As someone who didn't have many healthy attachments growing up and has spent a lot of time with a wide variation of therapies. I agree with the article, many different therapies can fix people and I’ve found it better to have more than one type of therapy. I believe at the root of it is a mindset which centres around the cultivation of self-leadership.
My multi-year long journey of what I learned and getting back to health - which most visibly manifested itself as CFS symptoms (Post exertional malaise) - can be summed up as:
Trusting the therapist and understanding they are not perfect humans themselves. Accepting they are not going to fix me, they are a companion on the journey, I must fix myself with their help.
Going on a journey through all major points in my past and re-experiencing what I'd been through. Whilst having the therapist with me to slowly help unfold the emotions and understand it from a different perspective (i.e. I did not cause the bad things that happened to me, it was not my fault).
This helped me build a foundation, a place of support that didn't rely on other people, which gave me self-confidence to listen to the negative self-talk that I had blocked off for years, because it was too overwhelming to hear. When I started listening to this self-talk, I could then start to converse with it. e.g. "You aren't good enough", "Perhaps I'm not, but let's see what happens when I apply my focus to it", which started taking away its power and effect over me.
Which led me to realising that my intellect and conscious part of my mind is probably only in control of 20%-30% of me. That I'm not a fully logically creature and that I needed to come to peace with my body's needs and messages from my less conscious mind and work together as an integrated whole, rather than trying to force my will based on pure 'rational' thought.
Life has been considerably better since and my decades of depression and low energy have begun to abate.
Whilst the points may seem simple, understanding like this rarely comes from knowing in the conscious mind. It is understanding that has to be understood at a deep level, which is why therapy can take a long time. My favourite way of describing this conscious acceptance but lack of sub-conscious understanding can be summed up as: “I know that, but try telling me that”.
> Different methods of therapy appear to be equally effective despite having theoretical foundations which are conflicting with each other. The common aspect between different therapies seems to be "having someone to talk to", so I'm inclined to believe that really is what's behind the success.
This isn't true. Different methods work better for different problems. I've been in behavior health for 7 years now. It's having someone with a lot of education to talk to, someone with education in social and psychological problems and healthy coping mechanisms.
Therapy has really helped me, for a number of reasons:
- It helped reduce my stress level and helped me cope.
- My therapists have made constructive, useful suggestions and provided insights that I hadn't thought of on my own.
- I've faced and dealt with things I've avoided facing and dealing with on my own.
- I've come to understand myself much better.
Those things alone are worth their weight in gold for me. That said, I've completely avoided CBT and related short-term, "evidence-based" therapies. Instead, I've preferred to work with therapists who have more of a Jungian, depth psychology approach, which are a much better fit for me.
In addition to therapy, in recent years I've been eating a lot healthier, started exercising and supplementing nutrients that I was deficient in and all of these changes have had a very positive effect on my mood, health, and energy level.
I also journal a lot, and that also helps me to destress and put things in perspective. It's often almost as good as talking to someone.
Back to the subject of therapy: I believe it's absolutely critical to find a therapist that you like, respect, and can easily talk to and open up to. The other half of the equation is your own willingness and ability to put in the hard work of both confronting the difficult issues you need to in therapy and following through outside of therapy. Without all of these things coming together, the results are likely to be disappointing.
"... the deeper reason why no single psychotherapy seems to provide unique advantages over any other is that they ALL work because of shared elements. Chief among these is the therapeutic relationship, connected to positive outcomes by a wealth of evidence."
"The emotional bond and the collaboration between client and therapist – called the alliance – have emerged as a strong predictor of improvement, even in therapies that don’t emphasize relational factors..." cites co-author of the book "Attachment in Therapeutic Practice" (2018).
".. what if, attachment theory asks, therapy gives you the chance to reach back and repair your earliest emotional bonds, correcting, as you do, the noxious mechanics of your mental afflictions?"
> CBT almost entirely resolved my baseline 'mental' anxiety of the nature you seem to explain. YMMV.
That is CBT with a therapist, or self-applied CBT? I've been meaning to go through "Feeling Good" book, it seems to be widely regarded as an effective way to apply CBT to yourself.
