Note to all: don’t give up! Stay positive and determined! It’ll always work out

[Angst]

The NHS website lists the advantages and disadvantages of CBT (NHS AND CBT search). Two of the problems mentioned refer to context mainly the system and the family. CBT considers mental problems are an individual pathology caused by biased thinking and you need to test the veracity of your beliefs by testing them. If you are checking the electrics in a house with faulty wiring or checking fire risks in a flat with faulty fire prone cladding then checking is perhaps necessary. You may check more than necessary but the context is important. Solving the environmental problem will aid recovery.

The B in CBT stands for behaviour. The behavioural modification involved in ERP rests on behaviourism. Behaviourism considers that influences in the environment cause behaviour in that we are conditioned to respond in a given way. ERP is about reconditioning ourselves sometimes in an environment where we have little control.
 

Clinical psychologists in their Power, Threat, Meaning publication say that CBT can be e effective but the client’s experiences in their environment - the context - needs to be examined.

[bluegas]

And when cbt doesn’t even touch the sides the likes of me are left with very little hope ! All I’d like is for people to acknowledge it doesn’t work for everyone! At least that way there’s more chance of more promising therapy’s to advance! 

[PolarBear]

10 minutes ago, bluegas said:

And when cbt doesn’t even touch the sides the likes of me are left with very little hope ! All I’d like is for people to acknowledge it doesn’t work for everyone! At least that way there’s more chance of more promising therapy’s to advance! 

Maybe what you need is a more holistic approach. There may be something going on with you that is affecting your ability to engage in CBT. Comorbidities are common with OCD. 

At the end of the day, you have to stop reacting to your obsessions in order to recover. If there's another therapy out there that accomplishes that, great. I haven't found it. 

[Angst]

One of the other factors mentioned by the NHS are complex cases which I took to mean comorbidities or having more than one condition including mental health conditions. I have known and read about people who have engaged in a variety of therapeutic approaches each one appropriate at a particular time.

Edited October 1, 2022 by Angst

[DRS1]

6 minutes ago, Angst said:

One of the other factors mentioned by the NHS are complex cases which I took to mean comorbidities or having more than one condition including mental health conditions. I have known and read about people who have engaged in a variety of therapeutic approaches each one appropriate at a particular time.

Can agree with that. I know for example people on the spectrum do have to be able to have CBT and ERP adapted to them. This could be more amounts of sessions where the initial sessions are spent trying to identify feelings and understanding what might be felt, understanding what intrusive thoughts are, how the OCD cycle works etc. Then you start to move into the more typical CBT route that will include ERP towards the end of those sessions. In terms of a "SUDS scale" or a distress/anxiety scale, people on the spectrum will have that adapted from a 1-10 scale to a traffic light system which is easier to differentiate as its possible for people who are autistic to become pedantic over numbers so instead of it being a 7/10, maybe that one is a 7.1 and another situation is 7.23 which isn't super helpful. Again that's not everyone's case. I'm autistic and I didn't get that kind of adapting as it wasn't needed (and I'm grateful for that experience to have went as well as it did). I got maybe 6/7 sessions and the initial ones were spent covering what OCD was and how that worked as well as how being autistic and the autistic traits like being more susceptible to black and white thinking may play in. Equally, sometimes its hard to work out what a repetitive behaviour is versus a compulsion and further whether or not something is a sensory issue or something OCD related i.e. is it something I find personally uncomfortable or something I want to fix to make it right.

 

I imagine for people with other co-morbid conditions, if the therapist isn't aware of them or isn't able to work with them at the same time as tackling the OCD, that therapy may be less effective.

[northpaul]

43 minutes ago, Angst said:

Behaviourism considers that influences in the environment cause behaviour in that we are conditioned to respond in a given way.

 

5 minutes ago, Angst said:

One of the other factors mentioned by the NHS are complex cases which I took to mean comorbidities or having more than one condition including mental health conditions. I have known and read about people who have engaged in a variety of therapeutic approaches each one appropriate at a particular time.

In terms of environmental influences I know from my own experience that changes in these influences has greatly lifted my mood.  It was one of the factors which stopped some of my OCD behaviours without even needing to apply any CBT (some of my  more stubborn behaviours were tackled by using CBT).

In terms of comorbidity my primary problem is depression.  When my mood is lifted then some of the compulsions again just melt away without me applying CBT.

Like others say, CBT is a very good tool but sometimes other tools wiil do the job adequately.

[northpaul]

6 minutes ago, DRS1 said:

I imagine for people with other co-morbid conditions, if the therapist isn't aware of them or isn't able to work with them at the same time as tackling the OCD, that therapy may be less effective.

That is a good point. When I had my last CBT nearly 2 years ago my therapist extended my number of sessions from 10 to 20.  One of the reasons for this was she was aware of my CVD (Cerebrovascular Disease).  This causes me to have ultra short term memory issues along with concentration and coordination issues.  The challenge is how can I not go checking things when I really cannot remember what I have just done.

I do agree with some of those who are indicating that they believe that CBT therapy in itself has alot to learn.  There is always room for learning.  

[snowbear]

Bluegas said:

Quote

when cbt doesn’t even touch the sides the likes of me are left with very little hope ! All I’d like is for people to acknowledge it doesn’t work for everyone! At least that way there’s more chance of more promising therapy’s to advance! 

