Cognitive therapists say yes. Are they onto something?
May 22, 2000 -- Dawn H. is a successful banker who got hit with four downsizings in the last six years. Although she found a new position each time, the repeated stress soon undermined her confidence and sent her spiraling into depression. "I was a vice president and making a good salary, yet all I saw was that I was going to be out of a job," she says.
Dawn had been in counseling for years, but this time her therapist couldn't seem to help. Eventually, she grew so depressed she was admitted to a hospital. It could have been the worst of times, but it turned out to be the best. A staff member suggested Dawn try cognitive therapy, a form of short-term treatment that helps patients analyze their own thoughts, rather than rely on therapists for months, even decades.
"Finally," Dawn says, "someone gave me some practical tools."
Quick, Inexpensive Treatment
Cognitive therapy has become the fastest growing, most extensively studied form of therapy in the United States -- the new century's treatment of choice for everything from depression to substance abuse. Pick up a health magazine or turn on the radio, and you'll likely hear about some new study in which cognitive therapy helped patients just as well -- or even better -- than drugs did. Even the insurance companies love this "therapy du jour," for an understandable reason: It usually takes just 10 or 12 sessions to see results, at a cost of about $1,500 -- peanuts compared to the cost of long-term psychotherapy.
What, exactly, is cognitive therapy? And why does it apparently work so well? Simply put: Cognitive therapists believe that the way we think shapes our emotions. If we expect the worst to happen and routinely focus on the negative, this can become a self-fulfilling prophecy.
For instance, Dawn went into job interviews thinking, "If I don't get this position, nobody will want to hire me." Another person might respond more pragmatically, "If I don't get this job, I'll find out why and be better prepared next time."
After Dawn learned to change the way she thought, she was eventually able to change her emotions -- and her life.
Challenging Negative Thoughts
Cognitive therapists argue that it's not necessary to delve into childhood traumas, or talk about your feelings about your parents, for good mental health. "Instead of looking at the past, we focus on the present," says Judith Beck, PhD, director of the Beck Institute for Cognitive Therapy in Pennsylvania. "You look at your thoughts on a daily basis and do a reality check. And you get better at it the more you practice."
Beck's father, Aaron Beck, developed cognitive therapy in the 1970s, after he concluded that many of our psychological problems come from habitual assumptions of the conscious mind, rather than from fears or longings buried deep in the subconscious, as Freud thought. As Aaron Beck puts it, "There is more to the surface than meets the eye."
The timing couldn't have been better for a challenge to long-term psychoanalysis. Managed care health plans were taking over the market, and most limit coverage of mental health to 20 sessions a year.
Cognitive therapy is making headlines, however, not because it's cheaper, but because studies show it works. In the last 30 years, 325 studies involving more than 9,000 patients have found that cognitive therapy effectively treats a litany of mental ailments: depression, anxiety, eating disorders, hypochondria, chronic pain, sexual dysfunction, substance abuse, and even migraines.
More Effective Than Drugs
"One of the big problems with depression is that it's a recurring disorder. But eight major studies have found that patients who did cognitive therapy had half the relapse rate one year after they completed their treatment of those on medication," says Andrew Butler, PhD, a research associate in the department of psychiatry at the University of Pennsylvania Medical School. Butler's review of these studies on depression will appear in a forthcoming issue of the Journal of the Norwegian Psychological Association.
"The message here is that you don't have to be on medication for the rest of your life," says Butler. No researcher suggests that patients dump their medications without the advice of their doctor, and some do very well on antidepressants. But, says Butler, for other patients it's important to know: "You can learn certain thinking skills that will reduce or eliminate your need for drugs."
The first step is for people to learn to identify their thinking errors (see Fixing Common Thinking Errors). For instance, a common error is "all or nothing" thinking: "If I don't get this promotion, I'll never move up in the company." Then people are taught how to test those assumptions. "You have to ask yourself, 'What do I really believe is going to happen? What's the evidence that supports this?' " says Judith Beck.
In writing exercises, Beck has patients identify their fears and ask themselves, "What's the worst that can happen? What's the best?" Once you've looked at these two extremes, Beck says it's far easier to identify the most realistic outcome.
Becoming Your Own Therapist
"With exercises like these, we essentially teach you how to become your own therapist," says Leslie Sokol, PhD, director of education at the Beck Institute. (See The Art of Self-Examination.)
Dawn tried this process, and was quickly amazed at how she always assumed the worst. "At first, I was real good at writing down all the bad thoughts I had at the end of the day," she says. "My notebooks were full of thoughts like, 'I should have handled the meeting better; I should have been more sensitive to a colleague's feelings; I didn't look my best -- I should have worn the blue suit, not the gray.' "
But gradually she began to see the whole picture and make more-realistic appraisals of situations. "After a while, I began to take credit for my accomplishments: I'd managed to achieve a senior management position and learn the new technology. Later, I even looked beyond the job and became an amateur photographer. I learned to live a more balanced life."
Valerie Andrews has written for Intuition, HealthScout and many other publications. She lives in Greenbrae, Calif.
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