April 17, 2007
Change your thinking, change your life
Learning to redirect thoughts can fight depression and other mental illnesses, cognitive behavioral therapists say...
By Shari Rudavsky
The stereotypical image of psychoanalysis depicts a patient on a couch, talking about her dreams while the analyst strokes his beard and says, "Ver-r-ry interesting. How does that make you feel?"
But not all therapy follows this Freudian path.
A newer type of analysis, known as cognitive therapy or cognitive behavioral therapy, takes the patient off the couch and puts her on the same level as the therapist.
Unlike other forms of therapy that encourage patients to talk about their feelings, cognitive behavioral therapy (CBT), focuses on teaching people to think differently about their world so as to empower them to make needed changes.
"When people are depressed, it's as if they're wearing the darkest sunglasses imaginable, so everything they see gets filtered through in a dark way," says Judith Beck, director of the Beck Institute for Cognitive Therapy and Research in Bala Cynwyd, Pa.
"What we're trying to do is scrape away the darkness and have them see through clear glasses. We're not trying to give them rose-colored glasses; we're trying to give them clear glasses."
Take this scenario: A boss or spouse makes you mad. Traditional therapy would delve into why you feel the way you do. Cognitive behavioral therapy takes a different approach.
"A cognitive behavioral therapist would respond, 'You decided to become angry,' " says Steven M. Herman, director of the outpatient mental health clinic at the Indianapolis Veteran's Administration Medical Center. "It recognizes that we choose how we respond to things."
Once the person comes to that realization, he or she can focus on making changes rather than wallowing in emotions, cognitive behavioral therapists agree.
"If the thoughts can change, the feeling changes automatically," says Michael Dettner, a certified CBT and founder of Integrity Health, a psychotherapy practice in Indianapolis. "The goal is basically retraining a patient how to think about situations."
That approach worked for Jerry Hall. The 43-year-old Indianapolis resident had seen therapists before, but none had helped him with his critical problem -- his weight, which in recent years has yo-yoed from 220 to 370.
Two-and-a-half years ago, Hall started working with Dettner. The two explored Hall's relationship with food, noting he eats when he feels stressed, unhappy or powerless.
Then they devised ways to change that dynamic.
Now, when Hall feels frustrated, instead of stuffing a honey bun into his mouth, he finds other ways to blow off steam, such as riding a bike or reading a book. For him, cognitive therapy succeeded where other forms of therapy had not.
"I can look at food as what I need to nourish me, and I can stop there. I'm not using it for that emotional security blanket anymore," Hall says.
"Instead of just looking for what the problems are and commiserating that you have them, the cognitive behavioral therapist pushes you to do the next step. . . . To me, it's the expectation that the patient has to take an active role in it."
Hall did so well that Dettner gave him his blessing to have bariatric surgery. Since the operation in January, Hall has lost nearly 90 pounds and currently weighs about 280.
For Debbie Warman, who teaches the method as an assistant professor of clinical psychology at the University of Indianapolis, cognitive therapy is all about teaching people how to identify and correct biases or errors in their thinking.
A self-conscious person, for instance, might interpret someone looking at him as a sign that the person doesn't like him. Cognitive therapy teaches the patient how to analyze the glance more objectively.
"When people are distressed, if a bias is operating, by correcting the bias they oftentimes feel better," Warman says.
Numerous scientific studies over the past 25 years suggest that this approach actually works. Research has shown that cognitive therapy can be just as effective for mild, moderate and severe depression as medication. Other work suggests the treatment is about twice as effective at preventing relapse.
More controversial research centers on what actually occurs in the brain when cognitive therapy works, Dettner says.
Some researchers believe that negative thought patterns may contribute to a lack of the neurotransmitter serotonin, a deficit that may be related to depression. Teaching a person to redirect such thoughts and think positively might boost serotonin levels, address that imbalance and help correct the problem.
However cognitive therapy works, therapists recommend its use for a variety of conditions, including schizophrenia, anxiety disorders, bipolar disorder, insomnia, infertility and irritable- bowel syndrome. It can even play a role in helping the developmentally disabled.
"Whatever kind of problem you're having, chances are real good that a cognitive behavioral therapist can help you," says Herman, associate professor of psychiatry at the Indiana University School of Medicine.
In some instances, a person can resolve an issue in as few as a dozen directed sessions with a therapist. Other patients benefit from longer stints in therapy.
Cognitive therapy grew out of work done in the early 1960s by Judith Beck's father, Pennsylvania psychoanalyst Aaron Beck.
Beck noticed that some of his patients continually had negative thoughts. For instance, in the middle of therapy, one patient worried she was boring him, says Beck. He wondered whether he could teach people to identify such thoughts, adopt a different view of the world, and act accordingly.
More than 40 years later, hundreds of therapists around the world have adopted this methodology, says Judith Beck, also a clinical associate professor of psychology at the University of Pennsylvania.
At its most basic level, however, there's little that is mystical about the way cognitive therapy works, many practitioners agree.
"We tell patients that half of what we do in cognitive therapy is straightforward problem-solving and half of it is teaching them skills," Beck says.
Call Star reporter Shari Rudavsky at (317) 444-6354.
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