Way To Got Tabby! This is what I try to tell everyone about taking Med's. Med's are just the First Step in taking control back of your life. Second Step.....Learn everything there is about your Disorder. Find out what does and doesn't work for you. It's too easy to just sit back and feel sorry for your self. This is the First Step in failing, and letting the Disorder win.
We all go into shock when we learn who and what this Disorder is. But isn't it great that we have finally been given a name to what Bipolar is?! To why we act so different! To why we do centain things most people don't do! To know that there are others in this world just like US!
We can finally start to take control back or perhaps for the first time in our lives. But this control doesn't happen over night, just because we started taking med's. It's like everything else we had to learn to do. It comes in baby steps. We trip and fall, but then we have to pick ourselves back up and start again.
Even those of us who have been working at this for a long time. We still trip and fall. We think it would just be so much easier to give in. Then we start thinking of all the good things and people we would loose in our lives. So once more, we are back at the baby steps.
We with this Disorder have to grow a thicker skin than most. We see these commericals on TV. They tell you all you have to do is take this pill...and all will be better. Hog Wash! What they don't tell you is.....There are so many people who never find the right meds. These are the people who have to have Thicker skin. These are the people that I admire most! Because they find something each morning worth getting up for. They are the ones who teach us how to fight this Disorder. They are the ones behind the invention of Challenging Negative Thinking.
Learn from them, take their advice. Best of all, tell them Thank You!
John,
Nice follow up on Jerry's post.
WWSD---Captain, I believe your engaged in stinkin' thinkin'. With my Vulcan senses, I can even smell irrational thoughts. If you alway believe we must succeed in our mission to explore strange new worlds and go where no man has gone before, then we had better get underway. Leave me and do not interupt me again with your Vulcan logic. Can't you see I'm musterbating here!
I liked how you reference practicing cognitive behavioral techniques as "the mind watching the mind," the mindfulness technique also referred to as "Witness Consciousness" in the practice of Yoga Nidra. this is the conscious self watching the self, the I-I. It is the same consciousness that steps in during meditation to refocus attention or bring one back into the deep sleep from sliping into unconsciosness. I think it has to do with the subconscious, as these are part of the intention set at the beginning of meditation.
Hi there,
I am suffering from deep depression now. Not much helps including medication. According to the theories of John and Eric I should print this post here and wipe my ass with it. Tempted I am. But on the other hand, I like what Alfredo writes here which keeps me hopeful. Do the opposite of what the depression tells you. Now this helps me.
Dear John,
I agree with both you and professor Kennard. Why? Because my defnition of Cognitive Therapy is different from yours. For me what you call any attempt to do something to help us 'IS' Cognitive Therapy. Cognitive Therapy is not going to a psychologist or psychiatrist to sit down and listen alone and to learn new ways to cope. It is to willingly partecipate, using our mind and will, to help ourselves. I think that both what you say and what Kennard says is obfuscated by a lack of a definition of the term Cognitive Therapy.
Alfredo
Doctor Oleg is staying with me for a couple of weeks. He comes from Italy where he is a practicing GP and he suffers from Bipolar Disorder. I have been translating some of what he likes to say here and in this sense his opinion is biased. But he does like my method of doing the opposite of what Depression or Mania tells us to do and to recognise the triggers early.
I think that there is a terrible misunderstanding here because we do not have a clear understanding of what Cognitive Therapy means. This is what Dr Oleg wants me to say here. 'Witnessing Consciousness' is part of Cognitive Therapy. Cognitive Therapy is not only one imposed on us by a psychologist but also our own effort, any effort, to help ourselves even in John's terms. Hence a great misunderstanding here. So many intelligent people and so little constructive communication. In other words we are all trying to say the same things only that we are bipolars engaged in stinking thinking.
Alfredo
So that we have a basic definition that can be expanded on Cognitive Behavioral Therapy is based on the work of Albert Ellis and Aaron Beck. The definition, from The Free Online Dictionary, is as follows:
Cognitive-behavioral therapy is an action-oriented form of psychosocial therapy that assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and "negative" emotions. (Maladaptive behavior is behavior that is counter-productive or interferes with everyday living.) The treatment focuses on changing an individual's thoughts (cognitive patterns) in order to change his or her behavior and emotional state.
