Proof that CBT (alone) does not work

LittleMissMuffet

Well-known member
I found this just now on the net!!!!!

it was found at: www.mindfulness.net.au

Mindfulness-based
Cognitive Behaviour Therapy

--------------------------------------------------------------------------------



What is MCBT ?
Mindfulness-based Cognitive Behaviour Therapy, or MCBT, is a sophisticated integration of skills developed with mindfulness training and principles of Cognitive Behaviour Therapy (CBT). The Mindfulness-CBT integration represents the effort of authors and clinicians from multidisciplinary backgrounds whose dedication to the scientific inquiry, creativity, and openness has contributed to the current paradigm shift in psychotherapy.



A Brief Conceptual Outline
Traditional cognitive therapy models attempt to alter maladaptive behaviour by modifying its concomitant dysfunctional thoughts and underlying assumptions. However, there is empirical evidence that our attempt to actively change aversive internal experiences (e.g., thoughts, emotions, body sensations) often multiplies our problems (e.g., in PTSD, GAD, pain etc). Consistent with Einstein’s opinion that “we cannot change a problem with the means that created it”, mindfulness and acceptance-based approaches take the view that attempting to change the content of incapacitating thoughts is less productive in the long term than learning to develop control over the processes that maintain them.

To achieve such control, mindfulness training involves paying attention to each event experienced in the present moment within the framework of one’s body and mind, with a non-judgmental, non-reactive and accepting attitude. It may be broadly operationalised as a “generalised metacognitive and interoceptive exposure and response prevention” technique. Trainees begin with a set of breath concentration exercises to develop meta-cognitive awareness and minimise distractibility. This alone enables a more objective appraisal of what thoughts are, just “thoughts”, rather than “truths” they have about themselves and the world.

Then trainees are taught how to scan their body systematically and develop an ability to feel both salient and more subtle sensations while purposefully inhibiting learned (automatic) responses. This entails a systematic desensitisation to whatever internal experience is encountered on the way.

Taken together, developing these skills involves the training of attentional functions which may engage the vigilance network (dorsolateral region of the prefrontal cortex and its reciprocal connections to a centralised area of the striatum) and the executive control network (orbital-frontal regions of the left prefrontal cortex and its reciprocal interconnections with the ventromedial region of the striatum).

Bruno Cayoun’s (2004) model of Mindfulness-based Cognitive Behaviour Therapy (MCBT) is a sophisticated integration of mindfulness core principles and traditional CBT, which rests on a neurophenomenological model of reinforcement, the co-emergence model of reinforcement. This approach involves a detailed account of micro-level reinforcement and extinction principles, as they are actually experienced. It suggests that once a trigger is perceived via sensory pathways, its judgemental interpretation at higher cortical levels leads unavoidably to some co-emerging body sensations, towards which one automatically (“mindlessly”) reacts. Thus, reinforcement is regarded as being dependent upon learned reactions toward intrinsically coupled cognitions and body sensations. Cayoun and colleagues' recent series of case studies and group outcome data demonstrate that preventing such reactions while remaining fully aware and accepting of bodily experiences leads to rapid extinction of conditioned responses, whatever is the nature of the disorder. Cognitive reappraisal emerges naturally from this freeing experience. "Self-worth", or rather satisfaction with life, springs from a deep sense of achievement, sense of self-control and self-efficacy.
 

phoenix1

Well-known member
I can understand what you mean, but its not like littlemissmuffet is simply saying that it doesn’t work for her and thus it cant work for anyone else. I’m sure she can speak for herself though. She has done several posts on the theory of why it struggles to fully capture SA and I believe its worth taking a look at. People can make up their own mind, but I think its an important discussion to be had. I think keep in mind that people also come looking for what doesn’t work and *specifically* why it doesn’t seem to work.

You say it worked well for you. In what ways did it work, and why do you think it worked well for you?
 

van_sp

Active member
I have some spare time so I'll add add my 2 cents.
I think posting personal opinions in a forum and sharing personal experiences is the purpose of a forum like this one. But, stating absolutes, is something else.
It's fine to post a link stating something such as, "I think you may find this interesting", or, "I believe CBT may not have the results currently claimed", but posting "Proof that CBT (alone) does not work", is a statement that warrants a lot more leg work than, "I found this just now on the net!!!!!".
Anyway, I think people generally make their own minds on these issues, but if you state absolutes when it's actually an opinion, you may need to dress in armor and prepare yourself for the front lines.
Just my humble opinion ;)
 

