anxious dog laying downAs anyone who’s ever lived with a dog can attest, dogs’ emotions are complex and occasionally bewildering. And for some dogs, emotions are overwhelming. Whether they’re tearing up the house in sheer terror because a beloved owner leaves for a few hours, or they’re shamelessly snarling and lunging at every dog who walks by, some dogs struggle to cope with the stresses of everyday life.

The science of dog behavioral pharmacology aims to help exhausted pet owners and their stressed-out four-legged companions. Although it was once controversial to prescribe mental health medications to dogs, the pioneering work of Dr. Nicholas Dodman, a Tufts University veterinarian, has steadily moved dog psychology into the mainstream.

Do Dogs Need Mental Health Medication?

The behaviorism of the early twentieth century would have you believe that dogs are little more than machines reacting to their environment. But dogs have much of the same brain circuitry as humans, and when brain chemistry goes haywire, so too can a dog’s behavior. A recent article in The Atlantic, for example, tells the tales of dogs whose behavior miraculously changed after getting the right prescription medication.

[fat_widget_right]Veterinarians typically rely on human medications rather than special formulations for dogs. An anxious or depressed dog is almost as likely to be prescribed Prozac as an anxious or depressed human. The dosage has to be adjusted to reflect the size difference between dogs and humans, of course, and veterinarians sometimes have to do some tweaking to find a medication that works.

How to Tell If Your Dog Needs Help

Medication isn’t a panacea for everything. You still have to socialize your dog and train him or her to be friendly and obedient. Reward-based training methods often improve the behavior of even the stubbornest dogs. If your dog seems untrainable or does things that put her health and safety in danger, though, she could be struggling with a mental health issue. It’s not safe to give your dog your own medication, but if you see any of the following symptoms, it’s time to consult your veterinarian:

Not all veterinarians embrace pharmacological options for dogs’ mental health. If you want to give medication a try, you’ll need to call vets and ask whether they offer pharmacological solutions for behavioral problems.

References:

  1. Beaver, B. V. (2009). Canine behavior: Insights and answers. St. Louis, MO: Saunders/Elsevier.
  2. Fisher, T. (2014, May 02). Dogs get anxiety, too. Retrieved from http://www.theatlantic.com/health/archive/2014/05/dogs-who-take-prozac/360146/
  3. Psychological disorders. (n.d.). Retrieved from http://dogsnsw.org.au/resources/dogs-nsw-magazine/articles/health/177-psychological-disorders.html

DepressionPortrait of a sad woman can make people feel like a dark cloud hovers over them, while the sun shines brightly on the rest of the world. According to the U.S. Department of Health and Human Services, major depression affects approximately 14.8 million American adults each year, and as many as 1 in 33 children and 1 in 8 adolescents experiences clinical depression.

When people feel like they don’t have the strength to pull themselves out from under the shadow of depression, there are many therapeutic options to choose from. Depression is a highly treatable mental health condition with 80% to 90% of those who seek treatment reporting relief.

One of the most popular forms of behavioral therapy used to treat depression is cognitive behavioral therapy (CBT). Cognitive behavioral therapy techniques are routinely used to treat depression by focusing on a person’s internal dialogue and how it affects his or her behavior.

What Is Cognitive Behavioral Therapy (CBT)?

CBT is a blend of two types of therapies: cognitive therapy and behavioral therapy. Cognitive behavioral therapy has proven to be effective for a wide range of mental health conditions including anxiety, eating disorders, and depression. Cognitive therapy focuses on how our thought patterns and belief systems affect our mood and actions, while behavioral therapy aims to transform unhealthy habits and behavior patterns.

How Do CBT Techniques Help with Depression?

Cognitive behavioral therapy focuses on the present moment, concerned more with the thoughts and behaviors themselves rather than their origins. A therapist using CBT techniques might assist a person in therapy for depression by first educating him or her about automatic thoughts, known as cognitive distortions, and then by teaching the person to monitor themselves for such thoughts.

Cognitive distortions are irrational or inflated thoughts and beliefs that cause a person to have a distorted and often negative view of reality. These distortions often reinforce negative thought patterns and perpetuate mental states like anxiety and depression. Some common dysfunctional thinking patterns include all-or-nothing thinking, over-generalization, “should” statements (ruminating about the way things should be or how you expect them to be, not as they are), and personalization.

