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Cognitive Behavioral Therapy, Does It Work?

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Cognitive Behavioral Therapy, Does it Work?

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what separates this article from others is that it mentions how  genes and brain cells is what affects the outcome of our mood and finding a treat to said individual. "The hope is that as researchers pinpoint the genes involved in mood disorders and better understand their functions, treatment can become more individualized and more successful."

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Onset of depression more complex than a brain chemical imbalance

It's often said that depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is. Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, and stressful life events. It's believed that several of these forces interact to bring on depression.

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.

With this level of complexity, you can see how two people might have similar symptoms of depression, but the problem on the inside, and therefore what treatments will work best, may be entirely different.

Scientists have learned much about the biology of depression, but their understanding of the biology of depression is far from complete. Major advances in the biology of depression include finding links between specific parts of the brain and depression effects, discovering how chemicals called neurotransmitters make communication between brains cells possible, and learning the impact of genetics and lifestyle events on risk and symptoms of depression.

This article will address the how different parts of the brain affect mood.

Brain regions and mood

Popular lore has it that emotions reside in the heart. Science, though, tracks the seat of your emotions to the brain. Certain areas of the brain help regulate mood. Researchers believe that - more important than levels of specific brain chemicals - nerve cell connections, nerve cell growth, and the functioning of nerve circuits have a major impact on depression.

Increasingly sophisticated forms of brain imaging - such as positron emission tomography (PET), single-photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI) - permit a much closer look at the working brain than was possible in the past. An fMRI scan, for example, can track changes that take place when a region of the brain responds during various tasks. A PET or SPECT scan can map the brain by measuring the distribution and density of neurotransmitter receptors in certain areas.

Use of this technology has led to a better understanding of which brain regions regulate mood and how other functions, such as memory, may be affected by depression. Areas that play a significant role in depression are the amygdala, the thalamus, and the hippocampus (see Figure 1).

Research shows that the hippocampus is smaller in some depressed people. For example, in one fMRI study published in The Journal of Neuroscience, investigators studied 24 women who had a history of depression. On average, the hippocampus was 9% to 13% smaller in depressed women compared with those who were not depressed. The more bouts of depression a woman had, the smaller the hippocampus. Stress, which plays a role in depression, may be a key factor here, since experts believe stress can suppress the production of new neurons (nerve cells) in the hippocampus.

Researchers are exploring possible links between sluggish production of new neurons in the hippocampus and low moods. An interesting fact about antidepressants supports this theory. These medications immediately boost the concentration of chemical messengers in the brain (neurotransmitters). Yet people typically don't begin to feel better for several weeks or longer. Experts have long wondered why, if depression were primarily the result of low levels of neurotransmitters, people don't feel better as soon as levels of neurotransmitters increase.

The answer may be that mood only improves as nerves grow and form new connections, a process that takes weeks. In fact, animal studies have shown that antidepressants do spur the growth and enhanced branching of nerve cells in the hippocampus. So, the theory holds, the real value of these medications may be in generating new neurons (a process called neurogenesis), strengthening nerve cell connections, and improving the exchange of information between nerve circuits. If that's the case, depression medications could be developed that specifically promote neurogenesis, with the hope that patients would see quicker results than with current treatments.

Figure 1: Areas of the brain involved with depression

The regions shown here are mirrored in both hemispheres of the brain. Also, these structures are interlocking; the illustration suggests relative position but not precise location.

Amygdala: The amygdala is part of a group of structures deep in the brain that's associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. Recalling an emotionally charged memory, such as a frightening situation, activates the amygdala. Activity in the amygdala is higher when a person is sad or clinically depressed, and this continues even after recovery from depression. This increase in activity may actually cause the amygdala to enlarge.

Basal ganglia (not pictured): The basal ganglia are a related group of structures deep in the brain. They are connected to and interact with structures that are closer to the brain's surface. They may help facilitate movement and may be involved in memorizing, thinking, and emotional processing. Some studies have found shrinkage and other structural changes in the basal ganglia in people with depression.

Hippocampus: The hippocampus plays a key role in processing long-term memory. Interplay between the hippocampus and the amygdala might account for the adage "once bitten, twice shy." It is this part of the brain that registers fear when you are confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of dogs you come across later in life. The hippocampus is smaller in some depressed people, and research suggests that ongoing exposure to stress hormones impairs the growth of neurons in this part of the brain.

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What causes depression? - Harvard Health

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Depression has many possible causes, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It's believed that several of these forces interact to bring on depression.

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In the podcast between Joe Rogan and Johann Hari they talk about doctors that tell their patients that they have a "chemical imbalance" but that is not real and by being told that patients end up consuming medication. Doctors are backed up by pharmaceutical corporations and are encouraged to prescribing medication.

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Joe Rogan - Depression Isn't a Chemical Imbalance?

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In the video the speaker breaks down the purpose of therapy and how to stop the negativity in the brain to prevent going further downhill. "Thoughts impact emotions. Thoughts and emotions impact actions which impact health." Through CBT doing something he enjoys will stop the negative thoughts.

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Cognitive Behavioural Therapy CBT Techniques

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In Hope Reeses article “The Real Problems With Psychiatry”, she states that “the reason there haven't been any sensible findings tying genetics or any kind of molecular biology to DSM categories is not only that our instruments are crude, but also that the DSM categories aren't real.”