I definitely understand where you're coming from. Surely there are a lot of people that this stuff actually helps really well. In the past I did have serious issues, but I was able to bring myself out of it over time, by myself. And now, I have nurtured a far more stable and enduring mindset. :)
EDIT: By far the biggest part in me getting better was moving on to a different way of life. Basically, changing the set and setting. Which I think is underrated by the professionals described in this article, hence the problem:
"How I found & fixed the root problem behind my depression and anxiety after 20+ years" by Kaj Sotala.
It describes the concept of 'self-concept' and a, I guess, pseudo-treatment for addressing deep-set neurosis/anxiety caused by having one that is a little malformed. This post led (in a sort of roundabout way, hitting at a good time in my life and while I was already thinking in the direction of fixing this problem) to a sort of self-therapy where I snapped out of an unhealthy mental state I had been in for something like a decade. Probably good therapy could have had the same effect but I've always had trouble with that, and the ideas here led to a non-unsuccessful self-therapy. My issue was not at all related to the one he describes in the post, but the approach seemed to work anyway.
Out of necessity (after existing conventional treatments offered little help) I've been conducting a 10+ year self-experiment related to this topic.
Like others have described, when I started experiencing symptoms of conditions resembling anxiety, depression, ADHD, mild bipolar, paranoia and CFS/ME, I initially sought mainstream medical psychiatric treatment and undertook talk therapy and was prescribed anti-anxiety (benzos) and antidepressant (SSRI) medications. There was some relief but there were also unpleasant side-effects, and I just had a strong feeling these treatments were not really addressing the core problems, and indeed I even felt like the symptoms were fairly normal reactions to the life experiences I'd endured.
Later I tried to heal myself with nutritional and exercise-based approaches, and relatively conventional emotional approaches like meditation. Again, some mild/temporary improvements were noticeable, but they were inadequate, and it still felt like there was something deeper I needed to connect with.
About 8 years ago, I found an approach that involves identifying and releasing traumas, attitudes, behavioural patterns, self-perceptions and defense mechanisms that are held in the subconscious mind, particularly ones that have been attained in early life and have snowballed through repetition compulsion [1] (a concept that Freud first articulated).
I've been undertaking these approaches continually since I discovered them, and bit by bit all the symptoms have resolved.
My experience has confirmed, at least to me, that these conditions are "adaptive responses to adversity" (or something else related to that concept), and that in order to heal the symptoms, I needed to understand their basis at a very deep level; as Jung said, "making the unconscious conscious" [2].
Once that had been done, adopting new, healthy attitudes and behaviours and living free of those symptoms has been fairly easy; i.e., healthier behaviours just emerged naturally once the causes of the unhealthy behaviours were identified and understood.
If any researchers or laypeople are interested to know more about the techniques I've used and the results I've experienced, I'm happy to be contacted (email address in profile). None of the approaches I've used or their underlying hypotheses are novel; it's been written/spoken about extensively by veteran experts on mind+body health including Maté and Bruce Lipton. But there doesn't seem to be much in the way formal studies into these concepts, so I'd be happy to connect with anyone working in the field or anyone else interested to explore further.
CBT gets props because its empirical results have shown to be more effective than the traditional talk therapy approach. It's been around for a long time, has been studied enough for us to be confident that it makes a real difference, and I consider it as medicine for thoughts. Of course there's no way for us to quantify its precise method of action, so it's not that different than making the observation that the bark of a certain tree seems to reduce pain and inflammation, but if the burden of proof is to show direct causation from our thoughts and CBT to a better outlook on life, we might as well be asking about the nature of human consciousness.
CBT is a framework more than it is a manual, and not nearly as robotic as you've described. All therapy requires a human relationship to be successful. You have to trust your therapist to believe in the things they say, and that belief is a prerequisite for putting in the effort to reshape your thoughts and attitudes, but what's so robotic about a therapist asking you to explore the origin of a preconceived notion? About them asking you to be mindful of those type of thoughts? On coaching you to intercept those negative thought patterns and replace them with improved ones?
