Why Is There Such a Stigma About Cognitive Behavioural Therapy?

[bobvann]

I guess what bothers me is what bothers many others is the lack of this being taken seriously. Especially by the medical community.

I remember when I told my GP. He just said "yeah a lot of people are getting that."

One of the CBT or psychological aspect is to change the "distorted thinking." WTF does that even mean?

Let me get this straight. Because I overdid it with blasting my life through headphones (Electronic drums, watching TV, Listening to rock and metal on transit, bike riding, at the gym) I somehow messed my my psych and thinking process as opposed to actually cause physical trauma? That I can simply "think" my way out of this?

By what? Telling myself "the noise is not real or does not bother me"? By breathing slowly and pretending my breaths are a physical object moving in and out of my body by pretending I am back on the beach in Riviera Mayan and all is well?

I want to make something clear. I am open to healthy debates and opinions. I will not respond to any cheezy arguments on any online forums.

For the most part my experience here so far has been really positive.

 

[JohnAdams]

I guess what bothers me is what bothers many others is the lack of this being taken seriously. Especially by the medical community.

I remember when I told my GP. He just said "yeah a lot of people are getting that."

One of the CBT or psychological aspect is to change the "distorted thinking." WTF does that even mean?

Let me get this straight. Because I overdid it with blasting my life through headphones (Electronic drums, watching TV, Listening to rock and metal on transit, bike riding, at the gym) I somehow messed my my psych and thinking process as opposed to actually cause physical trauma? That I can simply "think" my way out of this?

By what? Telling myself "the noise is not real or does not bother me"? By breathing slowly and pretending my breaths are a physical object moving in and out of my body by pretending I am back on the beach in Riviera Mayan and all is well?

I want to make something clear. I am open to healthy debates and opinions. I will not respond to any cheezy arguments on any online forums.

For the most part my experience here so far has been really positive.

Your problem is that you have a functioning bullshit detector.

 

[linearb]

I think he is upset, that these people make absolutely no effort to explain, that there is also a severe end of the spectrum, to which none of this applies.

applying these principles may be easier or lead to greater relative gains in people with less severe problems, but the idea that CBT techniques "don't apply" to people with severe, unfixable, life-wrecking problems is silly to me because I have attended mindfulness and zen sitting with people in such severe pain that they have to do it all in modified postures and through clear agony.

the fact that monks who have calmly self-immolated in protest all had decades of meditation experience is no coincidence, I do not think. Living with tinnitus is sort of like being on fire all the time, so I think it makes sense to cultivate as calm an awareness of that as possible, since running from it doesn't work and panic just makes it worse.

also, I've seen a half dozen CBT practitioners (including some meditation teachers in that, but I think that's fair) and all but one of them told me very bluntly "this might or might not help you, it takes effort and it works better for some people than others". If there are a bunch of CBT practitioners making unrealistic claims, sure let's roast them, but it's pretty alien to my own experience.

 

[JohnAdams]

applying these principles may be easier or lead to greater relative gains in people with less severe problems, but the idea that CBT techniques "don't apply" to people with severe, unfixable, life-wrecking problems is silly to me because I have attended mindfulness and zen sitting with people in such severe pain that they have to do it all in modified postures and through clear agony.

the fact that monks who have calmly self-immolated in protest all had decades of meditation experience is no coincidence, I do not think. Living with tinnitus is sort of like being on fire all the time, so I think it makes sense to cultivate as calm an awareness of that as possible, since running from it doesn't work and panic just makes it worse.

also, I've seen a half dozen CBT practitioners (including some meditation teachers in that, but I think that's fair) and all but one of them told me very bluntly "this might or might not help you, it takes effort and it works better for some people than others". If there are a bunch of CBT practitioners making unrealistic claims, sure let's roast them, but it's pretty alien to my own experience.

You just can't criticize the establishment CBT world. That's so sad.

