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Thread: Cognitive-behavioral therapy. It works?

  1. #1 Cognitive-behavioral therapy. It works? 
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    Hi

    I'm new in the forum but I'd like to open a new topic about the Cognitive-behavioral therapy. This therapy consists in being conscious of the thoughts and emotions in a particular situation and from that point, knowing these thoughts, change them and get a particular result. It's a therapy because it's supposed that is not that easy to achieve, so a coach or therapist is needed.

    I want to know your opinions about it. Mine is that it could work if, and only if, the subject is conscious of wanting a change in his life.

    Peace


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  3. #2  
    Forum Professor marcusclayman's Avatar
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    Changing thought patterns changes behavior. If the person wants to change their bahavior it might be easier to show them how, but if the person doesn't want to change, it doesn't mean they won't. We are always changing, it's merely a matter of guiding that change.


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  4. #3  
    Ots
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    Cognitive behavioral theory was initially put forth by Tolman, a UC Berkeley psychologist from the first half of the last century.

    I don't believe it had widespread support and it received an abundance of criticism from a number of theorists. Two main criticisms were the difficulty of making predictions from an expectancy point of view, and the minor role given to the concept of reinforcement (W. S. Sahakian, Introduction to the Psychology of Learning).

    So it's probably not the most productive approach out there.
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    I remember an experiment done on CBT using neuroimaging in patients with obsessive-compulsive disorder.

    First they mapped the activity in the caudate nucleus of several patients. Then they divided the patients in three groups: one would receive cognitive behavioural therapy, another would undergo pharmacological treatment, and a third would stand as controls.

    After some time (three months I believe), they scanned the patients again. As expected the control subjects showed no change, and the pharmacological patients showed less activity in the caudate nucleus -- an effect of the drugs that targeted the neural activity in that area.

    The surprise came with the psychotherapy patients, as the activity in their caudate nucleus also decreased. And after interruption of both treatments the CBT patients either stabilized or kept improving their condition, while the group that were on drugs experienced relapse.

    Quite amazing, eh? Who knew psychotherapy would work? And on the long run it was less harmful than the drugs.
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  6. #5  
    Forum Professor marcusclayman's Avatar
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    "I don't believe it had widespread support and it received an abundance of criticism from a number of theorists. Two main criticisms were the difficulty of making predictions from an expectancy point of view, and the minor role given to the concept of reinforcement (W. S. Sahakian, Introduction to the Psychology of Learning). "

    Ots, Is this a quote?

    Anyway, one person's beliefs, even if they are a reputable psychologist, is not valid evidence.

    Of the two main criticisms, one is less applicable than it was in the first half of last century, and the other isn't valid. Statistical analysis of relatively-widespread psychological studies, makes us much better at predicting things. Although I'm not sure what an "expectancy point of view" is, and what it has to do with the modern idea of CBT that focuses on accomplishing short term goals in efforts to eleviate symptoms. Also, modern CBT is centered around reinforcement(when short term goals are accomplished, and symptoms are relieved), maybe a lot has changed since the days Sahakian is refering to.
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  7. #6  
    Ots
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    It's not a direct quote. I referenced the author and source of the information I gave though. I have no personal experience with CBT but I recalled reading what Sahakian wrote about it.
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  8. #7  
    Forum Professor marcusclayman's Avatar
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    I have no experience with it at all. Wikipedia is about the only source I can cite, which is not a source at all.

    The only problem with CBT, according to the wiki article's citations, is that there is too much money invested in studies of CBT and it overshadows other forms of therapy that are equally as usefull, but more appealing(and thus usefull) for different patients.
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  9. #8  
    Administrator KALSTER's Avatar
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    but more appealing(and thus usefull)
    Might be true to a degree, but not necessarily. I tend to believe that the more one understands of one's self, the better one can deal with negative aspects of one's self. That is certainly how it works for me and, unfortunately, why the "auditing" of people by scientologists can actually be effective in some ways. There is a difference, however, between being able to recite a summary of your problems and understanding your problems fully in a holistic way, including in an in-depth, totally sense-of-self kind of way (if that makes sense). I would guess though that the average person would be almost completely unaccustomed to probing themselves in an honest way and would render the therapy ineffective in that it would take a long time to train a person to do so. These are just my thoughts though and not a product of actually studying the subject (other than studying myself, that is).
    Disclaimer: I do not declare myself to be an expert on ANY subject. If I state something as fact that is obviously wrong, please don't hesitate to correct me. I welcome such corrections in an attempt to be as truthful and accurate as possible.

    "Gullibility kills" - Carl Sagan
    "All people know the same truth. Our lives consist of how we chose to distort it." - Harry Block
    "It is the mark of an educated mind to be able to entertain a thought without accepting it." - Aristotle
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  10. #9  
    Veracity Vigilante inow's Avatar
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    Yes, CBT works. Just look at applications like exposure therapy. The example I remember from one of my professors is fear of elevators, which can be well treated via CBT.

