GAD and Therapy

[lcfrogs]

What type of therapy have you tried or are currently using to help with your GAD? What type of therapy do you believe works best for you (this can include natural remedies, lifestyle changes, medications, professional help, or a combination of any of these)?

- I have been doing a combination of medications and therapy for over 4 years.
- I find that anti-psychotics help the most for my physical symptoms
- My therapist helps me the most with confronting my fears and worries that aren't helped by medication

My therapist uses more of an eclectic approach on me. We have done CBT, DBT (Dialectical Behavior Therapy), Person-Centered, and Humanistic. I am definitely a fan of the Humanistic approach, but recently I have asked to also do more CBT...especially exposure therapy. I guess I believe that incorporating many different therapy approaches helps me cope with a wider range of issues.

[Cuchculan]

Exposure theraphy works well once you are ready for it. If you are not ready for what it can do to you it can knock you for six. It is the one type of theraphy I have always used. You have to be willing to accept that those bad feelings you run from as a rule as going to hit you hard and this time you can't run away from them. Hence the name ' exposure theraphy '. You are been exposed to those things you have spent your life running from. But it does get results. If you are ready to do it. Rome wasn't built in a day. Expect a long haul with this one. But the more you put yourself out there, the easier things do become. But you will mix it with normal talk theraphy. Just to sort out what is going on inside your head. How you are thinking. This is were CBT comes into plays. You can mix these therapies together. Change the mood to change the thought to change the reaction to change the symptoms. They all have an effect on each other. So by altering one you are altering the lot. One you manage to master it you will feel good about yourself. You will view things in a different way. Want to try and do bigger things. Be ready to push yourself that little bit further each time. No miracle cure involved. Just hard work by yourself and your therapist. Hard work that will get you the results that you have been looking for.

[Quietowl]

As far as what I'm doing. I'm on Cymbalta and Clonazepam. I also take natural remedies like Ashwaganda and lemon balm and supplements. I've done cognitive therapy, exposure therapy, sort of like in vivo exposure (wasn't called that but I can't think of the name right now) and now I'm working towards more mindfulness and just getting deeper to the root of the problems.

Food can sometimes be a problem. I found out I was intolerant to wheat, gluten, dairy, peanuts and am not a bit sensitive to grain. Changed those things and noticed a change in energy and just overall feelings.

What's humanistic approach like? I've never heard of it. I hope your CBT goes well. Don't push yourself beyond your limit. Take the steps you need to in your time.

[lcfrogs]

Well, person-centered therapy is actually a part of humanistic psychotherapy. My therapist tends to focus more on the person-centered approach. The most important thing in person-centered therapy is that the therapist provides a warm and accepting environment, is empathetic, and the goal of the therapist is to develop "unconditional positive regard" for the client. Unconditional positive regard is basically total acceptance of the client, no matter what the client reveals about himself/herself. It takes a long time for a therapist to develop unconditional positive regard for a client, especially since people can do some pretty shameful things. The only thing I can really compare unconditional positive regard to is unconditional love...think of someone really important in your life who you love and no matter what they say or do, it doesn't change your feelings about them. That is how my therapist feels about me. Person-centered therapy is also a bit different from other therapies because the therapist is supposed to provide some self-disclosure about himself/herself. As a result, I know A LOT about my therapist. For the client, the idea is to eventually play an active role in society and take responsibility for his/her own actions. Basically this type of therapy focuses on the client's goals and accomplishments.

There is actually a lot more to it than that, but that is the basic understanding of it.

[coeus]

What type of therapy have you tried or are currently using to help with your GAD? What type of therapy do you believe works best for you (this can include natural remedies, lifestyle changes, medications, professional help, or a combination of any of these)?

Mindfulness meditation or the inclusion of mindfulness exercises through the therapeutic relationship and non-therapy environment has been extremely helpful for me. The Cognitive Behaviour Therapy (CBT) was far too rigid for me and while both mindfulness practice and core CBT exercises require patience and commitment - I simply found the CBT cognitive distortion identification exercises and cognitive restructuring exercise profoundly mechanistic and overwhelmingly time-consuming. However, what it helped with was understanding how rumination and worry works through cognition. I feel that it was CBT gave me the basic psychoeducation to try other things to help me in achieving the therapeutic goals.

