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

Research Results: Group CBT Reduces Anxiety among Women with Breast Cancer

A new study published in the American Journal of Psychiatry shows that group Cognitive Behavior Therapy (CBT) can reduce unwanted thoughts, anxiety and stress among women who have recently had breast cancer surgery. For this study, 199 women who had recently had breast cancer surgery were randomly assigned to one of two groups — they received either 10 weeks of group CBT, or a one-day seminar following surgery. The University of Miami, Florida team that conducted the study observed the women for one year, and found that those who had received group CBT had significantly less anxiety, intrusive cancer-related thoughts, emotional distress, and overall life stress than those in the control group. These improvements were maintained during the year post-treatment.

Aaron T. Beck Writes In: Early Response to CT, and Current Success

The following is a direct email excerpt from Dr. Beck’s conversation with an interviewer. [In response to a question about meeting resistance in publishing articles about Cognitive Therapy (CT) when Dr. Beck was first developing CT.] Dr. Beck: I did not have any resistance at all in publishing articles in psychiatric journals at the very beginning of my description of the theory and therapy. My first two articles in 1963 and 1964 were published in the prestigious Archives of General Psychiatry. The second article was also the subject of an editorial in the Journal of the American Medical Association. Having said that, the major phenomenon that I noticed (until there was a critical mass of empirical studies supporting cognitive therapy) was more or less disregard. That is, articles on depression in the mainstream professional journals occasionally mentioned cognitive therapy, although they generally emphasized psychodynamic therapy as well as the biological studies and pharmacological treatment. Cognitive therapy was totally ignored in the psychoanalytic journals; it was not perceived until fairly recently as a competitor of psychodynamic therapy. Certain individuals from the psychoanalytic field, however, ranged from skepticism to hostility in comments that they made to other people, which were brought to my attention. One psychoanalyst said that cognitive therapy was dangerous because it treated the symptoms instead of the causes, and eventually the patient would get worse because the causes were not addressed. Other criticisms were that it was superficial; it was like treating meningitis with mood music. Even today, a prominent British psychoanalyst said that cognitive therapy is like aspirin rather than an antibiotic. Also, the guidelines for depression published by the American Psychiatric Association tended to emphasize drug therapy and psychodynamic therapy, and cognitive therapy was addressed in a secondary way. The problem still exists today in that most of the training programs in psychiatry have a much larger load of training in psychodynamic therapy than in cognitive therapy and the other empirically based therapies largely (I suppose) because the instructors have been trained only in psychoanalytic therapy. This has become a self-perpetuating phenomenon. [In response to a question about why Cognitive Therapy (CT) has been successful.] Dr. Beck: I believe that success of cognitive therapy has been based on the following: a. With each disorder, the investigators (including myself) first made a careful phenomenological study of the disorder and created a cognitive model that fit the disorder. There is a generic cognitive model which needs to be adapted to each disorder. Thus, there are significant variations in the formulation of the specific disorder and also in the treatment. Based on the formulation, the treatment for obsessive-compulsive disorder is totally different from the treatment for panic disorder, which is totally different from the treatment for depression. b. The investigators validated the theory through research and then developed treatment manuals based on the formulations. c. I also believe the success has been based not only on the careful understanding of each disorder using the generic cognitive model, but on the strategies of cognitive therapy itself, which involves a number of features such as “guided discovery” and “collaborative empiricism.” The technique includes skills training, a reasonable degree of structure in the interviews (agenda setting), and homework assignments. d. The therapy has been validated in hundreds of clinical trials of numerous disorders.

Research Results: New Review Shows CBT is Effective for Children & Adolescents with OCD

A new review shows that Cognitive Behavior Therapy (CBT) is effective for pediatric Obsessive Compulsive Disorder (OCD). CBT can reduce distress and interfering symptoms among children and adolescents with OCD, and reduce the risk of relapse. CBT is effective by itself, and is also effective with medication, more so than medication alone. This review evaluated four separate studies, which were all randomized controlled trials of CBT for OCD.

