half. That doesn't help me now, however.

In regards to Medication: I have in the past and under supervision, been on a laundry list of different meds, but none seemed to work out for me; I either felt completely dead to the world, or I was turned into an insomniac by everything I was prescribed. I would like to avoid taking drugs if possible.

I've been in therapy since we landed on this coast, and I've tried out a couple therapists. The therapist I have been working with the longest only works within a CBT model, and it's just not working for me. I have no idea why...maybe I'm too far down the rabbit hole? But it is not working for me, and i'm looking for alternatives. There seems to be a dearth of therapists out here (Portland, Maine, specifically) that seem to work with our insurance (Blue Cross Blue Shield).
posted by furnace.heart to Health & Fitness (8 answers total) 9 users marked this as a favorite
I didn't find CBT particularly helpful in the long term, instead finding an eclectic/psychodynamic talk therapist that was exactly what I needed. I found the therapist that worked for me by talking to my GP, then the psychiatrist on staff at my GP's office. Maybe make an appointment with your GP or ask your current therapist and ask for their recommendations? That way they can ask informed questions that might lead you toward the specific help you need now.

PS - I'm not far south of you in Boston and bike commute any time there isn't a lot of snow or ice - winter biking can be great, if it's an option for you.
posted by ldthomps at 10:10 AM on November 19, 2012

My only knowledge of CBT is through books, but the Sacred Self-Help Text is "Feeling Good" and boy, was it laborious. I just couldn't force myself through all those bloody long exercises. I found that thinking rationally about stuff works up to a point ("bwaaaa everybody hates me!" [thinks it over] "well actually, in reality, only my best friends have specifically said they hate me, whereas I'm quite popular with people who barely know me") so I'd say that thinking rationally about your situation is necessary, but quite often cold comfort.

I'm quite fond of a book called "The Happiness Trap" which introduces ACT on a self-help level (Acceptance and Commitment Therapy). It focuses on sitting with negative feelings and maybe realizing that they can't always be taken too seriously, rather than trying to rationalize them away. It's also quite firm that some negative thinking is inevitable, and a natural consequence of how we protect ourselves (if we didn't anticipate things going wrong, we might not survive).

Plus, and I know this is easy for me to say, try to get more sleep? Your mood is almost more dependent on sleep than anything else, other things being equal.
posted by tel3path at 11:50 AM on November 19, 2012 [3 favorites]

This MeFi post on different kinds of therapy might be helpful to you.

Since you mention physical factors so much, you might be interested in learning about the rosen method or googling to read about other somatic approaches.
posted by salvia at 12:14 PM on November 19, 2012

As a total layperson, I have the impression that CBT itself is aging. There's a new wave of therapies that come from the same scientific tradition but mix in "mindfulness" and make more sense to me. The new wave are therapies like ACT (mentioned above), DBT, and MBCT.

The difference is, CBT is about trying to understand and improve your thought processes, by thinking about them. It's about diving in and trying to correct your thoughts and emotions, using the same mental tools that are generating thoughts and emotions you don't like in the first place. Whereas mindfulness-based therapies bring in the idea that your thought processes are just one tool your brain has, designed for solving practical problems and keeping you alive, but terrible at dealing with complex emotions like long-term anxiety or sadness.

Depression and anxiety aren't created by sadness and fear, they're created by the things our mind does to try to fix anxiety and fear. So if you could watch them in slow motion, your thought process might look like: external trigger -> unpleasant emotion -> problem-solving -> associations -> new unpleasant emotions -> more problem-solving -> even more associations -> EVEN MORE EMOTIONS OH GOD WHY CAN'T I SLEEP. Instead of trying to detangle that mess and make sense of it (more problem-solving!), mindfulness-based therapies teach you to flip over to a different mode of thought where emotions aren't followed by problem-solving at all. They just rise and ebb on their own and don't need you to do anything. And then you can use them as signals to tell you things like "you should probably move when it becomes practical," instead of flashing red lights that have to be dealt with constantly using a problem-solving part of your brain that just makes things worse.

So again, I'm a total layperson, but if it was me, I would call around for a therapist who was at least familiar with ACT, MBCT etc., so I knew they were up to date with this wave of techniques, and see what they recommended. In the meantime, I've read the first half of this book and it seems to be pretty good, so you could read the introduction and first chapter with "Look Inside" and see if it speaks to you.
posted by jhc at 4:02 PM on November 19, 2012 [1 favorite]

Thanks for the answers thus far. This will at least give me the start of a direction to go into.

winter biking can be great, if it's an option for you.

Oh, how I wish it was. I've got an old knee injury that doesn't let me operate in the cold very well...and my new commute is about 40 miles away. I miss my bike terribly.
posted by furnace.heart at 4:50 PM on November 19, 2012

Thirding ACT (Acceptance and Commitment Therapy)
posted by QuakerMel at 5:53 PM on November 19, 2012

A little bit of a side note... You're in Maine? Are you used to living that far north? Talk to your GP about making sure SAD doesn't exacerbate your existing condition. No need to let something easily treatable (SAD) make things worse than they need to be!
posted by jrobin276 at 10:56 PM on November 19, 2012

Your issues is interesting because not all people place a therapist's school of practice highest on the list when making a decision, believe it or not. For example, a word of mouth recommendation from a trusted friend has proven to supersede other factors, such as school of practice.

Fact of the matter is, research has proven that the most important factor in therapy is the nature of the patient's relationship with the therapist (also called therapeutic alliance.) When a person feels deeply comfortable with their therapist, healing is much more likely to occur.

Good therapist are multi-skilled and vary their approaches upon a patient's needs. I would not see a therapist who was committed to only one method of therapy. This requires people to mold to the therapist needs when a therapist should be shifting technique based upon the patient's needs. This is ideal.

Don't worry about not responding to CBT. It simply isn't for you. My recommendation is to continue to look for therapists who are "eclectic" and stick with one who makes you feel safe, listened to, is non-judgmental, and expresses unconditional positive regard.
posted by Therapist in NYC at 6:01 PM on December 31, 2012

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