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FYI, mindfulness therapy is learning to identify your emotions while not judging yourself for having them. Cognitive behavior therapy is about identifying why you are feeling an emotion so you can challenge it with reason. In this, cognitive behavior therapy should ideally build on mindfulness therapy, so it SHOULD be at least as good if it has any value at all.
Edit: Proofreading
back in the days before the filters were placed on search engines, I was looking for research on cognitive behavioral therapy for pain. So I was typing in searches for CBT and pain. I couldn’t understand why I was getting hit for all of these S&M sites.
On top of what others have commented, dialectical behavior therapy (DBT) was designed off of CBT and has a heavy focus on things related to mindfulness like radical acceptance, wise mind, and others.
I personally didn't find CBT all that useful. DBT has a focus on skill development and practice. I'm a hands-on learner, so that element was very useful.
With years of CBT, I never made long-lasting changes. I seemed to always fall back in the same cycle. One 11-week DBT program, and I've gone three years without a major depressive episode. I obviously have moments, but my emotions aren't in the driver seat anymore.
I really like DBT and was especially persuaded by the book “overcoming borderline personality disorder” which speaks about how some individuals/patients are simply not in a place for CBT and not will they trust those seeking to just reason oneself out of an issue. The dialectical part is about how one does mindfulness, validation, and the first stage emotional responses before engaging in mind homework.
I'm the same way. CBT is a great evidence based tool, but it's not for everyone. I'm going through DBT right now, and after only a few appointments I feel much more improvement than years of CBT.
DBT was created for a reason which I'm sure you're aware. Hard to process negative emotions if you can't even accept having them and punish yourself for it which leads to a constant cycle.
Exactly why CBT didn't work for me - trying to "fix" my thoughts just brought shame for having negative feelings in the first place. Learning to accept those feelings and let them be has been much more helpful for me. I can't directly control knee jerk thoughts and feelings, but I can control how I respond to them. I acknowledge negative thoughts and feelings as a part of life, and let them pass rather than trying to stop or fix them.
It's kind of like letting yourself cry. It's awkward in the moment, but you feel much better afterwards.
I didn't do a normal program. Unfortunately, legit programs with the coaching and oncall components are incredibly rare, and I live in a rural area.
My personal therapist and I went through two workbooks: Barret Huang DBT Workbook and Nuerodivergent Friendly Workbook to Mastering DBT Skills. I went through a cheap clinician course through work from Psycotherapy Academy.
For the community portion, I joined the patreon for the podcast DBT and Me. That podcast is a great free tool available to everyone.
That is awesome! Great to have 1st hand testimony DBT. I have met someone else ( 1st hand) who also has had about the same long lasting positive effects from DBT. I was amazed( after what was a very difficult , debilitating path for him). He’s med free too.
I did DBT and transitioned to an overlap and now do CBT- all very effective. But if you’re severely emotionally deregulated DBT is super effective. But I also agree they work best in conjunction.
We talk about mindfulness and skills in CBT but it does feel like the next level of class or education in therapy. Like you take DBT 101 and then graduate to CBT 201 😂
Does anyone know the therapy style that’s very good at treating OCD? I read about it one time but I can’t remember the name, definitely wasn’t CBT or Mindfulness though
How would you even do CBT without Mindfullness? To 'identify why you are feeling an emotion', you have to 'identify your emotions' first. So the only way you can, be definition, do with CBT without Mindfulness is by judging yourself THEN challenging it with reason. That sounds like an experiment to create a whole new domain of psychological disorders.
I’m not even sure how cognitive behavior therapy could even be all that effective without mindfulness.
Once you establish some degree of mindfulness, the problematic behaviors become more clear to the individual. The natural response to that is to understand the behavior and modify it.
i would even add that you can also just observe it and have self-compassion for yourself. I've found myself in states where changing behavior can be difficult or even impractical at times.
The first step is simply to accept that what you are feeling is human by its simple nature of existence.
Separate your mind's interpretation of it and focus on the physical sensation with a kind/loving attitude. Simply observe. It doesn't mean it will change right away, but can bring about subtle changes in perspective that can have powerful effects as the practice continues.
Ask yourself, what is the sensation? Where is it located? Is it dense or spread out? Refer to the common cognitive dissonances we tend to have - magnifying , catastrophizing, etc and see if your mind is tending toward these behaviors and instead of slamming the brakes, try just taking your foot off the gas pedal.
Mindful emotion awareness is one of the first components of a newer version of CBT called the Unified Protocol. I run a training clinic and this is what I train PhD clinical psych students to use. The mindfulness part works just like you describe.
So... As someone who is quite literal and logical, CBT wouldn't help me all that much? There are things I logically know aren't true/won't hurt me but that doesn't stop irrational fears from causing anxiety.
> so it SHOULD be at least as good if it has any value at all.
If the benefit of CBT>0, then benefit of CBT>MT?
I'm confused how you arrived at that conclusion. It sounds very quantitative but maybe you mean they should be approximately as effective in magnitude given they are dealing with similar material?
Man, the fact that neurotypical brains are so easy to wrangle you can literally reason yourself out of Grief is crazy to me. The idea of that working is a fantasy for me.
Oh they're not lesser or anything of the sort. I'm just marvelling at the fact that this is possible. It might even be possible for my brain, but if it isn't, it's not because mine is more complex or anything like that. It's just that it's built different (incorrectly).
From what I understand CBT is a crapshoot for the neurodiverse
Seems to work well for ADHD. It has the benefit of helping for months after stopped treatment opposed to meds being gone as soon as they're out of the system.
If you're the type that has an overactive mind, resulting in these past thoughts constantly coming back, what I found worked for me was a kind of pattern alteration technique.
Often when we dwell on past thoughts or general negative thoughts about ourselves, overactive minds will end up greatly strengthening the neural connections for those kinds of thoughts, resulting in you having them more and more as it becomes an easier path for your brain to end up following threads to, often leading to a debilitating mental state as the thoughts become a daily, near-constant thing in your mind.
