Psychotherapy for mental illness

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

Psychotherapy is form of "talking therapy" treatment for mental disorders, and not a treatment used to directly treat myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, multiple chemical sensitivity, or any other physical illnesses. Psychotherapists are trained in the working of the mind, and do not have medical training.[1]

Psychiatrists rather than psychotherapists are medical doctors trained in mental illness, and prescribe psychiatric medications or treatments.[1]

Purpose[edit | edit source]

Psychotherapy is designed to treat mental illness, whether it impacts or occurs in people with physical illnesses or not.

A person with ME/CFS might see a psychotherapist to treat either a pre-existing mental disorder, one caused as a reaction to the effects of living with ME/CFS, or an unrelated mental disorder that begins later, for example:

Difference from counselling[edit | edit source]

Psychotherapy is different from counseling because:

  • psychotherapists have more extensive training
  • psychotherapists typically offer longer term work, counseling is often brief
  • counseling is sometimes delivered by people who aren't mental health professionals but have training in a particular method of counseling, this means that their understanding of more serious or long term difficulties in particular may be limited, and these "paraprofessionals" may not be registered with any counseling or psychotherapy professional body, and they may not work under a clear ethics framework or by licensed by a regulatory body for counseling or psychotherapy
  • counseling is often sought for issues unrelated to mental health, to allow someone to be able to work through feelings or difficult decisions, for example family matters or pregnancy counseling and life transitions[1][4][5][6][7]

Cognitive behavioral therapy[edit | edit source]

Cognitive behavioral therapy (CBT) is a form of talking therapy that was developed initially to treat depression, then later models were developed for anxiety, post-traumatic stress disorder and other mental illnesses.[3] CBT is an extremely popular form of therapy that can be delivered in either psychotherapy or counseling. In CBT, "homework" such as worksheets completed between sessions is often expected, which may mean that it is more demanding in terms of energy than some other types of therapy.[8]

Many people who deliver CBT counseling are not registered mental health professionals and do not work primarily in counseling or psychotherapy.[9] Acceptance and Commitment Therapy is also a form of CBT.[8]

CBT for ME/CFS[edit | edit source]

Cognitive behavioral therapy has also been developed for ME/CFS based on a highly controversial biopsychosocial model of ME/CFS that does not accept that it has an underlying biological disease process, and views psychological factors such as fear of exercise as a key part of the disease, something which has been found to be incorrect.[10][11][10][12] This form of CBT, which is often delivered by the UK's Improving Access to Psychological Therapies (IATP) but may be delivered by any counselor in any country, aims to cure or significantly improve physical symptoms through encouraging the person to change their thoughts and behaviors.[2] In this model of CBT the person assumed to have an "unhelpful" (irrational) beliefs that exercise is harmful or to be engaging in a viscous circle of thoughts and behaviors that are claimed to make the illness worse.[3][12] This extremely controversial model of CBT,[13] which is typically delivered by nurses, occupational therapists and sometimes counselors, treats ME/CFS as medically unexplained physical symptoms (MUS) and may be treat symptoms as "bothersome" or as if they can be "reversed" by altered behaviors rather than acknowledging ME/CFS as a serious, neurological disease with a very low recovery rate; this cognitive behavioral and biopsychosocial model of ME/CFS was abandoned by the CDC in 2017, and by the UK's NHS guidelines in 2021 due to the evidence that is was ineffective and often harmful,[14][9][15] Some people experiencing this form of CBT have reported that they felt like they were experiencing gaslighting, which is a form of emotional abuse, and that their experiences of illness were not believed, and that medical facts were disputed by their counselor: in the UK, a significant minority of people found that CBT for ME/CFS made their mental health worse.

See also
Cognitive behavioral therapy and Illness beliefs.

Forms of therapy[edit | edit source]

Many different types of therapy exist, including:

  • EMDR, which is mostly used for post-traumatic stress disorder after abuse or trauma, and is based on a mixture of eye movements and addressing distressing and intrusive memories and feelings
  • Person-centered therapy, which is based on fully accepting you as you are, and does not attempt to challenge your thoughts or beliefs, developing self-compassion and self-acceptance is encouraged. Typically not a fixed number of sessions.
  • Dialectic behavioral therapy - while this is derived from CBT and is very structured rather led by the patient it is based on the principle that you/the patient are doing the best you can, and is very focused on skills training and coping strategies
  • Interpersonal therapy, which is based on how you interact with others and how other people's actions affect you, and vice-versa, and icreasing support from others
  • Mindfulness-based therapies - based around stress reduction, increased self-awareness, and regular practice of mindfulness
  • Art therapy, in which feelings or difficulties are expressed creatively, and the value is on emotional benefits with no need for artistic skills
  • Solution-focused - a short term therapy where you work towards a particular goal you have
  • Group therapy - attending regular sessions with others who have similar difficulties to share problems and thoughts, with a therapist acting as a facilitator

Somatization and Somatic Symptom Disorder or Bodily Distress Disorder[edit | edit source]

These are a group of mental disorders in which emotional problems are converted into physical symptoms in place of emotions, sometimes called Conversion Disorder. For example, a child might have abdominal pain whenever they are sad but not be able to recognize their sadness, or an adult survivor of rape may experience chronic pain in their genitals which is not caused by physical illness, and that resolves or improves with psychological support to work through the emotional consequences of the rape.[16]