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A psychotherapist contends that the DSM, psychiatry's "bible" that defines all mental illness, is not scientific but a product of unscrupulous politics and bureaucracy.

On May 22, the American Psychiatric Association will release the fifth Diagnostic and Statistical Manual of Mental Disorders, the DSM-5. It classifies psychiatric diagnoses and the criteria required to meet them. Gary Greenberg, one of the book's biggest critics, claims these disorders aren't real -- they're invented. Author of Manufacturing Depression: The Secret History of a Modern Disease and contributor to The New Yorker, Mother Jones, The New York Times and other publications, Greenberg is a practicing psychotherapist. The Book of Woe: The Making of the DSM-5 and the Unmaking of Psychiatry is his exposé of the business behind the creation of the new manual.

Can you talk about how the first DSM, published in 1952, was conceived?

One of the reasons was to count people. The first collections of diagnoses were called the "statistical manual," not the "diagnostic and statistical manual." There were also parochial reasons. As the rest of medicine became oriented toward diagnosing illnesses by seeking their causes in biochemistry, in the late 19th, early 20th century, the claim to authority of any medical specialty hinged on its ability to diagnose suffering. To say "okay, your sore throat and fever are strep throat." But psychiatry was unable to do that and was in danger of being discredited. As early as 1886, prominent psychiatrists worried that they would be left behind, or written out of the medical kingdom. For reasons not entirely clear, the government turned to the American Medico-Psychological Association, (later the American Psychiatric Association, or APA), to tell them how many mentally ill people were out there. The APA used it as an opportunity to establish its credibility.

How has the DSM evolved to become seen as the "authoritative medical guide to all of mental suffering"?

The credibility of psychiatry is tied to its nosology. What developed over time is the number of diagnoses, and, more importantly, the method by which diagnostic categories are established.

You're a practicing psychotherapist. Can you define "mental illness"?

No. Nobody can.

The DSM lists "disorders." How are disorders different from diseases or illnesses?

The difference between disease and disorder is an attempt on the part of psychiatry to evade the problem they're presented with. Disease is a kind of suffering that's caused by a bio-chemical pathology. Something that can be discovered and targeted with magic bullets. But in many cases our suffering can't be diagnosed that way. Psychiatry was in a crisis in the 1970s over questions like "what is a mental illness?" and "what mental illnesses exist?" One of the first things they did was try to finesse the problem that no mental illness met that definition of a disease. They had yet to identify what the pathogen was, what the disease process consisted of, and how to cure it. So they created a category called "disorder." It's a rhetorical device. It's saying "it's sort of like a disease," but not calling it a disease because all the other doctors will jump down their throats asking, "where's your blood test?" The reason there haven't been any sensible findings tying genetics or any kind of molecular biology to DSM categories is not only that our instruments are crude, but also that the DSM categories aren't real. It's like using a map of the moon to find your way around Russia.

So would you say that these terms -- disorder, disease, illness -- are just different names for the same concept?

I would. Psychiatrists wouldn't. Well, psychiatrists would say it sometimes but wouldn't say it other times. They will say it when it comes to claiming that they belong squarely in the field of medicine. But if you press them and ask if these disorders exist in the same way that cancer and diabetes exist, they'll say no. It's not that there are no biological correlates to any mental suffering -- of course there are. But the specificity and sensitivity that we require to distinguish pneumonia from lung cancer, even that kind of distinction, it just doesn't exist.

What are the most common misconceptions about the scientific nature of diseases such as depression?

I guarantee you that in the course of our conversation a doctor is telling a patient, "you have a chemical imbalance -- that's why you're depressed. Take Prozac." Despite the fact that every doctor who knows anything knows that there is no biochemical imbalance that causes depression, and most doctors understand that a diagnosis of depression doesn't really tell you anything other than what you already knew, that doesn't stop them from saying it.

Research on the brain is still in its infancy. Do you think we will ever know enough about the brain to prove that certain psychiatric diagnoses have a direct biological cause?

I'd be willing to bet everything that whenever it happens, whatever we find out about the brain and mental suffering is not going to map, at all, onto the DSM categories. Let's say we can elucidate the entire structure of a given kind of mental suffering. We're not going to be able to say, "here's Major Depressive Disorder, and here's what it looks like in the brain." If there's any success, it will involve a whole remapping of the terrain of mental disorders. And psychiatry may very likely take very small findings and trump them up into something they aren't. But the most honest outcome would be to go back to the old days and just look at symptoms. They might get good at elucidating the circuitry of fear or anxiety or these kinds of things.

What is the difference between a disorder and distress that is a normal occurrence in our lives?

That distinction is made by a clinician, whether it's a family doctor or a psychiatrist or whoever. But nobody knows exactly how to make that determination. There are no established thresholds. Even if you could imagine how that would work, it would have to be a subjective analysis of the extent to which the person's functioning is impaired. How are you going to measure that? Doctors are supposed to measure "clinical significance." What's that? For many people, the fact that someone shows up in their office is clinical significance. I'm not going to say that's wrong, but it's not scientific. And there's a conflict of interest -- if I don't determine clinical significance, I don't get paid.

