Why Talking Therapies don’t work for everyone

Posted on: June 1st, 2021

CBT, and other ‘Talking Therapies’ present the following difficulties for some people with OCD.

The therapist needs information about the problem.

The patient has to explain what triggers the intrusive thoughts and the associated anxiety.

Whilst explaining this, intrusive thoughts – and the extreme anxiety associated with these – are triggered.

Imagine how you would feel if

you were anxious about going to an appointment anyway;

you had already spent the first hour of your day, before you could even get out of bed, in the grips of a hideous and overpowering anxiety;

getting showered and dressed presented a whole other set of problems;

you found it extremely difficult and anxiety-provoking to talk about even your least anxiety-provoking intrusive thoughts,

and then, when you got to the appointment, you were asked to answer this:-

‘What is your worst, most frightening intrusive thought?’

For some people, being asked to bring their worst fears to mind will trigger the kind of paralysing anxiety that shuts down cognitive processing and renders communication impossible. When in ‘fight or flight’ mode, adopting a rational, logical approach to the thoughts and compulsions in your head is not always an accessible option.

Also, if you introduce a more rational, logical pattern of thought into the mix with irrational thoughts, it can create more anxiety because the illogical and logical thought becomes a conflict. So even the suggestion of logical methods by a therapist can cause spiralling.

Spiralling intrusive thoughts and anxiety are like a parallel dialogue, a constant noise, in the patient’s mind. Often at full volume, drowning everything else out.

So – in complex cases of OCD, with these obstacles getting in the way,

patient-therapist interaction is not as straight forward as it may sound.

In addition to all this, there is often a fear of not being understood.

If a patient cannot explain the whole extent of the problem, can only articulate a small part of it, that is all the therapist has got to go on. The therapist may – understandably – assume they have understood the full extent of the problem, when actually…it is not the whole story. Not at all.

It can become the lesser of two evils, after years of seeking help and being misunderstood, to not explain anything, rather than try to explain, and be misunderstood.

I have used the phrase for some people a lot.

It is absolutely the case that CBT works very effectively for some people. The premise of CBT is that the way to change your behaviour is to challenge the way you think. If you can change the pattern of thought, you can change the way you behave.

However, it is also the case that some people with OCD are unable to change their habits and patterns of thought using talking therapy.

Orchard OCD are raising funds for research right now because we believe that Psilocybin, a drug capable of disrupting activity in the brain involved in habits of thought and behaviour, will help such people.

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