Cognitive Behavioral Therapy
CBT combines cognitive psychotherapy with behavioral therapy, including behavioral activation. It aims to reduce emotional distress, including depression, by challenging and reversing irrational beliefs and distorted attitudes and encouraging patients to change their maladaptive preconceptions and behaviors. Generally, behavioral techniques are used in relation to a patient’s realistic worries and concerns such as actual loss, while cognitive techniques are used in relation to unrealistic worries and concerns such as their self-image. Behavioral techniques include activity scheduling and distraction with the use of a diary, in which the patients list the things they do and the mood/emotion they experience while doing those things. After 1 or 2 weeks, this is used to activate the patients’ life and improve their mood. Distraction is a method that can be used to empty the mind of worrying thoughts and replace them with neutral thoughts. When using distraction, patients are advised to describe to themselves in detail a picture, a scenery, a story, etc. or think of a relaxing image such as seashore or a lake. The cognitive techniques used are a thought diary, often used for self-monitoring and psycho-education, which includes talking to the patient about how thoughts affect mood. The use of a leaflet to introduce thinking errors to patients can also be helpful. For example, the definition of black and white thinking is introduced as ‘viewing situations, people or oneself as entirely bad or entirely good, with nothing in between’. For a cancer patient, this may be recognized in thoughts such as ‘My family never understands my needs. They never get it!’ Then, patients are introduced to cognitive re-structuring. The use of Socratic questioning is another central technique of CBT. This involves engaging patients in a dialog in which the therapist uses questioning to encourage the patients’ ideas. Some frequently used Socratic questions include ‘Can you tell me about…?’ and ‘What would happen if…?’ Such questioning provides a process of guided discovery.
CBT research now provides substantial evidence of its effectiveness in the treatment of many anxiety disorders and depression. Current evidence suggests that CBT is comparable to antidepressant medication for at least mild-to-moderate depression. Furthermore, the American Psychiatric Association Practice Guidelines indicate that among psychotherapy methods, CBT and interpersonal psychotherapy are the most efficacious for the treatment of depression. The Depression in Adults with Chronic Health Problems guidelines of the UK National Institute for Health and Clinical Excellence also recommends CBT for the treatment of depression among patients with chronic physical diseases.
Ref: Tatsuo Akechi, Psychotherapy for Depression Among Patients with Advanced Cancer, Japanese Journal of Clinical Oncology, Volume 42, Issue 12, 1 December 2012, Pages 1113–1119