The best treatment for mental health distress we have to date

A word on the DSM and it’s credibility: It is my opinion, as someone actually at a university who is studying mental health care, is that there is scientific evidence being incorporated more and more into the DSM. But, diagnosis in general is considered by many, past and present day, in the mental health industry as possibly unnecessary, and possibly even damaging.

For example, regardless of if you have schizophrenia or not, regardless of if it’s mostly genetic, the treatment that is most effective doesn’t drastically change. Cognitive behavioral therapy has the most research behind it, and has now been shown to be more effective than medication for a long, exhaustive list of disorders.

Here is Cognitive Behavioral Therapy in a simple, easy to understand visual. Although it includes a vast array of techniques, this is a good 101.

CBTgraphic

(Source)

Basically, boiled down for time, everything affects everything. An event happens > followed by thoughts > followed by emotions, behavior, and physical reactions. So the thinking is, you can’t control the situation, but you can alter your thoughts. And thinking alternative, evidence based thoughts, actually tends to make people healthier. This reduces the negative emotions, behaviors, and physical reactions that result from the event and the thoughts.

CBT is solution focused and action oriented. Instead of looking for unconscious meaning behind behaviors and diagnosis, Behaviorism (part of CBT) thinks of something for example, depression, as a connection between a feared stimulus, an avoidance response. This results in a conditioned fear. Cognitive therapists think conscious thoughts influence behavior. The Cognitive and Behaviorist approach were combined to create what we now call Cognitive Behavioral Therapy. (Source)

What are some CBT techniques?

Some coping skills that are taught in CBT are challenging or debating patterns and beliefs, and replacing them with healthier patterns and beliefs.

For example, some unhealthy thoughts might be overgeneralizing, looking for evidence of the negative only, minimizing positives, and catastrophizing. Coming up with more realistic explanations or cognitions decreases emotions distress and self-defeating behavior. (Source)

Other techniques are distraction, imagery, motivational self-talk, relaxation, minimizing negative or self-defeating thoughts, slow exposure to anxiety-provoking events, and goal setting.

This causes cognitive restructuring. The brain has neuroplasticity and can change. CBT actually modifies the neural circuits involved in regulation of negative emotions and fear extinction. It is able to change dysfunctions of the nervous system. This was discovered using neuroimaging techniques on neurobiological changes related to CBT before and after treatment. (Source)

These are some of the condition CBT has shown to be effective for:

  1. mood
  2. anxiety
  3. personality
  4. eating
  5. addiction
  6. dependence
  7. tics
  8. psychotic disorders
  9. schizophrenia
  10. fibromyalgia
(Lambert MJ, Bergin AE, Garfield SL (2004). “Introduction and Historical Overview”. In Lambert MJ. Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (5th ed.). New York: John Wiley & Sons. pp. 3–15)

CBT in the short term is equivalent in effectiveness as medication. Long term, it is superior to medication. In a meta-analysis (comparison of many studies), after 16 weeks of treatment, 58.3% of patients felt relief from depression, versus 57.5% for the antidepressant. Later, medication patients were switched to placebo over the course of 12 months. The CBT group discontinued therapy except for 3 “booster sessions” over the course of the same 12 months. After 1 year, 76% of patients on the placebo relapsed into depression, while only 31% of CBT clients relapsed into depression. (Hollon SD et al, Arch Gen Psychiatry 2005;62(4):417–422)

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