ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, August 27, 1996 TAG: 9608270159
SECTION: EXTRA PAGE: 3 EDITION: METRO
COLUMN: Personal Health
SOURCE: JANE BRODY
Betsy Jacobson of Brewster, N.Y., had grappled with the crippling effects of depression and a deflated ego almost her entire life. Reared in a domineering family with a controlling father, she was unable to fulfill her ambitions and use her talents as an actress.
``I was scheduled to fail at everything I did,'' she recalled in an interview. Years of psychotherapy, including analysis, did nothing to ease her psychic pain - nothing, that is, until she began seeing a cognitive therapist.
Cognitive therapy helps to improve people's moods and behavior by changing their faulty thinking, how they interpret events and talk to themselves. It guides them into thinking more accurately and realistically and teaches them coping strategies to deal with their problems.
``He saved my life,'' Jacobson said emphatically of her cognitive therapist.
``At age 52, I was suddenly able to grow an ego. The difference in the therapeutic approach was dramatic, and the relief I felt was immediate. Instead of dwelling on the negative, which the other therapists did, and which only ground my ego further into the ground, the cognitive therapist treated me like a decent, respectable human being with valid feelings. A healthy sense of myself was drummed into my head while I learned how to change my thoughts and feelings.''
``In midlife, I finally became a free woman, a person with self-respect,'' she continued. ``I could start a brand-new life and do things Betsy wanted to do, not just what my family wanted me to do.''
Although Jacobson returns to the therapist occasionally for booster sessions, she said, she has acquired therapeutic tools she can apply on her own, in case she finds herself slipping into old patterns of thought or behavior.
Cognitive therapy is, in most cases, a short-term treatment that can have long-term results. Typically, less than three months of weekly sessions can achieve therapeutic benefits that may take years to accomplish with traditional talk therapy. That alone suggests that cognitive therapy will enjoy an ever-widening role in the treatment of emotional disorders.
Many, if not most, people have no coverage for outpatient psychotherapy, and medical insurers and managed-care providers who offer such benefits usually strictly limit their duration.
Furthermore, studies have shown that the results of cognitive therapy are long-lasting, with relapse rates far lower than with other modes of treatment, including psychiatric drugs.
And while medication is sometimes used, at least briefly, to relieve acute emotional disturbances and improve receptivity to therapy, most patients can be spared the side effects of drugs, which may include loss of libido and inability to function sexually, gastrointestinal upsets, sleep disturbances and difficulty concentrating.
Jacobson's experience with cognitive therapy is hardly unique. While no one approach to psychotherapy is suitable for everyone, many thousands of patients have benefited from the strategies unique to cognitive therapy.
In the 30-odd years since the approach was developed by Dr. Aaron T. Beck, a world-renowned psychiatrist at the Beck Center for Cognitive Therapy in Philadelphia, it has become the most scientifically tested form of psychotherapy.
Independent studies have shown that cognitive therapy is as effective as medication and traditional psychotherapy in helping patients who suffer from depression, anxiety disorders (including panic attacks) and bulimia, according to professional analyses and a recent survey by Consumers Union.
Cognitive therapy is also proving useful for patients with chronic or recurring pain Jacobson, for example, said the therapy had helped her enormously in coping with the symptoms of fibromyalgia, chronic muscle pain.
A cognitive therapist directs a patient's attention to ``automatic'' thoughts, the things people say to themselves, that result in unpleasant feelings.
For example, someone prone to anxiety attacks might automatically think, ``I'm going to mess up,'' when taking an exam, participating in a social event or being interviewed for a job. After failing such a challenge, the person may conclude, again automatically, ``I'm a loser.''
In therapy, the person is helped to recognize errors in thought, which include exaggerating the sense of threat, anticipating disaster as the likely outcome, overgeneralizing from one negative experience and ignoring times when things went well.
Once damaging automatic thoughts are recognized, the person is helped to examine how realistic they are, consider alternative explanations, imagine other outcomes and realize that the symptoms of anxiety are not the prelude to a heart attack or some other medical disaster.
A similar approach is taken with depression. Dr. Judith S. Beck, Dr. Aaron Beck's daughter and the current director of the Beck Institute, said depressed patients have continual unpleasant thoughts and that each such thought deepens the depression.
Generally, however, these thoughts are not based on facts and result in feelings of sadness far beyond what the situation warrants.
``Depressed persons make such mistakes over and over,'' the Becks have written. ``In fact, they may misinterpret friendly overtures as rejections. They tend to see the negative, rather than the positive side of things. And they do not check to determine whether they may have made a mistake in interpreting events.''
Rather than delve into the origins of such negativism, cognitive therapists teach patients to identify their negative thoughts, recognize their erroneous nature and devise a corrective plan that leads to more positive assessments and an ability to deal more realistically with day-to-day problems. Dr. Frances M. Christian, a clinical social worker and cognitive therapist at the Medical College of Virginia in Richmond, explained: ``Thoughts and beliefs have a lot to do with how people feel and behave. Early in life, people develop core beliefs about themselves and other people and about how the world operates.''
For one reason or another, some people develop negative core beliefs that distort their interpretations of events and their predictions about their lives.
Dr. Christian said: ``Because cognitive therapy focuses primarily on the present and is problem-specific, patients generally are not in therapy for a long time, and they learn coping skills they can use throughout their lives.
Much of the learning takes place outside of the office. It's a self-help approach, and the therapist acts like a coach, helping the patient acquire coping skills.''
FINDING HELP
The techniques of cognitive therapy can be applied in individual counseling and in group, family and couples therapy. The professionals trained in cognitive therapy include psychiatrists, psychologists and social workers. For help in finding a cognitive therapist in your area, get in contact with the Beck Institute, GSB Building, Suite 700, City Line and Belmont Avenues, Bala Cynwyd, Pa., 19004-1610. You can call the institute at (610) 664-3020 or call its program director, Barbara Marinelli, at (215) 898-4102.
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