Aaron T. Beck, M.D. appears on the Charlie Rose Show!

As part of a panel discussion, Dr. Beck discusses Cognitive Therapy (which he developed in the 1960s) and how it differs from Freud’s psychoanalysis. His segment starts 8 minutes into the show and runs until 19 minutes in. You can view video footage from this episode, entitled The Charlie Rose Science Series – Part One: The Human Brain, which aired on Tuesday, October 31st, 2006.

CT Worldwide: The UK, ahead of the game

globe.pngWe’ve been closely watching the UK, which has recently begun trying to make evidence-based mental health treatment more readily available to its citizens. The UK is far ahead of the U.S. in trying to implement an evidence-based agenda for mental health care, and ahead of many other countries as well. Back in 2004, the UK’s Lord Layard recommended increased use of Cognitive Behavior Therapy (CBT) to respond to the UK’s mental health needs. Providing evidence-based care is an effective and economical way to ensure that citizens receive a form of treatment that is clinically demonstrated to actually help. Layard points out that improving citizens’ access to evidence-based mental health treatment will help alleviate their mental health problems, and will also help many who are receiving “incapacity benefits” (disability benefits) due to mental health problems get back to work. Everyone wins in this situation — those with mental health problems get better care, and the UK’s costs in paying out incapacity benefits will go down as more citizens return to work.

Now, in 2006, the UK is beginning to move towards its goals by initiating a pilot program to improve citizens’ access to evidence-based treatment, including CBT.

Research Results: CBT Reduces Fatigue among Cancer Survivors

A new study just published in the Journal of Clinical Oncology shows that Cognitive Behavior Therapy (CBT) can help cancer survivors who are experiencing severe fatigue and functional impairment. If you know someone who has been cured of his or her cancer, but has unexplained fatigue, you may want to check out this study.

112 cancer survivors with severe fatigue were randomly assigned to one of two groups — half of them received CBT, and the other half was assigned to a waitlist for therapy (i.e. they did not receive therapy during the six month timeframe of the study). The group that received CBT treatment showed significantly reduced fatigue and functional impairment as compared to the control group.

Choosing a CT Therapist?

Cognitive Therapy (CT) has been demonstrated to be effective for many disorders in hundreds of clinical trials — it’s one of the most widely tested forms of psychotherapy.  As CT becomes increasingly favored among consumers and insurance companies, many therapists are now “saying” that they practice CT, even if they have not actually received sufficient training. Often, they may simply be incorporating some elements of CT into their practice, without fully delivering actual Cognitive Therapy treatment.

In 1998, Aaron T. Beck, M.D. (who developed Cognitive Therapy in the 1960s) and other leaders in the field established a non-profit certifying organization, the Academy of Cognitive Therapy (ACT), to serve consumers, thoroughly evaluate  therapists, and certify those who are truly qualified Cognitive Therapists. If you’re looking for a good Cognitive Therapist, we recommend that you search for an ACT-Certified Cognitive Therapist.

CT Worldwide

We’re going to start highlighting interesting Cognitive Therapy developments in specific U.S. states and countries around the world. You’ll see these highlights here as “CT Worldwide” followed by the location and a description of the new development. If you know of a geographic development that you’d like to see covered here, please let us know.

Books: The Beck Diet Solution is coming soon…

What does Cognitive Therapy (CT) have to do with dieting? That’s exactly what Judith S. Beck talks about in her new book: The Beck Diet Solution: train your brain to think like a thin person. CT has been effectively applied to a broad range of disorders, including eating disorders, and the same techniques that help people learn to think more realistically, feel better, and change their behavior for other problems can also help them to lose weight. Dr. Beck has written a book for consumers with a truly new approach to dieting. It’s a six-week program that provides step-by-step instructions for using cognitive (thinking) and behavioral skills to lose weight and keep it off permanently. Look for The Beck Diet Solution in April of 2007.