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Ordinarily I'd post this in Wellness Wednesday, but it's Sunday, so...
Does anyone have any idea when someone should walk away from CBT therapy if they're not seeing any improvement?
I've been in therapy for 12 weeks now, and we're getting close the point where CBT normally ends. I like my therapist a lot and I think she's a good practitioner of the school of therapy, but my progress tracker looks like a straight, if squiggly, line -- I've seen no improvement. I'm doing the homework every week and trying to integrate the reality checking and cognitive flexibility portions of CBT into my life, while facing my fears and being more flexible.
The CBT skills have probably taken a little sliver off the top of my negative experiences. They don't control me quite as much. But they still control me a lot -- I feel like I'm staring down an angry bull every day. This much hasn't changed since starting therapy. I don't catastrophize as much, but I definitely shake, and struggle to sleep, and feel like my chest is going to explode. And, predictably, this has a real impact on my quality of life.
I feel like the approach I've been given for dealing with physical sensations has failed. That unit was just "let's try to simulate the negative physical sensations you struggle with so you can see them subside." We were unable to replicate the physical sensations of anxiety I struggle with the most, and essentially just moved on without it doing anything for me. I guess the point of that segment of therapy was "you must have cognitive distortions about the severity of your physical sensations, so let's confront that." But, um, I don't think my appraisal of my sensations is distorted -- I struggle with them every day. I know they subside, I've seen it happen. But that doesn't mean they don't affect my quality of life severely and recur. They are powerful until they subside -- and then, like clockwork, they seem to come back. I probably spend 80% of my life in some state of moderate anxiety, with occasional bouts of more severe distress.
I determined not to go through insurance so I could choose my own therapist, so these sessions are very expensive. And I feel like I'm getting little value out of them.
My medical doctor has also run out of things to do to help -- we've tried the various SSRIs and SNRIs, as well as buproprion, with little success, and he's unwilling to go any farther. He seems to be under the misapprehension that I need to make lifestyle changes (okay, doc, what ones?) and believes that "medication is not my problem." He also seems to believe most psychotherapeutic interventions take years, not months (try telling that to evidence-based psych researchers, they'll laugh at you). I don't like this doctor, and I think he's judgmental and ignorant while thinking himself helpful. And I don't know how to find a doctor who will be more understanding.
I feel, in some sense, like all the professionals in my life who are supposed to help me deal with this serious problem I struggle with, and that makes a major dent in my quality of life, have given up on me. Or, at the very least, that the tools they're trying to offer me to help with them aren't the right fit. I feel talked down to and misunderstood by a medical doctor who refuses to refer me to a psychiatrist, and I feel like the well-intentioned interventions of my therapist are failing. I believe the medical system has failed me.
And the worst part is, I'm going to have to enter a period of no insurance soon -- so even if I did find some medical intervention that worked, I'd have to quit it.
I just don't know what to do now. I worry that, in some sense, I'm a living demonstration of "HBD for mental illness" -- nothing helps because nothing can help. I felt very optimistic about the ability of the CBT intervention to help, but it hasn't.
If you struggle with anxiety, I strongly recommend lavender oil as a short-lived solution. Scott Alexander wrote about the potential calming effects of lavender. I just take one or two drops of lavender oil and inhale it using the simplest aromatherapy chimney. It is very potent and calms me significantly even for a longer periods of time. I am extremely neurotic, I was probably around 95th percentile and now maybe around 80th and it helped me significantly.
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Hey man, just want to give you some solidarity. I also struggle with chronic anxiety that has awful physical symptoms. The medical world can be harsh, and frankly doesn't know what to do with patients like us. I've made improvements over time though, so I know it's possible. I wish you the best.
Happy to discuss further in a PM if you think it might help.
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If you're most concerned with physical symptoms of anxiety, have you/your doctor considered beta blockers? Off label for anxiety, but very commonly prescribed, seem to work well for the somatic shaky-sweaty type symptoms.
Also great for hand tremor and general "body on overdrive" symptoms.
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