You say one of the issues with taking these categories too seriously is that it eliminates the moral aspect behind certain behaviors.

It's our characteristic way of chalking up what we think is "evil" to what we think of as mental disease. Our gut reaction is always "that was really sick. Those guys in Boston -- they were really sick." But how do we know? Unless you decide in advance that anybody who does anything heinous is sick. This society is very wary of using the term "evil." But I firmly believe there is such a thing as evil. It's circular -- thinking that anybody who commits suicide is depressed; anybody who goes into a school with a loaded gun and shoots people must have a mental illness. There's a certain kind of comfort in that, but there's no indication for it, particularly because we don't know what mental illness is.

How do diagnoses affect people?

One of the overlooked ways is that diagnoses can change people's lives for the better. Asperger's Syndrome is probably the most successful psychiatric disorder ever in this respect. It created a community. It gave people whose primary symptom was isolation a way to belong and provided resources to those who were diagnosed. It can also have bad effects. A depression diagnosis gives people an identity formed around having a disease that we know doesn't exist, and how that can divert resources from where they might be needed. Imagine how much less depression there would be if people weren't worried about tuition, health care, and retirement. Those are all things that aren't provided by Prozac.

What are the dangers of over-diagnosing a population? Are false positives worse than false negatives?

I believe that false positives, people who are diagnosed because there's a diagnosis for them and they show up in a doctor's office, is a much bigger problem. It changes people's identities, it encourages the use of drugs whose side effects and long-term effects are unknown, and main effects are poorly understood.

In 1850, doctor Samuel Cartwright invented "drapetomania" -- a disease causing slaves to run away. How do social and historical context affect our understanding of mental illness?

Cartwright was a slaveholder's doctor from New Orleans -- he believed in the inferiority of what he called the "African races." He believed that abolitionism was based on a misguided notion that black people and white people were essentially equal. He thought that the desire for freedom in a black person was pathological because black people were born to be enslaved. To aspire to freedom was a betrayal of their nature, a disease. He invented "drapetomania," the impulse to run away from slavery. Assuming there wasn't horrible cruelty being inflicted on the slaves, they were "sick." He came up with a few diagnostic criteria and presented it to his colleagues.

So we corrected our notion of what counts as a "disease." Is there a modern equivalent?

Homosexuality is the most obvious example. Until 1973, it was listed as a disease. It's very easy to see what's wrong with "drapetomania," but it's easier to see the balancing act involved in saying homosexuality is or isn't a disease -- how something has to shift in society. The people who called homosexuality a disease weren't necessarily bigots or homophobes -- they were just trying to understand people who wanted to love people of their own sex. Disease is a way to understand difference that includes compassion. What has to shift is the idea that same-sex love is acceptable. Once that idea is there, it doesn't make sense to call homosexuality a disease.

Who was involved in the creation of the DSM-5?

The American Psychiatric Association owns the DSM. They aren't only responsible for it: they own it, sell it, and license it. The DSM is created by a group of committees. It's a bureaucratic process. In place of scientific findings, the DSM uses expert consensus to determine what mental disorders exist and how you can recognize them. Disorders come into the book the same way a law becomes part of the book of statutes. People suggest it, discuss it, and vote on it. Homosexuality was deleted from the DSM by a referendum. A straight up vote: yes or no. It's not always that explicit, and the votes are not public. In the case of the DSM-5, committee members were forbidden to talk about it, so we'll never really know what the deliberations were. They all signed non-disclosure agreements.

What are the important changes made in the new DSM, and how will they affect patients?

It's going to cause a lot of trouble when Asperger's Syndrome disappears. It may cause some trouble when the bereavement exclusion disappears. That's a good example of why the APA's going to be in trouble. It was so unnecessary, so stupid. They've made the absurd statement that they know the difference, two weeks after someone's wife dies, whether that person is "depressed," or just "in mourning." Come on! Who are these guys?

The APA released a series of drafts of the DSM-5 before publication. Why?

They solicited public input, to their great credit. But they never said what they were doing with it. They said "we got this number of responses" but not what the responses were. How they influenced the process, if at all. The other problem with the drafts is that they deleted them. The history of how these things developed will be difficult to trace unless you happened to make copies of the website, which was in explicit violation of the APA's copyright. They also tried to prevent people from using the draft criteria in any kind of academic paper -- an unprecedented move. They demanded that anybody who wanted to use the criteria would have to seek and obtain their permission for academic publication. Nobody's ever done that. There were a couple of high profile, embarrassing studies that were conducted with the draft criteria, and once that happened, the APA asserted copyright over the draft criteria.

The APA considers the DSM-5 a "living document." What do you think they mean by this?

It's one of those rhetorical flourishes that, if you dig into it, you realize is a real problem. There's a difference between a constitution and a book of medical diagnoses. It's not entirely clear what they mean by "living document," but it appears that they want to update as evidence comes in. That's not a bad idea -- they don't want to go through one of these massive, expensive, embarrassing overhauls of the diagnostic manual every five or ten or fifteen years, they want to update as they go. But in the meantime, people are getting diagnosed, drugs are getting developed and prescribed, research is being done, and nobody knows to what extent things will get revised as time goes on. The APA is trying to say it's always in flux. But if that's the case, why should we let it have so much power?

