jueves, 11 de julio de 2019

Cognitive Behavioral Therapy for Depression, Anxiety, PTSD and More

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By Lois Zoppi, BAReviewed by Dr. Jennifer Logan, MD, MPH

Talking therapy, or psychotherapy, can form part of the treatment plan for a multitude of mental health conditions, and can be used to improve a patient’s mental health as a sole form of treatment, or in conjunction with medication. Patients do not need to be diagnosed with a mental health condition to access cognitive behavioral therapy (CBT), as it can be used to help anyone struggling to cope with stress in any area of their lives.

Professional psychologist doctor consult in psychotherapy session or counsel diagnosis health. Image Credit: BlurryMe / Shutterstock

Cognitive behavioral therapy is a common type of talking therapy and patients are supported and guided throughout the process by a mental health therapist, also known as a psychotherapist. Patients choosing CBT as a treatment for their mental health condition should be committed and open to changing their thought patterns and behaviors in order to gain the best results possible from the therapy.

CBT aims to make patients aware of negative thinking patterns that may be having a detrimental effect on their mental health, as well as addressing a patient’s negative or unhelpful beliefs about themselves so they are able to more accurately assess their feelings and reactions towards situations and other people. Self esteem, confidence, and a sense of control over emotions and thoughts are just some of the benefits CBT can offer those struggling with their mental health.

What is Cognitive Behavioral Therapy Used For?

Managing physical symptoms of mental health or other medical conditions
Managing the psychological symptoms of mental health conditions
Preventing relapses of symptoms of mental health conditions
Promoting positive and balanced thinking
Recognizing unhelpful and unhealthy behaviors and thought patterns
Replacing or complementing medication treatment for mental health conditions
Teaching coping techniques for stressful situations or the symptoms of medical conditions
Teaching patients about emotions and how to manage them
Teaching patients how to communicate their thoughts and feelings effectively.

Which Mental Health Conditions Can Cognitive Behavioral Therapy Help?

Evidence shows that symptoms of other health conditions, such as irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS), can be improved through the use of CBT. The physical symptoms of these conditions cannot be cured by talking therapy, but patients will be able to learn how to better cope with and manage the symptoms of their condition and address the effect their symptoms may be having on their mental health and life as a whole.

What Happens in a Cognitive Behavioral Therapy Session?

Through structured discussions, usually consisting of five to 20 sessions over a period of weeks or months, patients are able to analyze and unpack their thought processes and any triggers or habits that sustain unhealthful behavior impacting their mental health.

The therapist will work with the patient to break down the problems they are struggling with, compartmentalizing them into thoughts, physical feelings, and actions. How these three responses to problems affect the patient’s mental health will be analyzed to determine if they are unhelpful, unrealistic, or unhealthy.

Patients will work with their therapist to create a plan to improve their responses to their problems by identifying areas in which they can change and modify their way of thinking or acting. Between each session, the patient is given time to put these new coping methods into practice.

CBT aims to equip patients with the ability to carry on using the techniques learned during the treatment course in their daily life.

Cognitive Behavioral Therapy and Anxiety

Anxiety is a mental health condition characterized by constant and unrealistic worry and tension. There may not be a specific or obvious cause for a person’s anxiety, as is seen in Generalized Anxiety disorders.

People with anxiety will often struggle with the scale of their worry and find their worrying difficult to control. They may find it difficult to maintain concentration, or feel jumpy, on edge, irritable, restless, and tired. Sleep problems can also be experienced.

There are some physical symptoms associated with anxiety disorders, which include headaches, muscle weakness, palpitations, stomach problems, and nausea.

Anxiety can be a symptom of other mental health conditions, but anxiety disorders can be present on their own, as seen in:

Generalized anxiety disorder – unnecessary and non-specific worry and tension
Social anxiety disorder – anxiety and stress surrounding social interaction and situations.

With CBT for anxiety, patients will be taught how to neutralize panic-inducing thoughts after identifying the exact causes of their anxiety symptoms. Methods on how to relax to relieve anxiety symptoms and how to manage them when they flare up are also talked through.

Cognitive Behavioral Therapy and Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder is characterized by repetitive behaviors and difficulties in communicating or socializing with other people and understanding and recognizing other people’s emotions. People on the autistic spectrum tend to have restricted interests or subjects they specialize in.

