# Anyone who has done CT or a therapist



## bonniei (Jan 25, 2001)

This is from the book k referenced from the paper. Irritable Bowel Syndrome: Psychosocial Assessment and ftreatments by Blanchardï¿½The cognitive therapy regimen consisted of 10 individual 1- hr sessions, twice per week for the 1st 2 weeks, then ob=nce per week for the next 6 weeks. Treatment started with a clear rationale for the treatment approach, describing IBS as an autonomic-nervous-system- mediated reaction to stress; the reaction was described as having three related components:cognitions, behaviors and physiological responses. Cognitions were emphasized as the determining factors in IBS symptomatologyThe therapy was an amalgamation of elements from the work of Meichenbaum(1985), Beck (1976) and Persons (1989). The intervention was structured and directive, yet it required the patients active collaboration. Therapy focused on increasing the patients awareness of the associations among stressors, thoughts and IBS symptoms. Next was emphasized training patients to identify and then modify their appraisals and interpretations of threatening stimuli. Intervention encompassed the use of both verbal and behavioral techniques to identify and modify underlying psychological mechanisms, fundamental beliefs, and assumptions.Self recording of automatic thoughts was emphasized. Patients were provided monitoring forms and asked to monitor daily, throughout treatment, automatic thoughtsas they occurred across daily situations that they found to be stressful. The therapist focused on the cognitive responses generated on the patientï¿½s monitoring sheets and working collaboaratively with the patient, identified control themes, or ï¿½working hypothesesï¿½, concerning the patientï¿½s underlying psychological mechanisms.Therapeutic work was directed at activating three change mechanisms:*1)* ï¿½rational self analysisï¿½ or self understanding (in which the patient explores idiosyncratic beliefs and fears, their connection to the cognitive, behavioral, and affective components of their IBS, and in which they reach an understanding of their fundamental maladaptive orientation to self and world)*2)* The second part of the therapeutic change mechanisms was ï¿½decentering,ï¿½. in which the patient gains distance from self by identifying his or her self talk and labeling it as self talk, thereby ï¿½explicitly ï¿½owningï¿½ automatic thoughts.*3)* Lastly one begins to involve experential disconfirmation (admittedly focused) in which patients are led to challenge their maladaptive beliefs through strategically planned behavioral experiments and deliberately acting differently so as to experience the self in different ways.Clinical HintSome patients balk at step 1. They may claim to live a stress-free lifw and to find no connection between IBS symptoms and environmentalevents and their thoughts. The first step is to push the patient gently to reexamine his or her life. If that fails one can ask the patient to make a working hypothesis that there may be a connection. They are then asked to go along with the recording and analysis, even if ï¿½they knowï¿½ that it does not apply to them personally.If the latter fails then this may not be an approach which will work for this patient. We find this in about 10% of the cases, mostly menï¿½Anyone who has done CBT or a therapist, would you please answer these questions- I am really curious about CBT- were you aware of these 3 steps that I listed above during therapy or was that through osmosis on a subliminal level and could you tell us an irrational belief of yours and take us through the three steps which helped you get over it, please?


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## AZMom (Oct 13, 1999)

I've done CBT. It is helpful, not a cure for IBS, but can help lessen our reactons to symptoms. Done on a cognitive level it won't do much to change subconsious thoughts. It is also a lot of work and takes practice. I would recommend it a part of a therapy.However...hypnotherapy is faster, less work, and makes the changes on a subconscious level which are longer lasting.AZ


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## Kathleen M. (Nov 16, 1999)

I came out really pretty much having no idea how it worked, just that it did.I was unaware of the process, I just jumped in and participated rather than trying to figure out what was going on.The one belief I am really aware of that I had before, that I can counter act now came about because during the treatment I started having pain-free periods and that altered some of my emotional response to the pain.Before CBT was in pain all the time and the biggest mal-adaptive thought I can easily suss out was "how can I live every day the rest of my life in pain like this" Which was always negative and not good in the coping end of things. Looking only at how bad everything would be forever. I believe this pattern tends to make episodes last longer as the feedback to the ENS is keep it going...make more pain...Once I started having pain-free periods when the pain would be bad I would focus more on this is temporary, it will pass, soon it will be over (And having had things go from unending episodes to having breaks gave me confidence that this was true, not that I would hurt this bad every moment forever) When I can focus my energies on this it seems that the signals going to the ENS are more of calm down...relax...let this end...and it responds by easing the pain and the episode is soon over.K.


