Comment by wodenokoto | Hacker News Reader

Comment by wodenokoto | Hacker News Reader

Nobody in this thread (at time of writing) seems to have the slightest idea about what CBT is.

It is not about denying thoughts. It is not about telling yourself that you are happy, when you are not.

It can't treat severe depressions, but it can treat mild ones, and it can lower the amount of medication needed to treat severe ones.

You can think about it as "good posture for your mind". Nobody wants a bad posture, but lots of people have it, and some have it so bad, that they get pains so severe they cannot work. Some people with back pain take pain medication, and never solve the problem, but can go on with their lives.

For some people, there are external influences on their posture that cannot be negated by exercise and they do need to change their environment.

Some do need an operation with everything that entails, but most just need to fix their posture: Do the right exercises and stretches and they won't need medication or operations.

If you are depressed because of your abusive boyfriend, then CBT's answer is not "stop thinking about it" or "just think happy thoughts when you're being beaten" it is "get the fuck out of it".

I agree that CBT falls short with severe issues. I was going to CBT therapy and it caused the relationship issues with my wife (who suffers from borderline personality disorder) to be amplified greatly. My CBT therapist would constantly show me how my wife is irrational and manipulative. It caused huge amounts of distress to the relationship. I am now going to a therapist who does DBT and understands borderline personality disorder. CBT is still applied where it is useful but these issues require deep self-introspection and looking into the past. I've been so much better at communicating with my wife and have discovered my own codependency issues I need to work on. I no longer see my wife as someone who is evil and manipulative but understand that what she does and says is out of fear of abandonment.

CBT can treat severe depression, but the problem is that all those deep-seated underlying mental patterns don't just change because you want them too.

Most people don't seem to realise that the celebrated prefrontal cortex is the youngest and in a way weakest part of the brain. It surrounds older structures that don't work much different than in reptiles.

Changing your thoughts is easy, changing the attached emotions, fight/flight responses etc., who might even trigger the thoughts in the first place is incredibly hard.

It takes time, the right corrective and endless patience and iterative practise.

> Nobody in this thread (at time of writing) seems to have the slightest idea about what CBT is.

I like to think that somewhere there's a discussion board for psychologists and they're talking about, say, using R and how it sucks or not.

Given how statistics seem to be an integral part of psychology research, I hope there is.

I hope their discussions about R aren't as pisspoor as our discussions about psychotherapy.

http://www.smbc-comics.com/index.php?db=comics&id=2177

I am the founder of a behavioral health practice management SAAS company and my cofounder is a therapist. So we actually get into those very discussions. I have enough mental health clinical knowledge to be dangerous and she knows enough code to make the discussion interesting.

As a side note we have a moderately successful CBT app so I have definitely spent plenty of time in the 'source code' of CBT methodology. It isn't bad or good anymore that C is bad or good. It's a tool that's useful when applied to the problem for which it is best suited.

Unfortunately, given the realities of health insurance payments, it's a tool often overused due to its 'promise' of fast results (compared to psychotherapy for instance.)

The real problem isn't CBT, it's an attitude by payers that mental health treatment can be quantified as easily as physical health. That leads to writing webpages in C so to speak.

In the psych community though the CBT vs. Psychotherapy debate reaches similar passions as debating PHP versus Rails. (Fix my analogies as appropriate, but you get the idea.)

CBT is like taking aspirin when you have a fever. It might lessen the fever but it doesn't do anything about what caused it.

In the case of a fever, that might be enough, but for psychological disorders it is not so likely.

> In the case of a fever, that might be enough, but for psychological disorders it is not so likely.

That might actually likely be enough. The reason why you have psychologist using CBT as therapy and not just self-help books is to identify if it is enough.

They're using CBT to see whether CBT is enough? I don't understand your statement.

My point was that there are typically unconscious thoughts that lead to disorders, and fixing those disorders at the surface without finding the root is likely to cause them to reappear later, in the same or different form. E.g. aspirin will not cure malaria.

I think they meant that the psychologist would tell the patient when a condition wouldn't benefit from CBT. As opppsed to relying on your own judgement and using self help books.

CBT goes a bit deeper than you think. Not as deep as psychoanalysis, but that's not really saying much. CBT does not dwell on how things came to be, but it does care about why things persist. CBT is in part about finding the flaws in your thinking that fucks you up.

Fair point, but the criticism generally is exactly that:

> CBT is in part about finding the flaws in your thinking that fucks you up.

That is, it focuses on conscious thought rather than unconscious. It seems to be enough only in the more benign cases.

Well, many of the assumptions underlying your conscious thoughts are unconscious. CBT does go into those assumptions.

It allows you some time and space to recognise the unconscious thoughts, and to identify the things that cause those thoughts.

> It seems to be enough only in the more benign cases.

you're assuming a false relationship between level of consciousness and severity. Case in point: war veteran with PTSD. His PTSD is from getting shot at, not from a disrupted relationship with his mother when he was 5.

case 2: patient has a phobia of flying. therapist gradually deconstructs the phobia using CBT methods, until the patient finally gets in a plane and flies.

Subconscious issues are not correlated to severity.

Your claim is that one's depression, anxiety, paranoia, etc., caused by post-traumatic stress, is purely the result of conscious thoughts, even though the individual knows, consciously, that they are no longer in immediate danger?

As for the second case, the "deconstruction" of a phobia is more characteristic of psychoanalysis than CBT.

Can CBT help with finding and addressing why one can't seem to find motivation and satisfaction from (most areas of) life? A state where almost everything feels boring, dull and lukewarm at best?

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