Cognitive-Behavioral Therapy Declining
Jul. 12th, 2015 05:37 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
ysabetwordsmithThis article talks about the declining effects of cognitive-behavioral therapy. I am fascinated to explore why something that used to work pretty well is now not working as well.
I can think of some possibilities not mentioned in the article:
1) The longer a therapy is around, the wider it is known. That means more people have access to it before official therapy. You can go online and find CBT theory, techniques, thought distortions and how to fix them, worksheets, and other tools. This raises the chance that someone already knows CBT and has tried at least some of its methods before seeking professional help. So if the therapist then does more CBT, it looks less effective measured from the start of therapy, because the client already did some of that stuff and got whatever benefit they got from it earlier. In this case, CBT only has a high rate of helpfulness for people who really need guidance and/or advanced techniques that don't work well alone.
2) CBT is terrific at treating certain types of problems, but mediocre or useless for others. If you have bad tape, this is a go-to therapy for fixing that, and you should definitely try it. Same with any other logical or practical problem. It's also ideal for people who do better with facts, logic, numbers, or other objective things than with subjective things. But if you are feeling unheard, your emotions are bent, unacknowledged memories are gumming up your subconscious, or your biochemistry is out of whack, then CBT is not ideal for those problems and won't help much. It is possible that certain types of problem are more or less common in different decades. If the problems presenting now are something other than logical/practical ones, this therapy will seem less useful overall.
Bottom line: If you have head problems that you need help with, start by identifying them as best you can. Then look at the available options for treatment. Each type of treatment is good at some things and bad at others. Pick one that's a good match for your problem(s). Try it for a while. If it doesn't help, drop it and try something else.
I can think of some possibilities not mentioned in the article:
1) The longer a therapy is around, the wider it is known. That means more people have access to it before official therapy. You can go online and find CBT theory, techniques, thought distortions and how to fix them, worksheets, and other tools. This raises the chance that someone already knows CBT and has tried at least some of its methods before seeking professional help. So if the therapist then does more CBT, it looks less effective measured from the start of therapy, because the client already did some of that stuff and got whatever benefit they got from it earlier. In this case, CBT only has a high rate of helpfulness for people who really need guidance and/or advanced techniques that don't work well alone.
2) CBT is terrific at treating certain types of problems, but mediocre or useless for others. If you have bad tape, this is a go-to therapy for fixing that, and you should definitely try it. Same with any other logical or practical problem. It's also ideal for people who do better with facts, logic, numbers, or other objective things than with subjective things. But if you are feeling unheard, your emotions are bent, unacknowledged memories are gumming up your subconscious, or your biochemistry is out of whack, then CBT is not ideal for those problems and won't help much. It is possible that certain types of problem are more or less common in different decades. If the problems presenting now are something other than logical/practical ones, this therapy will seem less useful overall.
Bottom line: If you have head problems that you need help with, start by identifying them as best you can. Then look at the available options for treatment. Each type of treatment is good at some things and bad at others. Pick one that's a good match for your problem(s). Try it for a while. If it doesn't help, drop it and try something else.
Re: Thoughts
Date: 2015-07-14 12:13 pm (UTC)Well, as I said in my response, fanfiction normally does a far better job than visual media - so fics like yours and other people's are doing a great job. :)
But as for television/cinema media, I am so fucking tired of jump cuts and juxtaposition where the past memories go through all post-production (desaturation, saturation, filters etc.) to make it very clear to an audience 'OH LOOK AT THIS DISTURBING MEMORY AREN'T YOU DISTURBED TOO'. (I've been informed that Mad Max does a lot of this to disorient, but it's such a damned cliche. Like, yes, it can be effective, and, yes, that's *sometimes* what visual flashbacks are like, but...eh).
It's effective (I remember the resonance I felt the first time I saw the technique back in the late 80s), but it's troped and lazy and cliched and no one tends to push past it in the visual mediums, especially in scriptwriting. It completely ignores things like sensory flashbacks: what about someone experiencing mysterious but serious gut pain for several days that happened to coincide with witnessing a show about stomach surgery, while they themselves have experienced traumatic hospital experiences? Sensory flashbacks are very common, yet hardly acknowledged. Where's a character who talks about phantom pains and goes through years of trying to explore chronic illnesses and many invasive tests only to one day learn that sensory flashbacks with no attending visual flashbacks happen? Ditto auditory and olfactory flashbacks (which are sometimes stronger and more pervasive than visual flashbacks for some people - and yet can be undiagnosed for ages, or misdiagnosed as atypical migraines).
I mean yes it makes sense that visual mediums would lean too heavily on visual flashbacks - it's what the format is for. But you meet someone who has PTSD and knows a bit about their own disorder and still don't understand olfactory/auditory/sensory flashbacks are a thing because it's just about never reflected back to them in mainstream media representations of PTSD (for me, PTSD also encompasses C-PTSD and PDSD there, as well). It's disappointing.
But then, since it's my area of personal interest, I've specifically consumed an awful lot of media based solely on representations on trauma and post-trauma and trauma recovery, so you do end up with a sense of 'same shit different day.' Sometimes it's done better, sometimes it's done worse. If I'm going to write a text including visual flashbacks, I have a rule for myself to include at least one sensory / auditory / olfactory flashback as well.