I hear you. Been there, thought and felt like that, got the t-shirt.  

I wasted decades thinking I was just one of those people that CBT just didn't work for. Worse than that - I believed trying to do CBT was making my OCD ever more entrenched!!

I felt like  @WorriedToHell - crushed.

I felt like  @Veryblue - Putting CBT on a pedestal is giving false hope and labels some of us as week , as failures. Failure is just how it is for some people.

I felt like @bluegas - hopeless. I'd given up on CBT and was waiting for an alternative solution to be invented.

 

But now I'm going to try to explain why I (and others advocating CBT/erp)  stand by the claim that CBT can work for everyone.

And before anybody gets on their high horse  and thinks I'm just a convert because CBT finally worked for me and I'm now 'one of the lucky few' who are 100% OCD free  - sadly not - at least, not yet.

I'm a work-in-progress. CBT is now work-ing for me because I understand it, I'm willing to apply it, and I'm willing to practise, practise, practise even when it pushes me far out of my comfort zone.

I now know with 100% certainty that - as long as I stay the CBT course - the finishing line is up there in front of me, even if I don't yet know exactly when. CBT can work for everybody - even for lost cause/ complicated cases like me. 

And by the way - I also ticked the boxes for ALL the reasons given on this thread for why CBT 'doesn't work for some'.

So let's look at those in turn (and while we're at it, a few not mentioned above )...

1. co-morbitities  - Is PTSD, depression, agoraphobia, ODD (oppositional defiant disorder), OCPD (OCD personality disorder), Tourettes, being somewhere on the autistic spectrum, multiple physical disabiliities, and over 12 years of unrelenting chronic pain enough co-momorbidity for you?

I have used CBT to deal with the depression and the PTSD and to completely overcome the ODD and OPCD. Perhaps it will surprise people to know I've also used it sucessfuly to deal with the physical pain and the physical limitations which I cannot overcome but must live with now to my dying day.

 

As @PolarBear said

Quote

I don't want to come across that I advocate CBT as the only thing you need. It is the core in the toolbox that we have. Cognitive Therapy and Behavioral Therapy are not rigid. There are a wide variety of methods within each that can be taught

   CBT is hugely adaptable and can treat many forms of physical and mental illness, including pain and schizophrenia and more. Things that until a decade or so ago doctors believed could only ever be treated with physical methods or pills.

 

I apply the CBT toolbox to my thinking every single day. Alongside mindfulness, meditation, relaxation exercises, diet, positive emotion generation and more.

Fundamentally, CBT is about changing the way you interpret the world and what happens to you.

We'll come back to that. Let's look at some more reasons given for CBT not working...

 

2. context - the system and the family

7 hours ago, Angst said:

Two of the problems mentioned refer to context mainly the system and the family.

CBT considers mental problems are an individual pathology caused by biased thinking and you need to test the veracity of your beliefs by testing them. If you are checking the electrics in a house with faulty wiring or checking fire risks in a flat with faulty fire prone cladding then checking is perhaps necessary. You may check more than necessary but the context is important. Solving the environmental problem will aid recovery.

 

CBT considers mental problems are an individual pathology caused by biased thinking  - true.

But it's not about  'you need to test the veracity of your beliefs by testing them'. That's behavioural therapy which is only a very small part of CBT.

 

So, if you've got a broken leg, or faulty electrics or some other rational problem, then CBT isn't the right way to treat it. Of course it's not! CBT teaches us that rational thinking is one of many alternatives we should be using instead of the irrational or emotional thinking that OCD favours.

If you've got faulty electrics or a broken leg then it's rational to think, 'I need to call an electrician/ doctor.'

'I need to keep checking the electrics to feel safe, I'm too frightened to leave the house in case I break my leg.' That's the irrational thinking of OCD. That is an individual person suffering a pathological (faulty) way of thinking about (interpreting) the world. Which is why CBT will work on OCD.

 

So that's part 1 of Angst's observation, when the system is broken. There's a real problem (not just a perceived problem) and you have to get rational, take a practical approach and fix the actual problem.

Part 2 of Angst's observation is family.

Sheesh. *rolls eyes*  Boy-oh-boy can I tick that particular box.  Your thinking messed up by your upbringing, family and life experiences? Tick, tick, tick.

So that's me stuffed, right?

Wrong. Just because I thought a particular way for 50 years because that's how I was raised... and just because it was second nature/a habit to react  to things a certain way on autopilot... doesn't mean I'm condemned to think and react that same way for the rest of my life.

You're never too old to start thinking and behaving differently.

Whic is good news. Because it means that if you start to apply it properly CBT will still work, right up to when you draw your last breath.  

 

3. beliefs and culture

CBT works across all cultures. It isn't limited by religion, race, gender, complicated personal circumstances, or complex interactions.

 

CBT is about looking at your current beliefs, challenging the irrational and unhelpful ones and choosing to adopt more useful and more rational beliefs in place of the old ones.

So yeah - if you want CBT to work you have to allow yourself to change.  A very common reason for 'CBT didn't work for me' can be reworded more acurately to,  'I wasn't willing to change my beliefs.' 

How to challenge your beliefs is a topic in its own right -let's keep that for another day.

Back to my list of 'CBT won't work' excuses oops, reasons people give.

 

4. genetics / anatomy

'It's not my fault. OCD runs in my family.'