 

[Harley]

applying these principles may be easier or lead to greater relative gains in people with less severe problems, but the idea that CBT techniques "don't apply" to people with severe, unfixable, life-wrecking problems is silly to me because I have attended mindfulness and zen sitting with people in such severe pain that they have to do it all in modified postures and through clear agony.

the fact that monks who have calmly self-immolated in protest all had decades of meditation experience is no coincidence, I do not think. Living with tinnitus is sort of like being on fire all the time, so I think it makes sense to cultivate as calm an awareness of that as possible, since running from it doesn't work and panic just makes it worse.

also, I've seen a half dozen CBT practitioners (including some meditation teachers in that, but I think that's fair) and all but one of them told me very bluntly "this might or might not help you, it takes effort and it works better for some people than others". If there are a bunch of CBT practitioners making unrealistic claims, sure let's roast them, but it's pretty alien to my own experience.

Of course, each to their own.
If this stuff works for you that is great, but there are lot of people who are way past any of this.

Again, we could argue about the effectiveness of CBT for another 100 pages and I'm pretty sure both sides can present convincing arguments, but the main point (as the title of this thread suggests) is being mostly ignored.

To me CBT for tinnitus is a liability, because once it establishes itself as a legitimate option, the urgency to look for a cure will be removed.
In other words, if we create the perception that we accept this treatment, it is most likely all we are ever going to get.
This is how the world works, unfortunately.

Again, I have no issues with people using CBT if it works for them.
But we really need to make sure that as many people as possible understand the fact, that CBT is not going to work on everyone and that we still desperately need a real medical solution.

A solution, that will work regardless of someone's attitude, or psychological profile.

 

[bobvann]

Your problem is that you have a functioning bullshit detector.

To me it just seem like pure logic. Just like blaring white noise in your ear canal using TRT.

What makes Lenire different? Since it also requires to apply noise in your ears?

 

[GregCA]

I did 13 months of CBT once a week and just told my therapist let's end this last week. The last few sessions we were talking about movies and food!!

That doesn't sound like CBT. I hope you weren't billed for talking about movies and food, if that's all you were doing in that "CBT" session.

 

[bobvann]

That doesn't sound like CBT. I hope you weren't billed for talking about movies and food, if that's all you were doing in that "CBT" session.

At $200 per hour... I was kinda lucky and did CBT with a group $300 out of pocket after my plan kicked in. I would have been less lucky if I did not have to fork out $200 for the 1st session. Still at the end of the day I may as well have flushed $300 down the toilet..

 

[linearb]

establishment CBT world.

You think this is a thing and it's not; "establishment" is some conspiracy nonsense. There's no "big CBT", there's a million different providers from a thousand different subdisciplines.

I'll criticize bad CBT providers, just as much as I'll criticize bad ideas from the BTA, the ATA, and posts I think on here are bad; I am non-discriminatory in my criticism of bad ideas.

I can certainly accept that a lot of people selling CBT are bad and some are scammers; you seem unable to recognize that some aren't or that anyone with severe conditions is helped by this stuff. That's just silly when you have a lot of fairly severe cases on here or who have come through here over the years who credit this stuff with helping their quality of life, combined with the large amount of clinical data showing neurological reasons you might expect that to be the case.

I have no axe to grind with people who think they got screwed by a given provider, and they should take that up with applicable medical or licensing boards if warranted.

 

[linearb]

To me CBT for tinnitus is a liability, because once it establishes itself as a legitimate option, the urgency to look for a cure will be removed.

This generally seems to be a crux of the arguments against CBT and I think it's totally unhinged because:
* CBT providers know this is a last-ditch, palliative treatment for something lacking better treatments
* the amount of money spent on actual CBT research is drops in the bucket compared to pharma, device, neuroimaging, etc
* the amount of novel tinnitus and HL treatments on the horizon has exploded in the last 20 years, we've never been in a better place as far as attention and research dollars.

People claim that somehow the existence of CBT, and the fact that it is offered to people because they lack better options, is somehow a threat to tinnitus treatments.

This specific paranoia also seems unique to tinnitus patients, in my experience with chronic pain conditions of other kinds. That is, for CPRS or debilitating pelvic floor pain, plenty of people will say "ugh all they can offer me is this CBT crap and pills and none of it does much", but they don't actually blame the existence of CBT for a lack of better treatments.

Going waaay back to the OP here,

Just out of interest, what's with all the hate towards CBT on this site? I agree it can be expensive, but it's proven to be effective at reducing some people's suffering and I don't see what's bad about that. As far as tinnitus goes, there's no proven treatment (yet), and there's certainly no cure, so all we have are ways to help one deal with the torment.