Negative thinking and behaviors often precipitate depression. CBT techniques can help people in therapy restructure their thought patterns and alter their behavior to alleviate depressive symptoms.

For example, a person experiencing depression may have an automatic thought such as “I am worthless and things are hopeless.” A cognitive behavioral therapist would help this person reframe the thought to something more realistic like, “I may have made some mistakes, but I am learning. I do have value as a person regardless of my imperfections.”

Another CBT technique for depression is pleasant activity scheduling. This involves scheduling healthy activities into your life that you enjoy—perhaps for 30 minutes a day, 3 hours a week, or whatever your schedule allows. You might read a book, ride a bike, or go for coffee with your friends. Whatever yours may be, pleasant activities create more positive feelings of joy and well-being in your life.

Is CBT Effective for Treating Depression?

Studies have shown that psychotherapy is at least as effective as antidepressants for individuals experiencing mild to moderate depression. In fact, varying degrees of depression can often be treated with psychotherapy alone, without the use of psychotropic medication. However, individuals experiencing severe depression may have a more difficult time utilizing cognitive behavioral therapy techniques alone and may require medication in addition to therapy to transform debilitating symptoms.

Therapeutic outcomes are improved by people’s capacity for self-motivation, introspection, and recognition that they have the power to change their lives—conditions which may not be met depending on the severity and root cause of a person’s depression.

Limitations of Cognitive Behavioral Therapy for Treating Depression

Some therapists don’t see CBT as the most effective method for treating depression because they believe deep-seated trauma and other circumstances may require a more long-term approach to treat effectively. California-based psychotherapist Cynthia W. Lubow, MS, MFT, for example, is one of many who share this opinion. “While there are cognitive elements of the work that I or any therapist does, I find that they are mostly helpful at the end of therapy when people are mostly resolved and doing well, or when people really are very psychologically healthy and just need a little guidance,” she said.

Lubow believes that CBT techniques are difficult to administer in those dealing with severe depression and that other therapies should be utilized first until the person is stabilized. “Trying to do [CBT] with people who are depressed or severely depressed because of trauma, abuse, or chemical issues is pointless. … They need intervention with their emotional state, including reprocessing trauma and resource building and strengthening before they can get to the cognitive and behavioral changes,” she said.

Therapy Is a Great First Step in Treating Depression

Just as depression is multifaceted, so is its treatment. If you are experiencing symptoms of depression, a great first step to take is to find a therapist you’re comfortable with who can help you understand your depression. [fat_widget_right]

Cognitive behavioral therapy is just one of many options for helping an individual experiencing depression, and it may or may not be the best one for you. Regardless of modality, therapy can help you reduce stress, gain perspective, learn to talk about your feelings, and change your thought and behavior patterns. Regardless of what type of therapy you and your therapist choose, there is much to be gained from seeking help and learning more about the mental health issues affecting your quality of life.

References:

  1. Depression Statistics. Retrieved from Depression and Bipolar Support Alliance. http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_depression
  2. Duckworth, Ken M.D. & Freeman, Jacob M.D. (2012).Cognitive Behavioral Therapy. National Alliance on Mental Illness. Retrieved from http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/About_Treatments_and_Supports/Cognitive_Behavioral_Therapy1.htm
  3. Facts on access to medications for people with depressive, bipolar and anxiety illnesses: The policymaker’s resource. (n.d.). National Alliance on Mental Illness. Retrieved December 8, 2014, from http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Public_Policy/Policy_Research_Institute/Policymakers_Toolkit/Facts_on_Access_to_Medications_Policymakers_Res
  4. Goldberg, Joseph. (2012). Cognitive Behavioral Therapy for Depression. WebMD. Retrieved from http://www.webmd.com/depression/guide/cognitive-behavioral-therapy-for-depression

Cognitive behavioral therapy (CBT)A therapist listens to his client seeks to help people identify negative or unhealthy thoughts, replace those thoughts with healthier thoughts, and in so doing, change their behavior and feelings. People don’t have to spend endless sessions discussing painful childhood memories, and the formulaic nature of CBT offers some people reassurance.

Preliminary studies of CBT showed impressive improvements in symptoms of conditions ranging from depression to personality disorders, leading to a surge in therapists who offered CBT. This type of therapy continues to be one of the most widely used evidence-based treatments available.