Can you talk about that? What does the DSM has power over?

To get an indication from the FDA, a drug company has to tie its drug to a DSM disorder. You can't just develop a drug for anxiety. You have to develop the drug for Generalized Anxiety Disorder or Major Depressive Disorder. You can't just ask for special services for a student who is awkward. You have to get special services for a student with autism. In court, mental illnesses come from the DSM. If you want insurance to pay for your therapy, you have to be diagnosed with a mental illness. Whatever future contact you have with the health care system will be affected by the fact that a mental illness is in your dossier. If you call it a living document, what happens to all the people who are diagnosed with Asperger's when that's thrown out? Will it be chaotic? Maybe.

Al Frances chaired the task force for the DSM-IV and has become one of the biggest critics of the DSM-5. What do you think of his arguments?

We agree that the DSM does not capture real illnesses, that it's a set of constructs. We disagree over what that means. He believes that that doesn't matter to the overall enterprise of psychiatry and its authority to diagnose and treat our mental illnesses. I believe it constitutes a flaw at the foundation of psychiatry. If they don't have real diseases, they don't belong in real medicine. Al's attack is overdone. I think he's really trying to keep scrutiny off of the whole DSM enterprise. That's why he's been so adamant that you don't throw the baby out with the bathwater -- he believes that the DSM-IV, for all of its flaws, its still worthwhile. I disagree.

Frances also worries that your criticisms are anti-psychiatry.

It's the universal paranoia of psychiatry that everybody who disagrees with them is pathological. You can't disagree with a psychiatrist without getting a diagnosis. I've been writing critically about psychiatry for ten years and I've always encountered that. Psychiatry is a defensive profession. They have a lot to protect and they know their weakness. To repel criticism in the strongest way possible, from their point of view, you diagnose the critic.

Can you talk about the intersection between psychiatry and psychology? How does the DSM relate to both fields?

Psychiatry's in charge of the DSM. Psychologists and other mental health professionals use the DSM. But psychiatrists have the power and money. I'm critical of the mental health professions in general, including my own practice. But the APA has appropriated this business to themselves. They guard it jealousy, they protect it with ruthless tactics, and yes, they take a disproportionate amount of the heat for this thing, but it's their baby. They make hundreds of millions of dollars off of this deal.

Related Story

Will the APA lose credibility?

Of course it will. The DSM-5 will come out on May 22 and people will take their pot shots at it -- like shooting fish in a barrel. I had to be convinced to write this book, though. How hard is it to criticize an organization that seriously thinks that it's okay to call "Internet Use Disorder" a mental illness? They're going to take shot after shot. And the response will be ineffectual and weak. They'll bob and weave, talk about the "living document," and unleash their line of bullshit.

Is there a solution?

The solution is to take the thing away from them. The APA owns these diagnoses. I didn't ask permission because I don't care -- let them sue me. But if anyone wants to put diagnostic criteria into this book, they have to pay the APA. That's absurd. And if you add the vacuousness of the document and the incompetence with which the revision was carried out -- take the damn thing away from them.

This interview was edited for length and clarity.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

Hope Reese is a writer and editor based in Louisville, Kentucky. She writes for The Boston Globe, The Chicago Tribune, and Vox. Her website is hopereese.com.

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A psychotherapist contends that the DSM, psychiatry's "bible" that defines all mental illness, is not scientific but a product of unscrupulous politics and bureaucracy. On May 22, the American Psychiatric Association will release the fifth Diagnostic and Statistical Manual of Mental Disorders, the DSM-5. It classifies psychiatric diagnoses and the criteria required to meet them.

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According to the National Institute of Mental Health shows actual numbers made from studies across the country among adults and teens. The numbers shown in this study backup the numbers given in "Cognitive Behavior Therapy for Anxiety Disorders(Talk Therapy) which I felt were really high but show that they are not that far apart.

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National Institute of Mental Health (NIMH)

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Definitions

The wide variety of anxiety disorders differ by the objects or situations that induce them, but share features of excessive anxiety and related behavioral disturbances. Anxiety disorders can interfere with daily activities such as job performance, school work, and relationships.

For the data presented on this page, any anxiety disorders included panic disorder, generalized anxiety disorder, agoraphobia, specific phobia, social anxiety disorder (social phobia), post-traumatic stress disorder, obsessive-compulsive disorder, and separation anxiety disorder.

Additional information about anxiety disorders can be found on the NIMH Health Topics page on Anxiety Disorders.

Prevalence of Any Anxiety Disorder Among Adults

Basedon diagnostic interview data from the National Comorbidity Study Replication (NCS-R), Figure 1 shows past year prevalence of any anxiety disorder among U.S. adults aged 18 or older.¹

An estimated 19.1% of U.S. adults had any anxiety disorder in the past year.

Past year prevalence of any anxiety disorder was higher for females (23.4%) than for males (14.3%).

An estimated 31.1% of U.S. adults experience any anxiety disorder at some time in their lives.²

Figure 1

Any Anxiety Disorder with Impairment Among Adults

Of adults with any anxiety disorder in the past year, degree of impairment ranged from mild to severe, as shown in Figure 2. Impairment was determined by scores on the Sheehan Disability Scale.