I think chalking up the efficacy of therapy to hope and placebo is a bit disingenuous. Yes, belief in change is a precursor to real change -- no therapist can help someone who isn't willing to believe or even want to change -- and in a way, the therapist's role is to guide you in your own endogenous healing process. However, there needs to be some rigor in the way they guide you to break bad patterns and replace them with better ones.
In a way, the therapist's challenge is like inception: how can I plant something in someone else's head but make them feel like they came up with it themselves? I think most of us could look at someone with low self esteem and negative thoughts and tell them what's wrong and what they should say or do or believe instead. However, that process needs rigor, and one of the best tools in the toolbox is to increase someone's mindfulness, and one of the best ways to do that is CBT.
I think overall you're a bit dismissive of it as a shallow, robotic approach when really it's a simple, repeatable, controllable frontline intervention. It's not going to work for deep-seated issues, but I think of it as almost being a prerequisite before those deeper issues can be tackled. I am of course speaking from personal experience, in both myself and what I've observed with others.
Most of the process of me getting better was learning to understand and recognise my own thoughts, so I totally agree. For me personally it was talking therapy that really worked.
This mindset is unfortunate, and detrimental to patients. There have been a lot of studies on CBT/GET, and there isn't really any doubt that they are moderately effective. The only issue I have with the treatments is that the theories behind them (deconditioning and abnormal illness beliefs) don't really have any evidence. I suspect they work for other reasons. However, that shouldn't be a reason to completely reject them.
I was speaking to someone recently who recovered from CFS (after being mostly bed-bound) through CBT and lifestyle changes, and she is now completely recovered. In her case there were a lot of recent traumatic experiences which contributed to her illness, so CBT was very helpful in addressing those issues.
Some charities, such as Action 4 ME, seem a little more open-minded about CBT.
CBT definitely won't work for everyone, but this seems like something a good therapist could help someone work through. Self blaming like that is one of the cognitive distortions that CBT should be able to help root out.
I realize that it very likely just wasn't the type of therapy that works for you, just throwing out the alternative perspective for anyone reading this and considering CBT.
> Different methods of therapy appear to be equally effective despite having theoretical foundations which are conflicting with each other. The common aspect between different therapies seems to be "having someone to talk to", so I'm inclined to believe that really is what's behind the success.
Just because talking is the common trait, doesn't mean that that's evidence that that is all it is. Paying someone to help you with the problem is also a common trait (and ironically, that is, no doubt, a contributory factor), but that isn't all that therapy is.
Let's say that there are three ways to solve a problem, and depending on context that we're not terribly good at determining, one of those ways will work quite often, one will work some of the time, and the other will be a disaster... but there's an equal probability that each of those ways are equally likely to fall in to each of those categories. Statistically, one could claim that how you solve the problem is not behind the success. In a sense, that would be correct, because the real determinant of success would be being lucky with the solution you chose to employ. While one could imply though that really it's nothing more than being lucky at choosing the solution, in reality without all of what's involved in that choice, the problem will remain.
> Another problem is the feedback loop of mental illness. A lot of people might feel better if they got exercise, ate healthy, got enough sleep, made some friends, took on some fun hobbies, etc. but most people aren’t willing or able to do any of that if they are stuck in a bad mental state.
I've found CBT super helpful for my ADHD because it focuses on the small steps to break that loop. I thoroughly recommend it for ADHD and mental illness, particularly for engineers as it's far more system based and obviously "logical" than any other form of therapy I've tried.
My story overlaps a lot with yours, especially the parts about never being able to form secure attachments (though for slightly different reasons).
I was stuck for a very, very, very long time until I encountered Internal Family Systems therapy. It has been able to help me heal the wounds in ways CBT/DBT/talk therapy never could (and not for lack of trying).
Absolutely. I haven't seen anybody mention David Burns' book "Feeling Good" but it probably saved my life from a descent into insanity. It's my "bible" now. I knew something was completely and absolutely wrong with my self-destructive thought patterns but didn't understand what until I learned about Cognitive Behavioral Therapy (CBT).
A sad observation: everytime I encounter a struggling friend with dysfunctional thought patterns, I work through their thoughts using CBT techniques (without mentioning that's what I'm doing). This almost always results in a calmer friend who starts feeling better about the situation, or at least more confident in their ability to deal with it.