CBT is evidence-based, so to dismiss it out of hand seems silly to me. Either one believes in the principles of science or one doesn't, surely? When one starts selecting how and when to believe in science and cherrypicks parts of it to confirm a belief, but also dismisses other parts, then I begin to see some cognitive bias at play. If a treatment came out that had an equal amount of scientific evidence, demonstrating that it could objectively lower tinnitus volume, then I'm sure many would have a lot more faith in what the data would have to say.

To me, this is no different to how flat Earthers operate. They cherrypick their theories whilst ignoring basic science that proves beyond a doubt that the Earth is a globe

I am still basically in lockstep agreement with Ed about this; and yes, it's fine that others disagree, I am going to live my life to the fullest and happiest I can, using every tool at my disposal to accomplish that. You do you

I think these principles have decades of clinical and neuroimaging studies behind them showing reliable, beneficial brain changes in some people who consistently apply them, including people with severe, debilitating pain. That's just a fact, there's dozens and dozens and dozens of papers including a bunch of imaging that shows structural brain changes including a reduction in the size of the amygdala, etc. So, the idea that this stuff "doesn't do anything" is just... not something which can be supported based on the data we've got.

I'm not real interested in people's feel-feels, show me the money, show me the data.

 

[linearb]

Show me, like, three cases where the existence of CBT prevented advancement in other treatment for any condition that CBT is commonly used as a palliative aid. Doesn't even have to be tinnitus.

If CBT is holding up all this great tinnitus research that would otherwise be happening, it must be holding up pain research, Lyme research, and a lot of other things. Is there some proof of that? The UMich people thought the idea was literally laughable (and that shows how long this dumb meme has been around, since it was four years ago that I was in that clinic).

Tinnitus researchers don't see CBT as a roadblock; neither do the MDs and neurologists I've seen. As far as I can tell, the only people who have this belief are people with tinnitus who have had negative experiences with being charged money for CBT that did not help them, or people who haven't even actually tried it (again, silly, since you can learn this stuff for free yourself if you put an hour a day into it).

I spent tens of thousands of dollars on bullshit before I found strategies that worked so I understand how tilting that can be, but it's beside the point. We all have to find our own way. For some of us, CBT or meditation (basically the same, IMO) have been very helpful, so when people start screaming that these things are all scams or shouldn't be offered, well, that defies my experience of reality.

 

[Ed209]

To anyone who's genuinely interested in the power that our thoughts have over us, then watch the meditation episode of The Mind Explained on Netflix. They show how longtime practitioners of mediation have vastly different brains to those who don't. This is a physical difference and not a philosophical one.

They also show the story of Thích Quảng Đức, the Buddhist monk who famously set fire to himself. He had such control over his mind that he never screamed as the flames burnt him to death. He sat calmly the whole time like he was at a health spa or something, and this is not something an ordinary person could just willingly do. The pain would have been horrific.

The mind is extraordinarily powerful and yet not very well understood.

 

[JohnAdams]

To anyone who's genuinely interested in the power that our thoughts have over us, then watch the meditation episode of The Mind Explained on Netflix. They show how longtime practitioners of mediation have vastly different brains to those who don't. This is a physical difference and not a philosophical one.

They also show the story of Thích Quảng Đức, the Buddhist monk who famously set fire to himself. He had such control over his mind that he never screamed as the flames burnt him to death. He sat calmly the whole time like he was at a health spa or something, and this is not something an ordinary person could just willingly do. The pain would have been horrific.

The mind is extraordinarily powerful and yet not very well understood.

That has nothing to do with the discussion. This is about shrinks insinuating to us that it is our fault that tinnitus bothers us and that we are mentally ill for avoiding social situations because we have irrational fears about this "benign sound". That is the world of CBT.

 

[Autumnly]

Show me, like, three cases where the existence of CBT prevented advancement in other treatment for any condition that CBT is commonly used as a palliative aid. Doesn't even have to be tinnitus.

People on here usually talk about TRT and CBT as well as attitudes surrounding the severity of chronic tinnitus having a negative impact on the need for medical treatments, or?

This specific paranoia also seems unique to tinnitus patients, in my experience with chronic pain conditions of other kinds. That is, for CPRS or debilitating pelvic floor pain, plenty of people will say "ugh all they can offer me is this CBT crap and pills and none of it does much", but they don't actually blame the existence of CBT for a lack of better treatments.