random

Well-known member
I am a LittleMissMuffet fan - I really enjoy reading what she writes and have told her that she is above my intellectual plane - yet I do disagree with her on this thread. Like Scatmanton I am concerned that posting sweeping statments indicating CBT doesn't work might needlessly discourage people who can benefit from it. In other threads I have objected to people stating that only one method 'really' works; I believe a variety of treatments work for a variety of people. I will rely on other experts to flesh out my opinion:
"There are more than 375 trials of cognitive-behavioral therapy in the research literature," Donna Sudak, M.D., director of psychotherapy training at Friends' Hospital in Philadelphia and a member of the APA Committee on Psychotherapy by Psychiatrists, told Psychiatric News. "There is very robust evidence of its efficacy in depression and in multiple anxiety disorders, particularly generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, and social phobia."
The quote above was taken from an article posted here:
http://pn.psychiatryonline.org/cgi/content/full/41/3/21
Increasing Use of CBT Suggests Promising Future
Joan Arehart-Treichel
Cognitive-behavioral therapy will be more widely used during the next five to 10 years, predicts one of its developers. He bases his projections in part on what has occurred in Britain and Scandinavia.
Cognitive-behavioral therapy (CBT) is an amalgam of cognitive therapy and behavioral therapies able to help patients counter negative thoughts and behaviors underlying various mental illnesses. Science has demonstrated that it can pack quite a therapeutic wallop……" See the website for the rest of the article

The folowing organization is a US government website for mental health.
National Institute of Mental Health: http://www.nimh.nih.gov/publicat/anxiety.cfm#anx8
Cognitive-Behavioral Therapy Cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations.
For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.
People with OCD who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them. The therapist helps the person cope with the anxiety that waiting produces; after the exercise has been repeated a number of times, the anxiety diminishes. People with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee and to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, these anxieties are lessened. People with PTSD may be supported through recalling their traumatic event in a safe situation, which helps reduce the fear it produces. CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.
Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Often the therapist will accompany the person to a feared situation to provide support and guidance.
CBT is undertaken when people decide they are ready for it and with their permission and cooperation. To be effective, the therapy must be directed at the person's specific anxieties and must be tailored to his or her needs. There are no side effects other than the discomfort of temporarily increased anxiety.
CBT or behavioral therapy often lasts about 12 weeks. It may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia. Often "homework" is assigned for participants to complete between sessions. There is some evidence that the benefits of CBT last longer than those of medication for people with panic disorder, and the same may be true for OCD, PTSD, and social phobia. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.
Medication can be combined with psychotherapy for specific anxiety disorders, and this is the best treatment approach for many people.

When referring to the article about CBT treatment used for anxiety located here:
American Psychologica Association: http://helping.apa.org/articles/article.php?id=46
The APA says this "No one plan works well for all patients. Treatment needs to be tailored to the needs of the patient and to the type of disorder, or disorders, from which the individual suffers. A therapist and patient should work together to assess whether a treatment plan seems to be on track. Adjustments to the plan sometimes are necessary, since patients respond differently to treatment."

From the website for Anxiety Disorders Asssociation of America:
http://www.adaa.org/GettingHelp/AboutAnxietyDisorders.asp
"Fortunately, the vast majority of people with an anxiety disorder can be helped with the right professional care. Alone or in combination, psychotherapy, cognitive-behavioral therapy, and medication therapy are effective treatments. There are no guarantees, and success and treatment rates vary with the individual. Furthermore, patients with an anxiety disorder sometimes suffer from clinical depression and substance abuse, further complicating proper diagnosis & prolonging treatment."
 

random

Well-known member
phoenix1 said:
I can understand what you mean, but its not like littlemissmuffet is simply saying that it doesn’t work for her and thus it cant work for anyone else.
Phoenix1,
LittleMissMuffet seems to be making a less personal, more all-inclusive statement. She would be perhaps too cautious if she said "it didn't work for me so it won't work for you' but I believe she is even more overly cautious in advising "Evidence that CBT (alone) doesn't work" so I resist that latter statement strongly. I think Scatmanton does a good job of encouraging openmindedness regarding treatment by saying that CBT worked for him and could work for others too.

phoenix1 said:
I’m sure she can speak for herself though. She has done several posts on the theory of why it struggles to fully capture SA and I believe its worth taking a look at.
I agree with you - she does indeed speak quite well for herself; perhaps I an others are taken off guard by this 'absolute' thread because we were not sufficiently aware of the other threads that round out her opinion. Perhaps someone would post those links in here so we could see more of the direction behind this thread?

phoenix1 said:
People can make up their own mind, but I think its an important discussion to be had. I think keep in mind that people also come looking for what doesn’t work and *specifically* why it doesn’t seem to work.
My stating that I am concerned that absolute statements rejecting CBT might be needlessly discouraging lives in peaceful harmony with the idea that people can make up their own minds and come here looking for balanced information.

phoenix1 said:
I think keep in mind that people also come looking for what doesn’t work and *specifically* why it doesn’t seem to work..

Very true - I see nothing in Scatmantom's comments that indicates he objects to people airing pro's and con's of various treatments so he says " dont discourage it in a place like this, people come here looking for advise and help...". Maybe Scatmantom and I agree that we just want to avoid absolutes that may serve to discourage people from trying a therapy that has provided others with sweet relief from suffering.

phoenix1 said:
You say it worked well for you. In what ways did it work, and why do you think it worked well for you.
I take a thorough interest in anything Scatmantom might want to post here about his experiences but I am a little surprised - might the question to him be heading off the topic of this particular thread? LittleMissMuffet says she has found evidence that CBT is not effective - by now you know that I resist the absolute (too discouraging) and will at least say it seems the experts don't agree on this point. I would like to know what evidence she found and asking Scatmantom to explain his sucess with CBT doesn't advance her purpose for this thread.
LittleMissMuffet,
I am wondering - looking at the similarity of names of the two therapies ( MCBT vs CBT) if MCBT is thought to add a key or vital enhancement ( the 'M') to an already sucessful therapy (CBT)? When I first started exploring CBT on the web I encountered many 'flavors' of CBT (and hence a variety of names) that some writers tried to classify loosely in a few different ways - is MCBT a flavor or does it reject the standard understanding of CBT and replace it with something entirely different?
 

