DR. NEAL HOUSTON

Adult Integrative/Behavioral Health Specialist

The Life Therapy Group®™ Mental Health & Life Wellness Site

MJA Healthcare Network

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Sunday, March 1, 2015

WHAT IS COGNITIVE BEHAVIORAL THERAPY



There are many kinds of psychotherapy. There is no "one-size-fits-all" approach. In addition, some therapies have been scientifically tested more than others. Some individuals may have a treatment plan that includes only one type of psychotherapy. Others receive treatment that includes elements of several different types. The kind of psychotherapy an individual receives depends on his or her needs.



Cognitive Behavioral Therapy (CBT) is a blend of two therapies: Cognitive Therapy (CT) and Behavioral Therapy. Cognitive Therapy was developed by psychotherapist Dr. Aaron Beck, M.D., in the 1960's. Cognitive Therapy focuses on an individual s thoughts and beliefs, and how they influence a person's mood and actions, and aims to change a person's thinking to be more adaptive and healthy. Behavioral Therapy focuses on a person's actions and aims to change unhealthy behavior patterns.

CBT helps an individual focus on his or her current problems and how to solve them. Both patient and therapist need to be actively involved in this process. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly.


Cognitive Behavioral Therapy (CBT) can be applied and adapted to treat many specific mental disorders.


CBT for Depression:
Many studies have shown that CBT is a particularly effective treatment for depression, especially minor or moderate depression. Some individuals with depression may be successfully treated with CBT only. Others may need both CBT and medication. CBT helps people with depression restructure negative thought patterns. Doing so helps people interpret their environment and interactions with others in a positive and realistic way. It may also help an individual recognize things that may be contributing to the depression and help him or her change behaviors that may be making the depression worse.

CBT for Anxiety Disorders:
CBT for anxiety disorders aims to help individuals develop a more adaptive response to a fear. A CBT therapist may use "exposure" therapy to treat certain anxiety disorders, such as a specific phobia, post-traumatic stress disorder, or obsessive compulsive disorder. Exposure therapy has been found to be effective in treating anxiety-related disorders.1 It works by helping a person confront a specific fear or memory while in a safe and supportive environment. The main goals of exposure therapy are to help the patient learn that anxiety can lessen over time and give him or her the tools to cope with fear or traumatic memories.
  • A recent study sponsored by the Centers for Disease Control and Prevention concluded that CBT is effective in treating trauma-related disorders in children and teens.

CBT for Bipolar Disorder:
Individuals with bipolar disorder usually need to take medication, such as a mood stabilizer. But CBT is often used as an added treatment. The medication can help stabilize a person's mood so that he or she is receptive to psychotherapy and can get the most out of it. CBT can help a person cope with bipolar symptoms and learn to recognize when a mood shift is about to occur. CBT also helps individuals with bipolar disorder stick with a treatment plan to reduce the chances of relapse (e.g., when symptoms return). 2

CBT for Eating Disorders:
Eating disorders can be very difficult to treat. However, some small studies have found that CBT can help reduce the risk of relapse in adults with anorexia who have restored their weight. 3 CBT may also reduce some symptoms of bulimia, and it may also help some people reduce binge-eating behavior. 4

CBT for Schizophrenia:
Treating schizophrenia with CBT is challenging. The disorder usually requires medication first. But research has shown that CBT, as an add-on to medication, can help a patient cope with schizophrenia. 5 CBT helps patients learn more adaptive and realistic interpretations of events. Patients are also taught various coping techniques for dealing with "voices" or other hallucinations. They learn how to identify what triggers episodes of the illness, which can prevent or reduce the chances of relapse.
  • CBT for schizophrenia also stresses skill-oriented therapies. Patients learn skills to cope with life's challenges. The therapist teaches social, daily functioning, and problem-solving skills. This can help patients with schizophrenia minimize the types of stress that can lead to outbursts and hospitalizations.


Sometimes psychotherapy alone may be the best treatment for a person, depending on the illness and its severity. Other times, psychotherapy is combined with medications. Therapists work with an individual or families to devise an appropriate treatment plan.







This post explains CBT - a commonly used therapy. However, it does not cover every detail about therapy. Patients should talk to their Doctor or a Mental Health Professional about planning a treatment that meets their needs.

It's important to remember that cognitive behavior approaches use a different formulation for each psychiatric disorder. We use this formulation in conceptualizing the individual patient which is an essential component to developing a sound therapeutic relationship, setting goals, planning treatment, and selecting interventions. Building trust and rapport with patients from the very first contact, demonstrating accurate empathy, sharing the conceptualization with the patient (and making sure it “rings true” for the patient), and collaborating are also essential. Another important part of every therapy session is helping patients respond to inaccurate or unhelpful ideas. The basic question to ask when a patient is reporting a distressing situation, emotion, or dysfunctional behavior is: “What is going through your mind right now?” Once we help patients identify their dysfunctional thinking, we help them gain more adaptive and accurate perspectives, especially by helping them examine the validity and usefulness of their thoughts. We also help them design behavioral experiments to test the accuracy of their predictions.

Citations
1 Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry. 2008 Apr; 69(4): 621-632.
2 Hausmann A, Hortnagl C, Muller M, Waack J, Walpath M, Conca A. Psychotherapeutic interventions in bipolar disorder: a review. Neuropsychiatry. 2007; 21(2): 102-109.
3 Pike KM, Walsh BT, Vitousek K, et al. Cognitive behavioral therapy in the posthospitalization treatment of anorexia nervosa. American Journal of Psychiatry. 2003;160(11):2046-2049.
4 Chen E, Touyz SW, Beumont PJ, et al. Comparison of group and individual cognitive behavioral therapy for patients with bulimia nervosa. International Journal of Eating Disorders. 2003;33(3):241-254.
5 Rathod S, Kingdon D, Weiden P, Turkington D. Cognitive-behavioral therapy for medication-resistant schizophrenia: a review. Journal of Psychiatric Practice. 2008 Jan; 14(1):22-33.
6 Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK, Lindenboim N. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry. 2006 Jul;63(7):757-766.
7 De Mello MF, de Jesus MJ, Bacaltchuk J, Verdeli H, Neugebauer R. A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. European Archives of Psychiatry and Clinical Neuroscience. 2005 Apr; 255(2):75-82.
8 Frank E, Kupfer DJ, Thase ME, Mallinger AG, Swartz HA, Fagiolini AM, Grochocinski V, Houck P, Scott J, Thompson W, Monk T. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Archives of General Psychiatry. 2005 Sep; 62:996-1004.
9 Miklowitz DJ, Richards JA, George EL, Frank E, Suddath RL, Powell KB, Sacher JA. Integrated family and individual therapy for bipolar disorder: results of a treatment development study. Journal of Clinical Psychiatry. 2003 Feb;64(2): 182-191.
10 Rea MM, Tompson MC, Miklowitz DJ, Goldstein MJ, Hwang S, Mintz J. Family-focused treatment versus individual treatment for bipolar disorder: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology. 2003 Jun;71(3):482-492.