It's not my fault, my brain is hardwired for OCD.'

For starters, who mentioned anything about fault?   That's blame thinking.  Everything has to be somebody's fault.

So things that hurt us are somebody else's fault (eg. exposed me to radiation. I'm righteously angry! )

And when things don't go as we'd like then it's our fault (eg. CBT didn't get rid of my OCD, I'm a failure.')

The only fault here is faulty blame thinking.

And what does CBT teach us? CBT teaches us that when we change the way we think about things it changes how we feel about them.

Apply a different kind of thinking to the two examples above. (There are lots and lots of thinking styles to choose from, I'm going to chose just one in each case) :-

'Somebody exposed me to high dose radiation.      (using blame thinking to interpret what's happened and catastrophic thinking to imagine the outcome.)

OR

'I've been exposed to high dose radiation. ( happens!)  But hey, that was a while ago and I'm not sick or dead yet.     (applying rational thinking to interpret what's happened and open-minded thinking to imagine the outcome)

 

And again:-

CBT didn't get rid of my OCD, I'm a failure.   (using blame thinking to interpret what's happened. Results in the belief that an external force/ miracle cure is needed (puts the locus of control outside yourself) and rumination (a bad way to attempt to solve problems) 

OR

'CBT hasn't worked for me yet' (applying open-minded thinking which leads to good problem solving skills)     The locus of control is internal.

'It's up to me to keep trying. I'll find a way to do this. I wonder why CBT hasn't worked for me'      

 

 

So, 4. genetics...

The idea we're defined by genetics is now ancient history. If you believe 'It's written in my genes and there's nothing I can do to change that' then go and read up on epigenetics.

Over the last 30 years scientists have moved on from the belief that our genetic make-up is responsible for who we are, how we think, how we behave. Genes aren't our fate written in stone. They are as fluid in their expression (how they function) as a light switch we can turn on or off.      So maybe one day there will be a 'magic pill' that turns off OCD thinking processes by switching off some genetic code. Maybe not, becaue OCD thinking isn't just about genes. But why wait when there are therapies that can work available now?

 

...and anatomy.

If you subscribe to the idea that you have faulty brain anatomy; a too large amydala, a miswired thinking circuit  then I've got good news for you. The brain isn't hard-wired for very much at all!

The amygdala increases in size while you are in the grip of OCD and will shrink back to normal size as you recover from OCD.

Thinking processes aren't hard-wired into the brain at all. Which thinking style we use to interpret the world is open to free choice for every second of our lives. 

It just so happens there is some circuitry devoted to being anxious, ruminating, thinking obsessively, feeling hopeless and helpless...   BUT it is countered - switched off,  like the light switch I mentioned before - by another set of circuitry that activates when we socialise, when we recive comfort or empathy from another, when we look outwards instead of navel-gazing, when we choose to take an open-minded approach   instead of using blame, judgement, irrational or fixed thinking styles.

 

I do waffle on...I know. I know.   What can I say?  I'm fascinated by how the brain works. How the way we interpret the world is forever within our control and available to us if only we put in the time to learn how and practise, practise, practise. If we're willing to challenge our current thinking and beliefs and allow ourselves to make changes.

 

So I'll finish on this reminder:-

 

On 01/10/2022 at 00:34, PolarBear said:

There are two things you need to do to recover. Change the way you think about your obsessions and change the way you behave as a result of having obsessions. Even simpler, change the way you react to obsessions. 

This organization emphasizes CBT for OCD, not just ERP. ERP is great and wonderful but it does not focus on getting sufferers to change their thinking, which is what Cognitive Therapy does... the C in CBT.

Behavioral Therapy (the B in CBT) is about changing your behavior. Primarily, it is about reducing and stopping compulsions. You can learn to reduce and delay compulsions over time. You can also do ERP, which is a specific Therapy to give you practice in not doing compulsions.

 

 

and a final suggestion:-

7 hours ago, DRS1 said:

Rather than have the clear difference in argument of ERP/CBT and whether or not it is effective or not. I'd want to know why for anyone that feels like the therapy they received (whether that was CBT/ERP or something else) didn't work for them?

talking about why it worked for people and why it didn't work for people I think would genuinely be really insightful for both sides to understand those particular issues better.

 

  I agree.

I hope my (rather lengthy )  reply goes some way towards achieving that goal.

[PolarBear]

Very well done, snowbear. Excellent post.

[Veryblue]

8 hours ago, snowbear said:

Bluegas said:

I hear you. Been there, thought and felt like that, got the t-shirt.  

I wasted decades thinking I was just one of those people that CBT just didn't work for. Worse than that - I believed trying to do CBT was making my OCD ever more entrenched!!

I felt like  @WorriedToHell - crushed.

I felt like  @Veryblue - Putting CBT on a pedestal is giving false hope and labels some of us as week , as failures. Failure is just how it is for some people.

I felt like @bluegas - hopeless. I'd given up on CBT and was waiting for an alternative solution to be invented.

 

But now I'm going to try to explain why I (and others advocating CBT/erp)  stand by the claim that CBT can work for everyone.

And before anybody gets on their high horse  and thinks I'm just a convert because CBT finally worked for me and I'm now 'one of the lucky few' who are 100% OCD free  - sadly not - at least, not yet.