Among adults with any anxiety disorder, an estimated 22.8% had serious impairment, and 33.7% had moderate impairment.¹

A majority of people with any anxiety disorder experienced mild impairment (43.5%).¹

Figure 2

Prevalence of Any Anxiety Disorder Among Adolescents

Based on diagnostic interview data from National Comorbidity Survey Adolescent Supplement (NCS-A), Figure 3 shows lifetime prevalence of any anxiety disorder among U.S. adolescents aged 13-18.³

An estimated 31.9% of adolescents had any anxiety disorder.

Of adolescents with any anxiety disorder, an estimated 8.3% had severe impairment. DSM-IV criteria were used to determine impairment.

The prevalence of any anxiety disorder among adolescents was higher for females (38.0%) than for males (26.1%).

The prevalence of any anxiety disorder was similar across age groups.

Figure 3

Data Sources

References

1. Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 2: 12-month prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.

2. Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 1: Lifetime prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.

3. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617-27. PMID: 15939839

4. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9. PMID: 20855043

Statistical Methods and Measurement Caveats

National Comorbidity Survey Replication (NCS-R)

Diagnostic Assessment and Population:

The NCS-R is a nationally representative, face-to-face, household survey conducted between February 2001 and April 2003 with a response rate of 70.9%. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay-administered diagnostic interview that generates both International Classification of Diseases, 10th Revision, and DSM-IV diagnoses. The DSM-IV criteria were used here. The Sheehan Disability Scale (SDS) assessed disability in work role performance, household maintenance, social life, and intimate relationships on a 0-10 scale. Participants for the main interview totaled 9,282 English-speaking, non-institutionalized, civilian respondents. Any anxiety disorder was assessed in a subsample of 5,692 adults. The NCS-R was led by Harvard University.

Unlike the DSM-IV criteria used in the NCS-R and NCS-A, the current DSM-5 no longer places post-traumatic stress disorder or obsessive compulsive disorder in the anxiety disorder category. They are listed in new DSM5 categories.

Survey Non-response:

In 2001-2002, non-response was 29.1% of primary respondents and 19.6% of secondary respondents.

Reasons for non-response to interviewing include: refusal to participate (7.3% of primary, 6.3% of secondary); respondent was reluctant- too busy but did not refuse (17.7% of primary, 11.6% of secondary); circumstantial, such as intellectual developmental disability or overseas work assignment (2.0% of primary, 1.7% of secondary); and household units that were never contacted (2.0).

For more information, see PMID: 15297905 and the NIMH NCS-R study page.

National Comorbidity Survey Adolescent Supplement (NCS-A)

Diagnostic Assessment and Population:

The NCS-A was carried out under a cooperative agreement sponsored by NIMH to meet a request from Congress to provide national data on the prevalence and correlates of mental disorders among U.S. youth. The NCS-A was a nationally representative, face-to-face survey of 10,123 adolescents aged 13 to 18 years in the continental United States. The survey was based on a dual-frame design that included 904 adolescent residents of the households that participated in the adult U.S. National Comorbidity Survey Replication and 9,244 adolescent students selected from a nationally representative sample of 320 schools. The survey was fielded between February 2001 and January 2004. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview.

Survey Non-response:

The overall adolescent non-response rate was 24.4%. This is made up of non-response rates of 14.1% in the household sample, 18.2% in the un-blinded school sample, and 77.7% in the blinded school sample. Non-response was largely due to refusal (21.3%), which in the household and un-blinded school samples came largely from parents rather than adolescents (72.3% and 81.0%, respectively). The refusals in the blinded school sample, in comparison, came almost entirely (98.1%) from parents failing to return the signed consent postcard.

For more information, see PMID: 19507169 and the NIMH NCS-A study page.

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An overview of statistics for anxiety disorders. Combined, anxiety disorders are the most common mental disorders in the United States.

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In this article it explains the benefits of cbt and other types of therapy and how they can be helpful. "It's used to help the person find ways to deal with everyday stressors. It can also encourage you to use your medications properly."

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Psychotherapy -- or "talk therapy" -- is an effective treatment for clinical depression. On its own, it may not be enough to treat severe depression. But it can play an important role when used with other treatments, including medications.

What Can It Do?

It's used to help the person find ways to deal with everyday stressors. It can also encourage you to use your medications properly.

Many studies support the idea that therapy can be a powerful treatment for depression. Some, although not all, have also found that combining depression medicine with therapy can be very effective. A large-scale trial involving more than 400 people with treatment-resistant depression found that talk therapy alongside medication made symptoms easier to take.

What Are The Benefits?

There are a number of them:

It can help ease stress.

It can give you a new perspective on problems.

It can make it easier to stick to your treatment.

You can use it to learn how to deal with side effects from your medicine

You learn ways to talk to other people about your condition.

It helps catch early signs that your depression is getting worse.

What Are the Different Types?

Cognitive therapy, behavioral therapy, and cognitive behavioral therapy focus on how your own thoughts and behaviors contribute to your depression. Your therapist will help you learn ways to react to things and challenge your preconceptions. You and your therapist might come up with goals. You might also get "homework" assignments, like to keep a journal or apply problem-solving techniques in particular situations.

Interpersonal therapy focuses on how your relationships with others play a role in your depression. It focuses on practical issues. You will learn how to spot unhealthy behaviors and change them.

