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Does Cognitive Behavioral Therapy Work? Will it Work for ME??

CBT-therapy

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:

Cognitive behavioral therapy
  • depression
  • generalized anxiety disorder
  • panic disorder with or without agoraphobia
  • social phobia
  • posttraumatic stress disorder
  • childhood depressive and anxiety disorders
  • marital distress
  • anger
  • 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)

therapy for depression 
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.

therapy for depression

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.

couple couple

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.

Source:

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.

 

A View from the Roof | Rewire Me

Author Psychotherapist Pamela Milam shares inspirational thoughts on viewing others from a place of greater emotional generosity.

A View from the Roof | Rewire Mecounseling for happiness

I know someone who had a series of different jobs: clerk, cook, waitress, courier, even construction worker. She told me that she once had a stint as a roofer. She worked every day with the same guy, a blue-collar philosopher who used to take breaks sitting on the roof eating his sandwich and telling her stories: “People think they’re alone, that no one can see them, but up here I can’t help but see people living their lives—in their living rooms, bedrooms, backyards. The world’s a different place to me because of that.”

He felt a warmth and grace toward the people living in those houses, cooking barbecue, pushing swings for children, vacuuming rugs, fighting with spouses, clicking away on laptops, cooking spaghetti, or reading books by windows. He saw them in private moments and tried his best to honor that privacy. I might see, for instance, a client who is a tough businesswoman, but in fact is anxiety-ridden and worried about her young son’s autism diagnosis.

It struck me later that, as a therapist, my view can be similar. We are the roofers of the soul, seeing into hearts and minds and getting a look into the private lives and relationships of people who otherwise might seem like just “the guy in the next cubicle” or “that jogger I see every Saturday on the trail” or “the unassuming neighbor down the block.”

I might see, for instance, a client who is a tough businesswoman, but in fact is anxiety-ridden and worried about her young son’s autism diagnosis. Many of her colleagues write her off as being brusque and cold, but that’s nowhere near the truth. Or I meet the olive-skinned young model who radiates a golden beauty, but discover that he is wracked with self-doubt. I encounter the narcissist who admits that he feels empty in spite of his résumé of accomplishments, or the pregnant teen who pretends to look forward to motherhood but confesses that she’s terrified.

It’s helpful to get a different view, looking into their lives and seeing them, really seeing them live life: struggling, failing, succeeding, and managing to get through it all somehow.

Getting a new perspective—simply paying attention—helps me break free from assumptions or stale beliefs about neighbors, friends, colleagues, and even strangers.There’s a freedom that comes from getting an alternate view. The more you really notice other people, the less likely you are to write them off or pigeonhole them. Getting a new perspective—simply paying attention—helps me break free from assumptions or stale beliefs about neighbors, friends, colleagues, and even strangers.

For me, it’s important not to get locked into a mindset, one of judgment or negativity or willful oblivion. The key to unlocking my mind is the very same key to building good relationships: noticing people, taking my time, imagining how they might feel, making an effort to do no harm, and trying to do good when I can.

If I find myself taking a knee-jerk attitude toward a person or summing someone up based on one or two obvious traits, it’s a sure bet that I’m missing something that I might understand more clearly from a place of greater emotional generosity. I try to remember that I’m always free to take a fresh look. I’m the roofer casting a graceful look into their hidden lives.

Read about Pamela Milam.

– See more at: http://www.rewireme.com/explorations/a-view-from-the-roof/#comment-3827

 

FEELING STRESSED OUT???

anxiety-adolescent

A recently-published study on the effects of altruism led by Michael J. Poulin of the University of Buffalo, followed 846 people over five years. The participants were all dealing with some level of stress in their lives.  The researchers tracked the amount of time these people spent helping others.  Dr Poulin summarizes the results of the study as, “we found that when dealing with stressful situations, those who had helped others during the previous year were less likely to die than those who had not helped others.”  For non-helpers, though, each stressful event increased the chance of dying over the next five years by 30 percent.

Wow.  Helping out others can significantly decrease your chance of dying!  Researchers do not yet understand why this relationship exists and continue to study possible causes.  They think the effect may come from the same biological mechanisms that drive parents to care for their children—such as the neurohormone oxytocin—which Dr. Poulin states, “can reduce certain physical responses to stress.” 

