Cognitive Therapy and The Placebo Effect

The recent CBS 60 minutes episode on “The Placebo Effect” sent shockwaves through the mental health community from cognitive therapy through psychiatry as Harvard researcher, Dr. Irving Kirsch, discussed his research on the placebo effect.

In reviewing lots of research, he concluded that, for example, while depressed people sometimes get better when put on anti-depressant medication, they also improve just about as much when they are given a “sugar pill”. That is NO active ingredients. In fact, in some studies, people got better on the sugar pill even when they were told it was a sugar pill!

Dr. Kirsch further revealed that none of the many studies that found these “lack of improved results” get published and they are “buried” by the drug companies that fund the studies.

Furthermore, the Food and Drug Administration has a policy that if even 2 of 10 studies report positive findings, the drug is often approved in spite of the 8 negative studies.

These findings support approaches like cognitive behavioral therapy, rational-emotive behavioral therapy and hypnosis which emphasize, to a large degree, the power of our mind in both causing and reducing negative emotional reactions and mood states.

The Psychiatry profession is up in arms, in part since the vast majority of their livelihood is based on prescribing medications for patients and managing them, rather than on verbal therapy. This is also true on the drug companies who spend billions of dollars touting the benefits of various drugs to treat depression and other mood states.

According to the report, in England, NO drugs are administered for mild-moderate depression until at least a 10 week trial of talk and/ or physical therapy is tried.

For more information about how approaches like Cognitive Therapy and Hypnosis works you can check on my video clips on You Tube and read additional blogs and articles on my website, www.cognitivetherapy.cc

Please address your comments to Dr.Robert Heller at info@robertheller.net.

Overcoming perfectionism can help you live a happier and more productive life. Perfectionsim is the greatest stopper there is…. It’s your excuse to yourself for not doing anything. Instead, strive for excellence, doing your best.” Perfectionists are highly self critical and are often not very productive because they are almost never satisfied with what they have done. Think of the student who never finishes the term paper because he is so unhappy with the first page, he keeps re-doing it over and over again!

This quote is not by a famous “psychologist” but the Oscar winning actor, Laurence Olivier.

Perfectionism is an illusion. Both achieving it and maintaining it even if you think you have it, just leads to anxiety, stress, depression and low self-worth. Perfectionists feel they are never good enough. It is like pouring water into a funnel. No matter how much you put in, it never stays full.

When you strive to do your best, you are focusing in on what you can control, appreciate your efforts and have goals you can work towards achieving. Your opportunities for improving and getting better increase and you feel good about your efforts and your progress towards your goals.

These are some of the ideas I explore with my clients in my Boca Raton office and through the many counseling clients I work with by phone and SKYPE.

As a cognitive therapist, I help people recognize and improve the way they think in order to feel and behave better. While understanding the past is useful in knowing how you learned to develop your thoughts and beliefs, changing them is often the key to both feeling and getting better and achieving success and excellence.

For articles, books and other “self-help” information visit, www.cognitivetherapy.cc

A series of studies recently discussed in the Wall Street Journal point out the relationship between sleep problems and a host physical and mental problems that can occur from too little and /or poor sleep including depression, anxiety, aggressive behavior, learning and memory problems and obesity. While the research focused on children and adolescents,  in my private practice of cognitive therapy,I have found similar effects in my own patients.

While problems with sleep can be both a cause and effect on anxiety, depression and related problems, often times, poor sleep habits is a key contributor.

Creating healthy routines around sleep can reduce the risk of sleep difficulties and its related negative consequences.

Going to bed and awakening the same time each day may take some planning and discipline but it is well worth the effort. A calming down ritual prior to bedtime is helpful such as reading or taking a bath. Sleeping in a dark room is naturally associated with sleep.

For those who tend to “worry” or “overthink” at bedtime, slow, deep breathing and visualizing quiet, peaceful and calming images relax the body and mind.

Finally, we need to accept the fact that our body and mind needs sleep to function at its best and that it is in our best interest to avoid the tendency to cut back on our sleep to fit more and more into a busier and busier day and lifestyle. These sleep hygiene strategies are part of the cognitive therapy approach to sleep problems.

Address comments and questions to Dr.Robert Heller at www.cognitivetherapy.cc.

