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Cognitive
Behavior Therapy
The
Basics
Hundreds of studies by research
psychologists and psychiatrists have made it clear Cognitive
Behavior Therapy is a clinically
and research proven break through in mental health
care. CBT has become the preferred treatment for
conditions such as these:
Substance abuse,
co-dependency and "enabling" Inadequate
coping skills, or ill chosen methods of coping with
eating disorders (anorexia and bulimia) and obesity.
Obsessions and compulsions (OCD
and related conditions) Panic attacks and phobias
Depression and
mood swings
Shyness and social
anxiety
Difficulty
establishing or staying in relationships
Chronic anxiety or
worry
Post traumatic stress symptoms (PTSD
and related conditions)
Trouble keeping feelings such as
anger, sadness, fear, guilt, shame, eagerness,
excitement, etc. within bounds
Over inhibition of
feelings or expression
Insomnia and other
sleep problems
Problems with
marriage or other relationships you are already in
Job, career or
school difficulties
Feeling
"Stressed Out"
Insufficient
self esteem (accepting or respecting
yourself)
Passivity, procrastination and
"passive aggression"
What is CBT? How
does it work?
CBT takes two effective forms of
Psychotherapy and combines them. They are:
Behavior
Therapy:
Behavior therapy teaches you how
to calm your mind and body so you can feel better
and think more clearly, thus making better
decisions. Many studies have shown that you need to
weaken the links between troublesome situations and
your learned reaction to them. Some of these
reactions are fear, depression, rage, self defeating
or self damaging behavior.
Cognitive
Therapy:
Cognitive therapy shows you how
certain thinking patterns can cause a persons
symptoms by giving them a distorted picture of
what's really going on in their life. This makes a
person feel, anxious, depressed or angry for no
apparent reason and can provoke a person into wrong
types of actions.
When these two forms are combined
into CBT, they provide you with very powerful tools
for stopping you symptoms and getting your life on a
more satisfying track.
CBT is active
therapy:
In CBT, the therapist doesn't
settle for just nodding wisely while you carry the
whole burden of finding the answers you came to
therapy for. The therapist takes an active part in
helping you to solve your problems. It is important
that at the beginning of the treatment a diagnostic
workup is made to make sure that your needs and
problems have been pinpointed as well as possible.
This step is most crucial and it
is often skipped or omitted altogether in
traditional kinds of therapy. Without this step it
would be impossible to make an explicit,
understandable and flexible treatment plan that
would accurately reflect your own individual needs.
CBT in this respect resembles education or coaching
or tutoring. Under expert guidance you will share in
setting the treatment goals and in deciding which or
what techniques work best for you personally.
Structured and
focused:
Unlike therapies that easily
venture off into interesting by unproductive side
trips, CBT sticks to the point and changes course
only when there is a sound reason for doing so. It
is important as you go thought the CBT program that
you do "homework" projects to speed your
progress. These assignments, which are developed as
much as possible with your active participation,
extend and multiply the results of the work done
with your therapist.
Your may also receive other
readings and or materials tailored to suit your own
individual needs and to help you to continue to
forge ahead.
What else is
different about CBT?
CBT focuses on finding out just
what needs to be changed and what doesn't and then
works by targeting those areas. People who come for
therapy need to change something in their lives,
whether it is how they feel, how they act or the way
other people treat them.
Past vs. present
and future:
CBT has found that it is important
to explore ones life history. Sometimes the current
problems are closely tied to "unfinished
emotional business" from the past or they might
be an outgrowth of a repeating pattern of
difficulty. It has been found that focusing on the
past (and on dreams) can help to explain a person's
difficulties but these activities all to often do
little to actually overcome them. Instead , with CBT,
the aim is for rapid improvement of your feelings
and moods and in early changes in any self-defeating
behavior that you may be caught up in. As you can
plainly see, CBT is more present centered and
forward looking that traditional therapies.
The levers of
change:
CBT focuses on exactly what
traditional therapies tend to leave out, how to
achieve BENEFICIAL CHANGE, as opposed to mere
explanation or "insight."
The two most powerful ways to
attain beneficial change (apart from medication in
some cases) are:
Altering the way of thinking, this
means changing a person's thoughts, beliefs, ideas,
attitudes, assumptions, mental imagery and ways of
directing his or her attention for the better. This
is the COGNITIVE aspect of CBT.
It is also important that a person
greet the challenges and opportunities in his or her
life with a clear and calm mind and then learning
how to take actions that are likely to have the
desirable results. This is the BEHAVIORAL aspect of
CBT.
CBT: The therapy
with by far the most research support:
In study after study CBT has been
shown to be as effective as drugs in treating both
depression and anxiety. Hundreds of studies on CBT
have been done and they have shown that CBT has been
more effective than drugs in avoiding treatment
failures and also in preventing relapse after the
end of the treatment. If there is a concern about
your ability to complete the treatment and maintain
the gains you have made keep this in mind.
The other symptoms for which CBT
has demonstrated its effectiveness include problems
with relationships, family, work, school, insomnia
and self esteem, it is also the preferred treatment
for shyness, headaches, panic attacks, phobias,
post-traumatic stress, eating disorder, loneliness
and procrastination.
No other type
of psychotherapy has anything like the track record
CBT has in outcome research.
What about drug
treatment?
CBT is usually employed by itself,
without psychiatric drugs. For some people, however,
drug treatment is needed to obtain a partial
reduction in symptoms before CBT can be fully
effective. Usually, though not always, it is
preferable to try CBT alone before prescribing
medication. This is for several reasons:
Benzodiazepine drugs such as
alprazolam (Xanax), plus certain other types of
tranquilizers, can be habit forming if taken over a
long period of time or in high doses. This is a
complication that needs to be avoided if possible.
Despite their reputation as "wonder
drugs", antidepressants such as amitryptaline (Elavil)
and fluoxetin (Prozac) work only about 65% of the
time. MAOI drugs (e.g.,Nargil) carry a risk of
hypertensive crisis, unintentionally consumed.
Finally, the mood stabilizer, Lithium Carbonate, can
produce toxic reactions unless it is very carefully
monitored.
In addition, research studies have
revealed these other facts about drug treatment for
depression and anxiety:
CBT and well chosen drugs, when
each is used alone, are about equally effective
during the period of active treatment.
Adding drug treatment to CBT is
not likely to get better results than using CBT
alone (except in special cases such as the one
described above).
Treatment failure is more likely
when drugs are used, typically because of side
effects.
Relapse after the end of treatment
is more likely when only drugs have been used. This
is believed to be because drugs, unlike CBT, do not
encourage the development of valuable coping and
emotional management skills.
Questions that are
being raised about antidepressant drugs:
There have been many questions
raised about antidepressant drugs, which are
increasingly being prescribed for anxiety condition
as well:
Whether widespread beliefs about
their effectiveness are scientifically justified.
The side effect and withdrawal
symptoms they can produce.
Their use with children.
Their safety, especially when used
in combination with other psychoactive drugs.
The theories about depression that
support their use.
Whether they really are as likely
to help as well chosen forms of psychotherapy.
What happens
further on in treatment?
The answer depends on how you are
progressing and on your therapist's and your own
preferences. These are among the options that are
often recommended.....
A trial termination of therapy -
with the option of resuming if the need develops.
Quite often, a follow-up session or phone contact is
scheduled for a future date.
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