According to famed British psychologist Oliver James, though, CBT is a “scam” that does little to address underlying psychological issues. James, a psychodynamic therapist, argues that until people understand what led to their psychological troubles, those troubles are likely to reoccur.

GoodTherapy.org CEO and founder Noah Rubinstein, LMFT, LMHC, takes a similar stance with regards to addressing underlying issues in therapy.

“I am certainly not an expert on what research has shown about the efficacy of CBT, and I certainly don’t want to throw the baby out with the bathwater. CBT is an evidence-based, short-term therapy that has helped many people. However, on a theoretical level, I’ve always considered CBT to be a surface-level treatment rather than a method for lasting changes,” Rubinstein said. “In my experience, the only way to make lasting change is to help people tend compassionately to the more vulnerable feelings that protective functions, or defense mechanisms—such as depression, anxiety, self-criticism, anger, or addiction—are shielding us from.”

CBT’s Short-Term Effectiveness

There’s no question about CBT’s short-term effectiveness; even James admits that people receiving CBT can see remarkable improvements in a short period of time. So effective is CBT in the short term, in fact, that CBT self-help manuals such as David Burns’s The Feeling Good Handbook have become bestsellers. Because CBT teaches people how to detect and stop automatic negative thoughts, it’s especially popular for treating depression and anxiety. Some therapists, regardless of therapeutic modality, even insist that their clients use CBT principles to treat these conditions. 

Can Short-Term Behavioral Interventions Provide Lasting Results?

When researchers evaluate the long-term effects of CBT, the treatment looks less promising. James points out that psychodynamic psychotherapy yields better results in the long term because it helps people address the root causes of their distress. Several studies support this claim. For example, a 2003 meta-analysis that compared CBT and psychodynamic therapy for depression across several studies found that people who used psychodynamic therapy had larger improvements. Another study of marriage therapy evaluated the effects of behavioral versus insight-oriented marital interventions. CBT relies on behavioral interventions, while psychodynamic therapy is built on insight. Thirty-eight percent of couples who used the behavioral strategies were divorced four years later, compared to just 3% of couples who relied on insight-based approaches.

Rubinstein takes the view that conditions such as depression and anxiety protect us from the vulnerable feelings associated with the true source of our distress.

“For example,” Rubinstein said, “the man with depression who’s shut down, can’t get out of the bed in the morning, and has given up might be protecting himself from trying, failing, and once again feeling that terrible worthlessness he’s felt in the past.” Like James, Rubinstein sees CBT as a short-term fix that “helps to eliminate the problematic, surface-level protective behavior.”

Indeed, one of the selling points of CBT is that it doesn’t require a long-term commitment to therapy. Many CBT programs take only a few months, and some promise near-immediate results. A study published in Psychological Medicine in 2008, though, found that long-term approaches may be preferable. That study compared long-term psychodynamic therapy to two short-term therapies: short-term psychodynamic therapy and solution-focused therapy. While the short-term approaches produced more immediate results, those results faded over time. At the three-year mark, people who had undergone long-term therapy saw more improvements. Although this study didn’t evaluate CBT, it does suggest that dedicating more time to gaining insight can be valuable. [fat_widget_left]

Laura Reagan, LCSW-C, a GoodTherapy.org Topic Expert on trauma and posttraumatic stress, blends CBT with a variety of other techniques. She sees CBT techniques as effective and essential, though she acknowledges that CBT may not be best for addressing long-term issues.

“In my practice with trauma survivors, focusing only on changing thoughts and behaviors through CBT without using a more depth-oriented approach will result in only temporary improvement of symptoms which are likely to return, as the underlying problem has not been addressed. I use CBT skills as part of my work with clients to challenge negative cognitions about the traumatic events experienced.”

Rubinstein agrees that underlying problems need to be addressed for lasting change, “I don’t agree with everything Freud postulated, but he did believe that if you eliminate a defense mechanism, another will take its place, and I think that is the problem with CBT in terms of its long-term effectiveness. Therapies that help people to resolve the deeper and more vulnerable feelings that fuel defense mechanisms offer potential for long-lasting change.”

Is It a Scam?

