COGNITIVE BEHAVIORAL THERAPY

CBT is a psychotherapy adopted for depression and other mental disorders. It solves the current problems and changes unhelpful thinking and behaviour. Most treatment given out to patients involving depression and anxiety are based on cognitive and behavioural therapy.

This treatment recognizes the fact that some behaviour cannot be controlled by rational thought process. CBT is problem focused and action oriented. It is different from Psychoanalytical method where the therapist enters into the  unconscious mind of the patient and try to find out the cause for the strange behaviour. Behaviourist believes that disorders such as depression are due to stimuli of fear and avoidance response resulting in a conditioned fear. Cognitive therapist believes that conscious mind can bring about desired change in behaviour. Combined together the name cognitive behavioural  therapy has come up.

CBT is effective for moods, depression, anxiety, personality, eating, addiction, dependence and psychotic disorders. It assumes that changing maladaptive thinking will change emotions and behaviours. It does not try to diagnose a person with a particular disease but try to fix up to cause improvement.

Steps of CBT are:

1.     Identifying the critical behaviour,

2.     Determining whether the critical behaviour is in excess or in deficit,

3.     Creating a base line after identifying frequency, duration and intensity.

4.     If in excess attempt decrease and if in deficit attempt increase in frequency, duration and intensity.

After conducting treatment the therapist must check up the present status with reference to base line to find out success or failure. CBT technique should challenge the errors in thinking such as overgeneralizing, magnifying the negatives, minimizing positives and catastrophizing with more realistic and effective thoughts. It will get rid of emotional distress and self-defeating behaviour. Cognitive distortions may be due to belief or overgeneralization on something.

CBT has six phases.

1.     Assessment

2.     Reconceptualization

3.     Skills acquisition

4.     Skills consolidation and application training

5.     Generalization and maintenance

6.     Post-treatment assessment and follow up.

Reconceptualization is mostly cognitive part of the strategy. CBT involves self- instruction (distraction, imagery, motivational self-talk), relaxation, development of adaptive coping techniques (minimizing negative thoughts), changing maladaptive beliefs about pain and goal setting.

Anxiety disorders:

There are two methods of treatment, exposure and glucocorticoids. When a person fears anything such as a place, an incident, or certain activity he will be exposed to that situation to prove that there is nothing to fear. When a baby fears a dark spot in the house he should be forcibly taken to that spot and made him to check for himself and get satisfied.

OBSESSIVE COMPULSORY DISORDER

Glucocorticoid is a hormone that binds to the glucocorticoid receptor present in every human cell. GC is part of feedback mechanism in immune system. It regulates metabolism of glucose, its synthesis in adrenal cortex and its steroid structure. They are used in medicine to treat diseases caused by an overactive immune system such as allergies, asthma, etc. GC has potentially harmful effects and hence not sold over the counter. GC may lead to a more successful extinction during exposure therapy. A combination of glucocorticoid and exposure therapy will be a better treatment for anxiety disorders.

Psychosis and mood disorders

Among psychotherapeutic approaches cognitive behavioural therapy and interpersonal psychotherapy have the best results for Psychosis and mood disorders. Depressed people acquire a negative schema of the world in childhood and adolescence as an effect of stressful life events. When the negative schema is activated later in the life the person encounters similar situations.

CBT is used to complement medication and is adapted to meet individual needs. Interventions particularly related to these conditions include exploring reality testing, changing delusions and hallucinations, examining factors which precipitate relapse and managing relapses. Anti-depressant medication is still viewed as significantly more effective than CBT, although success with CBT for depression was observed beginning in the 1990s.

Schizophrenia is a mental disorder by which patient exhibits false beliefs, confused thinking, hallucinations, reduced social engagement and lack of motivation. For this disorder CBT is effective.

Older Adults suffering from the above mental disorders should be treated with CBT with modification due to age. The generation gap between elder persons above 70 and younger persons above 30 may cause reaction differently to the therapy. The elder person might have formed his own image of role in life. He will find it very difficult to change his image demanded by therapy. Some elderly persons do not accept the natural aging process and hence they may not accept the malady given in CBT. The brain of elderly people learns slowly any new thing compared to younger generation. For anxiety disorders use of CBT has significantly reduced the generalized anxiety disorders and other anxiety symptoms.