In the meantime, when you are feeling stressed, think about helping a friend, relative, or neighbor.  The act will distract your mind from the stressful situation, but also may help you live longer!

A more detailed review of the research study and a link to the study can be found in an article from The Greater Good.


More Breast Cancer Treatments Hinted in Study – NYTimes.com

cancer treatment doctorSO many treatment advances have been made since my diagnosis of breast cancer in 2002.  We are going in the right direction in terms of finding a cure.  Please consider donating your time and/or resources to cancer research.

Here is an article published in the New York Times outlining current treatment strategies:

By GINA KOLATA
Published: September 23, 2012

In findings that are fundamentally reshaping the scientific understanding of breast cancer, researchers have identified four genetically distinct types of the cancer. And within those types, they found hallmark genetic changes that are driving many cancers.  These discoveries, published online on Sunday in the journal Nature, are expected to lead to new treatments with drugs already approved for cancers in other parts of the body and new ideas for more precise treatments aimed at genetic aberrations that now have no known treatment.

The study is the first comprehensive genetic analysis of breast cancer, which kills more than 35,000 women a year in the United States. The new paper, and several smaller recent studies, are electrifying the field.

“This is the road map for how we might cure breast cancer in the future,” said Dr. Matthew Ellis of Washington University, a researcher for the study.

Researchers and patient advocates caution that it will still take years to translate the new insights into transformative new treatments. Even within the four major types of breast cancer, individual tumors appear to be driven by their own sets of genetic changes. A wide variety of drugs will most likely need to be developed to tailor medicines to individual tumors.

“There are a lot of steps that turn basic science into clinically meaningful results,” said Karuna Jaggar, executive director of Breast Cancer Action, an advocacy group. “It is the ‘stay tuned’ story.”

The study is part of a large federal project, the Cancer Genome Atlas, to build maps of genetic changes in common cancers. Reports on similar studies of lung and colon cancer have been published recently. The breast cancer study was based on an analysis of tumors from 825 patients.

“There has never been a breast cancer genomics project on this scale,” said the atlas’s program director, Brad Ozenberger of the National Institutes of Health.

The investigators identified at least 40 genetic alterations that might be attacked by drugs. Many of them are already being developed for other types of cancer that have the same mutations. “We now have a good view of what goes wrong in breast cancer,” said Joe Gray, a genetic expert at Oregon Health & Science University, who was not involved in the study. “We haven’t had that before.”

The study focused on the most common types of breast cancer that are thought to arise in the milk duct. It concentrated on early breast cancers that had not yet spread to other parts of the body in order to find genetic changes that could be attacked, stopping a cancer before it metastasized.

The study’s biggest surprise involved a particularly deadly breast cancer whose tumor cells resemble basal cells of the skin and sweat glands, which are in the deepest layer of the skin. These breast cells form a scaffolding for milk duct cells. This type of cancer is often called triple negative and accounts for a small percentage of breast cancer.

But researchers found that this cancer was entirely different from the other types of breast cancer and much more resembles ovarian cancer and a type of lung cancer.

“It’s incredible,” said Dr. James Ingle of the Mayo Clinic, one of the study’s 348 authors, of the ovarian cancer connection. “It raises the possibility that there may be a common cause.”

There are immediate therapeutic implications. The study gives a biologic reason to try some routine treatments for ovarian cancer instead of a common class of drugs used in breast cancer known as anthracyclines. Anthracyclines, Dr. Ellis said, “are the drugs most breast cancer patients dread because they are associated with heart damage and leukemia.”

A new type of drug, PARP inhibitors, that seems to help squelch ovarian cancers, should also be tried in basal-like breast cancer, Dr. Ellis said.

Basal-like cancers are most prevalent in younger women, in African-Americans and in women with breast cancer genes BRCA1 and BRCA2.

Two other types of breast cancer, accounting for most cases of the disease, arise from the luminal cells that line milk ducts. These cancers have proteins on their surfaces that grab estrogen, fueling their growth. Just about everyone with estrogen-fueled cancer gets the same treatment. Some do well. Others do not.

The genetic analysis divided these cancers into two distinct types. Patients with luminal A cancer had good prognoses while those with luminal B did not, suggesting that perhaps patients with the first kind of tumor might do well with just hormonal therapy to block estrogen from spurring their cancers while those with the second kind might do better with chemotherapy in addition to hormonal therapy.