• "Ironically, the CBT/GET mantra by Santhouse and colleagues and denial of serious biological aberrations is exactly the reason why many patients feel that 'the medical profession has given up to them'." source
  
• The History of Hysteria - source (though there are definitely better sources); this is obviously not about CBT but about how misconceptions of and attitudes towards health issues can negatively impact a bigger focus on finding medical treatments

CBT providers know this is a last-ditch, palliative treatment for something lacking better treatments

Not of all of them do though, there are people offering CBT for tinnitus that seem genuinely convinced that it's "good enough for tinnitus as a problem".

 

[JohnAdams]

He sat calmly the whole time like he was at a health spa or something,

In 1556, Protestant Archbishop Thomas Cranmer was being burned at the stake by Queen Mary I and was so regretful of signing his forced conversion to Catholicism that he stuck his hand that he used to sign it into the flames to burn it off first. I severely doubt he had any CBT or practiced meditation. Both him and the self immolating monk were probably in a state of shock while they were burning. The monk used gas to fuel his fire and all of his nerve endings were probably burned off in the first 10 seconds. Cranmer's death would have been much more long and drawn out. Long story short, what does any of this have to do with CBT?

 

[Markku]

Talking of CBT, we are going to have a podcast episode dedicated to it, probably in the first half of 2020.

I'd like to know what all of you think would be the best format, and who should we ask to take part in the episode?

We're thinking it's going to be a panel discussion sort of, maybe with up to four people (more than that and it can become too hectic, although we could have short inserts of more people's comments cut into the episode).

Important for us is balance, it's not going to be one-sided or narrow-minded.

Serious suggestions only, no tomfoolery, thanks.

 

[JohnAdams]

and who should we ask to take part in the episode

Rilana Cima. I am serious.

 

[Ed209]

In 1556, Protestant Archbishop Thomas Cranmer was being burned at the stake by Queen Mary I and was so regretful of signing his forced conversion to Catholicism that he stuck his hand that he used to sign it into the flames to burn it off first. I severely doubt he had any CBT or practiced meditation. Both him and the self immolating monk were probably in a state of shock while they were burning. The monk used gas to fuel his fire and all of his nerve endings were probably burned off in the first 10 seconds. Cranmer's death would have been much more long and drawn out. Long story short, what does any of this have to do with CBT?
View attachment 34214

John, it was just a small post aimed at anyone who may be interested in that sort of thing, as a bit of a diversion. I wasn't expecting the third degree.

 

[all to gain]

Talking of CBT, we are going to have a podcast episode dedicated to it, probably in the first half of 2020.

I'd like to know what all of you think would be the best format, and who should we ask to take part in the episode?

We're thinking it's going to be a panel discussion sort of, maybe with up to four people (more than that and it can become too hectic, although we could have short inserts of more people's comments cut into the episode).

Important for us is balance, it's not going to be one-sided or narrow-minded.

Serious suggestions only, no tomfoolery, thanks.

Well there is Dr. Hubbard who swears by it and he has tinnitus and I know you already have contacts with him. Getting Derek Hoare or one of the others who made that figure @JohnAdams posted would be good.

But then you need two 'against' CBT. I personally find that figure insulting to even look at (although I also see the benefits of CBT for some things).

Also, it depends how you are going to approach the subject. Is it just about CBT or is it also about the possibility that it is taking away from a proper treatment being found. I think that would make for a much better episode, ie Why hasn't a proper treatment or cure been found yet?

 

[linearb]

@Autumnly thanks for the thoughtful response as usual, and I don't disagree. While I think you are getting what I'm saying, your response is also not answering the question I asked.

@Ed209 asked why CBT gets so trash talked on here.

@Harley brought up the frequent claim that "CBT is seen as an effective treatment and therefore this hurts research into other areas".

I quite agree with you, that this is an opinion lots of patients have as you said here:

People on here usually talk about TRT and CBT as well as attitudes surrounding the severity of chronic tinnitus having a negative impact on the need for medical treatments...

I agree that many patients feel this way; I don't agree that it's a rational idea based on fact.

