Psyched About CBT, Ctd

Judging by the in-tray, Dan was not the only one to notice the other meaning. On a more serious note, a reader writes:

I realize you’re trying to be balanced here, but Jenny Diski’s article makes it pretty clear she’s never actually tried cognitive behavioral therapy and is in fact just opposed to a political philosophy. I’ve been in and out of talk therapy for anxiety and depression all of my life, and my last therapist (not one specifically trained in CBT, as far as I know) pointed me toward The Feeling Good Handbook by David Burns, which is a do-it-yourself CBT manual. It helped to make me realize what I was thinking and which parts were really just in my head, and now at least some of the time I can short-circuit my own worst-case-scenario thinking. It has made me happier.

Diski dismissively says that “CBT aims to get the patient symptom-free, back to work and paying her taxes” – as though that weren’t the goal of other forms of therapy. Maybe I’m odd in that I’m happiest when I’m feeling productive, but that sounds like a pretty excellent goal to me.

Another also shares his story:

I’m a 30-year-old who just finished my 16th week of CBT after a suicide attempt in March.

I have found that working with my therapist on identifying thought patterns and behaviors surrounding my depression and anxiety to be of tremendous help. One of the best things to which I can compare my thought pattern when I begin to feel anxious or depressed is sliding down an icy hill in a car. Having the skills from CBT is like having just come out of a driving class and knowing that while you might not be able to stop the slide completely, you can control it and avoid the crash. The ability to pull back and distinguish what-I-know from what-my-mind-is-projecting is a skill that I lacked before therapy.

But as well as it does work for some of us, it’s not a silver bullet either. In addition to the CBT I am also taking a daily antidepressant and the occasional anti-anxiety pill when I can anticipate that certain situations are too much to handle on my own. My therapist is terrific, and we’ve adjusted the antidepressants when the first prescription wasn’t working as planned.


As the guy who wrote this reader email long ago, I thought I’d discuss my experience with cognitive behavioral therapy.

I have OCD, with an emphasis on the obsessive thoughts. To put it bluntly, CBT is the most effective treatment for obsessive thoughts that I have had. The counselor I had was a Buddhist and definitely not a “I’m going to make everything happy and great for you” kind of guy. In fact, one of the key elements of the CBT I had was acceptance of the obsessive thoughts. This is counterintuitive, because if you have OCD the number-one thing you want to do is get rid of the obsessive thought.

If I have a thought that I’m like Hitler, CBT teaches me to accept it like a leaf that passes over me as I lie in a stream. This is bitter medicine, because one’s instinct with a thought like that is to fight it over and over and try to rationalize it and thus rid yourself of it. But one of the key insights of CBT is that you cannot rationalize or “defeat” the obsessive thought. In fact, the only way I’ve found that you even move past the obsessive thought is if you allow it to exist within you. It will bother you immensely while it’s there. But when you mindfully acknowledge it rather than try to get rid of it, you do find that your mind moves on to more pleasant things.

My one criticism of CBT is the limited number of sessions. It’s admirable not to want to charge people money for endless counseling, but I have found it valuable to get a “tune up” once in awhile. Talking to a CBT counselor is helpful, and I don’t think should be cut off forever after just a couple of months.

My experience, of course, may not be universal for others with OCD. But I thought it was worth sharing.