While CBT doesn’t work for everyone, it’s far from a scam. James is a well-respected therapist, but he’s also a practitioner of psychodynamic therapy, so his opinion is by no means free of bias. While some studies have shown that psychodynamic therapy is more effective in the long term, others show that the two approaches are equally effective. Few studies show that CBT doesn’t work at all, and several studies suggest that CBT can work in the long term. A study that evaluated people who had been treated with CBT for social anxiety found that, even three years later, they were able to use what they had learned in CBT to more effectively cope with anxiety. A 2006 review of recent studies found that CBT may help reduce depression relapse rates, particularly when researchers compare the effects of CBT to the effects of medication alone.

Carey Heller, PsyD, a GoodTherapy.org ADHD Topic Expert who uses CBT as well as other forms of therapy in his practice, highlights the importance of a strong therapeutic alliance. He explains, “Many studies have shown that the quality of the relationship between the therapist and the patient/client is one of the best predictors of treatment outcome. Thus, the specific type of treatment, whether it is CBT, psychodynamic, or an integrative approach, is not the only determining factor in whether treatment will be successful for a specific individual. I feel it is more important to find a clinician who you feel comfortable with and can look at your unique needs in determining the best treatment approach to help you rather than just seeking out a specific type of treatment on your own.”

References:

  1. Hope, Jenny. (2014, November 10). ‘CBT is a scam and a waste of money’: Popular talking therapy is not a long-term solution, says leading psychologist. Retrieved from http://www.dailymail.co.uk/health/article-2828509/CBT-scam-waste-money-Popular-talking-therapy-not-long-term-solution-says-leading-psychologist.html
  2. Kendall, P. C., & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive–behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64. Retrieved from http://dx.doi.org/10.1037/0022-006X.64.4.724
  3. Knekt, P., Lindfors, O., Härkänen, T., Välikoski, M., Virtala, E., Laaksonen, M., . . . Renlund, C. (2008). Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine, 38(05). doi: 10.1017/S003329170700164X
  4. Leichsenring, F. (2003). The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: A Meta-Analysis. American Journal of Psychiatry, 160(7), 1223-1232. doi: 10.1176/appi.ajp.160.7.1223
  5. Snyder, D. K., Wills, R. M., & Grady-Fletcher, A. (1991). Long-term effectiveness of behavioral versus insight-oriented marital therapy: A 4-year follow-up study. Journal of Consulting and Clinical Psychology,59(1), 138-141. doi: 10.1037//0022-006X.59.1.138

cory f newmanEditor’s note: Cory F. Newman, PhD, ABPP, is a psychology professor at the University of Pennsylvania and the author or co-author of several books. His continuing education presentation for GoodTherapy.org, titled Core Competencies in Cognitive Behavioral Therapy: Becoming an Effective and Competent Cognitive Behavioral Therapist, is scheduled for 9 a.m. PDT on May 16. This event, free to GoodTherapy.org members, is good for two CE credits. For details, or to register, please click here.

Much has been written about the methods that comprise cognitive behavioral therapy (CBT). There is an abundance of research supporting CBT’s efficacy in treating a range of psychological maladies across a variety of groups (age, gender, ethnicity, etc.). As such, CBT is more accurately described as an entire set of psychotherapies, with key features in common but also demonstrating differences depending on the problem and person being treated, that have been designed and tested to meet the highest standards of care.

Over the past few decades, great strides have been made in developing CBT so that it helps people even when they demonstrate psychological difficulties on the more serious side of the spectrum, such as chronic mood issues, suicidality, debilitating anxiety, addictions, posttraumatic stress, eating disorders, and many other areas of mental health concern. Furthermore, the field is always improving, owing to the CBT tradition of refining and researching new ways of delivering care. Although CBT is not a magic “cure,” it is a powerful psychological technology that is helping more and more people, providing ever-increasing hope for even better outcomes in the future.

[fat_widget_right]

It is easy to think of CBT as comprising a set of “techniques,” mainly because there is indeed a set of core methods that are most often associated with this modality that have been identified as being key components in helping people to cope and live more effectively. The list below is just a sample of such techniques, all of which have been described in great detail in CBT texts and CBT treatment research protocols:

These are just some of the CBT methods that can be used effectively, not only in the therapist’s office but also as part of homework assignments—another powerful part of treatment that improves people’s sense of self-efficacy, consolidating their memories for the interventions and their skills in performing them, and leading to good maintenance of therapeutic gains.

