Recovery Today

“I never thought I’d end up here.” She said. Her clothes were torn.  Not in that fashionable way. But a sleeping outside and not having anything else to change in torn and worn way.  Her hair was matted. There was dirt on her hands and face. She was white at one time.  “I graduated college.  I had a husband and a child before social services took my baby.  I don’t know where she is now.”

She’d been sleeping in front of the bank because there was an overhang there that kept some of the rain off her sleeping bag and newspaper shelter.

“I drank first but then it got to harder stuff. I needed the drugs.  I didn’t like what I did for them.  Drug dealers are all disgusting pigs.  But I didn’t have any money. “. She was crying, shoulders shaking.  She did’t smell fresh either.

I didnt’ know if this was true or just a tale she’d picked up and used.  The stories are passed around and reworked for most impact. Especially the stories of abuse. They’re so polished that I’ve even heard the lawyers down here repeating them as their own.  Jungle tales.  But she sounded real.  What was sad is how the last thing blamed was the drugs. First the parents, then the men or women or the job or even the banks and government but finally one day if they’re lucky they look in the mirror and say, “It’s me. It’s the drugs. My drug dealer isn’t my friend.” 

AA considered calling the Big Book, the truly classic recovery read, “The Way Out”.

So many who develop drug and alcohol abuse had trauma that many think the subsequent self destructive lives are ‘identification with the aggressor’ and Stockholm Syndrome.  No one doubts that it becomes a disease.  The brain changes.  The amygdala and hypothalamus are altered. DNA and neurotransmitters are all altered.  The very thinking is high jacked like a worm in a computer. Addiction can be followed by public health like a viral epidemic.  It spreads in poverty and war from carrier to target.  There are well established vectors.  The enablers are the most interesting group.  A twisted form of narcissism.  Dr. Scott Peck described them in “People of the Lie’.  Without the enablers the natural history of the disease would be brief.

“I ran out of money and no one wanted me. That ‘s why I came in.” He said. He’d been a teacher at one time. 

I first met them in the detox ward I supervised nearly 40 years ago.  Back then the Delirium Tremens of the alcoholics challenged me. I’d be up all night trying to keep the patients alive as they crashed about screaming and hallucinating and I’d be afraid of how much medication I gave them because they’d have liver disease, heart disease and lung disease from smoking and drinking. Mostly they were older men then.

Today’s it’s children. Nobody realizes how many beautiful young women are addicts today. Female alcoholism has passed that of men.  Red Red Wine.! Poor ME. Poor Me . Poor Me Another Drink! The guys are coming in younger too.  

40 years ago it was alcohol or heroin but today it’s everything.  

“I don’t want the methadone or suboxone. I was just told I had to see you and fail your program before they’d give me the free heroin.”  He was 18 years old. He’d started using drugs when he was 6 years old. His mother was a prostitute and his father a career criminal.  “I”m pretty sure he’s my father. I visited him in jail. The guy my mother said was him. He acted okay and said we’d get to gether when he got out. He’s in for another 20 years. Manslaughter. I didn’t go back.” 

There’s lots of solutions. All the options are available here for treatment. The management of these options has been described as the worst managed in the western world.  The problem is communication and coordination.  The administration though is always playing their favourite game of divide and conquer and self aggrandizement. The emperors and empire building in beurocracy is rife.  

“I’d feel badly but when I see how incompetent the legal system is following known terrorists and dealing with criminals who use guns what is done in health care is genius by comparison.  Politics is just messy everywhere.” She said. A wise nurse teacher now working on the frontlines after leaving a cushy university position for reality.  

The housing crisis doesn’t help.  The bed bug stories and rats in 21st Century Canada frighten me.  Typhus outbreaks in Democrat California. Won’t be long before that spreads up there.  We still get syphilis cases and we’ve done everything to wipe out these diseases but as the government devolves the danger increases. We’ve got TB again but so far no Plague in Canada. The breeding grounds are growing though.  The anti vaccers don’t help either but who wouldn’t believe conspiracy theories with the lies coming out of Ottawa and Brussels about scientific ‘predictions’ that are just modern day political ‘prophecies’ .  