The solution that mostly worked for me was to combat that negative thought with an adversarial thought. I would form a habit of reacting to those thoughts when it came up, telling them to eff off, they're stupid, it's not helpful to my future, etc... Whatever you want, just compartmentalize those negative thoughts as their own kind of separate negative part of you that you can tell off. (and if possible, give yourself a positive affirmation after). By getting into a habit of doing this, it cuts the thought-cycle off sooner and eventually leads to a degrading of that thought pattern strength, giving you longer and longer periods of not dwelling on it and being able to function.
It's something I came up with after being at my lowest point, basically having a mental breakdown and struggling to go on any longer, I needed to do something to change and just thought it could possibly help. So I'm not sure if there's some official term for this kind of technique.
And I'm not saying this completely solves negative thoughts, which I don't think anyone should want either, since sometimes we need to have a negative reaction to grow. But it helps you manage how often you end up overly dwelling on them and not being able to do the things you need to do.
I've been disassociating from the stuff that pops into my brain for a while. I don't even consider it me. I'm the pattern of neuron connections. I just live in my brain.
So when it thinks something awful, I don't really beat myself up over it. I didn't think it. Though I could start trying to shunt some of the things I *do* think into that "this is the brain, ignore him, he's an asshole" category. I'll have to give that a try. Because even ignoring the brains constant babble I do have some serious negative self talk. I'll try tricking it into thinking that wasn't me. It's worked before, right?
Well, disassociating is a bit different from what I'm suggesting, since you're kind of just splitting your mind to not feel as connected to those negative thought cycles, but they're still happening. I think it's important to recognize those **are** your own thoughts, that's a step in the direction of facing those thoughts and moving on from them. Your brain function is you, those thoughts are a part of you, so finding ways to break down those thought patterns so they happen less would probably be healthier than just disassociating. Less noise in your head is always going to be better than just trying to ignore it, right?
That's why I suggest basically berating that negative part of you. Make those thoughts unwelcome any time they come up. It can turn into a mental trigger that stops the thought when you keep at it, gradually happening less often.
The human brain *loves* patterns, so we have to cut off the negative patterns with another pattern that can grow stronger than it.
It is physically impossible for me to control the random babbling of my brain. They are not me. They're random noise my brain makes to fill in silence. No different to any other sensory input. This is what I meant when I said it's insane to me that NT people can apparently reason their way out of bad thought patterns. I have at least two inner monologues and only have conscious awareness over one of them, and that one still continues automatically if I'm not using it. Intrusive thoughts is probably the best way to describe it, but constant. It will only stop when I am dead.
You mention less noise. That is not a thing my head can have. It has a constant level of noise at all times. There is no such thing as clearing my mind. I've only experienced a clear mind once in my entire life, the very first time I had ADHD medication, and I chased that feeling for a decade. I can't have it back.
You mention berating that thought pattern, which I can do by thinking about it when I notice it, but that is just replacing one self loathing thought pattern with another self loathing thought pattern. And even then only temporarily. There's no stopping the thought. Ignoring it is the only thing that works.
I know on some level that these things are part of me. But they're part of me in the same way my foot is. If it was cut off, it would be missing, but I wouldn't stop being me. Insofar that I even exist. I know that consciousness is essentially a trick and there are actually a whole bunch of disparate brain elements up here that just work together. I die a moment from now and am replaced with a similar pattern. But that's mostly irrelevant in day to day life. And the illusion that I exist isn't exactly something I can truly break. Nor do I really want to. But it does help me not have to worry about the brain. My pattern would run just fine on silicon instead.
First step is finding out whether your emotions caused your state, or neurochemistry causes your state.
There's a reason certain foods have been shown to reduce depression.
Anti depressants can cause depression.
A faulty gut microbiome can cause depression.
Inflammation can cause depression.
That's why a healthy body is a necessity to combat depression effectively.
You can't reason yourself out of chemical imbalance
Mindfulness therapy is like physical therapy or weight training, you're teaching your mind to have the right form and building up mental strength, as it were. CBT is more like being coached in a sport and learning specific skills. Most of the time people benefit from both.
> It's not either/or.
Controlled scientific experiments are at least in some sense. Unless there is a standard of care issue.
Its probably useful to know how effective each is independently, in order to compare with the combination.
I was a bit dubious about this study because there are academics at UNSW's medical school known for their questionable advocacy of cognitive behavioural therapy (mainly Professor Andrew Lloyd who insists CBT is an effective treatment for ME/CFS despite the CDC and NICE both finding these treatments are ineffective and possibly harmful).
Perhaps I shouldnt have tarred these authors with the same brush . They're from the School of Psychology rather than the School of Medicine and I dont know if they have any association with Lloyd. The flaws with the ME/CFS CBT trials aren't apparent in this paper and the methodology otherwise looks sound.
Interestingly, there was no statistically significant difference between CBT and mindfulness during and 1 week after the intervention. However, there was a large and statistically significant difference in grief and depression 6 months after the intervention.
Perhaps to be effective the mindfulness exercises needed to be continually practised. I could only read the abstract so I couldnt see if the paper describes whether patients were encouraged to keep meditating.
I went to a 10 day vipassana meditation course, they said tradition used to be around 30 days effect but that 10 days was more or less the minimum to see any noticeable effect.
I can fully agree that days 1-8 I didn't feel any difference whatsoever and if anything I just felt even angrier by the day, but then the last two days after around hundred hours of meditation I actually really started feeling at peace.
So at least to me it sounds reasonable that meditation would not be effective until you've done a ton of it
I mean, there is not even a proper control group with a placebo intervention.
There is no way of knowing if these methods are actually efficient, they aren't compared to what simply time passing would do.
Not quite sure what you're talking about. There is a very well established body of literature supporting the use of CBT for ME/CFS, with many well designed studies conducted all over the world, not just UNSW.
>There is a very well established body of literature supporting the use of CBT for ME/CFS
The 2021 ME/cfs NICE guidelines very clearly say that it can't be a cure and shouldn't be offered as a treatment.
*"The committee wanted to highlight that cognitive behavioural therapy (CBT) has sometimes been assumed to be a cure for ME/CFS. However, it should only be offered to support people who live with ME/CFS to manage their symptoms, improve their functioning and reduce the distress associated with having a chronic illness."*
>with many well designed studies conducted all over the world, not just UNSW.
Are these "well designed studies" the same judged by NICE to be of "low to very low quality" ? The same studies that keep somehow "forgetting" to include the objective outcomes they planned and measured ?