I'm a work-in-progress. CBT is now work-ing for me because I understand it, I'm willing to apply it, and I'm willing to practise, practise, practise even when it pushes me far out of my comfort zone.

I now know with 100% certainty that - as long as I stay the CBT course - the finishing line is up there in front of me, even if I don't yet know exactly when. CBT can work for everybody - even for lost cause/ complicated cases like me. 

And by the way - I also ticked the boxes for ALL the reasons given on this thread for why CBT 'doesn't work for some'.

So let's look at those in turn (and while we're at it, a few not mentioned above )...

1. co-morbitities  - Is PTSD, depression, agoraphobia, ODD (oppositional defiant disorder), OCPD (OCD personality disorder), Tourettes, being somewhere on the autistic spectrum, multiple physical disabiliities, and over 12 years of unrelenting chronic pain enough co-momorbidity for you?

I have used CBT to deal with the depression and the PTSD and to completely overcome the ODD and OPCD. Perhaps it will surprise people to know I've also used it sucessfuly to deal with the physical pain and the physical limitations which I cannot overcome but must live with now to my dying day.

 

As @PolarBear said

   CBT is hugely adaptable and can treat many forms of physical and mental illness, including pain and schizophrenia and more. Things that until a decade or so ago doctors believed could only ever be treated with physical methods or pills.

 

I apply the CBT toolbox to my thinking every single day. Alongside mindfulness, meditation, relaxation exercises, diet, positive emotion generation and more.

Fundamentally, CBT is about changing the way you interpret the world and what happens to you.

We'll come back to that. Let's look at some more reasons given for CBT not working...

 

2. context - the system and the family

 

CBT considers mental problems are an individual pathology caused by biased thinking  - true.

But it's not about  'you need to test the veracity of your beliefs by testing them'. That's behavioural therapy which is only a very small part of CBT.

 

So, if you've got a broken leg, or faulty electrics or some other rational problem, then CBT isn't the right way to treat it. Of course it's not! CBT teaches us that rational thinking is one of many alternatives we should be using instead of the irrational or emotional thinking that OCD favours.

If you've got faulty electrics or a broken leg then it's rational to think, 'I need to call an electrician/ doctor.'

'I need to keep checking the electrics to feel safe, I'm too frightened to leave the house in case I break my leg.' That's the irrational thinking of OCD. That is an individual person suffering a pathological (faulty) way of thinking about (interpreting) the world. Which is why CBT will work on OCD.

 

So that's part 1 of Angst's observation, when the system is broken. There's a real problem (not just a perceived problem) and you have to get rational, take a practical approach and fix the actual problem.

Part 2 of Angst's observation is family.

Sheesh. *rolls eyes*  Boy-oh-boy can I tick that particular box.  Your thinking messed up by your upbringing, family and life experiences? Tick, tick, tick.

So that's me stuffed, right?

Wrong. Just because I thought a particular way for 50 years because that's how I was raised... and just because it was second nature/a habit to react  to things a certain way on autopilot... doesn't mean I'm condemned to think and react that same way for the rest of my life.

You're never too old to start thinking and behaving differently.

Whic is good news. Because it means that if you start to apply it properly CBT will still work, right up to when you draw your last breath.  

 

3. beliefs and culture

CBT works across all cultures. It isn't limited by religion, race, gender, complicated personal circumstances, or complex interactions.

 

CBT is about looking at your current beliefs, challenging the irrational and unhelpful ones and choosing to adopt more useful and more rational beliefs in place of the old ones.

So yeah - if you want CBT to work you have to allow yourself to change.  A very common reason for 'CBT didn't work for me' can be reworded more acurately to,  'I wasn't willing to change my beliefs.' 

How to challenge your beliefs is a topic in its own right -let's keep that for another day.

Back to my list of 'CBT won't work' excuses oops, reasons people give.

 

4. genetics / anatomy

'It's not my fault. OCD runs in my family.'

It's not my fault, my brain is hardwired for OCD.'

For starters, who mentioned anything about fault?   That's blame thinking.  Everything has to be somebody's fault.

So things that hurt us are somebody else's fault (eg. exposed me to radiation. I'm righteously angry! )

And when things don't go as we'd like then it's our fault (eg. CBT didn't get rid of my OCD, I'm a failure.')

The only fault here is faulty blame thinking.

And what does CBT teach us? CBT teaches us that when we change the way we think about things it changes how we feel about them.

Apply a different kind of thinking to the two examples above. (There are lots and lots of thinking styles to choose from, I'm going to chose just one in each case) :-

'Somebody exposed me to high dose radiation.      (using blame thinking to interpret what's happened and catastrophic thinking to imagine the outcome.)

OR

'I've been exposed to high dose radiation. ( happens!)  But hey, that was a while ago and I'm not sick or dead yet.     (applying rational thinking to interpret what's happened and open-minded thinking to imagine the outcome)

 

And again:-

CBT didn't get rid of my OCD, I'm a failure.   (using blame thinking to interpret what's happened. Results in the belief that an external force/ miracle cure is needed (puts the locus of control outside yourself) and rumination (a bad way to attempt to solve problems) 

OR

'CBT hasn't worked for me yet' (applying open-minded thinking which leads to good problem solving skills)     The locus of control is internal.

'It's up to me to keep trying. I'll find a way to do this. I wonder why CBT hasn't worked for me'      

 

 

So, 4. genetics...

