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Cognitive Behavior Therapy, or CBT for short, is a specific
type of psychotherapy that is focused on helping people learn new thinking patterns that help them change their
emotional states. People who have been treated with CBT usually find that they have symptom relief
very early in the therapy process and they tend to find that they can maintain these gains over their lives.
They also find that they tend to only need a brief amount of therapy sessions (usually from 5-15 sessions) to achieve
their therapeutic goals
CBT is an active therapy that expects a cooperative working
relationship between therapist and client (and sometimes family members as well). Clients are taught that
they do have control over their emotions and moods and the relationship between the way they think and how
they feel. Negative thoughts are confronted and re-evaluated so that the client can actively work towards
eliminating first the cause of their emotional problem, then, the problem itself.
Our CBT therapists have worked with hundreds of clients
and have had great success with these set of techniques. Many clients have entered treatment with us after years
of psychoanalysis or other types of therapy that just did not work for them. After working with them
using CBT therapy, they found a new way to deal with their problem and started to feel better- at times, for the
first time in many, many years.
Don't just take our word for it- the recent literature
and government reviews are chocked full of support for this technique and its efficacy in helping people with anxiety,
panic and depression. The following article discusses how brain mapping may be able to show how CBT effects
brain function....
Apr 14 2005 - The Economist print editionTalk is cheap...and surprisingly effective
FOR almost a century after Sigmund Freud pioneered psychoanalysis,
“talk therapy” was the treatment of choice for many mental illnesses. Artists and writers lined up to lie down
and be analyzed, and the ideas of Freud, Jung, and other influential psychiatrists permeated the intellectual world.
They also seeped into the popular consciousness, and still pop up today whenever someone talks of a subconscious
desire, a Freudian slip, a death wish, or an Oedipal complex. But advances in neurology, and especially in pharmacology,
have called such therapy into question. When psychological and emotional disturbances can be traced to faulty brain
chemistry and corrected with a pill, the idea that sitting and talking can treat a problem such as clinical depression
might seem outdated.
Robert DeRubeis of the University of Pennsylvania and his
colleagues beg to differ, however. They have conducted the largest clinical trial ever designed to compare talk
therapy with chemical antidepressants. The result, just published in Archives of General Psychiatry,
is that talking works as well as pills do. Indeed, it works better, if you take into account the lower relapse
rate.
The study looked at a relatively modern type of talk therapy,
known as cognitive therapy, which tries to teach people how to change harmful thoughts and beliefs. Patients learn
to recognize unrealistically negative thoughts when they occur, and are told how to replace them with more positive
ones. It may sound too simplistic to work, but other studies have shown it can be used to treat anxiety, obsessive-compulsive
disorder and eating disorders. Dr DeRubeis wondered just how effective it really was for depression.
In the study, 240 patients with moderate to severe depression
were divided into three groups. One group was treated with cognitive therapy, a second with Paxil, an antidepressant
drug, and members of the third group were given placebo pills. (Those in the second and third groups did not know
whether their pills were placebos or not.) After 16 weeks of treatment, the results for those on cognitive therapy
and drugs were identical. Some 58% had shown perceptible improvement. By contrast, only 25% of those on the placebo
improved. That was encouraging. But the really surprising advantage of cognitive therapy is that it seems to keep
working even after the therapy sessions are over. A year after treatments ended, only 31% of those who had received
it had relapsed into their former state, while 76% of those who had been given antidepressants, and then been taken
off them, had done so. Even patients who stayed on antidepressants for the intervening year did not do any better
than those who had taken cognitive therapy and then quit.
If Dr DeRubeis's study can be replicated (an important “if”
in a soft-edged discipline such as psychotherapy), it has implications for the way clinical depression should be
approached in the future. One consideration, at least in America, where the study was done, is that many medical-insurance
companies that are willing to pay for antidepressant drugs nevertheless refuse to pay for psychotherapy. A successful
replication of the DeRubeis study ought to change that—not least because cost-benefit analysis shows that while
cognitive therapy is more expensive than drug treatment to start with (since it involves extended one-to-one sessions
with a highly paid specialist), it is cheaper in the long run because prescriptions do not have to be refilled
indefinitely.