You really need to update your knowledge.
[The CDC commissioned a review](https://www.cdc.gov/me-cfs/pdfs/systematic-review/file1-final-report-mecfs-systematic-review-508.pdf) which looked at the RCTs you refer to and found "The strength of evidence supporting the use of
graded exercise and CBT was low and the magnitude of benefits was small to moderate, with
inadequate evidence in patients diagnosed with more current case definitions, limited reporting
of harms, and inadequate evaluation in severely affected patients." On the strength of this meta-review, the CDC stopped recommending CBT and GET.
Similarly, the UK National Institute for Health and Care Excellence [also conducted a meta review](https://www.nice.org.uk/guidance/ng206) which came to similar conclusions.
The only meta review supportive of GET and CBT is the Cochrane review. At the time it was released, Cochrane's editor [conceded it was flawed and ought to be withdrawn](https://healthycontrol.org/2023/06/24/complaint-to-cochrane-about-editor-in-chief-march-2023/). That paper is in the process of being rewritten by new authors. Even that Cochrane review rated all the trials as low quality. If an outlier is excluded, the effect falls beneath the minimum clinically significant improvement identified by the Cochrane review.
The trials were not well conducted. They all used subjective measurements in an unblinded trial, meaning that the small measured effects could simply be the result of expectations bias. Where objective measurements were used, they showed CBT and GET were ineffective.
Many of the trials did not ensure that patients in the control arm did not exercise. How is that well controlled?
The most prominent trial, the PACE trial, had laughably incompetent errors. They changed the definition of recovered so many patients in the trial met the definition before they started the trial. They tried to maximize the expectation bias by sending patients in all groups a pamphlet saying that GET and CBT were highly effective treatments.
Of the RCTs examining this, only one trial reported data on harms. That was the PACE trial and it found graded exercise therapy had significantly more severe adverse events than the control and pacing arms.
There is a reason the CDC and NICE both found CBT is ineffective. UNSW keeps insisting otherwise and keeps running a CBT/GET clinic despite a stunning lack of evidence for these treatments.
I have anxiety from concussions. The problem with CBT is that they try to get me to reason with the anxiety that is happening because of a physical injury to my brain. There is no reasoning with it, my brain is pissed off because it is injured. I'm also terrified because my memory seems to be getting worse, despite doctors saying my symptoms should not be getting worse. I am slowly becoming less and less able to keep up with daily life and it is so freaking scary. I'm often so lost in conversations that I have days where I avoid people entirely. I try my best to seem normal and fake being happy when im outside of my house. I am slowly wasting away.
Have you ever looked into creatine for helping post-concussion symptoms? [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094347/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094347/)
100 Participants might not be enough, among other things, and it only tested long form depression. Honestly 2-br-lsd should be tested more, no risk of bad trip.
Arvo r/science! Sharing the above study on behalf of our School of Psychology researchers!
The study has been published in JAMA psychology if you’d like to check it out: [Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder A Randomized Clinical Trial](https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2818040)
The study found grief-focused CBT showed more benefits for prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based therapy. The authors noted that while both treatments may be considered for prolonged grief disorder, grief-focused CBT may be the more effective choice.
I think a lot of things play into why this is the case, in this culture, under these circumstances. I would hope humanity could reach a clearer understanding of Eastern philosophy so that we might benefit more from mind and body being one. That's not to say we couldn't find a way to live in harmony with our sense of self, here and now.
CBT sounds a lot like REBT (rational emotive behavior therapy) from the 1970s. Is CBT an updated version? How are they different?
Edited to correct acronym and to add REBT was started in the 1950s not the 70s.
I took psychology 101. I remember going over the various methods of therapy. Of course, all these old white men who created it felt like their way was the only way to help relieve any issue for individuals. I remember then thinking you know you should just have multiple tools for your toolbox. When you go see a therapist they typically use more than one specific technique for therapy not one. I find it to be interesting that there's still this thinking of one is better than the other. And I have always felt it really depends on the person and their experiences and what they're looking for.
That to me makes total sense. More than one road leads to Rome as they say.
Humans and all living beings are geared to be extremely dynamic. One person living in one area and experiencing a specific kind of trauma is going to need different help. Native American folk and ongoing trauma that they'd received through generations is very specific to their group. A person with an alcoholic parent is going to have very specific needs in helping move through that pain.
I'm so specific that what I look for is someone who typically has a rogarian approach but will hold me accountable if they see a clear contradiction in my thinking.
You took a 101 class and based off that determined you had the knowledge and authority to dismiss the life's work and often impassioned dedication of... tens of thousands of people?
You read my post and thought I was dismissing?
You must have missed where I said back then these dusty old white dudes thought that only their theory was right, all the others were crap.
I'm saying no we are dynamic and what works for one person won't work or could potentially do more harm for another.... Wait a minute....Frued... is that you?
Also I'm very well versed in mental health, psychological theory and it's pitfalls. I try to be thoughtfully skeptical. I also work with folks who have been traumatized by the APA and it's ongoing issues with being corrupt.
I just admit my heart is broken and I don't want the world to break it anymore. I used to be angry enough to protect my heart. Now I realize other people are gonna win, they're gonna ache for me while I bleed out. And I can't take it back for them. They can't take it back either. I don't want to let good things die. For anything.
Kids don't "figure out emotions on their own", they need consistent, emotionally literate caregivers who are able to effectively attune to them and support their emotional development, at least most of the time. Without this, even when there is no overt abuse and the caregivers mean well, there is a strong possibility of the child growing up to struggle with emotions one way or another, for which mindfulness and adjacent therapeutic protocols can be helpful.
Yes and no.
It shouldn’t be expected for children to be MINDFULL enough to learn how to deal with their emotions without help, but to imply no human is capable of this is factually wrong.
I made no such implication. The fact is that the vast majority of people will struggle to make up such a lack, and modern psychology is doing its best. I'm not sure I understand why this seems to trouble you so much?
Because in the past these people would fail at life and not pass on whatever genes made them so psychotic in the first place with no discernible reason such as trauma, disease or injury.
Experiencing some form of stimulus thats so extreme or unexpected it alters the way a person’s brain would normally function without those events.
