Alternatives to Drugs for Hyperactive Children? Psychotherapy Can Help

 

A recent NY Times article talks about the prevalence of ADHD in children, and parents who want to avoid drugs like Ritalin. The American Psychological Association in fact recommends that parents consider non-drug treatment first for children. The article discusses one family that used new parenting techniques to help with their son’s ADHD, and also says that Cognitive Behavior Therapy has been demonstrated to help teach children how to improve their anger, frustration, depression, and anxiety. We actually just posted on how nurses used Cognitive therapy to help children ages 7-18 — see below…

Nurses Trained to use Cognitive Therapy with Children in Low-Income Communities

In a recent Philadelphia area pilot program, thirteen Advanced Practice Nurses (APNs) were trained by the Beck Institute to use Cognitive Therapy techniques to treat mental and behavioral health problems of children and adolescents between the ages of 7 and 18. The APNs were the children’s primary care providers in low-income populations, primary care providers are sometimes the only point of access for mental health care.

For this program, APNs were trained by Dr. Christine Reilly, a psychologist with expertise in Cognitive Therapy, and a nurse herself. The nurses participated in workshops, group supervision conference calls, and individual supervision sessions as needed, during the year-long program. The population served included children and adolescents from the Philadelphia region who presented with a range of problems, including depression, anxiety, behavioral problems, teen pregnancy, obesity, and substance abuse. The pilot program showed that nurses improved their understanding of the Cognitive Therapy model and CT techniques (developed by Aaron T. Beck, M.D. in the 1960s). Patients demonstrated improved outcomes, as assessed using the Beck Youth Inventories at the start and end of the program. Moreover, the nurses saw benefits of the CT training program in other aspects of their practice, including applying CT techniques to patients in other age groups, and improving the nurse/patient relationship.

This pilot program indicates that training nurses in Cognitive Therapy is a practical, feasible way to improve mental health care and patient outcomes among children and adolescents. The program was conducted by the National Nursing Centers Consortium, in partnership with the Beck Institute for Cognitive Therapy and Research, through a generous grant from the van Ameringen Foundation.

Research Results: Cognitive Therapy Reduces Suicide Attempts by 50%

In light of all the recent discussion about antidepressant drugs that increase the risk of attempted suicide, we thought we’d highlight the study that came out last year, which showed that Cognitive Therapy (developed by Aaron T. Beck, M.D. in the 1960s) can reduce attempted suicide by 50% among those who have recently attempted suicide. This study, funded by the NIH and the CDC, followed 120 patients, half of whom were randomly assigned to 10 Cognitive Therapy treatment sessions, and the other half of whom received usual community services. At the 18 month follow-up, those who had not received CT treatment were twice as likely to attempt suicide as those who had received CT treatment. Check out the NY Times coverage of this study (you have to be registered to view the article – registration is free).

CT Myths: Three of the Most Common Misunderstandings about Cognitive Therapy

Myth: Cognitive Therapy (CT) is all about changing your thinking, and does not involve behavioral change.

Fact: Actually, Cognitive Therapy (developed by Aaron T. Beck, M.D. in the 1960s) addresses your thinking, emotions, behaviors, and physiological symptoms (if applicable). Cognitive Therapy (CT) is called Cognitive Therapy because it is based on the premise that your underlying beliefs about yourself, others and the world influence the way you perceive situations, and prompt you to have certain thoughts, emotions, behavioral responses and physical symptoms. CT treatment actually starts by addressing present problems and helping patients to have a better week — patients often begin evaluating their own thoughts and doing some behavioral experimentation very early on.

Myth: Cognitive Therapy only deals with surface layer problems, and it doesn’t do much to change the root of people’s problems.

Fact: Cognitive Therapy treatment starts by addressing present problems as a way to help patients gradually change their underlying problems. Cognitive Therapists work to understand patients’ ‘core beliefs’ — how they view themselves, others and the world. These beliefs are often formed in childhood and are deep-seated. And these beliefs pop up in every day situations in the form of anxious or depressed thoughts that lead to negative feelings and behavioral reactions to situations. Cognitive Therapists work with patients to analyze what’s happening in a given situation, come up with alternative responses, experiment with implementing new ways of thinking and acting, and gradually begin to change their responses to situations. When patients see how their reactions, mood and other symptoms can improve once they begin viewing situations in a more realistic light, they gradually begin to chip away at their ‘deep-seated’ core beliefs. In other words, Cognitive Therapists recognize that the best way to help patients alter their deep-seated beliefs and their current distress is to take action now, in the present, so that patients can see the effects of changing their thinking and behavior, and start to develop more positive and realistic outlooks after seeing the results in action their own lives.