Additionally, the CBT literature is clear that the therapeutic relationship is an indispensible part of a positive, efficacious intervention, as is a well-conceived cognitive behavioral case formulation. This is where CBT begins to go beyond techniques and into the realm of the therapist’s personal qualities, thinking style, interpersonal manner, and skills in listening, understanding, and communicating. CBT is not delivered by machines, and it does not come in prepackaged “doses” that are passively “taken.” It is delivered by fellow humans called “therapists,” a rather diverse lot of individuals with varying years of clinical experience and training histories, as well as individual personality characteristics that naturally play a role in their competency and expertise in conducting CBT. What are the qualities of therapists who are most likely to be highly competent? What should people look for in a therapist so as to be confident that the CBT they are receiving is top-notch care?

Most people think of competency and expertise as being related to training and experience, and there is more than a kernel of truth to this assumption. When a therapist is licensed, board certified in cognitive behavioral therapy (e.g., via the American Board of Professional Psychology and/or the Academy of Cognitive Therapy), has a substantial history of treating people and supervising trainees, and has a track record of publishing and lecturing on CBT, there is a good chance that this therapist will be knowledgeable and effective in the clinical sphere. However, there is evidence that even novice practitioners can deliver CBT very competently if they are well-supervised. Therefore, there is more to competency than repetition of methods and recognition of patterns over time.

What are some of the habits, attitudes, and personal qualities of therapists that amplify their competency and help get the best clinical results, whether they practice CBT or any other evidence-based treatment? The following may seem obvious, but they warrant more discussion and attention than they typically get. If the information below simply validates and reinforces what you already do as a therapist, I will have accomplished my goal with this post. Here is a sample list of suggestions, with some accompanying commentary:

Show respect for a person’s time: Make a concerted effort to be on time for sessions, to stay focused on the person in the session (e.g., rarely attending to your incoming calls, messages, or other distractions), to give them their full allotment of session time, and to try to see them as soon as your schedule will allow. Return their phone calls as promptly as you can, and be understanding when their legitimate life demands make it difficult for them to attend sessions and/or to do their therapy homework as regularly as would be optimal.

Do your homework and be organized: Be a good role model for taking care of business, being prepared, and being up to date on a person’s situation. This includes taking good therapy session notes, reviewing those notes so you are aware of and conversant in the matters that are on the person’s agenda, following through with extra-session tasks such as consulting with the person’s other practitioners and releasing records when requested, and being willing to review the person’s homework assignments as part of your own homework. Anything you can do to facilitate your memory of the details of the person’s current life and history (including the names of family members, important events in their lives, and noteworthy things they said in previous sessions) is very powerful in conveying the message, “I value you as an individual and I am providing a treatment that is focused on you, not just your diagnosis.”

Be professional, ethical, and respect cross-cultural issues: This covers a broad area, including speaking to people in a caring, supportive, confident tone, maintaining professional boundaries while still being friendly, attentive, and personable, going over the details of informed consent, explaining both your role and the person’s role in treatment, handling uncomfortable requests in a calm way that is not sanctimonious, speaking in a way that shows self-respect and respect for the other person, and being sensitive and responsive to his or her cultural identity and related issues.

Don’t just provide instructions; provide hope and inspiration: In thinking back to our school days, most of us can remember at least one teacher who was particularly adept at inspiring us to learn and to get the best out of ourselves as students. Be like that teacher when you treat people. Many people feel lethargic, distracted, helpless, and hopeless. It is not enough for us simply to provide instructions in a neutral tone. We need to “lean in” and speak in a way that gets their attention, promotes hope, and that expresses confidence in them. Express a commitment to help the person even when he or she has difficulty making a commitment to treatment. Give positive feedback even when people can’t believe it themselves. Be a role model for persevering in the face of obstacles and adversity, and for not giving up. Share some appropriate humor at the right time to make people smile and laugh, and to add some positive energy to the therapeutic dialogue.