I can't specifically say that one therapy form was a winner amongst the rest - they're all beneficial relative to different outcomes. Despite that, I would have to say that Acceptance and Commitment (ACT) helped me changed my attitude towards thoughts and feelings and build a better relationship with anxiety. It incorporates CBT, Eastern psychology and Aristotelian (I believe)/Humanistic elements through mindfulness practices and values identification. I might be slightly biased since I studied philosophy and enjoyed reading about Eudaimonia which I feel has a tinge of that in ACT through knowing what matters and doing what matters - which I feel also is a characteristic of the Humanistic movement/psychology.

Lastly, I think reading philosophy has helped to some degree in my life - mental improvement is one thing but intellectual enlightenment is as important.

We have done CBT, DBT (Dialectical Behavior Therapy), Person-Centered, and Humanistic. I am definitely a fan of the Humanistic approach, but recently I have asked to also do more CBT...especially exposure therapy.

I'm really glad to hear someone bring up having experience with third-wave therapy such as Dialectical Behaviour Therapy (DBT). Unfortunately, my therapist might have taken an integrative approach with a range of therapies including Acceptance and Commitment Therapy (ACT) and Cognitive Behaviouor Therapy (CBT) - he wasn't fully equipped to be able to provide an integrative perspective. I'm revisiting DBT as I find that it's good in covering the ubiquitous problem areas of our lives such as interpersonal relationships, dealing with distress and regulating emotions. CBT is too inflexible in only dealing with symptomatology and managing our thoughts; I'm no psychologist but it seems like it doesn't offer much except symptom reduction and lacks an emphasis on valued living and other important areas that are distinct from pain reduction.

By the way, it sounds like you've got a good therapist. I'm curious - are they quite compassionate and trusting? Or simply knowledgeable?

[lcfrogs]

By the way, it sounds like you've got a good therapist. I'm curious - are they quite compassionate and trusting? Or simply knowledgeable?

I have had ten previous therapists in my history of doing therapy, and two of them I saw at the same time I was seeing my current therapist (for additional support). I have been in many treatment centers and been exposed to many other therapists as well, and I've seen many different personalities and therapeutic approaches. With that said, my current therapist does not even compare to any of these other therapists. We have been seeing one another for over 4 years now. She was new to her career when I first met her, and I was her very first patient...she has also never seen a patient for as long as she has seen me. I have never had a relationship with a therapist for this long before, and it is definitely because we share a unique, incredible connection. I have seen her with other patients and she is the most compassionate therapist I have ever known. Not only does she deeply care about me, I truly care about her as a human-being...not just a therapist. She goes above and beyond what her job requires of her. She has always taken care of me when I am in a crisis, even when she is "off-duty." I am quite an intuitive person and I can often read her thoughts and reactions toward me...she has never once judged me or made me feel ashamed. I feel extremely relaxed and safe when I am in her presence. I have known therapists who would not agree with the amount of extra time and effort she puts into her patients' care, but I believe that her doing this shows that this is not simply just a job for her. She manages to do all of this while still maintaining her most important boundaries...yes, in our relationship we have definitely crossed some boundaries, but she holds onto her most important ones...such as not letting her patients' problems affect her emotional well-being when she is at home, with family, and with friends. She has never given up on any of her patients, and she constantly reminds and reassures me that she will never abandon me (this is a huge fear of mine because of my experience with past therapists). Anyway, I could go on and on about how great she is...but to answer your questions, yes she is both extremely knowledgeable and possibly the most compassionate person I have ever met.

I believe that everyone can experience a unique connection with a therapist, and I have learned that this can take many trails and errors with other therapists first (which helps you know what you do NOT want in a therapist).

I am also a psychology student, studying to become a professional counselor...and through both my studies and my experience with many therapists, I definitely know what treatments I am opposed to and the type of therapist I want to be.

