Cognitive and Behavior Therapies Issues - Essay Example

Cognitive Behavioral Therapy _________________ A Therapeutically study of cognitive behavior problems _________________ Submitted by: yOur name December 21, 2006 Cognitive and Behavior Therapies Background of the Study Cognitive Behavior is the study of human disorder from what they think and from what they do. It focuses on the problem and difficulties in human behavior such as: depression, anxiety, panic and phobias, obsessive compulsive disorder cause by drug addiction. Depression, anxiety, panic and phobias can cause disability of the patients and sometimes patients in this cognitive behavior problem commit suicide. Cognitive behavior problems occurred when patient is thinking about distorted thing around him and the connection between troublesome situations and the reactions to them. Failed to solved the problem within can cause fear or anger and self-defeating or damaging behavior. Cognitive Behavior Therapy helps to change the problem of bad thinking and doings of one patient. These therapy changes the feeling better rather than other treatments used to treat patients. It focuses in the causes of the behavioral problems and treats to improve the state of mind. In this therapy, the patient teaches how to be calm not only the body but it is more focuses on mind to think better, clearly, cleverly and positively and to make better decisions. Data Gathering Information: Behavioral and Cognitive Therapies, CBT, Cognitive therapy According to the study of "Whittal ML, Thordarson DS, McLean PD et.al", (see superscripts and endnotes) Cognitive therapy postulates that certain thinking patterns can cause symptoms by creating a distorted picture of the world around us and our place within it, causing anxiety, depression or anger or provoking injudicious or inappropriate actions. Behavior therapy helps weaken the connections between troublesome situations and habitual reactions to them. These include fear, depression or anger and self-defeating or self-damaging behavior. It also teaches the patient how to calm the mind and body, to feel better, think more clearly, and make better decisions. Amenable conditions: There is a strong evidence base for the effectiveness of CBT. It can be used in a wide number of conditions and the following list is by no means exhaustive: Depression and mood swings Panic attacks and phobias Obsessive compulsive disorder (OCD)1 Drug addiction including cocaine addiction2 Chronic anxiety It can reduce the rate of relapse in both schizophrenia3 and bipolar disorder4 post traumatic stress disorder5 eating disorders6 Chronic fatigue syndrome7 and fibromyalgia Chronic pain.8 Many of the common behavioral problems in childhood and adolescence including anxiety and depression.9 The nature of therapy: Cognitive therapy is focused on the present rather than delving far back, focused by being limited in time and oriented towards solving problems. Much of what the patient does is to solve current problems. They also learn specific skills that they can use for the rest of their lives. Then they learn to change their distorted thinking, to think more realistically and they feel better. There is consistent emphasis on solving problems and initiating behavioral change. Setting goals is an important feature. These goals may relate to work, relationships or just eliminating bad habits. Goals include learning skills to cope. Before therapy starts an assessment is usually made by means of a questionnaire. These are discussed in recognizing and screening for depression in primary care. One of the most frequently used is the Beck inventory to assess feelings of depression, anxiety and hopelessness. The patient and therapist set an agenda for topics to be covered. Therapy involves a combination of problem-solving and assessing the validity of the patient's thoughts and beliefs in the troublesome situation. New skills are learned. Both parties discuss how to make best use of what has been learned during the session in the coming week and the therapist will summarize the important points of the session and ask for feedback. What was helpful about the session What was not Both therapist and patient are quite active in this form of treatment and the therapist is not a passive listener. Sessions usually last about an hour and are once a week. Extra sessions can be arranged in a crisis and sometimes, towards the end of therapy they may be spaced out to be 2 or 3 weeks apart. Some treatments may be as short as 6 to 8 sessions. Usually they continue for months but not years. Between sessions the patient tries to implement what has been learned. An additional session to ascertain continued progress may be arranged 3, 6 or 9 months after the end of regular therapy. Some improvement should be noted after 2 or 3 sessions. Books and leaflets may help to give additional help and support. Drug treatment: CBT can be used in conjunction with medication and the two may complement each other. However, the fact that it does not involve medication may be seen as an advantage. It tackles the problem at its root rather than adjusting levels of chemicals in the brain and psychotropic medication is not suitable for everyone. The limitations of antidepressants are discussed in who benefits from antidepressants Such drugs have to be used with extreme caution in children and adolescents where they may increase the risk of suicide. If the problem is one of inappropriate perception and response to situations it is more logical to engage in therapy than to take drugs. Many adults