Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy is a relatively short-term, focused psychotherapy for a wide range of psychological problems, including depression, anxiety, anger, panic, fears/phobias, eating disorders, substance and alcohol use, personality problems, and chronic medical conditions. The focus of CBT is on how you are thinking, feeling, behaving, and communicating today rather than on your early childhood experiences. The therapist assists the patient in identifying specific distortions and biases in thinking and provides guidance on how to change these thoughts and thought patterns.

CBT helps the patient learn effective self-help skills that are used in homework assignments that help you to change the way you think, feel, and behave. CBT is action-oriented, practical, rational, and helps the patient gain independence and effectiveness in dealing with real-life issues.

Health/Illness Anxiety

Like many people you may worry excessively about your health–some people may have called you a hypochondriac. As with any health concerns you should get a full medical examination by your physician. However, if you find that you are repeatedly requiring medical examinations that result in no findings of any disease—but you still feel worried about your health—then you may be suffering from hypochondriasis or health anxiety. This form of anxiety is a combination of depressive rumination and obsessive-compulsive thinking. About 16.5 % of us have health anxieties with 5.5% qualifying for the diagnosis of hypochondriasis. Fortunately, it can now be treated effectively with cognitive-behavioral therapy.

People with health anxiety have 80% more doctors’ visits and are very likely to have other problems–most commonly depression and other anxiety disorders. The typical pattern is to demand “health perfectionism”—every physical discomfort or imperfection is interpreted by you as a sign of a dreaded disease. You may scour medical texts and internet sites that lead you to believe that you have another serious medical problem. You may check yourself in the mirror, continually feel yourself for lumps and imperfections, demand reassurance, and feel in a constant state of dread. You have difficulty accepting any uncertainty about your health and quickly discount the doctor’s claim that there is nothing wrong with you. You may view your worry as a sign that you are responsible–that you take your health ‘seriously”. Ironically, research on health anxiety shows that people with this problem are not less likely to smoke. In some cases, health anxiety is so severe that the person actually neglects seeing a doctor, feeling certain that an examination will reveal the dreaded news.

CBT helps in the following ways: 1) Develop the motivation to modify your health anxiety (since you may falsely believe that your worry has prevented terrible things from happening); 2) Learn how to distinguish between productive (or prudent) worries and unproductive worries; 3) Learn how to accept uncertainty as an inevitable part of life; 4) Develop alternative–and less catastrophic–interpretations of everyday imperfections; and 5) Avoid reassurance seeking and checking yourself.

Traumatic Brain Injury/Concussion

What are common symptoms following a TBI/Concussion?

Common symptoms after a TBI fall under several categories: physical, cognitive, emotional, and behavioral.

Physical: chronic pain, migraines, sleep disturbance, changes in appetite and sexual functioning, impaired movement, sensation, and dizziness

Cognitive: confusion, difficulty with attention/concentration, problems with organization and planning, memory impairment, communication difficulties, trouble with reasoning, problem-solving, decision-making, and judgment

Emotional: psychiatric disorders (depression, anxiety, adjustment, post traumatic stress disorder), personality changes, irritability, apathy, emotion dysregulation, and rumination

Behavioral: verbal/physical outburst, impulse control, apathy, rigidity, lack of initiation, and engaging in risky behavior

Psychologists are specially trained to help individuals and families cope with many of these complex changes.

How can CBT help?

Extensive research has found CBT to be a highly efficacious treatment for:

Mood disorders

Large numbers of people with a brain injury have clinically significant mood disorders following their injury.  Comorbid mood disturbances are a major contributing factor of impaired function and symptom exacerbation.

Common presenting problems:

o   Depression
o   Anxiety
o   Post Traumatic Stress Disorder
o   Rumination
o   Emotion Dysregulation
o   Adjustment post injury

Treatment strategies include:

o   Education to better understand the impact of injury
o   Self-monitoring
o   Behavioral experiments
o   Cognitive restructuring
o   Emotion regulation
o   Problem solving techniques

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