Fibromyalgia – real disease getting real benefit from CBT

People with Fibromyalgia suffer on many levels. They live with a chronic and painful, life-altering, multi-system disease that affects about 2% of the general U.S. population. For many years, they also suffered from widespread skepticism and debate about the disease itself. Was it real? Wasn’t it the same as Chronic Fatigue Syndrome, which the media disparagingly called Yuppie Flu?

Thankfully, the uncertainty officially ended in 1990 when the American College of Rheumatology established criteria for its diagnosis. This was a positive step; however, appropriate treatment would remain unclear.

A good deal of research has emerged since then and a recent review of treatment protocols for Fibromyalgia showed that the best outcomes involved pharmacologic therapies in combination with Cognitive Behavioral Therapy (CBT). Exercise and patient education, part and parcel of a CBT approach, were also important.

Cognitive therapy strategies “help patients understand the effect that thoughts, beliefs, and expectations have on their symptoms.” It was also very important to use the strategies to help patients prioritize time to achieve balance in their daily lives.

When patients get angry in session

Judith S. Beck writes in:

Some therapists are quite concerned about their patients becoming angry at them. Yet when therapists respond sensitively, they can help patients learn important lessons.

The first thing I do when a patient becomes angry is to elicit their automatic thoughts and positively reinforce them, in a genuine way. “I’m so glad you told me that.” And I am glad. If there’s a problem, I want to know about it, so I can fix it.

Next, I conceptualize the problem in order to decide what to do. If I think the patient is correct, I’ll apologize – and in so doing, become a good role model. For example, a patient might be annoyed because he felt I was interrupting him too much. If he had that reaction, he’s right. I overestimated his tolerance for interruptions, so I can – again genuinely – say, “You know, I think you’re right. I did interrupt you too much. I’m sorry.”

If I don’t think I made a mistake, I can still genuinely say, “I’m sorry you’re feeling distressed,” because I truly am sorry if something I’ve said or done (or not said or done) made the patient feel worse. Then I try to figure out how to solve the problem, which might involve helping the patient evaluate his negative ideas about me or suggesting we change what we’re doing in the session.

Demonstrating to patients that interpersonal problems can be solved is sometimes one of the greatest benefits of therapy.

There’s nothing either good or bad, but thinking makes it so…

Does Shakespeare’s famous maxim apply to head injury?

According to a new study, the answer is yes.

Researchers recently looked at patients with mild head injuries (90% of head injuries in Western countries are classified as “mild”) to see whether perceptions of illness contributed to the development and severity of post-concusional syndrome (PCS). 73 patients with mild head injuries participated in the study. They were monitored for PCS symptoms, post-traumatic stress symptoms, perceptions of illness, depression and anxiety. Scales were completed at the time of injury, and at 3-month follow-up.

The results: patients who believed their injuries would have a serious effect on their quality of life were at greater risk for post-concusional symptoms.

What are the implications for treatment? As the article states: “Recognition of the maladaptive cognitions that contribute to poor outcome of the sort suggested by this study will be helpful in the development of effective cognitive-behavioral interventions.”

Love is Never Enough

Say you’re having an argument with your partner, housemate or friend. What’s going through your mind during the interaction? How are you interpreting the other person’s remarks and behaviors? How is the other person reading what you say and do? And how often are you both reading each other’s signals correctly?

Cognitive Therapy (CT) is used for many disorders, but it’s also effective for everyday problems… including relationship problems. It can help people untangle the misinterpretations and distorted thinking that pop up, especially when expectations are high.

For instance, let’s say Adam and Laura, a married couple, are headed to a dinner party one night, hosted by one of Adam’s friends. Laura gets held up at work, and comes home late, thereby making both of them late for the dinner party. Adam gets disgruntled and thinks, she doesn’t care about me or my friends. She never manages to be on time and it just isn’t respectful. I’m sick of this. Meanwhile, Laura gets annoyed with Adam and thinks, he never asks what’s going on at work. All he cares about is his stupid social life. Can’t he see I’m stressed out?  Read more

All-male CBT workshops effective for men with insomnia

CBT has been successfully used to treat insomnia in both men and women, but according to a recent article men tend to seek treatment less often than women. Even when they consult their primary care providers, those providers are often unaware of CBT’s effectiveness and may have limited CBT resources to offer their patients.

To address this, researchers offered group CBT in the form of 1-day, all-male CBT workshops. The study ran six months, and drew 111 inquiries, some of them self-referred. The researchers noted that roughly half of the participants had not mentioned their insomnia to their primary care providers. In a six-week follow-up, the men “reported significant improvements in their sleep, as well as reductions in their depression.”

–Read more about CBT for insomnia.

Maximizing daily satisfaction to help alleviate Depression

At a recent case conference, Dr. Aaron Beck met with a patient suffering from depression while graduate students watched the session via live video feed in another room. The patient expressed strong dissatisfaction with his job and career direction (even though he held an objectively desirable position). At the same time, the patient was depressed, and did not presently have enough initiative or belief in himself to alter his trajectory.

During the session, after hearing about the patient’s typical week and what was bothering him most, Dr. Beck began to focus on alleviating the most pressing current problem – depression. He asked, “if your job isn’t giving you satisfaction, what else could give you satisfaction?” Read more

Cognitive Behavior Therapy helps prevent spread of HIV

The National Institute of Mental Health (NIMH) recently launched a Healthy Living Project to promote healthful behaviors among those who have HIV. The Healthy Living Project had two phases: 1) to qualitatively investigate and understand the living contexts of those with HIV and 2) to offer an intervention – Cognitive Behavior Therapy (CBT). Read more

Unemployed? Cognitive Behavior Therapy may be able to help

Usually we write in about recent studies — and this unemployment study is actually from 1997, but we thought it was interesting enough to warrant highlighting. People often ask us about using Cognitive Behavior Therapy (CBT) techniques for everyday life issues (as opposed to using CBT for specific psychiatric disorders), and this unemployment study, conducted in the UK, is a great example of how CBT can be applied to other areas.

Here’s the overview: researchers recruited 289 people who had been unemployed for more than one year (but who did not have psychiatric disorders). They were randomly assigned to either group CBT or a control group that focused on social support. Read more

Men Have Eating Disorders – Cognitive Therapy Can Help

Anorexia and bulimia are not just affecting women. A recent Harvard Medical School survey showed that nationally, 25% of those with anorexia or bulimia and 40% of those who binge eat are male. The reported prevalence of eating disorders among men was much higher than previously expected.

This article in the Washington Post discusses the survey, and notes that, “Treatment for males and females involves cognitive therapy to overcome a distorted body image, which is at the core of eating disorders.”

Cognitive Restructuring Group

We recently received the following update from Kevin Benbow about the positive effects of teaching Cognitive Restructuring in a group format:

About six months ago I came up with the idea to create a group based on the premises of Greenberger and Padesky’s “Mind Over Mood.”  This was a pilot program, and the intention of the group was to solely teach the basics of cognitive restructuring to the participants.   This was done via handouts, movie clips, and a power point presentation. The group ran for 12 sessions and we systematically taught all participants to make the connection between situations, moods and automatic thoughts.  The BDI* and BAI* were administered prior to beginning group and were also administered at the last session.

It should be noted that in addition to the teaching of CR techniques these clients would also receive individual therapy as well as psychotropic medication if needed.

While I have seen the power and utility of CR before, I was pleasantly surprised to see how group dynamics can be used to reinforce the completion of homework and normalize symptoms of depression and anxiety.  Once the basic concepts were taught, we would complete thought records on the white board using actual stressors from the clients’ lives.  Read more