Depression Therapy Treatment with Cognitive Therapy
At a fundraiser on November 11, 2013, Aaron Beck talked with an audience about Depression Therapy. While treating patients for depression in the 1960’s, he recognized a repeated pattern. When he helped patients change their current thoughts about themselves, the patients’ moods would improve. For example, a patient would stop thinking “I am useless” because he lost a job, to “I am talented, I will find a new job.” Dr. Beck began to change his focus of therapy from analyzing childhood events, to challenging patients to change their negative thoughts. Additionally, he began encouraging them to recognize and remember the many positive aspects of their lives. He went into academia at the University of Pennsylvania where he expanded, researched, and taught his ideas to others in the field of psychology,
Dr. Beck, 92, is known as the father of Cognitive Behavioral Therapy (CBT), and is internationally respected for his views on psychotherapy. Dr. Beck has written dozens of books detailing effective ways to treat different disorders by using his “thought changing” techniques. The November 11 event was a fundraiser for his Beck Institute of Cognitive Therapy. The money raised will be used to defray the costs of teaching CBT to practitioners and allow low-income clients to receive CBT treatment at the Institute.
Stacy Burling’s article published in the Inquirer on November 11, 2014 describes the details of the event:
Judith Beck, a formidable psychologist in her own right, describes her father, the psychiatrist Aaron Beck, with a mixture of amusement and veneration, as a “rock star.”
The Becks were the attractions at a fund-raising event last week for their Beck Institute in Bala Cynwyd. But it was clear that the elder Beck, known as the father of cognitive behavior therapy and one of the world’s most influential therapists, was the main draw.
Before they took the stage at WHYY in Center City to discuss their form of treatment – aimed at changing self-defeating thinking – they met with 70 “patrons” who had paid $250 a ticket for one-on-one access.
Aaron Beck, known as Tim to friends, is 92 and seriously stooped, but he was engaging and congenial as well-wishers waited in line for a chance to bend down to talk with him.
He seemed to relish the job of selling the institute, which he and Judith Beck founded 20 years ago. After the remaining 90 ticket-holders ($150 and $75) were within earshot, he joked that he and she had kept news of the center quiet until now.
“This is sort of a coming-out party for the Beck Institute,” he said.
The institute provides training in cognitive therapy as well as treatment. It recently expanded both and was raising money to help defray costs for students and patients who cannot afford the fees. This was its first fund-raiser.
“We decided the time was right to get the word out more about what we do,” Judith Beck said.
Many people think all psychotherapy is the same and equally effective, she said. “You need someone with a kind ear and the expertise to get you over what you’re suffering.”
Aaron Beck was an early advocate of measuring the effectiveness of his therapeutic approach and says cognitive therapy is now well-positioned because the Affordable Care Act encourages the use of “evidence-based” treatments.
Under the benevolent questioning of WHYY host Marty Moss-Coane, the Becks talked about their past and future with a very supportive audience.
Before Aaron Beck described how he happened on the new approach in the 1960s, he warned, “I’ve told this story before, so those who’ve heard it before can turn off their hearing aids.”
He was doing traditional psychotherapy when a patient revealed that she worried during their sessions that she was boring him. Her tales of her sexual escapades were not boring. Beck started asking other patients what they were thinking, and a theme emerged. As they went about their lives, they were telling themselves, “I am a loser.”
No wonder they were unhappy.
Beck thought it might be more fruitful to worry less about how patients felt about their mothers and work instead on changing their thinking. In each case, he’d ask them “What is the evidence?” for the negative thoughts, and challenge them to consider another explanation. He also urged them to focus more on positive things that happened, since his depressed patients seemed to selectively remember the bad.
Patients started feeling better, he said, and after 10 or 12 sessions, they told him they longer needed him.
“Until then, I was able to fill my schedule up,” Beck said drily.
This newfound efficiency, he said, led to his academic career at the University of Pennsylvania.
While new therapists get training in cognitive therapy, and many say they do it, Judith Beck said most are not doing what she recognizes as cognitive behavior therapy.
In a true CBT session, she said, the therapist assesses the patient’s mood, asks about changes since their last meeting, including positive events, and works with the patient to set an agenda for the hour. They talk about distorted automatic thoughts and how to change them.
At the end, the therapist asks the patient to summarize what happened and write down what was important. They talk about the patient’s homework for the next session, and the therapist asks for feedback and ideas on how to do better next time. That sets a “collaborative” tone.
As for the future, Aaron Beck said he thinks that evidence eventually will lead to a single approach. Cognitive therapy will be a big component of it, but it will be “fleshed out and modified in many ways.”
