cognitive behavioural therapy. image of a therapist talking to a client.

The Science of Cognitive Behavioural Therapy

Here at Ormond Neuroscience we offer various kinds of psychotherapy, including cognitive behavioural therapy (CBT).  It is a liberating treatment because it allows you to take control of your thoughts and emotions. Furthermore, that way you do not need to keep seeing a therapist forever. 

Standard operating protocol at Ormond Neuroscience is to use treatment that is scientifically proven to be beneficial.  Numerous studies show that CBT is either as effective or better than other types of psychotherapy and psychotropic drugs in the management of mental illness.  Afterall, ideas are the currency of the mind and your brain processes meaning. Therefore, to treat the mental, we should use mental constructs, ideas and feelings. Consider the following observation about psychotherapy:

Neuroscience surprisingly teaches us that not only is psychotherapy purely biological, but it is the only real biological treatment. It addresses the brain in the way it actually develops, matures, and operates. It follows the principles of evolutionary adaptation. It is consonant with genetics. And it specifically heals the problematic adaptations of the brain in precisely the ways that they evolved in the first place. Psychotherapy deactivates maladaptive brain mappings and fosters new and constructive pathways.

Dr Robert Bezerin

(You can find more of Dr Berezin’s explanation of the power of psychotherapy on the Medscape website.)

Sometimes resolution of psychological trauma calls for dredging through old trauma and focusing on the past. In that case, we might then use a psychodynamic approach to treatment. More frequently, though, we use cognitive behavioural therapy because it is relatively quick and effective.

The Risks of Psychotropic Medication

Unfortunately, we live in a world that favours quick fixes and eschews making an effort. For many people, it is easier pop a pill than to deal with the underlying cause of their psychological distress. Let’s be clear, drugs may blunt the uncomfortable feelings but they will never solve the problem because they do not lead to understanding.  Moreover, it is only by virtue of talking and feeling that we achieve understanding and true resolution of emotional distress.

At least in my view, psychotropic medication may be helpful for seeing people through acute emotional crises but it is seldom an appropriate long-term solution. Unfortunately, many people use psychotropic medication like fast food, like eatingsomething on the run that provides little nutritional benefit. It is certainly true that psychotherapy demands more effort that popping a Prozak. Almost always though, the drugs merely provide symptomatic relief and do not address the cause.

What Defines Cognitive Behavioural Therapy

CBT addresses psychological problems that arise because of faulty or unhelpful ways of thinking.  These damaging ways of thinking often arise from a habitual way of evaluating problems and making automatic assumptions, typically based on past experiences.  Fortunately, it is possible to think about circumstances differently and not to resort to habitual, ineffective modes of problem-solving.

Treatment requires one to recognise the assumptions and distortions in one’s thinking and to see how these assumptions are creating problems.  We teach you to recognise what is real and close the gap between your assumptions and reality.  Therapy gives you a better understanding of the behaviour and intentions of others and how their behaviour makes you feel.  It teaches problem-solving skills and enables you to feel confident about your evaluations. 

With CBT, you learn how to contain your emotions, contextualise them, and interpret them appropriately and accurately.  Crtically, you learn to take control and not be overwhelmed.  Effectively, you will become your own therapist and change your thinking and your emotions.

Taking Control with Cognitive Behavioural Therapy

There are many different conditions for which to use CBT. Below you’ll find brief commentary on its use in these conditions. The list is far from exhaustive and only intended to give you an idea of potential applications. These conditions include the following:

Depression

CBT is slightly better than other types of psychotherapy for the treatment of depression and is better than, or comparable to, antidepressant medication.  Current thinking is that optimal treatment for depression combines CBT and antidepressant medication.

Heart Disease

CBT is helpful for treating patients suffering from catastrophic health problems.  There is a complex relationship between coronary heart disease and depression.  We know that depression is a risk factor for developing cardiac disease.  Depression is a significant problem for survivors of heart attacks and for those living with chronic coronary heart disease.  CBT is beneficial for treating depression in these circumstances.

Parkinson’s Disease

Parkinson’s disease is a complex neurological disease and typically causes serious impairments of physical and mental functioning. CBT improves disrupted sleep in Parkinson’s patients and helps to treat their depression.

Compulsive Gambling

CBT is helpful in the treatment of impulse control disorders.  For example, it has been used to manage compulsive gambling.  In that context, it reduces gambling behaoviour and other symptoms such as lying. CBT improves quality of life and reduces depression, stress, and anxiety in compulsive gamblers.  In the context of gambling, CBT is even more effective when combined with Mindfulness Therapy.

Chronic Pain

We manage chronic pain with CBT. About 43% of studies show benefits for chronic pain patients. In other words, CBT is less effective at managing chronic pain than its performance in other conditions.  The effectiveness of CBT depends on the type of pain. For example, CBT appears to be effective in dealing with lower back pain but is less effective when dealing with cancer pain. Recommendations are that chronic opioid use should be reserved for individuals undergoing active cancer treatment, palliative care, or end-of-life care.

Bipolar Mood Disorder

Research has shown that CBT is effective in treating bipolar mood disorder.  Systematic reviews show that it is effective at decreasing the relapse rate, in improving depressive symptoms, reducing the severity of mania, and improving psychosocial functioning.  With bipolar patients, treatment sessions typically need to be 90 minutes or longer to be effective.

Stroke

Meta-analytic reviews have provided strong evidence of the efficacy of CBT in stroke patients.  CBT effectively reduces symptoms of depression and anxiety in stroke survivors.  Furthermore, the benefits appear to be permanent.

Traumatic Brain Injury

Traumatic brain injury causes a multitude of different symptoms.  CBT is effective in treating sleep disorder caused by brain injury.  CBT is effective at treating symptoms of depression and anxiety in aquired brain injury, albeit less effective than in people with no brain injury.

Further Information about Cognitive Behavioural Therapy

If you would like further information about cognitive behavioural therapy, try these resources.  The American Psychological Association have a nice short article on CBT.  The National Health Service in the UK also have a nice discussion about taking control with cognitive behavioural therapy.