Rational Emotive Behavioral Therapy  believes “People are disturbed not by things but by the view they take of them”. This famous quote by the ancient Greek philosopher, Epictetus is the foundation of one of the most powerful and influential approaches to mental health of our time, “ Rational Emotive Behavior Therapy”REBT, developed by psychologist, Dr.Albert Ellis has transformed the field of psychotherapy and helped millions of people overcome negative emotions and in many cases, saved their lives.

In  Rational Emotive Behavioral Therapy people are shown how to recognize how their thoughts and attitudes affect their mood and behavior and how by shifting thought and beliefs, new feelings and behaviors can emerge.  Clients are taught how to powerfully dispute negative thoughts and beliefs in their head, in written form and through tape recording their voice and listening to themselves out loud.

I had the good fortune to study with Dr.Ellis and some of the finest teachers in the world at his institute more than 30 years ago. Since that time, I have used the principles of practices of Rational Emotive Behavior Therapy (REBT) to improve the lives of hundreds of clients and have hopefully positively influenced others through my self-help guidebooks (www.cognitivetherapy.cc) and lectures to the public and professional audiences.

Often times, individuals who have been suffering for years and have tried all sorts of medications and different therapies have found Rational Emotive Behavioral Therapy and related cognitive behavioral therapy to make a huge difference in how they think, feel and behave.

Although my principle office is in Boca Raton, Florida I have found that distance coaching through the telephone and video (skype) has helped me reach individuals that do not have access to Rational Emotive Behavioral Therapy or CBT therapist nearby.

For more information on Rational Emotive Behavioral Therapy, visit www.albertellis.org or www.cognitivetherapy.cc

I received a phone inquiry recently from a mother concerning her adult son. Apparently, he has been diagnosed with bi-polar disorder and has had numerous problems with school, drugs and the law as a result. He was put on medication but has stopped taking it and has refused any kind of therapy. The mother had read about SMART Recovery, a free alternative group style self-help program for alcohol and drug treatment based on principles of Rational Emotive Therapy and Cognitive Therapy.

Most recently he had been arrested. His car was stopped for reckless driving and he was found to have an unprescribed bottle of anti-anxiety drugs in his possession. The mother wanted to know if the self-group would be worthwhile.

Since bi-polar disorder is made up of both severe depression coupled with periods of behaving in impulsive and manic ways, I told her straight out that her son needed to be on his medication and in individual treatment. I felt the voluntary group self help might be useful in addition but not in place of the other treatments.  When she replied again that he wouldn’t cooperate, I told her to allow the natural consequences to unfold and allow him to stay in jail until his court date. The judge will determine whether he will go to jail or insure that he gets treatment in lieu of jail time. With bi-polar disorder, beyond the medication, treatment needs to address his underlying core issues and help him develop better awareness of this thought and control over his feelings. I did not explore with mom the details of her “enabling” behaviors but pointed out if she continued to bail him out, more serious problems were likely in store.

For comments on this article or further information on this and related topics, visit Dr.Robert Heller at www.cognitivetherapy.cc

The American Psychiatric Association came out with its updated practice guidelines for the treatment of major depression. COGNITIVE BEHAVIORAL THERAPY (CBT) was one of only two approaches to therapy that were recommended, especially in the initial phase of depression treatment. In my pocket-sized guidebook, DEPRESSION I give a number of cognitive and behavioral tips and strategies to help identify and manage depression. Non drug approaches are especially important in working with pregnant women due to the danger to the fetus and for children and adolescents where increases in suicidal thinking have been reported.

For serious depression various drugs continue to be recommended along with electro convulsive shock therapy for treatment resistant depressions. I usually recommend a trial of 12-20 sessions of cognitive behavioral therapy before recommending a medication consult unless the individual needs stabilization or is compromised cognitively.

The new guidelines do not speak to Bi-polar depression.

For more information about this topic, go to www.cognitivetherapy.cc

COGNITIVE BEHAVIORAL THERAPY (CBT) and RATIONAL EMOTIVE BEHAVIOR THERAPY (REBT) have a long history of helping individuals overcome addictions and substance abuse problems. In fact it was Jack Trimpy, the founder of Rational Recovery, (the first alternative substance abuse program to AA 12-step types programs) who was himself effectively treated personally by the originator of “Rational Emotive Therapy”, Dr. Albert Ellis. Some years later, SMART Recovery was born and now offers hundreds of meetings based on the scientific principles of REBT to those suffering with alcohol and drug problems.

