CBT for CPTSD

[malt2018]

My therapist recently suggested CBT for helping when I am being triggered. She thinks noticing my thoughts will help to reduce my reactivity and response. I don't beleive this will help me and am very annoyed by this. I don't get caught up in negative thoughts . I spend far too much time in my had and I have too many thoughts about what may or may not be happenning. I have tried to talk it through with her but it's like she has dug her heels in and believes this is the key. I have gone the other direction and feel more resistance than ever as I don't feel it is the solution she wants it to be . I am wondering if it is all just resistance on my part and I need to do this. Anyone had exerpeince with the thought record and found it helpful or unhelpful?

[Armee]

Hi. My therapist of 3.5 years is a CBT therapist and drank the kool-aid. I didn't know about trauma or cbt or therapy when I started with him. I just wanted to be a good client so he would help me. So i kept trying and trying and trying and trying with the CBT. Until he finally started to learn more about trauma and to see how we were making things worse in many ways.

I did learn things from CBT. It did increase my awareness of thought patterns and my ability to notice things and to get better in some ways.

I welcome it as one of many many tools.  But not the main one. My biggest problem with it is that I logically  KNOW the thoughts I have when triggered are distorted and when I am not triggered they are not bothersome because I know they aren't true. But the triggers are many and they are hair triggers and once I am triggered they are true. And asking me to defeat them is like denying these parts of myself and further beating up on myself.

There's a place for CBT though and maybe you could tell your T you are willing to learn some CBT skills as long as you both can stay mindful of whether it is helping or worsening symptoms and as long as she interweaves other techniques too and stays flexible with the approach. There's always something to learn. Trauma requires many different tools.

CBT has been both helpful and harmful for me. What has made using it  ok is having a therapist who listens and adjusts when something isn't working and is humble enough to try new things.

We went through a lot of bumps and set backs when he listened too much to his CBT guru but eventually he learned to trust himself more and I'm glad i suffered through those painful times because the healing has been really impressive the past year or so.

[malt2018]

Thanks for your response. Yes my belief is that it won't help me. I practice alot of mindfulness so am aware of alot of my thoughts. My understanding is that the nervous system kicks into place and we are triggered even before the thoughts arise. At that point I don't feel my thoughts are going to help calm my nervous system especially it is not necessarily about evidence for or evidence against whats real and not. e.g one day a woman fell beside me in a cafe and made a loud bang. I was immediately triggered and sent into an emotional flashback as I saw my mother falling down drunk many times. the woman was helped back up and was fine and not harmed in any way. I knew she was okay. Was able to tell myself she was okay. could 'see' she was okay but no amount of talking to myself here would help me calm my nervous system down at this point.

[Armee]

I agree with everything you say here. There are areas of life where it is helpful but again only as one component of therapy.

[Kizzie]

I just wanted to add my recent experience with CBT echoes what has been discussed in this thread - good for some things but not for the deeper wounds of trauma. What I have noticed as someone who recently was in in-patient and out-patient care is that the professionals dealing with myself and the groups I was with seemed to quietly push any talk of why we were depressed and anxious away when we brought them up.  It did not seem to matter why we felt the way we did, all that mattered was replacing negative thoughts with more balanced/positive ones. 

I was in a day treatment program when I found out my NM had terminal cancer recently and everything just spun out of control for me.  I could not bear going back to the program and trying to fit my feelings into the CBT mould so I left. Her impending death just brings about very mixed and deep feelings I need to talk about, not work on how I can think differently (more positive, balanced) about what was and is major trauma in my life.  I need relational therapy with a T who can bear witness to the whirling, up-ending emotional feelings and thoughts I am really struggling with at the moment. It may be or at least sound irrational for my younger self to rise to the surface because of what's happening, but there she is and I can't bear the thought of a CBT T cutting her off or trying to make her conform to the tenets of the model. She so needs to be heard and hugged and comforted.  I'm not going to get that with CBT, just a gold star if I can replace my thoughts and by extension my feelings which frankly isn't going to happen, It's just not.

There's a line from a review of a book by Farhad Dalal called "CBT: The Cognitive Behavioural Tsunami" that says "By avoiding to take a look at the causes of depression, CBT is doing away with meaning."  And "Your CBT therapist will have little interest in why you are depressed. The whole process has a number of advantages for a number of people - except for patients."  Isn't our suffering and struggles all about meaning and isn't that how we will recover - by making meaning of all that has happened to us? 

What I didn't know about CBT is that it gained popularity after the Vietnam war when there was a "massive influx of PTSD" and the approach proved very economical for treating soldiers. At the same time, however, according to Dalal it "purged all things human" and therein lies the problem.  Little parts of us may improve but overall, we need relational treatment for a relational mental health issue that is deeply and fundamentally human.

