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Psychotherapy
Written and researched by Bob Murray, PhD
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Is Cognitive Therapy Enough?
April 1, 2005
We have been saying for a long time that Cognitive Behavior Therapy (CBT), though effective, is by no means sufficient to eradicate depression.
Now Dutch researchers have found that individuals with a history of depression may be using thought suppression to prevent reoccurrence of their symptoms. This is the finding of a study carried out by Dr Van der Does of Leiden University in the Netherlands and published in the British Journal of Clinical Psychology.
The study builds on the idea that depression is associated with negative thought patterns that reinforce depressive symptoms. The results confirmed previous research that the maladaptive thoughts that maintain depression do not disappear entirely, instead they become dormant because they are actively suppressed (which is what CBT gets the depressive person to do). In other words, thought suppression may be one of the mechanisms by which mental control is gained over depressive ideas.
But Dr Van der Does warned thought suppression is a short-term solution to depression that may even exacerbate future problems. He said: "Thought suppression may work relatively well for a period of time but under conditions of increased stress, when cognitive capacity is reduced, the mechanism may backfire. One theory even predicts that thought suppression eventually intensifies unwanted thoughts because when mental control weakens, unwanted thoughts become more intrusive than they would have been if mental control had never been attempted."
Previous findings suggest that cognitive therapy has a more positive effect on the reactivity of negative thought patterns than alternatives such as drugs treatments. However, cognitive therapy may also not be risk-free: In the initial phases of cognitive therapy patients are often taught to use distraction techniques to regain control over their thoughts and mood states. In later phases this is followed by techniques in which the negative thoughts are confronted and changed.
This research supports earlier studies carried out at the University of Washington have shown that CBT has a 80% relapse rate after two years. We advocate a multi-pronged approach to depression treatment, which addresses not only cognitive, but also underlying emotional, physical and spiritual issues. The Uplift Program and Fortinberry-Murray Method teach individuals awareness of the origin of depressive thoughts as well as techniques for ensuring ongoing support. BM
Read more in the British Journal of Clinical Psychology
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Henry, King of the Classroom
December 2, 2003
With his impeccable breeding and double-barrelled surname, he's an unlikely candidate to restore order to a group of troublesome teenagers, but Henry Fanshawe Smart is a Cavalier King Charles spaniel on a mission. The foot-tall four month old is thought to be the first dog in the UK to become a classroom assistant.
Staff at Dronfield school, Derbyshire, swear by Henry's power to control a group of 30 children with behavioural problems, previously considered a "bunch of hard nuts".
Behavioral support manager Wendy Brown and school counselor Wendy Smart decided to bring a dog in after reading about the therapeutic effects of pets, something we have written extensively about.
According to Ms Brown: "We realized the benefits of having a dog in a hospital or around the house. I've got one at home and it has a wonderfully calming effect. Many of our children have attention deficit and hyperactivity disorder and have a reputation around the school as being a bit of a handful. They come here and they are tough nuts until they see this dog. He makes them realize it isn't uncool to show love. A lot of them go a bit gooey and can't stop fussing over him."
Having had just toilet training and a few lessons in food-grabbing etiquette, Henry started in the classroom at the beginning of the school year. In his first three months, he has charmed the children in a way which had eluded his human counterparts, reducing the level of bad behavior. The spaniel's suitably aristocratic name comes from Henry Fanshawe, a school governor, and Ms Smart, who looks after him when he is not at work.
Unlike other classroom assistants, Henry never complains about poor pay. In fact, he costs the school nothing, as local vets supply his leads and baskets, while a dog food firm keeps him in meat, bones and biscuits.
Ms Brown said: "He's lovely, a really nice dog. We got him from a local breeder, having researched the most appropriate breed. Cavalier King Charles spaniels are very bright. We didn't want a dog that was too yappy or energetic, who might disrupt lessons. Henry's very relaxed. It's rubbed off on the kids and really calmed them down. It's been amazing. There's been a massive difference in behavior."
Read
more on BBC News Online
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Written Word Helps Wounds Heal
September 21, 2003
New research indicates that writing about troubling experiences helps people deal with them. This could then help the immune system work more effectively, researchers told the British Psychological Society conference in Stoke-on-Trent in the UK.
They say their findings offer a cheap and easy to administer way of helping patients heal faster.
In the study, which involved 36 people, half were asked to write about the most upsetting experience they had had, spelling out how they had felt. The rest of the study participants wrote about trivial things, such as how they spent their free time. Both groups spent 20 minutes a day for three days writing.