I then tell them what I'd done to improve their emotional state and how they can learn to do it for themselves by pointing them to CBT and Burns... and a few months later I find they still suffer from dysfunctional thoughts and haven't bothered following my advice.
Funny thing is I was the same; it took a bout of severe depression and reading "Feeling Good" exactly at the time when I could introspect my severely dysfunctional thought patterns for me to accept my situation (having purchased the book a year previously but being dubious about its claims of my "mild" depression at the time). I don't know if this is social conditioning (only "weak" people get depression) or general ignorance of the fact that the mind needs "maintenance work".
I've been living with depression and anxiety for so long that it is my state of normal. I find cover from my feelings by working 12 hours a day and focusing as much as I can. When I lose focus is when depression resurfaces. I finally invested in my mental health in the last year, seeing a therapist and practicing CBT. This has been a breakthrough year for me, emotionally. I am thinking about quitting my work and working on something entrepreneurial related to mental health. I've found that the most important part of self-therapy is practicing what is learned, developing new mental habits that trigger as countermeasures to cognitive distortions.
I feel like I'm a survivor of a emotional holocaust where people see an emaciated mind and don't understand the cause.
>You have to consider that the field faces significant practical challenges when it comes to applying the scientific method. Nevertheless, I wouldn't be so quick to dismiss it, cognitive behavioral therapy does show results on par with commonly prescribed medications.
Yet any sort of talk therapy is almost as good as CBT, and psychiatric medications lose effectiveness over years since their development. The former leads me to suspect that the therapy isn't the point, it's a psychological connection with one's therapist. The latter leads me to suspect that most psychiatric medication isn't "fixing the problem" so much as re-rolling a few stats such that the user can feel different for a bit, and hopefully thereby pull up from their metaphorical depressive nosedive.
Yes it did, thank you for the explainer. It's a good example of the fact that changing how our minds work for the better is a multi-modal, multi-disciplinary endeavor.
Would be interesting to see if there are doctors out there who can practice a more integrated approach rather than just focusing on one avenue of getting better.
>> A doctor I spoke to about CBT said he thought CBT was effective for the relatively intelligent, introspective people
That makes sense to me. From my experience you have to be willing to take small events in your life and read into them/pull them apart in great detail. If you can't understand the root issue (the reason you react to your thoughts/feelings in a certain way) by examining your thoughts in that way then you can't really put into practice the basic tenets of CBT. Maybe it depends on the therapist but from my perspective it seemed like quite an intellectual way of dealing with your problems.
My multi-year long journey of what I learned and getting back to health - which most visibly manifested itself as CFS symptoms (Post exertional malaise) - can be summed up as:
Trusting the therapist and understanding they are not perfect humans themselves. Accepting they are not going to fix me, they are a companion on the journey, I must fix myself with their help.
Going on a journey through all major points in my past and re-experiencing what I'd been through. Whilst having the therapist with me to slowly help unfold the emotions and understand it from a different perspective (i.e. I did not cause the bad things that happened to me, it was not my fault).
This helped me build a foundation, a place of support that didn't rely on other people, which gave me self-confidence to listen to the negative self-talk that I had blocked off for years, because it was too overwhelming to hear. When I started listening to this self-talk, I could then start to converse with it. e.g. "You aren't good enough", "Perhaps I'm not, but let's see what happens when I apply my focus to it", which started taking away its power and effect over me.
Which led me to realising that my intellect and conscious part of my mind is probably only in control of 20%-30% of me. That I'm not a fully logically creature and that I needed to come to peace with my body's needs and messages from my less conscious mind and work together as an integrated whole, rather than trying to force my will based on pure 'rational' thought.
Life has been considerably better since and my decades of depression and low energy have begun to abate.
Whilst the points may seem simple, understanding like this rarely comes from knowing in the conscious mind. It is understanding that has to be understood at a deep level, which is why therapy can take a long time. My favourite way of describing this conscious acceptance but lack of sub-conscious understanding can be summed up as: “I know that, but try telling me that”.
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