Posted in Health Issues

Online Cognitive Behavioural Therapy: a patient’s view

I finished the online CBT course on Friday. Do I feel any different? No… just relieved it’s over!

A number of people on the forum say it made things better for them.

“It must be nice to be you,” I mused enviously. “Able to say something positive and encouraging about the course, and follow it up with a ‘thank you!’ That’s the desirable reaction.” Some went so far as to say it has turned their lives around. It would be amazing to be able to say that.

One or two, on the other hand, say they didn’t find it helpful. I was disappointed we were in the minority, but maybe only a few of us negative nellies made it to the final session. I read that a lot of people drop out of the course. It shouldn’t have taken me so long, but I had a long hiatus in the middle.

The course is intended for ‘mild to moderate depression or anxiety’, but it seems if it doesn’t work, it’s because of “low adherence and engagement with treatment, rather than lack of efficacy.” See the Guardian article: Questions raised over effectiveness of online CBT for treating depression

I don’t know enough myself to be able to pinpoint why it works for some and not others — can only give my personal experience.

A lot of the time when I was trying to do the CBT exercises, I felt irritated, even angry. If I put it down and did something else for a while, I would eventually be able to complete the exercises, but my heart wasn’t in it… I felt distanced from what I was doing. For instance, I had to list positive self-beliefs, and was jollied along with, “don’t be modest.”

Having got over my spat of grumpiness, I wrote: “I read a lot; I write well; I try to improve my artwork.”

As the online course reminded us, ‘practice makes perfect’. I’m supposed to keep doing these exercises; these tools to improve my mood or how I handle things — but right now I look at those three self-beliefs and feel on the low side of neutral. I’m confused about the kind of beliefs I’m supposed to come up with, and have a sneaking feeling I got it wrong. This exercise is a spin-off from a section about ‘attributional style‘. Healthy beliefs about oneself should be ‘permanent, internal and general’ as opposed to ‘specific, external and temporary’.

So… ‘I read a lot’… is that specific or general? I would have said ‘specific,’ as it’s a specific thing that I do, but the relevance by-passes me at the moment.

It’s internal, I think, because it’s a way of taking credit to myself. I’m not depending on someone else to do all my reading for me! Also, it’s a permanent belief; I read a lot while I can. So what does a temporary belief look like? “I read a leaflet yesterday but probably won’t bother again?”

A lot of people on the CBT forum seem to like that exercise, so they must know what it means and how to correctly label their beliefs. It’s just me who’s the numpty!

Come to think of it, “I was lucky to win that tennis match,” is probably a temporary belief. A more self-believing belief would be, “I won the match because I’m a good tennis player.” No wait, that’s an internal belief, whereas “I was just lucky” is external because the gods smiled on you.

“I read a lot” doesn’t make me feel I can take on the world. People write such contradictory things I find myself believing stuff that cancel each other out, don’t know what to believe, or do daft things because I uncritically internalized the last thing I read. So much for all that reading.

At any rate, perhaps a better self-belief would be “I am kind.” That’s more ‘general’ because it’s something I am, whereas “I read a lot” is a specific belief because it’s something I do… though don’t take my word for it!

It should really be “I am sometimes quite kind.” 😛 Does that make it a more temporary belief? Is that the very thing I’m being warned against by the CBT course? I would probably be told I’m giving away credit for my success.

Well, that brings us to the point of the attributional style. When you have successes or disappointments in life, you use your self-belief in the following way: “I made a new friend today because I’m kind.”

That would be better than saying, “I made a new friend today because the other person is kind,” which would suggest there’s nothing about you the other person thought was remarkable.

“I made a new friend today because I was on my best behaviour and hid my usual surliness”… that’s pretty realistic for many people, especially me, but I think the CBT would frown on it!

I could just switch off the niggles in my head and say, “I made a new friend because I’m kind and witty and clever, and the other person likes me.”

Does that make me feel good? Hmm……..

Just had a lightbulb moment! I noticed the word ‘control’ when reading online about attributional style. People are depressed and anxious if they don’t feel in control, so it makes sense that being able to make more powerful statements should be beneficial. That’s easier for me to grasp than whether or not my beliefs are ‘permanent, internal and general’.

I hate to be curmudgeonly, but you’ll note I didn’t say that I believe telling myself that I believe something that I don’t believe is going to make me step out more confidently! However, since practice makes perfect, I will keep trying the various exercises for a while. I would enjoy setting up a special CBT journal to fill in every day… though perhaps actually filling it in is another story?

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