This Treatment Can Be as Effective as Meds in Battling Depression
It's also proven helpful in treating substance use disorders, anger issues and eating disorders.
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What is CBT, and how did it become one of the most prominent forms of therapy?
In the early 1960s, American psychologist Aaron T. Beck began studying the effectiveness of psychoanalysis—the type of “talking cure” that most people associate with therapy—on patients with depression in an effort to validate the treatment in a more scientific way. His research showed that the psychoanalytic view of depression—that it is repressed aggression turned inward—was inaccurate. Instead, Beck found that negative thoughts in the present influence our responses.
According to Beck, these “automatic thoughts” are affected by our core beliefs, or the central ideas that we have of ourselves. For instance, if someone who believes that they’re a failure does poorly on a test, their response might be, “Of course I failed, because I’m a failure—so what’s the point of trying?” They may feel depressed and unmotivated and consequently don’t adapt in ways that could produce better outcomes. When they fail again, their negative core belief is “proven.”
Beck developed cognitive behavioural therapy (also known as CBT) to help patients recognize negative thought patterns, to question and evaluate them, and then to adjust their behaviour in response. CBT has since become the most researched form of psychotherapy and is now considered the gold standard in evidence-based treatment for anxious and depressive disorders.
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What does CBT entail, and how do I know if it’s right for me?
CBT is a structured and focused process, typically lasting between 12 and 20 sessions, with the ultimate goal of providing patients with the tools they need to become their own therapists. CBT therapists often assign homework to help patients analyze their thoughts in between sessions. Journaling, for example, can help a patient keep track of triggering events and recognize negative thought patterns.
While CBT is considered a first-line treatment for anxiety and depression, it has also been shown to be effective for substance use disorders, anger issues and eating disorders. Research also suggests that CBT can be beneficial for conditions that might be considered more physical than psychological, like irritable bowel syndrome and fibromyalgia, by helping patients manage their response to pain. “Any human ailment that can be improved by better thinking and better habits can be helped by CBT,” says Greg Dubord, director of CBT Canada.
However, due to the short-term nature of the treatment, CBT may not be appropriate for those who want to focus exclusively on past issues or want ongoing supportive counselling. In those cases, conventional talk therapy or group therapies may be preferred. Patients should talk to their health care provider to determine the type of therapy best suited to them.
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How does CBT compare to medication?
Depression is often treated with medications, including selective serotonin reuptake inhibitors (SSRIs). But according to a recent article published in the Cognitive Therapy and Research journal reviewing the past 50 years in CBT research, CBT is at least as good as medication in most cases. In fact, the researchers reported that depressive patients successfully treated with CBT were less than half as likely to relapse than those treated with medication. One possible explanation, they said, is that depression is an “evolved adaptation that served to keep our ancestors ruminating about complex social problems until they arrived at a solution.” Therefore, the researchers noted, interventions that facilitate a similar type of reflection are more likely to be successful than ones, like medication, that simply suppress symptoms.
However, Dubord notes that some conditions—schizophrenia, bipolar disorder and persistent forms of depression (in which symptoms last for a year or more)—almost always require medication combined with therapy.
When considering CBT as a possible alternative to medication, Dubord suggests people keep in mind the amount of homework involved and whether they have the time to put in that effort. And if you’re already on medication, any changes should be done in consultation with your physician.
Now that you know what CBT is, check out these expert tips on how to quiet negative self-talk.