My therapist also loves Eastern philosophies and I myself have always been fascinated with Eastern culture and religion. I definitely agree with you that each psychotherapy approach is helpful in it's own way. CBT is definitely not my favorite, so it took a lot of courage on my part to decide that exposure therapy might be useful for me. I am very familiar with Acceptance and Commitment therapy, my therapist sometimes also incorporates that with me. Overall, the therapies associated with Humanistic psychotherapy are by far my favorite. My therapist is also licensed and well-practiced in DBT, but I must admit I definitely struggle with the mindfulness component. I see it as useful for others but personally I struggle with finding how it is beneficial for me. However, I am definitely becoming more open-minded about the different approaches and am on the right path to being more open to mindfulness. I'm glad to hear it has been beneficial for you.

[Quietowl]

I just have to say that I think it's amazing that you've found such a great connection with a therapist. Your story could inspire a lot of people to keep searching for a therapist, even when they feel like they'll never find one that understands.

[lcfrogs]

I just have to say that I think it's amazing that you've found such a great connection with a therapist. Your story could inspire a lot of people to keep searching for a therapist, even when they feel like they'll never find one that understands.

I really do believe everyone can make a good connection with a therapist. It is very similar to any other relationship, sometimes you just have to search for awhile before you find the "right one." My hope is that everyone who is suffering with a mental illness can experience the type of relationship that they want with a therapist. Everyone deserves someone in their lives that can guide them and help them get better. But you must be willing to trust, if not initially in the relationship then eventually...I would not be seeing my therapist today if I didn't trust her with my whole being. 

[coeus]

but to answer your questions, yes she is both extremely knowledgeable and possibly the most compassionate person I have ever met.

I truly believe that the nature of the quality of the therapeutic connection between therapist and client is one of the most important things in therapy. Having a compassionate and genuine therapist helps a lot with moving towards the client's therapeutic goals. So happy to hear that you've got a caring therapist :)

I am also a psychology student, studying to become a professional counselor...and through both my studies and my experience with many therapists, I definitely know what treatments I am opposed to and the type of therapist I want to be.

Oh cool. I'm almost done with my undergraduate studies in a completely unrelated discipline but am thinking of studying to become a clinical psychologist while I continue to work full-time. I did an introduction to psychology and read quite a few books on psychotherapy. Really interesting stuff but unfortunately, I think by the time I become fully accredited (through part-time studies and training) - I'll be 35-40 ugh. Are you currently doing your masters?

but I must admit I definitely struggle with the mindfulness component. I see it as useful for others but personally I struggle with finding how it is beneficial for me.

I'm curious to know what difficulties you have with the mindfulness component just to see if there's any similarities between the difficulties I might experience. Is it the patience? The practice itself?

[lcfrogs]

Oh cool. I'm almost done with my undergraduate studies in a completely unrelated discipline but am thinking of studying to become a clinical psychologist while I continue to work full-time. I did an introduction to psychology and read quite a few books on psychotherapy. Really interesting stuff but unfortunately, I think by the time I become fully accredited (through part-time studies and training) - I'll be 35-40 ugh. Are you currently doing your masters?

No, I am still an undergrad. My favorite psychology course was probably Abnormal Psychology, but Personality Theories runs a close second. Personality Theories is a good class to take if you want to go more in-depth about the different psychotherapies and how they originated. I would like to work in a clinical setting, but I am interested in all aspects of psychology, including research. I have also done a lot of reading on psychology in my own time.

I won't earn my Master's until I am at least 30. I have been in and out of college for eight years. Sometimes I get depressed about how far behind I am compared to the people who graduated high school with me, but overall I believe it's never too late to earn a degree. Better late than never, I say you should go for it! 

I'm curious to know what difficulties you have with the mindfulness component just to see if there's any similarities between the difficulties I might experience. Is it the patience? The practice itself?

