Cognitive Therapy: A Fresh Examination of Ancient Knowledge
We Are What We Think.
Cognitive therapy is a form of psychotherapy that offers you a means of gaining control over unwanted thoughts, feelings, or habits. The development of cognitive therapy had two major sources of influence. The one in which I was first trained emphasized the process of self-talk or internal dialogue and was developed by Donald Meichenbaum, P.hD.
CBT – Cognitive Behavioral Therapy
Following the early success of behavior therapy researches began to investigate whether its principles of reinforcement could be extended to the treatment of problems in the area of thoughts and feeling. Anxiety and depression were found to be reduced by focusing on the way people perceived thenselves and the situations they were faced with.
The second major trend in cognitive therapy emphasized faults in the logical processes and assumptions that are thought to influence our appraisal of ourselves and the world. This work is identified withAaron T. Beck, M.D. and has been the dominant force over the past two decades. In its simplified form this approach cites a discrete set of thinking defects and assumptions that are presumed to be at the core of many psychological problems. One such defect is over-generalization from a small number of observations to evaluate an entire set of events. One of the common logical defects is the assumption that “If I don’t do what someone wants they won’t love me.” When combined with overgeneralization the outcome is “If I displease anyone, I won’t be loved.”
DBT – Dialectical Behavior Therapy
In th e last decade the cognitive therapy model has been applied to problems involving personality with a technique called Dialectical Behavior Therapy or DBT. This approach was developed by Marsha M. Linehan, Ph.D. and integrates core techniques of mindful awareness, tolerance of distressing emotions, emotional self-regulation, and a systematic examination of interpersonal effectiveness. More recently DBT has been extended to the treatment of depression and other problems. DBT is best offered by a team of professionals and I typically only offer some of its compentents (i.e., mindfulness training). Full programs are available in Fairfield County at Silver Hill Hospital; in Westchester County at Weill Cornell Westchester; and in Manhattan at New York-Presbyterian Hospital, NYU Medical Center, and Mt. Sinai Hospital. Additional provides can be located through BP Central.
ACT-Acceptance and Commitment Therapy
Another intriguing development has been the emergence of Acceptance and Commitment Therapy or ACT. This latest method was developed by Steven C. Hayes, Ph.D. and is a further refinement of cognitive therapy. ACT focuses on thoughts within the context of the individual. Rather than judging the truth of individual thoughts and attempting to change those that are unsupported, ACT suggests accepting the thought, but without passion, recognizing that it is indeed just a thought. Psychological suffering is viewed to be largely due to avoidance and rigidity that leads to a failure to take appropriate action that is in line with one’s deepest values. Together DBT and ACT can be thought of as the third generation of cognitive therapy.
From the beginning of my career I have chosen to integrate cognitive therapy with the methods of clinical psychophysiology. Psychophysiology examines the physiological (bodily) changes that accompany mental events. In many ways it provides the window that helps make your non-observable emotional reactions observable. Biofeedback is a prime example of a psychophysiological technique. This integration of cognitive therapy and psychophysiology came as a result of my learning both the art of psychotherapy and the practice of meditation at the same time early in my career. The combination has had a profound effect on the way I approach my work helping people cope with the challenges of life and illness
Cognitive Therapy Doesn’t Deny Biology
The emphasis on cognition is does not imply a rejection of the certainty that biochemical disruption lies at the heart of most forms of anxiety and depression. The first step always is to be seen by your physician to rule out the possibility of underlying medical problems. Medication may be advised and should be carefully considered if recommended. If you are reading this because your doctor recommended seeing me you have already taken that step.
Medication and Cognitive Therapy
Cognitive therapy and medication are ideal partners. Medication may make your progress in therapy easier and effective therapy may reduce the length of time medication is needed. The treatment of panic attacks is a perfect example. The underlying problem is often an inherited intolerance for changes in the blood gas carbon dioxide. The risk of having a panic attack is greatly reduced with antidepressants. The lingering fear of having another attack can be lessened with anxiety medication. Learning to control the attacks with a breathing technique described on my applications page is often much easier than you might expect. Relaxation techniques can then be practiced to help prevent further episodes and tolerate going back into situations where panic episodes have occurred in the past. The antidepressant might be reduced or withdrawn after a year.
Read Dr. Wilson quoted in the New York Times about panic attacks at the Woodstock Music Festival
CBTi-Cognitive Behavioral Therapy for Insomnia
Cognitive therapy has been successfully used in the treatment of insomnia and some have chosen to view the specialized treatment as CBTI. This treatment focuses on the role of anxiety and depression as well lifestyle change to promote restorative sleep. Most recently the utility of training in mindfulness practices to help reduce overactive though has received a great deal of attention.
Continuing Evolution of Cognitive Therapies
Cognitive therapy is a vibrant field and continues to evolve at an increasing pace. The continuing evolution appears to parallel those of the earlier behavior therapy. There is an increased emphasis on the function and context of cognitive events, rather than on their form.
Read Dr. Wilson’s comments in the 10/9/2008 Journal News story on the psychological impact of the current economic downturn.
To find a cognitive therapist in your area go to ABCT to search their directory of providers.