Compulsory CBT?

28 July 2014 - 14:17

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Hi Grams & Others

This post is about Gram's idea of starting a thread about how CBT could be improved. He suggested the idea in another thread about how to make best use of professionals whilst undergoing CBT. I think this will become an important issue in the context of a Daily Telegraph report on the 13 July 2014 that the government is thinking of making it compulsory that people will have to accept therapy if they are to receive benefits such as ESA and are diagnosed with anxiety or depressive conditions. According to the article the plan consists of on line therapy in addition to face to face therapy as well as connecting back to work sessions with therapeutic interventions. I have no experience of on line therapy and feel it would be interesting if there were comments on the effectiveness of such approaches. 

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5 August 2014 - 0:30

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Hi Check, Hi everyone

Interesting points raised by a lot of us.

I think you got it in one there Goofy when you said about helping people as if they are unique individuals as instead of the (one-size-fits-all rule on everyone). When it comes down to things we shouldn't think of it as black or white, people have lots of complex needs so trying to find the right therapy can sometimes be difficult. I try to look at the bar in the middle as oppose to black and white, still I think we need to be careful not to pressure anyone as this can sometimes maybe put therapy in a negative light as I really believe we must actually want to do it as oppose to dealing with it in a ultimatum fashion.

5 August 2014 - 11:17

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Hi Graeme, Hi everyone,

You're absolutely right Graeme that CBT won't succeed unless the patient is both willing to co-operate and eager to make it work. But the prospect of being unemployed and denied state benefits may help give people the required motivation when they would otherwise slump into a rut of inertia and be unable to push themselves to try CBT willingly. It's a delicate balance between motivating people to help themselves and pressganging people against their will, but I am of the opinion that at the moment the balance is tipped too far towards the UK being a nanny state. When my nephew was at school he didn't bother to study because he knew he would never starve even if he became unemployed. When he took his GCSEs he deliberately flunked his exams and competed with his mates to see who could get the lowest exam results "just for a laugh". After leaving school he had an opportunity to get a job as an office cleaner but he turned it down because it would have involved cleaning toilets and he couldn't lower hiself to such a demeaning task. Contrast his attitude with people living in Poland where there the state does not hand out unemployment benefit. All school pupils try hard, even those who aren't academically bright. And when they leave school they are willing to do any paid work regardless of how grotty or demeaning it is.

In the case of helping people with OCD to get better, I hope the government would take into account that sometimes CBT doesn't work because of a personality clash between patient and therapist where it is no fault of the patient. The first therapist I saw mocked my irrational fears and compulsive rituals, which certainly scotched any chance of that CBT succeeding. And some cases of OCD seem stubbornly resistant to improvement despite honest efforts by the patient to expose themselves to their fears under the guidance of a sympathetic therapist.

How are you today Graeme? I hope you're feeling calmer and stronger in your mind, and that you have a positive day.

5 August 2014 - 12:01

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Hi Goofy, Hi everyone

Thanks for asking Goofy I'm feeling a little bit better but still feeling slightly scared by the thoughts, but that's ocd for you.

I tend to go by the saying as long as we try our best but if we do fail or we don't get the results we want it's not the end of the world there are opportunities out there to progress.

As always I really believe there can be deeper issues in relation to why someone might refuse help, they might feel that everything is okay or they don't see themselves as having a problem. It's takes massive courage to come forward and speak about your ocd and that part of me makes me think we are strong human beings mentally.

In certain instances there might be a fear to commit to someone this can probably be with anything in life to accepting a job offer to undergoing treatment and there might be a fear behind that just in case we think it might not work out or we might disappoint our family members but all in all if we are not happy with the way something is going we must speak up I feel. Again the other fear maybe that once we commit we can't escape type thinking.

5 August 2014 - 12:24

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Quote:
In certain instances there might be a fear to commit to someone

oops I made a mistake there, it was meant to read commit to something.

5 August 2014 - 16:56

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Hi Graeme,

I'm really pleased you're feeling slightly better - I hope you go on improving steadily. After a bad patch the lingering anxiety can take a long time to subside, even though the original trigger is no longer present. Take it easy and be patient and rejoice in each little sign of improvement!

This is a very interesting discussion - thanks for sharing your views. You said: "I really believe there can be deeper issues in relation to why someone might refuse help, they might feel that everything is okay or they don't see themselves as having a problem." Yes, I agree with you there, but if someone didn't think they had a problem or weren't prepared to admit they had a problem, then they wouldn't apply for state benefits on the grounds of being too psychologically ill to hold down a job, so that situation wouldn't arise.

