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cbt for pain

CBT for Pain: Johns Hopkins study shows Improvement

Researchers at Johns Hopkins showed CBT for pain management with patients with knee osteoarthritis (KOA) significantly  improved their symptoms.  Patients in the study reported significantly lower levels of pain after CBT sessions.  Additionally, patients with KOA in the study reported improved quality of sleep.  The new double-blind, randomized placebo-controlled clinical trial findings were published online January 26 in Arthritis and Rheumatology.  Jennifer Garcia summarizes the results of the study in the February 25, 2015, edition of OrthoSpineNew.

Holly Scott of Uptown Dallas Counseling specializes in Cognitive Behavioral Therapy (CBT).

CBT For Weight Loss

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The concepts from Cognitive Behavioral Therapy (CBT)  can be especially helpful when trying to lose weight.  In this week’s ReadersINC blog post, Anthony Healy, a personal trainer at Vivacia, outlines ideas on motivation for weight loss.  Each of these ideas is an example of techniques learned during Cognitive Behavioral Therapy.

Here are Anthony’s top tips on how to motivate yourself to lose weight:

1. Decide why you want to lose weight

Is it to look good in a bikini, to feel better about yourself or another reason?

2. Set goals

‘Lose weight’ is too vague. You need a clear and achievable goal, such as ‘lose 10lb in 10 weeks’. Write down how you’re going to achieve this, such as ‘run three times a week’ or ‘go to the gym every Monday, Wednesday and Friday’ and STICK TO IT.

2. Create visual goals

Visual cues are a great motivator. If you want to look good on the beach in a size 10 bikini then buy that bikini (or dress for special occasion/favorite pair of jeans) and hang it outside your wardrobe.

3. Write a morning mantra

Write and then read a motivational mantra every day. Make the goal seem like something that has already having been achieved,

E.g. “I have successfully lost 10lbs, and I am about to board the plane for Spain at Heathrow airport. I can’t wait to get to the beach in my yellow bikini….”

By doing so you get the good feelings associated with the goal ahead of time.

4. Kick the bad habits

Long-term transformations take time.

To get quick results and keep the weight off you need to kick bad habits.

In the beginning you need to go cold turkey. For many people the enemy is booze, processed food and/or sugar in all its forms – most obviously, chocolate and sweets.

Giving these up for at least 6-12 weeks “breaks the back” of the usual suspects, forms some good eating habits, and brings about those quick results – which will keep you motivated and “hungry” for more success.

5. Think positive

With sufficient motivation anything is achievable, and those obstacles can now be overcome.

CBT for Anger Management

Image courtesy of artur84 at FreeDigitalPhotos.net

Image courtesy of artur84 at FreeDigitalPhotos.net

CBT for Anger is one of the most effective ways to treat uncontrolled anger problems.  Anger can be managed using a method from Cognitive Behavioral Therapy (CBT) called Cognitive Reframing.

 

 

In the following article published on PsychCentral.com, Dr. Hartwell-Walker outlines 7 common assumptions that can be reframed to reduce anger.

7 Mistaken Assumptions Angry People Make By Marie Hartwell-Walker, Ed.D.

I guess I have an anger problem. I lose my temper pretty quick. But it’s not like my wife doesn’t do things to make me mad.”

Richard has reluctantly come to treatment because his wife took out a restraining order after their last fight. He admits he lost control. He acknowledges that maybe he said things he shouldn’t have. But he also thinks she shouldn’t have done or said what she did. “I can’t help getting mad when she jerks my chain. I can’t let her get away with that!” he says.

What Richard doesn’t yet understand is this: Temper isn’t something you lose. It’s something you decide to throw away.

Raging, shouting, name-calling, throwing things and threatening harm is all a big bluff. It’s the human equivalent of animal behavior. From the puffer fish that puffs itself up to twice its size to look more intimidating to the lion on the veldt who shakes his mane and roars, creatures who feel threatened posture and threaten in order to protect themselves and their turf. The display often is enough to get the predator or interloper to back off. If not, the fight — or flight — is on.