Be open and eager to learning: One of the most rewarding aspects of being a therapist is meeting so many people who have so much to teach us. We can provide people with an education about using CBT effectively in their lives, but they provide us with lessons about life itself. Don’t just be aware of and open to the idea that people are often our teachers, embrace the idea. It is very empowering for people when their therapists thank them for sharing their knowledge and wisdom, and it enriches the therapist—both in his or her personal life, but also in terms of being that much more aware and sensitive toward a diversity of people in the future. It also demonstrates a respectful humility that amplifies the validity and meaningfulness of what therapists communicate when they do show confidence and authority in teaching CBT methods to people.

Find the “picture that is worth a thousand words”: A little bit of creativity can go a long way in therapy, especially if it makes a positive impression on people and helps them remember important concepts for the long term. Using metaphors, analogies, images, hypothetical questions, and stories with which people can personally relate are powerful learning vehicles. When therapists make it a point to pay attention to the things that matter to people most (and that define them as individuals), such as their hobbies, their profession, their cultural practices and beliefs, their most important relationships and memories, and their views about life and the world, the therapists are in a position to give feedback that deeply resonates. Brief examples include:

In sum, CBT is a powerful technology for psychological change, but the human element is part and parcel of CBT methods. Competent CBT practitioners know how to use the core techniques that have been demonstrated to be efficacious, but they magnify the positive impact of these methods via their personal qualities, habits, and attitudes that communicate care, convey accurate understanding and respect, and inspire people to remember and use the most important aspects of treatment for the long run.

References:

  1. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford.
  2. Butler, A. C., Chapman, J. E., Forman, E. M., and Beck, A. T. (2006). The empirical status of cognitive behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.
  3. Dobson, D., and Dobson, K. S. (2009). Evidence-based practice of cognitive behavioral therapy. New York: Guilford.
  4. Gilbert, P., and Leahy, R. L. (Eds.). (2007). The therapeutic relationship in the cognitive behavioral therapies (pp. 106-142). New York, NY: Routledge.  
  5. Greenberger, D., and Padesky, C. A. (1995). Mind over mood. New York, NY: Guilford.
  6. Hays, P. A., and Iwamasa, G. Y. (Eds.). (2006). Culturally responsive cognitive behavioral therapy: Assessment, practice, and supervision. Washington, D.C.: American Psychological Association.
  7. Kazantzis, N., Whittington, C., and Dattilio, F. (2010). Meta-analysis of homework effects in cognitive and behavior therapy: A replication and extension. Clinical Psychology: Science and Practice, 17, 144-156.
  8. Knapp, S. J., and VandeCreek, L. D. (2006). Practical ethics for psychologists: A positive approach. Washington, D.C.: American Psychological Association.
  9. Kuyken, W., Padesky, C. A., and Dudley, R. (2009). Collaborative case conceptualization: Working effectively with clients in cognitive-behavioral therapy. New York: Guilford.
  10. Newman, C. F. (2012). Core competencies in cognitive-behavioral therapy: Becoming a highly effective and competent cognitive-behavioral therapist. London: Routledge.
  11. Newman, C. F. (2011). Cognitive behavior therapy for depressed adults. In D. W. Springer, A. Rubin, and C. G. Beevers (Eds.), Clinician’s guide to evidence-based practice: Treatment of depression in adolescents and adults (pp. 69-111). Hoboken, NJ: Wiley.
  12. Nezu, A. M., Nezu, C. M., and D’Zurilla, T. J. (2013). Problem-solving therapy: A treatment manual. New York: Springer.
  13. O’Donohue, W. T., and Fisher, J. E. (Eds.). (2009). General principles and empirically supported techniques of cognitive behavior therapy. Hoboken, NJ: Wiley.

Childhood anxiety is a serious but often undiagnosed condition. Separation anxiety, social phobia and generalized anxiety are among the most common mental health issues affecting children and adolescents. Anxiety in childhood often predicts the occurrence of such problems later in life.

Identifying and treating anxiety and other mood disorders at early as possible is therefore an important goal of psychiatric research. Undiagnosed mood issues represent a large public health burden and result in a poor quality of life of those affected. The standard treatments for childhood anxiety are antidepressant medications and cognitive behavioral therapy.

