May 16, 2022
Last week, David answered four questions posed by the British TEAM-CBT group. Today, he answers five more questions, including one on controversies in the treatment of PTSD.
When you do Positive Reframing to reduce Outcome Resistance, how extensively do you have to do it? Do you have to include every emotion the patient has listed on their Dailly Mood Log? Do you also have to focus on most or all of their Negative Thoughts? What’s the best approach?
After reading The Body Keeps the Score, by trauma specialist and psychiatrist, Dr Bessel Van De Kolk, it would appear that people with complex trauma require a high degree of stabilizing work, like deep-breathing, meditation, or yoga, before they can engage with effective therapy. Otherwise, they might not have the words to describe their emotions, or might have repressed memories. In addition, they might not engage or might become destabilized and highly emotional or destructive towards themselves and other people.
I wonder if that’s your experience with patients you have seen with severe complex trauma in your career? Do you think the TEAM-CBT model has limitations in this area and would you refer to a trauma specialist before embarking on TEAM therapy with such a patient?
I’m curious about dealing with the somatic experiences of patients struggling with anxiety, depression, insomnia, trauma, etc. Clients can often challenge their distorted Negative Thoughts but still struggle with the somatic symptoms.
I’m curious to know David's thoughts.
I’m wondering if David has had experiences with chronic doubters - obsessive doubt in which a patient might say:
"Yeah, all these cognitive techniques seem good and all, but what if really I am useless and worthless, and all of this has just been a gimmick? What if it is all a lie? What if we have missed something which really would show how worthless I am ?"
Basically, this is closely related to the Pure O version of OCD. OCD is known as the doubting disease, and I really want to hear David's thoughts on how he operates with extremely sticky doubting thoughts.
I have a question about clients with Generalized Anxiety Disorder. When they present with multiple worries, do we need to cognitively restructure every worry? Clients with GAD often have multiple worries so we could be there for quite a while if we have to work on every single worry!
End of the Part 1 Questions. David will return to the British group for Part 2 in the future, since they had many additional questions.
Here is a note from Dr. Peter Spurrier to all who want more information about the UK TEAM-CBT training group:
If you are interested in learning more about our group, or want to contact members, please visit us at: https://feelinggood.uk.com/
You will find contact details for many of us on the "Our TEAM CBT Practitioners" page. If you are interested in joining our TEAM-CBT training group, or want more information, you can email me (Dr. Peter Spurrier) at Docspurr@gmail.com.