If the person has a job and family in tact as Dr. Ray Baker literally preaches, “We can get 80% or better outcomes at 5 year follow up with early intervention.  We do better with addiction that any of the other specialities in this regard but we are no better than they are treating end stage illness’.  Dr. Baker was the one who started the first medical school addiction education program when the authorities were in complete denial and blaming the victims like the courts and judges and too many politicians still do.  

The treatment of choice has been around since the Navy Pilot program. When AA began in 1935 there was no ‘cure’ but 50 men in Akron found that abstinence and accountability groups, 12 steps and broad based ‘spiritual’ focus rather than narrow focus resulted in 5 year cures for what was an otherwise deadly disease.  Unfortunately until people understood immunity, partial immunity and genetics of disease and disease spread little more progress was made for decades .But now, thanks to AA that millions of alcoholics were surviving and then Addicts too there were test subjects and money to continue the research that has lead to a broader based approach to the disease. The Navy Pilot program was 80% successful with early identification in the workplace, referral to a psychiatrist trained and experienced with addiction , seeing them monthly, seeing a drug and alcohol counselors weekly and attending three AA meetings a week after an initial 4 to 6 week (proverbial 28 day) inpatient treatment.  

There’s little change in that winning formula today except that there’s now ‘outpatient’ ‘DAYTOX’ and “SMART” Recovery groups alternative to the 12 step programs and a variety of faith based ‘accountability groups’ more appealing to particular religious affiliation.  Psychologists and psychiatrists have begun to treat the trauma that is usually associated with addiction at 3 to 6 months abstience.  Motivation Therapy and DBT groups are now psychological advances over the CBT developed in the 80’s .  Recovery Capital work is the foundation of modern psychosocial therapies. 

In addition a variety of drugs like Revia 50 mg a day have been developed to reduce craving and assist recovery much like the highly successful Chiantix used for quitting smoking. 

Harm reduction strategies have expanded the applicability from the original , ‘take it or leave it ‘ approach so that a number of approaches have been established to get people into the now generically termed ‘RECOVERY’ process. It’s becn said ‘you’re either on the up elevator or the down elevator.” Once it was believed that you couldn’t be ‘forced’ into recovery but functional MRI studies show that people who have been using drugs are literally ‘not in their right minds’ for at least 90 days or 3 months.  Intervention and rescue models and treatment Centers offering 3 month initial programs have followed this learning. The old ‘tough love’ AA program is still likely best practice for ‘relapse prevention’. 

 These harm reduction procedures include replacement models, like methadone, suboxone, and now morphine and injectable morphine. Internationally the highly successful injectable long acting antagonist treatments have been used though Canada and the US often because of the long delays haven’t  haven’t caught up with the Russian and Australian approaches to chronic relapsing disease. . Mostly the local  courts and beurocrats cause delays because of their lack of  scientific education in face of  crisis.  When I worked with the AIDS epidemic the courts and individual judges and beuroccrats by their delaying tactics and self aggrandizement accounted for thousands of passive aggressive deaths.  That said hundreds  of judges and thousands of beurocrats along with the front line workers turned that disease around as they are now grappling with this fentanyl epidemic.

Dr. Jordan Peterson though, always one to avoid the political correct language of deceit, confronts the problem directly but saying that today 10% of the population are ill equipped to have any work. Work and the family are the cornerstone of community and without community the gangs and drugs take over.  Work has been a key component in limiting the spread of addiction.   It literally keeps people in contact with positive associations however as Dr. Peterson points out in the past there were all kinds of work that didn’t require intellect or computer knowledge or even reading and writing. But these kinds of jobs have been mostly taken over by machines. Society must come to terms with this problem. Some countries have brought back conscription while others are moving to a similar non military but public health peace corp type approach for those young people who are not going to make it to college or trade schools.  Anything is better than leaving these marginalized people to gang predators.  Some 75% of those in jail are there for crimes to obtain drugs.  The enablers are often those with a conflict of interest in maintaining the antiquated punishment jail based legal system which has much value but not in this arena.  The drug court is just one of the very best solutions to the problem but recovery houses and work must follow.  

