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Removing Therapy Type Confusion

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anthony

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Something I have gathered from people is that they often become tangled over a specific name of therapy, ie. this type is better than that, etc... so I created the below image just now to try and help people understand the therapy models and then the tiered defense strategy for PTSD based on what to date, has the absolute best effects for longevity of PTSD symptoms.

First of all, here is what many may get a shock from, but all the below types are actually classified as Cognitive & Behavioural Therapy's (CBT), as are many that aren't mentioned as they have zero relevance for treating PTSD, ie. Person Centered Therapy (PCT) which is the fundamental name given to the basic type of therapy used by all therapists, though is focused at general therapy, not trauma therapy.

cbt.png


Yes, EMDR is actually CBT, being a form off. It attempts to access memory by the patient focusing on an object with their eyes, whilst responding to questions, then answers, ie. the patient is doing talking, which is cognitive, and the therapist is distracting you through eye movement, whilst they then feedback cognitive interpretations and methods for the patient to adapt and change their cognition.

Another, DBT... also CBT therapy. The name represents a specific type / area of focus, ie. instead of using all CBT facets, they take specific facets from CBT and focus them, broaden specifics, to concentrate on a demographic, ie. DBT concentrates on those with Borderline Personality Disorder, or Seeking Safety, concentrates on those with substance abuse.

These are all specialties of CBT, they are not some vastly different therapy, they are CBT. They literally require you to talk, they require a feedback loop from someone else (cognitive change) and then often will require performing specific acts (behaviour / exposure therapy).

I wanted to clarify this because I feel people become somewhat confused at times with people constantly coming up with all these different names, usually some PhD wanting to get a name for themselves by taking an existing, changing it, then naming it themself for status. Don't get all caught up in names, focus on CBT methods, as they are proven to have the highest rate for longevity.
 
Very impressive Anthony, BTW, do you get any sleep ? No really, this is really appreciative information. I was also explained that EMDR and EMI were also considered as a neuro-biology restructure. Heard anything about this ? Another term that I heard of was neuro-plasticity. If you have anything on this, I'm trying to get some books or authors on this subject.
 
I keep reading about EMDR and how it is supposed to, at least as far as I understand it now, sort of recondition the neurological pathways to the brain where trauma memories are stored. How exactly do they do this? I have read about people doing this therapy on here but I have not really read anythign about how it is actually acccomplished....so i am curious.

I asked the facilitator of the VA PTSD group I go to about this and the VA here does not offer it and she said she doubts its effectiveness anyway. However most of the people I have read about doing it on here seem to think it does do some good even though it seems to be qite difficult. i am wondering if I should look into some private practitoner of this method. Or is this a type of therapy that should be undertaken later on in therapy. i have only been at this for a little more than 4 months now and I am not sure which way to go. I am afraid if I stay in the VA programs I am never going to get any better and will still be in therapy like some of the Korea and Vietnam Vets are. Some of these guys have been going to the same groups and stuff for the last 15 to twenty years and sometimes more, and it is because it is all that is offered at the VA hospital in this area. So they just keep repeating the same groups over and over and like the one guy I have gotten to know kind of well says, soemtimes he feels like he is just spinning his wheels.....but he keeps going because it IS all there is and also because it keeps him at least somewhat sane. However I am wondering if I do not deserve a bit more out of life. I honestly think if I have to go through the next 20 years feeling like I take two steps forward only to take three more backwards, it will slowly drive me completely, as opposed to now being just partially, insane.
 
ooh. I must admit I started reading this Anthony and wanted to scream at you 'no you're wrong'.
But then I read it carefully and I guess it kinda makes sense
redface.png
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The problem I had was in you saying that with EMDR - and the others- you are required to talk. Mine was done differently as I had not the ability to talk at first, and I also was not 'distracted' by moving objects. However I must concede that my therapist said he was doing it in an unconventional manner to suit me and my situation. I would argue though that the therapist does not
feedback cognitive interpretations and methods for the patient to adapt and change their cognition.
He would follow my lead in that I would process until I could change my interpretation.

When I say I did not talk, I mean that quite literally. I was asked to think about and visualise a memory, but was unable to verbalise it at all. I had the beeping headphones AFTER thinking about the image. Not at the same time.

I am sure all therapy types are tough, as the subject matter is tough.
 