Dear knowthyself,
I agree that the correct terminology from various dictionaries is as you state here. However, I like to appropriate the terminology following the idea that cognitive psychology http://en.wikipedia.org/wiki/Cognitive_psychology can help us to formulate our own particular kind of Cognitive Therapy. So I take aspects of what is normally understood to be Cognitive Therapy and I have changed it to suit myself and also to facilitate the existing misunderstanding. Perhaps we could write together a new definition for the term. It helps to have a look at the following website below.
http://spiritize.blogspot.com/2006/12/cognitive-therapy.html
Cognitive Therapy is all about changing your thinking, and does not involve behavioral change.
Actually, Cognitive Therapy addresses your thinking, emotions, behaviors, and physiological symptoms (if applicable). Cognitive Therapy is called Cognitive Therapy because it is based on the premise that your underlying beliefs about yourself, others and the world influence the way you perceive situations, and prompt you to have certain thoughts, emotions, behavioral responses and physical symptoms.
I agree with you an John about professor Kennard but I also know that professor Kennard has good intentions and is a very capable psychologist. I think that the concept of cognitive therapy can and should be modified and expanded to include any attempt to help ourselves be it with witnessing consciousness, elements of Buddhism or anything at all that helps us.
Having said this I do think that you are a very intelligent person my dear knowthyself. You are a good poet and a very gifted writer. In any case I do think that Professor Kennared has good intentions and a lot of experience. He deserves to be respected even though we may disagree.
I know what the professor is trying to say and I am sure that so do you and John. John's comments are based on direct experience that we share. It is hard to know what it is like to suffer directly. No amount of studies can ever replace direct experience.
However, I would be delighted if we would all agree to find our own definition of Cognitive Therapy here fro Bipolar Connect and use it to describe/include any efforts that we make to help ourselves with both the spiritual and rational intellect. The theory itself has much good on which to build upon this is what I am really trying to say.We need to reformulate the theory.
For example today I feel miserable. The depression is coming on me and I would call it a 5 force. It is as if something has gone wrong. I think about getting older and the failures in my life. So I stop myself and I try hard to focus on what good I have that is positive. I have a computer and I can communicate with the good people who suffer like me and who understand me. So even if I desagree I still care for everyone here. For example, even though Eric has been particularly unkind to me I hope to see his writings because there is also some good in what he says.
I would like to make it clear that I am not saying that Bipolar is not a serious condition, nor am I trying to say that it is all in our mind and that we can controll it at all times. I would be fooling myself if I was to state this. But I do think that we can help ourselves more so than we can imagine and why not talk about how to achieve a better existence? This is what I am about. I may be complex to understand I do not doubt it.
Following this complexity of mine I know that the term Cognitive Therapy has some good potential and that we can modify the concept to use it to describe any method that we can use to help ourselves. The concept has this capacity but has not been used adequately. Time for us to change it.
Alfredo
Dear Tabby,.
Dr Oleg is from Italy and he is staying with me for a few weeks. I am translating what he likes to say breifly and I am trying to help him as he has lost his wife. I am using my computer. If I was to mislead people I would not use the same computer for BipolarConnect knows where the messages are coming from (ie the same source). But yes I can see what you are trying to say that Oleg and I are the same person. No Oleg is an old friend from Italy. He is going back next week.
Alfredo
As much as I hate too...I guess I need to shore up what I had to say in a prior post concerning Cognitive therapy. Prior to medications and treatment...I did read everything under the sun looking for any form of relief. I did everything that each book quoted right down to the journals and having positive phrases to every negative one going through my head. Nothing and I repeat nothing worked.
So what I am saying is that if you are clinically depressed...not sad, upset or just having a bad day or week...this form of therapy is NOT going to work without some form of medications being introduced. It will help if your in treatment and the medications have at least lifted you up to a point of where you have some form of control over things.
It really bugs me when I see people use the term depressed when in actuality they are not and never were. If a relationship fails, loss of a loved one, loss of a job does not make a person depressed.... It means you have hit a hurdle in the road and you really need to use some positive thinking to get you on the right track.
Depressed is when there is noting going on and no matter how hard you try...nothing works. It's when you are constantly thinking suicidal thoughts and planning the outcome. It's when you put on a fake face to make everyone think everything is great while inside you feel like your soul is being ripped to shreds to its inner core.
I still hold to my comments of if you are clinically depressed and not taking any medications to help with it...you might as well rip the pages out of these books to wipe your ass. If your using it after getting and receiving treatment...then yes, it will help and not hinder.
To those of you that feel you can simply will away clinical depression by thinking positive... you have never experienced it first hand and I hope you never will.