Zipper

Well-known member
I believe that cognitive-behavioral therapy alone can be used to halt the progress of the disorder and even to recover from the disorder. A combination of SSRI's and CBT is better than either alone, but CBT alone is useful nonetheless.
 

LittleMissMuffet

Well-known member
Ok, I was careless I think. :?
Hopefully people will forgive my mistake and understand that I did get a bit carried away with my own personal experience of social anxiety.
I'm sorry about that: I was just very enthusiastic to find supporting opinions of psychiatrists that CBT may not be very effective.
Also, I was trying to sensationalise my title so that it would catch peoples' attention -which, I know was not the most truthful thing to do.
So, sorry about over-generalising and forgetting others who do not have my own specific experience.


It is funny that they are saying things that I've already thought of on my own -proving I think that the patient should place trust in their own opinions and experiences. And that is the thing to remember here. -Technicially, this is what at least some of the experts are saying -that CBT alone is ineffective in the long term. ...yet, again, I would loook to my own personal experience -since, my own personal experience has told me that CBT does not work for me and the Mindfulness does. So, if others find that CBT does work for them: read this article perhaps just to be informed, but trust your own experience; since the experts change their minds as they go. And one day, such-and-such a treatment is the right one, and the next day it no longer is. ...And my own experience seems to be proven by what -some- psychologists are now saying. Again, the lesson here is TRUST YOUR OWN EXPERIENCE. (...how much smarter can psychologists be if they end-up turning round and telling you things you've already thought of.) Really, honestly: go with your own experience and don't let anyone override what you personally believe is true. But it is also good to know of other's experiences and other options.


So, if CBT works for a person then it works. I think that it is good however to know about Mindfulness as well.

My own personal hunch is that CBT works for people whose anxieties may in fact be a little less out of control. Whereas, people like me, need to step away from judging what thoughts are 'good' and 'rational' -which CBT does- as well as that being 'prepared' and 'armed with counter thoughts' seems to add to my already apprehensive mood; and also concentrating on the various ways my anxiety can manifest it self, being that it latches onto any little thing, I think just makes me more uptight and 'emotionally fussy'.

So, according to my own hunch ....CBT may work for a person and may last, but it may also depend on how strong your anxiety is. -That is my hunch.

Look at it this way: if CBT works than brilliant. If it doesn't, then you can always try Mindfulness. It is there and it exists as a viable alternative.
 

signs05

Well-known member
What, unfortunately, has not been mentioned about mindfulness is that it deals with automatic thoughts, i.e you observe the automatic thoughts that fly through your head at any given time. It does not, however, deal with the core beliefs that are so deeply rooted within us that we don't even notice they are there. This is where CBT comes in. You can observe and distance yourself from your automatic thoughts, but you can not observe and distance yourself from your core beliefs unless you actually deal with them.

CBT can not be done by yourself, you have to have someone trained who can notice your core beliefs which you do not yourself notice, because they are so second nature that you do not even question them.

I believe that a combination of both CBT and some sort of mindfulness is the best option.
 

LittleMissMuffet

Well-known member
Hi Signs,

I think you're essentially right. The experts, for one, seem to be using both Mindfulness and CBT together. I recently read one opinion that stated that either could work as well, but that also Mindfulness may be more necessary for cases where the problem is more entrenched.

-I know that Minfulness is all about acquiring concious awareness over one's thoughts and emotions. And I think that without this, CBT may be too superficial. IT depends though, I think on how deep and unconcious certain emotions/beliefs are.

Anyhow, I still don't know for sure and I jsut make my own theories mostly. And there is an array of opinions about this.

One interesting thing to know is that the Buddhists believe that there is no need to DO anything, that there is only the requirement to SEE and then what to do has become a natural matter. -So they recommend Mindfulness practise in order to have this concious 'sight'.
 
LittleMissMuffet said:
I know that Mindfulness is all about acquiring conscious awareness over one's thoughts and emotions.

In Acceptance and Commitment Therapy (ACT) we use mindfulness to retain awareness of what's going on around us (such as in anxiety causing situations). I personally am quite tired of my thoughts and emotions. I'm more interested in doing things and getting my life back together. I don't meditate, I work, I study, I do chores, etc. Life provides me enough opportunity for gradual exposure and to practice the ACT version of mindfulness (focusing on what's going on around me not within me).

CBT made me worse. I'm no longer interested in challenging, changing or otherwise bothering with my thoughts, emotions and/or beliefs. ACT lets me do what I want to do using my own values as motivation and guidance.
 
Top