The good news is recovery is working. A week doesn’t go by that I don’t meet someone who says they remember me , like others,  who were along the way in their recovery journey. They stop me and say ‘thank you’ .  I don’t remember them. I’ve seen so many thousands of patients struggling and recovering from the disease.  They never look like they did when I met them in their addiction or early in recovery. 6 month, a year or 10 years later the big difference to me is the ‘eyes’.  They look alive’. “Dead eyes’ is a well known term among those who care and know.  

What’s even better is the ‘life’ the people in recovery have.  They tell me about their new jobs, their education, the trips to exotic places, their reunions with family, their church or temples.  It still remains that those who are 20 years or more recovered tend to be going to AA groups or involved in some spiritual organization.  

It’s a tough field to work in especially with the alcoholism and addiction rampant in the authorities  and the denial in high places where the desire is to expand the tax base and hope that the 90% of people who can play with fire safely are not destroyed by the 10% of people who turn out to be arsonists.  Despite that it’s still rewarding in time to see the lives gained.  Those young people who I knew who had so much potential but died premature unnecessary undignified deaths still remain with me.  But the woman who lost her children and family is now 2 years clean and sober . That’s thanks to methadone, her drug and alcohol counselors, AA,  a smart psychologist, her local church, an enlightened social worker and family who were glad to have their daughter back. She has a job working as a secretary for a housing authority, a government beurocrat going out of his way to help her get work without stigmatizing her for the other non life she’d lived before recovery. That’s the new normal story in this work.  I’m thankful to have been a part of the recovery process.