Amen. I, too, needed medication to help clear up my thinking enough to benefit from therapy. Not only was I depressed, but also had delusional thinking. The medication cleared that up so that I could understand & apply what being "taught" in therapy (Dialectical Behavioral Therapy has been really helpful).
I may be a bit of a prude, but can we leave off the "wiping our asses" kind of commentary? Surely, there can be more tasteful ways of expressing ourselves. But, I may be just a prude & everyone else thinks it is OK to use that kind of terminology, so I will just practice my DBT skills of "radical acceptance."
Many thanks, Everyone, for commenting. To clarify some points people raised:
1. I don't see any points of difference between my take on cognitive therapy and Dr Kennard's. We need to combat "negative thinking," but readers seemed to have drawn their own conclusions that cognitive therapy had to do with "positive thinking." Positive thinking - popularized by Dale Carnegie and Norman Vincent Peale - is a different animal altogether, though there is clear overlap. The purpose of my sharepost was to clear up reader misperceptions, not to disagree with Dr Kennard. As I said, our positions are similar.
2. While I am in sympathy with Eric's position, I do not subscribe to his fatalism. Monica Basco's comment about us not having to be passive recipients of care is where I stand.
3. Cognitive therapy is not a general catch-all for anything that makes us think differently. Prayer, for instance, helps us think differently. So does loving kindness meditation. But neither is to be confused with cognitive therapy. Having said that, these practices and many others (including positive thinking) work very well with cognitive therapy (and vice versa).
4. A study by Martin Keller et al found that cognitive therapy and an antidepressant together produced far better results on a chronic unipolar depressed population than either treatment alone. But note that antidepressants are very problematic on bipolars. As a general rule, it helps to be stabilized on meds before engaging in cognitive therapy, but for certain populations (such as those with trauma and abuse) it may be wise to cut straight to the cognitive therapy.
5. Following from point 4, we need to revisit the distinction between the brain and the mind. This distinction suggests that the former is the province of meds and the latter the province of talking therapy. Studies by Helen Mayberg and others have challenged that notion. Brain imaging has found that cognitive therapy physically alters certain parts of the brain in a similar manner to antidepressants. Of course, we have to learn a lot more about which subgroups respond best to particular treatments.
6. Thinking (and acting) the opposite of what your error-prone depressed brain is telling you is brilliant practice. This leads to my next point ...
7. The core of cognitive therapy is mindfulness. Before you can turn negative thinking around, first you have to be aware of those negative thoughts. Cognitive therapy makes it very clear that our erroneous automatic thoughts can overwhelm us before we even realize what's going on. Next thing, we're feeling depressed, then we are really depressed. The trick is to spot these wrong thoughts at their inception, then intercept the mood swing before it happens.
8. Cognitive therapy also provides us with tools for recognizing our negative thoughts (such as "catastrophizing") as they are occurring. Then we can spot the error in our thinking before it gathers force.
9. Dr Basco's book also makes it clear that cognitive therapy is about leading disciplined lives. For instance, she points out that there may be nothing wrong with a manic idea or even acting on it. But if we act on the idea when we should be sleeping, then there will be all hell to pay the next day.
10. For me, cognitive therapy and other techiques work best at prevention. But depression happens. So (for me) do panic and anxiety and mixed states. The tools I have picked up won't always help me get unstuck, but they do allow me to negotiate my way through whichever state I'm in. In effect, if I'm depressed, I will treat my depression as a case of the flu rather than a depression, which dramatically lessens the force of my depressions. I'm accepting reality, but I'm not being passive about the state I'm in either.
11. I say all of the above with extreme caution, as any day, without warning, my personal Sword of Damocles may slice my head wide open. This illness takes no prisoners, and I know I could easily be the next casualty. Hence this dialogue. I'm happy to contribute what I know and what I found works for me, but my life and well-being also depends on what I learn from you. So - please - keep commenting.
Thank you Jhon. If you were a woman I would send you a big kiss but as things are now I send a big friendly hug. I am passionate about Cognitive Therapy and I have taken it as a cause and a crusade. This is why I get so involved not to mention the many months of struggling here with people who think that I am against medication simply because I love Cognitive Therapy my kind of idea of the concepts which I hope I have made clear. Forgive me if I have misinterpreted your intentions and I certainly enjoy your writings here infact to be truly honest we do not have enough from you and Jerry. I have a bipolar Disorder and I cope with no medication. This is why at times I am strange. I ask for forgiveness for my occasional 'crazy behavior'. In any case you understand me and can forgive me. After all I am not too bad without medication. It is true it is important to start with medication and to gradually move onto cognitive therapy. It takes many years of self discipline, personal struggles and making mistakes.