Psychodynamic therapyis more traditional. You and your therapist explore behavior patterns and motivations that you may not be aware of which could contribute to depression. You may focus on any traumas from your childhood.

Individual counseling is a one-on-one session with a professional therapist who might be an MD (psychiatrist/doctor), PhD (psychologist), PsyD (psychologist), LCSW (licensed clinical social worker), or NP (nurse practitioner), with experience in treating depression and other mood disorders. Your therapist can teach you more about depression and help you understand yours. You can discuss new strategies to manage stress and to keep your depression from getting worse or coming back.

Continued

One-on-one sessions can help you identify specific stresses and triggers that worsen your depression. A therapist can help you work through issues at home or at work, and encourage you to maintain healthy connections with family and friends. Your therapist can also help you adopt good habits, like making sure you take your medicines, seeing your doctor regularly, and getting enough sleep.

Family counseling treats the entire family -- because it's not only the person with the diagnosis who is affected by depression. If you're depressed, your family feels it, too. And unfortunately, although family members may have the best of intentions, without professional guidance, they sometimes make things worse.

Family therapy is a great way for your relatives to learn about depression and the early warning signs. Studies suggest that family sessions might really help with treatment, too, improving lifestyle, compliance with medication, and sleep habits.

It also lets you and your family members talk about the stresses of life with depression. You may all feel more comfortable talking openly with a therapist there to guide the conversation.

Group counseling sessions give you a chance to meet other people who are going through the same things you are. You can share experiences and strategies. The give-and-take is often a good way to learn new ways to think about your illness.

How Do I Find a Therapist?

You will want to find a qualified therapist -- usually a psychiatrist, psychologist, social worker, psychiatric nurse, or counselor. If possible, find one who has expertise with treatment-resistant depression. Ask your doctor for recommendations. Or get in touch with an organization like the National Alliance on Mental Illness (NAMI) or the Depression and Bipolar Support Alliance (DBSA).

How Long Does Therapy Take?

While some people may benefit from short-term therapy, people with longstanding or treatment-resistant depression tend to derive more benefit from longer-term psychotherapy . Studies show long-term therapy for those conditions leads to greater improvement in depression symptoms and better life satisfaction and social functioning. It may also lower the risk of relapse after you get better. You and your therapist can watch for signs your depression might be getting worse. Over time, you'll also learn about the patterns in your life that may trigger feelings of depression.

Continued

If you have treatment-resistant depression, you may have already tried therapy. Maybe you didn't feel like it worked. But it may be time to give it a second chance. Here are some things to consider before you try again:

Think about the reasons you didn't find therapy useful in the past. Why didn't it work? What did you need from therapy that you weren't getting?

Decide what you want out of therapy now. Do you want to tackle specific problems? Do you want to work through upsetting events from your past? Come up with goals.

Consider going back to your old therapist. Even if therapy didn't work last time, that doesn't mean the therapist was at fault. The experience may be different if you approach it with specific goals this time. Going back to a previous therapist may be easier, since they'll already know your history and situation.

Consider trying someone new. Make sure that the therapist you're seeing has training and expertise in psychotherapy forms that are specific to the treatment of depression. Make sure you you like and respect your therapist. Ask yourself if you feel you can both work together effectively . If you and your therapist don't "click," therapy is unlikely to work. So you could try someone new. You might even want to meet with a few therapists before choosing one. Ask about their approaches. Talk about your goals.

Give it time. Once you've settled on a therapist, give therapy a chance to work. Don't give up after a few sessions. Like with depression medicine, therapy can take time before you feel the benefits.

Sources

SOURCES:

Wiles, N. Lancet, Feb. 2013.

National Institute of Mental Health: "What is Depression?"

FDA: "The Lowdown on Depression."

Mental Health America: Mpower: "Facts about Depression and Suicide."

Depression and Bipolar Support Alliance: "Psychotherapy: How it works and how it can help."

American Psychiatric Association, Practice Guideline for the Treatment of Patients with Major Depression, 2000.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric Pub, 2000.

Fieve, R. Bipolar II, Rodale Books, 2006.

Little A. American Family Physician, July 15, 2009.

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treatment resistant depression and psychotherapy

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Psychotherapy -- or "talk therapy" -- is an effective treatment for clinical depression. On its own, it may not be enough to treat severe depression. But it can play an important role when used with other treatments, including medications. It's used to help the person find ways to deal with everyday stressors.

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In my interview with Dr. Catterson, mention something that had not been brought up by any of my sources which was that anxiety is a mood disorder. Although he's not an expert on my topic we were able to talk about the importance of talking about issues that and not hold them in. Dr. Catterson was able to guide me to other sources that were more reliable but also shed some light on my previous sources that had no reference to where they were getting their information from.

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in this article is states several studies that have been done comparing the similarities of behavior therapy and the effects of certain medications such as prozac "the researchers compared behavior therapy with fluoxetine treatment. Both treatment modalities demonstrated similar changes in the brain especially in the caudate nucleus."

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I always hear people taking medication for anxiety and other disorders but hearing about alternative options was rare until I started looking it up for myself. "CBT is an effective intervention in helping people with various types of anxiety disorders." Cognitive behavior therapy can be be helpful along or even to better help when taking medication with cbt.

