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Cognitive Analytic Therapy

Kiosk

He Thinks He's People
Kiosk
Joined
Oct 1, 2007
Messages
349
Recently, I have been looking into the possibility of receiving CBT, as I can no longer take antidepressants and it's my understanding that this is the only form of psychotherapy that isn't (to some extent) woo.

However, the guy I spoke to at the assessment seemed to think CBT wasn't necessarily right for me, and suggested Cognitive Analytic Therapy instead. I've researched it a little, but can't come to a conclusion as to whether this is something worth committing to, or just CBT diluted with old-school psychoanalysis (and whether that is, in itself, entirely a bad thing).

Does anyone here have an educated view on this? Is there an element of woo involved, or is CAT a "proper" form of therapy which might be genuinely useful (or is the answer somewhere inbetween)? It's pretty hard to reach a conclusion from the information I've found on the internet, unsurprisingly. I don't want to waste my chance here - no money is involved, as this is all happening through the British NHS, but I've been on a waiting list for well over a year and don't want to have to go back to square one. It seems stupid to insist on CBT if an alternative approach might produce better results, but I'm highly dubious about most forms of psychotherapy and don't want to commit to something I might regret.

I appreciate how subjective this stuff is, but it would be very helpful to hear from anyone with an informed, unbiased view.
 
Reading the ACAT page it seems largely like a touchy-feely version of CBT. However:

...

Despite its integrationist ideals and despite its many publications - including some polemical writing seeking to evoke debate - CAT has generated little discussion in the journals of current schools of therapy but this has not prevented a rapidly growing demand for training and the establishment of training and practice in many parts of the UK as well as in Finland - Greece and some other centers. The proof of the pudding may be in this eating, but we still need a more extensive research basis than has so far been assembled.


To the Future

Over the 25 years since CAT was formally launched it has grown in size in the UK and abroad, it has developed theoretically, it has been applied to different conditions and different contexts, it is generating an increasing volume of research and in ACAT it has an effective professional organization. These developments have been the work of increasing numbers of practitioners, therapists, supervisors and trainers. Despite the damage done to the NHS and despite the political dominance of other models, it seems destined to continue to grow.

Tony Ryle - Originator of CAT and Founder of ACAT - 2008
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The bolded sections ring alarm bells for me.
 
Alarm bells because this is close to the language of a frustrated/bitter woo merchant, or because those quotes suggest CAT is not taken as seriously as it might be? Thanks, anyway.

Incidentally, a Google search for "Tony Ryle" threw up some interesting links, which I'm ploughing through right now. I still haven't been able to work out whether the "extra" stuff in CAT augments or dilutes the elements of CBT that seem to be at the core, but at least I now have a bit more to go on.
 
I am presuming that the rason the think CAT might be more useful for you is because your depressionseems to have its roots in past events and they think you would benefit from looking at how these events are connected with your depression. I don't know much aout it, but here is a quote I found on netdoctor:

CAT first concentrates on discovering why a person’s emotional/psychological problems have happened – including going back to childhood. Then it looks at the effectiveness (or otherwise) of the mechanisms which the sufferer has developed in order to cope with these problems. Finally, the therapist helps the client to see how he or she can improve their ways of coping.
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http://www.netdoctor.co.uk/diseases/depression/cognitiveanalytictherapy_000510.htm

I haven't looked into how much research there has been into its effectiveness yet.
 
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If I'm understanding this correctly, it differs from "pure" CBT in that it tries to find the "roots" of the problem while CBT just treats the problem. IMHO there is considerable evidence that CBT actually works. Does CAT have any evidence that it works any better? Or is it an attempt to revive a component of classical psychiatry?
 
I discussed this with my SO who is a psychiatrist, and she said that there are three red flags on this:

  • She's never ever heard of this, and it's not introduced in Canadian any psychiatric residency training. She confesses that this could be a North American thing.
  • Only one RCT, comparing with a known ineffective Tx. Suspicious.
  • Most of the other research appears to have been done by the guy who developed it, with very little independent replication.
 
Has anyone else noticed how successful psychological therapies such as CBT boil down to applying scepticism and experimentation to that little (but sometimes rather convincing) voice in your head?
 
Kiosk said:
Recently, I have been looking into the possibility of receiving CBT, as I can no longer take antidepressants and it's my understanding that this is the only form of psychotherapy that isn't (to some extent) woo.