In some cases, genetic aberrations were so strongly associated with one or the other luminal subtype that they appeared to be the actual cause of the cancer, said Dr. Charles Perou of the University of North Carolina, who is the lead author of the study. And he called that “a stunning finding.”

“We are really getting at the roots of these cancers,” he said.

After basal-like cancers, and luminal A and B cancers, the fourth type of breast cancer is what the researchers called HER2-enriched. Breast cancers often have extra copies of a gene, HER2, that drives their growth. A drug, Herceptin, can block the gene and has changed the prognosis for these patients from one of the worst in breast cancer to one of the best.

Yet although Herceptin is approved for every breast cancer patient whose tumor makes too much HER2, the new analysis finds that not all of these tumors are alike. The HER2-enriched should respond readily to Herceptin; the other type might not.

The only way to know is to do a clinical trial, and one is already being planned. Herceptin is expensive and can occasionally damage the heart. “We absolutely only want to give it to patients who can benefit,” Dr. Perou said.

For now, despite the tantalizing possibilities, patients will have to wait for clinical trials to see whether drugs that block the genetic aberrations can stop the cancers. And it could be a vast undertaking to get all the drug testing done. Because there are so many different ways a breast cancer cell can go awry, there may have to be dozens of drug studies, each focusing on a different genetic change.

One of Dr. Ellis’s patients, Elizabeth Stark, 48, has a basal-type breast cancer. She has gone through three rounds of chemotherapy, surgery and radiation over the past four years. Her disease is stable now and Dr. Stark, a biochemist at Pfizer, says she knows it will take time for the explosion of genetic data to produce new treatments that might help her.

“In 10 years it will be different,” she said, adding emphatically, “I know I will be here in 10 years.”

A Great Web Resource on Teenage Suicide, written by Kurt Cobain’s cousin

Living Matters Website

Bev Cobain’s Living Matters website is an outstanding resource for anyone dealing with youth depression and/or suicide.  Ms. Cobain’s bio from this site reads:

Bev Cobain is a Registered Nurse, with credentials in psychiatric/mental health nursing. Her own struggle with depression and the suicides of three family members–most recently the 1994 death of her young cousin, Kurt Cobain, front man for the band, Nirvana–ignited a passion in Bev to educate professionals, lay persons, and youth about depression and the significant public health issue of suicide. Her desire to educate resulted in her writing the acclaimed book, “When Nothing Matters Anymore: A Survival Guide for Depressed Teens” and developing the Living Matters website site to provide an additional avenue to share her knowledge and experience of youth depression and suicide.

Latest Facts About Teen Suicide

The following statistics will probably surprise you.  Teen suicide is a serious problem in the United States.

  • Suicide is the 2nd leading cause of death in the U.S. for ages 15 through 19.
  • In this country, a child or adolescent dies by suicide every 80 minutes, and a youth attempts to take his/her life every 45 seconds.
  • One of ten high school students attempt suicide, while one in five has had suicidal thoughts within the previous year.
  • The suicide rate for 10 to 14-yr olds has tripled in the last three decades.

YOU CAN MAKE A DIFFERENCE and help change the current statistics on suicide.  Please take a few minutes to review this list.  If you, your friends, your family, or anyone you know has any of these symptoms, please reach out and share with someone.

Sadness (with or without crying)
Anxiety
Lack of energy and/or motivation
Temper outbursts and/or violent episodes
Easily irritated
Sleeping too little or too much
Little or no appetite, or eating too often
Withdrawal from friends and family
Loss of interest in activities usually enjoyed (including school activities)
Feelings of fear (even if there is no conscious reason)
Feelings of extreme guilt or shame
Inability to concentrate
Poor memory
Increased use of alcohol or drugs
Worsening grades
Skipping school or classes
Self-critical remarks
Feelings of helplessness to change a situation*
Feelings that things will never get better*
Comment(s) about death or dying*
Writing, drawing, or listening to music about hopelessness, guns, or death*
Threatening suicide (even in a joking manner)*

*These last 5 symptoms should be taken very seriously, do not wait to contact a parent, counselor, teacher, or other trusted adult.  Please let someone know right away.

For immediate help, call National Suicide Hotline Number:  1-800-273-TALK, or 9