Following the writing exercise, researchers created a small skin puncture on the participants' upper arms. The wounds were examined two weeks later. It was found that the group who had written about their emotional experiences had smaller wounds, meaning they had healed more quickly. Those whose wounds were healing more slowly were found to have higher levels of stress and psychological distress.
Suzanne Scott, from the Unit of Psychology at King's College London, who led the research said: "These findings have implications for the development of relatively brief and easy interventions that could have beneficial effects on wound healing." The theory is that there's a long-term health benefit. "It's easy to administer because the people don't need to have gone through some awful experience, they just need to write about their most upsetting experience."
Read more in BBC News Online
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Telephone Therapy Can Be Successful for Depression
May 25, 2003
Three months after enrolling in a disease management program offered
by telephone, patients with acute depression were six times more likely
to have their symptoms reduced to a low level than those who received
the standard care of diagnosis and education about their condition.
Primary care doctors participating in the program were also more apt
to use nationally approved guidelines in treating their patients, say
David W Oslin, MD, of the University of Pennsylvania and colleagues
Treatment provided through the phone program included many more opportunities
for feedback and monitoring of patients as they continued with their care--a
strategy that had been tested previously in face-to-face follow-up treatments.
The new findings “suggest that beneficial results are possible when
delivering disease management exclusively by telephone,” Oslin says.
Phone contact between the patients and specially trained nurses was used
to support the primary care doctor in treating acute depression. The nurses
monitored symptoms and treatment outcomes at three-week intervals, reporting
the results back to each patient’s primary care doctor.
Although doctors were more likely to prescribe guideline-recommended
care for their patients in the phone program, the patients themselves
were not any more likely to follow their doctor’s orders than patients
receiving standard care, according to the researchers. “If we can
identify significant patient characteristics that predict non-adherence,
then an intervention or educational program could be directed to these
patients in order to improve their engagement in the management of their
depression,” Oslin says.
“Depression in primary care is a pressing public health problem.
More depressed patients of all ages are seen by primary care clinicians
than by specialty mental health providers,” according to Oslin.
What this study really shows is that as humans are relationship-based
animals it is relationships that are both the prime cause of depression
and its cure. BM
Read more in General Hospital Psychiatry
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Therapy Can Change Brain Neurobiology
May 25, 2003
Brain changes that occur with cocaine use and the tendency toward relapse
may be reduced by a behavioral treatment using extinction training--a
form of conditioning that removes the reward associated with a learned
behavior.
A recent study by researchers at the University of Texas led by Dr David
Self found that specific kinds of training during cocaine withdrawal produces
changes in brain receptors for glutamate, a brain chemical found in the
nucleus accumbens, the reward center of the brain. A reduction in glutamate
input from chronic cocaine use is thought to contribute to persistent
cravings for the drug.
The researchers trained rats to self-administer cocaine by pressing a
lever and to associate the availability of cocaine with certain environmental
cues (lights and noise). Once the rats had learned to expect cocaine when
they pressed the lever, cocaine and the cues were removed so that the
rats did not receive the cocaine that they were anticipating. One group
of rats received this so-called “extinction” training during
cocaine withdrawal while another group did not.
After the training was over, the researchers exposed the rats to the cocaine-associated
cues and administered cocaine to induce relapse. The researchers found
that the rats given extinction training during withdrawal had more than
a 30 percent increase in glutamate receptors in the outer regions of their
nucleus accumbens. The number of glutamate receptors did not increase
in rats that did not receive the training during withdrawal. When cocaine-related
cues were reinstated, rats showing relatively no response to these stimuli
had a greater increase in receptors than rats that responded to the cues.
These findings indicate that behavioral-based treatment approaches have
the potential to reverse or lessen the harmful neurobiological and behavioral
consequences of chronic drug use. Increasing the number of glutamate receptors
may help ease cravings for cocaine during abstinence and also help prevent
relapse.
That therapy can induce neurobiological, and even structural, changes
in the brain is something that we have been saying for some time. In particular,
we believe, that learning and applying certain relationship techniques--which
we call the “needs process”--can cause profound and beneficial
changes in areas of the brain whose growth was stunted by childhood trauma.
The how-to of the needs process, and of relationships, is set out in our
audio-set Using Your Needs to Transform Your Life. BM
Read more in Nature
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About the Author
Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Together with his wife and long-term collaborator Alicia Fortinberry, he is founder of the highly successful Uplift Program, and author of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).
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