Zoloft (sertraline) belongs to the class of antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs), and researchers have identified it as the medication of choice for treating most instances of childhood anxiety. Compared with similar medications, Zoloft offers the greatest benefit to anxiety sufferers with the lowest incidence of adverse side effects. However, as with many antidepressant medications, there is a small risk of suicide or self-harm in children and young adults at the start of a new drug regimen. Those with anxiety rather than depression are less likely to experience these effects. Children and adolescents should be assessed for suicide risk before beginning any antidepressant medication.

Several clinical trials have offered strong evidence that a combination treatment including Zoloft and cognitive behavioral therapy offers the most substantial improvement for children who have been diagnosed with anxiety issues. In one such study, 80% of participants receiving combination treatment saw significant improvement after 12 weeks. Researchers theorize that therapy and medication have a synergistic effect with one enhancing the effects of the other.

Regular therapy sessions also provide an opportunity for children and parents to report side effects from the children’s medication. In the previously mentioned study, both therapy and Zoloft alone also led to improvements on an anxiety rating scale that far outperformed placebo. Most importantly, participants receiving Zoloft did not report more adverse side effects than participants receiving placebo did, and none considered or attempted suicide.

When considering childhood anxiety, the rewards of effective treatment for outweigh the potential risks of medication. A combination of weekly cognitive behavioral therapy sessions and prescription of the antidepressant medication Zoloft seems to promise the best results for the greatest number of patients. As always, attending physicians must prescribe drugs like Zoloft cautiously, especially to children and adolescents.

References:

  1. Sertraline – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved April 6, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001017/
  2. Walkup, J.T., Albano, A.M., Piacentini, J., Birhamer, B., Compton, S.N., Sherrill, J.T., Ginsburg, G.S. et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359, (26), 2753-2766.

Cognitive behavioral therapy (CBT) is a widely used approach to treat symptoms of general anxiety disorder (GAD). The goal of CBT is to help an individual be more tolerant of their worrying behaviors, thus decreasing the negative psychological and physical symptoms of GAD. Applied relaxation (AR) is an alternative approach that is used for various mental health problems, including GAD. It focuses on the somatic symptoms of tension and physical discomfort associated with anxiety, with the goal of reducing worry. Both CBT and AR have been shown to be effective at diminishing the symptoms of GAD in individuals who struggle with emotional and somatic symptoms. However, few studies have compared the dynamics that cause the symptom reduction in each of these treatment approaches.

Eleanor Donegan of the Department of Psychology at Concordia University in Montreal sought to identify the mechanisms by which AR and CBT worked and also to determine if one was more effective than the other at maintaining long-term symptom reduction. For her study, Donegan evaluated 57 individuals who underwent either AR or CBT over a period of 12 weeks. She found that for both groups, the amount of time they spent worrying each day decreased from approximately 36% of the time to 20%. Additionally, both AR and CBT reduced the amount of daily anxiety by nearly 50%.

Donegan noted that even though the participants were much less anxious as a result of their treatment, they still had significantly higher levels of worry and anxiety than non–clinically anxious individuals. When Donegan looked at how the effects were achieved, she found similarities and differences. Specifically, even though both AR and CBT decreased somatic anxiety, the effect on worry was more significant in the individuals who underwent CBT. However, Donegan believes that both of these techniques could be useful to address GAD. She added, “Change in worry occurs in part because of change in somatic anxiety, and vice versa, in both CBT and AR.”

Reference:
Donegan, E., Dugas, M. J. (2012). Generalized anxiety disorder: A comparison of symptom change in adults receiving cognitive-behavioral therapy or applied relaxation. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0028132

A recent study of people who are trying to quit smoking shows that Cognitive Behavioral Therapy can help reduce cigarette cravings. Overcoming cravings is an essential part of successful addiction therapy, as the craving to pick up another cigarette may, in the short term, overpower the rational reasons for quitting. Helping people overcome cravings by “retraining” the brain has the potential to help people quit smoking more effectively. The study, which was funded by the National Institute of Drug Abuse, took brain scans of people who’d been undergoing cognitive behavioral therapy with the goal of smoking cessation. The scans showed interesting behavior in two areas of the brain.

One area, known as the prefrontal cortex, helps a person control their emotions (among other things). This part was more active in people who’d undergone the smoking therapy. A second area, called the striatum, is related to reward-seeking and craving. This area was less active in people who’d been having therapy. In addition, people who’d been undergoing therapy also reported that their cravings were less intense. (more…)

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.