Thank you again for putting up with me and my intense games. I mean no harm and my heart is in the right place. I can be annoying though. Usually I realize that my behavior is not quite right and I go about to change things for the better. I am able to see the triggers in time and control myself as you all have witnessed.
Ciao
As my therapist says, I am a very ruminative person. I get lost in my own thoughts. Someof these thoughts comprise some very bad "mental habits" that lead me down the road to depression. Distraction from that path and action is the key. I agree whole hearteldly with Jerry Kennard.
Dear Melissa,
Kennard's post is an excellent plain-language explanation of one commonly used (and evidence-based) form of cognitive therapy.
I agree with John McManamy the only thing is that I would like John to expand the concept of COgnitive Therapy so as to include his mindfulness and even being in control I want it to be part of Cognitive Therapy. But this is asking too much. Do not be fooled by what appears to be. I seem to be totally opposed to what John says but in reality I am not. I just feel that he could save the concept of Cognitive Therapy because it is the stronger alternative to Medication Alone therapy. But what he says is absolutely true and correct. Yes I know I am a complex nut who cannot make up his mind. I am complex and possibly no one understands me I know. Sorry this is the way things are.
Dear all,
the sad reality is that very few people understand that John McManamy is really agreeing to Jerry Kennard's article, but cricitising some of the people who had responded. So I have found out that we are writing for a very small audience. The majority is not able to understand or follow according to the emails that I have received. What to do?
Alfredo
Hi Everyone,
I am delighted to see this discussion on CBT. it has been the only thing to consistently work for me. A good resource by a protege of Dr. Aaron Beck is Feeling Good: The New Mood Therapy by Dr. David Burns. There's also a workbook available by the same author. This method lends itself to personalization and is flexible for individual needs. It addresses issues of self-worth, depression, procrastination, anger, et alia.
The most important point, no matter how you modify this method, is to WRITE IT DOWN! The nurse John mentioned didn't just think about a plan--she wrote it down, thus making it concrete and do-able.
I like your methods, Alfredo. But, aren't you still at the mercy of your moods even if you are doing the opposite? if my mania or depression tells me to write poetry, I'm going to do it because that's what I live for!
Arresting the dysfunctional thoughts by writing them down does change the behavior. Then, it becomes ingrained, and brain chemistry is changed, not through unpleasant drugs, but through our own thoughtful participation in our recovery.
Hats off to you all for your bravery and honesty! and sympathies to Dr. Oleg.
Dear Virginia W.,
thank you for your kind words about Cognitive Therpay. I just like to add that I work on 5 websites one from Italy, two from Australia, one from the UK and this one, and yes Depression Connect as well which makes 6. I devote 4 hours per day to these sights as I am studying the complex topic of Depression and bipolar Disorder.
Having statistics and information and can tell you, using this person's post, that the majority of people, I would say 89%, use medication alone therapy and do not want to know about Cognitive Therapy in combination with positive thinking. I suppose that Cognitive Therapy require that a person becomes involved with their own consciousness and this is terribly difficult and can be painful as well. Here is what a sufferer said (I think that he is also a Doctor or GP
Yes,Its always helped me 99 percent of the time unless something real bad happens,I tryed to share this theroy with people some 4 or 5 months back very few where interested. In fact it even made some very mad that I even mentioned it they insisted they couldnt do it and blamed there inability to do it on there sickness,I tryed to explain that you cant just do it. ,It takes practice but they just were not interested. 
Some interesting links:
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http://en.wikipedia.org/wiki/Aaron_Temkin_Beck
http://www.beckinstituteblog.org/
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As I've often said here
Meds are for the physical symptoms
Therapy is for the illness that causes the physical symptoms and well, the dysfunctioning in our lives
you can't just take meds and think all will be good and better
it doesn't work that way
meds only relieve, they do not totally rid
and the illness will continue to churn up the symptoms irregardless of how many meds you pop
so, you must treat the illness and in order to do that you must do the therapy
however, as you said CBT isn't for everyone
nor is DBT
or any of the other forms of therapy currently out there for anyone and everyone
and you can practice and practice and practice for years, those skills you learn and re-learn, and re-learn and still
when you are in a Force 9 or even Force 10 depression as you called it
those skills, those lessons having been learned and practiced for years, sometimes just simply do not work
still, it doesn't mean those skills and lessons learned & practiced, re-learned & re-practiced for years are all for waste
because often times if you do catch the start of those - when they are say Force 1 - Force 4s and you take control of the thoughts and attempt to do something, anything, proactive... it will - in the very least - stave off that Force 9 that may inevitably come a calling just a wee bit longer
and sometimes time is a very valuable thing
cause with time, comes med adjustments, comes more therapy to help ride it out
but yeah, if you just sit there and do nothing whatsoever
and let it just hit you
you will be taken under over and over
and those meds you are a popping... will just touch the surface
my opinion and perception
and only my opinion and perception
Dear John,
Could you please define in your own words the term Cognitive Therapy?I think that we use this term very broadly without knowing what it really means. Cognitive Therapy is a two way street not one imposed on us.
