Saturday, March 31, 2007

cbt

From The Wall Street Journal, Tuesday, March 27, 2007, p. B9:

When it comes to treating certain mild to moderate forms of mental illnesses, cognitive behavioral therapy, or CBT, is gaining ground on drug therapy and "the talking cure" of analysis. Rather than delve into patients' past traumas to fix anxieties through conversation, or medicate the symptoms, CBT teaches patients to keep bad thoughts at bay, writes Forbes reporter Robert Langreth.
[Informed Reader]

"If you were abused, you accept it," says therapist Albert Ellis, who started developing many CBT techniques in the 1950s, having become convinced that Freud's approach didn't work. He coached depressed patients to evaluate their reactions to minor setbacks and assess them more realistically. Other similarly minded psychologists developed breathing exercises and "exposure therapy" to deal with anxiety attacks and insomnia.

The University of Pennsylvania's Aaron Beck, another founder of CBT, says there isn't enough money to prove CBT's efficacy in large-scale trials. But in a large number of trials with a few dozen, or a few hundred, subjects, CBT has been as effective as medication for some ailments. In a 240-patient trial, 16 CBT sessions worked as well as Paxil at treating moderate-to-severe depression. Last June a study published in the Journal of the American Medical Association showed six sessions of CBT worked better than a Lunesta-style drug at getting patients to sleep. Plus, CBT has no side effects.

Health insurers are especially attracted to CBT since it aims to heal a patient after 10 to 25 visits, in contrast to the lifelong conversation with therapists depicted in Woody Allen movies. Samuel Mayhugh, founder of Integrated Behavorial Health, which manages mental health benefits for companies employing 1.5 million people, says over half of his cases involve CBT, up from 10%-20% a decade ago. He likens traditional psychotherapy's building of long-term relationships between the therapist and patient as akin to renting a friend.

However, there are downsides to CBT. Even its supporters acknowledge that some severe ailments can be treated only by drugs and long-term care. Also, few psychiatrists have received rigorous training in cognitive behavioral therapy, since hospitals only started requiring it in 2001. "It is the psychiatrist that makes the difference, not a particular kind of therapy," says University of Wisconsin-Madison psychologist Bruce Wampold.

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