The idea we're defined by genetics is now ancient history. If you believe 'It's written in my genes and there's nothing I can do to change that' then go and read up on epigenetics.

Over the last 30 years scientists have moved on from the belief that our genetic make-up is responsible for who we are, how we think, how we behave. Genes aren't our fate written in stone. They are as fluid in their expression (how they function) as a light switch we can turn on or off.      So maybe one day there will be a 'magic pill' that turns off OCD thinking processes by switching off some genetic code. Maybe not, becaue OCD thinking isn't just about genes. But why wait when there are therapies that can work available now?

 

...and anatomy.

If you subscribe to the idea that you have faulty brain anatomy; a too large amydala, a miswired thinking circuit  then I've got good news for you. The brain isn't hard-wired for very much at all!

The amygdala increases in size while you are in the grip of OCD and will shrink back to normal size as you recover from OCD.

Thinking processes aren't hard-wired into the brain at all. Which thinking style we use to interpret the world is open to free choice for every second of our lives. 

It just so happens there is some circuitry devoted to being anxious, ruminating, thinking obsessively, feeling hopeless and helpless...   BUT it is countered - switched off,  like the light switch I mentioned before - by another set of circuitry that activates when we socialise, when we recive comfort or empathy from another, when we look outwards instead of navel-gazing, when we choose to take an open-minded approach   instead of using blame, judgement, irrational or fixed thinking styles.

 

I do waffle on...I know. I know.   What can I say?  I'm fascinated by how the brain works. How the way we interpret the world is forever within our control and available to us if only we put in the time to learn how and practise, practise, practise. If we're willing to challenge our current thinking and beliefs and allow ourselves to make changes.

 

So I'll finish on this reminder:-

 

 

 

and a final suggestion:-

 

  I agree.

I hope my (rather lengthy )  reply goes some way towards achieving that goal.

Great comment. The issue for me or rather issues is I’ve tried pretty much every drug going and am currently tapering off Venlafaxine which is the last one I’ll try as it and all the others did nothing but make me feel extremely ill physically on the highest doses recommended. I’ve had tons of therapy - privately and through the NHS and the latter (the OCD service where I live) has refused to treat me now and ignored correspondence about being referred to a more experienced service elsewhere. I had meetings with them along with a mental health advocate and it was pretty obvious nothing I said would make any difference - they’d already made their decision. NICE guidelines I mentioned were ignored. I’d had issues with the head of this service after accessing my medical records and being horrified what he’d written about me which I won’t go into publicly and believe him knowing I know now what he did has influenced this. I accessed this information in January and I’m still very upset at what I read and the betrayal of trust. What HAS happened is I was referred to a different mental health team and have now been offered one year of therapy once a week (not started yet) with another assessment on October 12. This is not for OCD though - but for childhood trauma and the legacy of it. I don’t have a specific “co-morbidity” diagnosis but the people who assessed me more recently clearly think I need help to deal with horrendous childhood abuse in a psychodynamic therapy context. I have concerns about this re OCD as I know it’s not a type of therapy recommended for OCD (I may be wrong) but I can’t afford to see anyone privately and it’s not - apparently - the end of the road when it comes to treatment for OCD but what is highly recommended for now. It’s out of my hands. Obviously I’ll go despite major reservations.

[bluegas]

I think the problem is when it comes to problems in the brain people think it can automatically be fixed by therapy! But why is the brain any difference from any other organs! You wouldn’t fix the heart liver ect with therapy!! 

[DRS1]

2 minutes ago, bluegas said:

I think the problem is when it comes to problems in the brain people think it can automatically be fixed by therapy! But why is the brain any difference from any other organs! You wouldn’t fix the heart liver ect with therapy!! 

It's not that it "automatically" can be fixed by therapy but we do know is are brains are malleable, the way we think can be changed. That's a good thing too as otherwise we wouldn't really be able to learn things be equally on the other side sometimes that means we take on stuff that's unhelpful like having an intrusive thought is bad and we need to fix it. Other body parts can respond well to a different type of therapy in physical therapy but our minds require therapy that work on the mental side of things as that's what we deal with.

 

[DRS1]

44 minutes ago, Veryblue said:

Great comment. The issue for me or rather issues is I’ve tried pretty much every drug going and am currently tapering off Venlafaxine which is the last one I’ll try as it and all the others did nothing but make me feel extremely ill physically on the highest doses recommended. I’ve had tons of therapy - privately and through the NHS and the latter (the OCD service where I live) has refused to treat me now and ignored correspondence about being referred to a more experienced service elsewhere. I had meetings with them along with a mental health advocate and it was pretty obvious nothing I said would make any difference - they’d already made their decision. NICE guidelines I mentioned were ignored. I’d had issues with the head of this service after accessing my medical records and being horrified what he’d written about me which I won’t go into publicly and believe him knowing I know now what he did has influenced this. I accessed this information in January and I’m still very upset at what I read and the betrayal of trust. What HAS happened is I was referred to a different mental health team and have now been offered one year of therapy once a week (not started yet) with another assessment on October 12. This is not for OCD though - but for childhood trauma and the legacy of it. I don’t have a specific “co-morbidity” diagnosis but the people who assessed me more recently clearly think I need help to deal with horrendous childhood abuse in a psychodynamic therapy context. I have concerns about this re OCD as I know it’s not a type of therapy recommended for OCD (I may be wrong) but I can’t afford to see anyone privately and it’s not - apparently - the end of the road when it comes to treatment for OCD but what is highly recommended for now. It’s out of my hands. Obviously I’ll go despite major reservations.

