Cognitive Behavior Therapy for Back Pain

A lot of people know that Cognitive Behavior Therapy (CBT) is effective for anxiety, depression, and many other psychiatric problems… But we’re guessing that not as many people know that CBT also reduces physical pain associated with many medical disorders and problems.

Check out this NY Times article — it talks about a review of 22 different studies, which show that psychological treatments reduce lower back pain. The two treatments that were most effective were Cognitive Behavior Therapy (CBT) and Self-Regulatory Therapy. For a full list of disorders that CBT can treat, including MANY medical problems, see Cognitive Behavior Therapy Outcome Studies (sources are at bottom of disorder list).

Judith S. Beck Writes In: Self Disclosure in Cognitive Therapy

I’ve recently been thinking about Self Disclosure in CT. In traditional psychoanalysis, analysts deliberately refrain from revealing anything about themselves. There is no such prohibition in Cognitive Therapy and I find that I do a lot of self-disclosure to patients whom I think will benefit from it. For patients with perfectionistic standards, I might reveal the standard I apply to myself and have taught my children: To try to do a reasonable job a reasonable amount of the time. For patients who believe they are inferior because they have not achieved as much as they or others expect them to, I often talk about my son who has severe learning disabilities and my view that he is neither inferior nor superior to others. For patients who struggle with self-esteem, I usually describe how I give myself credit throughout the day, whenever I complete a task (or part of a task), even if it’s minor and not particularly difficult. Following self-disclosure, I discuss with patients how they believe what I’ve said might apply to them. 

I don’t use self-disclosure with every patient but I do with most. Self-disclosure often gives them a different way of thinking about their problems. And it goes a long way in strengthening our relationship when patients recognize that I am a human being who is willing to share something of herself to help them.  

Judith S. Beck Writes In: More on CT for New Year’s Resolutions

judith-beck_1024w.jpgI enjoyed being interviewed for an NPR radio story on the Cognitive Therapy approach to New Year’s resolutions. When I’ve been interviewed for radio shows in the past, I’ve almost always talked to the interviewer by phone from my office. But this time the reporter, Joanne Silberner, asked me to go to the local NPR affiliate (WHYY) in Philadelphia, so I got to wear headphones and speak into a big microphone (and had the nicest conversation with the sound engineer).

Joanne interviewed me for almost an hour.  Most of what I talked about wasn’t included in the final piece though (Joanne oriented the story toward one specific New Year’s resolution — losing weight. See the post below). Here’s what didn’t make it onto the show:  I talked about how Cognitive Therapy basically helps people set resolutions (that we term “goals”) at the very first treatment session when we ask, “How would you like to be different as a result of therapy? How would you like your life to be different?”  I talked to Joanne about how we help people get to their goals by:

(1)     making sure that people’s goals are realistic
(2)     helping people break down big goals into small steps
(3)     collaboratively devising a plan to implement these steps
(4)     problem-solving difficulties that interfere with implementation
(5)     effectively responding to “sabotaging” thoughts that interfere with implementation

The interview was fun, despite the fact that I was incredibly congested, following a bad head cold. I’ve now done so many media interviews that I don’t get nervous at all any more. (I used to be worried about getting asked questions I didn’t know the answer to…)

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.