The CBT/GET study is interesting, but GET involves exertion -- so we're talking about taking a patient population known to have fatigue issues, and forcing them to exert, along with CBT. That's hardly a test of CBT in isolation.

This study looked at CBT in isolation longitudinally, also specifically for CFS, and found a positive effect that they say needs more study, but lacks a non-CBT control group as far as I can tell so dubious:
https://www.ncbi.nlm.nih.gov/pubmed/31006534

Here's a more specific study which was attempting to recreate earlier clinical work, which found a positive effect but not as significant as the clinical study had:
https://www.ncbi.nlm.nih.gov/pubmed/31603428

In any case, we can swap whitepapers all day and probably still not come to complete agreement.

 

[linearb]

That has nothing to do with the discussion.

Sure it does; most modern CBT involves mindfulness which is procedurally similar enough to buddhist meditation, that one would expect long-term practitioners of CBT meditation to show similar brain changes to long term zen meditators.

It's super relevant to the issue at hand, and the fact that you're not seeing that says a lot.

The way you choose to think, moment to moment, impacts the way neurons fire which affects plasticity and brain structure. Of course doing some kind of consistent meditative practice is going to change your brain structure, just as assuredly as doing crunches every day will build abdominal muscles.

 

[JohnAdams]

Sure it does; most modern CBT involves mindfulness which is procedurally similar enough to buddhist meditation, that one would expect long-term practitioners of CBT meditation to show similar brain changes to long term zen meditators.

It's super relevant to the issue at hand, and the fact that you're not seeing that says a lot.

That's what people knock CBT for. Nobody is arguing against mindfulness or trying to think about life more positively. When CBT gets trashed by us it is usually related to the medical establishment's quackery regarding it.

 

[linearb]

That's what people knock CBT for. Nobody is arguing against mindfulness or trying to think about life more positively. When CBT gets trashed by us it is usually related to the medical establishment's quackery regarding it.

Okay, can you give me some examples of what you're calling the medical establishment's quackery? I'll happily agree that Julian CH is a quack; John Kabat-Zinn is not and neither is the mindfulness research crew at UMass Amherst.

Some people learn meditation for free on a cold mat in a room where a monk periodically whacks you with a stick, some do it in a yoga studio for $10, and some people benefit from one on one talk therapy that includes instruction in CBT techniques. There are other obvious benefits for someone in a distress state to be regularly checking in with a talk therapist, if they are someone who finds that beneficial.

 

[Ed209]

Sure it does; most modern CBT involves mindfulness which is procedurally similar enough to buddhist meditation, that one would expect long-term practitioners of CBT meditation to show similar brain changes to long term zen meditators.

It's super relevant to the issue at hand, and the fact that you're not seeing that says a lot.

The way you choose to think, moment to moment, impacts the way neurons fire which affects plasticity and brain structure. Of course doing some kind of consistent meditative practice is going to change your brain structure, just as assuredly as doing crunches every day will build abdominal muscles.

Just as the corpus callosum is larger in musicians' brains than in non-musicians'. There are many other physical brain differences between people based on all sorts of things.

The things we say to ourselves internally on a daily basis can start to become mantra-like, and the narrative can have a profound effect on our emotional and mental wellbeing.

This is why people often say we are the accumulation of the three closest people that are in our lives at any given time.

 

[Autumnly]

Talking of CBT, we are going to have a podcast episode dedicated to it, probably in the first half of 2020.

I'd like to know what all of you think would be the best format, and who should we ask to take part in the episode?

We're thinking it's going to be a panel discussion sort of, maybe with up to four people (more than that and it can become too hectic, although we could have short inserts of more people's comments cut into the episode).

Important for us is balance, it's not going to be one-sided or narrow-minded.

Serious suggestions only, no tomfoolery, thanks.

Someone from the University of Maastricht that worked on the Stepped-Care CBT program, e.g. Rilana Cima or Dyon Scheijen. I genuinely want to know what they mean by saying "CBT can ensure recovery" and if they think tinnitus can ever be debilitating in itself. However, I'd hope someone (e.g. the interviewer) would call them out if they said anything along those lines, otherwise, I'd be worried about the podcast episode further spreading misconceptions.

 

[linearb]

Talking of CBT, we are going to have a podcast episode dedicated to it, probably in the first half of 2020.

