Research Results: Cognitive Therapy Reduces Suicide Attempts by 50%

In light of all the recent discussion about antidepressant drugs that increase the risk of attempted suicide, we thought we’d highlight the study that came out last year, which showed that Cognitive Therapy (developed by Aaron T. Beck, M.D. in the 1960s) can reduce attempted suicide by 50% among those who have recently attempted suicide. This study, funded by the NIH and the CDC, followed 120 patients, half of whom were randomly assigned to 10 Cognitive Therapy treatment sessions, and the other half of whom received usual community services. At the 18 month follow-up, those who had not received CT treatment were twice as likely to attempt suicide as those who had received CT treatment. Check out the NY Times coverage of this study (you have to be registered to view the article – registration is free).

CT Myths: Three of the Most Common Misunderstandings about Cognitive Therapy

Myth: Cognitive Therapy (CT) is all about changing your thinking, and does not involve behavioral change.

Fact: Actually, Cognitive Therapy (developed by Aaron T. Beck, M.D. in the 1960s) addresses your thinking, emotions, behaviors, and physiological symptoms (if applicable). Cognitive Therapy (CT) is called Cognitive Therapy because it is based on the premise that your underlying beliefs about yourself, others and the world influence the way you perceive situations, and prompt you to have certain thoughts, emotions, behavioral responses and physical symptoms. CT treatment actually starts by addressing present problems and helping patients to have a better week — patients often begin evaluating their own thoughts and doing some behavioral experimentation very early on.

Myth: Cognitive Therapy only deals with surface layer problems, and it doesn’t do much to change the root of people’s problems.

Fact: Cognitive Therapy treatment starts by addressing present problems as a way to help patients gradually change their underlying problems. Cognitive Therapists work to understand patients’ ‘core beliefs’ — how they view themselves, others and the world. These beliefs are often formed in childhood and are deep-seated. And these beliefs pop up in every day situations in the form of anxious or depressed thoughts that lead to negative feelings and behavioral reactions to situations. Cognitive Therapists work with patients to analyze what’s happening in a given situation, come up with alternative responses, experiment with implementing new ways of thinking and acting, and gradually begin to change their responses to situations. When patients see how their reactions, mood and other symptoms can improve once they begin viewing situations in a more realistic light, they gradually begin to chip away at their ‘deep-seated’ core beliefs. In other words, Cognitive Therapists recognize that the best way to help patients alter their deep-seated beliefs and their current distress is to take action now, in the present, so that patients can see the effects of changing their thinking and behavior, and start to develop more positive and realistic outlooks after seeing the results in action their own lives.

Myth: All Cognitive Therapists do the same kind of therapy. So if I already tried a Cognitive Therapist and it didn’t help, that means that the treatment itself doesn’t help.

Fact: Not all therapists who call themselves Cognitive Therapists, or Cognitive Behavior Therapists are really trained and qualified to practice Cognitive Therapy (CT). As CT becomes more and more well known, due to the many studies that have shown it to be effective, more and more therapists are including CT ‘techniques’ in their practices, and some may call themselves Cognitive Therapists even if they do not have much training in Cognitive Therapy. Just because someone uses some part of CT in their practice, does not mean that he or she is actually delivering overall CT treatment (which is an integrative form of therapy that requires mastery of many different therapeutic techniques, and understanding of individualized treatment approaches for different disorders). We recommend that patients who are interested in CT treatment search for an ACT-Certified Cognitive Therapist. The Academy of Cognitive Therapy is the only Cognitive Therapist certifying organization that reviews therapists’ knowledge and ability before granting certification.

Research Results: CBT is Effective for Seasonal Affective Disorder

Need help getting through the winter? This week’s NY Times article says that Cognitive Behavior Therapy (CBT) is effective for Seasonal Affective Disorder (SAD) with or without light therapy, and that CBT is actually better than light therapy in preventing relapse among SAD sufferers.

The NY Times article refers to Dr. Kelly Rohan’s initial pilot study of 23 individuals with SAD. Dr. Rohan conducted a larger randomized controlled trial of 61 patients with SAD in 2005, and again found CBT to be effective in SAD treatment and relapse prevention. This later study is described in Science Daily, although the results have not yet been published. You can also read an interview with Dr. Rohan, in which she discusses her research on CBT for SAD.