Farhad Dalal's book CBT: The Cognitive Behavioural Tsunami

Rather than the "gold standard" those in various sectors (mental health, government, veteran's affairs, etc), claim it is Dalal argues that "CBT is an exercise in symptom reduction which vastly exaggerates the degree to which symptoms are reduced, the durability of the improvement, as well as the numbers of people it helps."

[Kizzie]

Why CBT Alone Is Not a Trauma-Informed Approach: Helping clients to "connect the dots" between their past and present. by Lisa Ferentz LCSW-C.  Posted November 6, 2019

Good article about why CBT is unhelpful for deeper trauma wounding. Some sample excerpts:

"When therapists only focus on re-framing negative or distorted cognitions or give clients a formulaic approach to changing their behavior without exploring the underpinning of those beliefs or self-destructive choices, it's as if they are building a house on sand rather than a foundation of concrete."

"Although there is absolutely a place to address negative, inaccurate beliefs and behaviors that are unsafe or promote shame, if therapy doesn't take into consideration clients' histories, their affective states, and the somatization of their trauma, then we are putting a band-aid on something that requires surgery."

[Blueberry]

I need relational therapy with a T who can bear witness to the whirling, up-ending emotional feelings and thoughts I am really struggling with at the moment. It may be or at least sound irrational for my younger self to rise to the surface because of what's happening, but there she is and I can't bear the thought of a CBT T cutting her off or trying to make her conform to the tenets of the model. She so needs to be heard and hugged and comforted. 

Your younger self definitely needs to be heard and accepted, not swept under the rug so to speak.

I am very lucky in that I now actually have therapy - outpatient and soon inpatient again - that does actually address what you and all of us need. I am so sorry that it doesn't seem available where you are   Kizzie you know what country I'm in - and I'm so grateful how much help is available here, I wish your health care service provided similar. I don't mean just financing it, though that's obviously part of it, but there just being the option out there. I used to do healing retreats, which I had to pay for privately, but all this sort of stuff like inner child work was addressed there. Work, or more indepth work, with a younger self might have been postponed for a couple of hours, but then your younger self would have been heard, seen, worked with within the retreat. I've also had my fair share of Ts or docs or whoever trying to shut my younger selves down and that didn't pan out in the long-term putting it mildly.

I'm sorry you're struggling so much atm. That thing with NM is a big tsunami, to state the obvious.

Kudos to you for leaving the program, for trusting your own feelings and/or those of your younger self And kudos to you for doing the research you're sharing with us on here to back up your feelings. You're finding professionals who agree with your perception

[Kizzie]

Tks so much for your kind and insightful words BB.  I felt like a bad person for leaving even though my gut was telling me I had to so I starting looking for considered/reasoned opinions about why CBT left me feeling empty.  I found them and they resonated so much with all that I was and am feeling.  The more I look the more I find that reassures me I did the right thing for me and what I'm dealing with, but at the same time leaves me quite sad there isn't much if any treatment for trauma available here.

I am so very happy you are getting genuine trauma treatment, I can see a big difference in you.     

[Armee]

Absolutely Kizzie (and Blueberry). That part of you needs to grieve (actually with that level of trauma, multiple parts need to grieve their own unique losses). You need to grieve. You don't need to be told your thoughts are distorted that your mom didn't love you or whatever the exact thoughts are. You need to be heard that that was the truth, as painful as it is and was and to be supported in grieving that.

One of my main triggered thoughts is "I'm bad and wrong." I have that persistent thought for many reasons but primarily because the mental mind games of being raised by someone with a severe severe PD made you constantly question your own reactions and beliefs about yourself and the world. Guess what CBT does? Same thing. It is almost retraumatizing. It tells us we are bad and wrong to feel or think the way we do.

Interestingly I've noticed now that my own T has expanded beyond CBT and DBT (also bad for dissociation, I believe) and now is well trained in EMDR and partially trained in parts work that he can successfully weave in CBT methods with emdr and especially parts work in an effective way. I haven't experienced it long enough to describe what is happening in a useful way but I see that it is a promising way to work, at least with my constellation of symptoms.

Kizzie, we are here for you. It is actually really hard to find people who can hear and accept the truth of your situation. Like with every situation you go through I know you'll also find space within your grief to educate and advocate for the rest of developmental trauma survivors. I hope I did a little of that with the hospice grief counselor who reached out to me after my mom's death with a long spiel about how hard it is to lose one's parents and that you never really get over the loss etc.

Keep taking care of yourself and paying attention to what you need. Even hating my mother the way I did and even with the relief I felt, that experience knocked me on my butt for 1.5 years. It's hard. But it wasn't quite as hard as I thought it would be.