People who rage are the same. Feeling a threat, they posture. They throw away all mature controls and rant and rage like an out-of-control 2-year-old. It’s impressive. It’s scary. It gets folks around them to walk around on eggshells. Others often let them “win” just to get away.

But are they happy? Usually not. When I talk to the Richards of the world, they usually just want things to go right. They want respect. They want their kids and their partners to give them the authority they think they deserve. Sadly, their tactics backfire. Not knowing what might set him off, kids, partners, coworkers and friends distance and leave him more and more alone.

Helping someone like Richard with “anger management” requires more than helping him learn how to express his angry feelings appropriately. Giving him practical skills alone assumes more control than he can probably hold on to. To be able to integrate those skills into his self-image, he needs to reconsider some of his basic assumptions about life and his place in it.

 

7 Mistaken Assumptions Angry People Often Make

They can’t help it. Angry people have lots of excuses. Women will blame their PMS. Both sexes will blame their stress, their exhaustion, or their worries. Never mind that other people who have PMS or who are stressed, tired, or worried don’t pop off at the world. Angry people don’t yet understand that they are actually giving themselves permission to rant. In that sense, they are very much in control.
The only way to express anger is to explode. People who rage believe that anger is like the buildup of steam in an overheated steam engine. They think they need to blow off the steam in order to be OK. In fact, raging tends only to produce more of the same.
Frustration is intolerable. Angry people can’t sit with frustration, anxiety or fear. To them, such feelings are a signal that they are being challenged. When life doesn’t go their way, when someone doesn’t see things as they do, when their best-laid plans get interrupted or they make a mistake, they simply can’t tolerate it. To them, it’s better to blow than to be left with those feelings. They don’t get it that frustration is a normal part of everyone’s life and that it is often the source of creativity and inspiration.
It’s more important to win than to be right. Chronically angry people often have the idea that their status is at stake when there is conflict. When questioned, they take it overly personally. If they are losing an argument, they experience a loss of self-esteem. At that moment, they need to assert their authority, even if they are wrong. When it is certain that they are wrong, they will find a way to prove that the other person is more wrong. For mature people, self-esteem is grounded in being able to put ego aside in order to find the best solution.
“Respect” means that people do things their way. When another driver tailgates, when a partner refuses to go along with a plan, when a kid doesn’t jump when told to do something, they feel disrespected. To them, disrespect is intolerable. Making a lot of noise and threatening is their way of reasserting their right to “respect” by others. Sadly, when the basis of “respect” is fear, it takes a toll on love and caring.
The way to make things right is to fight. Some angry people have learned at the feet of a master. Having grown up with parents who fight, it is their “normal.” They haven’t a clue how to negotiate differences or manage conflict except by escalating. Then they become very much like the parent they loathed and feared when they were kids.
Other people should understand that they didn’t mean what they did or said when they were angry. Angry people feel that anger entitles them to let loose. It’s up to other people not to take seriously hurtful things they say or do. After all, they say, they were just angry. They don’t get it that other people are legitimately hurt, embarrassed, humiliated, or afraid.
Helping my patient Richard means helping him identify which of these assumptions are driving his temper tantrums. Some or all may apply. He may even have a few that are more uniquely his own. Teaching him rules for anger management, although important, isn’t enough to have long-term impact. Changing his assumptions will enable him to use such skills with conviction and confidence.

Source:

7 Mistaken Assumptions Angry People Make By Marie Hartwell-Walker, Ed.D.

Cognitive Behavioral Therapy and Cognitive Restructuring

CBT uptown DallasCognitive Behavioral Therapy (CBT) is based on the theory that our Thoughts, Emotions, and Behaviors all impact each other.

During therapy, the client learns how to identify distorted thinking patterns.  The client then learns the connection between distorted thinking and her emotions and behaviors.   By making changes to distorted thinking, the client experiences changes in feelings.