What does Cognitive Therapy have to do with Nursing?

As Advanced Practice Nurses (APNs) interact with patients who have health problems, many of them find that their patients also suffer from mental health problems, including depression, anxiety, and other illnesses. So how can APNs best address the mental health needs of their patients? Two articles published this fall in Medscape’s Advanced Practice Nursing ejournal discuss how Cognitive Therapy (CT), also referred to as Cognitive Behavior Therapy (CBT), is an effective, time-limited, clinically tested treatment that is ideal for nursing settings. (To view these articles, you have to be registered with Medscape – registration is free.)

In Cognitive Behavioral Therapy in Advanced Practice Nursing: An Overview, Dr. Sharon Morgillo Freeman, a psychologist and certified Cognitive Therapist, discusses how CBT meets APNs’ need for effective, empirically based treatment — it’s a great overview for any APN interested in CBT, and includes a case example of a depressed patient treated with CBT. In Nurses Integrate Cognitive Therapy Treatment Into Primary Care: Description and Clinical Application of a Pilot Program, Dr. Judith Beck and Dr. Christine Reilly describe a pilot program that trained 12 APNs in CT, and monitored their success in implementing CT with low-income, underserved patients. This pilot program, conducted by the Beck Institute and the National Nursing Centers Consortium (NNCC), showed that APNs were able to integrate CT techniques in their primary care practices, with better patient results. We expect that in the future, we’ll see more and more integration of CT in nurse settings…

Research Results: CBT plus Medication is Effective for Gambling

An initial randomized, controlled trial shows that Cognitive Behavior Therapy (CBT) plus Selective Serotonin Reuptake Inhibitor (SSRI) can improve pathological gambling. For this study, 34 patients were randomly assigned to either medication alone, CBT plus medication, or CBT plus placebo for 16 weeks. Patients who received CBT plus medication improved the fastest. Further study is needed to assess long-term outcomes and other variables. Results were presented at the November, 2006 Canadian Psychiatric Association’s annual meeting.

CT Worldwide: Australian Government Provides Universal Mental Health Care Rebates

AUs

The Australian public health care system, Medicare, has just taken an important step in recognizing that mental health care is just as important as medical care. As of November 1st of this year, Australian patients suffering from mental health problems will be able to receive Medicare rebates for evidence-based treatment, including Cognitive-Behavior Therapy (CBT).

Patients can receive Medicare rebates for 12 annual individual or group consultations (or up to 18 in special cases) from approved mental health providers who practice evidence-based therapy (therapy that has been demonstrated in clinical trials to be effective). Patients must be referred to a mental health provider by a general practitioner, psychiatrist or pediatrician in order to receive the rebates, which can be used for the treatment of depression, anxiety, eating disorders, schizophrenia, and other illnesses.

This new Medicare rebate program was prompted in part by a highly successful pilot initiative called “Better Outcomes in Mental Health,” which aimed to integrate mental health care and primary care, and which specified that CBT or Interpersonal Therapy were the best evidence-based treatments. For more information about Cognitive Behavior Therapists in Australia, please visit The Australian Association of Cognitive and Behavior Therapy. Congratulations to Australia for helping to make mental health treatment more affordable to its citizens!

Research Results: Having Trouble Sleeping? Experts Recommend CBT for Insomnia

The American Academy of Sleep Medicine recently published updated guidelines for treating Insomnia and recommended Cognitive Behavior Therapy (CBT) as an effective, evidence-based treatment. The Academy’s new guidelines are based on a large review of 37 sleep studies that examined the effectiveness of various treatments for 2,246 insomnia patients. This review showed that Cognitive Behavioral Therapy (CBT), among other behavioral/psychological interventions, is an effective treatment for insomnia, and that sleep improvements last over time.

Research Results: CBT May Reduce Depression Relapse after ECT

 

Many studies have demonstrated that Cognitive Therapy (CT) is effective for depression, and twice as effective as medication in preventing relapse among depressed patients. So what’s new in CT for Depression research? A recent initial study shows that Cognitive Behavior Therapy (CBT) may decrease the risk of relapse specifically for depressed patients who are undergoing electroconvulsive therapy (ECT). For this study, six patients received 12 weeks of CBT following a course of ECT-only treatment. At follow up, five of the six patients had “much improved” or “very much improved” scores on depression measures, as compared to their measures after ECT treatment. Results indicate that CBT may prolong improvement among depressed patients who have received ECT.

