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Archive for Therapeutic Approach

Cognitive Behavioural Therapy

Basic Concept:

CBT is a psychotherapeutic therapy or a talking therapy. The model is based on two main ideas: the way that you feel depends on your thoughts and beliefs (‘cognitions’ in the jargon) and is also strongly influenced by what you do (‘behaviour’). That is why it is called cognitive behavioural therapy. The main premise is that external things like people, situations and events do not cause our feelings and behaviours. Furthermore we can change the way we think to ‘feel better’ and choose our actions even if the situation does not change, therefore unhelpful, negative and unrealistic thoughts can be a major source of distress.
What is CBT For?
CBT can be effective in helping people suffering from: Depression, Anxiety, Panic Attacks, Phobias including agoraphobia and social phobia , Low Self-Esteem, Addictions, Trauma, Anger Problems and Stress, eating disorders , obsessive compulsive disorder , post traumatic stress disorder , bipolar disorder and psychosis , low opinion of yourself or psychical health problems like pain or fatigue . CBT also involves repeatedly confronting feared situations that are avoided – this is called exposure.

How does it work?
CBT can definitely help to make sense of a problem or thought and break it into a smaller part. In fact it makes it easier to see the link between them.

To describe it further, the parts can be divided as below:
The Situation- a difficult situation, a problematic area or an event

From the situation thoughts, emotions, and physical feelings whether comfortable or uncomfortable ones and actions can occur.

Each area can impact on each other e.g. How you think about a problem can affect how you feel or act. It can also have a huge impact on what you do about it .There are numerous both positive and negative reactions to most situations depending how you think about them.

The whole sequences, and parts of it, can also feedback like this:

Situation

Thoughts

Actions Feelings

The pattern as shown above can worsen feelings. It can create new situations that further worsen the feelings. You can end up believing the negative talk about yourself that at times is unrealistic. Usually this is seen when we are distressed and are more inclined to interpret things and jump to conclusions while our thinking is unhelpful.CBT can be used to help you break the cycle of negative or damaging thoughts, feelings and behaviours. A CBT therapist aims to give you the skills to take control and break the cycle while tackling these problems.

What does CBT involve?
The sessions
CBT can be done individually or with a group of people. It can also be done from a self-help book or computer programme.

If you have individual therapy:
You will usually meet with a therapist for between 6 and 24, weekly, or fortnightly sessions. Each session will last between 30 and 60 minutes.
In the first 2-4 sessions, the therapist will check that you can use this sort of treatment and you will check that you feel comfortable with it; this is also where the therapeutic alliance is built.

The therapist will also ask you questions about your past life and background. Although CBT concentrates on the here and now, at times you may need to talk about the past to understand how it is affecting you now.
You decide what you want to deal with in the short, medium and long term and set goals to look at these.
You and the therapist will usually start by agreeing on what to discuss that day.

The Process
While working with the therapist, you break each problem or symptom down into its separate parts. To aid this process, the therapist may ask you to keep a diary. The diary may aid you in identifying your individuals’ patterns of thoughts, emotions, feelings and actions.
With your therapist, you will look at thoughts, feeling and behaviors to look at whether they are realistic and helpful and how they affect you.
The therapist will then help you to work out how to change unhelpful thoughts and behaviors.

It is really easy to talk about doing something; it is actually much harder to do it. So after identifying. There will be ‘homework’ – the changes that you have looked at in therapy need to be practiced in everyday life.

Depending on the situation, the client might need to question or indeed analyze negative or self critical thoughts and replace them with helpful ones that you have learn with your therapist. The client also needs to have an awareness of when they are about to do something negative and replace it with something more positive and healthy.

Furthermore at each session the therapist and client will look and how you have got on since the previous session. If homework or indeed bringing the task into your everyday life is proving difficult the therapist along with you can look at ways of adapting it easier.

You will not have to do anything that you don’t want to do – this is your therapy, you decide on the pace of your treatment and what you want to do and what you don’t want to do. The main premise is that you can practice and further develop your skills after sessions. It makes it less likely although not impossible for the symptoms or problems to return.

How long will the treatment last?
A course may be from 6 weeks to 6 months. It will depend on the type of problem and how it is working for you. The availability of CBT varies between different areas and there may be a waiting list for treatment. CBT is also available in private practice where there may be fewer waiting lists; many therapists offer a sliding scale or reduced cost session.

Problems with CBT
It is not quick fix and the client needs to do it for themselves with the support of the therapist.
If a client is feeling low, their motivation and concentration on change may not be there
Anxiety needs to be faced; this involves confronting it which may lead to some short term increased anxiety.
The client needs to stay in control and pace their sessions to their ability.

What happens when you finish therapy if the symptoms return?
With all therapies there is a risk that the symptoms may return. With CBT, if they do return, you have the skills from your sessions to make it easier to control them. This is why it is vitally important to keep practicing your skills even when you are feeling well. If necessary, you can return to therapy for some refresher training or support.

Dialectical behavior therapy (DBT)

What is DBT?

