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 12:46 pm (UTC)True, though the rates of PTSD (and complex forms of PTSD) still remains staggeringly high amongst those experiencing abuse at home (children more than adults, and adult rape and domestic violence survivors more than the military).
Media awareness of PTSD tends to skyrocket in tandem with the military, because the media validates (as much as the government doesn't want to) military PTSD (which happens globally in lower incidents when compared to incidents of PTSD in home abuse situations) likely due to connections to the patriarchy vs. validating incidents of PTSD in the home environment. Since they are statistically more often caused by men, and that kind of patriarchy is invisibilised, invalidated, and then responsibility to deal with it is more likely to be placed upon the victim.
Shows and fics about military or military-type PTSD tend to have more traction, even though they represent a less common cause for PTSD overall. Complex PTSD is still most commonly caused by systemic long-term child abuse, and *most* of all by long-term systemic child sexual abuse. That will always trump the military in terms of statistics (unless we suddenly come a long way in actually shining a spotlight on domestic child abuse and home abuse and actually manage to reduce it to a point where military personnel do actually get the disorder more often abroad than at home). There's a lot of things to take into account when you look at the cultural visibility of PTSD, and misogyny plays into it a huge amount. Especially into what kinds of people get PTSD and how it's portrayed in an episode or film.
One has to take into account that a media culture is often more willing to validate PTSD in context of war (because a country is often dependent on validating a country going to war in the first place, so PTSD becomes a 'noble injury' or illness, which is also ridiculous when one looks at how countries tend to universally treat their mentally ill war vets - the visual media is pretty confused there, lol).
I mean, considering that to date, more people in the US military get PTSD from being raped or assaulted by their own colleagues, than by witnessing violence or by being hurt by the enemy: how many shows and movies outside of SVU can you count that actually address 'military acquired PTSD caused by troops assaulting another troop?' There's more visual pieces about child abuse related PTSD than there are about that.
So...where the media shines a spotlight is not necessarily where the biggest problems are.
Not really a cohesive reply, I know. Just kind of thinking out loud about how the changes in society that 'break more people' aren't actually always where you think they are. One only need consider the skyrocketing numbers of people getting PTSD from chemo treatment re: cancer, to realise that. After all, it's an issue hardly anyone really knows about, and some people still struggle to realise that repeated chemo treatments can caused complex forms of PTSD.
Re: Thoughts
Date: 2015-07-15 02:57 am (UTC)Also true.
Hrm ... of the sexual abuse survivors I write, the Rescuer and Hadyn have gotten good therapy after the fact. Over in Path of the Paladins, it's rape rather than abuse; Ari has gotten good support, but Gailah has had a rougher time.
I've got a character sheet for one in Polychrome Heroics that hasn't been introduced yet, touching on the issue of rape in the military. Stiletto started out in the Army because they recruited her for her Healing ability, only it turns out she has no real interest in that. When someone raped her bunkmate and the Army refused to do anything about it, Stiletto fragged the rapist and ran off to become an assassin. Where she is much happier, go figure. Not exactly PTSD but some seriously fucked-up shit anyhow.
>> Media awareness of PTSD tends to skyrocket in tandem with the military, because the media validates (as much as the government doesn't want to) military PTSD (which happens globally in lower incidents when compared to incidents of PTSD in home abuse situations) likely due to connections to the patriarchy vs. validating incidents of PTSD in the home environment. <<
I agree. People are far more open to talking about war than about rape.
>> Since they are statistically more often caused by men, and that kind of patriarchy is invisibilised, invalidated, and then responsibility to deal with it is more likely to be placed upon the victim. <<
Also true.
>> Shows and fics about military or military-type PTSD tend to have more traction, even though they represent a less common cause for PTSD overall. Complex PTSD is still most commonly caused by systemic long-term child abuse, and *most* of all by long-term systemic child sexual abuse. <<
Don't forget bullying for children; and abusive bosses, a common cause of PDSD in adults.
>> There's a lot of things to take into account when you look at the cultural visibility of PTSD, and misogyny plays into it a huge amount. Especially into what kinds of people get PTSD and how it's portrayed in an episode or film. <<
Sadly so. And the type of PTSD can influence the type of symptoms: body memories are more common with survivors of sexual or medical abuse, whereas combat veterans have more issues with audio stuff.
>> One has to take into account that a media culture is often more willing to validate PTSD in context of war (because a country is often dependent on validating a country going to war in the first place, <<
That's a good point.
>>so PTSD becomes a 'noble injury' or illness, which is also ridiculous when one looks at how countries tend to universally treat their mentally ill war vets - the visual media is pretty confused there, lol). <<
Much of the system is devoted to denying claims for PTSD so they don't have to pay for it. Obviously that makes the problem worses. They they are upset when veterans commit suicide instead. They don't want to take care of people, but refuse to let them leave: the classic dynamic of an abuser. They try to convince people that it's okay to have PTSD on one hand, but without guaranteeing any protections on the other, so that the stigma and costs remain very high. People are not stupid. They know it's a trap. Once you admit to having a problem then society will flush you down the crapper. These people have been trained to keep putting one foot in front of the other until they drop, so that's exactly what most of them do.
>> I mean, considering that to date, more people in the US military get PTSD from being raped or assaulted by their own colleagues, than by witnessing violence or by being hurt by the enemy: how many shows and movies outside of SVU can you count that actually address 'military acquired PTSD caused by troops assaulting another troop?' There's more visual pieces about child abuse related PTSD than there are about that. <<
Pretty much none that I can think of. Huh, I need to write out that piece about Stiletto and company.
Not to mention the time someone shot up Buraq despite him being marked as a medic, and by the time Rampart went charging over there to deal with it, someone on the enemy side had already fragged the sniper and thrown him over the wall. Most folks in Terramagne take medical neutrality rather more seriously.
>>So...where the media shines a spotlight is not necessarily where the biggest problems are. <<
Sadly so. I'm trying to fill in some gaps.
>> Not really a cohesive reply, I know. Just kind of thinking out loud about how the changes in society that 'break more people' aren't actually always where you think they are. <<
I've spotted some, but others are outside my areas of expertise.
>> One only need consider the skyrocketing numbers of people getting PTSD from chemo treatment re: cancer, to realise that. After all, it's an issue hardly anyone really knows about, and some people still struggle to realise that repeated chemo treatments can caused complex forms of PTSD. <<
PTSD from medical cases is very common, and most people don't realize that. It's especially high surrounding surgery because they like to use mindwipe drugs so people won't remember all the horrible things that happen. Well, once you start messing with human memory like that, it tends to go extremely haywire. And sometimes that can't be fixed. Another factor on the medical side is plain old helplessness. It's bad enough to have your body rebelling, before you get trapped somewhere you have zero power and other people often view you as a nuisance. Helplessness is one of the leading risk factors for PTSD -- people can survive amazingly bad circumstances as long as they feel that they have some influence over what happens to them. That would be the easiest variable to change, but it requires work and money, two things that hospitals do not want to spend extra on patients. And then they wonder why about a third of their serious casualties are having PTSD afterwards.