Aaron Beck, who uses an iPhone, iPad, and Skype, also thinks technology will bring better treatment to rural residents.
Judith Beck said her highly accomplished family – her mother is retired Superior Court Judge Phyllis Beck – gets along well.
“My father would say, ‘Problems are meant to be solved,’ ” she said.
“Have you thought about working with Congress?” Moss-Coane quipped at one point.
Aaron Beck said his publisher considered sending copies of his book, Prisoners of Hate, to lawmakers when it came out in 1999, but never did.
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Depression Therapy: When is it time to see a Professional?
- You feel hopeless or helpless. According to Serani, your thoughts might sound something like this: “Why is everything so hard for me? “Often, helplessness is a negative circle. If you feel helpless, you get more depressed. When you get more depressed, you feel helpless.”
- You feel guilty, worthless or ashamed. Unfortunately, depression is sometimes misperceived as a character flaw (instead of a real, debilitating illness), said Serani, also author of the books Living with Depression and Depression and Your Child. “So many children and adults blame themselves for not being able to snap out of depressed episode.” They think: “I’m so stupid,” or “I can’t do anything right.”
- You experience extreme irritability, anger or impatience, Serani said. “These symptoms are often misunderstood and viewed as ‘burnout’ or ‘stress.’” However, when agitated individuals are further questioned, they “reveal more classical symptoms of depression like negative thinking, helplessness, sadness and hopelessness.”
- You don’t want to be around others. You might start taking time off from work, Coleman said. “Coworkers might ask if you’re feeling OK, or comment to you that you don’t seem like yourself.”
- You have a harder time concentrating on tasks, even ones you enjoy, Coleman said. “It’s common for people with depression to read, write and even think more slowly.”
- You’re tired, have less energy or don’t feel like getting out of bed, he said. “A lot of the time, the signs of depression show up in our bodies.”
- You have headaches or body aches, Serani said.
- Your sleeping patterns have changed. You might have trouble sleeping and wake up much earlier than you normally do, Coleman said. Or you start oversleeping. “The key is to look out for a major change in the way you sleep”
- Your eating has changed. Some people with depression find food to be less appetizing and start to eat less, whereas others eat more than usual, Coleman said. Again, the factor to zero in on is change.
If you have any of the above symptoms, you may be clinically depressed. Ask yourself if it is time to look for a professional to help alleviate these symptoms.
** If you’re having thoughts of suicide, please get help immediately. Call the National Suicide Prevention Lifeline at 1-800-273-TALK or 1-800-273-8255.
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Symptoms of Depression & How Talk Therapy can Help
While the number of suicides is at its lowest in December, the number of people who report symptoms associated with depression is at its highest. During the holidays, many of my clients report new symptoms of depression, including:
- Fatigue and decreased energy
- Inability to make decisions
- sadness or unhappiness
- Irritability or frustration, even over small matters
- Loss of interest or pleasure in normal activities
- not wanting to be around other people
One of the most common issues my clients struggle with during the holidays is that of managing expectations about people, events, and feelings. Many people have beliefs about the holidays that are simply not true, such as:
It is the best time of the year.
Everyone will show their love for everyone else.
Family will all gather together and feel only joy.
Carefully chosen presents will be appreciated.
My partner is going to give me that gift I have always wanted.
I am going to love going to 12 cocktail parties.
I have to eat and drink all that is offered.
I am going to use this family time to “fix” all our problems.
I can get by with only 4 hours of sleep.
This tree and my decorations are so fabulous, everyone will know and appreciate how hard I worked.
It is OK to stay up until 3:00am on a work day, because I have to have 4 dozen decorated cookies.
My child will not be able to survive if she does not get DaisyDoItAll Doll.
Everyone else is going to parties every night, I am only invited to one.
I lied to my friend and told her I was busy the night of her party, now I feel guilty.
Why is everyone else have such a great time, and I am miserable? What is wrong with me?
This list goes on and on. What are your expectations for the holiday time? Do you share any of the above beliefs? Your therapist may be able to help you see the connection between these unreasonable expectations and your symptoms of depression.
Some things you can try to help prevent falling into the holiday depression cycle are:
Plan ahead, make a schedule.
Only say “Yes” when you want to say “Yes”. Be okay with saying “No”.
Get your regular number of sleep hours each night.
Let go of Perfection, you can buy cookies at the store, eight strands of lights on the tree are enough.
Prepare a neutral response to conflictual situations, especially with family members.
Don’t expect anyone to behave in a way significantly different from the way they behaved last year, the holidays are not a good time to do a family “intervention” or “rescue”.
