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Psychoanalysis vs CBT


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Having finished my personal research on this and having discussed with some top Greek psychiatrists I have concluded that CBT helps you live with OCD, take back control of your life but not totally cures you. CBT is also easy and cheaper, it can been applied and work for everyone. Psychoanalysis is difficult, expensive, needs a lot of time but if it succeeds then the patient is unleashed, free to live his life in peace. 

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Your research is flawed. CBT is the only recognized therapy for OCD. It is not about learningto live with OCD. It is about teaching you techniques that can help you overcome OCD.

The other is completely useless for treating OCD.

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54 minutes ago, PolarBear said:

Your research is flawed. CBT is the only recognized therapy for OCD. It is not about learningto live with OCD. It is about teaching you techniques that can help you overcome OCD.

The other is completely useless for treating OCD.

The other needs good psychoanalysts, which are very rare to find...

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While psychoanalysis might help a patient recognize inaccurate thought patterns and behaviors developed as a result of OCD, it will not cure OCD.  Evidence based research backs up CBT as the effective psychiatric treatment for OCD.  This is widely recognized by major psychiatric health organizations around the world including the American Psychiatric Association (US) and the National Institute for Health and Clinical Excellence (UK) among others.  While it is up to each individual to make their own choices on how to proceed with treatment, the evidence does not support psychoanalysis as an effective option for treating, let alone curing, OCD.

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Hi diomedes. You need to give the reasons why ‘top Greek psychiatrists’ believe that psychoanalysis is better than CBT. Otherwise you are simply using a rhetorical device by using the phrase ‘top Greek psychiatrists’ suggesting that we submit to their assumed authoritative knowledge. This is neither rational nor scientific.

Having said that, CBT is cheaper than psychoanalysis. In England IAPT - the system where you can receive therapy on the NHS without going through your GP - was agreed in Partiament because of economic arguments. The cost of treatments such   as CBT would pay for themselves by improving people’s well being. This would result in fewer welfare payments, increased employment and raised productivity. There was a cost-benefit analysis which indicated that the costs of treatment would be less that the accrued benefits of therapy.

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My sister was subject to Freudian psychoanalysis for some time before her OCD was recognised. 

The psychiatrist blamed her problems on her upbringing, and her relationship with Mum. 

This was some 45 years ago. Thank goodness the less obvious types of OCD - the more invisible, mental only, types are now better spotted and we have CBT. 

For me, CBT is the core treatment, and other concepts like The Four Steps, meditation, mindfulness helpful. 

Someone talked about Acceptance and Commitment Therapy on another thread. But for me the issue with that is it doesn't get into challenging the disorder through exposure and response prevention - so the underlying nonsense of the OCD core belief can remain in place. 

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First I would like to thank you all for your responds,

I personally did CBT the last 10 years back in Greece and now I just take medicines, waiting to figure out how to continue here my therapy. CBT has worked for me, the only issue I have is difficult to concentrate, but it isn't ADHD (I have been examined by psychiatrists of the Hallowell Centre in Athens). For example I cannot watch a movie and concentrate in what is happening. Anything to suggest me?

It is true that OCD resists to Psychoanalysis and I now believe the reason is that good psychoanalysts are very rear and very expensive to have access to, this was my only point, I don't believe that CBT doesn't work, I still read CBT books and I feel so lucky and excited to not need to be an affluent to get help and support. I now read the 

OCD, Anxiety, Panic Attacks and Related Depression - The Definitive Survival and Recovery Approach (Pulling the trigger) by Adam Shaw and Lauren Callaghan

and also the 

Cognitive Behaviour Therapy: Your Route Out of Perfectionism, Self-Sabotage and Other Everyday Habits with CBT by Avy Joseph

Please have always in mind that we don't all have the same spectrum of perception and understanding, I personally have studied physics and have witnessed the cold fact of how much more stronger minds than me were sitting just next to me in the auditorium. The same exactly happens with the psychoanalysts.

Regards

 

 

 

 

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I feel like the best thing to do is always go with published research and known authorities when treating any illness.  Studies have proven cbt, act, mindfulness and medication to all be good ways of dealing with ocd.

If your argument is that psychoanalysis isn't a well documented cure for ocd because most psychoanalysts aren't very good... It doesn't really inspire me to consider psychoanalysis I'm afraid.   Do you have any non-anecdotal evidence?

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On ‎05‎/‎03‎/‎2019 at 21:33, raven said:

I feel like the best thing to do is always go with published research and known authorities when treating any illness.  Studies have proven cbt, act, mindfulness and medication to all be good ways of dealing with ocd.

If your argument is that psychoanalysis isn't a well documented cure for ocd because most psychoanalysts aren't very good... It doesn't really inspire me to consider psychoanalysis I'm afraid.   Do you have any non-anecdotal evidence?