 Having trained with Dr.Ellis at the Institute for Rational Emotive in 1980-81, I eventually published a number  of self-help books in the addictions field based largely on a cognitive-behavioral approach including: “The Pocket Therapists Guide for Problem Drinking”, “Freedom from Alcohol”,”Drug Awareness” and related books like, Freedom from Tobacco” and “Weight Management”. 

While AA and 12 step approaches have helped a great many individuals, not everyone has been helped. Because of its faith based approach, needing to admit powerlessness etc, many individuals have preferred and done quite well with a “cognitive behavioral” approach that emphasizes self-responsibility and self-empowerment through rational thinking and emotional problem solving. I use this approach in my private practice and have taught SMART facilitators how to use it with their group members in the past. 

Recognizing that “one size doesn’t fit all” and that providing a variety of effective options will eventually help the largest number of people get well and stay well, SMART and CBT related approaches have made a significant impact in the addictions and substance abuse fields.

For more information on this topic, please go to www.cognitivetherapy.cc

Post traumatic stress disorder is commonly associated with combat stress and the horrors of war. While many combat veterans do suffer PTSD, victims of physical and sexual abuse, horrific accidents, natural disasters and other life threatening events can often leave individuals suffering with symptoms of anxiety, panic, nightmares, flash backs and a host of other problems. Sometimes, in an effort to deal with these unpleasant symptoms, people rely on drugs and alcohol and end up with additional problems as well. Cognitive behavioral treatments particularly, exposure based methods like flooding, systematic desensitization and EMDR are often effective in alleviating the harmful symptoms of PTSD. Hypnosis can also be an effective treatment either alone or in conjunction with one or more of these approaches. In my experience, especially in the case of automobile accidents, early detection and treatment can often lead to rapid and complete improvement. As a cognitive behavioral psychologist I have come to embrace “EMDR” as my favorite treatment for both acute and chronic cases of PTSD. It is non-directive and well tolerated by most clients and often leads to partial or complete remediation of the presenting problem. The eight phases of evaluation and treatment can occur over a relatively short period of time. Clients who have had long standing problems or who have not been helped by other approaches have found EMDR to literally be a life savior.

Cognitive therapy has long been a well known and effective treatment for sleep problems, especially insomnia, which accounts for over 80% of sleep problems. Sometimes, a behavioral analysis can help determine negative habits which interfere with the natural sleep process. Once identified, relatively simple, straight forward behavioral changes can often correct these problems. 

At times chronic sleep problems can cause problems of fatigue, irritability, short temper,anger and depression. It is also true that depression and anxiety disorders can also cause sleep disorders like insomnia. 

Many times, a hectic lifestyle or a “type A” non stop personality can make it difficult for the brain to slow down as it is supposed to prepare for sleep. Maintaining an active mind at bedtime makes it difficult to fall asleep and/ or stay asleep. 

A careful cognitive behavioral assessment is key to deciding what type and combination of treatment strategies will be most effective in overcoming sleep difficulties. Often times, training in deep muscle relaxation, guided imagery can do the trick. Sometimes, dealing with underlying problems and worries is needed before normal sleep returns.

Bullying is the threat of or actual physical assault of another person. Often it is pushing, shoving, grabbing, poking and sometimes punching and/or kicking. Bullies are often weak, insecure individuals who pick on perceived “weaker” targets for the purpose of hurting, controlling, manipulating gaining financial or other gain. 

Bullying is common is schools, playgrounds and even sporting contests. As a “behavioral psychologist” who specializes in cognitive therapy, I can tell you that there is no single strategy to deal with bullying behavior. However, as Teddy Roosevelt famously said, “walk softly but carry a big stick”. As a wise coach once told me, “never start a fight but be sure you finish it”. It is important for kids to stand up for themselves and not appear scared or cowardly. Often times, just as in the animal kingdom, these behaviors generally embolden an aggressor and increase the likelihood of attack. I believe children should be taught how to fight, that is to be able to physically defend themselves. Self-defense is a skill everyone should know. If attacked, a well placed kick to the groin or elbow to the solarplexes will usually make a bully back off and seek an easier target. 

Self-defense training must be taught along with self-control and self discipline. The movie, “The Karate Kid” is a fine example of such an approach.