fabrisse

Tonight my sister and I took Mom out for dinner. Sis and I hit this restaurant about once a week, and tonight, as usual, we ordered the Matzo ball soup. It was good.

Mom ordered a very dry martini on the rocks with extra olives. I quote: "That's my idea of dinner."

On a lighter note (sort of), I've seen a competent doctor who prescribed a book called "The Feeling Good Handbook." I bought it, but I'm a bit put off by the author's tone. Does anyone know more about it?

Current Mood: disappointed

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From:

siderea

[continued]

This in turn brings up another problem: debugging the cognition of someone smarter than you is pretty damned hard. And, AFAIK, it absolutely cannot be done from a position of authority. It simply doesn't work to say "I am going to tell you where you're wrong" and then make substantial mistakes. You completely lose the patient's rapport and trust. That's the talking-down-to-the-patient problem you have just discovered. It's absolutely typical of the cognitive therapies. Actually, Ellis, founder of REBT, is famed for swearing at his patients and acting very superior. (Am v. jealous.)

When I am doing anything which might be cognitive debugging, I usually try to manouver myself into an equal or one-down social position, offering insights to the authority, presenting myself as someone attempting to check or proofread their work, not grade it.

It's really hard to say to someone "You're wrong!" in a way that they'll feel good about, you know? And that's the heart of the cognitive therapies: telling people that what they think is incorrect, not true, wrong.

Of course, that's also what's right about it. Lots of stupid, ignorant, confused, mistaken and misinformed people out there. Especially where the insides of their own heads are concerned. Explaining to them, "No, really, that's just not true" can be enormously powerful.

There's a lot more commentary where that came from. But it's already gotten long and I have to go do stuff. As a half-assed conclusion I'll say that in my incredibly poorly and anecdotally informed opinion (here, let me buy you some salt), CBT works well (or at least better) on people whose depression is comorbid with anxiety disorders. CBT apparently works wonderfully on anxiety, and the depressions which go along with anxiety are also helped considerably when the anxiety is treated. But depression which is not accompanied by anxiety... not so much. CBT can, I gather, help ameliorate some symptoms of depressions, but on average not a whole lot, and as such can be helpful yet disappointing. CBT treats the negative thoughts which are typically comorbid with depression; CBTers seem to think those thoughts cause depression and I am quite certain that that is Wrong, though they surely exacerbate it. Releaving the patient of those negative thoughts, clearly, can make the patient feel better to whatever extent those negative thoughts were plaguing them, but I don't believe it can cure the rest of the depression, which is affective/emotional in nature.

From:

pamelina.livejournal.com

It's really hard to say to someone "You're wrong!" in a way that they'll feel good about, you know? And that's the heart of the cognitive therapies: telling people that what they think is incorrect, not true, wrong.

I'd quibble with you here: I think the heart of cognitive therapies is teaching people to figure out for themselves if what they think is incorrect, not true, wrong. And giving tools to fix it when found.

Of course, that's also what's right about it. Lots of stupid, ignorant, confused, mistaken and misinformed people out there. Especially where the insides of their own heads are concerned. Explaining to them, "No, really, that's just not true" can be enormously powerful.

Yes, if the explanation is accurate, and the person believes it. That's another beauty of cognitive therapy by book: it's not someone telling you you're wrong--it's you figuring it out for yourself--using your smarts to accept the ideas that apply to you, and reject the useless ones. It's a tool for breaking oneself out of Negative spirals, which (negative spirals) tend to distort one's thoughts and make them inaccurate to reality.

CBTers seem to think those thoughts cause depression and I am quite certain that that is Wrong, though they surely exacerbate it. Releaving the patient of those negative thoughts, clearly, can make the patient feel better to whatever extent those negative thoughts were plaguing them, but I don't believe it can cure the rest of the depression, which is affective/emotional in nature.

But you yourself are highly aware of that causality/correlation problem. Does inaccurate thinking cause depression or does depression cause inaccurate thinking? Does imbalanced brain chemistry cause depression or vice-versa? It doesn't matter so long as the fix works. And I thought cognitive therapy was very empirically oriented. Do you have evidence that CT doesn't work well? Because I thought there'd been lots of studies that show cognitive therapy to be as effective or better at relieving depression than drugs in the short term, and better in long term lack of relapse. Am I behind the current thought about cognitive therapy's usefulness to treat depression?

I believe the parent book to "The Feeling Good Handbook," (titled "Feeling Good") along with "The Dance of Anger," (both books suggested to me by the only good therapist I managed to find at the time) were lifesaving to me during the breakup of my marriage. I can see what you mean about Scott's irritating cheerfulness, but that didn't bother me as it does you. And his audience does include hopeless depressed people who've given up--he's trying to convince them that feeling better is actually possible.

I've recommended these books to you, and I hope you can handle your irritation at the pollyanna writing style, because I think that book can really help you. It helped me. I didn't even have to do all the exercises. I also know another person who used the Feeling Good book to get over her depression.

From:

siderea

But you yourself are highly aware of that causality/correlation problem.

What causality/correlation problem? Since it's possible to have wholly affective depression without negative thoughts, there's can't be either causality or correlation assumed. Ta-da!

The difference between causality and correlation is only a problem if you're trying to argue for them.

It doesn't matter so long as the fix works. And I thought cognitive therapy was very empirically oriented.

Yes, that it is. Very empirically oriented.

Oh, go on, ask me what I think about their research.

Do you have evidence that CT doesn't work well?

I am increasing convinced that studies of the comparative efficacy of CBT smell funny.

I hesitate to comment further because I haven't looked into it as much as I like, but I have started becoming very, very suspicious.

For instance, did you know that the standard tool for measuring depression in research was designed, and is named after, the founder of Cognitive Therapy? The Beck Depression Inventory. I'm not real impressed with it: someone who has chronic depression without cognitive distortions is going to score as so minimally depressed that they'll be excluded from a study on depression!

There's other things which aren't problems, but add to the odor: CBT is, by it's structure and it's implicit nosology, both the easiest of all forms of therapy to build studies around; it is also incredibly attractive to insurers, so there's money to study it. That combination, that doing CBT research is the path of least resistance and there's lots of invested parties willing to pay for such studies, makes me leery for precisely the same reason drug efficacy research done by drug companies makes me leery.

There's more, but I'll stop here.

Because I thought there'd been lots of studies that show cognitive therapy to be as effective or better at relieving depression than drugs in the short term

There are now SSRIs which are effective in a single week, as opposed to the two-month ramp up with, e.g. Prozac. I don't know a talk therapy that can beat that land-speed record! But not everybody has the same response to SSRIs, the same as not everyone has the same response to CBT.

And as far as "effective or better", the current party line is that drugs+therapy beats any individual drug or therapy. Which, IMHO, makes a lot of sense, based on what we know of depression. But I haven't hit the papers myself to examine the quality of the research.

I'm certainly glad to hear the book worked for you! It makes me think more kindly on it.

From:

fabrisse.livejournal.com

Thank you for taking the time for a detailed analysis.

Some of what you're saying fits with my general impression. But I'm at a point where I need something more than I have at the moment, and I don't dare do talk therapy because it might get reported to the company.
So. I'll give it a shot. If it doesn't help, I'm out $20. If it does, it's priceless.

From:

fabrisse.livejournal.com

Aha! I knew I'd heard about it before. :-)

I'll give it a try, but the introduction and the first chapter could have been conveyed by quoting two lines of Shakespeare:

There is nothing either good or bad but
thinking makes it so.

But, the situation is bad. I'll try anything that could help.