I guess I struggle with most aspects of mindfulness. I am recovering from anorexia, and I have trouble being aware of the taste and my enjoyment of the food I'm eating. I also have severe anxiety and depression, and I have never been able to accept my thoughts without judgment. While in treatment, any time we did a mindfulness group I would become extremely uncomfortable with any sort of meditation or relaxation techniques. I simply could not relax, it would always make me a lot more anxious and I would have racing thoughts...and I usually ended up walking out of the group prematurely. For a long time, instead of expressing that mindfulness was hard for me, I simply told people that mindfulness is "stupid" and "I hate it." But I have matured a lot since then, and I'm not as afraid to admit my faults in therapy. Deep down I know that mindfulness could be useful, I guess I mostly just struggle with the initial anxiety mindfulness will create for me. I have never been one to live in the present moment...my mind is always in the past or future.

[coeus]

No, I am still an undergrad. My favorite psychology course was probably Abnormal Psychology, but Personality Theories runs a close second. Personality Theories is a good class to take if you want to go more in-depth about the different psychotherapies and how they originated.

Similar interests as well! In particular, borderline personality disorder though - I've had the experience of dating someone with it and well yeah, it's was very overwhelming yet really interesting. I've read some stuff about existential therapy which was rather interesting too. Not as popular as the contemporary therapies we all see nowadays.

I have been in and out of college for eight years. Sometimes I get depressed about how far behind I am compared to the people who graduated high school with me, but overall I believe it's never too late to earn a degree.

Haha, I've been doing my double degree for about eight years too - part-time on and off. I have two more units until I graduate and exactly share the same ... dismay. Then again, I've been working full-time throughout. I guess I shouldn't be complaining and yes, I'm still going to pursue psychology thereafter.

I am recovering from anorexia, and I have trouble being aware of the taste and my enjoyment of the food I'm eating. I also have severe anxiety and depression, and I have never been able to accept my thoughts without judgment. While in treatment, any time we did a mindfulness group I would become extremely uncomfortable with any sort of meditation or relaxation techniques.

You definitely seem to have the self-clarity though to be aware of what you're going through and your inner noise. Do you think that your psychology studies have helped with your own treatment/recovery? Also, I'm interested to know what your opinion on DBT is? (I only ask because it's great to see some psychology students on the forums)

[lcfrogs]

You definitely seem to have the self-clarity though to be aware of what you're going through and your inner noise. Do you think that your psychology studies have helped with your own treatment/recovery? Also, I'm interested to know what your opinion on DBT is? (I only ask because it's great to see some psychology students on the forums)

Sorry it took me sooo long to respond, I've been either too anxious or too busy to get on this site in over a week.

I think that knowing psychology and the different psychotherapy approaches helps me understand the reason why my therapist is taking a certain approach. However, I actually think that being in therapy and treatment for so many years has really made my psychology courses a lot easier for me. I don't really have difficulty grasping the logic behind different approaches, as I have my own personal experience with mental illnesses and the different psychotherapies that helped/didn't help me. I have also known many people with different mental illnesses that I am not personally diagnosed with, such as Bipolar disorder, OCD, Borderline, OCPD, etc...There are others. I have also personally experienced misdiagnosis, and have watched one of my former treatment centers over-diagnose DID...which is one of the many reasons why I believe DID is not a true mental disorder.

Have you ever heard of IFS (Internal Family Systems)? It is my LEAST favorite therapy approach. You should look it up if you're interested in learning about it. I absolutely do not agree with any aspect of this approach.

As for DBT, I am guilty of having an incomplete DBT workbook in my bedroom.  I am one of those people that has a hard time committing to tangible projects. But certain aspects of DBT I have learned in therapy and have incorporated in my life...especially interpersonal effectiveness. I have changed from once being able to be pushed around easily to becoming extremely assertive and expressing my needs and boundaries. As I said before, I have always struggled with mindfulness...but I'm getting better at it. Emotional regulation is very difficult for me in the present...currently I am struggling with self-harm and have a hard time coming out of a sad state. With this all said, notice how I don't have Borderline Personality Disorder...and yet I'm still using DBT. When I was in treatment for my eating disorder a couple of years ago, there was one young woman who, during DBT group, scoffed at the use of DBT for eating disorders and became so angry about it that she stormed out of the room. Personally, I believe she was being extremely narrow-minded. Much like anti-psychotics were originally intended for psychosis but are now used for other mental illnesses, I don't think DBT should only be used when treating BPD and self-harm. I believe it can be applied to many different mental illnesses. Overall, while DBT isn't my number one favorite form of treatment, I certainly favor it over CBT...but I do believe they both have good uses. So anyway, that's my opinion. 