Canadian Psychiatric Association 66th Annual Conference

I am truly enjoying this Canadian Psychiatric Association conference.  The last conference I attended in Vancouver I so enjoyed Dr. Trevor Hurwitz presentation but then I always enjoy Dr. Hurwitz and hear him frequently at UBC.
19 years ago I joined the International Doctors in AA and have really enjoyed the psychiatrists  and psychiatric presentations there. That was mostly because of the spirituality.    I'm also connected with the Christian Medical and Dental Association and truly enjoy the psychiatrists I've befriended there. I’ve attended the World Congress of Psychiatry and International Society of Addiction Medicine and various other conferences where psychiatry and psychiatrists congregate but I really feel I might have enjoyed attending more CPA.
The CPA Journal did get a new editor, with the result it stopped being a publishing place for academic psychologists and began again to be relevant to me as a psychiatrist.  Reading the journal more is how I read the notice of this meeting.   I’ve been a member of CPA for decades and haven’t felt I got nearly as much bang for the buck as I get from the Christian Medical and Dental Society, until now.
This  CPA conference  is truly outstanding. I am beginning to think my issue with CPA might have less to do with transference and more to do with counter transference.  It’s like that time in therapy where your realize the therapist really might have something more to offer.  I hate to think this is solely my aging and increased wisdom.  I've wanted to attend this CPA since first I saw the line up of topics and speakers.  There are just so many excellent clinically relevant,  valuable and timely presentations.
Having to be at Kingston Hospital yesterday for a family meeting,  I missed that day, sorry to have not been present to hear Sidney Kennedy on Major Depression. I’d really wanted to do the advanced motivational interviewing course as motivational interviewing is something I do a lot of in my DTES clinical work.There was a new Canadian ECT Standards presentation and as I’ve referred several patients with intractable depression for ECT with good results (it’s been 25 years since I’ve given it myself,).  I really thought this was b important for me to review.  There were also some courses on use of social media which is extremely important and relevant. Given the mess the DSMV made of Somatic Symptom Disorder I had also looked forward to hearing this expertly addressed.
Today’s presentations made up for Thursdays academic loss. Being with family,  knowing love first hand and seeing the excellence of clinicians and a wonderful care team in action at Kingston made today’s presentations all the more poignant.
Today I was delighted to attend the ABC of DBT, Applying Principles to the Care of Patients with Substance Use Disorders.  Having treated a former professor of dialectics and discussed DBT extensively in therapy I’d studied it in journals,  on line and seen the excellent research findings of it’s benefits for the SUD populations.  Ketan Vegda, and Wiplove Lamba were truly awesome.  Their presentation alone was worth the price of admission.
I absolutely loved their role play.  It made sense of the theoretical material they had presented very well.  Watching and listening to the role play I felt  that I’ve  ‘got it’ in a way I’d not untill then. Next week in my clinic I’ll be applying simple variations on my well honed eclectic approach to therapy with patients.  Now that’s not something that I can say happens often given years of psychoanalytic psychotherapy training, group psychotherapy training, focal therapy training, CBT training starting in the 80’s, motivational therapy training, former hypnosis training, family therapy training and 12 step facilitation therapy training.  The fact is these young guys really know their stuff. It’s now obvious why and how DBT works and why patients with SUD would appreciate it.  I even went out and bought the recommended text, DBT Skills Training, Handouts and Worksheets by Marsham M. Linehan.  It’s not the same old same old repackaged thing.
I’m skeptical of advances in my field since so much of psychology is ‘renaming’ the old things. One young ‘person’ in the audience commented on the feelings of the therapist in relationship to the patient and how she appreciated the comments about this. I couldn’t resist later saying, “we used to refer to that as ‘counter transference’.  An older woman beside her laughed. It wasn’t against the young person but rather in amusing at the two of us being older and from a different era.   Not that that’s bad.
It was amusing later listening to books and names being bandied about by younger colleagues.  I hoped they still knew Freud, Jung, Karen Horney, Seligman, Kohut, Kernberg.  I did feel though that the ‘pop stars’ of today are a generation beyond my own pantheon. The classics obviously remain but not the lesser stars.   The field is just so broad too today.   It's like my days of Elvis, the Beatles and Rolling Stones.  I remember looking at the line up of a local rock festival and realizing I didn’t know a single entertainer.  I’m still listening to the Guess Who.