would prefer treatment without pharmacotherapy but in children there are considerable limitations due to restricted licenses and it is not reasonable to assume that children's brains will respond to medication in the same way as adults. Therapists: As with any form of therapy, whether psychological or surgical, it is important that it is administered by a duly trained and qualified professional. Within the NHS it is fair to assume that only an appropriate person would offer such therapy but where private arrangements are made it may be necessary to be more circumspect. Usually the therapist will be a clinical psychologist or psychiatrist. An attempt to train GPs to offer CBT after a short training package failed to show any significant improvement in outcome.12 A Cochrane review of CBT in schizophrenia showed that it produced fewer relapses but the reviewers were concerned about this being a time-consuming approach provided by scarce and highly trained staff and the value of offering it by less qualified people was unknown.3 Making CBT more available: In general practice the use of drugs to manage psychological problems has been much more popular than CBT over the years and there are a number of reasons for this: GPs understand drugs and how to use them. They may not understand the potential and the limitations of other therapies. Prescribing drugs is easy. Referring patients to other therapies may be difficult and need to go through a psychiatrist first. This takes time before treatment starts and the patient may still be unsuitable or not able to be accepted if resources are limited. There is often a lack of clear referral criteria and pathways. Face to face for one hour a week with a healthcare professional, often a psychiatrist or clinical psychologist is rather more expensive than most drugs. It is possible to get an interactive computer program. There is some evidence that it produces results that are not inferior whilst saving therapist's time.10 Rational Emotive Behavioral Therapy: While similar views of emotion have existed for millennia, cognitive therapy was developed in its present form by Albert Ellis, who developed his Rational Emotive Behavioral Therapy, or REBT, in the early 1950s, as a reaction against popular psychoanalytic and increasingly humanistic methods at the time, and (Aaron T. Beck), who followed up Ellis' approach in the 1960s. It rapidly became a favorite intervention to study in psychotherapy research in academic settings. In initial studies, it was often contrasted with behavioral treatments to see which was most effective. However, in recent years, cognitive and behavioral techniques have often been combined into cognitive behavioral treatment. This is arguably the primary type of psychological treatment being studied in research today11. Art Therapist: In the Roth and Fonagy book What Works for Whom A Critical Review of Psychotherapy Research there is no mention of the work of art therapists with people with serious mental disorders even in the chapter on schizophrenia. Nevertheless unusual amongst those professionals taking a psychotherapeutic approach, art therapists have created a base for their practice within the public sector. The psychotherapeutic tenor of contemporary art therapy practice with this client group means however, that it has not been within a tradition of evidence for outcome (e.g., Killick, 1995; Killick & Greenwood, 1995; Wood, 1996; Killick & Schaverien, 1997). Consequently this presents the task of making visible in terms of outcome, the work already done by art therapists with the seriously mentally disordered. My paper will discuss what might be done to ensure that the knowledge born out of the discipline's historical commitment to these clients is not lost to the development of future services. The efficacy of drug treatment is broadly comparable to that of exposure and response prevention. However, relapse after withdrawal of medication is high, and long-term outcomes are clearly inferior to that obtained with exposure treatment. Psychological treatments that do not include exposure and response prevention (e.g., relaxation training or anxiety management) have been shown to be ineffective with obsessive compulsive disorder (OCD) patients. The critical parameter enhancing the effectiveness of exposure seems to be exposure of a sufficiently long duration. There is no indication that OCD patients benefit additionally from inpatient treatment, and outpatient treatment is recommended.13 Meta-analyses indicate that treatment gains are, on the whole, maintained with psychological treatments. The impact of medication generally appears to be short- term after discontinuation 14 Combinations of cognitive treatments and exposure seem effective in treating panic with agoraphobia in two-thirds of cases; for panic disorder without agoraphobia about 85% improve 15 Phobic symptoms respond best to exposure treatments; a very high percentage of specific phobias - perhaps as many as 70-85% are effectively treated by this method. The addition of cognitive techniques appears to add little to efficacy. Blood phobics may need tension exercises as well as exposure. There is some limited evidence to suggest that therapist-directed exposure is more effective than self-directed exposure 16 Meta-analytic studies show moderate to strong effect sizes for cognitive and behavioural treatments for social phobia. There is no indication that cognitive therapy or social skills training alone, without an exposure component, whether self-administered or therapist-directed, can be effective 