[coeus]

I actually just quickly read through IFS and it looks like it's full of bullshit. Subpersonalities? Parts? This all sounds like Jungian archetypal wishy-washy psychobabble. I'm so glad that we are past the Jungian/Freudian era. They might have contributed largely to how we view psychology now but some of their understanding of psychology was way too entrenched in understanding the unconscious domain.

Don't feel guilty - I'm in the same boat. I have several workbooks lying around that are incomplete too, mainly because they tend to provide the skillset to become self-sufficient rather than needing to complete the whole entire thing. I'm glad to hear that you've benefited from the interpersonal effectiveness component and I'm sure that you're on the right path to recovery.

In terms of the self-harm, I do find that strange. I always thought that the self-harm tendencies is only associated with BPD. And I agree that DBT is diverse in its application - given that there's substantial evidence to show that mindfulness can be effective in managing anxiety and depression - DBT seems like it could help with a wide array of mental conditions. I do especially appreciate that DBT is exactly that - 'dialectical'. And that's why it doesn't just concentrate on one area and that's where the limitation of CBT lies.

Thanks for the perspective.

[Happy sailing]

Hey the,
Can someone explain DBT to me, please?
Give sort of point form the process of it.
Thanks! 

[coeus]

Hi Happy Sailing,

DBT stands for Dialectical Behaviour Therapy and was created by Marsha Linehan and was initially a treatment line for those suffering from Borderline Personality Disorder (BPD). However, the therapeutic span of DBT has grown extensively to help those with a wide range of mental disorders and even for those that are not clinically diagnosed.

The following provides a glimpse of what DBT is about (Dimeff & Koerner, 2007; Herbert & Forman, 2011):

Broad stages of treatment:

• From behavioral dyscontrol to control
• From emotional inhibition toward experiencing
• From problems in living to ordinary happiness and unhappiness
• From a sense of incompleteness to a sense of freedom and joy

Four core modules:

• Mindfulness - awareness of one's experiences in a nonjudgmental, receptive manner and participarting in activities that cultivate this.
• Distress tolerance - learning impulse control and self-soothing techniques aimed at surviving crises.
• Emotion regulation - behavioural and cognitive strategies for reducing unwanted emotional responses.
• Interpersonal effectiveness - learning a variety of assertiveness skills to achieve one's objectives while maintaining relationships and one's self-respect

Hope this helps.

• Dimeff, L.A. & Koerner, K. (2007). Dialectical Behavior Therapy in Clinical Practice. The Guilford Press: New York
• Herbert, D.J & Forman, E.M. (2011). Acceptance and Mindfulness in Cognitive Behavior Therapy. John Wiley & Sons: New Jersey.

[lcfrogs]

I actually just quickly read through IFS and it looks like it's full of bullshit. Subpersonalities? Parts? This all sounds like Jungian archetypal wishy-washy psychobabble. I'm so glad that we are past the Jungian/Freudian era. They might have contributed largely to how we view psychology now but some of their understanding of psychology was way too entrenched in understanding the unconscious domain.



In terms of the self-harm, I do find that strange. I always thought that the self-harm tendencies is only associated with BPD.

Yes, I believe IFS is bullshit too. I mentioned it because I brought up the subject of how a certain treatment center I went to often over diagnosed DID. My experience at this treatment center, which is a eating disorders and trauma-based treatment center, actually nearly traumatized me.

While I was a patient there, I had little experience with therapy or treatment and so I didn't really understand why some things that happened there seemed really...WRONG...to me. The founders of the treatment center, particularly Mark Schwartz, were really odd...they dressed really funny and just did things that seemed unusual to me. I witnessed multiple patients constantly having "flashbacks" (they were totally faking it) and even claim that they had "trauma food" (food that reminds them of a trauma they have). I was pretty naive at the time, but I was smart enough to know that this was all bullshit. Anyway, my therapist tried IFS on me. I actually did give it a chance for maybe a week or so...but the way they talk in IFS makes patients sound like they are nuts and I didn't want to sound like that. For example, one patient there would sometimes start talking like a child and claim that this was her "child part."