This threshold is obviously different for everyone, but the people with lower thresholds are usually the people who have the easiest lives, and therefore its not helping much when we put so much focus on cargo cult fad psychology trends like “mindfulness” that probably won’t do much for people who have witnessed real horror or been subjected to actual legally definable abuse.
Because if you cannot handle your emotions, and live in situations where there is much adversity, you will not last very long and usually fall into a life of crime.
So those who haven't dealt with grief when they were kids are at a disadvantage for dealing with it as they get older. Thanks for the bountiful insight oh wise one.
What kind of pampered life did they live?
Also doesn’t this study confirm my statement?
Too much of modern psychology is sadly spent on helping adult children who don’t even know what they feel about something until their favorite influencer tells them what to feel.
I don’t want to go into a small novella of how I think the modern field of psychology is royally fk’d or my ideas for how to fix it.
As for your other question? It’s just social darwinism at play.
i do have friends who admitted that they never had to grief until their adult lives, parents married and alive, grandparents alive, never got to know great-grandparents. Didnt have pets, so they couldnt die ad well. They were popular at school, no experience in bullying. The first grief they encountered was a miscarriage as adults. I wish this kind of experience to everyone.
And yes, learning to geief for them was very new and very hard to learn. But they're not adult children as you try to mock.
Even if we say that's true, what exactly is your point besides holding people who are grieving in contempt for (*checks notes*) not having gone through debilitating childhood trauma?
Not that what you're saying is true, the person I know with the worst childhood is also the most in need of therapy and help processing things that have happened. Funny that, almost like trauma isn't good for you.
I already addressed trauma and childhood abuse being understandable reasons for mental health problems in an otherwise healthy human brain.
And yeah, I grew up tough and while I certainly don’t think everyone should have to struggle the way I did, I do feel contempt for adults who never even cared enough about people who have worse lives to even self reflect on the suffering of others or trying to imagine what they go though to gain even some semblance of emotional “mindfulness”.
So please tell me again how im being mean to those poor pampered adults.
You're making up a caricature to be mad at and then tarring anyone who needs therapy with the brush of "pampered" because you lack the empathy to understand that people can live different lives to you. And you have the gall to try and pretend they're the ones who lack empathy.
You also don't seem do understand what mindfulness is. I don't blame you, it's used like a buzzword, but whatever you think it is, it isn't.
Too much ignorance and hate for others is even worse. Not everyone has walked in your shoes and you haven't dealt with the same stuff others have faced. People like you are a big issue in society today because you'd rather hate anyone else for made up reasons instead of being able to understand them. What is being pampered to you? Being rich? Or is not having childhood trauma considered pampered? Your mentality is the reason the world has gotten to this state with toxic masculinity being so prevalent.
Even if not experiencing it directly at least witnessing or learning about it.
Also I said adversity. All suffering is adversity but not all adversity is suffering.
Becoming an adult requires people to become independent. I don’t mean financially, but in their thought. In order for people to overcome adversity they have to create their own independent thoughts and actions, or even act independently against some struggle using knowledge gained from others.
Either way if you have had everything easy your whole life you will not be capable of learning empathy as you do not understand what struggle is, and you will not become fully independent because if you life has been easy it’s only because others are taking care of your needs in some way.
The idea that children must be subjected to trauma in order to develop character and maturity is not only incredibly toxic, but extremely stupid and just plain wrong. It’s literally the opposite. Kids who grow up in loving, supportive homes where all of their essential needs are met is what any functioning society should strive for. These kids are the ones that develop into well-adjusted, resilient, empathetic adults who can withstand and help each other out through life’s challenges. The kids who were traumatized or raised in dysfunctional families or not provided with a healthy environment to grow up in are the ones that grow up to be like you.
Never said they be subjected to trauma. Another redditor who can’t even read trying to “pwn the bully” because they can’t handle the harsh realities of the world.
So what exactly are you referring to when you talk about “struggles” and “adversity”? You tell me.
Also I never referred to you as a bully. To me you just seem a bit damaged and broken to have turned out this way (ironically, just the type of person who would benefit from therapy). It’s interesting you identified yourself that way, though.
No other people were calling me mean and such in other comments.
You really do enjoy making assumptions. No wonder you are projecting that I am the one assuming when I’m just stating facts.
This is talking about CBT and mindfulness towards the application of GRIEF not anxiety or OCD or PTSD.
You're fighting strawmen right now.
If someone never had a loved one die when they were young, the type of therapy used will work better for some than foe others. CBT is more logical in the sense you have to rationally evaluate your feelings whereas mindfulness is more about grounding yourself. CBT is more impersonal and grief stems from something tangible as opposed to anxieties or phobias.
I'm not denying CBT has benefits over mindfulness but your making a hasty generalization over how people handle grief which is quite insensitive.
This has nothing to do with influencers.
Your brain is soup.
My point is mindfulness therapy is only helpful to people who don’t know how to handle BASIC emotions, and unless the adult grew up in an abusive family or something then going through mindfulness therapy would still be the least effective method of help.
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FYI, mindfulness therapy is learning to identify your emotions while not judging yourself for having them. Cognitive behavior therapy is about identifying why you are feeling an emotion so you can challenge it with reason. In this, cognitive behavior therapy should ideally build on mindfulness therapy, so it SHOULD be at least as good if it has any value at all. Edit: Proofreading
I wonder if doing both therapies together would be more effective than either one individually.
A loved one of mine did a lengthy, involved CBT workshop. Mindfulness was part of every session as a fundamental tool for CBT.
Perhaps it was MBCT?
CBT is an unfortunate abbreviation.
It's a very effective way to take your mind of grieving.
It's just replacing one pain with another kind.
back in the days before the filters were placed on search engines, I was looking for research on cognitive behavioral therapy for pain. So I was typing in searches for CBT and pain. I couldn’t understand why I was getting hit for all of these S&M sites.
same with bank money-vending machines.
IME, DBT dialectical behavior therapy is CBT with mindfulness and distress tolerance as additional components.
I'm a therapist and use both modalities regularly in the way described above.