I'm sorry this happened. This isn't acceptable to have happened full stop. It shouldn't matter how many times you have had therapy, you should always be able to access more, and especially on the NHS as I understand it anyone can have as many rounds of CBT as they need (although it could be capped at 12-20 sessions per round). It's also to be honest pathetic that they have ignored you when you enquired about more experienced services. They can't just abandon you but I don't know what the other options are in terms of getting better access. Have you contacted OCD-UK about this? They probably will know better how to approach it to hopefully get you access to the therapy you want.

 

In terms of the medical records thing, I'd also like to say that's not how that was supposed to work either. I can give you an example because whilst in therapy, I had a document of my progress, intrusive thoughts, images, describing the exposures. That contained private information specific to me and the OCD treatment I was receiving. I was asked if I wanted to put that on the record system. All communications with that document were encrypted. So that is on the record now, but that was my choice.

 

Also just as a further thing I was told right at the start of therapy that the psychologist would be discussing my case with the other psychologists and if I was okay with that. Again, I was asked to consent to that happening. The way I saw it was the more its talked about either the better my therapy gets or the more knowledge about OCD gets shared and I liked those two possibilities very much after hearing so many stories of people not understanding OCD.

 

Any information that you told them either shouldn't have been on record without your explicit consent or if they informed you that they would be adding everything to the record but wouldn't share their private information with anyone else. Again, this hasn't happened in your case and I'm sorry that has happened.

[Veryblue]

1 hour ago, DRS1 said:

I'm sorry this happened. This isn't acceptable to have happened full stop. It shouldn't matter how many times you have had therapy, you should always be able to access more, and especially on the NHS as I understand it anyone can have as many rounds of CBT as they need (although it could be capped at 12-20 sessions per round). It's also to be honest pathetic that they have ignored you when you enquired about more experienced services. They can't just abandon you but I don't know what the other options are in terms of getting better access. Have you contacted OCD-UK about this? They probably will know better how to approach it to hopefully get you access to the therapy you want.

 

In terms of the medical records thing, I'd also like to say that's not how that was supposed to work either. I can give you an example because whilst in therapy, I had a document of my progress, intrusive thoughts, images, describing the exposures. That contained private information specific to me and the OCD treatment I was receiving. I was asked if I wanted to put that on the record system. All communications with that document were encrypted. So that is on the record now, but that was my choice.

 

Also just as a further thing I was told right at the start of therapy that the psychologist would be discussing my case with the other psychologists and if I was okay with that. Again, I was asked to consent to that happening. The way I saw it was the more its talked about either the better my therapy gets or the more knowledge about OCD gets shared and I liked those two possibilities very much after hearing so many stories of people not understanding OCD.

 

Any information that you told them either shouldn't have been on record without your explicit consent or if they informed you that they would be adding everything to the record but wouldn't share their private information with anyone else. Again, this hasn't happened in your case and I'm sorry that has happened.

I’ll tell you the worst thing despite my reservations. The psychologist MEANT to be treating me for OCD back in 2016 and now in charge of the Specialist Services applied for a Police National Computer check on my background in December 2016. I found this out in January. Imagine how I felt? This information can only be applied for and accessed if the person has a very good reason. He didn’t even write in my notes any concerns he had to explain why he’d done it. He basically did it because he could.

[DRS1]

5 minutes ago, Veryblue said:

I’ll tell you the worst thing despite my reservations. The psychologist MEANT to be treating me for OCD back in 2016 and now in charge of the Specialist Services applied for a Police National Computer check on my background in December 2016. I found this out in January. Imagine how I felt? This information can only be applied for and accessed if the person has a very good reason. He didn’t even write in my notes any concerns he had to explain why he’d done it. He basically did it because he could.

My only guess with that is that he didn't understand OCD and in general what intrusive thoughts are? No matter what, its unacceptable. It is very strange that he did that without any documentation as to why. Surely he would have to justify a reason when applying for that. There should be a process for that.

[Veryblue]

38 minutes ago, DRS1 said:

My only guess with that is that he didn't understand OCD and in general what intrusive thoughts are? No matter what, its unacceptable. It is very strange that he did that without any documentation as to why. Surely he would have to justify a reason when applying for that. There should be a process for that.

He’s now in charge of the whole OCD service for the local health Trust! When he found out I’d accessed my records (I told him in a meeting with my advocate) he was clearly shaken/surprised and mumbled some BS and stereotypical OCD rubbish. I believe part of the reason I’ve been denied treatment is because of what I’ve found out. His team is small - there’s no way he could “work” with me. I don’t trust him at all. Like I said there’s nothing in the medical notes stating why he applied for any information. He only mentioned it in passing four months later. I’ve no criminal record at all or anything to hide but as I’m sure you’ll understand that’s not the point.

[WorriedToHell]

I am inclined to hoping for this to be true: "And by the way - I also ticked the boxes for ALL the reasons given on this thread for why CBT 'doesn't work for some'.". Because the opposite means a lifelong suffering for many people. However, it will give off very fundamentalistic vibes to, well, to everyone outside the convinced circle. And it should. All "100% statments" should draw (bad) attention to itself. 

