This week’s focus is on mental health.
The third year of psychiatry residency usually focuses on outpatient care. The resident learns how to manage medications in different outpatient settings (as opposed to inpatient settings) as well as the basics of therapy.
Right now we are learning cognitive behavioral therapy (CBT), and my supervisor and I are preparing to jointly lead 12 sessions of group CBT helping people experiencing symptoms of depression.
So what is CBT? It’s a form of psychotherapy originally developed in the early 1960s by Aaron Beck. It was first developed to treat depression by changing unhelpful thinking and behaviors. It was later adapted to address a wide range of other mental health conditions.
In a nutshell, the cognitive model is based on the belief that dysfunctional thinking is common to all psychological disturbances. In other words, when a situation or event happens, an automatic thought occurs which then produces an emotion. Symbolically, it looks like this:
Situation/event->automatic thought->reaction (emotional, behavioral, physiological)
For example, if I came into work this morning and the administrator didn’t greet me, my automatic thought might be “oh no, she’s angry with me, what did I do wrong?” which then results in my feelings of anxiety, fear and/or self-doubt. I might not even be aware of the thought (or the validity of that thought) that occurred between the event and the negative emotions. I just know I suddenly feel uneasy.
CBT helps people to evaluate their thinking which results in an improvement in their overall emotional state and behaviors. Multiple studies have shown CBT to be effective. (See Clark and Beck (2010) on Pub Med for a comprehensive review of the CBT studies.)
If you’re interested in beginning to monitor your own thoughts to see how they might be impacting your mood, you can use the following chart:
Situation or Event
Emotional, Behavioral, Physiological Response
As you become more aware of your automatic thoughts, you can then add columns, such as evidence that supports this thought, evidence that doesn’t support this thought, and an alternative thought. You can also start to look at the core beliefs that might be behind an automatic thought. (Going back to the example above, the core belief might be "I can't do anything right" which then leads to the self-blaming automatic thought and the resulting anxiety.)
There is MUCH MUCH more to CBT, but if this way of looking at the relationship between events, thoughts, and emotions appeals to you, you might consider finding a CBT therapist or group. There are also many workbooks available on Amazon and other places that you can work through on your own. A copy of the participant manual that we'll be using in our group CBT class can be viewed by clicking here.
Information from Cognitive Behavior Therapy: Basics and Beyond 2nd Edition by Judith Beck used as a resource for this post.
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