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Do you suffer from some form of anxiety? The most likely answer is yes. You are not alone. In fact, there are 40 million people in the US with an anxiety disorder. That is nearly 1 in 5 people.

Would it surprise you to know, of those suffering from anxiety, less than half actually seek help?

Why? It could be that they think nothing can be done to help and they must just 'cope.' That is not true. Your anxiety can be treated and your quality of life can improve.

Don't be a statistic. Read on and discover how cognitive behavioral therapy for anxiety can change your life for the better and sooner than you think.
What is Cognitive Behavioral Therapy?
CBT is an effective intervention in helping people with various types of anxiety disorders. CBT is the product of a lot of at least 2 forms of therapy that have their roots in different psychotherapy camps.
Behavioral Therapy
Behavioral therapy preceded CBT in its current form today. The basic concept of behavior therapy is that what we do affects how we think. We may not even realize the truth of this ourselves. But rest assured it is true.

In fact, there are many behaviors that we may have developed without even realizing it that we believe are helping us to get on with life.

The opposite is true.

Often, these behaviors or habits may reinforce our anxiety. CBT in its modern form can help you to identify and challenge those behaviors.
Cognitive Therapy
The mind is more powerful than the body. While it is true, what we do affects how we think, it is also true that we think affects the body and how we behave. Positive thoughts have a powerful effect on the body and wellbeing.

The opposite is true. Negative thoughts are destructive and they can erode our belief system in our self and what we are capable of. This, in turn, will affect what you do or do not do in life.

Now you see the advantage of CBT. It brings together the best of both psychotherapy camps and approaches the problem holistically. You are a person who thinks and behaves.

CBT will help you understand this relationship between thinking and behavior and use it to positively impact your emotions and well-being.
What Types of Problems can CBT Help?
CBT is an effective treatment intervention for many types of anxiety disorders. After reading this article, you may not be surprised to know that anxiety can express itself in multiple ways. That 'output' for your anxiety may also change.

If you have an anxiety disorder do not feel it is your fault. Anxiety is the result of complex interactions between genetics, environment, brain chemistry and general wellbeing.

Please know that with expert help you can overcome the following anxiety disorders:

1. Post Traumatic Stress Disorder

2. Generalized Anxiety Disorder

3. Obsessive Compulsive Disorder

4. Panic Disorder

5. Social Anxiety Disorder

What are Automatic Negative Thoughts?
These are mental responses to external stimuli or even physiological stimuli from within our own body. They are automatic in the sense that we do not have to work for them, they simply arise in our thinking.

They are negative because we have automatically chosen a perception that in all likelihood is not true but represents some degree of fear that it could be true. The way we think tends to be on a spectrum of positivity and negativity.

What we really want are thoughts that are balanced and realistic. Automatic negative thoughts are powerful and feed our anxiety. They first need to be identified and then challenged.
What Will Happen During the First Consultation?
No individual therapy is guaranteed to produce first-class results every time with everyone. Why not? We are individuals and that is the point.

CBT is not an 'off the shelf' therapy. It has to be individualized according to your unique needs. Of course, the therapy will follow well-established principles and evidence-based techniques. That is why it is so valuable.

However, CBT is not right for everyone. Your first few sessions will focus on asking questions about the severity of your symptoms and under what circumstances you experience them.

If you engage an expert like then it doesn't matter if CBT is not a perfect fit for you. They will adjust the therapy strategy appropriately.
What is Exposure?
If you know anyone who has gone through CBT they may have told you something about exposure. It is not anything to be afraid of. It is a tool that the therapist will use and also teach you to use to challenge yourself.

Remember this is about taking control. You will always be in control of any exposure exercises. Your exposure will start small and gradually increase.

It will usually start as a thought being played out in your mind and will develop from there. Exposure is your friend.
Treatment Plan
Anxiety can come from things that are out if our control. However, there are things you can control. Your treatment plan is going to teach you that.

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Cognitive Behavioral Therapy for Anxiety Disorders (Talk Therapy) - GetHealthAccess.com

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Do you suffer from some form of anxiety? The most likely answer is yes. You are not alone. In fact, there are 40 million people in the US with an anxiety disorder. That is nearly 1 in 5 people. Would it surprise you to know, of those suffering from anxiety, less than half actually seek help?

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this article points out specific tools and reasoning of behavioral therapy and where in the brain it takes place and how also how treatment varies from person to person. "In CBT, typical cognitive techniques include problem-solving and cognitive restructuring of irrational beliefs, and typical behavioral techniques include contingency management and exposure to feared stimuli."

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Cognitive behavioral therapy in practic...alifications, and relation to research

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Mentions how talk therapy has similar outcomes to taking medication. "When patients improved, the changes in their brains, as shown in the PET scans, looked the same regardless of whether they had received antidepressants or psychotherapy."

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Insight is a prerequisite of happiness, the theory goes, and well-being achieved without the hard work of psychotherapy is artificial and inauthentic.

But new evidence suggests that the talking cure and psychotropic medication have much more in common than had been thought. In fact, both produce surprisingly similar changes in the brain.

