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I am a 29 year old woman diagnosed with bipolar disorder type 1 and also suffer from general anxiety and panic attacks. I have only been recently diagnosed but have been ill since I was a teenager. I tend to have mixed-manic episodes, hence the name of my blog. I am a regular guest blogger for Black Dog Tribe. I am not a mental health professional. I am just writing from my own experiences with mental illness. If you wish to use any of my blog content please contact me at lababup@gmail.com. Visit me on twitter @lababup

Monday, 20 April 2015

CBT didn't work for me. Why am I made to feel guilty and ashamed?


Cognitive Behavioural Therapy (CBT) is one of the main types of therapy available to those suffering from mental illness. It is supposed to work by changing the way you think and behave in response to external events. You are taught to identify negative thought patterns, weigh up the evidence for these thoughts objectively and come up with more balanced thoughts. By doing this, you are supposed to be able to change the way you feel and behave.

I’ve tried CBT a number of times: twice with two different therapists every week for a year and once in a group for 20 weeks. I definitely think that therapy should be explored and would advise anyone with a mental illness to give it a go. However, with CBT, I found that it didn’t made me feel any better and at times it has actually made me feel worse. I don’t wish to diminish the help it may give to other people, but for myself, I have found it lacking.

When I read about CBT it sounds like it is based on good common sense. Your thoughts, feelings and actions are certainly connected. The idea behind CBT is that by changing one of these (your thoughts) you change the rest. One of the problems I have had with CBT is that my thoughts are so ingrained that they have proved impossible to change. Most thoughts that we have are automatic. We are not always aware of where they come from, they just appear. Changing these is an uphill task. I found it impossible to change these thoughts once they had already ‘lit up’ in my brain. 

CBT teaches you to assess your thoughts and come up with more balanced thoughts. When I did this however, I found that although I could easily come up with the more balanced thoughts, I didn’t really *believe* them. I found myself in the strange situation of having a balanced thought and an ingrained, unbalanced thought fighting with each other in my mind. For me, CBT created a situation where I believed two contradictory things and this caused me quite a lot of stress. The more the negative thought popped up in the brain, the more I punished myself for thinking it and the more stressed I became.

In doing CBT, I was aware of what thoughts were more balanced but it still didn’t change the way I felt or the way I behaved. Perhaps this was due to the cognitive dissonance happening in my brain. Maybe other people are able to hold on to the balanced thought whilst discarding the unbalanced, automatic thought and so their feelings and behaviours change. But for me, this never happened.

One potential problem with CBT is that you don’t know which comes first, the automatic thought or the feeling. CBT seems to be based on the idea that it is the thought which originally causes the feeling which, in turn, causes the behaviour. However, I find that I often feel distressed, depressed or anxious for no good reason and that this then causes me to start having negative thoughts. Changing the thought then won’t necessarily cause a change in the feeling if the causal relation is the other way around. 

One of the difficulties I had with CBT is that I was made to feel guilty for my feelings and behaviours. I kept being told that my unbalanced thoughts were causing my illness and this made me feel ashamed. Thoughts seem like something you should have control over so I was sometimes made to feel like it was my lack of control over my own mind that was leading to my illness. 

It seems to me that it is fairly controversial to say that a certain therapy wasn’t helpful. I found that when I attended CBT, the therapists believed in it so strongly that I wasn’t able to say that I didn’t think it was helping. When I filled in forms before and after therapy that assessed how I was feeling, they made lots of excuses for why I wasn’t feeling better. There was no allowance that CBT may not be effective for everyone.

If you don’t find a certain therapy helpful and express this opinion, you are often treated like you just aren’t trying hard enough. You feel like a failure for not being able to take control of your life and fix your mental health problems. The reality is that I am trying really hard every day. I try and eat healthily, take long baths, go on walks, listen to relaxation CDs and take medications with horrible side effects. I don’t *enjoy* doing any of these things and I am not even sure if any of them are effective but I give them a go because I am told that they work and I want so badly to feel normal. 

CBT may be effective for some people and I am glad that it is available for people to try (although of course many people have to wait months to receive treatment on the NHS and it is often a short course with not enough allocated time). I think that it is good practice to try and become aware of your thoughts and see how they might not be accurate. However, personally as a therapy I found it didn’t help cure my mental illness. In fact I felt guilty and ashamed as a result and was made to feel like I wasn’t trying hard enough. Therapists should always be aware that some therapies don’t suit everyone and that this is no reason to judge someone for not getting better.We are all trying our hardest. No one chooses to be unwell.

2 comments:

  1. Thank you so much for sharing your experience. I am right there with you in nearly every detail. It is comforting to know that I am not alone.

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  2. CBT did not work for me at all. I put a lot of effort into it. I went every week and did all the "homework" everyday. I only got worse. I saw three different therapists. I tried it in group and one-on-one settings. I am never trying it again. I now take medication, which has been much more helpful. I do not believe CBT works for everyone. I believe it is oversold. I have often thought it is for people with mild anxiety and depression, not debilitating anxiety and depression, which is why I sought treatment. I have also thought there may be a placebo effect. I know one thing for sure. It was not helpful for me in the least, and my condition worsened while undergoing CBT treatment. The therapists took no insurance of any kind, and I also see my money as having gone down the drain. There is no refund for failed treatment. I hope you are not feeling guilty or ashamed any longer because CBT was ineffective in your case. CBT is being sold like hotcakes for everything. Those who say they practice CBT certainly have great financial stakes in hyping its effectiveness, and I am sure they do. I assume you are from Great Britain. I am from the U.S.

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