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Originally posted by Dr James Alexander

Back2it. Yes, i agree- it makes no real difference to most people if Hayes et al works are called CBT or not- it is of no real significance. I only comment on it because 'genuine' CBT (ie. the approach devised by Aaron Beck-CBT; and Albert Ellis-RET) became the flavour of the month in psychology for several decades. This was largely to the exclusion of all other innovations, and all that had come before. You bemoan that most counsellors, psychologists, psychiatrists, clincal social workers etc dont do psychotherapy- and you are correct. Most of these professionals only do a version of CBT/RET (as per Beck and Ellis). It is bec CBT was favoured by psychology academics (it is simple and easy to teach) and by psychology researchers (it is simple to administer and easy to measure relevant cognitions/emotions before and after) who held power in the American Psychological Association, and American Psychiatric Association in the 80's that CBT became the preferred option. Because CBT was well suited to randomised controlled trials (only one form of assessing the usefulness of an approach), the evidence based push viewed evidence from RCT's as the only valid form of evidence, and the academics/researchers succeeded in dictating to everyone what worked in psychology. Because of this, most forms of 'depth-psychology' (psychotherapy) fell out of favour, stopped being taught, and within a decade or so had become almost unavailable. As such, we are now at a point where, like you said, most mental health practitioners dont do psychotherapy- they tend to keep it all on the surface cognitive level. Now, i am not saying this will not help some people for some things- clearly it will. But CBT (as per Beck and Ellis) has been way over sold as the only approach which is useful for all things. More recent meta-analytic studies have demonstrated that rather than being a superior way of doing psychology, CBT is merely one way- which is actually no better than any other way. There has simply been a fantastic marketing job on it, which is fine, apart from the fact that this has resulted in a disparagement and then discarding of all other approaches, eg depth psychology. The range of choices have become radically reduced as a result.

In regards to Indiana's original question- there is simply no evidence that (pure) CBT does have any positive impact on the intensity and duration of chronic pain, much like physical therapies. There is evidence that (pure) CBT can have as much of a positive impact on other problems (eg. anxiety, depression, etc) as any other approach, but no evidence when it comes to chronic pain. This is not to say it is useless with chronic pain. As you have correctly stated, many people will appreciate feeling less panicked about their pain, less catastrophising, more perspective, etc. This is all beneficial, and can be a result of CBT. But on its own (pure) CBT is not likely to either radically reduce the pain or eliminate it- this is because (according to the TMS approach) such pain is being generated from a level which is psycho-neurologically deeper than the neo-cortex, which is where (pure) CBT operates. As such, in order to successfully address it, the suggestion is that one needs a depth-psychology approach which works with this deeper level (psychoanalysis is only one option- i am aware of EMDR for trauma, and Coherence Therapy as other viable depth psychology options, but no doubt there are others).

To me, the irony is that when people pick up the TMS approach from books, they are essentially undergoing a cognitive change process. Our beliefs (cognitions) about what is generating the pain is challenged, and new ideas are presented and incorporated. As such, this is akin to a CBT process- the irony is that they are learning a depth-psychology way of making sense of their pain (and CBT and depth psychology dont usually exist in the same sentence, unless it is in juxtaposition). This tells me that the right type of cognitive change (via the right depth-psychology ideas) can be effective in stimulating healing. This does work for many people- the book cure does happen. I have experienced, seen it in other people, and have read accounts of it here. When this cognitive change is not enough to create healing, then it may be time to consider therapy as an opportunity to get to a deeper level than what we can usually do on our own. Most of us can work at the surface cognitive level quite well- the (pure) CBT practitioner is more like a coach, simply urging the person to do what they already know how to do. it is more difficult for us to access and work with the deeper levels of our psycho-neurological functioning- it can be done, as evidenced by some of the people posting here, but it is substantially more difficult. Thats where a competent and trusted therapist can come in.

