Monthly Archives: January 2013

HILARIOUS example of CBT


So in addition to this photo being HILARIOUS—I think it’s a great visual of CBT.  Hold on—I’ll explain.

Last post I discussed the importance of CBT, cognitive-behavioral therapy.  Cognitive Behavioral Therapy (CBT) is a form of treatment that focuses on examining the relationships between thoughts, feelings and behaviors. By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people with mental illness can modify their patterns of thinking to improve coping (NAMI).

CBT is a great tool for many mental illness, for me it’s been particularily helpful for managing my anxiety and “getting rid of the garbage” I discussed several posts ago. For those of us “lucky” enough to deal with mental illness, anxiety in particular, we often have many scary thoughts predicting the worst possible outcomes—regardless of the likelihood of the predictions coming true. When ignored or improperly dealt with, they can begin to take on a life of their own. Similar to the child in the photo, we can see this huge ball coming straight at our heads, and there is nothing we can do to stop it. It’s terrifying and dehabilitating….

BUT there’s hope!  With CBT, we can transfer ourselves to the second photo. One great tool is the “Dysfunctional Thought Record” I’ve attached below. It can help you identify a situation/thought, examine it for realism, and compose alternative responses. 

 When I’m feeling particularily anxious, I will do one of these to help me regain a sense of reality.  So I tend to do them at least three times a week.  While you can do them alone—sometimes you might need an outside perspective to help provide  the alternative responses. It’s great if you have someone you can trust to look at it, otherwise taking it with you to therapy is always a good option.

I have one final piece of advicethat is not covered on the DTR I attached, write down the alternative response you identify. Unfortunately, completing the DTR will rarely eliminate the anxious thoughts for good, instead they might intermittedly continue to bother you. Use the alterenative response you identify to combat the thoughts as they continue to pop into your head.

So like that baby now realizes, when that ball starts coming towards your head—remind yourself, that it can’t hit you. And if you can—laugh at the ridiculousness of the thought!

Anyone else use this tool?  If so, what’s your experience with it?

Try it—and let me know if you  have any questions or need an outside perspective—maybe we can muddle through the waters together.


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Successful treatment of pediatric depression

Ah! TOO (much too!) long ago, I posted about the importance of intervention. I raised the question “What types of intervention are most successful?” I found a study by several professors of psychiatry that seeks to answer this question, specifically focusing on pediatric depression (youths 11-18).  The highlights of the study are below:

  • Continuation-phase CBT combined with continuation pharmacotherapy reduced the risk of relapse 8-fold compared with continuation of medication alone.
  • The continuation of medication treatment for 6 months after acute treatment (initial 12 weeks of treatment) reduced the relapse rate by 27% (42% vs 69%).
  • 6 months of continuation-phase CBT (after acute-phase CBT) lowered the relapse rate by 46% (6% vs 50%).

Now to avoid “quote dropping” (a writing flaw my AP English teacher scared out of me), here’s the lessons I draw from these findings.

First, the most successful treatment is a combination of therapy and medication. While this is a “duh” statement to some, I think it is an important reminder. To those who are resistant to medication (Like me!), it is the reminder that to “retrain” your brain through CBT you might need the help of medication. For those resistant to therapy—well that’s a whole another blog.

Second, do NOT discontinue treatment too soon. While “too soon” is hard to identify, it appears treatment should last at least SIX months after the depression/anxiety goes into remission.

Recovery is hard!  So often I wish it was as easy as managing my allergies. The doctors gave me a nasal spray—and life has never been the same! But unfortunately, it’s hard work.  After graduating from my master’s program, my mom and I were going through old t-shirts from my childhood through college. You know all the swim team shirts or ones marking plays I was in (I know, me being dramatic is shocking!). 

I didn’t collect any in graduate school (and not just because I was older—you never outgrow those shirts. I just washed one for my husband the other day—it was from a bar), but because I was busy learning to take care of myself I didn’t commit myself to as many things. My mom jokingly suggested she could print me a “Proud Survivor–Therapy—2009-2011” t-shirt. While sometimes I did feel like I was missing out, I know dedicating two years of my life to continued treatment has helped me build the skills that keep me healthy and allowed me to re-engage on all those activities now. Score myself some free bar tshirts!

Rick recently reminded me, “I hope that I’ve mentioned to you that you are not going to have to be in therapy for the rest of your life (or even indefinitely). However it does seem to me that for the present it would be quite useful for you to maintain a relationship with a person that you have confidence in.”  He always joked his goal was to “work himself out of a job”. And trust me, there have been times (especially in the beginning when I hated therapy!) that I wished he was out of a job. : )

So when you start helping someone with a mental illness, here are the two clear steps to take. I suspect starting treatment will not be the problem, it will be convinceing them to continue treatment once they feel better. I had a friend the other day tell me he was likely going to go off his medication because he was feeling better. And it had only been three months!! Fortunately, I was able to whip out this study and convince him to stay with it. (Or at least lie and tell me he would!)

But what about those of us with “chronic and persistent mental illness”? I think this applies to us too. Keep on your medication, and realize that you are going to need to have some maintenance or “tune-up” therapy now and then as well. 

I write that very simply—like it’s oh so easy. And everyone reading this post knows how important these steps are. So why mention it? Because it’s not easy–even re-reading that gets me all wound up. So I give you this article so you can return to the statistics when you decide you no longer need treatment. I often use these short, clear facts to combat the dysfunctional thoughts in my head.