Which is not to say that cognitive therapy will suit everyone
with depression. According to Dr DeRubeis, it is still likely that some patients will respond better to drugs than
conversation. The next breakthrough might be a way of working out in advance who fits which treatment
Cary Goldberg Globe Staff, 1/6/04Brain
mapping may guide treatment for depression
For the first time, researchers have mapped what
happens in the brain when a patient recovers from depression using cognitive behavioral therapy, a common form
of psychological treatment aimed at breaking the bad habits of thought that bring people low.
The changes in the pattern of brain activity
are quite different from those observed when patients recover with antidepressant drugs, and in some areas, even
opposite, according to findings reported yesterday.
The mapping may provide a first step toward
using brain scanning to determine which patients should receive antidepressants and which should receive psychological
training, a decision that is now often based on trial and error, said Dr. Helen Mayberg, the study's senior author.
"This experiment lays the groundwork
for looking for different markers that will help to optimize the treatment for a given individual; that's the really
cool part," said Mayberg, a professor of psychiatry and neurology who conducted the study while at the University
of Toronto but recently moved to Emory University in Atlanta.
Researchers also predict that the study
could help raise the public standing of cognitive behavioral therapy, a series of lessons that trains patients
to recognize their negative thoughts -- "I'm worthless" or "it's hopeless" -- and combat them
with facts.
More highly directed and shorter-term
than ordinary talk therapy, the psychological practice is already solidly established and is routinely paid for
by insurance companies, but it tends to get much less attention than antidepressant drug therapy.
The scanning study's importance is
"that you can see such a solid physical finding from a psychological treatment," said Dr. Bruce M. Cohen,
president of McLean Hospital in Belmont. He was not involved in the research.
More broadly, Cohen added, the findings
represent "one more step toward answering the question: What is happening in the brain when it's depressed?
What happens when you change the way you think or take a drug and change the way you feel?"
Mayberg and colleagues used a brain-scanning
technique called positron emission tomography to analyze for 15 to 20 sessions the brain metabolism of 14 subjects
whose depression lifted considerably after cognitive behavioral therapy.
They found, among other things, that some
areas in the cortex -- the outer rind of the brain associated with higher functions, such as thinking -- appeared
to become less active, seemingly because patients learned to ruminate and worry less. With antidepressants, those
regions became more active.
In essence, Mayberg said, depression stems
from a malfunction not in a single spot in the brain, but in a network or circuit of brain connections. The study,
published in this month's Archives of General Psychiatry, helps to contrast the two main approaches to fighting
it.
"The network can reset itself
via inputs working from a bottom-up perspective -- that, I think, is how drugs work -- while cognitive therapy
works by influencing top-down inputs, turning down rumination and worry areas," said Dr. Zindel Segal, a University
of Toronto psychiatry professor who worked on the study.
"Top-down" cognitive therapy
begins with the cortex and its higher thinking functions; "bottom-up" drug therapy begins with the deeper,
more primitive parts of the brain such as the brain stem and limbic system, which affect emotions and basic bodily
functions. Each eventually affects the other through a complex network that remains little understood. An estimated
one-fifth of Americans suffer from prolonged depression at some point.
Studies have shown that cognitive therapy
is not only at least as effective as antidepressant drugs for some patients, but that many are less susceptible
to relapse, said Aldo Pucci, president of the National Association of Cognitive-Behavioral Therapists.
Patients typically attend an average of
16 sessions, replete with homework, and come away with new skills that last much longer.