As far as the new wave of CBT- yes, i think they are excellent. I just dont think they are CBT. To me, for CBT to lay claim to these approaches is just the actions of a dying orthodoxy clambering for quodos by coat-tailing on new innovations which actually have almost nothing to do with the orthodoxy. Where people like Hayes claim that their approach is a new wave of CBT, i think this is just a smart marketing move, as (pure) CBT has convinced the entire western world that the only approach that has any credibility is CBT. Just becuase it is smart marketing doesnt make it true. And i realise this is not an important issue to most people. But to a psychologist who began my training when the CBT revolution was happening, and seeing how this became the orthodoxy which, like a mono-culture farm that destroys bio-diversity, i see how it has resulted in people not being able to access competent psychotherapy when they want it.

James

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Originally posted by chickenbone

Hi indiana. I suffer from a lot of what you describe. If I had access to professional treatment, I would take it. However, it is important that you get the treatment that is right for you. Before deciding on a therapist, you might want to read Dr. James Alexander's book called "The Hidden Psychology of Pain". This book picks up where Dr. Sarno left off. It provides an excellent summary of the problem of TMS and what forms of treatments are available today. This book could help both you and your therapist decide on a workable course of treatment for you. There is also a lot of self-help stuff in the book also.

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Originally posted by Back2-It

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[i] Don't know what this means. I realise I have a lot of work to do but I am on my way.I still think I need some sort of therapy as I have a great need to talk to somebody completely openly and honestly. What I don't know is whether it should be CBT or psychonanalysis (I think Sarno suggests the latter). Should I just leave everything to the psychiatrist? On the other hand I have read so many threads lately and have become a lot wiser on many things.

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The problem I found with psychotherapy is that there are so few psychiatrists and counselors who practice psychotherapy. The psychiatrist gives you some meds and then sends you to a counselor. Most psychiatrists do not accept the idea of emotions causing physical distress, and many counselors do not either.

If you have a trusted friend, or even can make one on one of the TMS sites, it might serve to expunge the emotions and find some relief in being totally honest. Often, it hard to do this with close friends, as you have a big investment in how they perceive you. That is why perhaps a friend who has been through the same but is not too close (there are probably more people you know than you think who have been where you are). Once you talk things out things often get easier and you find that you are practicing CBT without even knowing.

Another factor is the cost and the clock watching. I went to a counselor who had a clock on her desk that she would look at throughout the session. I know they have to make money, but the idea that I was just another psycho-widget to process was a turn-off and I stopped going.

I began to examine my life and and personality based on Sarno's books and found I fit a number of those personalities. I then went back in time to see and understand the different patterns of action and reaction and how they applied to the current stresses in life. I learned that I was not who I thought I was, and that my thoughts were not mine but adapted by the words and phrases I associated with the person I was and had been. I was a ball of fear.

Luckily, I found two things that helped me further. One was a friend but not a close friend, who had suffered the same and also a massage therapist who did nothing to reduce the chronically tight muscles but explained how muscles work and that my case was nothing out of the ordinary, and we got along very well. It was soothing to know this and eventually the muscles relaxed.

Talk to a friend, or find a good counselor, but read and re-read "The Keys", and meditate on them and apply them personally and you might find that it will be enough.


"Bridges Freeze Before Roads"

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Originally posted by Dr James Alexander

Indiana- when it comes to most problems other than chronic pain, research suggests that CBT is about as effective as any other approach (including psychoanalysis)- there are many approaches to choose from,and it think its a matter of finding one that suits the kind of person you are and your interests. Than, apart from the approach, you want to find a therapist who you can relate to- what kind of person are they? There needs to be a reasonable match. However, when it comes to chronic pain, there is simply no evidence that CBT can help other than help you to adjust to the fact that you are in pain. This may be a welcome relief for some/many, but the goal of the TMS approach is to help you to either radically reduce the pain or to become pain free. There is evidence (eg. Sarno's outcome studies) that a depth-psychology approach is more helpful in achieving this. Psychoanalysis is only one variation of depth-psychology. If you want to use the TMS approach, then it is important that you are invited by your therapist to go beyond surface level thoughts and feelings (which is where CBT keeps it- all very safe, and largely ineffective in dealing with chronic pain). If you think your pain is resulting from traumatic experiences, my suggestion is to explore EMDR (see my website for more details: www.drjamesalexander-psychologist.com). If you think your pain is resulting from pain incurred as a child from unloving parents, neglect etc (ie. more what positive things didnt happen rather than what bad things did happen), then i'd suggest Coherence Therapy- google it, and there is some stuff about this on my website as well. If you want to just learn how to manage being in pain, CBT will help.