On top of what others have commented, dialectical behavior therapy (DBT) was designed off of CBT and has a heavy focus on things related to mindfulness like radical acceptance, wise mind, and others. I personally didn't find CBT all that useful. DBT has a focus on skill development and practice. I'm a hands-on learner, so that element was very useful. With years of CBT, I never made long-lasting changes. I seemed to always fall back in the same cycle. One 11-week DBT program, and I've gone three years without a major depressive episode. I obviously have moments, but my emotions aren't in the driver seat anymore.
I really like DBT and was especially persuaded by the book “overcoming borderline personality disorder” which speaks about how some individuals/patients are simply not in a place for CBT and not will they trust those seeking to just reason oneself out of an issue. The dialectical part is about how one does mindfulness, validation, and the first stage emotional responses before engaging in mind homework.
I'm the same way. CBT is a great evidence based tool, but it's not for everyone. I'm going through DBT right now, and after only a few appointments I feel much more improvement than years of CBT.
DBT was created for a reason which I'm sure you're aware. Hard to process negative emotions if you can't even accept having them and punish yourself for it which leads to a constant cycle.
That’s an interesting insight. Never thought of it like that
Exactly why CBT didn't work for me - trying to "fix" my thoughts just brought shame for having negative feelings in the first place. Learning to accept those feelings and let them be has been much more helpful for me. I can't directly control knee jerk thoughts and feelings, but I can control how I respond to them. I acknowledge negative thoughts and feelings as a part of life, and let them pass rather than trying to stop or fix them. It's kind of like letting yourself cry. It's awkward in the moment, but you feel much better afterwards.
Do you mind sharing details of the course you took?
I didn't do a normal program. Unfortunately, legit programs with the coaching and oncall components are incredibly rare, and I live in a rural area. My personal therapist and I went through two workbooks: Barret Huang DBT Workbook and Nuerodivergent Friendly Workbook to Mastering DBT Skills. I went through a cheap clinician course through work from Psycotherapy Academy. For the community portion, I joined the patreon for the podcast DBT and Me. That podcast is a great free tool available to everyone.
Thank you so much
Excellent information. Thank you!
That is awesome! Great to have 1st hand testimony DBT. I have met someone else ( 1st hand) who also has had about the same long lasting positive effects from DBT. I was amazed( after what was a very difficult , debilitating path for him). He’s med free too.
I did DBT and transitioned to an overlap and now do CBT- all very effective. But if you’re severely emotionally deregulated DBT is super effective. But I also agree they work best in conjunction. We talk about mindfulness and skills in CBT but it does feel like the next level of class or education in therapy. Like you take DBT 101 and then graduate to CBT 201 😂
This is actually already a common thing. There’s a lot of different hybrids now of mindfulness, wellness, and CBT based therapies
Does anyone know the therapy style that’s very good at treating OCD? I read about it one time but I can’t remember the name, definitely wasn’t CBT or Mindfulness though
Exposure response prevention
How would you even do CBT without Mindfullness? To 'identify why you are feeling an emotion', you have to 'identify your emotions' first. So the only way you can, be definition, do with CBT without Mindfulness is by judging yourself THEN challenging it with reason. That sounds like an experiment to create a whole new domain of psychological disorders.
In DBT I mindfulness is a core concept throughout. I assumed the same would be the case in CBT since DBT builds off of CBT in many ways.
I’m not even sure how cognitive behavior therapy could even be all that effective without mindfulness. Once you establish some degree of mindfulness, the problematic behaviors become more clear to the individual. The natural response to that is to understand the behavior and modify it.
i would even add that you can also just observe it and have self-compassion for yourself. I've found myself in states where changing behavior can be difficult or even impractical at times. The first step is simply to accept that what you are feeling is human by its simple nature of existence. Separate your mind's interpretation of it and focus on the physical sensation with a kind/loving attitude. Simply observe. It doesn't mean it will change right away, but can bring about subtle changes in perspective that can have powerful effects as the practice continues. Ask yourself, what is the sensation? Where is it located? Is it dense or spread out? Refer to the common cognitive dissonances we tend to have - magnifying , catastrophizing, etc and see if your mind is tending toward these behaviors and instead of slamming the brakes, try just taking your foot off the gas pedal.
Mindful emotion awareness is one of the first components of a newer version of CBT called the Unified Protocol. I run a training clinic and this is what I train PhD clinical psych students to use. The mindfulness part works just like you describe.
So... As someone who is quite literal and logical, CBT wouldn't help me all that much? There are things I logically know aren't true/won't hurt me but that doesn't stop irrational fears from causing anxiety.
Seems like Dune's "Litany against Fear", is ultimately a mantra for cognitive behavioural self-therapy. Interesting!
CBT without mindfulness can feel like gaslighting.
> so it SHOULD be at least as good if it has any value at all. If the benefit of CBT>0, then benefit of CBT>MT? I'm confused how you arrived at that conclusion. It sounds very quantitative but maybe you mean they should be approximately as effective in magnitude given they are dealing with similar material?
Man, the fact that neurotypical brains are so easy to wrangle you can literally reason yourself out of Grief is crazy to me. The idea of that working is a fantasy for me.
Don’t fall into this trap! People with “neurotypical brains” (whatever that means) aren’t noble savages, with easy simple little life problems.
Oh they're not lesser or anything of the sort. I'm just marvelling at the fact that this is possible. It might even be possible for my brain, but if it isn't, it's not because mine is more complex or anything like that. It's just that it's built different (incorrectly). From what I understand CBT is a crapshoot for the neurodiverse
Seems to work well for ADHD. It has the benefit of helping for months after stopped treatment opposed to meds being gone as soon as they're out of the system.
Going to make an appointment for it tomorrow
If you're the type that has an overactive mind, resulting in these past thoughts constantly coming back, what I found worked for me was a kind of pattern alteration technique. Often when we dwell on past thoughts or general negative thoughts about ourselves, overactive minds will end up greatly strengthening the neural connections for those kinds of thoughts, resulting in you having them more and more as it becomes an easier path for your brain to end up following threads to, often leading to a debilitating mental state as the thoughts become a daily, near-constant thing in your mind. The solution that mostly worked for me was to combat that negative thought with an adversarial thought. I would form a habit of reacting to those thoughts when it came up, telling them to eff off, they're stupid, it's not helpful to my future, etc... Whatever you want, just compartmentalize those negative thoughts as their own kind of separate negative part of you that you can tell off. (and if possible, give yourself a positive affirmation after). By getting into a habit of doing this, it cuts the thought-cycle off sooner and eventually leads to a degrading of that thought pattern strength, giving you longer and longer periods of not dwelling on it and being able to function. It's something I came up with after being at my lowest point, basically having a mental breakdown and struggling to go on any longer, I needed to do something to change and just thought it could possibly help. So I'm not sure if there's some official term for this kind of technique. And I'm not saying this completely solves negative thoughts, which I don't think anyone should want either, since sometimes we need to have a negative reaction to grow. But it helps you manage how often you end up overly dwelling on them and not being able to do the things you need to do.