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## bonniei (Jan 25, 2001)

Interesting kmottus...


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## trbell (Nov 1, 2000)

what paper by Blanchard are you talking about. I know he's written a book that's worth reading. he's also written a number of articles on the subject.Bada


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## trbell (Nov 1, 2000)

k, that's an interesting thought, I think: "I was unaware of the process, I just jumped in and participated rather than trying to figure out what was going on."As an IBS sufferer I can identify with the tendency to spent all my time trying to fidure out what is going onBada


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## trbell (Nov 1, 2000)

bonniei, I'm not evading answering your questions, just trying to sort out for awhile what qustions you want answered from a sufferer and what you want answered as an expert and what yiou want me to answer as a therapist?Bada


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## bonniei (Jan 25, 2001)

K got the reference from this paper I thinkGastroenterology. 2003 Jul;125(1):19-31. Related Articles, Links Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders.Drossman DA, Toner BB, Whitehead WE, Diamant NE, Dalton CB, Duncan S, Emmott S, Proffitt V, Akman D, Frusciante K, Le T, Meyer K, Bradshaw B, Mikula K, Morris CB, Blackman CJ, Hu Y, Jia H, Li JZ, Koch GG, Bangdiwala SI.Background & aims: Studies of antidepressants and psychological treatments in functional bowel disorders (FBD) are methodologically limited. The aim of this study was to assess the clinical efficacy and safety of cognitive-behavioral therapy (CBT) against education (EDU) and desipramine (DES) against placebo (PLA) in female patients with moderate to severe FBD (irritable bowel syndrome, functional abdominal pain, painful constipation, and unspecified FBD). We also evaluated the amenability of clinically meaningful subgroups to these treatments. METHODS: This randomized, comparator-controlled, multicenter trial enrolled 431 adults from the University of North Carolina and the University of Toronto with moderate to severe symptoms of FBD. Participants received psychological (CBT vs. EDU) or antidepressant (DES vs. PLA) treatment for 12 weeks. Clinical, physiologic, and psychosocial assessments were performed before and at the end of treatment. RESULTS: The intention-to-treat analysis showed CBT as significantly more effective than EDU (P = 0.0001; responder rate, 70% CBT vs. 37% EDU; number needed to treat [NNT ], 3.1). DES did not show significant benefit over PLA in the intention-to-treat analysis (P = 0.16; responder rate, 60% DES vs. 47% PLA; NNT, 8.1) but did show a statistically significant benefit in the per-protocol analysis (P = 0.01; responder rate, 73% DES vs. 49% PLA; NNT, 5.2), especially when participants with nondetectable blood levels of DES were excluded (P = 0.002). Improvement was best gauged by satisfaction with treatment. Subgroup analyses showed that DES was beneficial over PLA for moderate more than severe symptoms, abuse history, no depression, and diarrhea-predominant symptoms; CBT was beneficial over EDU for all subgroups except for depression. CONCLUSIONS: For female patients with moderate to severe FBD, CBT is effective and DES may be effective when taken adequately. Certain clinical subgroups are more or less amenable to these treatments.


