Tuesday, August 9, 2022

Comments by fergkane

Showing 3 of 3 comments.

  • Interesting (disclosure: I use CBT and its underlying research and evidence-base as the cornerstone of my psychological practice, albeit mostly in a ‘third-wave’ form – so the things the author is arguing against). There are some valid criticisms here, but there is a lot of what I’d call straw man arguments. For example:

    “The delusion continues: thoughts precede emotions and are separable from them…Once corrected, once cognition matches reality, then the emotional life falls into line and the person is in recovery. This is readily achievable in anything between six and twenty sessions. Here endeth the delusion.”

    Well this may be taught on some CBT training, but it was not on mine. In fact, in my training, we were specifically taught that behavioural change was generally necessary for stable cognitive and emotional change. Cognitive challenging, psycho-education and functional analysis is one way of helping a person engage/reengage in intrinsically valuable and rewarding behaviours in a way that will facilitate their recovery.

    I’m also not at all sure that (as argued in the youtube video) the ethos of ‘second wave’ CBT was ever ‘control’. CBT for phobias, OCD, trauma etc, implicitly, (if not explicitly in all teaching), requires the person to give up on their attempts to control their fear and thoughts. That is the only way out, to give up on unworkable attempts to control and try something else.

    The adoption of other approaches (from attachment and Eastern thought) can be used criticism, but I think the reality is better than that, in that CBT practitioners have acknowledged what is missing from their practice and attempted to correct their previous practice. I think we should welcome attempts to improve our work, and that requires seeing the flaws, and testing our assumptions. Otherwise we’d be stuck with the damaging and ego-driven over-interpretations, racism, misogyny, homophobia and ineffective practice (especially for issues such as seen in OCD) and such like that we started with.

    Now that said, CBT can be done extremely badly. It can:
    -place all the blame for suffering on the person
    -be used in collaboration with societal systems of control
    -collaborate with a persons’ unworkable desire to control thoughts, emotions and suffering when mindful acceptance of ‘uncontrollable’ internal experiences may be more effective
    -conspire with the idea that there is a ‘correct cognition’ that will make things better.

    We need to watch out for all of that.

  • For some with mania it may be as you describe, for others it’s horrible and destructive and it’s far more than heightened awareness. Mood stabilisers, for all their terrible side effects have proven efficacy in reducing relapse rates to depression and mania.

    What is the correct mood to have? Well only the individual can really be the judge of that, but many of those I’ve worked with would be very happy to sacrifice some heightened awareness in order to never again have a manic or depressive episode. Others feel that the benefits of medication in no way make up for the side-effects.

  • A note on… “All participants were taking “antimanic” medication, also known as “mood stabilizers” (e.g. lithium)”

    Mood stabilisers are not generally considered specifically ‘anti-manic’ – they are instead generally considered as exactly mood stabilisers, in that they prevent ascent into mania AND descent into depression – as well as being used to treat acute mania and depression.

    Thanks for the report.