 

A CBT therapist teaches clients techniques to make theses changes.  Cognitive restructuring is a key technique of CBT therapy.  Dr. Aaron Beck, the founder of Cognitive Therapy, talks about cognitive restructuring techniques.

CBT Uptown Dallas Counseling

Dr. Aaron Beck, founder of CBT

Uptown Dallas Counseling provides CBT: Aaron Beck’s Blueprint

CBT Uptown Dallas Counseling

Dr. Aaron Beck, founder of CBT

Uptown Dallas Counseling provides CBT or Cognitive Behavioral Therapy.  The founder of CBT, Dr. Aaron Beck, explains his view of CBT in this 6-minute audio track.

Dr. Beck founded the Beck Institute of Cognitive Therapy in 1994.  From the Beck Institute website:

Beck Institute for Cognitive Behavior Therapy is a leading international source for training, therapy, and resources in CBT. Our Center for Training delivers workshops to a worldwide audience of mental health professionals, researchers, and educators, and our Philadelphia-based Center for Psychotherapy provides state-of-the-art therapy and consultations.
Dr. Aaron T. Beck developed Cognitive Behavior Therapy (CBT) at the University of Pennsylvania in the 1960s. In 1994, Dr. Beck and his daughter, Dr. Judith Beck, established Beck Institute as a non-profit 501(c)(3). Their goal was to create a new clinical setting that would provide both state-of-the-art psychotherapy and comprehensive training opportunities for professionals worldwide.
Over the past 20 years, our organization has carried out Dr. Beck’s therapeutic model and guiding principles in training more than 3,500 professionals through our Center for Training, and providing clinical therapy services to over 2,000 individuals, couples, and families through our Center for Psychotherapy.
In addition to our professional workshops and on-site psychotherapy practice, Beck Institute remains an international authority on, and resource for, CBT information and research. Our organization continues to partner with universities, hospitals, community mental health centers, health systems, and other institutions to create and improve cognitive behavior therapy programs.

Uptown Dallas Counseling provides CBT for anxiety, depression, bipolar disorder, and other mental health problems.

CBT for Weight Loss in Dallas

Weight LossLooking for CBT for Weight Loss in the Dallas area?  Uptown Dallas Counseling can help.

From The Beck Diet Solution workbook:  Feeling deprived is a state of mind. You can limit yourself to one cookie and think, “This is so unfair, I wish I could eat more, this really stinks,” OR you could limit yourself to one cookie and think, “It’s not all-or-nothing. I can still have one cookie and lose weight. Good for me for stopping here, this will really help me reach my goals.”

If you are looking for help in using CBT for Weight Loss in Dallas, Uptown Dallas Counseling can help.

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.

 

Mental Health Therapy and Cancer

Cancer-2Mental 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
Mental health counseling or therapy can be beneficial during this critical time of transition.  One of the goals of the therapy will be to help the patient recognize, process, and reframe the anxiety-producing thoughts above.  The therapist can help the patient learn to work through the anxiety of transitioning into survivorship, and learn to celebrate the joys of the present.
Remember, the fight is not over once the treatment ends.  For some patients, an equally difficult struggle remains.  Mental health counseling can help ease this struggle.

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).

450px-Fire-lite-bg-10Here is a basic example:
A fire alarm goes off in a hotel at night
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Person A thinks:  some kids pulled the alarm and now I am awake!
Person A feelsanger at the kids andannoyance about being awake.

Person B thinks: there must be a fire, I must get out!
Person B feelsfear 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 feelsunderstanding 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?

women smilingOnce 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:

  1. How are you licensed? What are your training credentials? Do you belong to any professional groups?
  2. 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.
  3. What kind of evaluation process do you use to recommend a treatment plan?
  4. What are the measurable criteria you use to assess how well treatment is working? Can you give me a few examples?
  5. Do you use published clinical practice guidelines to guide your treatment planning? How?
  6. What psychotherapeutic approaches and tools do you use?
  7. How do you decide which approach is best for the patient? Do you ever use more than one approach? When?
  8. How will you work with other medical providers, such as psychiatrist, who may also provide care?
  9. 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.