Psychotherapy

Cognition” has more than one meaning. Cognitive-behavioral therapy refers to therapies that work on changing automatic thoughts and resulting schemas.

Anew study shows that the rate of remission in adolescents treated for depression for 36 weeks was more than double that of adolescents treated for 12 weeks, whether treatment was with an antidepressant, cognitive-behavioral therapy, or a com­bination of both.1

Psychotropic treatment can often prevent the relapse of psychotic and mood symptoms. However, many patients take medication intermittently or not at all; or the symptoms may be only partially responsive to medication. Therefore, there is a need for interventions that can supplement the effect of medication and improve treatment outcomes.

A combination of cognitive-behavioral therapy (CBT) and antidepressants to treat anxiety disorders in youngsters has yielded positive results in a government-funded study that was published online by the New England Journal of Medicine.1

The substantial and often recurrent distress and impairment associated with major depressive disorder (MDD) in youth has prompted increased interest in the identification and dissemination of effective treatment models. Evidence supports the use of several antidepressant medications, specific psychotherapies, and, in the largest treatment study of depressed teenagers, the combination of fluoxetine and cognitive-behavioral therapy (CBT) as effective treatments.1-3 CBT is the most extensively tested psychosocial treatment for MDD in youth, with evidence from reviews and meta-analyses that supports its effectiveness in that population.3-5

Although several studies indicate that psychotherapy (alone or in combination with medications) can help psychiatric patients reach recovery faster and stay well longer, a declining number of office-based psychiatrists are providing psychotherapy to their patients.

I have been invited to write a clinical article on psychotherapeutic interventions for chronic depression.

Unipolar major depressive disorder is a debilitating condition with a lifetime prevalence of 17%. Recent epidemiological evidence indicates that MDD is the fourth leading cause of disease burden and the leading cause of disability-adjusted life years.

Agitation in older adults is frequently associated with multiple psychiatric and medical conditions and comorbidities. It commonly occurs in patients with anxiety, affective illness, psychosis, dementia, stroke, brain injury, delirium, or pain.

The practice of one human being helping another to feel better through the use of talk is as old as humanity itself. As a profession, however, psychiatry has existed for only 100 years.

Traumatic brain injury (TBI) is the major cause of death and disability among young adults. In spite of preventive measures, the incidence of a TBI associated with motor vehicle accidents, falls, assault, and high-contact sports continues to be alarmingly high and constitutes a major public health concern. In addition, the recent military operations in Iraq and Afghanistan have resulted in a large number of persons with blast injuries and brain trauma. Taking into account that cognitive and behavioral changes have a decisive influence in the recovery and community reintegration of patients with a TBI, there is a renewed interest in developing systematic studies of the frequency, mechanism, and treatment of the psychopathological alterations observed among these patients.

As psychiatrists we need to clarify within our profession and with our patients what therapies actually treat an illness and what therapies help one learn to function better.

Both cognitive-behavioral and pharmacological treatments for panic disorder have been found to be effective over the short term. Not all patients, however, can tolerate or fully respond to these approaches, and the effectiveness of these interventions over the long term remains unclear.

Although cognitive therapy (CT) is the best-studied form of psychotherapy, its effectivenes compared with antidepressant medication remains controversial. Over the years, there has been some variability in the results of randomized controlled trials and other types of clinical trials, as well as meta-analyses.

Patients with somatization disorder (SD) who are treated using the psychiatric consultation intervention (PCI) may benefit from the addition of cognitive behavioral therapy (CBT) to their regimen. Dr Leslie A. Allen and colleagues recently conducted a randomized controlled trial to determine the outcomes of patients with SD who were treated using a combination of CBT and PCI or treatment with PCI alone. The results were reported in the July issue of Archives of Internal Medicine.

Anxiety disorders are the most prevalent psychiatric disorders in the United States. Although effective treatments are available, such as the SSRIs and cognitive-behavioral therapy (CBT), it is estimated that in about 40% of patients, anxiety disorders are partially or completely resistant to first-line treatment.

Depression has long been recognized as a primary concern for health care providers. Many approaches to treating depression have been developed, ranging from medications, to long-term psychotherapy, to shorter, more structured cognitive-behavioral treatments--all of which help some of the patients, some of the time, to some extent.

CBT is a comprehensive system of therapy that builds on core therapeutic values by using a wide range of reliable methods to produce cognitive and behavioral change.

While social anxiety disorder (SAD) may cause observable signs of anxiety and social awkwardness in some, many others suffer silently. Cognitive-behavioral therapy can be helpful for most patients with SAD, with alternative therapies such as psychodynamic therapy and interpersonal therapy filling the gaps.

Patients with OCD generally respond best to cognitive-behavioral therapy (CBT). At the core of the behavior therapy program is a technique known as exposure and ritual prevention (ERP).

New ways to address medication adherence problems in patients with schizophrenia offer the hope of better treatment outcomes. Two new and promising approaches for individuals with schizophrenia are the use of environmental supports and cognitive adaptation training and cognitive-behavioral therapy.

Cognitive-behavioral therapy (CBT) for children with anxiety disorders may be especially effective when the family is included in treatment.

This article examines the use of cognitive-behavioral therapy for psychosis, the evidence for its use, and the implications for practicing psychiatrists given the short-comings of pharmacologic therapy.

Diagnosis of the two main major eating disorders, anorexia nervosa and bulimia nervosa, can be difficult because of denial of symptomatology by the patients and problems with some of the diagnostic criteria. Although CBT has been the most effective, there are no treatments available that can guarantee a cure for either disorder. Medication is only a helpful adjunct to the treatment of anorexia, while many controlled studies that show antidepressant medications are effective in reducing binge/purge behavior in bulimia.

Cognitive-behavioral therapy can be tailored for use with children who have experienced sexual abuse in order to relieve symptoms of PTSD.