Take Eric's obsessive compulsive disorder. It hobbles patients with unwanted thoughts, often violent or sexual, that play in the mind like a broken record. Owing to the sometimes lurid nature of the thoughts, the treatment mainstay had for years been psychoanalytically oriented therapy to unlock the sexual and aggressive conflicts presumed to underlie the symptoms.

There was just one problem. That form of psychotherapy rarely, if ever, worked for those patients, a point now widely accepted by most psychoanalysts themselves.

But two seemingly different treatments can be highly effective: a form of talk therapy called cognitive-behavior therapy and a class of antidepressants called selective serotonin reuptake inhibitor antidepressants, or S.S.R.I.'s, drugs like Prozac and Zoloft. It is well known that patients with the disorder have altered serotonin function compared with normal controls.

Brain imaging that uses PET scans, or positron emission topography, has shown that the disorder is associated with functional hyperactivity of the caudate nucleus, a structure buried beneath the cerebral cortex. Some researchers hypothesize that the caudate is part of a subcortical circuit that acts as a kind of filter, sifting out extraneous thoughts and impulses.

In obsessive compulsive disorder, they theorize, the subcortical filter malfunctions, allowing the unwanted thoughts to reach the cortex and then on to consciousness.

In a study by Dr. Lewis Baxter at the U.C.L.A. School of Medicine, patients with the disorder who responded to either a reuptake inhibitor like Prozac or cognitive behavior therapy over 10 weeks showed virtually the same changes in their brains, decreases in the activities of the caudate nuclei and, thus, changes toward normal function.

When patients improved, the changes in their brains, as shown in the PET scans, looked the same regardless of whether they had received antidepressants or psychotherapy.

An S.S.R.I. works, in part, by enhancing the neurotransmitter serotonin, whose activity is often abnormal in people with obsessive compulsive disorder and depression. Cognitive behavior therapy focuses on changing distorted patterns of thinking.

The intriguing finding from the PET scans is not limited to O.C.D. Two studies of patients with depression, reported last year in The Archives of General Psychiatry, compared the effects of interpersonal psychotherapy with an antidepressant on brain function, as observed in PET scans. In those studies, the depressed patients received interpersonal therapy, a short-term talk treatment that focuses on the effects of social relationships and major life events on mood.

In one study, a 12-week trial that compared an S.S.R.I., Paxil, to interpersonal psychotherapy, Dr. Arthur Brody, also at U.C.L.A., found that depressed patients who responded to either treatment had nearly identical changes in their brain function, a decrease in the abnormally high activity seen in the prefrontal cortex before treatment.

In the second study, Dr. Stephen D. Martin at the research unit of Cherry Knowle Hospital in Sunderland, England, reported that six weeks of Effexor, an antidepressant that enhances both serotonin and norepinephrine, and interpersonal therapy produced similar effects in those depressed subjects who responded either to medicine or to psychotherapy. Each had shown an increase in the activity of the basal ganglia, a subcortical brain structure.

Although the observed changes with psychotherapy and antidepressant were similar in that study, they were not identical. Subjects with interpersonal therapy but not Effexor also had activation of a brain area called the cingulate gyrus, which responds to serotonin in the brain and has a role in regulating mood.

The studies show that pharmacotherapy and psychotherapy can produce remarkably similar effects on functional brain activity. But does that mean that antidepressants and psychotherapy are really equivalent?

In a word, no. Psychotherapy alone has so far been largely ineffective for diseases like schizophrenia, where there is strong evidence of structural, as well as functional, brain abnormalities. So it seems that if the brain is severely disordered, then talk therapy cannot alter it.

But it is clear that talk therapy can alter brain function. The reason may come from the elegant work of a Nobel Prize-winning psychiatrist and neurobiologist, Dr. Eric Kandel. Studying the simple and well-mapped nervous system of a sea slug, Aplysia, Dr. Kandel showed that learning leads to the production of new proteins and, in turn, to the remodeling of neurons.

Sea slugs exposed to the controlled-learning condition that produced long-term memory ended up with double the number of neuronal connections as the untrained animals. In essence, Dr. Kandel has proved that learning involves the creation of new neuronal connections.

The clear implication for humans is that learning literally changes the structure and function of the brain.

Now it may seem a big leap from a snail to a human. But if psychotherapy is thought of as a form of learning, then when therapists talk to patients, they cause them to learn, perhaps changing their brain function and, perhaps, for the long run.

In the end, Eric chose cognitive behavior therapy and improved drastically. Through exposure to those situations that he feared like messy dirty places, he became desensitized to them and lost his compulsion to wash.

Had he chosen an antidepressant, chances are that he would also have improved.

If psychotherapy produces nearly the same brain changes as pharmacotherapy, then the boundary between mind and brain is purely artificial -- even unnatural.

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BEHAVIOR; Like Drugs, Talk Therapy Can Change Brain Chemistry

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Insight is a prerequisite of happiness, the theory goes, and well-being achieved without the hard work of psychotherapy is artificial and inauthentic. But new evidence suggests that the talking cure and psychotropic medication have much more in common than had been thought. In fact, both produce surprisingly similar changes in the brain.

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Eagleman, David. The Brain; The Story of You. Random House LLC, 2015.

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Read 1,725 reviews from the world's largest community for readers. Locked in the silence and darkness of your skull, your brain fashions the rich narrative...