I was also explained that EMDR and EMI were also considered as a neuro-biology restructure. Heard anything about this ? Another term that I heard of was neuro-plasticity. If you have anything on this, I'm trying to get some books or authors on this subject.
Wikipedia sums this up about right:
Neuroplasticity (also known as cortical re-mapping) refers to the ability of the human brain to change as a result of one's experience, that the brain is 'plastic' and 'malleable'. The discovery of this feature of the brain is rather modern; the previous belief amongst scientists was that the brain does not change after the critical period of infancy.
This is like SSRI's actually, in that initial beliefs stemmed that once a brain cell dies, it is gone forever and not replaced, however, modern medical break through with science had demonstrated otherwise, and that our brain does actually regrow cells via specific methods, and medications tested have demonstrated this, along with brain exercises and other treatment options. Cognitive restructuring has significantly proved this at even the most basic level, that we can change our brains perception on past stressors, ie. malleable refers that if the past thought was cemented to affect the rest of our lives, it is proven we can completely change that thought and our future impact via cognitive restructuring. It was thought it was all psychological, simply put, but the psychological change is showing a physical change with it via cell regrowth, hence malleable.

For example, SSRI's. Our brains cells pass information via serotonin, and other chemicals. It was initially found that some cells died when serotonin was being reabsorbed, along with other attributes, but through the use of SSRI's, cell growth has been discovered and new cells forming, through nothing more than getting the negative change within our brain corrected... and the brain takes over. This is why you have an effective period to SSRI's, as not only does it take time it seems from recent science, but they also note that whilst efficacy occurs, so does brain cell regrowth.

There are certain neuroimaging aspects thought to have been linked with PTSD as markers, yet some of that has changed some-what. For example, hippocampal volume has been a marker via MRI for medical diagnosis, however; further studies demonstrate that hippocampal decrease is more linked to stress over a long period of life, as younger patients don't necessarily have the decrease, and children and adolescents don't show it at all.

They have found one bullet-proof marker for PTSD identification thus far via neuro-imaging, and that is the Rostral Anterior Cingulate Cortex (rACC). Via MRI with PTSD, it will be decreased in function and size, where the amygdala is increased in function, the hippocampus is increase and decrease, so it can't be used, as well as decrease in its size, though that only shows longevity stress, not trauma. A person never exposed to abnormally traumatic events, though works a career in a high stress role, will show a decreased hippocampal volume... though they don't have PTSD.
 
I keep reading about EMDR and how it is supposed to, at least as far as I understand it now, sort of recondition the neurological pathways to the brain where trauma memories are stored. How exactly do they do this?
As the diagram above outlines, they actually all achieve this through cognitive change.

For example, Lucycat above headed into a different way in which trauma therapy was done, but it is still cognitive change, whether the therapist has already given you a plan to execute and you do it silently in your head, or whether you do it via talk... the method is cognitive remodelling.

It is not EMDR that does this, it is cognitive remodelling that helps open up your brains neural pathways to access the information in the sub-conscious. CBT does this, all forms... if done right and if the patient is willing to be pushed mentally. EMDR attempts to get around the pushing mentally, by distracting you via another method, then you are either performing a specific task or answering questions from the therapist, whilst distracted cognitively, at which point you are either reshaping your thoughts via prior tasks, or the therapist is helping you shape the thoughts through talk.

You may have read about the use of MDMA in trauma therapy, the science shows that by lowering the inhibition, the person relaxes (distraction to the brain) thus when questioned their brain can't be as resistant to the answer, ie. not wanting to remember vs. suddenly the question has hit the sub-conscious, the answer has begun returning to the conscious, and due to the MDMA slowing thought process and lowering inhibition, by the time the person has thought about fighting the memory, the memory is now in the conscious brain for the person to release.
 
Great thread!

This really explains a lot and helps clarify the different approaches to CBT. Interestingly, my T has worked with me on some of the CBT steps to handle emotional flashbacks. I don't have a lot of memory of specific events, but that does not appear to preclude this approach.
 
Thanks for the explanation. I am still trying to understand all these different types of therapy and stuff. I still do not get how a lot of it is supposed to work but the explanation you gave anthony really helped me understand some of it a bit more. I guess I did not understand EMDR because different people have talked about having to listen to things in headphones but then I read about the Eye Movement stuff on anotherr website that tried to explain it. I still do not really get how it is supposed to work though. I guess for now I am just going to continue fpocusing on trying to talk about things first and maybe later there will be an opportunity somewhere for me to undergo some of this more advanced stuff.

Again thanks.
 
thanks Anthony, interesting and factual! I've found DBT (using mindfulness and acceptance mainly) and EMDR (still new to it but it is powerful if properly done) most helpful for trauma stuff.
 
Is dialectical behavior therapy psycodynamic therapy? I think I am more confused now. I have never done CBT with the therapist trying to accesss memories, only psycodynamic therapy with the therapist accessing the memories. Does CBT get done differently with different therapists?
 
Psychodynamic is a big word for cognitive therapy. Again... industry confusion on the play of words.
 
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