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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).

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.

Who gets Depression? What does it look like? How will I know?

what is depression

What is depression?

I love this video created by the Canadian Family Law Firm of Neinstien & Associates.  They published this video to show their support for the annual Let’s Talk Day.  This event helps bring the topic of mental health and depression to the forefront in an attempt to break the stigma of suffering from a mental disorder.

Quotes from the participants in the video include:

I am a mother, a father, a student.  I am loving, smart, generous.  I am alone, in a room full of people.  I want to feel anything, I can’t stand to feel anything, I want the pain to go away.  Depression is not a mood, depression is not a bad day, depression is a disease.  It feels like I am underwater, I need help.  Please don’t judge me, don’t give up on me.

Take a few minutes to watch and see what you think.  Please spread the word.

Holly Scott, MBA, MS, LPC sees clients at Uptown Dallas Counseling. Holly is trained in the specialty of Cognitive Behavioral Therapy, and holds the position of Diplomate in the Academy of Cognitive Therapy. Holly works with clients to help them overcome challenges in their daily lives that may be preventing them from achieving happiness. She helps clients with stress management, depression, parenting, marriage counseling, and other mental health concerns. If you are looking for a counselor or therapist, explore this website to see if Holly may be able to help you. 

To make an appointment for therapy or counseling with Holly at her Uptown Dallas Counseling, you have the option of using the Online Patient Portal to register and schedule. 

Getting through the Hard Days of Depression

Getting through the hard days of depression can be extremely difficult.  People diagnosed with Major Depressive Disorder often feel better pretty quickly once they begin treatment with therapy, medication, or both.  Unfortunately, even when the person is completely compliant with treatment recommendations, there can be relapses.  Patients can experience an unexpected setback as they are recovering.
major depressive disorder
Many times the patient is completely surprised and alarmed by this sudden drop in mood.  Illinois therapist and writer Jacqueline Marshall gives suggestions on how to handle those really bad days as part of her article on PSYWEB.com.

Ms Marshall’s techniques can provide relief for many people. Her suggestions include relaxation, breathing, distraction, and seeking support from friends and family.

It is important to remember, however, there may be a time when you do not find relief from any of these methods.  If you think you are in danger of hurting yourself, call 911 and ask for help.

Holly Scott, MBA, MS, LPC sees clients at Uptown Dallas Counseling. Holly is trained in the specialty of Cognitive Behavioral Therapy, and holds the position of Diplomate in the Academy of Cognitive Therapy. Holly works with clients to help them overcome challenges in their daily lives that may be preventing them from achieving happiness. She helps clients with stress management, depression, parenting, marriage counseling, and other mental health concerns. If you are looking for a counselor or therapist, explore this website to see if Holly may be able to help you. 

To make an appointment for therapy or counseling with Holly at her Uptown Dallas Counseling, you have the option of using the Online Patient Portal to register and schedule. 

Fighting Suicidal Thoughts

Natasha Tracy writes in her blog, Breaking Bipolar, about the effect of her grandmother’s end-of-life struggle on her ability to fight off suicidal thoughts.   In her post, she shares her thoughts as she stood by her grandmother in the hospital and how those thoughts now help her in her struggle with bipolar disorder.

Breaking Bipolar

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.

 

Happiness and Belonging

happiness

How Do We Find Happiness?


Dallas author and psychotherapist, Pamela Milam, writes about finding happiness on the website www.RewireMe.com.  In her article, I love the way Pamela describes her thinking as a young adult in the line:

“I just went with the societal flow without examining how I really felt or what I really wanted.”

As a psychotherapist, I regularly treat clients who are struggling with life choices and decisions of all kinds (financial, career, family) that were made based on societal flow. They describe themselves as very successful and “having it all”, and state they cannot understand their overwhelming feelings of emptiness or sadness. During the therapy process, they often find relief by allowing themselves to explore what they really want and separating individual wants from societal influences. They are able to find joy by making changes in their lives to honor their true feelings.

Can you find a way to allow yourself to explore what you really want, change your thinking, and create happiness?