The symptoms of ME/CFS, fibromyalgia and irritable bowel syndrome are not caused by this somatization process but some professionals may view the symptoms as "unexplained" or "having no medical cause" and assume that psychotherapy for a somatization disorder and/or antidepressants might help.[17] Historically, this approach has been used for many illnesses that medicine was not able to recognise properly or not able to understand at the time, for example multiple sclerosis was treated under this model as a "hysterical paralysis".[18] Jennifer Brea was misdiagnosed with conversion disorder, and as a result tried to push through her symptoms, causing her physical to decline dramatically.[19]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Saling, Joseph. "Psychiatry, Psychology, Counseling, and Therapy: What to Expect". WebMD. Retrieved January 13, 2022.
  2. ↑ 2.0 2.1 "Overview - Cognitive behavioural therapy (CBT)". National Health Service. February 10, 2021. Retrieved January 13, 2022.
  3. ↑ 3.0 3.1 3.2 Geraghty, Keith J; Blease, Charlotte (September 15, 2016). "Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent" (PDF). Journal of Health Psychology. 23 (1): 127–138. doi:10.1177/1359105316667798. ISSN 1359-1053.
  4. ↑ "Counselling". Mind in Haringey. May 12, 2020. Retrieved January 13, 2022.
  5. ↑ "What therapy can help with". British Association of Counselling Professionals. Retrieved January 13, 2022.
  6. ↑ "Chronic Illness: Sources of Stress, How to Cope". Cleveland Clinic. Retrieved January 13, 2022.
  7. ↑ Montgomery, E. C.; Kunik, M.E.; Wilson, N.; Stanley, M.A.; Weiss, B. (2010). Can paraprofessionals deliver cognitive-behavioral therapy to treat anxiety and depressive symptoms?. Centre for Reviews and Dissemination (UK). PMID 20235623.
  8. ↑ 8.0 8.1 "Therapy Techniques". WestSide Psychotherapy. Retrieved January 13, 2022.
  9. ↑ 9.0 9.1 Doctors with M.E. (November 1, 2021). "NICE 2021: A Triumph of Science over Discrimination". The new guideline discards discredited psychological theories and therapies in favour of a more patient centred approach, driven by improved scientific understanding. It represents a positive and total paradigm change, uniting around the science, official disease classification and medico-legal compliance implications.
  10. ↑ 10.0 10.1 Michiel, Tack (July 4, 2019). "Why Graded Exercise Therapy and Cognitive Behaviour Therapy are Controversial in Chronic Fatigue Syndrome". BMJ Medical Humanities Blog. Retrieved July 9, 2019.
  11. ↑ Wilshire, C; Kindlon, T; Courtney, R; Matthees, A; Tuller, D; Geraghty, K; Levin, B (2018). "Rethinking the treatment of chronic fatigue syndrome—A reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT". BMC Psychology. 6 (6). doi:10.1186/540359-018-0218-3.
  12. ↑ 12.0 12.1 Spandler, Helen; Allen, Meg (August 16, 2017). "Contesting the psychiatric framing of ME/CFS" (PDF). Social Theory & Health. 16 (2): 127–141. doi:10.1057/s41285-017-0047-0. ISSN 1477-8211.
  13. ↑ Twisk, Frank N. M.; Maes, Michael (2009). "A review on cognitive behavioral therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS". Neuro Endocrinology Letters. 30 (3): 284–299. ISSN 0172-780X. PMID 19855350.
  14. ↑ Tuller, David (July 10, 2017). "Trial By Error: The CDC Drops CBT/GET". Virology blog.
  15. ↑ Institute of Medicine (2015). Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press. doi:10.17226/19012. ISBN 0309316898. PMID 25695122.
  16. ↑ APA (2013). "Somatoform Symptom Disorders". DSM-5. Washington, D.C.: American Psychiatric Press.
  17. ↑ Skyes, Richard (September 2002). "Letter to the British Journal of General Practice". The British Journal of General Practice. 52 (482): 762–763. PMC 1314419. PMID 12236282.
  18. ↑ Hooper, Malcolm (June 21, 2002). "Letter to The British Journal of General Practice" (PDF).
  19. ↑ "I made a film from my bed to show my illness is real". BBC News. November 9, 2017.

cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

See cognitive behavioral therapy.

See medically unexplained physical symptoms.

medically unexplained physical symptoms (MUPS) - Technically, this term means that no cause or explanation for the patient's symptoms has yet been found. However, patients diagnosed with "MUPS" are generally lumped into a psychosomatic, or psychologically-caused category by those in the medical profession, without any scientific basis for doing so.

cognition Thought processes, including attention, reasoning, and memory.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

See somatic symptom disorder.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

See somatic symptom disorder.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

BMJ The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

See American Psychiatric Association.

American Psychiatric Association (APA) - The main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. Not to be confused with the American Psychological Association (also APA).

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

See Diagnostic and Statistical Manual of Mental Disorders.

Diagnostic and Statistical Manual of Mental Disorders (DSM) - A psychiatric reference book published by the American Psychiatric Association, often referred to as "the psychiatrist's Bible". Although the most recent version (DSM-5) purports to be the authoritative guide to the diagnosis of mental disorders, the editors of both previous versions of the manual have heavily criticized the current version due to the climate of secrecy that shrouded the development of the latest version. 69% of the people who worked on DSM-5 reported having ties to the pharmaceutical industry. Dr. Allen Frances, who headed the development of the previous version, warned of dangerous unintended consequences such as new false 'epidemics'. The British Psychological Society criticized DSM-5 diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements" and expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences". A petition signed by over 13,000 mental health professionals stated that the lowered diagnostic thresholds in DSM-5, combined with entirely subjective criteria based on western social norms, would "lead to inappropriate medical treatment of vulnerable populations". The director of the US National Institute of Mental Health, Dr. Thomas R. Insel, pointed out that the diagnoses in DSM-5 had no scientific validity whatsoever. (Learn more: www.scientificamerican.com)

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