Northwest Health Summer 2012

Emotional Health

Cognitive Behavioral Therapy

Questioning negative thoughts is one way to improve mental health.

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For so long, the popular image of psychological therapy was one of a patient talking about their feelings to an almost silent therapist — which was sometimes actually true. But today's mental health therapists have a more effective method to offer patients seeking aid with conditions ranging from anxiety to eating disorders: cognitive behavioral therapy (CBT).

"It's one of the developments in psychotherapy that has the broadest research base to support its effectiveness," says Jamie Keyes, PhD, a Group Health psychologist with Behavioral Health Services. "Its focus is the understanding that people's own expectations and perceptions can make a difference in how they feel."

Research has shown that certain types of negative thinking and behavior patterns are more frequent in people with many mental health conditions, Keyes says. The more of these negative thought patterns, the worse people do in coping with challenges like depression, anxiety, and relationship problems. In CBT the aim is to improve awareness of negative thought patterns and teach coping skills to change the thought patterns or behaviors into more realistic, useful ones.

It's talk and more. This type of therapy also involves collaborative work between patient and therapist to change behavior patterns that keep the patient "stuck." Sometimes these patterns must be changed before the patient will feel better, says Keyes.

For example, a patient with depression might learn to identify automatic negative thoughts ("Why go to work? I know I won't get anything done, and no one there even likes me.") and replace them with more realistic thoughts. ("My coworkers frequently ask me for my advice on projects, I do get things done at work, and I feel better when I get out of the house.")

The same is true for ingrained behaviors in conditions such as anxiety. "Many people have anxiety in social situations about what other people think of them," Keyes says. "In cognitive behavioral therapy, a patient and a therapist will discuss the associations the patient has in these situations. A next step might be to practice being around other people and doing things that they feel might draw criticism or create embarrassment. People discover it's not the end of the world, and they can tolerate even worse situations than they would typically experience in their regular life."

Research and results. Some research on CBT has demonstrated that it is as effective for anxiety and mild to moderate depression as medication alone — without any of the side effects of medication, Keyes says. (However, CBT is often used with medication, especially for more severe depression.) While there is little risk to this kind of therapy, it can make patients feel uncomfortable or emotional at times as they tackle ways of thinking or situations that may have created the anxiety, nervousness, or depression.

Patients should expect to see improvement fairly quickly. "There should be clear progress within six sessions," Keyes says. "If the therapist and patient realize something has not changed within six sessions, they would work together to adjust the treatment plan." That could include trying different exercises or approaches to get at a problem. But it's worth the effort, Keyes says. "Once people have begun to change unhealthy thinking and behavior patterns, and have experienced a different reaction to stressful situations, they realize how much better they can feel, reinforcing the changes they've made for the next time."

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