Anyway, fanfiction is definitely making strides where mainstream visual media is not.
Re: Thoughts
Date: 2015-07-14 08:12 pm (UTC)Yay!
>> But as for television/cinema media, I am so fucking tired of jump cuts and juxtaposition where the past memories go through all post-production (desaturation, saturation, filters etc.) to make it very clear to an audience 'OH LOOK AT THIS DISTURBING MEMORY AREN'T YOU DISTURBED TOO'. (I've been informed that Mad Max does a lot of this to disorient, but it's such a damned cliche.<<
Valid point about how that is overdone.
I think it's interesting to compare examples, though. Arrow makes the flashbacks much flatter and colder, so they feel like derealization to me. Fury Road makes them warped and wavering, like mirages -- and there are audio whispers that sometimes precede the visual distortions. So it's more like depersonalization. Oliver feels like his world is coming apart; Max feels like HE is coming apart.
>> Like, yes, it can be effective, and, yes, that's *sometimes* what visual flashbacks are like, but...eh).<<
What I haven't seen, and I think this would work better in a visual format than print, is the kind of flashback where you can't distinguish the weird memory trip from ordinary experience. That's what makes this type of flashback so dangerous. It's not an instant replay of something you know is a memory. But it's not exactly a hallucination either. It's bleedover from memory into current experience, kind of like when you're dreaming and the phone rings so you dream about a phone ringing -- or an alarm going off.
>> It completely ignores things like sensory flashbacks: what about someone experiencing mysterious but serious gut pain for several days that happened to coincide with witnessing a show about stomach surgery, while they themselves have experienced traumatic hospital experiences? Sensory flashbacks are very common, yet hardly acknowledged. Where's a character who talks about phantom pains and goes through years of trying to explore chronic illnesses and many invasive tests only to one day learn that sensory flashbacks with no attending visual flashbacks happen? <<
That makes sense. I could write that. Nobody really covers body memories -- the only place I've heard them mentioned much is material for sexual abuse survivors. And I've already got a character, the Rescuer, who specializes in helping abused people.
>> Ditto auditory and olfactory flashbacks (which are sometimes stronger and more pervasive than visual flashbacks for some people - and yet can be undiagnosed for ages, or misdiagnosed as atypical migraines). <<
Also true. I have a complete description for a character I haven't introduced yet. Jerryrigger has severe PDSD from kidnapping, mad science torture, and isolation. But she's far more a tactile person than visual. I suspect that her flashbacks are coming through as body memories, smell/taste, and occasionally audio more than visual. Her senses have been heightened, and she has a problem with conventional food now. I doubt that much of it is coherent enough to form complete scenes that play out. Flickers, flashes, jarring little details that keep knocking her off balance. That would be really interesting to write.
Tuesday, July 21 is the "anything goes" fishbowl so either of these would fit there. I'm always up for exploring different sensory portrayals.
>> But you meet someone who has PTSD and knows a bit about their own disorder and still don't understand olfactory/auditory/sensory flashbacks are a thing because it's just about never reflected back to them in mainstream media representations of PTSD <<
Yes, that's a problem. I've had people write to me and ask if stuff I'm describing is real, because they've experienced it but nobody else has written about it.
>> (for me, PTSD also encompasses C-PTSD and PDSD there, as well). It's disappointing. <<
I tend to shorthand the same way. Stress disorders are distinct yet overlapping, kind of like eating disorders.
>> But then, since it's my area of personal interest, I've specifically consumed an awful lot of media based solely on representations on trauma and post-trauma and trauma recovery, so you do end up with a sense of 'same shit different day.' Sometimes it's done better, sometimes it's done worse. <<
I've read a lot about it too, for similar reasons.
>> If I'm going to write a text including visual flashbacks, I have a rule for myself to include at least one sensory / auditory / olfactory flashback as well. <<
I tend to focus on individual characters and try to map out their unique pattern of experience. Because PTSD has a yard-long list of symptoms, but they don't always manifest the same way. Like almost everyone has sleep disorders, of which the most common are nightmares and insomnia. But some people sleep almost all the time, some have night terrors, some can't remember their dreams anymore, etc. So too with intrusive memories. Some are full-immersion flashbacks, many are just sensory fragments, and some are repetitious ideas like abruptly viewing the grocery store as an ambush site and you can't stop comparing it to ones you remember. If I'm doing it right, each character's 'style' of PTSD should be recognizable yet particular to their experiences.
>> Anyway, fanfiction is definitely making strides where mainstream visual media is not. <<
That's good to hear.
Huh, it gives me another idea, though -- fanfic has a lot of podcasting. That would be a natural place to explore audio flashbacks. You could make a separate soundtrack for the flashbacks. To make it coherent, you'd have to bend the physics a little: use a binaural recording so that you could play the flashback into one ear and the 'regular' narrative into the other. Occasionally switch back and forth. If you had the regular narrative playing in stereo most of the time, and switched to a split track during flashbacks, it should be comprehensible but still eerie.
One of the things I found impressive about Mad Max was the way his auditory flashbacks used surround-sound to skitter around the sides and back, not really in front of him like the main dialog. It was the equivalent of seeing something from the corner of your eye, only in sound.