Anger and Divorce: a better way

Here is a great article by author and Licensed Professional Counselor, Pamela Milam, on reframing anger and other negative emotions following a divorce or break-up.
http://tracycoopercounselingblog.wordpress.com/2013/06/12/the-angry-ex-tips-for-self-respect-fairness-and-insight/

Your Memory is like the Telephone Game: Northwestern University News

old telephoneNewest studies on memory.  How sure are you of your memories?  Could you actually be remembering later events?

Your Memory is like the Telephone Game: Northwestern University News

 

YOUR MEMORY IS LIKE THE TELEPHONE GAME

Each time you recall an event, your brain distorts it

September 19, 2012 | by Marla Paul

CHICAGO — Remember the telephone game where people take turns whispering a message into the ear of the next person in line? By the time the last person speaks it out loud, the message has radically changed. It’s been altered with each retelling.

Turns out your memory is a lot like the telephone game, according to a new Northwestern Medicine study.

Every time you remember an event from the past, your brain networks change in ways that can alter the later recall of the event. Thus, the next time you remember it, you might recall not the original event but what you remembered the previous time. The Northwestern study is the first to show this.

“A memory is not simply an image produced by time traveling back to the original event — it can be an image that is somewhat distorted because of the prior times you remembered it,” said Donna Bridge, a postdoctoral fellow at Northwestern University Feinberg School of Medicine and lead author of the paper on the study recently published in the Journal of Neuroscience. “Your memory of an event can grow less precise even to the point of being totally false with each retrieval.”

Bridge did the research while she was a doctoral student in lab of Ken Paller, a professor of psychology at Northwestern in the Weinberg College of Arts and Sciences.

The findings have implications for witnesses giving testimony in criminal trials, Bridge noted.

“Maybe a witness remembers something fairly accurately the first time because his memories aren’t that distorted,” she said. “After that it keeps going downhill.”

The published study reports on Bridge’s work with 12 participants, but she has run several variations of the study with a total of 70 people. “Every single person has shown this effect,” she said. “It’s really huge.”

“When someone tells me they are sure they remember exactly the way something happened, I just laugh,” Bridge said.

The reason for the distortion, Bridge said, is the fact that human memories are always adapting.

“Memories aren’t static,” she noted. “If you remember something in the context of a new environment and time, or if you are even in a different mood, your memories might integrate the new information.”

For the study, people were asked to recall the location of objects on a grid in three sessions over three consecutive days. On the first day during a two-hour session, participants learned a series of 180 unique object-location associations on a computer screen. The next day in session two, participants were given a recall test in which they viewed a subset of those objects individually in a central location on the grid and were asked to move them to their original location. Then the following day in session three, participants returned for a final recall test.

The results showed improved recall accuracy on the final test for objects that were tested on day two compared to those not tested on day two. However, people never recalled exactly the right location. Most importantly, in session three they tended to place the object closer to the incorrect location they recalled during day two rather than the correct location from day one.

“Our findings show that incorrect recollection of the object’s location on day two influenced how people remembered the object’s location on day three,” Bridge explained. “Retrieving the memory didn’t simply reinforce the original association. Rather, it altered memory storage to reinforce the location that was recalled at session two.”

Bridge’s findings also were supported when she measured participants’ neural signals –the electrical activity of the brain — during session two. She wanted to see if the neural signals during session two predicted anything about how people remembered the object’s location during session three.

The results revealed a particular electrical signal when people were recalling an object location during session two. This signal was greater when — the next day — the object was placed close to that location recalled during session two. When the electrical signal was weaker, recall of the object location was likely to be less distorted.

“The strong signal seems to indicate that a new memory was being laid down,” Bridge said, “and the new memory caused a bias to make the same mistake again.”

“This study shows how memories normally change over time, sometimes becoming distorted,” Paller noted. “When you think back to an event that happened to you long ago — say your first day at school — you actually may be recalling information you retrieved about that event at some later time, not the original event.”

– See more at: http://www.northwestern.edu/newscenter/stories/2012/09/your-memory-is-like-the-telephone-game.html#sthash.jP3p8MP0.dpuf

The research was supported by National Science Foundation grant BCS1025697 and National Institute of Neurological Disorders and Stroke of the National Institutes of Health grant T32 NS047987.

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.”