I partly agree with wahat you say and I also agree with professor Kennard.
However, see if you have a name for this:
when the depression comes I do the opposite of what it tells me. If it tells me to stay in bed I get up; if it tells me not to eat I eat and if it tells me not to talk to anyone I make sure to increase my comunication with people. I have learned that when I am Depressed there is a silent voice in my brain that tells me to do things that will lead to more depression and even death if I let it go on.
If the mania comes i try to do less with tremendous effort and if needed I take some sleeping tablets just for a while till the mania goes. I am constantly in guard to look for triggers that try to take me either into the abyss or the mania. I refuse to listen to the voice of depression or mania. I am in control now and I listen to my own education and consciousness. Eductaion and truth is everything John. We cannot always get to the full truth but we can get close to it.
What do you call this? This is what both my wife and I, both Bipolar1, use everyday. And if we are able to do this we know that we are in control.
I think that to say that when we are deeply depressed papers on cognitive theraphy are just good to wipe our ass is absolutely untrue. Anything helps even if we are not aware at the time. If you are Depressed and I give you words of hope these may not register at the time when you do not want to hear my voice but the words remain in your brain and linger till a time when they become useful. Anything, no matter how little, helps and piles up in our brain. Every positive or negative thought piles up in our mind and stays there for a while. Feed your brain with enough negativity and it will give up.If I tell you that there is no hope for you when you are depressed than these words will remain in your brain. They do not go away for a while. The brain remembers everything for a while.
I think that sometimes we like to cling to the hoplessness of our illness. It is the only defence that we may know untill we try something else. If your illness was truly hopeless you would not be here John and I guess that this is not just because of medication but because of a number of things.
REMEMBER THAT THIS SITE IS ALL ABOUT COGNITIVE THERAPY AND IT IS A FINE EXAMPLE OF IT. WE ARE ALL ENGAGED IN IT. DOES IT HELP US TO WRITE AND EXPRESS OURSELVES HERE? YOU BET YOUR ASS THAT IT DOES. DO WE WIPE OUR ASS WITH PRINTED PAGES FROM THIS STIE? YOU BET YOU ASS THAT WE DO NOT DO THIS.
Good on you Tabby I agree and what you say here is what I have been trying to say for months now. If you just sit there and do nothing this does not help. Exactly what I feel. And, moreover, anything at all that you do to help yourself, under my definition of cognitive therapy which is a self help cognitive therapy not just going to apsychologist, IS Cognitive Therapy. We can do therapy on ourself using our intelligence both of the brain and emotional creativity. This is what I call cognitive therapy. Therapy of the mind, soul and spirit.
Now, I have heard all sort of different theories on Cognitive Therapy but, if we take Cognitive Therapy to mean any means what so ever to pull ourselves out of the Depression or Mania this is what I call Cognitive Therapy. This effort plus medication taken sensibly is the way to go.
I have here a friend, Dr Oleg, who has come to visit me from Italy because he was so depressed that he was unable to function. He always suffered from Bipolar II but when his wife died his depression got really severe. I told him off in a nice way and told him to do the opposite of what the depression tells him. So with great effort he bought himself a ticket to come here to Australia to visit me for a couple of weeks. And together we are working to help his depression and to do the oppostie of what his depression is telling him to do.We are good friends and we know each other since teenagers.
So I take him out around Sydney to show him a few places. He suffers from a very severe and deep depression that prevents him from eating. So now he is feeling a bit better because he has given me the opportunity to help him and because he is really trying hard. This effort is Cognitive Therapy at least for me under my definition. In his own words his depression is very deep so using your terminology it would be a force 9. With great effort he got dressed and got on a plane to come here. He has been getting better ever since.
Tabby, This sounds like a poem.