The therapy works, Segal said, by helping
patients become aware of their negative "self-talk" and how it interacts with their mood. For example,
he said, if patients have thoughts like "I'm unattractive," they are more likely to accept that thought
as fact. Cognitive therapy helps them "develop a capacity to talk back to this depressive propaganda."
There are no national statistics available
on how many people perform or undergo cognitive therapy, Pucci said, but his nine year old association already
has 5,000 members.
"We maintain that for the overwhelming
majority of people who are depressed, it's their thinking that causes their depression, not some biochemical problem,"
he said. The study, he said, "just supports what we've already been saying." Cognitive behavioral therapy
"doesn't need the support, but certainly we'll take it," he said.
In fact, the study does not address the
origins of depression, but it did suggest a basic aspect of antidepression therapy that surprised Mayberg: Drugs
and cognitive therapy appear to operate on two different tracks, with no "final common pathway," she
said.
Nov 21 2003Medications
or Psychotherapy for Depression?
That's a question that many people ask. The answer is complex.
More antidepressants are prescribed by family practitioners than by psychiatrists. These medications are often
the first treatment offered to people who are depressed. Managed care companies like this approach because antidepressant
medications are less expensive than psychotherapy.
Numerous meta-analyses of research have come to similar conclusions
about effectiveness. Cognitive-behavioral psychotherapy
alone is at least as effective as antidepressant medication. Combined psychotherapy with medication are also more
effective than medications, but some studies
suggest that the combination is no more effective than psychotherapy alone. Studies also suggest that the
relapse rate is higher among depressives treated with combined treatment than with just psychotherapy. Many studies
have found a higher dropout rate among those receiving medication, either because of side effects or because the
medication has not helped.
If the only tool you have is a hammer you tend to treat everything
like a nail. As providers of health care and mental health care we tend to use the tools that we are trained
to use. This can sometimes create problems. A saying attributed to different people (including Milton Erickson,
M.D.) says it best: If the only tool you have is a hammer you tend to treat everything like a nail. It may be no
coincidence that the authors of the studies cited here are psychologists. Psychologists are able to provide psychotherapy
but not medications. It's also no coincidence that most primary care physicians prescribe antidepressant medications
before they refer for counseling or psychotherapy. They have a prescription pad handy - but they do not have much
time to spend talking with their patient. We tend to use the tools that we have.
Studies agree that both antidepressants and psychotherapy
are effective treatments for depression. There is even agreement that a combination of the two may be more effective
than either alone. It may well be that one treatment is likely to be more effective than the other for a particular
person. The art and science of psychology and psychiatry are not yet refined enough to be able to predict which
treatment will be more effective for a given person.
If you are depressed keep these principles in mind. The practitioner
that you are seeing may have only certain tools available to him or her. Their recommendation for treatment may
have more to do with their training than with any particular knowledge of your situation. The most important point
may be that there are a variety of treatments that are effective for depression. It may not matter which treatment
your doctor or therapist offers first. If it doesn't work, ask him or her about alternatives.
References:
Antonuccio, David O., Danton, William
G., & DeNelsky, Garland Y. Psychotherapy Versus Medication for Depression: Challenging the Conventional Wisdom
With Data Professional Psychology: Research and Practice. December 1995 Vol. 26, No. 6, 574-585.
Jacobson, Neil S. Cognitive-Behavior
Therapy Versus Pharmacotherapy: Now That the Jury's Returned Its Verdict, It's Time to Present the Rest of the
Evidence. Journal of Consulting and Clinical Psychology February 1996 Vol. 64, No. 1, 74-80.
Karon, Bertram P. & Teixeira,
Michael A. "Guidelines for the Treatment of Depression in Primary Care" and the APA Response, American
Psychologist June 1995 Vol. 50, No. 6, 453-455
Schulberg, Herbert C. Clinical Practice
Guidelines for Managing Major Depression in Primary Care Practice Implications for Psychologists, American
Psychologist January 1994 Vol. 49, No. 1, 34-41
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