Don’t expect a partner of friend to be able to read your mind and deliver the perfect gift.
Create activities that you truly enjoy, even if they are outside your usual holiday traditions.
Challenge yourself to set realistic goals for your holiday time. Remember, there will be things that do not go as planned. Try to enjoy the good times.
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Controlling Emotions: Is it possible?
This discussion about controlling emotions compares two different women’s reactions to the same event.
First Woman’s Reaction: Take a Picture
When photographer Hannah Price moved from Colorado to Philadelphia, she began to experience something new to her – catcalls from men on the street. After several catcalling episodes, she decided to take action. She would either snap a photo of the man immediately; or she would talk with him about the incident, and then ask if she could make his portrait. Ms Price created a project called “City of Brotherly Love” from these photographs.
Ms Price states her project is not meant to be an aggressive rebuttal to the individuals in the photos. It is, she states, “just a way of trying to understand it. It was way for me to just deal with it on another level besides avoiding it. Sometimes it’s easier to … just respond….. you just start talking to people, you find out more about them than your initial [impression].”
To see the complete 17-photo collection, see the NPR blog post of Code Switch by Kat Chow.
Second Woman’s Reaction: Send a Message
Brooklyn artist Tatiana Fazlalizadeh’s response to her experiences in Brooklyn is very different from Ms. Price’s response with the photography project. She created posters with direct negative messages to the catcallers and posted them around her neighborhood. Ms Fazlalizadeh states she can’t walk down her street without getting catcalled or harassed. “It happens almost daily to me where I get frustrated or annoyed or upset by something that someone has said to me or done to me outside on the street.”
Why the Difference?
Why does one woman feel okay to take photos and even have a conversation about the experience, and another woman feel anger and frustration? Our individual responses to catcalls are a result of our thoughts about the experience. If we think: “wow, someone thinks I’m cute.”, “I still have it”, or “this is going to be a good day”, our response may be: happiness, a big smile, a skip in our step, better posture.
If we think: “that reminds me of my abusive former boyfriend”, “will he try to come after me?”, “they must think I am promiscuous”, our response may be: fear, increased heart rate, hunched posture, a frown, anger.
Kat Chow, A Photographer Turns Her Lens On Men Who Catcall, October 17, 2013.
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CBT for Teens
CBT for Teens is a workshop being offered by a group in New York City. I just signed up at the American Institute for Cognitive Therapy. Workshop will be lead by Dr. Laura Reigada, and focus on Cognitive Behavioral skills when working with children and their parents. I look forward to learning new skills and insight into parent-child relationships.
Laura Reigada Ph.D., American Institute for Cognitive Therapy, is currently an Assistant Professor in the Department of Psychology at Brooklyn College of the City University of New York and an Adjunct Assistant Professor of Pediatrics at Mount Sinai School of Medicine. She completed a two-year NIMH postdoctoral clinical research fellowship at the Institute for Anxiety and Mood Disorders, at the NYU Child Study Center, within the NYU School of Medicine. Dr Reigada continued her education by becoming a NIH Child, Intervention, Prevention and Services fellow. Currently she has grant funding to develop and test an integrative cognitivebehavioral intervention that jointly addresses anxiety and physical complaints within the context of pediatric chronic illness. Based on her research, the Crohn’s and Colitis Foundation of America named her the first Goldman Scholar in Pediatric Research. Dr. Reigada has extensive clinical experience working with children and adults on anxiety, mood disorders, parenting, school avoidance, functional pain and chronic illness. She is a founding member, and pastpresident, of the New York City Cognitive Behavioral Therapy Organization.
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Your Brain Changes After "Talk Therapy"
- biological brain changes after cognitive behavioral therapy
- the effects of cognitive behavioral therapy can be studied empirically
Does Cognitive Behavioral Therapy Work? Will it Work for ME??
As a Cognitive Behavioral Therapist, I believe in what I do, see daily results, and know that Cognitive Behavioral Therapy (CBT) can change lives. My confidence in this type of therapy was strengthened when I came across a scientific study analyzing the effectiveness of CBT. Experts in the psychology field reviewed the therapeutic results of using CBT when working with patients with differing mental health disorders. The study was published in the Clinical Psychology Review 26 (2006) under the title: The empirical status of cognitive-behavioral therapy: A review of meta-analyses by Andrew C. Butler, Jason E. Chapman, Evan M. Forman, and Aaron T. Beck.
