So long Prozac. Goodbye couch.
By Tony Freeman - 02/11/2009
The days of traditional therapy – lying on a couch talking about your awful childhood – may be numbered. Those who seek therapy today are likely to find a very different kind of treatment; short-term, goal-oriented and evidence-based. And you may be asked to sit up and pay attention.
CBT (Cognitive Behavioural Therapy) is the fastest growing and most rigorously studied form of therapy available, the subject of hundreds of clinical trials evaluating its efficacy in treating everything from Depression to Schizophrenia. For both financial and clinical reasons, it has replaced Freud’s long-winded therapy as the dominant treatment in the NHS.
NICE (the institute that recommends treatment to doctors), now advises CBT be used in most cases, before prescribing anti-depressants. Some private insurance companies, only cover CBT therapy. Why has traditional therapy fallen out of favour?
Depression, anxiety and other mental problems are not only the result of the past, but what we tell ourselves right now. CBT shows how beliefs and thoughts shape our emotions. It helps you identify unhelpful thinking, and then change it.
There is also a backlash against anti-depressants. One British University found placebos were just as effective. 60% of those on medication do not find adequate relief, and 70% of those who stop - relapse. Side effects can be severe. CBT has been shown to be as effective as anti-depressants. Relapse rates are lower, as patients learn to heal themselves, rather than relying on mood altering medication.
Have you ever got yourself terribly upset about a situation, only to find out later that you had simply been mistaken. Anxiety and angst are usually the result of what we tell ourselves, more than the situation we find ourselves in. However, many people are unaware of the power of their thoughts in shaping their moods.
Sarah, developed a phobia to needles in her third year of employment as a nurse at her local hospital. What started as a slight aversion developed into full blown fear of needles, that forced her out of work and into long term depression.
Counselling was unsuccessful, but a short course of CBT was able to help. She was encouraged to examine her phobia logically, and test her fear of needles against a scale of what was reasonable, rather than what ‘felt right’. After 3 months of CBT therapy she was able to identify and reject unhelpful thoughts which had caused her so much anxiety, and replace them with more reasonable, helpful thoughts.
Unlike traditional therapy, in which the therapist gives insight over a long period, CBT teaches people to ‘be their own therapist’. They learn to solve their own problems, rather than rely on expert advice. These techniques are learned in therapy and practiced in day to day life.
All this is music to the ears of cost-conscious Health Trusts and private medical insurers. In these Credit-Crunch times, the expensive indulgences of long term therapy of the 80’s and 90’s seem a world away. The pragmatic and cost-saving approach of CBT fits leaner times.
CBT may change the way you see the world, and yourself.
Tony Freeman is a therapist in North London. www.freemancbt.com