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## bonniei (Jan 25, 2001)

Bada try this thread . I gave you the wrong thread by mistake. Sorry! Please try http://www.ibsgroup.org/ubb/ultimatebb.php...c;f=11;t=001601


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## trbell (Nov 1, 2000)

The article seems to say that some people might be helped more by CBT dome by a professional and some might be helped by education and an antidepressant and a larger pecentage were helped by CBT. it might be helpful to ask your doctor about these options and how you could try them? As you know treatment for IBS is avery individual thing. remember also that you are reading an abstract posted on the internet and not the whole article but if you have any other specific questions about the abstract I'll try to give you an opinion. It does look as if it was a fairly well designed study so the information is probably pretty good, but remeber that in studies like this you really need to have 5 or 10 studies before anyone with any reputation will make statements or draw conclusions.Bada


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## bonniei (Jan 25, 2001)

Bada , Thanks for your opinion on this thread. I gave you the wrong thread I am sorry. I appreciate you putting in the effort you did. I am looking for a book on cognitive therapy on this thread http://www.ibsgroup.org/ubb/ultimatebb.php...c;f=11;t=001601


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## trbell (Nov 1, 2000)

bonniei, I hope you understand but after thinking about it, it's not appropriate for me to answer your questions here as an 'expert'. You seem to be asking for personal reasons relating to diagnosis and treatment and these kinds of questions are better answered in person by someone who is familiar with your specific situation. you probably are better off getting your answers from other sufferers anyway as they are often the best sources of information on something like IBS. I hope you understand this and don't think I'm just putting you off.if you have specific questions about the book or article, though, I'll try and answer them.Maybe you can talk jeff into doing an "ask the specialist" link for mental health questions? I'm not sure I'd want to be the 'specialist' but it might make things a little less awkward.Bada


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## bonniei (Jan 25, 2001)

Bada, I am in a hotel room in Boston and had thought I would only lurk but fel compelled to post to this. I have tried saying on couple of threads atleast tht al I wanted you to answer was whih is a good book for cognitive therapy. Clear? Bada I suggest you stop suggesting to me anyting. show some self control.It s not only very irriting but confusing


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## eric (Jul 8, 1999)

Bonniei, this is a book on treating IBS with CBT. http://www.irritablebowel.net/


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## trbell (Nov 1, 2000)

Yes, Dr. B's book is very good. I guess I just assumed you knew about it. Sorry, bonnieiBada


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## bonniei (Jan 25, 2001)

This miscommunication s getting to be funny if it weenot for the fact that I have to type in the hotel room with the key pad in my hand constantly aimed at the TV! Blanchard's book does not have cogitive therapy techniques. THey assume you ar atleast a 4th year grad student in Psychology so you have are familiarwith cognitive therpy. I want a general book on cognitive therapy Blanchard's book is just a guide for people who are already cognitive therapists. So if you can oblige please or I will look up the references in Blanchards book. That may be the easiest


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## trbell (Nov 1, 2000)

I would recommend the basic book on the subject for the general public which is _Felling Good by David Burns and Aaron Beck which should be in almost any library and just last week i saw a copy at my local grocery store. i think Dr. Bolen also recommended this on an earlier thread. I think the Burns bool is interesting as it goes into the psychoanaltic roots of the theory.Others here might have some ideas of good books for you.


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## Guest (Jul 19, 2003)

From my own personal experiences I can relate that CBT is empowering. How empowering it is may depend on how receptive the patient/client is at any given moment in their life. It all goes back to the "ya gotta wanna" concept. Example: If someone is intent on proving the rest of the world wrong, CBT won't be very effective. It's only when they come to grips with the idea that their repressed emotions are causing their grief, and go on to develop better perspectives that healing will ensue. (been there & done it)CBT provides a better sense of self-awareness. And it's only when we become aware of what is going on inside of us and why, that we can begin to alter our responses to our environment.And the sooner we learn to shift the blame for our plight in life away from others around us, recognizing that we do have choices, the sooner we learn to live with peace and content.It's sort of like continuing to beat our heads up against a brick wall.... the wall isn't going to move.... we might have to go over it, around it, under it or through it. Become upset or angry that it is there might be normal, but is ineffective in dealing with it. I don't know about you guys, but I think I can outsmart a brick wall any day.....