The psychologists found CBT to be an effective treatment for:
- generalized anxiety disorder
- panic disorder with or without agoraphobia
- social phobia
- posttraumatic stress disorder
- childhood depressive and anxiety disorders
- marital distress
- childhood somatic disorders
- chronic pain
(Savannah Krantz (Greenhill, 2014) provides a comprehensive summary of the study at the end of this post.)
These results are so encouraging to patients and treatment providers who deal with the pain of mental illness everyday. This wide-ranging, scientifically significant study gives confidence and hope to people entering therapy. If you are reading this post, and looking for help with a mental health challenge, consider finding a Cognitive Behavioral Therapist. You can find more information and details about the treatment process by going to the Beck Institute of Cognitive Therapy.
If you live in the Dallas area, and would like to talk about treatment with a Cognitive Behavioral Therapist, please read my web page at Holly Scott, MBA, MS, LPC.
Effectiveness of Treatment with Cognitive Behavioral Therapy
by Savannah Krantz (Greenhill, 2014)
Cognitive Behavioral Therapy, also known as CBT or CT, has been closely examined in many psychological studies relating to treatment results. The cognitive-behavioral treatment of mental disorders is often compared and contrasted with other treatments. CBT differs from behavioral therapy because it suggests that cognitive thoughts produce aberrant behavior, and therefore, CBT focuses on cognation. In an attempt to determine whether CBT has a higher success rate than other treatments, this study required a meta-analysis. This type of research pulls results from previous studies, works to sort out their differences, and essentially combines them. Meta-analysis measures what is called the effect size, which is the measure of strength in statistics. This process aims to estimate the effect size with a large sample of studies rather than a single study, which would only provide data drawn from a single set of circumstances. Similar to using a large sample size in an experiment, using meta-analysis sharpens the precision of the effect size because it eliminates the involvement of erroneous factors.
This CBT study examined many mental disorders: adolescent and adult unipolar depression, generalized anxiety disorder, panic disorder, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, schizophrenia, anger, bulimia nervosa, internalizing childhood disorders, sexual offending, and chronic pain. Not only does the meta-analysis inspect the effects of CBT treatment, but the study also compares the results to other treatment results whenever possible. Out of these disorders, three used data from an uncontrolled effect size: obsessive-compulsive disorder, schizophrenia, and bulimia nervosa. Unlike a controlled effect size, the improvement was measured within its group, rather than being compared to other treatments and/or conditions.
In the results, the U3 score is provided next to the effect size. The U3 score is a percentage that indicates whether or not CBT was more successful than other treatments. If the U3 score is 50%, that means that on average, the CBT patient experienced the same results as the control patient who received other treatment. If the percentage is above 50% and the effect size is positive, the CBT patient’s outcome was superior. If the percentage is above 50% and the effect size is negative, the CBT patient’s outcome was inferior to the control. The higher the percentage, the more (if positive ES) or less (if negative ES) successful CBT was on average.
CBT was proved to be superior to all other treatments for adult and adolescent depression, but was only very slightly more successful than behavioral treatment, with a U3 score of 52%. CBT was more successful than all other treatments for general anxiety disorder, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, schizophrenia, anger, bulimia nervosa, internalizing childhood disorders, and sexual offending. Two exceptions, chronic pain and panic disorder (with and without agoraphobia), had either one or two elements that were proven to be less successful when treated by CBT.
Overall, the meta-analysis proved that CBT appears to be the superior treatment for these sixteen mental disorders. This can be accredited in part to the fact that CBT differs from other treatments due to its ability to teach the patient therapeutic skills that the patient can then apply, without external assistance, into his or her everyday life.
Clinical Psychology Review 26 (2006), The empirical status of cognitive-behavioral therapy: A review of meta-analyses by Andrew C. Butler, Jason E. Chapman, Evan M. Forman, and Aaron T. Beck.
Mental Health Therapy and Cancer
Mental health counseling and therapy can obviously be helpful when dealing with the anxiety and depression a patient may experience after first hearing a cancer diagnosis, but counseling can be essential later also, after the initial shock is gone. Some patients handle the initial crisis stage quite well, but then struggle emotionally once treatment is completed.
When I was a cancer patient, I had a large red X on my calendar that showed me The Last Day Of Treatment. It was almost always the first topic of conversation with fellow cancer patients. We each asked of the other, “How many more rounds of chemo do you have?” or “When is your last day of radiation?”, etc., as we all eagerly looked forward to that last day.
As the last day came and went, I began to feel better physically, a little stronger each day. Psychologically, however, I began to experience some surprising new anxiety. During treatment, my fears where assuaged with thoughts of “I am fighting this!” and “My doctors and nurses are doing everything they possibly can to help cure me.” Once I was no longer seeing a medical professional weekly, I began to feel much more alone with my cancer.
