Health and Psychology

Cognitive Behavior Therapy is an evidence based treatment that is effective in significantly improving symptoms of depression, anxiety and other psychological problems.  There are a couple of problems with the method.

1.  First-Cognitive Behavior Therapy is NOT effective in treating depression and anxiety as a symptom of a medical illness that is NOT a psychological illness.  So one of the things I look for in evaluating a medical condition is that an evidence based treatment for anxiety or depression was NOT at all effective.  

Here's my famous example.  A man came to me with depression that was going on for several years and appeared to be getting worse.  He was doing Cognitive Behavior Therapy for the first time and appeared to be doing all the steps correctly.  He could walk through a thought record in the office, appeared to be doing homework, and everything looked fine except he was not improving in his scores on a depression scale.  He appeared to be using the rating scale correctly.  I sent him to his physician for laboratory data.  His white cell count (the part of the immune system used to fight off infection) came back slightly elevated.  I then had him keep track of all physiological symptoms, and he noticed minor knee pain. His physician did a needle aspiration of material at the knee and found an infection cultured to be Staph.  He was treated with antibiotics and his depression resolved completely.  The slight elevation in white cell count had been seen previously, but he wasn't complaining of pain, so it wasn't investigated earlier.  If he had improved with cognitive behavior therapy the underlying infection could have been left untreated for years.

2.  Second-Cognitive Behavior Therapy holds people accountable.  If I'm working with someone who collects, saves or hoards things and they agree to do homework over the course of the week, then when the next week comes around it will be clear that they did not do the homework.  Unlike supportive psychotherapy, Cognitive Behavior Therapy is results oriented.  The goal of treatment is clear.  The requirements of the therapist in providing the exercises and structuring the homework are clear.  The excuses for not working toward the mutually agreed goal become sharp.  Many people want to complain about their situation, but get overwhelmed when they have to take action.  They decide therapy is "too hard,"  "too stressful," "and not something I want to do at this time."  

It's not my goal.  It's the goal of my client.  If they want the outcome--to feel better, to lose weight, to be more organized, to be on-time for work, to date more effectively, to plan better, to be less distracted, to have a clean house, to be healthy, to find out what's wrong...any of those...then they have to decide to work towards that goal.  I can't do the work for them.  I can hold them accountable and set up a system that lets them know clearly when they are on track or off track.  For some the psychological issues involved in the goal are too painful to manage.  They want the goal, but they are not able to work on the goal because there's an emotional issue they don't want to deal with that keeps coming up.  These clients will leave treatment early because they aren't ready to address the issues.  

3.  Third--Cognitive Behavior Therapy is work.  It's applying and using new strategies to improve behavior and feelings by changing thoughts or behavior.  It's tracking the strategies and behaviors.  It starts off as a lot of initial work until the system becomes automatic.  It can be used whenever the person decides to use it.  They can use it always or never or for specific situations.  It takes a couple of weeks to learn the system and about 6 weeks to master it so that it becomes automatic.  After that point I can ask someone why they are choosing not to use the system after it's been shown to them to be effective.

4.  Fourth--It's not magic and it doesn't work in 20 minutes.

If you're interested in learning more about Cognitive Behavior Therapy and how it works, feel free to contact me.