17 Cognitive Behavioral Therapy (CBT) delivered by experienced therapists' shows good evidence of efficacy. Two-thirds to three fourths (sic) of patients may be expected to show clinically significant improvement at 6 months follow-up. These medium term effects are markedly greater than those observed from analytic therapy, non-directive counseling, and behavioral methods such as applied relaxation training or biofeedback. CBT appears to be the most acceptable treatment in terms of attrition from therapy and outcome on follow-up 18 Conclusions: Although at the present era, some people who had been in cognitive behavioral problems usually used antidepressants administered as medical treatment, patients always believes that therapy is more safe to handle. It can be done by the procedure of "do it yourself" and practices and physical exercises can be done by itself. ENDNOTES References Used Whittal ML, Thordarson DS, McLean PD; Treatment of obsessive-compulsive disorder: Cognitive behavior therapy vs. exposure and response prevention; Behav Res Ther 2005 May 21;.[abstract] Aharonovich E, Nunes E, Hasin D; Cognitive impairment, retention and abstinence among cocaine abusers in cognitive-behavioral treatment; Drug Alcohol Depend 2003 Aug 20;71(2):207-11.[abstract] Jones C, Cormac I, Mota J, et al; Cognitive behavior therapy for schizophrenia; Cochrane Database Syst Rev 2000;(2):CD000524.[abstract] Lam DH, McCrone P, Wright K, et al; Cost-effectiveness of relapse-prevention cognitive therapy for bipolar disorder: 30-month study; Br J Psychiatry 2005 Jun;186:500-6.[abstract] Bisson J, Andrew M; Psychological treatment of post-traumatic stress disorder (PTSD).;Cochrane Database Syst Rev 2005;(2):CD003388.[abstract] Cooper MJ; Cognitive theory in anorexia nervosa and bulimia nervosa: Progress, development and future directions; Clin Psychol Rev 2005 Jun; 25 (4):511-31. Epub 2005 Mar 31.[abstract] Price JR, Couper J; Cognitive behavior therapy for adults with chronic fatigue syndrome; Cochrane Database Syst Rev 2000;(2):CD001027.[abstract] Bandolier Cognitive behavior therapy and behavior therapy for chronic pain Compton SN, March JS, Brent D, et al; Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review; J Am Acad Child Adolesc Psychiatry 2004 Aug;43(8):930-59.[abstract] Wright JH, Wright AS, Albano AM, et al; Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time; Am J Psychiatry 2005 Jun;162(6):1158-64.[abstract] Beck A.T; Cognitive therapy and the emotional disorders; New York: International Universities Press, 1976 King M, Davidson O, Taylor F, et al; Effectiveness of teaching general practitioners skills in brief cognitive behavior therapy to treat patients with depression: randomized controlled trial; BMJ 2002 Apr 20;324(7343):947-50.[abstract] Roth A, Fonagy P. What works for whom: a critical review of psychotherapy research. New York: Guilford Press, 1996 pp. 155-156 Roth A, Fonagy P. What works for whom: a critical review of psychotherapy research. New York: Guilford Press, 1996 p. 141 Roth A, Fonagy P. What works for whom: a critical review of psychotherapy research. New York: Guilford Press, 1996 pp. 113-144 Roth A, Fonagy P. What works for whom: a critical review of psychotherapy research. New York: Guilford Press, 1996 p. 120 Roth A, Fonagy P. What works for whom: a critical review of psychotherapy research. New York: Guilford Press, 1996 p. 123 Roth A, Fonagy P. What works for whom: a critical review of psychotherapy research. New York: Guilford Press, 1996 p. 127 Internet: Department of Health NSF for mental health Academy of Cognitive Therapy British Association for Behavioral and Cognitive Psychotherapies, website History: The originator of CBT is said to be Aaron Beck, an American psychiatrist born in 1921 but the philosopher Epictetus who lived from about AD50 to 138 is worthy of mention. He started life as a slave in the Greek-speaking Roman province of Phrygia, now in central Turkey. One day when he was working in the field, chained to a stake, his master suggested a tighter shackle to prevent him running away but he advised that it was not needed but it would break his leg. The master persisted and Epictetus's leg was broken. He did not protest or give any sign of distress and when his master asked him why, he said that as the leg was already irreversibly broken, there was really no point in getting upset about it. His master was so impressed that he set Epictetus free, and sent him away with money so he could become an itinerant philosopher. Regan CA, is more focus on the study of Arthritis appraisal and ways of coping: scale development. Arthritis Care, Res 1988;3:139-50 Acknowledgements EMIS is grateful to Dr Paul Hewish for writing this article. The final copy has passed peer review of the independent Mentor GP authoring team. EMIS 2006. Last issued 05 Jul 2006 *****Note: To the customer:***** Kindly omit this note after reading the message! I would like to inform you that base on the study in research of Cognitive Behavioral Therapy, Hollen et al not even mention in 200 form of research. Regan C. A. although have a small contribution in CBT, Regan is more focused in RA (Arthritis appraisal and ways of coping: scale development. Arthritis Care, Res 1988;3:139-50). Ellis with Beck is much reliable on this study. Thanks and Sorry for the inconvenience. The Writer P.S. (To minimize the time consuming in locating the research for your references makes sure to state the correct surname of the person Fonagy instead of Fongay from what you stated on your desired reference). DITTO Read More