I am not against it because I think it gives hope that EVERYBODY can get over OCD, but many people see it as you shame them for being lazy and this notion will only get stronger in society, where own responsibility becomes a more and more distant notion. Some people would even call you evil. I see it all the time in OCD-groups on Facebook.

CBT helps some, maybe most people, but not everyone. Saying everyone implies a very very black and white thinking. Which we all know is bad.

Edited October 2, 2022 by WorriedToHell

[Angst]

36 minutes ago, WorriedToHell said:

I am inclined to hoping for this to be true: "And by the way - I also ticked the boxes for ALL the reasons given on this thread for why CBT 'doesn't work for some'.". Because the opposite means a lifelong suffering for many people. However, it will give off very fundamentalistic vibes to, well, to everyone outside the convinced circle. And it should. All "100% statments" should draw (bad) attention to itself. 

I am not against it because I think it gives hope that EVERYBODY can get over OCD, but many people see it as you shame them for being lazy and this notion will only get stronger in society, where own responsibility becomes a more and more distant notion. Some people would even call you evil. I see it all the time in OCD-groups on Facebook.

CBT helps some, maybe most people, but not everyone. Saying everyone implies a very very black and white thinking. Which we all know is bad.

It is interesting. I mentioned three things which restrict the efficacy of CBT - family, system and complex cases - but one poster attributed these things to me rather than information provided by the NHS which are presumably based on evidence. I also gave examples of checking in cases of faulty electrics and cladding. Faculty electrics tend to occur in rented properties and cladding problems involve many £100,000s to solve on a block by block basis. A ‘rational’ problem cannot always be solved by individual action and can deteriorate into a mental health problem. 
 

I have recently moved and my checking behaviour has improved because I moved from troublesome neighbours who caused many problems. For example checking the front door was locked. I feel more secure in sheltered accommodation. Although I had to sell at below market price because of the state of the communal areas caused by neighbours. I was able to move because I had the resources.

The environment is a crucial determinant of one’s mental health. And the move from an intellectual understanding of OCD to an emotional awareness is ERP. Behavioural learning is vitally important it is the way we permanently change our behaviour.

Not all things are in our heads. There is a real world out there which can spark mental heath problems or intensify them.

[northpaul]

25 minutes ago, Angst said:

The environment is a crucial determinant of one’s mental health. And the move from an intellectual understanding of OCD to an emotional awareness is ERP. Behavioural learning is vitally important it is the way we permanently change our behaviour.

Not all things are in our heads. There is a real world out there which can spark mental heath problems or intensify them.

Environmental factors are indeed a major factor in mental health.  As I stated earlier:

On 01/10/2022 at 19:31, northpaul said:

In terms of environmental influences I know from my own experience that changes in these influences has greatly lifted my mood.  It was one of the factors which stopped some of my OCD behaviours without even needing to apply any CBT (some of my  more stubborn behaviours were tackled by using CBT).

 

[snowbear]

11 hours ago, bluegas said:

I think the problem is when it comes to problems in the brain people think it can automatically be fixed by therapy! But why is the brain any difference from any other organs! You wouldn’t fix the heart liver ect with therapy!! 

Maybe you can explain to us why you think the brain shouldn't be fixed with therapy? 

You fix the heart with exercise because that's the function of a heart. You fix the liver with a change in diet because processing the products of digestion is it's function.

The function of the brain is to think, to make sense of the world. So why wouldn't you fix it with a therapy designed to help you make sense of the world in a healthier way? If you're arguing that physical ailments need physical solutions, then surely it's appropriate to fix mental problems with a mental approach?

 

2 hours ago, WorriedToHell said:

All "100% statments" should draw (bad) attention to itself.
CBT helps some, maybe most people, but not everyone. Saying everyone implies a very very black and white thinking. Which we all know is bad

Actually, I did write 99% certain at first.   But then thought, 'No, OCD thinking always latches onto that 1% of doubt. Best not to give it that opportunity - demonstrate my confidence in what I'm saying and go the full hog.'  So, in this instance, it wasn't black and white thinking.

However, I absolutely (dare I say 100% ) take on board what you mean. It's true that extremes are often found when black and white thinking is used. I have noted your helpful remark and will be more careful how I use percentages in future. Thank you.

 

2 hours ago, Angst said:

I mentioned three things which restrict the efficacy of CBT - family, system and complex cases - but one poster attributed these things to me rather than information provided by the NHS which are presumably based on evidence

If the poster you're referring to was me, Angst, please note I was careful to say 'Angst's observation' and not 'Angst's opinion'.  In doing so, I left the findings attributed to your source, not to anything you personally were saying.

I'm not disputing the NHS information. I was merely making a point about the difference between rational and irrational thinking, and how it's easy to fall into the trap of behaving towards real evenironmental problems in an irrational way without realising that's what's happening.

 

2 hours ago, Angst said:

The environment is a crucial determinant of one’s mental health.

Not all things are in our heads. There is a real world out there which can spark mental heath problems or intensify them.

Our experiences and environment can indeed spark mental health problems or intensify them. But I will argue - my opinion, yours may differ - that everything IS in our heads.

How we view the world and make sense of it -the interpretation we choose - varies hugely from one individual to another. As Shakespeare noted, 'There is nothing in the world...but thinking makes it so'.

