Cognitive
Behavior Therapy and
Tourette Syndrome
Cognitive
behavior therapy (CBT) is based on the belief that the way a person
thinks about an event determines in part how he or she responds to
the event, both in terms of feelings and behavior. The goal of CBT
is to help the patient learn to identify and correct erroneous beliefs
and systematic distortions in information processing in order to reduce
distress and increase efforts to cope. The literature indicates that
CBT is effective in the treatment of depression, panic disorder, generalized
anxiety disorder, and bulimia nervosa. It has emerged as the treatment
of choice for these disorders often proving to be more effective than
alternative therapies and typically longer lasting. Research indicates
that there are also indications that CBT may be of use in the treatment
of schizophrenia and other psychotic disorders largely as an adjunct
to medications. NIMH is currently funding research on the effectiveness
of CBT in the treatment of mental disorders.
Cognitive
behavior therapy is a clinically and research proven breakthrough
in mental health care. Hundreds of studies by research psychologists
and psychiatrists make it clear why CBT has become the preferred treatment
for conditions such as these . . .
•
Depression
and mood swings
•
Shyness and social anxiety
•
Panic attacks and phobias
•
Obsessions and compulsions (OCD and related conditions)
•
Chronic anxiety or worry
•
Post-traumatic stress symptoms (PTSD and related conditions)
•
Eating disorders (anorexia and bulimia) and obesity
•
Insomnia and other sleep problems
•
Difficulty establishing or staying in relationships
•
Problems with marriage or other relationships you're already in
•
Job, career or school difficulties
•
Feeling “stressed out”
•
Insufficient self-esteem accepting or respecting yourself)
•
Inadequate coping skills, or ill-chosen methods of coping
•
Passivity, procrastination and “passive aggression”
•
Substance abuse, co-dependency and “enabling”
•
Trouble keeping feelings such as anger, sadness, fear, guilt, shame,
eagerness, excitement, etc., within bounds
•
Over-inhibition of feelings or expression
Exposure and Response Prevention
Perhaps this will help make it clear. You must have
noticed that when you are experiencing an emotion, your body feels
different. This is because you're sensing certain distinctive changes
in your internal physiology. It's no accident that the word “feeling”
can be a synonym for “emotion.” In other words (to simplify
things a bit) . . .
To have an emotion is to feel the physical (bodily)
consequences of our thoughts.
Cognitive behavior therapy* combines two very effective
kinds of psychotherapy — cognitive therapy and behavior therapy.
Behavior therapy helps you weaken the connections between troublesome
situations and your habitual reactions to them. Reactions such as
fear, depression or rage, and self-defeating or self-damaging behavior.
It also teaches you how to calm your mind and body, so you can feel
better, think more clearly, and make better decisions.
Cognitive therapy teaches you how certain thinking patterns are causing
your symptoms — by giving you a distorted picture of what's
going on in your life, and making you feel anxious, depressed or angry
for no good reason, or provoking you into ill-chosen actions.
When combined into CBT, behavior therapy and cognitive therapy provide
you with very powerful tools for stopping your symptoms and getting
your life on a more satisfying track.
In CBT, your therapist takes an active part in solving your problems.
He or she doesn't settle for just nodding wisely while you carry the
whole burden of finding the answers you came to therapy for.
You will receive a thorough diagnostic workup at the beginning of
treatment — to make sure your needs and problems have been pinpointed
as well as possible.
This crucial step — which is often skimped or omitted altogether
in traditional kinds of therapy — results in an explicit, understandable,
and flexible treatment plan that accurately reflects your own individual
needs.
In many ways CBT resembles education, coaching or tutoring. Under
expert guidance, as a CBT client you will share in setting treatment
goals and in deciding which techniques work best for you personally.
CBT provides clear structure and focus to treatment. Unlike therapies
that easily drift off into interesting but unproductive side trips,
CBT sticks to the point and changes course only when there are sound
reasons for doing so.
As a CBT client, you will take on valuable “homework”
projects to speed your progress. These assignments — which are
developed as much as possible with your own active participation —
extend and multiply the results of the work done in your therapist's
office.
You may also receive take-home readings and other materials tailored
to your own individual needs to help you continue to forge ahead between
sessions.
CBT has been very thoroughly researched. In study after study, it
has been shown to be as effective as drugs in treating both depression
and anxiety.
In particular, CBT has been shown to be better than drugs in avoiding
treatment failures and in preventing relapse after the end of treatment.
If you are concerned about your ability to complete treatment and
maintain your gains thereafter, keep this in mind.
Other symptoms for which CBT has demonstrated its effectiveness include
problems with relationships, family, work, school, insomnia, and self-esteem.
And it is usually the preferred treatment for shyness, headaches,
panic attacks, phobias, post-traumatic stress, eating disorders, loneliness,
and procrastination. It can also be combined, if needed, with psychiatric
medications. (See next section.)
No other type of psychotherapy has anything like this track record
in outcome research.
CBT is usually employed by itself, without psychiatric drugs. For
some people, however, drug treatment is needed to obtain a partial
reduction in symptoms before CBT can be fully effective. Usually,
though not always, it is preferable to try CBT alone before prescribing
medications. This is for several reasons:
Benzodiazepine drugs such as alprazolam (Xanax), plus certain other
types of tranquilizers, can be habit-forming if taken over a long
time or in high doses. This is a complication that needs to be avoided
if possible. Despite their reputation as “wonder drugs,”
antidepressants such as amitryptaline (Elavil) and fluoxetine (Prozac)
work only about 65% of the time. MAOI drugs (e.g., Nardil) carry a
risk of hypertensive crisis, stroke or even death if common foods
or beverages containing tyramine are unintentionally consumed. Finally,
the mood stabilizer lithium carbonate can produce toxic reactions
unless it is very carefully monitored.
In addition, research studies have revealed these other facts about
drug treatment for depression and anxiety:
Most CBT patients are able to complete their treatment in just a
few weeks or months — even for problems that traditional therapies
often take years to resolve, or aren't able to resolve at all.
Meanwhile, for people with complex problems, or who are forced to
live in adverse conditions beyond their control, longer-term treatment
is also available.
Cognitive therapy, drugs work in child OCD
United Press International - October 26, 2004
DURHAM, Va., Oct 26, 2004 (United Press International via COMTEX)
-- A U.S. study finds children with obsessive-compulsive disorder
do well when treated with cognitive behavioral therapy and the drug
sertraline, or Zoloft.
Duke University Medical Center researchers in Durham, N.C., said
children and adolescents with obsessive-compulsive disorder dwell
on unwanted thoughts and perform repetitious actions, such as compulsive
hand washing, as a way of relieving the anxiety of those thoughts.
The cognitive behavioral therapy used in the study is an OCD-specific
psychotherapeutic treatment designed to create and reinforce new thought
patterns and behaviors. The drug sertraline is a selective serotonin
reuptake inhibitor commonly used in the treatment of depression.
"The results are so robust, decision makers at all levels of
the health care system simply have no reason not to recommend cognitive
behavioral therapy as the starting place for treatment of OCD in children
and adolescents," said Dr. John March.
"Starting with medication has no clear benefit for the patient.
Our research team feels very strongly that we now have conclusive
evidence that cognitive behavioral therapy -- alone or in combination
with medication -- works exceptionally well for this patient population."
The findings are published in the Journal of the American Medical
Association.
Copyright 2004 by United Press International.
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