Lidia Schapira, MD, medical oncologist at Massachusetts General Hospital, describes a patient’s coping with the end of active cancer treatment as follows:
Typically, there is a surge in anxiety and worry over the possibility that the cancer will return once active treatment is completed. Often, people feel they are not doing enough to actively fight the cancer. People often want to know what signs to look for to detect a cancer recurrence (return) as early as possible and recognize the long-term side effects of treatment.
If you are in treatment now, or know someone in treatment, remember the transition from cancer patient to cancer survivor can be a difficult one. Some common symptoms of anxiety during this transition are:
- worry about recurrence
- worry about finances
- thinking about dying young, before you expected
- loss of ability to plan for the future
- poor body image or self esteem
- thoughts of “why me?”
- blaming self and feeling “deserving” of the cancer
- anger over the losses of time for treatment
- fear of the long-term side effects of the treatments
- fear of ongoing fatigue and weakness
- inability to handle social situations
Therapy for Managing Depression, Anger and Aggression
Classic Cognitive-Behavioral Therapy models are based on the assumption that thoughts(cognitive processes) dictate feelings. Those feelings then dictate behaviors (or actions).
Here is a basic example:
A fire alarm goes off in a hotel at night
Person A thinks: some kids pulled the alarm and now I am awake!
Person A feels: anger at the kids andannoyance about being awake.
Person B thinks: there must be a fire, I must get out!
Person B feels: fear of being trapped in the fire, worry about how to escape
Person C thinks: I remember when my friends and I liked to pull the fire alarm.
Person C feels: understanding of kids having fun and comfortable to go back to sleep.
You CAN control you thoughts, which leads to the ability to have more positive feelings.
Christy Motta, MA summarizes a Cognitive-Behavioral approach to dealing with aggression below:
In the case of aggression, the individual must change the perceptions and beliefs that contribute to increased anger. In order to do this, the individual must: 1. Cope with arousal. The first step is to identify (observe) what is happening. The individual must become aware of when they are angry and notice the physical sensations and thoughts that accompany it.
2. Replace problem thoughts with thoughts that are helpful in dealing with PROVOCATION. “This could be rough, but I can deal with it” “easy does it” “Live and let live” “Stick to the issues. Don’t take it personally.”
3. Modify problem thoughts to those that are helpful in dealing with CONFRONTATION. “keep my cool, walk away, take a time out” “I don’t need to prove myself” “There’s no point in getting mad”
4. Change appraisals and reflections AFTER A CONFRONTATION.
a. Unresolved: “They don’t have to agree” “let it go” “don’t take it personally”
b. Resolved. Label (Describe) what happened. Praise self.
People frequently need some external limits in order to identify their aggression as a problem and begin actively working on modifying their thoughts. Probation, the risk of losing housing and the risk of losing important valued relationships are common consequences that get people thinking about their aggression.
How to YOU choose your therapist?
Once you make the decision to pursue counseling, you must then decide WHICH therapist to call. Many people ask friends or family members for recommendations, others search the internet, and still others use the old-fashioned yellow pages. No matter how you choose, that first session is your opportunity to see if you have found a therapist who will meet your needs.
Dr. John Grohol, CEO of PsychCentral, writes
The four most important attributes of a good therapist are:
1. A good therapist is positive and empathetic.
2. A good therapist is professional, courteous, and respectful.
3. A good therapist recognizes her strengths and limitations.
4. A good therapist is genuine.
As you meet and talk with your therapist the first time, look for these characteristics. Here are some suggestions of questions you could ask as you are determining if your therapist has the four key criteria listed above:
- How are you licensed? What are your training credentials? Do you belong to any professional groups?
- How would you describe your treatment style? Many different treatment styles exist. Different approaches may be more or less appropriate for you depending on your situation and needs.
- What kind of evaluation process do you use to recommend a treatment plan?
- What are the measurable criteria you use to assess how well treatment is working? Can you give me a few examples?
- Do you use published clinical practice guidelines to guide your treatment planning? How?
- What psychotherapeutic approaches and tools do you use?
- How do you decide which approach is best for the patient? Do you ever use more than one approach? When?
- How will you work with other medical providers, such as psychiatrist, who may also provide care?
- How often will we meet? How long will treatment last? How do I know when treatment is complete?
Think about how well you will be able to relate to the therapist as she answers these questions. You want to achieve the best possible match in order to have the greatest chance of meeting your goals.
If you would like to ask me any of the above questions, or learn more about my practice. Please contact me.