However, the guy I spoke to at the assessment seemed to think CBT wasn't necessarily right for me, and suggested Cognitive Analytic Therapy instead. I've researched it a little, but can't come to a conclusion as to whether this is something worth committing to, or just CBT diluted with old-school psychoanalysis (and whether that is, in itself, entirely a bad thing).
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That is a terrible thing :(

Take something effective and add garbage to it.
 
Having read a little more, I'm now wondering if the "strength" of CAT is that it takes an effective technique (CBT) and adds something that doesn't really help, but allows the patient to talk about themselves. I guess some people feel better if they think someone's actually interested in them, rather than just telling them what to do. What bothers me is whether this is more than a garnish - whether the therapist's suggestions would be based more on a woo-ish (Freudian?) interpretation of your past than on what would work best in practice, in the present. In other words, whether it's a case of "I see, this-or-that happened to you when you were nine... anyway, here's the CBT solution to your anxiety", or "I see, this-or-that happened to you when you were nine... therefore, you must do this. We'll talk about your anxiety next time."

The leaflet handed out by the NHS - which, incidentally, features a truly appalling line drawing of a glum-looking man staring out of a window - mixes a basic description of what I understand to be CBT with much talk about "how the situations you've experienced in the past still influence your current behaviour". I'm tempted in the sense that I would like to discuss certain parts of my past which still trouble me, but I have a bad feeling about the way some of the descriptions of CAT are phrased, and I haven't found much in the course of my research that makes me feel any better about that. The jury's still out here, but I'm leaning towards asking for CBT instead.

I'll follow any further discussion of this with great interest, anyway.
 
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maybe we can hash out some effective treatment right here?

care to talk about it?
 
I have not heard of this here in the US, but it reminds me of Thought Field Therapy, which combines proven behavioral techniques with something completely different, like a man with three buttocks.
While TFT combines behavioral techniques with silly tapping rituals - http://skepdic.com/thoughtfield.html - this seems to combine them with hallowed psychoanalytic rituals.
A true test would be to compare this with straight systematic desensitization, with appropriate controls.
After all, if one were to evalauate a new painkiller that was mixed with morphine, wouldn't the control goup have to receive just morphine?
 
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Ha, I've been reading up on "psychodynamic therapy", elements of which are apparently included in CAT.

I laughed out loud twice. Firstly at this:

True psychodynamicists will not be worried by long silences - they may decide that some important work has been done in those quiet periods.
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And then at this:

Psychodynamic therapists never talk about themselves. And if you ask something like, 'Where are you going on holiday?' the chances are that your therapist will say, 'I wonder why you want to know where I'm going? Perhaps we can talk about your feelings connected with my holiday and see why it's important to you, and what it might mean?'
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Do you remember those chat-bot websites? You'd ask it a question and it would reply from a pre-programmed list of answers, usually with some hilarious evasion of the actual question. "Talk To Jesus" was a popular one. This is precisely how conversations with them used to go. "Why do you ask whether I get scrambled egg caught in my beard, my child?"

Strikes me you'd be as well-served by chat-bot Christ as a "psychodynamic therapist". Can't believe half the population of Manhattan used to spend their life savings on that garbage.
 
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quarky said:
maybe we can hash out some effective treatment right here?

care to talk about it?
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CBT does involve talking about it, however the goal is to 'derail', 'decouple', 'redirect' or 'retrain' the patterns

If reliving experiences with set outcomes, set cognitive frames of helplessness/anger/unhealthy/etc... is part of the issue. And what you want to do is change the pattern in the moment, the repetition of the set piece won't help.

Now, the conversation can go along the lines of 'you feel XXXXX in situation YYYYY since it appears that YYYYY triggers thoughts ZZZZZZ about situation WWWWWW", although that is a little more directive than most counselors will state.

It can be helpful to understand the settings of experience, the mistake that Freudian theory makes is in stating that you have to relive and retraumatize yourself to get through it. There are not set pieces (excluding PTSD for clarity) of behavior that are made concrete and relived.

They are reinforced sets of behavior! The issue is that each time the person encounters a similar situation they make choices and engage in behaviors that reinforce the appearance of the set piece.

That is the Freudian error, they are not set pieces, they are reinforced and renewing sets of behaviors in the moment.

While people may want to relive the trauma and tell someone what happened to them, the issue is this "Does it actually help or hinder the process." Freudian psychobabble is a waste of time and often retraumatizes the client.
 
