Milestones in Alcoholism

[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?

Comments

[siderea]

Hadn't run into it before. It's CBT. Some people get a lot out of it. I have a complicated professional opinion about the cognitive therapies which is not entirely positive.

What about the tone is putting you off?

[fabrisse.livejournal.com]

He's so cheerful. I know it's supposed to be about thinking oneself happy, but happy and cheerful are not the same thing. Or if they are, take me now, lord.

To a certain extent I feel that he's talking down to me as a reader.

I recognize that some of my behaviors are self defeating. I'd certainly rather read a book and do little workbook things than have my antidepressants upped, but the introduction and first chapter irritated me.

If you're ready to share your CBT opinion, I'd like to hear it.

[riverfox.livejournal.com]

{{{{{{{{{{{{{{{{ hugs }}}}}}}}}}}}}}}}}}}
Sorry, hun. :(

Also, never heard of the book though. Sorry I can't help there. I might have to have a look tho. ;)

[wadjet-theperv.livejournal.com]

*hugsyou* I can't help with the book either, but I do feel for you.

[gileswench.livejournal.com]

If you think the exercises might be helpful but the tone of the book is annoying the snot out of you, is it possible there's another book out there with similar information written in a less irritating way? If there's one thing I learned while working in bookstores all those years, it's that there are more self-help books than you can shake a stick at! Of course, when you're done talking to Sideria you may decide to opt out of this particular concept, anyway. ; ) If so, ignore what I just said. I won't be the least bit put out.

Cheerfulness and happiness are two different things where I come from. I can be cheerful at the oddest times without really being happy, and vice versa. Of course, it's easiest when it all comes together...like this morning when I'm feeling disgustingly chipper and honestly content.

Your mother's idea of dinner scares me.

[gileswench.livejournal.com]

I just want to note that your icon is a thing of beauty and a joy for at least the rest of the day.

[riverfox.livejournal.com]

::beams:: Thanks. Makes me sigh every time I look at it. :)

[siderea]

My opinion is probably longer and more involved than will fit in the margin of this post. ;) Not least because it involves a lot of equivocating.

The whole premise of the cognitive-based therapies (CT, CBT, REBT, et possibly cetera) is that they endeavor debug a patient's thinking. That's what cognition is. I'm all about debugging people's thinking, so, clearly, I think there's a lot of utility to that premise. But it's also fraught with a bunch of issues, and I get every impression that the proponents of the cognitive-based therapies have absolutely no respect for any of those issues. They really think their therapy can be used to treat anything from anorexia to cancer (OK, slight exaggeration, but I've read a case of CBT being used to treat warts), and all too frequently it is coupled with an attitude of "all other therapeutic modalities suck."

While all modalities (stupidly, IMHO) have a rivalry thing going on, this attitude is not only (IMHO) currently worst among the cognitivists, it's also particularly unfortunate in that cognitive approaches are the most superficial. That's actually one of their bragging points, that they only treat symptoms and do not do depth or insight-based psychology.

From my point of view CBT is sort of like Band-Aids(tm). Band-Aids(tm) are awesome; they are a boon to western civilization, no question, and they do a world of good. But nobody thinks you can use Band-Aids(tm) inside your body, and nobody thinks that there's no need for other forms of treatment now that we have Band-Aids(tm).

CBT (and CT and REBT) is a heck of a lot more powerful than Band-Aids. Maybe penicillin is a better analogy, though it loses the "superficial" concept. But at the end of the day, it's not enough to solve all problems. Root causes can matter. Other branches of the mental health field explore different possible locations of causes of distress, whether it's psychiatry investigating brain chemistry, or gestalt psychotherapy investigating figure-ground relations, or humanist therapies investigating feelings and socialization, or existential therapies investigating beliefs, or psychoanalytic therapies investigating internal dynamics arising from childhood, or whatever. There's a lot which can go awry, a lot more than merely cognition.

The partisans of the cognitive approaches really seem to have come to believe that if only you can get people to think "right" you can solve any problem, even if that problem is not with cognition. It is as if they have jumped from the idea that insight into the patient's problem is not necessary in therapy to the conclusion that insight into how humans work is not necessary to developing and applying therapies.

And, of course, that "right", above, alludes to other related issues. The cognitive therapies embody within them certain ideas of "right thinking". They're actually pretty good, as far as I can tell! But if a practitioner's interpretation of "right thinking" is substantially mistaken in a patient's case, the therapy collapses -- and can even be quite toxic as it becomes normalizing, unwittingly applying a pressure to conform to inappropriate standards.

As you might suspect, one of the places where even a talented, kind and reasonably informed CT/CBT/REBT practitioner is likely to err is dealing with people who are GT. In fact, if you go to the Amazon page for your book, you'll find one of the currently prominent reviews is from someone who didn't find it useful because it kept trying to get him to disown his perfectionism, and then later found a much more useful, humane approach in learning he was GT and through the GT literature. The cognitive-based therapies are all about training people what is reasonable to think and expect of themselves, and that is different with GTs. The expectations of GTs must be calibrated to their capacities.

[cont.]

[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.

My Experience: Excellent Book.

[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.

Re: My Experience: Excellent Book.

[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.

Re: My Experience: Excellent Book.

[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.

Re: My Experience: Excellent Book.

[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.