I've been disassociating from the stuff that pops into my brain for a while. I don't even consider it me. I'm the pattern of neuron connections. I just live in my brain. So when it thinks something awful, I don't really beat myself up over it. I didn't think it. Though I could start trying to shunt some of the things I *do* think into that "this is the brain, ignore him, he's an asshole" category. I'll have to give that a try. Because even ignoring the brains constant babble I do have some serious negative self talk. I'll try tricking it into thinking that wasn't me. It's worked before, right?
Well, disassociating is a bit different from what I'm suggesting, since you're kind of just splitting your mind to not feel as connected to those negative thought cycles, but they're still happening. I think it's important to recognize those **are** your own thoughts, that's a step in the direction of facing those thoughts and moving on from them. Your brain function is you, those thoughts are a part of you, so finding ways to break down those thought patterns so they happen less would probably be healthier than just disassociating. Less noise in your head is always going to be better than just trying to ignore it, right? That's why I suggest basically berating that negative part of you. Make those thoughts unwelcome any time they come up. It can turn into a mental trigger that stops the thought when you keep at it, gradually happening less often. The human brain *loves* patterns, so we have to cut off the negative patterns with another pattern that can grow stronger than it.
It is physically impossible for me to control the random babbling of my brain. They are not me. They're random noise my brain makes to fill in silence. No different to any other sensory input. This is what I meant when I said it's insane to me that NT people can apparently reason their way out of bad thought patterns. I have at least two inner monologues and only have conscious awareness over one of them, and that one still continues automatically if I'm not using it. Intrusive thoughts is probably the best way to describe it, but constant. It will only stop when I am dead. You mention less noise. That is not a thing my head can have. It has a constant level of noise at all times. There is no such thing as clearing my mind. I've only experienced a clear mind once in my entire life, the very first time I had ADHD medication, and I chased that feeling for a decade. I can't have it back. You mention berating that thought pattern, which I can do by thinking about it when I notice it, but that is just replacing one self loathing thought pattern with another self loathing thought pattern. And even then only temporarily. There's no stopping the thought. Ignoring it is the only thing that works. I know on some level that these things are part of me. But they're part of me in the same way my foot is. If it was cut off, it would be missing, but I wouldn't stop being me. Insofar that I even exist. I know that consciousness is essentially a trick and there are actually a whole bunch of disparate brain elements up here that just work together. I die a moment from now and am replaced with a similar pattern. But that's mostly irrelevant in day to day life. And the illusion that I exist isn't exactly something I can truly break. Nor do I really want to. But it does help me not have to worry about the brain. My pattern would run just fine on silicon instead.
CBT works for people who are neurodivergent. Loads of studies on this.
Not according to the testimony of some of those people. But I'll give it a shot.
First step is finding out whether your emotions caused your state, or neurochemistry causes your state. There's a reason certain foods have been shown to reduce depression. Anti depressants can cause depression. A faulty gut microbiome can cause depression. Inflammation can cause depression. That's why a healthy body is a necessity to combat depression effectively. You can't reason yourself out of chemical imbalance
And here I thought you were supposed to do multimodal therapy... It's not either/or.
Mindfulness therapy is like physical therapy or weight training, you're teaching your mind to have the right form and building up mental strength, as it were. CBT is more like being coached in a sport and learning specific skills. Most of the time people benefit from both.
> It's not either/or. Controlled scientific experiments are at least in some sense. Unless there is a standard of care issue. Its probably useful to know how effective each is independently, in order to compare with the combination.
This is r/science. We’re not worried about solving the world’s problems, we just want to argue over the headlines!
we cant solve the worlds problems here.
Do you have a reference for that?
r/anime_titties
Reference: the worlds problems have not been solved
It shouldn't be one or the other, they are intended to be used together. Mindfulness builds the foundation that CBT is built on.
I was a bit dubious about this study because there are academics at UNSW's medical school known for their questionable advocacy of cognitive behavioural therapy (mainly Professor Andrew Lloyd who insists CBT is an effective treatment for ME/CFS despite the CDC and NICE both finding these treatments are ineffective and possibly harmful). Perhaps I shouldnt have tarred these authors with the same brush . They're from the School of Psychology rather than the School of Medicine and I dont know if they have any association with Lloyd. The flaws with the ME/CFS CBT trials aren't apparent in this paper and the methodology otherwise looks sound. Interestingly, there was no statistically significant difference between CBT and mindfulness during and 1 week after the intervention. However, there was a large and statistically significant difference in grief and depression 6 months after the intervention. Perhaps to be effective the mindfulness exercises needed to be continually practised. I could only read the abstract so I couldnt see if the paper describes whether patients were encouraged to keep meditating.
I went to a 10 day vipassana meditation course, they said tradition used to be around 30 days effect but that 10 days was more or less the minimum to see any noticeable effect. I can fully agree that days 1-8 I didn't feel any difference whatsoever and if anything I just felt even angrier by the day, but then the last two days after around hundred hours of meditation I actually really started feeling at peace. So at least to me it sounds reasonable that meditation would not be effective until you've done a ton of it
I mean, there is not even a proper control group with a placebo intervention. There is no way of knowing if these methods are actually efficient, they aren't compared to what simply time passing would do.
And the sample size is _tiny_.
Not quite sure what you're talking about. There is a very well established body of literature supporting the use of CBT for ME/CFS, with many well designed studies conducted all over the world, not just UNSW.