Aaron Beck Video Clips

People often ask us for video footage of Aaron T. Beck, especially students. Here is a list of all the video footage we are aware of:

Brief Video Clips of Aaron T. Beck:
2006 Lasker Foundation Interview Clips with Aaron Beck (Free)
Aaron Beck speaks about origins of CT, how psychological treatments affect physiology, and widening use of CT, plus a clip of Beck and the Dalai Lama. If you have trouble viewing the clips on your computer, try selecting a different video player or speed.

2006 Aaron Beck Appears on the Charlie Rose Show (Free)

2001 Aaron Beck Accepts the Heinz Award (Free)
Brief video clip of Beck’s acceptance speech for the Heinz Award for the Human Condition. The full text of his speech is also available on the Heinz Awards website.

When the Mind Causes Pain (scroll down to view)
As part of this Video/DVD, Aaron T. Beck provides treatment strategies to reduce the symptoms of anxiety and depression.

Full Videotapes & DVDs of  Aaron T. Beck:
(2005) A Meeting of Minds: Aaron T. Beck and the Dalai Lama
A phenomenal DVD of Dr. Beck and the Dalai Lama engaging in conversation in front of a live audience at the International Congress of Psychotherapy in Sweden on June 13, 2005.

(2005) Recent Advances in CT: An Interview with Aaron T. Beck
Created for the European Association for Behavioural and Cognitive Therapies, September 21st, 2005.

(1979) Cognitive Therapy of Depression (scroll down to view)
A classic recording of an actual therapy session between Aaron T. Beck and a depressed patient.

(1977) Demonstration of CT of Depression (scroll down to view)
In this seminal Video/DVD, Dr. Beck demonstrates Cognitive Therapy (CT) while roleplaying with a depressed, suicidal woman.

One Therapist Writes In: Switching to CBT

Last week, we received the following in an email from a therapist in Arizona who began using CBT with his clients, and for his own battle with Multiple Sclerosis. Here’s what he experienced, in his own words:

I am a Licensed Associate Counselor in Arizona currently working toward independent status.  I have had supervisors of various theoretical orientations.  A few months into my M. A. internship it became apparent that very few had any real insight into client problems and psychopathology.  While some were very gifted, others seemed clueless.  I found this discouraging.

About 2 years ago I began to read everything I could on CBT.  I have read many works from the UK, works from both Drs. Beck, and a host of works on OCD, chronic depression, etc. etc.  Imagine my surprise when a good number of my clients suddenly began completing homework and actually GETTING BETTER!! Interestingly, I now find that practitioners from around my area now refer clients to me with depression and anxiety disorders, in spite of the fact that I am not independently licensed (of course, I continue to practice under direct supervision in a state funded community agency, though I hope to enter private practice one day).  I don’t think this would be happening had I not embraced CBT.  I work in rural southwestern AZ.  Many people here claim to use CBT, but after conversation it becomes obvious to me that most of them simply use one or two cognitive techniques here and there and really don’t utilize any type of case conceptualization.

In May of 2006 I received some bad news and was diagnosed with Multiple Sclerosis.  Looking back, my disease probably began to present around 1999, but I did not recognize it at the time.  I have found the techniques set forth in Padesky’s “Mind over mood“, along with antidepressant medication, extremely helpful for coming to grips with the uncertain future that characterizes MS.  While complete disability is a real possibility for me, I have been able to really look at things from a realistic point of view, and avoid catastrophizing.  I recently began walking with a cane (something I should have begun doing about 6 months ago) and was surprised when two of my clients told me that their doctors have been hounding them for a long time to use a mobility aid.  When I told them how much more energy it gave me they seemed interested and seemed to make the connection that walking with a cane does not automatically mean that one is weak (especially when they see how fast I can move with it!!). Anyway, wanted to share this information.  I anticipate taking a formal training course in CT once I can get the tuition saved and looking into certification with the Academy once I hit independent licensure.

— Kevin L. Benbow, MA, LAC