James

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Originally posted by Back2-It

I was where Indiana was, and worse. I did have a complete breakdown. While CBT may keep things in safe and "on the surface", it can be a useful step in the WILLINGNESS to accept your pain. This in itself can be comforting and a way of training your thoughts toward deeper healing.

Then you can dig around in emotions if the results are not providing the "cure", but often facing the fear of the pain will initiate a cure for most.

Once the emotions are at least understood to be the cause, and if you can establish patterns of the past that carry through to the present, and make adjustments that you can, you will find that you are practicing CBT without knowing. That is my opinion, anyway.

In addition, CBT has modified over the years and grown. If Indiana wants to explore further I would suggest Steven C. Hayes "Get Out of Your Mind and into Your Life," which is the "third wave" of CBT. Also, as a companion piece I would suggest the CD of "A New Earth", by Eckhart Tolle, which, in my opinion, is a spiritual approach to newer CBT. In fact, I would not explore one without the other, because it rounds out the ideas in full dimension.

Still, the iQuick way to get an understanding is to read and re-read "The Keys". Maybe record them and play them back to yourself, as often auditory is more effective and lasting than simply reading. I wish I had had The Keys when I was suffering. Meditate on them, digest them word by word, apply it personally to your thoughts and actions, and you will have the ultimate companion piece to the authors mentioned above.

I'm just a guy on a forum. If you can find good professional help, then that is a good way to go, too.

You will get there, Indiana.

"Bridges Freeze Before Roads"

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Originally posted by plum

Marlis,

If you visit his site, you'll find links to a couple of youtube videos where James explains EMDR in much detail. He's also an advocate of eft, which many people have found incredibly beneficial. I'm fairly new to it but can say it has helped. I mention eft because I'm going this alone too and need healing practices I can do myself. A while back chickenbone offered this link http://www.eftuniverse.com/index.php

It contains a wealth of resources. Currently I'm learning about it and following videos on youtube. I find it's an excellent compliment to the Keys.

As for reading, there's a big difference in reading books in the hope that this one is 'The Grail', and reading to be informed. So many posters who have healed repeatedly assure us that there is nothing to cure because tms is benign. Forest wrote this very thing today. In the spirit of evolving and growing, of which understanding ourselves and why we have pain in our lives is but a part, reading is ok. It's only when it becomes an obsessive method of 'curing ourselves' that the balance tips.

Wishing you well my love.

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Originally posted by Ace1

Hello All,
First I believe, as plum has already said, that the trauma sensitizes your nervous system and lead to habits that tend to continue to sensitize you and become the major problem. In the US, we look at ourselves like victims and we tend to dewell on our pain or what hapened to us in the past. In other instances, the repeated trauma, makes us react intensly to everything, its like we get in that mode from the trauma and then we start doing normal things and now our brains associate that intnesity with normal activity and then it becomes a normal part of our lives to be that way with everything. SInce the ANS results in fight or flight, the two are so intertwined that somehow annoyance, fear, anger somehow also stimulates feelings of escape (or flight). This is subtle, but try to see this in yourself and you will understand. THis then becomes carried over in normal activity automatically. The symptoms, if importance is given to them (which many in the 3rd world do not bc there is no health insurance and no health anxiety), contribute to this cycle. As you can see you have to unravel all of this, especially in most severe cases and therefore takes time and practice. Now one has to come to terms with their trauma as not to let it continue to sensitize one in the present. All of the problems from the trauma comes from how it affects you in the PRESENT. So you have to decondition yourself to this event, by reliving it in your mind, but making it that it is ok now because it is over and your a better person for it and that you forgive. The deconditioning process is listed in my keys.

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