After I discharged from the treatment center, the more time that passed where I was back out in the 'real world'...the more strange the treatment center seemed to me when I thought about it. I stayed in touch with some former patients, and many of them continued to go back inpatient at the treatment center. Many of these people that I personally know will tell you (and they really believe it) that not only did Mark diagnose them with DID, but their families were part of a satanic cult that ate babies. Soon I personally made a correlation between IFS and the misdiagnosis of DID. I can't say that IFS caused the diagnosis...but I can say that each person I know who was diagnosed with DID was an active participant in IFS therapy.

Furthermore, this was all broadcast in the media about a year and a half ago. Many patients came forward and sued Mark, claiming he had planted in them false memories (specifically about being in a satanic cult). I can give you some links if you want to read more about it.

With this experience I believe it gave me a new perspective on life, particularly what is healthy and what is not. The treatment center ironically felt very much like a cult...and I didn't really realize it until after I had been discharged for some time and 'snapped out of it.' So although it was a bad experience for me, it was also a good experience...because now I know both how good therapy can be and also how potentially damaging it can be.

Oh, and while self-harm is certainly associated with BPD, it is not always directly caused by it. One of my best friends is a recovered self-harmer...and she would have been considered 'hard core' (she has the scars to prove it). She is not diagnosed with BPD nor does she behave at all like someone with BPD. I have seen many self-harmers, both with and without the BPD diagnosis.

Here is a short article about the treatment center lawsuit, which also provides links to lawsuit cases:
http://www.kmov.com/news/editors-pick/Castelwood-Treatment-Center-Lawsuits-178973201.html

[coeus]

Sorry about the late reply. I too have been quite busy with work and other commitments. Life still goes on with or without anxiety hmph.

I skimmed through that article and was shocked. What a disgrace.

While I've (fortunately I suppose) haven't needed to admit myself into a treatment centre, I have to say that any therapy form exposes the individual to some level of risk given that openness and disclosure is one of the main components of recovery. Some may benefit and some may not, however, it seems that most do benefit from it.

I've only ever come across someone with BPD traits before as mentioned in my earlier post (no official diagnosis but the psychologist did observe the clinical traits) but it was comorbid with depression so the self-harm as a behaviour was unclear whether it was from any of those two diagnoses. But based on the DSM, it's probably that it could have been BPD. It's very intriguing how behaviours can manifest over different mental conditions or absence thereof. I guess the diagnostic labels are just there for reference, not a fact.

[Fireraiser]

I have been reading this thread and have found it very interesting. 
Myself I have done ACT (acceptance and commitment therapy).  I found this very useful.  I have been on Celexa during the treatment (a very high dose) and since than as well (a slightly lower dose).  The ACT treatment also gave me a better relationship with my anxiety and I feel a good basis for being able to keep it at a manageable level.

The comment about self harm, I have not been diagnosed with BPD, but diagnosed with GAD, but I have self harmed.  Not sure if I missed the gist of the comment, but I thought I should mention this.

[lcfrogs]

The comment about self harm, I have not been diagnosed with BPD, but diagnosed with GAD, but I have self harmed.  Not sure if I missed the gist of the comment, but I thought I should mention this.

I don't think you misunderstood the comment, that is actually what I was trying to explain. I don't think self-harm happens on it's own, rather it is a symptom of another mental illness and not just BPD. My self-harm is a symptom of my major depressive disorder. So when I'm not in a phase of depression, I don't self-harm. For others, self-harm is more frequent...possibly because they are never not depressed and also because they have not developed a healthy way to cope with their emotions. I really only resort to self-harm when I feel like my body is going to explode from so much tension and emotion...and I guess the cutting "releases" tension. But for me, I have only gone through phases of self-harm...I wouldn't be considered a frequent or hard core cutter. I encountered many self-harmers when I was in treatment for my eating disorder...it is a common symptom found in the mental illness. I don't know much about GAD causing self-harm symptoms, but I wouldn't be surprised if that is true.