 

I sympathise with you over the difficulties you experienced with your accomodation and neighbours. It was a very real effect with very real consequences. And I'm sorry you had that unpleasant experience. 

But your experience of that situation is the result of 'what went on in your head' and not directly because of the physical accomodation situation.

This is in no way a criticism of you or how you processed things mentally.

My point is only that how we experience the world is a direct result of how we interpret what happens to us, and not a matter of 'what happens to us.'

Take a war zone for example. Lots of people experiencing the same trauma. But how they individually process that, the meaning they give it, is personal to them. That's the result of what goes on in their heads. Some will take it in their stride, some will develop PTSD, some will process it faster and recover more fully, others will find it hard to function normally for a very long time. ALL the result of what's in their individual heads, not a direct result of having experience of the war, but an outcome based on how life shaped their thinking before, during and after.

And that's the exciting bit!

Because once you accept you can fundamentally change the way you experience your life just by changing how you think, the future opens up with endless possibilities.

How we interpret our thoughts, our environment, and our experiences determines how we feel.

How we interpret things is always open to change.

No matter how rigid and fixed our thinking was before, opting for a different thinking style will change the way we feel, will change the way we see the world, can change a bad experience that would once have severely traumatised us into one we're able to take in our stride.

Is that a skill worth having in your mental toolbox? I believe it is.

 

[snowbear]

13 hours ago, Veryblue said:

I’d had issues with the head of this service after accessing my medical records and being horrified what he’d written about me 

I accessed this information in January and I’m still very upset at what I read and the betrayal of trust.

I've has some similar experiences with officialdom myself.  A psychiatrist who had decided to section me before he'd even seen or assessed me. A social worker who wrote a load of judgemental lies about me that then got put in my medical records. A traumatising event that left me with PTSD and when I finally got my head togather enough to seek tharapy the only option in my local area was to go to the same psychiatrist who'd tried to section me. Needless to say, not an option I was willing to consider.

Add to that my OCD is all about 'betrayal of trust'   (these days referred to as mental contamination) and the result was I spent a very long time feeling betrayed yet again by a system that had made me ill by betraying me in the first place.

I never did go back through the system. All the CBT I know has been self-taught. Books, online courses etc.

I did speak to a private counsellor who helped me with the PTSD and I know how very lucky I was to be able to afford that option. Although she wasn't CBT trained and we never tried any CBT together, interestingly it was her who got me started on the path of understanding 'how you think determines how you feel and ultimately what your experience of what happens to you will be.'

All these years on I look back on the traumas of my childhood and 'the PTSD episode' and feel markedly different about them. Because I've learned how to change my thinking, how to interpret them in a different way. A way that doesn't leave me paralysed and angry, but allows me to function and thrive.

 

13 hours ago, Veryblue said:

I was referred to a different mental health team  [excellent, great news! ] and have now been offered one year of therapy once a week (not started yet) with another assessment on October 12.

This is not for OCD though - but for childhood trauma and the legacy of it. I don’t have a specific “co-morbidity” diagnosis but the people who assessed me more recently clearly think I need help to deal with horrendous childhood abuse in a psychodynamic therapy context.

I have concerns about this re OCD as I know it’s not a type of therapy recommended for OCD (I may be wrong) but I can’t afford to see anyone privately and it’s not - apparently - the end of the road when it comes to treatment for OCD but what is highly recommended for now. It’s out of my hands. Obviously I’ll go despite major reservations.

 

No need to have reservations about it. Go! This is all good stuff.

Learning to process the childhood abuse may well give you insights to the way you 'naturally' think and why you adopted that thinking style as your default. This could help you hugely when you eventually do CBT specifically for OCD later on. Look on it as building a solid foundation for your mental wellbeing as a whole.

Wishing you the best of luck for October 12th and beyond.

[WorriedToHell]

19 hours ago, Angst said:

It is interesting. I mentioned three things which restrict the efficacy of CBT - family, system and complex cases - but one poster attributed these things to me rather than information provided by the NHS which are presumably based on evidence. I also gave examples of checking in cases of faulty electrics and cladding. Faculty electrics tend to occur in rented properties and cladding problems involve many £100,000s to solve on a block by block basis. A ‘rational’ problem cannot always be solved by individual action and can deteriorate into a mental health problem. 
 

I have recently moved and my checking behaviour has improved because I moved from troublesome neighbours who caused many problems. For example checking the front door was locked. I feel more secure in sheltered accommodation. Although I had to sell at below market price because of the state of the communal areas caused by neighbours. I was able to move because I had the resources.

The environment is a crucial determinant of one’s mental health. And the move from an intellectual understanding of OCD to an emotional awareness is ERP. Behavioural learning is vitally important it is the way we permanently change our behaviour.

Not all things are in our heads. There is a real world out there which can spark mental heath problems or intensify them.

In theory we might be right but we have to be practical too. I mean if we have a OCD-sufferer maybe/we should just say "this works" so the sufferer moves on with the work. We both know that you can make this into a obsession, and therapy and all of the theory about therapy tend to be another obsession with sufferer. 

But in a deeper sense I have a hard time with accepting that 100% could get better. I do believe in the mechanism behind CBT but 100% is too much. In the sense that CBT is evidence based (science) and you can never say 100% in science.