Myth: All Cognitive Therapists do the same kind of therapy. So if I already tried a Cognitive Therapist and it didn’t help, that means that the treatment itself doesn’t help.

Fact: Not all therapists who call themselves Cognitive Therapists, or Cognitive Behavior Therapists are really trained and qualified to practice Cognitive Therapy (CT). As CT becomes more and more well known, due to the many studies that have shown it to be effective, more and more therapists are including CT ‘techniques’ in their practices, and some may call themselves Cognitive Therapists even if they do not have much training in Cognitive Therapy. Just because someone uses some part of CT in their practice, does not mean that he or she is actually delivering overall CT treatment (which is an integrative form of therapy that requires mastery of many different therapeutic techniques, and understanding of individualized treatment approaches for different disorders). We recommend that patients who are interested in CT treatment search for an ACT-Certified Cognitive Therapist. The Academy of Cognitive Therapy is the only Cognitive Therapist certifying organization that reviews therapists’ knowledge and ability before granting certification.

Research Results: CBT is Effective for Seasonal Affective Disorder

Need help getting through the winter? This week’s NY Times article says that Cognitive Behavior Therapy (CBT) is effective for Seasonal Affective Disorder (SAD) with or without light therapy, and that CBT is actually better than light therapy in preventing relapse among SAD sufferers.

The NY Times article refers to Dr. Kelly Rohan’s initial pilot study of 23 individuals with SAD. Dr. Rohan conducted a larger randomized controlled trial of 61 patients with SAD in 2005, and again found CBT to be effective in SAD treatment and relapse prevention. This later study is described in Science Daily, although the results have not yet been published. You can also read an interview with Dr. Rohan, in which she discusses her research on CBT for SAD.

What does Cognitive Therapy have to do with Nursing?

As Advanced Practice Nurses (APNs) interact with patients who have health problems, many of them find that their patients also suffer from mental health problems, including depression, anxiety, and other illnesses. So how can APNs best address the mental health needs of their patients? Two articles published this fall in Medscape’s Advanced Practice Nursing ejournal discuss how Cognitive Therapy (CT), also referred to as Cognitive Behavior Therapy (CBT), is an effective, time-limited, clinically tested treatment that is ideal for nursing settings. (To view these articles, you have to be registered with Medscape – registration is free.)

In Cognitive Behavioral Therapy in Advanced Practice Nursing: An Overview, Dr. Sharon Morgillo Freeman, a psychologist and certified Cognitive Therapist, discusses how CBT meets APNs’ need for effective, empirically based treatment — it’s a great overview for any APN interested in CBT, and includes a case example of a depressed patient treated with CBT. In Nurses Integrate Cognitive Therapy Treatment Into Primary Care: Description and Clinical Application of a Pilot Program, Dr. Judith Beck and Dr. Christine Reilly describe a pilot program that trained 12 APNs in CT, and monitored their success in implementing CT with low-income, underserved patients. This pilot program, conducted by the Beck Institute and the National Nursing Centers Consortium (NNCC), showed that APNs were able to integrate CT techniques in their primary care practices, with better patient results. We expect that in the future, we’ll see more and more integration of CT in nurse settings…

Research Results: CBT plus Medication is Effective for Gambling

An initial randomized, controlled trial shows that Cognitive Behavior Therapy (CBT) plus Selective Serotonin Reuptake Inhibitor (SSRI) can improve pathological gambling. For this study, 34 patients were randomly assigned to either medication alone, CBT plus medication, or CBT plus placebo for 16 weeks. Patients who received CBT plus medication improved the fastest. Further study is needed to assess long-term outcomes and other variables. Results were presented at the November, 2006 Canadian Psychiatric Association’s annual meeting.