I loved the booths and papers and lounge area.  I spent literally  an hour on two separate occasions talking to medication representatives, military forces personnel,  treatment centre personnel, recruiters, banking and insurance folk and regional representatives.  I go to trade shows these days, mostly to do with motorcycles and boats.  But I like to look at what’s being offered and sometimes really enjoy chatting with the folk there.   I always love meeting the Edgewood folk.  Interior BC Health and BC recruiters were terrific.  I love learning that Ability,  a medication I use  extensively in tablet form has come out with Ability Maintena, a monthly injectable form.   I didn’t even know about Latuda (Lurasidone hydrochloride) which is apparently much more used in Eastern Canada. It’s real attraction for me as an antipsychotic was the lack of QT complications.  The Pristiq rep showed me that Pristiq had few side effects than high dose effexor and was well tolerated when used with other meds. I also met the folks from the Medical Psychotherapy Association of Canada.  Having talked with them and learned about MDPAC, I really think this is a group I need to belong to.
Everyone loved the keynote speaker, Clara Hughes, Open Heart, Open Mind. There was a line up forever of folks, who having bought her book were happily waiting for an autograph.
The book selection provided by two sellers was awesome. I tend to down load e books mostly these days reading everything on my Ipad but even so I came away with a Medical Clinics of North America Travel and Adventure Medicine.  I used to attend those conferences when I was more focussed on off shore sailing, having sailed solo to Hawaii in winter.  I loved the whacky doctors I there, no psychiatrists stick out except some fellow who liked the places ‘above where helicopters go’. We related to how our work caused us to enjoy time in extreme wilderness.
I mostly like conferences for networking. I  talked to several psychiatrists I liked instantly.  There was a real international flavour to the conference with every colour of skin and a multitude of accents represented.
The Royal College of Physicians and Surgeons had a terrific young man answering questions about MOCOMP. I love MOCOMP and Mainport our continuing medical education service. I bored the young man with my pet peeve but really otherwise love MOCOMP.  He was there to present on the new ‘competency’ approach to following careers.  Given that Mainport is an excellent reflection of my ongoing study which I like as a journal, I think the very smart and creative folk at RCPS are going to keep astounding us. Who knows, they may address my libertarian pet peeve.  The engineers have rebelled and done a masterful job of facing the gun toting political bullies. I don’t mind recording my study as a professional but am questioning ‘administrators’ arrogance with their self serving money driven  ‘educational accreditation’ processes.  I will probably ‘forget’ to fill in some form about this CPA conference and some supercilious shit will object that I didn’t get my ‘attendance’ cosigned in triplicate. I remember I lead an insurrection against the hospital management wanting clinicians to use a ‘time clock’.  I think this is something I discussed at length in my psychoanalytic therapy in training years.
Unfortunately the Transcultural Psychiatry workshop I’d wanted to attend overlapped with the Chronic Pain, PTSD and TBI workshop I really felt I needed to attend.  So much of my work is specifically trauma,head injury and pain related.  I’m often called upon to be an expert witness and sometimes actually undertake that role voluntarily.  Zohar Waisman MD FRCPC and Adam Little LLB were incredible!  They did a role play with discussion by themselves and incorporating the audience.  Zohar, “performed” as doctor expert witness and Adam as lawyer in a case which had actually occurred.  The audience discussion and the points made and the nitty gritty of expert witness/clinician was humorously and pertinently discussed.  I commented later that their presentation had been so ‘like’ the 'real thing’ I was having ‘flashbacks’ of my own worst moments in court.  What a great presentation! Well worth attending the conference for the learning in that session alone.
I am pissed that I missed Susan Abbey and George Jarvis.  I even missed Harry Kaplinsky!  The CPA Conference is as  bad as going to an ice cream counter and having to choose.  I get Cherry Ice Cream but must forgo the Pistachio and Green Tea flavours. It’s not fair!.
I was also highly responsible and chose Advances in Diagnosis Treatment and Prevention of Dementia, not just because I personally need to know how to prevent it, but mostly because I’m seeing more elderly patients in my practice. Having thoroughly enjoyed the presentations of Tarek Rajji, Zahinoor Ismaiel, Amer Burhan and Sanjeev Kumar I feel more confidence, recognized a couple of mistakes I’ve made which I can address next week without harm to patient,  but now I mostly know where to turn.  I really am going to change my practice for the better.   I have answers to questions I’d had put to me by patients and family which I’d not been able to answer. Now I can.  I really liked the humanity of these fellows too. Yes they were researchers and published internationally accredited papers but it was clear that they cared for people.
So that was the day.  Tomorrow I have a whole day more of really great psychiatry learning. They’re even going to feed me at a Thing called the President’s Gala. This Westin Harbour Castle Hotel in Toronto is really fine too.  I love my view of the Harbour. Now that my sailboat is in these fresh waters I can imagine one day anchoring somewhere out there. I see an island and wonder if it’s the same one where I was swimming as a teenager and participated in rescuing a drowning woman.  Toronto is a favourite city with so many memories for me. Another reason I was glad to come to CPA.  2017 the Conference is in Ottawa. As so many close family are there, I believe I’ll be attending the CPA again.  I’m really enjoying this conference.

