Cognitive behavioural therapy: experiences? recommendations?

Thirith · July 2019

My wife suffers from various, to my mind fairly strong anxieties (not necessarily caused but most likely aggravated by major health issues and childlessness) and analysis paralysis. We have talked in the past about whether she might benefit from some form of analysis or therapy, but she's always been very adamant that she's not interested - with one exception: she has said that she could imagine cognitive behavioural therapy, though only just about.

I'm definitely not going to push her, not least because that would be the best way of ensuring that it won't ever happen, but I'm wondering whether there are people here who have some experience when it comes to cognitive behavioural therapy: how well it worked for them, what kind of things to be aware of if one is considering this option. If my wife was to decide to give this a try, I'd want to be in a better position to be there for her.

nexuscrawler · July 2019

I went to a CBT-based therapist for a couple years a while back and found it helpful.

CBT might be easier to deal with for someone who doesn't like the idea of therapy. It's very results focused. You're walked through breaking down cycles of behavior. Then you're supposed to relearn coping strategies and dispel misconceptions that led to the problem behaviors.

To me it was very utilitarian but effective.

Thirith · July 2019

Thanks, that's some useful information. I can see how the utilitarian, results-focused thing would appeal to my wife.

Gnizmo · July 2019

I don't have a lot of experience as a client going through CBT as it is not my jam. I am a therapist who uses some CBT stuff, and I do know a decent amount abou it. I am a little lost as to what kinda stuff you might want to known. What about the idea of CBT appeals to her? I would love to offer some insight, but I am not entirely certain what you would want to know vs what you already know.

CBT tends to be fairly work sheet based, and involves a lot of outside work. It doesn't focus as much on insight as it does working in the problem at hand. That isn't to say it can't happen, but the focus is more reducing symptoms. It is not the most problem focused therapy model in existence, but it certainly is on the end of the spectrum.

I would also be open to trying a few people with CBT to see if you can find the best fit. Even more so than usual. It is a very simple model when you look at just the basics. Even I can muddle through the basic stuff with a good deal of competency even though I am not particularly good at CBT work in general. I have seen a lot of my colleagues default to it because it can offer such an easy template for what to do next, and they are terrible with it. I have also met some people who are amazing at it. The first time I saw a good CBT session it was a revelation.

Ultimately, as you know, it is about getting your wife on board. I would say talk to her and see what she is willing to try. Psychology Today is the standard advertising platform for therapists in private practice which would give you a blurb about them to see what resonates. They should also be sortable by insurance taken I think, or at least if they accept any insurance. Agencies work just as well, but it is harder to get to know who she would be working with until she met with them at least once.

Thirith · July 2019

Thanks, Gnizmo. I think I'm mainly looking for more experiential information than what I'd find on Wikipedia: whether people's experiences with CBT generally were good, what they wish they'd known about it beforehand, that sort of thing.

I assume the Psychology Today thing would only be applicable in the US, right? I'm not sure we'd have that sort of thing for Switzerland, but there are definitely a few therapists using CBT in our city. I'm hoping that my wife is thinking about this as an option, because at present I'm pretty much 99% of her support system (her best friend lives in a different country and she doesn't have many close friends here), and it can be pretty draining. Admittedly there's some selfishness in me hoping that she'll consider this, because it would have the potential of providing some relief to me as much as it could help her. In that respect, addressing the symptoms would already take some pressure off the both of us.

Echo · July 2019

I did CBT for my IBS about five years ago. I went there thinking it would just be about shutting up and accepting things, which I suppose is strictly speaking true.

What it actually was about was analyzing your behavior, and then working to change it.

My IBS made it really stressful for me to go anywhere. On the very worst days I couldn't leave the apartment, and most of the time going anywhere on the subway was a project.

The CBT was about analyzing this behavior. When I feel that I need to do number two, I have a very natural reaction: I go to the bathroom.

What that actually did was training my body to expect immediate relief, and then I couldn't handle situations where I no longer had immediate access to a toilet, such as being stuck on a subway train for 30 minutes.

The CBT part was analyzing this and then adapt yourself to a new behavior. It started with simply logging when I felt the need to go to the bathroom, and setting a time to wait before actually going - it wasn't about waiting as long as possible, just set a time and try to wait that long. I started with two minutes, and couldn't even do that at the start, but eventually I could. Then I tried waiting a little longer.

Again, that wasn't about setting a new world record in holding it in, but to adapt to situations where you don't have immediate toilet access.

I also learned some meditation-like breathing exercises, because when you need to poop real bad, you can't think about anything but your stomach. That was about being aware of the rest of your body at the same time - not to distract yourself from your stomach, but to put it in perspective with everything else.

tl;dr CBT worked very well for me. I still have IBS, and I still have bad stomach days, but it went from a constant source of anxiety to a problem I can manage. I still have days where I'm on the subway and my brain tells me I will poop my pants in about 90 seconds while I'm still 15 minutes away from work, and it kind of hurts, but I can cope with it. I don't stress out and get off the train to look for the nearest public bathroom.

Thirith · July 2019

Thanks, Echo, that is very helpful, in particular this:

... it went from a constant source of anxiety to a problem I can manage...

I think it's exactly this sort of thing that would help my wife, and that would also appeal to her. She constantly tries to come up with coping mechanisms for her anxieties, but the ones she tends to choose seem to aggravate things more often than not in terms of how they interact with her issues of self-worth, which in turn tends to make her more anxious. I'm thinking that an external perspective could help her with that process. She's not going to shed her anxieties any time soon, but the better she can handle them in practical ways, the less she might reinforce her anxieties while trying to conquer them.

Fry · July 2019

I understand that there are different kinds of CBT for different issues. I think I've heard about it being used to help with smoking cessation; I did a bit of it for general depression. I found it to be helpful, in combination with medication.

Sessions usually started with "how have you been feeling since the last time we met?" and from there it was a sort of guided introspection about any negative feelings (anxiety, sadness, unhappiness, etc). Sort of a logic-based approach to emotion management. "You say you feel like you're the worst student/parent/sibling/whatever in the world. How many people are there in the world? Do you think you're really even in the bottom 10%?" Since I was only mild-to-moderate depressed, thinking critically that way helped me shake off the unhappiness. YMMV

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Cognitive behavioural therapy: experiences? recommendations?

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