Evie


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## bonniei (Jan 25, 2001)

THANKS Bada! I am sorry for the bitchy mood I was in the morning. Part ofit was because I was working with ths remote keypad aimng it at the TV with one hand and typing with the other. It was eating up half the letters in theprocess causing me to retype every word. Anyway i am in a better mood after seeing the USS Constitution.Thanks again


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## trbell (Nov 1, 2000)

that's fine, bonniei. I was getting a letter flustered by all the links in different places. If you find the book I mentioned I think others might appreciate your comments on it.Bdad


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## trbell (Nov 1, 2000)

excuse the spelling. 'little' flustered is what I meant.Bada


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## bonniei (Jan 25, 2001)

Will do!


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## bonniei (Jan 25, 2001)

Bada, I got the book by david Burns and it was dedicated to Aaron Beck! I got a couplre of books by A Beck too so I have a lot of reading on my hands. Will keep you posted. But need to get the fund raising out of the way.


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## trbell (Nov 1, 2000)

Have you given up on Blanchard? Be areful of Beck, though, he was a psychoanalyst and it might corrupt you?Bada


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## bonniei (Jan 25, 2001)

Blanchard doesn't have much. He just gives basic guidelines. I want a bok which will teach me how to do cognitive therapy. so i am looking towards Beck. I don't know why Beck would corrupt me. i guess i don't appreciate the fine difference between CTs and psychoanalysts. Blanchard says he has built upon the work by Beck and Meichenbaum and Person's so I am trying to get my hands on their boks. there is also a book byJudith Beck- CT: basics and beyond. that sounds like it could be the bok for me. BTW Bada what is the difference betwen CBT and CT?


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## trbell (Nov 1, 2000)

Sorry I said that about Beck. It's probably not going to help you a lot to get into the history of these things. There have been a lot of schools of behavioral therapy and cognitive therapy and they've been taught at the graduate level for 40 or 50 years and they are still arguing about the research.To answer your question, CT or Cognitive Therapy means the therapist concentrates on the patients cognitions or thinking and CBT or Cognitive Behavioral Therapy means the therapist concentrates on the cognitions and behaviors or what a person does in addition to what they think. But obviously when it comes to practice you can't distinguish them._Feeling Good and Dr. Bolen's book are the best I'm aware ofbut you could do a search through amazon or ask your librarian. I know, another suggestion? I was asking about Blanchard because I'm interested in what people think about his perspective on IBS.Bada


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## bonniei (Jan 25, 2001)

I have read blanchard's book solely from the perspective of getting practical help. So i have just read a couple of chapters where he gives the exact session by session breakdown of the Albany studies. I do think CBT helps people with IbS. I know i was` m personal thoughts about what having an IBS attack in public meant which caused the stress it did. It has taken me years of practical experience to change` my cognitions which could have easily been have been changedby a few sessions with a good CB therapist


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## trbell (Nov 1, 2000)

right, all therapists do is help people change quicker. sometimes they can do it on their own and sometimes they need a little advice. It's pretty much like hypnosis.Bada


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## Guest (Jul 23, 2003)

Tom..... if appropriate, could you maybe touch on the importance of finding the correct therapist for the individual? I am thinking along the lines of potential damage if/when the wrong therapist attempts to treat a patient/client. More specifically I guess I am thinking of regression therapy in particular (I think you know from where this was born.)Evie


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## trbell (Nov 1, 2000)

You need to think of what's best for yourself and keep that in mind. I know that this isn't going to go over big but I would SUGGEST that the best first step would be to find a therapist or priest or other advisor and talk to them about whether it's best to proceed. The next step would be to talk with the therapist's supervisor or a lisencing board. The very last thing would be find a lawyer who would be glad to jump in for cash and the whole process could be what's called a retraumatizing experience for you. I also think you could find on the web these days a support group for people who have been retraumatized by regression therapy but that could be either good or bad.Bada


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## BQ (May 22, 2000)

bump


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