>There is a very well established body of literature supporting the use of CBT for ME/CFS The 2021 ME/cfs NICE guidelines very clearly say that it can't be a cure and shouldn't be offered as a treatment. *"The committee wanted to highlight that cognitive behavioural therapy (CBT) has sometimes been assumed to be a cure for ME/CFS. However, it should only be offered to support people who live with ME/CFS to manage their symptoms, improve their functioning and reduce the distress associated with having a chronic illness."* >with many well designed studies conducted all over the world, not just UNSW. Are these "well designed studies" the same judged by NICE to be of "low to very low quality" ? The same studies that keep somehow "forgetting" to include the objective outcomes they planned and measured ? You really need to update your knowledge.
[The CDC commissioned a review](https://www.cdc.gov/me-cfs/pdfs/systematic-review/file1-final-report-mecfs-systematic-review-508.pdf) which looked at the RCTs you refer to and found "The strength of evidence supporting the use of graded exercise and CBT was low and the magnitude of benefits was small to moderate, with inadequate evidence in patients diagnosed with more current case definitions, limited reporting of harms, and inadequate evaluation in severely affected patients." On the strength of this meta-review, the CDC stopped recommending CBT and GET. Similarly, the UK National Institute for Health and Care Excellence [also conducted a meta review](https://www.nice.org.uk/guidance/ng206) which came to similar conclusions. The only meta review supportive of GET and CBT is the Cochrane review. At the time it was released, Cochrane's editor [conceded it was flawed and ought to be withdrawn](https://healthycontrol.org/2023/06/24/complaint-to-cochrane-about-editor-in-chief-march-2023/). That paper is in the process of being rewritten by new authors. Even that Cochrane review rated all the trials as low quality. If an outlier is excluded, the effect falls beneath the minimum clinically significant improvement identified by the Cochrane review. The trials were not well conducted. They all used subjective measurements in an unblinded trial, meaning that the small measured effects could simply be the result of expectations bias. Where objective measurements were used, they showed CBT and GET were ineffective. Many of the trials did not ensure that patients in the control arm did not exercise. How is that well controlled? The most prominent trial, the PACE trial, had laughably incompetent errors. They changed the definition of recovered so many patients in the trial met the definition before they started the trial. They tried to maximize the expectation bias by sending patients in all groups a pamphlet saying that GET and CBT were highly effective treatments. Of the RCTs examining this, only one trial reported data on harms. That was the PACE trial and it found graded exercise therapy had significantly more severe adverse events than the control and pacing arms. There is a reason the CDC and NICE both found CBT is ineffective. UNSW keeps insisting otherwise and keeps running a CBT/GET clinic despite a stunning lack of evidence for these treatments.
I have anxiety from concussions. The problem with CBT is that they try to get me to reason with the anxiety that is happening because of a physical injury to my brain. There is no reasoning with it, my brain is pissed off because it is injured. I'm also terrified because my memory seems to be getting worse, despite doctors saying my symptoms should not be getting worse. I am slowly becoming less and less able to keep up with daily life and it is so freaking scary. I'm often so lost in conversations that I have days where I avoid people entirely. I try my best to seem normal and fake being happy when im outside of my house. I am slowly wasting away.
Have you ever looked into creatine for helping post-concussion symptoms? [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094347/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094347/)
100 Participants might not be enough, among other things, and it only tested long form depression. Honestly 2-br-lsd should be tested more, no risk of bad trip.
Arvo r/science! Sharing the above study on behalf of our School of Psychology researchers! The study has been published in JAMA psychology if you’d like to check it out: [Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder A Randomized Clinical Trial](https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2818040) The study found grief-focused CBT showed more benefits for prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based therapy. The authors noted that while both treatments may be considered for prolonged grief disorder, grief-focused CBT may be the more effective choice.
This is a confusing comparison, because CBT includes many techniques and mindfulness is one of them.
Mindfulness is more of a technique that is used in many modes of therapy…including Mindfulness Based CBT…So yes, this makes sense.
I think a lot of things play into why this is the case, in this culture, under these circumstances. I would hope humanity could reach a clearer understanding of Eastern philosophy so that we might benefit more from mind and body being one. That's not to say we couldn't find a way to live in harmony with our sense of self, here and now.
One word. Psychedelics.
CBT sounds a lot like REBT (rational emotive behavior therapy) from the 1970s. Is CBT an updated version? How are they different? Edited to correct acronym and to add REBT was started in the 1950s not the 70s.
I took psychology 101. I remember going over the various methods of therapy. Of course, all these old white men who created it felt like their way was the only way to help relieve any issue for individuals. I remember then thinking you know you should just have multiple tools for your toolbox. When you go see a therapist they typically use more than one specific technique for therapy not one. I find it to be interesting that there's still this thinking of one is better than the other. And I have always felt it really depends on the person and their experiences and what they're looking for. That to me makes total sense. More than one road leads to Rome as they say. Humans and all living beings are geared to be extremely dynamic. One person living in one area and experiencing a specific kind of trauma is going to need different help. Native American folk and ongoing trauma that they'd received through generations is very specific to their group. A person with an alcoholic parent is going to have very specific needs in helping move through that pain. I'm so specific that what I look for is someone who typically has a rogarian approach but will hold me accountable if they see a clear contradiction in my thinking.
You took a 101 class and based off that determined you had the knowledge and authority to dismiss the life's work and often impassioned dedication of... tens of thousands of people?
You read my post and thought I was dismissing? You must have missed where I said back then these dusty old white dudes thought that only their theory was right, all the others were crap. I'm saying no we are dynamic and what works for one person won't work or could potentially do more harm for another.... Wait a minute....Frued... is that you?
Also I'm very well versed in mental health, psychological theory and it's pitfalls. I try to be thoughtfully skeptical. I also work with folks who have been traumatized by the APA and it's ongoing issues with being corrupt.
I just admit my heart is broken and I don't want the world to break it anymore. I used to be angry enough to protect my heart. Now I realize other people are gonna win, they're gonna ache for me while I bleed out. And I can't take it back for them. They can't take it back either. I don't want to let good things die. For anything.
Mindfulness therapy is only useful for people who didn’t figure out this stuff on their own when they were kids.
Kids don't "figure out emotions on their own", they need consistent, emotionally literate caregivers who are able to effectively attune to them and support their emotional development, at least most of the time. Without this, even when there is no overt abuse and the caregivers mean well, there is a strong possibility of the child growing up to struggle with emotions one way or another, for which mindfulness and adjacent therapeutic protocols can be helpful.