    So, you have a patient who is deathly afraid of elevators. Refuses to use them.
    Therapist has them on the first day stand in front of an elevator... maybe in a lobby... and just watch people getting into and out of it safely.

    Second day, the doctor has the patient press the button to summon the elevator. The elevator arrives, and they leave... they don't go in.

    Third day, the doctor has the patient summon the elevator, and when it arrives, they step inside. The doctor is cautious not to let the doors close, and they just stand there. After a few moments, they exit the elevator. This is the first time the patient has gone into and out of an elevator, and they have essentially trained the mind that they survived the occurrence, so it's really not that bad. They also assuaged much of the fear by slowly approaching the elevator and not going in on days one and two. Those days prepared the mind for day three, where they entered the elevator for the first time.

    Fourth day... the doctor and the patient return to the elevator and they get in. This time, though, the doctor lets the doors close. They don't go anywhere... they just stand there experiencing being inside the elevator. Then, they open the doors and leave.

    Then, the patient has been "taught" cognitively... through their behavior... that the elevator can result in safe experiences. They are now ready to ride the elevator up a floor since many of the "approach" fears have been extinguished.

    Fifth day, doctor and patient get in the elevator and ride up a floor. They exit the elevator and the doctor reinforces the patient for being so brave and for doing so well.

    Then, the patient must practice... they ride the elevator multiple times, until their fear is gone and the terror response extinguished.


    This is known as exposure therapy, and is a form of CBT (focused more, obviously, on behavior than just cognition)... and, yes... It works rather well.
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  11. #10  
    Forum Professor marcusclayman's Avatar
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    "recite a summary of your problems and understanding your problems"

    Two major errors here: although they are equivelent to any self help propaghanda. They might help the individual by giving them something to reflect on, which is rarely bad, but is bad in the sense that it spreads falsehoods as psychological facts.

    The two falshoods presented here are:
    A: talking about your problems is equivelent ot reciting a summary of them.
    B: understanding your problems is necissary to relieve symptoms, which is the primary focus of most patients, and many doctors.

    I respect your feelings towards holistic treatment -- everything is indeed connected, beyond what we will ever be willing/able to admit/percieve -- but it is nonetheless a culturally coined concept, which has been through much pupular abuse. Some problems can be dealt with, and are better dealt with, by changing one thing at a time(which is the point of CBT: accomplish small short term goals each bringing the patient closer to the ultimate goal of the relief of symptoms... the focus being not on the ultimate goal, or even one's next goal, but the present one)

    also

    sometimes people just need guidance because they lack confidence, and talking to someone who is interested and involved in what you have to say is a good way to build confidence

    sometimes people are just lonely, and for the same reasons a therapist helps, even though they have no problems: their life just hasn't given them the right social opertunities, in which case a therapist is a good investment for many
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  12. #11  
    Ots
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    Progressive desensitization is effective with phobias and isn't as brutal as exposure therapy.
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  13. #12 Re: Cognitive-behavioral therapy. It works? 
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    ...And that sounds more like
    being conscious of the thoughts and emotions in a particular situation and from that point, knowing these thoughts, change them and get a particular result
    than pressured exposure.

    I was afraid of heights, and as a child heard about "confronting fears". Fortunately what I took from that was a will to gradually desensitize myself to heights, as opportunity arose, tempered by an acceptance of my fear i.e. it's understandable, it's OK.

    So between the ages of 5 to 25 I just nudged myself little by little beyond comfort, until the comfort zone included high scaffolding and ultralight aircraft. I've probably pushed too far in that way.

    The root of the fear was from being hung out an apartment window by my probably drunk father, by my ankles. So to truely lick it, I reasoned, I should face similar predicament. It just happened that my girlfriend was afraid of acting on sudden evil impulses that would spring to mind... and she just happened to live in an apartment building. I wasn't satisfied until I'd gotten my whole body out the window and was pushing off with both feet, while she, white-knuckled, held my arms that grasped nothing. It had to be difficult, irrational, crazy. It worked.

    A therapist can't do that and shouldn't even suggest it.
    A pong by any other name is still a pong. -williampinn
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  14. #13  
    Forum Professor marcusclayman's Avatar
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    nice story
    Dick, be Frank.

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  15. #14  
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    Touché.

    I wanted to illustrate how an individual may chip away at some discomfort, even over decades, without coaching.

    I don't understand how it's possible. People should avoid discomfort, whether that's uncomfortable thoughts or uncomfortable situations. It seems there's a mechanism at work here that's essentially contrary. It is willful wrongheadedness.

    How can one guide another to think about things they don't like thinking about? Especially when we're dealing with a black box.
    A pong by any other name is still a pong. -williampinn
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