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Cognitive Behavioral Therapy

Looking back at how his behaviors, such as depression and compulsive shopping affected his life, Bob realized he had been in a downward spiral for quite some time. "No doubt my behaviors had a lot to do with my marital troubles."

It took therapists in Butler Hospital's Partial Hospital and outpatient programs, using Cognitive-Behavioral Therapy (CBT), to help Bob understand his behaviors and learn to lessen their impact.

CBT is a form of talk therapy in which patients discuss their thoughts, feelings, and behaviors with a mental health professional. Based on a combination of behavioral and cognitive principles, CBT focuses on how the way we think affects the way we feel and act. A therapist helps a patient identify negative thoughts and then replace them with new ones.

CBT helped Bob "learn how to live" and turn his life around. The therapy helps patients:

  • Cognitive Behavioral TherapySet goals
  • Learn constructive assertiveness
  • Improve communication skills
  • Practice relaxation techniques and coping skills  

Bob needed help with compulsive shopping. "Going out and buying clothes, tools or camping equipment was a high for me, like a drug," he says, adding that he confronted the behavior with his therapist at Butler. 

He also had problems at work because of severe bouts of depression, and often called in sick because he couldn't get out of bed. "I would just lie there crying. I had no energy. I couldn't move," he recalls.

First steps

In the Partial Hospital program, patients are immediately introduced to a key CBT concept — that a person's thoughts, feelings and behaviors are connected like a triangle. Making a positive change to one side will lead to progress on the other sides. Patients also learn that their negative feelings may not be accurate when looked at rationally.

"(CBT) helps them weigh the evidence," says Shannon Erisman, PhD, staff psychologist in the Women's Partial Program (WPP) at Butler. "It may not change the circumstance, but it will change how someone feels about something, and how they react to it."

The behavioral piece of CBT helps people engage in the activities that make them feel unmotivated or anxious. For example, if someone is depressed and does not want to leave the house, therapists might encourage them to get out of the house for 30 minutes or an hour, and see how it affects their mood or if the experience was as scary as they thought it was going to be."

CBT also helps patients develop good coping skills.

 "We immerse patients in CBT," explains Lisa Shea, MD, Butler's associate medical director for quality and regulation and associate chief of the Partial Hospital Program. "It's intensive and can be difficult, but it's amazing how much can be accomplished in just five days. We are really committed to helping our patients learn these skills."

Taking control

Butler's clinical staff may recommend that some patients participate in interpersonal CBT group meetings.

"We are setting the recovery process in motion," notes James Sullivan, MD, associate medical director of inpatient care at Butler. "When appropriate, we help patients explore CBT concepts, especially how they view themselves and their situation, and take steps toward making positive changes in their lives."

When Bob was admitted to Butler's partial program, he was having conflicts with a younger co-worker who was making things difficult for him. His medications were adjusted, and the CBT concepts he knew were reinforced. 

"Through the assertiveness training, I learned it was alright for me to let people know how I felt," he says. "I also learned my co-worker was being passive-aggressive and I learned some skills to deal with that."

Just a few months after treatment, Bob was doing much better. With the help of supportive family and friends and the new skills he learned at Butler, he's optimistic about his future. "If people got this kind of care before they really started feeling bad, they would be so much better off," he says.

- By Pam Berard

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