No I don't have, and as I have already implied if I was an affluent I would follow the psychoanalysis path with a psychoanalyst that I trust (my father was an MD so I have some access to information about elite psychoanalysts in Athens, Greece) Now I am based in London and still not affluent, so CBT will still be my way of struggling with it. Can you give me any information about NHS CBT options and how much money it needs? 

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At the moment there is evidence that CBT is best for OCD. However, there are six psychotherapeutic approaches for the treatment of depression and equally ranked on the NICE site are CBT and psycho dynamics. Basically another name for psychoanalysis. To put it crudely.

In the book CBT for OCD written by largely the same people as Break Free From OCD there is an increased emphasis on the creation of core beliefs that fuel OCD. The authors are among the most respected therapists in the UK for OCD. This is reflected in the text by the reference to compassion based theory and the work of Paul Gilbert. His work is influenced by attachment theory, amongst other things, which explores the development of the mind during our early and formative years.

I think we owe to ourselves and others to be open minded. I still interested in hearing your reasons why psychoanalysis for OCD is a good idea. I think it is fair to say that in CBT for OCD a rigorous long term commitment to psychoanalysis is not recommended. The core treatment is the same in both texts.

 

 

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I have already read two books of Paul Gilbert (in Greek) and now reading "COGNITIVE BEHAVIOUR THERAPY" by Avy Joseph and "Pulling The Trigger - OCD ANXIETY PANIC ATTACKS and RELATED DEPRESSION" by Adam Shaw and Lauren Callaghan. They really give you a huge perception of your issue and I feel very lucky to have them.

Psychoanalysis is about curing the reason of the OCD (ideally)

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10 minutes ago, diomedes said:

Psychoanalysis is about curing the reason of the OCD (ideally)

There may be value in that if the OCD was started up by some seeding traumatic event which is in the mental background and needing bringing out and resolving. 

But generally CBT says we don't need to establish the cause, we simply need to challenge the OCD false, exaggerated or revulsive core belief created by the OCD which causes all the damage. 

Edited by taurean
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25 minutes ago, paradoxer said:

I wasn't breast fed, so I have OCD. :;

:biggrin:. I was taught in CBT that looking for the original cause of my OCD was a pointless waste of time. 

Rather, I should get on with the CBT programme and get recovered :)

 

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7 hours ago, diomedes said:

Psychoanalysis is about curing the reason of the OCD (ideally)

OCD is caused by a malfunction in your brain, no amount of psychoanalysis can change that.

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An interesting proposition that OCD is caused by a malfunction in the brain. It appears CBT psychotherapy can sort it out but psychoanalysis cannot. dksea mentions CBT as the gold standard for OCD earlier in this thread. At the moment it is.

The neuroscientist, Ledoux, in a highly influential textbook charted the way therapy impacts upon the brain. He describes the neurological consequences of behavioural  therapy to be found in the B component of CBT and the neurological consequences of psychodynamic therapy.

What is the neurological evidence that CBT is superior to psychodynamic therapy in the context of OCD?

 

Edited by Angst
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On ‎08‎/‎03‎/‎2019 at 03:54, dksea said:

OCD is caused by a malfunction in your brain, no amount of psychoanalysis can change that.

This is also true, if it is a malfunction then it needs only pills and CBT

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6 minutes ago, diomedes said:

This is also true, if it is a malfunction then it needs only pills and CBT

As core therapy yes. 

But additional concepts can really help, such as 

ACT - acceptance and commitment therapy 

"The Four Steps" from Jeffrey Schwartz's book "Brainlock"

Mindfulness 

REDS - relaxation skills, exercise, careful Diet choices, getting quality Sleep. 

I have used the last three of those in my own recovery programme on top of the key core therapy of CBT. 

 

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46 minutes ago, taurean said:

As core therapy yes. 

But additional concepts can really help, such as 

ACT - acceptance and commitment therapy 

"The Four Steps" from Jeffrey Schwartz's book "Brainlock"

Mindfulness 

REDS - relaxation skills, exercise, careful Diet choices, getting quality Sleep. 

I have used the last three of those in my own recovery programme on top of the key core therapy of CBT. 

 

Of course this differentiates from person to person, all these are good, the good psychiatrist can take from all the different approaches in order to help the patient 

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As Ledoux maintains: therapy affects the brain.

In the recent edition of Biological Psychiatry - Neuroscience and Therapeutics there is an interesting open access research article on deep brain stimulation where two areas of the brain are stimulated. The trial patients had what was thought to be intractable OCD.  Two parts of the brain were stimulated. One region which encourages cognitive flexibility so people can switch out of their obsessional thought patterns; and the other area improves mood. The success rate is excellent. However, OCD returns when the batteries run out so need to be replaced.

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On 07/03/2019 at 15:25, taurean said:

:biggrin:. I was taught in CBT that looking for the original cause of my OCD was a pointless waste of time. 

Rather, I should get on with the CBT programme and get recovered :)

 

Agree, and I might take it a step further and suggest it can actually be harmful, since a search for meaning can feed in to OCD's 'narrative'. Anyway, at best a time waster. 

Edited by paradoxer
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