The combination of the symptoms of ASD can negatively impact how a person with autism copes with daily life. According to a study by researchers at York University, about 70 percent of children with autism will experience some form of emotional problems. Approximately half of these children will have anxiety, and 25 to 40 percent will experience depressive episodes.

CBT for autism helps patients to cope with and manage the symptoms of their condition, which may vary in severity between individuals, as is the case with spectrum disorders. CBT is recommended for children with mild symptoms of autism, with sessions aiming to identify triggers of certain behaviors so they can be taught practical responses to stressful situations.

Negative or irrational thinking can also be improved with CBT. Reducing “all or nothing” or “black and white” thinking, where a patient will only think about the extremes of a situation, can be reduced by showing that success and failure, for example, can be judged on a scale.

Cognitive Behavioral Therapy and Claustrophobia

Claustrophobia is a type of anxiety in which a person fears small spaces and physical restriction. Claustrophobia can present a range of symptoms, from sweating and trembling to fainting and panic attacks.

CBT for claustrophobia works on rationalizing irrational thoughts and helping the patient build tools to stop unhelpful thought patterns before they escalate, and patients can reassess their feelings towards spaces or situations that trigger their claustrophobia symptoms.

Claustophobia in the elevator. Image Credit: Bodnar Taras / Shutterstock

Cognitive Behavioral Therapy and Depression

Depression is a persistent feeling of sadness over a period of weeks, months, and sometimes years. It can present itself in many different ways between individuals, but symptoms can include:

Low mood
Loss of interest in hobbies
Hopelessness
Feeling tearful
Fatigue
Loss of appetite
Decreased libido
Physical aches and pains.

Changing negative thinking patterns is important in CBT for depression. Recurring negative thoughts can be gradually replaced with more realistic and more positive thoughts and beliefs, and CBT can also help a patient be more aware of what may trigger negative thinking and remind themselves of the benefits they will get from engaging in positive thinking and behaviors so they can apply these new, healthy behaviors throughout their daily life.

CBT can also help with suicidal thoughts, with patients learning how to recognize negative spirals into suicidal thoughts and behaviors, and developing personal strategies to calm themselves and abstain from harmful or potentially life-threatening behavior.

Cognitive Behavioral Therapy and Fibromyalgia

Fibromyalgia is a condition causing pain across the whole body. Patients with fibromyalgia can experience:

Increased sensitivity to pain
Fatigue
Muscle stiffness
Insomnia
Problems with memory and concentration
Headaches
IBS.

CBT can help with fibromyalgia by emphasizing the view that behavioral, cognitive, sensory, and physical aspects are all important components in understanding the pain caused by the condition.

CBT will aim to increase a patient’s sense of control over their symptoms, relieve unhealthy thought patterns, and train them in relaxation techniques and behavioral pacing, which allows patients to carry out optimal amounts of activities with no over- or underuse of their muscles and energy.

Cognitive Behavioral Therapy and Post-Traumatic Stress Disorder

PTSD can occur in people who have experienced or witnessed traumatic events. Traumatic situations can include natural disasters, serious accidents, terrorist acts, being involved in or witnessing war or combat, or being involved in personal assaults such as rape or other violent acts. Although often associated with soldiers, PTSD can develop in anyone of any age, with women being twice as likely to develop PTSD as men.

The condition is characterized by intense and distressing thoughts related to their traumatic experience. This can occur long after the traumatic event has passed. Patients with PTSD may relive the event in nightmares or intrusive thoughts, and can react negatively to stimuli associated with their trauma or ordinary events, like loud noises.

As with other conditions, CBT for PTSD aims to improve a patient’s ability to change their thought patterns and behaviors to improve their mental health. CBT will help the patient gain a more objective understanding of their traumatic experience, reinstate their sense of control, improve self-esteem and confidence, and improve their ability to cope and reduce avoidance behaviors.

Some CBT techniques for PTSD can include:

Modifying cognitive distortions (overgeneralizing bad situations or having negative expectations) to develop more balanced thought patterns
Exposing patients to reminders of the trauma in a controlled way to allow them to confront their distress instead of avoiding it
Educating the patient about common reactions to trauma, planning for potential crises and teaching them to manage their stress and engage in relaxation activities.