Cognitive Behavioural Therapy - CBT

Cognitive Behavioural Therapy was developed first by Aaron Beck.  Feeling Good, by Dr. Burns is a book by Dr. Becks student that best summarizes some of the techniques developed by Dr. Beck. 

First, the principal of Cognitive Behavioural Therapy, CBT, was that 'what you think" is 'what you feel'.  Hence the program worked with the 'conscious mind' as opposed the psychoanalytic therapy that felt the emotional substrate was best accessed through 'unconscious' processes such as 'free association' and 'interpretation'. 

CBT was and is rather straight forward.  It's success followed it's simplicity and use by those trained in a limitted process.  It gave itself to reproducible formats and protocoled work books which could be used more easily in scientific research than previous therapies that often depended on the extent of training and experience of therapist.   Because it is essentially an "educational" model of 'relationship therapy' a counsellor could be taught how to do CBT, reducing costs of specialist services and it was commonly coupled with drug studies.  All manner of "work book' and 'take home' materials have been developped for accompany therapy.

I formally trained in Cognitive Behavioural Therapy as a psychiatry resident in 6 months weekly weekly psychotherapy supervision.  Because of the metaphor of computers and 're programming' the model of 'CBT' has had a currency that is as timely today as Freud's model was in it's scientific day.

Some standard examples of Cognitive Behavioural Therapy include the following:

1)  Identify the various 'negative self talk' that is used.
eg. "I'm no good" , "I'm a failure", "Everything is hopeless."  "Nobody cares for me"
(The list is endless)
2) These have been called "cognitive distortions'.  Often psychologists will take old ideas and repackage them with new labels.  The cognitive distorions of CBT to a large extent were first identified in philosophy and logic as "fallacious' thinking. There are various lists of common 'fallacies'.
3) In the examples given one would by oneself or with a counsellor reflect on the internal error in this self talk.  For instance , "I'm no good".  The word 'good' or 'bad' here is used as a 'generalization' and when one seriously breaks down the statement of what "I am" it's usually meant that I am 'no good at doing something' Ie 'pleasing my mother, pleasing my boyfriend, pleasing society, pleasing my boss".   
4) Each negative 'self talk' is explored rationally and then replaced by a more positive statement.  Eg.  "I'm no good" is replaced by "I am okay'.  Here the Transactional Analysis movement was a precurser in terms of Cognitive Behavioural Therapy and many of the ideas of Dr. Berne who developed this Cognitive Behavioural Therapeutic system, best described in the book "Games People Play', can be collapsed into standard CBT
5) Self talk is often done initially as a positive form of communication and one can write the short form of the outcome in columns.  So that whenever I say to myself "I'm no good" I don't again go through the whole process but instead say, "I'm okay" and possibly add to this "I breathe well, I've five fingers and toes, I'm a child of God, I macrame well, my hampster thinks I'm okay" whatever the list is to re inforce the positive counter thought to the negative recurrent cognitive distortion.
6) Other forms of CBT homework include writing out lists of all the good things I have done rather than focussing on all the negative.  To achieve this a criminal might say I was in jail 10 years but the therapist would say, 'you're 40 years old' so for 30 years you were not in jail.  If a matter like 'lying' behaviour is addressed, the person might list how many hours or days they didn't lie. 
7) Patient doing CBT are encouraged to read and record positive statements and positive reading material. It's not 'pollyanna' but rather optimistic. Depressed patients for whom CBT was first developped were so far out in left field that they didn't even have a glass to have it half filled so CBT is by nature 'optimistic' and 'positive thinking' in the conventional and traditional sense but realizing that the ideas might not be 'true' in a strictly rational sense but surely 'counter balance' the preponderance of negativity that people who use CBT first encounter.
8) The Behavioural aspect of CBT therapy looks at changing behaviour to change feelings. So if a person calls their wife names and she gets a restraining order, CBT would suggest that maybe this husband should not call his wife names if he wants to avoid a restraining order.
9) Another example of CBT is the writing of the events around trauma. Dr. Judith Wallenstein , the leading authority on PTSD at Harvard recommends that people who have experienced trauma write their "trauma story" as a kind of 'police report' then on the second line write the emotions that would be appropriate to the events.  During this process the person is to stop whenever they feel agitated rather than be 'retraumatised by the recall'.  This 'dissociation' recurrence is common in people who simply tell their trauma over and over again but never get on with life.  CBT encourages people to look at an event from 'multiple foci' rather than only seeing an 'event' from one perspective.
10) A typical CBT recommendation is to call a person when one is having negative thoughts rather than remaining alone with the negative thoughts.  There are Suicide Support Lines and Mental Health Support lines simply because "misery loves company' , a 'problem shared is a problem halved", the realization that one of the principle ways of breaking a negative chain of negative thinking is to talk to another person rather than 'nursing' the 'resentment' or 'bad mood' or 'negative thoughts'.
11) At one point for several years I had patients chart their moods with numbers 1-5 against other aspects of their daily life, eg sleep (hours), work (hours),  exercise (hours) , meals (number per day), positive meeting attendances (number per week or hours per week). In hospitals the nurses kept such graphs and we could see that patients moods, especially on geriatric wards, were commonly affected by lack of sleep or missing meals.  I also had as a family physician done several great detective hunts to find what was causing children patient to have allergic reactions or environmentally induced athmatic attacks. Given the CBT idea that changing the thoughts and behaviour would change the mood and ultimately improve thoughts and behaviour, this search for 'negative' triggers has often been quite fruitful.  People have found that certain 'friends' indeed were 'soul suckers' and didn't really want the patient to improve because they enjoyed their being down and as a 'sob sister'.  Often becoming emotionally well requires one to get away from emotionally draining people, not as a first resort, because more often than not we take our problems with us, but ultimately as a solution when others have failed.
I personally have to limit the amount of 'news' I watch because 'news' is marketted as 'depressing' and 'anxiety provoking. I once wondered why when my life was just fine I wasn't feeling a hundred percent and the answer was that I was allowing myself to be bombarded with all the problems of the world without any real way of my helping or changing matters.  One of the negatives of 'global community' is that much false information comes from a distance and we are commonly subjected to the insinuating blaming and begging that goes with 'enquiring minds need to know'.  So many of my patients have come in depressed simply because they are 'news aholics' and simply need to get away from the boob tube and computer screen.
12) Today in terms of Cognitive Behavioural Therapy I am as likely to recommend a person learn an 'affirmation' or positive prayer and use this as a 'thought blocking' technique when their mind is malfunctioning. I see the mind as either going forward with creative and  life affirming useful processing or going backward with past,  death, loss  and negativity. I see this is a car and that I have to simply change direction so use the prayer or affirmation as a kind of transmission neutral before I can get my mind on a forward track.  My favourite affirmations are 'All Shall be Well, All shall be well, and all manner of things shall be well,'  The Serenity prayer,  or sometimes just repeating the word 'peace' or 'one' as a meditation so well researched by Relaxation Response scientist, Dr. Herbert Benson.