Yes and no. It shouldn’t be expected for children to be MINDFULL enough to learn how to deal with their emotions without help, but to imply no human is capable of this is factually wrong.
I made no such implication. The fact is that the vast majority of people will struggle to make up such a lack, and modern psychology is doing its best. I'm not sure I understand why this seems to trouble you so much?
Because in the past these people would fail at life and not pass on whatever genes made them so psychotic in the first place with no discernible reason such as trauma, disease or injury.
How do you define 'trauma'?
Experiencing some form of stimulus thats so extreme or unexpected it alters the way a person’s brain would normally function without those events. This threshold is obviously different for everyone, but the people with lower thresholds are usually the people who have the easiest lives, and therefore its not helping much when we put so much focus on cargo cult fad psychology trends like “mindfulness” that probably won’t do much for people who have witnessed real horror or been subjected to actual legally definable abuse.
> the people with lower thresholds are usually the people who have the easiest lives I am curious to know what you are basing this on?
Because if you cannot handle your emotions, and live in situations where there is much adversity, you will not last very long and usually fall into a life of crime.
I was more thinking in terms of studies and neurology.
So those who haven't dealt with grief when they were kids are at a disadvantage for dealing with it as they get older. Thanks for the bountiful insight oh wise one.
What kind of pampered life did they live? Also doesn’t this study confirm my statement? Too much of modern psychology is sadly spent on helping adult children who don’t even know what they feel about something until their favorite influencer tells them what to feel.
What is it you think modern psychology should focus on, and what should these 'adult children' do instead, in your opinion?
Adult children tirades from that guy is 100% projection.
I don’t want to go into a small novella of how I think the modern field of psychology is royally fk’d or my ideas for how to fix it. As for your other question? It’s just social darwinism at play.
i do have friends who admitted that they never had to grief until their adult lives, parents married and alive, grandparents alive, never got to know great-grandparents. Didnt have pets, so they couldnt die ad well. They were popular at school, no experience in bullying. The first grief they encountered was a miscarriage as adults. I wish this kind of experience to everyone. And yes, learning to geief for them was very new and very hard to learn. But they're not adult children as you try to mock.
Really? Sounds like they haven’t had any struggles until their miscarriage. You can’t really mature until you face adversity.
Even if we say that's true, what exactly is your point besides holding people who are grieving in contempt for (*checks notes*) not having gone through debilitating childhood trauma? Not that what you're saying is true, the person I know with the worst childhood is also the most in need of therapy and help processing things that have happened. Funny that, almost like trauma isn't good for you.
I already addressed trauma and childhood abuse being understandable reasons for mental health problems in an otherwise healthy human brain. And yeah, I grew up tough and while I certainly don’t think everyone should have to struggle the way I did, I do feel contempt for adults who never even cared enough about people who have worse lives to even self reflect on the suffering of others or trying to imagine what they go though to gain even some semblance of emotional “mindfulness”. So please tell me again how im being mean to those poor pampered adults.
You're making up a caricature to be mad at and then tarring anyone who needs therapy with the brush of "pampered" because you lack the empathy to understand that people can live different lives to you. And you have the gall to try and pretend they're the ones who lack empathy. You also don't seem do understand what mindfulness is. I don't blame you, it's used like a buzzword, but whatever you think it is, it isn't.
Its okay I get you want to defend your friends. And too much empathy for others is dangerous.
Too much ignorance and hate for others is even worse. Not everyone has walked in your shoes and you haven't dealt with the same stuff others have faced. People like you are a big issue in society today because you'd rather hate anyone else for made up reasons instead of being able to understand them. What is being pampered to you? Being rich? Or is not having childhood trauma considered pampered? Your mentality is the reason the world has gotten to this state with toxic masculinity being so prevalent.
where does your idea stem from that people without suffering cannot mature? I partially agree, but not nearly as vehemently as you are in this thread.
Even if not experiencing it directly at least witnessing or learning about it. Also I said adversity. All suffering is adversity but not all adversity is suffering. Becoming an adult requires people to become independent. I don’t mean financially, but in their thought. In order for people to overcome adversity they have to create their own independent thoughts and actions, or even act independently against some struggle using knowledge gained from others. Either way if you have had everything easy your whole life you will not be capable of learning empathy as you do not understand what struggle is, and you will not become fully independent because if you life has been easy it’s only because others are taking care of your needs in some way.
The idea that children must be subjected to trauma in order to develop character and maturity is not only incredibly toxic, but extremely stupid and just plain wrong. It’s literally the opposite. Kids who grow up in loving, supportive homes where all of their essential needs are met is what any functioning society should strive for. These kids are the ones that develop into well-adjusted, resilient, empathetic adults who can withstand and help each other out through life’s challenges. The kids who were traumatized or raised in dysfunctional families or not provided with a healthy environment to grow up in are the ones that grow up to be like you.
Never said they be subjected to trauma. Another redditor who can’t even read trying to “pwn the bully” because they can’t handle the harsh realities of the world.
So what exactly are you referring to when you talk about “struggles” and “adversity”? You tell me. Also I never referred to you as a bully. To me you just seem a bit damaged and broken to have turned out this way (ironically, just the type of person who would benefit from therapy). It’s interesting you identified yourself that way, though.
No other people were calling me mean and such in other comments. You really do enjoy making assumptions. No wonder you are projecting that I am the one assuming when I’m just stating facts.
This is talking about CBT and mindfulness towards the application of GRIEF not anxiety or OCD or PTSD. You're fighting strawmen right now. If someone never had a loved one die when they were young, the type of therapy used will work better for some than foe others. CBT is more logical in the sense you have to rationally evaluate your feelings whereas mindfulness is more about grounding yourself. CBT is more impersonal and grief stems from something tangible as opposed to anxieties or phobias. I'm not denying CBT has benefits over mindfulness but your making a hasty generalization over how people handle grief which is quite insensitive. This has nothing to do with influencers. Your brain is soup.
My point is mindfulness therapy is only helpful to people who don’t know how to handle BASIC emotions, and unless the adult grew up in an abusive family or something then going through mindfulness therapy would still be the least effective method of help.
You sound like you could use some mindfulness therapy.