You pointed out that: "In certain instances there might be a fear to commit to something" such as a course of CBT. Yes true, but fear is a natural part of being human and not all fear is bad. Sometimes fear is positive and can work for our good. I think most people are afraid to commit to things, and we all have to overcome our fear of failure or of disappointing family members whether we've got OCD or not.

People with OCD are often very fragile mentally so I hope any government scheme would sensitively filter out scroungers from those who are genuinely incapacitated by their OCD from going to work and who are also truly unable to embark on a course of therapy.

5 August 2014 - 19:58

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Hi Goofy

I begin to sweat when I get a bad thought or thoughts, the thoughts feel a bit better but hoping it stays like that for awhile. (If only we could pick and choose when we have our ocd attacks). I know it's probably no laughing matter but I try and look at the funny side of it, we need laughter in our lives I feel.

I like your point and it does make a lot of sense but I'm more of the view that we should (live and let live) but as long as we encourage each other to try new things also support each other when we need the support, I think we are becoming a more understanding society.

6 August 2014 - 16:08

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I am glad that Truddles has posted the original article on the site. The discussion is really wide ranging and international in debate and I certainly feel that we can learn from international comparisons both in regard to welfare systems and health systems. But it would be helpful if people could cite sources. For example it has been stated that Poland the 'state does not hand out unemployment benefit'. I am no expert on Polish affairs but I looked up Wilkapedia which indicated that it did as well as benefits for incapacity. It would be good if somebody could quote the actual figures from an academic source. It is interesting that comparisons have not been with nation states with a similar GNP such as France nor with other nation states with a history of liberal democracy at least since the end of the Second World War such as Germany, the Netherlands, Canada, and Sweden. The recent changes in the USA and New Zealand  are interesting.  In itself the argument that because X does something then Y should do something is open to some difficulties for example some countries practice widespread child labour similar to Britain before the political movement to abolish it in a series of Factory Acts.

6 August 2014 - 16:22

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Sorry Check, I realised that you had read the article but door bell rang and I pressed reply when meant to save.

There are some points to consider in this article

  • The article refers to anxiety and depression - given that OCD now has a separate classification in DSMV will OCD be included in this?

  • The article states:

    Quote:
    The reforms however, would apply only to those claimants judged to be capable of some work in future.

    Those who are judged to be incapable of work due to the severity of their conditions would not be targeted under the plans.

  • Most people on these forums are already either engaging in treatment or are actively seeking treatment and so if OCD is included in this proposal it wouldn't affect them.

7 August 2014 - 12:59

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Hi Graeme ... I like your approach to try to see the funny side of OCD. Some ignorant people may misinterpret that as trivialising our suffering or mocking one another's quirky behaviour but I think humour can be a cathartic safety valve for us when we are at our lowest. We're not always able to see the funny side of life but it's good if we can. I remember when I had great difficulty turning off light switches. It used to take me 10 minutes or more to leave a room because I was so anxious I hadn't tuned the light off. I ended up switching the light on and off many times in quick succession. It was gruelling at the time but I can look back now and smile at the thought of how puzzled my neighbours must have been if they had noticed my light flashing on and off like a car indicator light!

I absolutely agree with you that it would be wrong to pressurise people with OCD to seek treatment if they didn't want it. As you say, we should live and let live. Thankfully I don't think the government is proposing to force people with OCD to seek treatment. Correct me if I'm wrong but I think the proposal is merely to give the taxpayers of this country some assurance that their taxes are not being used to financially support people who are capable of earning their own living but who prefer to take the easier option. As a taxpayer myself I am very happy to pay my taxes and for my taxes to be used to help anyone who, for whatever reason, cannot paddle their own canoe. But I do resent my taxes being used to sponsor selfish greedy people who just want to exploit the system. If anyone with OCD doesn't want to seek treatment and doesn't want to claim state benefits, then that's fine. But if that person does want taxpayers to support him, then I think it's only fair and reasonable that he should provide evidence that he has tried to get better by seeking treatment or that he has a legitimate reason for not seeking treatment.

Hi Check ... My apologies to you and to everyone for getting my facts wrong about state benefits in Poland. I was describing the situation approx.10 years ago (according to someone I knew living in Poland) and I didn't realise it had changed since then. I wasn't suggesting that we in the UK should blindly copy what Poland does, but was just trying to show the extreme solipsism and entitlement culture that results from a bloated welfare system that was originally designed to save people from starvation but has grown out of control to save people from poverty too, and unfortunately harms the very people it tries to help. I think this could be especially true for people with OCD because OCD expands and controls us more if we make any concessions to it.

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