   
The assumption in CBT is not that "I'm okay and you're not" but rather that I have mental 'skills' and 'techniques' and 'training' that help one's thinking and feeling'.  Change the thinking and behaviour and the feeling follows.  Further by disrupting these repetitive patterns of negative thinking and behaviour and feeling, the general result is a higher more functional form of thinking and feeling.
CBT was originally found to be most effective for mood disorders but has been used in all areas of mental illness with varying levels of efficacy. 
It has been extremely beneficially in treating panic attacks, phobias and a variety of anxiety disorders, though personally I'd say the insight therapies are probably of more long term and deeper benefit.

In addictions, Freud said that alcoholics were essentially untreatable and Jung said they needed a miracle.  Psychoanalytic therapy or "insight' therapy often made alcoholism worse as addicts tend to 'rationalize' and as they explored their personal history found even more reason for drinking. Dr. Jung felt that alcoholism needed a miracle.  Dr. Bob, co founder of Alcoholics Anonymous, said, 'Never deny an alcoholic the consequences of their alcoholism, because they only learn from consequences".  The recognition was that 'right behaviour lead to right thinking" given that MRI and various other evidences today suggests the brain of an alcoholic or addict is hijacked by the disease and therefore can't itself 'self repair' without a period of 'abstinence".  After a period of 'abstinence' there is the possibility that a person will be able to see their own behaviour and their situation from a wholly different perspective than the drug induced 'unreal' or even 'psychotic' perpsective.

Dialectic Behavioural Therapy is a form of CBT that has been found beneficial for personality disorders noting that personality disorders have a long standing pattern of maladaptive behaviour. The original adaption may have been essential at one time in that place but no longer serves a positive purpose. I found this most evidence in long term institutionalized patients whose 'jail house' behaviour had helped them survive but outside of the institution very much interfered with their ability hold jobs and establish relationships.  Dialectics is best consider in the Marxist Lenninist context considering origins but also it's been liked to Socratic method of investigation of the individuals behaviour pattersn. Again the 'rational' and 'cognitive' almost 'education' programing involved in these therapies is at variance to the original psychoanalytic therapy or even the Gestault therapies or Ericksonian models of therapy known to have high efficacy for behaviour change.

Eclectic therapy tends to incorporate a variety of therapies as does traditional and conventional 'supportive' therapies. CBT is commonly seen in this context as opposed t o it's purer more research based form.