Dancing David said:
<snip>

It can be helpful to understand the settings of experience, the mistake that Freudian theory makes is in stating that you have to relive and retraumatize yourself to get through it. There are not set pieces (excluding PTSD for clarity) of behavior that are made concrete and relived.

They are reinforced sets of behavior! The issue is that each time the person encounters a similar situation they make choices and engage in behaviors that reinforce the appearance of the set piece.

That is the Freudian error, they are not set pieces, they are reinforced and renewing sets of behaviors in the moment.

While people may want to relive the trauma and tell someone what happened to them, the issue is this "Does it actually help or hinder the process." Freudian psychobabble is a waste of time and often retraumatizes the client.
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I watched an interesting programme on TV a few months ago about giving a beta blocker (Propranolol) to patients who are having a severe emotional reaction when remembering a past traumatic event.

The theory was that when the memory of an event is accessed, it needs to be re-encoded and stored each time. The drug interferes with this re-encoding process and allows the emotional component of the memory to be attenuated.

http://www.ncbi.nlm.nih.gov/pubmed/11822998?dopt=Abstract

BACKGROUND: Preclinical considerations suggest that treatment with a beta-adrenergic blocker following an acute psychologically traumatic event may reduce subsequent posttraumatic stress disorder (PTSD) symptoms. This pilot study addressed this hypothesis.

METHODS: Patients were randomized to begin, within 6 hours of the event, a 10-day course of double-blind propranolol (n = 18) versus placebo (n = 23) 40 mg four times daily.

RESULTS: The mean (SD) 1-month Clinician-Administered PTSD Scale (CAPS) score of 11 propranolol completers was 27.6 (15.7), with one outlier 5.2 SDs above the others' mean, and of 20 placebo completers, 35.5 (21.5), t = 1.1, df = 29, p =.15. Two propranolol patients' scores fell above, and nine below, the placebo group's median, p =.03 (sign test). Zero of eight propranolol, but six of 14 placebo, patients were physiologic responders during script-driven imagery of the traumatic event when tested 3 months afterward, p =.04 (all p values one-tailed).

CONCLUSIONS: These pilot results suggest that acute, posttrauma propranolol may have a preventive effect on subsequent PTSD.
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I'm not sure if there's been any more work done on this.

ETA: Yes, there has:

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Effect of post-retrieval propranolol on psychophysiologic responding during subsequent script-driven traumatic imagery in post-traumatic stress disorder.

The beta-adrenergic blocker propranolol given within hours of a psychologically traumatic event reduces physiologic responses during subsequent mental imagery of the event. Here we tested the effect of propranolol given after the retrieval of memories of past traumatic events. Subjects with chronic post-traumatic stress disorder described their traumatic event during a script preparation session and then received a one-day dose of propranolol (n=9) or placebo (n=10), randomized and double-blind. A week later, they engaged in script-driven mental imagery of their traumatic event while heart rate, skin conductance, and left corrugator electromyogram were measured. Physiologic responses were significantly smaller in the subjects who had received post-reactivation propranolol a week earlier. Propranolol given after reactivation of the memory of a past traumatic event reduces physiologic responding during subsequent mental imagery of the event in a similar manner to propranolol given shortly after the occurrence of a traumatic event.
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Do you want to try and solve your problem now and for free?

Kiosk said:
Recently, I have been looking into the possibility of receiving CBT, as I can no longer take antidepressants and it's my understanding that this is the only form of psychotherapy that isn't (to some extent) woo. <snip>
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*Shameless promotion of EFT, that "fraudulent method that is exploitative of the sick and prevents them from seeking real medical care" according to Jame Randi*

Try EFT, you know the "bunk" that everyone here takes the mickey out of. I am being very irrational and unscientific and stuff, but you see I don't care about proving things to the prejudiced, but to help the ailing and suffering, that's what my Hippocratic oath is about, not about showing about how smart I am a proving everything I know nothing about, have not experienced and don't understand as being unscientific, or useless. I want you to have a free of charge opportunity to solve your own problem or at least gain benefit, if you don't solve it completely. (To do that you need to study hard or go to a competent woo-free practitioner, unless you really love woo that is). My advice to you is from one who has woolessly used this method with success at far greater levels than placebo (like psychoanalysis is IMHO). If you don't try something free and fast and has no side effects and you can use with anything else you're doing, then you are more irrational than I'm being here, aren't you? As for your question, I have no answer as I know nothing about it and don't understand it, so I won't knock it. Though I really like EFT, you might too. Let us know
 
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