DBT stands for dialectical behavior therapy. It is based on a bio-social hypothesis that an emotionally vulnerable person is exposed to certain stressors in their life and has trouble regulating emotions because of this. “Dialectical” refers to a philosophical argument where a happy medium is found between two extremes. DBT aims to resolve conflicting emotions and behavior in clients in this way. “Dialectics”_involves assumptions about the nature of reality: 1) everything is connected, 2)change is constant and inevitable, and 3) opposites can be integrated to form a closer approximation to the truth (which is always evolving). DBT uses specific techniques of acceptance and validation derived from mindfulness meditation, as well as problem solving and emotion regulation techniques derived from cognitive behavioral therapy. It is focused on the present, and current things that are controlling behavior.

DBT includes:

  • Individual therapy
  • Group skills training
  • Telephone contact
  • Therapist consultation

DBT goals are:

  • Decreasing suicidal behaviors
  • Decreasing therapy interfering behaviors
  • Decreasing behaviors that interfere with the quality of life
  • Increasing behavioral skills
  • Decreasing behaviors related to post-traumatic stress
  • Improving self esteem
  • Individual targets negotiated with the client

Who can use DBT?

 

DBT is a treatment designed specifically for individuals with self-harm behaviors, such as self-cutting, suicide thoughts, urges to suicide, and suicide attempts. Often, people who engage in these behaviors have borderline personality disorder (BPD). Original research on DBT was done with women who were diagnosed with BPD, but DBT is now being used for women who binge-eat, teenagers who are depressed and suicidal, and older clients who become depressed again and again. Many people who have found traditional CBT unhelpful may respond better to DBT.

 

Pros of DBT

  • DBT may work better than CBT for those who have suicidal ideation or self-harm
  • The goal of DBT is to make life worth living
  • DBT assumes that people are doing the best they can, but want to improve
  • DBT is supportive and collaborative
  • DBT can help control attention and focus on the present moment, without worrying about the past or future
  • DBT can help understand, regulate, and appropriately experience emotions, without self-harming
  • DBT can help with real-life problem solving
  • In DBT you primarily work with an individual therapist, but there is group work too
  • In DBT, the therapist is available by phone after-hours (with certain limitations)
  • DBT is supported by research
  • You cannot fail at DBT

Cons of DBT

  • A course of DBT takes a long time – at least a year
  • It may be difficult to find a DBT therapist, and waiting lists may be long
  • It is unlikely, but possible that DBT is not the right treatment for some people
  • DBT may be expensive
  • Clients have to enter into a contract with their therapist and agree to not self-harm

Where to find a DBT therapist

  • To find a therapist in the USA, you can visit www.behavioraltech.com, go to the “Resources” button, and click on “Find a Therapist”, or go to the National Alliance for the Mentally Ill at www.nami.org, or the National Alliance for Borderline Personality Disorder at www.borderlinepersonalitydisorder.com
  • To find a therapist in the UK and Ireland, you can visit the Society for Dialectical Behavior Therapy at http://www.sfdbt.org/
  • In the UK Most DBT is provided by NHS teams and your point of referral will initially be your GP, who should be able to tell you if there is a DBT team in operation near you. Most referrals for DBT will be made through a secondary care service – This means you may need to be a patient of a community treatment team or specialist service before you can access DBT.  Some private hospital groups also offer DBT and you can approach these direct to see if they will accept self-referrals.
  • Contact your local college or university's psychology or psychiatry department and inquire about clinicians trained in DBT. You can also get this information from your state mental health board.

How do I know if a therapist does DBT?

You should ask the therapist these questions, and the answers should be yes. You have a right to check credentials, to know if they are licensed, to know the extent of their training and treating clients with similar problems, and to know their arrangements for coverage or emergency contacts.

 

  • Have you completed a 10 day intensive DBT training?
  • Are you a member of a DBT consultation team?
  • Have you been supervised by an expert DBT therapist?
  • Are you familiar with the main sets of DBT strategies (CBT, validation, dialectics)?
  • Do you teach skills, practice behavior analysis, and review diary cards?
  • Do you do phone coaching?
  • How many clients have you treated using DBT?

Medication & Depression

 

Anyone can develop depression. But, treatment is effective in about 80% of identified cases, when treatment is provided. Psychotherapy and medication are the two primary treatment approaches. Antidepressant medications can make psychotherapy more effective, for some people. Someone who is too depressed to talk, for instance, can't get much benefit from psychotherapy or counselling; but often, the right medication will improve symptoms so that the person can respond better.

This is intended to help you understand how and why drugs can be used as part of the treatment of depression. It is important for you to be well informed about medications for depression, if you are taking any of these medications, but this is not a "do-it-yourself" manual.

Self-medication can be dangerous. Interpretation of both the signs and symptoms of depression, and identification of possible side effects, are jobs for the professional. The prescription and management of medication, in all cases, must be done by a responsible physician working closely with the patient, his/her psychologist, and sometimes the patient's family. This is the only way to ensure that the most effective use of medication is achieved with minimum risk of side effects or complications.