Indications

Randomized, controlled trials have shown that CBT is effective in mild to moderate depression (Butler et al., 2006). Other trials have shown it to be effective for anxiety disorders (Bisson, 2006; Gale and Browne, 2006; Kumar and Browne, 2006), bulimia nervosa (Hay and Bacaltchuk, 2006), and possibly somatoform disorders, and even psychotic disorders. As well as treating an index episode, this therapy may have prophylactic value in preventing future episodes (secondary prevention).

Case example

A man who had been made redundant from his job as bank manager developed depressive illness; retaining his private medical insurance for a limited time, he saw a psychiatrist privately. Declining medication, he was referred for cognitive therapy; the insurer agreed to pay for 10 one-hour sessions. The patient considered himself an utter failure at work, and extended this belief to all other aspects of his life (overgeneralization), perceiving rejections where none were intended, and becoming even more depressed in consequence. Objective consideration revealed that his redundancy was one of many in the bank, occasioned by transfer of jobs to foreign parts, rather than a personal rejection, as he had assumed (arbitrary inference). Keeping a mood diary quickly convinced him of the connection between his thoughts and his depressed mood. He made rapid progress in the first three sessions, but then 'got stuck'. Further cognitive work increased his insight but did not improve his mood. The therapist noticed his reluctance to set practical goals, and placed more emphasis on activity scheduling, especially pleasurable activities outside the home. By the end of therapy, he had made further progress, and was happy with the outcome: patient and therapist agreed that residual symptoms (mainly social anxiety, lack of energy, and poor concentration) would continue to improve if he continued to practise the new thinking skills he had learnt, and to build up his social activities, which had previously been mainly related to his work.

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