Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is an empirically supported treatment that focuses on patterns of thinking that are maladaptive and the beliefs that underlie such thinking and on maladaptive behaviors. For example, a person who is depressed may have the belief, “I’m worthless,” and a person with a phobia may have the belief, “I am in danger.” While the person in distress likely holds such beliefs with great conviction, with a therapist’s help, the individual is encouraged to view such beliefs as hypotheses rather than facts, and to test out such beliefs by running “experiments.” Furthermore, those in distress are encouraged to monitor and log thoughts that pop into their minds (called “automatic thoughts”) so that they can determine what patterns of biases in thinking they have and then develop more adaptive alternatives to their thoughts. People who try CBT can expect their therapist to be active, problem-focused, and goal-directed.
Studies of CBT have demonstrated its usefulness for a wide variety of problems, including mood disorders (depression, bipolar disorders), anxiety disorders (panic, generalized anxiety, PTSS, obsessive-compulsive behaviors, phobias), personality disorders, eating disorders, substance abuse disorders, and psychotic disorders.
Could CBT be helpful to you?
CBT has been shown to be as useful as antidepressant medication for individuals with depression and is superior in preventing relapse. Patients receiving CBT for depression are encouraged to schedule activities in order to increase the amount of pleasure they experience. In addition, depressed patients learn how to restructure negative thought patterns in order to interpret their environment in a less biased way. CBT for Bipolar Disorder is used as an adjunct to medication treatment and focuses on psychoeducation about the disorder and understanding cues and triggers for relapse. Studies indicate that patients who receive CBT in addition to treatment with medication have better outcomes than patients who do not receive CBT as an adjunctive treatment.
DBT
DBT (Dialectical Behavior Therapy) was developed by Marsha Linehan, PhD ABPP beginning in the late 1980’s to treat BPD (Borderline Personality Disorder). It is a modification of standard CBT (Cognitive Behavioral Therapy) and in its standard, comprehensive form is used in a setting that involves groups as well as individual therapy, often attended on a daily basis for an extended period. However, over the years, because of the efficacy of the skills and concepts patients learn, it is now being used to treat a wide range of psychological issues in a variety of settings.
The treatment consists of four modules of psychosocial skills: Mindfulness Skills, Interpersonal Effectiveness Skills, Emotion Regulation Skills; and Distress Tolerance Skills. As the name suggests, DBT is based on a dialectical world view, with its emphasis on holism and synthesis of opposing perspectives. The primary dialectic within DBT is in finding a balance between the seemingly opposite strategies of acceptance and change. It approaches therapy as a collaborative working relationship between the patient and the therapist and, as in other CBT therapies, requires the patient to practice new skills outside of the therapy setting. This requirement is necessary for the patient to incorporate these new skills into their every-day approach to life and to use them to manage specific life challenges.
My approach to DBT is to incorporate many of its basic concepts and skills into therapy with a patient as appropriate depending on the patient’s needs. For those who need a more intensive treatment within the basic DBT framework I can recommend comprehensive treatment centers in the NY area.
EMDR
EMDR (Eye Movement Desensitization and Reprocessing) was developed by Francine Shapiro, PhD in the late 1980’s in response to her search for a treatment to address PTSS (Post Traumatic Stress Syndrome) Her belief, later validated through research and advances in brain imaging technology, was that bilateral eye movements such as those of REM sleep could facilitate in reprocessing traumatic events to reduce the negative emotions associated with those events. Although EMDR is best known and was initially named for its eye movements, it is a whole system approach in which eye movement is only one form of stimulation and only one component of the complex approach. After more than 30 years of research and refinement of the protocols and procedures, EMDR has evolved to draw on concepts from many psychological orientations and theories, such as psychodynamic, cognitive, behavioral, experiential, etc., and incorporates a three-pronged protocol of past, present, and future. It has become a comprehensive approach that addresses the physiological storage of memory and how it informs experience and is empirically validated to successfully treat many types of psychologically based problems in addition to PTSS. These include anxiety disorders such as panic, GAD (Generalized Anxiety Disorder) and phobias, grief, somatic disorders, and depression to list a few.
Research has shown that when an experience is successfully processed (whether positive or negative) it is adaptively stored and integrated with other similar experiences about self and other. However, during adverse life experiences which typically involve high arousal states, disruptions to the information processing system results in memories that are inadequately processed and maladaptively stored. EMDR targets unprocessed memories that contain negative emotions, sensations and beliefs so that these old memories can be reprocessed or “digested”. In other words, what is useful from these memories is learned, stored and available to inform future experiences, what is no longer adaptive is discarded (e.g. negative images, feelings, beliefs), and the old memory is now stored in a way that is no longer damaging. Reprocessing takes place when dual attention on a past memory combined with bilateral stimulation, or BLS (eye movements, tactile taps, pulses, and auditory tones) facilitates this reprocessing by activating an associative process that allows relevant connections to be made.