I'd like to know what all of you think would be the best format, and who should we ask to take part in the episode?

Dream panel:
John Kabat-Zinn to explain CBT and how we got to where we are in 2019
Dr. Hubbard to apply principles to tinnitus
Dr. James H. Austin to explain what's known about how these practices impact neurology
Dr. Rauschecker from Georgetown to tie a connection between Dr. Austin's explanations, and tinnitus

Doubt you can pull this off, but I will become a megabenefactor if you can

 

[Autumnly]

Okay, can you give me some examples of what you're calling the medical establishment's quackery?

I'm not sure we could provide you with examples that would convince you since it seems like you'd look at them thinking they're not harmful whereas we'd see them as potentially harmful. Personally, I wouldn't use the term "quackery" but I'm guessing John means things such as:

• Dyon Scheijen, who is working with Rilana Cima said: "With tinnitus, a signal is given every time: This is not good for you. If we can change that with cognitive behavioral therapy and allow the sound, we will ensure recovery." source
  
• "Simply put, patients should not avoid activities they think may make their tinnitus worse. Patients should not be putting their life on hold. Tinnitus does not have to control their life." - The European guideline for the treatment of tinnitus
  
• The fear and avoidance model of tinnitus - source
• About exposure therapy for tinnitus: "These experiences lead to a "neutralisation" of tinnitus by adaptation of fear expectancies; consequently, the tinnitus becomes less intrusive and bothersome, the more they engage in exposure." - source (they're not mentioning that this process doesn't work for everyone)

Dr Hubbard to apply principles to tinnitus

Nooooo, not him but if you bring him on, you have to bring me on too - there's A LOT I'd love to discuss with him.

 

[linearb]

I'm not sure we could provide you with examples that would convince you since it seems like you'd look at them thinking they're not harmful whereas we'd see them as potentially harmful. Personally, I wouldn't use the term "quackery" but I'm guessing John means things such as:

• Dyon Scheijen, who is working with Rilana Cima said: "With tinnitus, a signal is given every time: This is not good for you. If we can change that with cognitive behavioral therapy and allow the sound, we will ensure recovery." source
  
• "Simply put, patients should not avoid activities they think may make their tinnitus worse. Patients should not be putting their life on hold. Tinnitus does not have to control their life." - The European guideline for the treatment of tinnitus
  
• The fear and avoidance model of tinnitus - source

No opinion on #1, don't know either person, or care, if you say this is a bad provider I believe you.

#2 to me, just needs a rewording. I strongly agree with the sentiment, provided "activities they think..." doesn't include 120db clubs, and that "putting their life on hold" doesn't mean "not riding a motorcycle with no earplugs for 4 hours a day". More or less, obviously people with hearing damage should protect their ears, every ENT I have seen has echoed that, and they have also echoed that if you are protecting your hearing, you should not let tinnitus control your life. I agree. Do you think people should let tinnitus control their lives, beyond taking basic precautions to protect their hearing?

#3 sounds like someone selling something you can do pretty easily for free at home; I am not wading through that whole thread, because it's easier for me to just say "you're a reasonable person so if you think this clinic is a scam, then I am happy to also believe that, but it does not change any of my general opinions on this topic".

 

[Bndsmheowqhe]

You know what people that are genuinely no longer bothered by their tinnitus don't do? Go around telling everyone that they're no longer bothered by their tinnitus.

 

[Lane]

I am still basically in lockstep agreement with Ed about this; and yes, it's fine that others disagree, I am going to live my life to the fullest and happiest I can, using every tool at my disposal to accomplish that.

Just to chime in briefly here: I'm also basically in lockstep agreement with both Ed and Linearb on virtually all of their points. Since I have CFS and don't have a lot of extra energy to write out my own thoughts, I'm very much appreciating their input. Ditto on the 3-4 other points linearb made above.

The way you choose to think, moment to moment, impacts the way neurons fire which affects plasticity and brain structure. Of course doing some kind of consistent meditative practice is going to change your brain structure, just as assuredly as doing crunches every day will build abdominal muscles.

I couldn't agree more with these assertions. I'm constantly amazed by some of the posts on this forum that are so consistantly angry, and I wonder how those posters don't seem to understand that anger will almost assuredly affect tinnitus volume and/or intensity to some degree (sometimes a lot!).