Archive for category cognitive

[WEB SITE] TherapWii – game suggestions

Why TherapWii

Gaming activates and is fun to do! In a playful and often unnoticed way skills are trained. Adolescents grow up in a digital world; they enjoy gaming and do it frequently. For adults and elderly gaming has been shown to be a useful type of therapy.

In a virtual environment moving, executing, learning and enjoying are appealing; if circumstances or limitations keep you from going to the bowling alley or playing an instrument, gaming can broaden your boundaries.

Gaming with the Wii can complement therapy, can make therapy more attractive, intenser and more provocative.

TherapWii has been developed to support therapists in an effective and specific way while using the Nintendo Wii and offer options to game in the home environment.

TherapWii is the product of an exploratory research project done by the Special Lectorship Rehabilitation at the Hague University. The results of this project can be found by clicking on the header ‘research’ at the end of the page.

How does TherapWii work?

Per therapy goal there are three colored tabs to help find the most suitable games. Each game lists specific information in text and symbols. There is also a level of difficulty; by moving the cursor over this button you see more information.

User information is saved in ‘explanation and tips’. To enhance this section you can email recommendations and suggestions to the email address listed below.

TherapWii has been developed, also for home use, so that experience lead to personal growth.

Advice for game adjustments

It is important that the therapist stays close to the patient’s goals and abilities and adjusts the game program appropriately. If you, as therapist, want to make the game easier, more difficult or more daring, you can change the instruction, implementation or setting.

A few examples:

Physical: strength (add weights to the arms or legs or change the starting position); balance/stability (play while standing on an instable foundation (ball, mat). Or play the games while sitting on a stationary bicycle!

Cognition: create double tasks (ask mathematics, questions or riddles); spatial orientation or visual adjustments (play with one eye covered or in front of a mirror).

Social-emotional: stimulate cooperation or competition (create bets or role-playing).

Let us know if you have other ideas to make the games more provoking.

How are the games rated?

The games were tested by several professionals (physical therapists, occupational therapists and sport therapists). Differences in opinion or scores were discussed and voted on.

Give us feedback, corrections and advice, we will adjust the TherapWii program monthly and will use your suggestions.

Which ability do you choose?

Social-Emotional

Physical

Cognitive

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[Abstract+References] A Serious Games Platform for Cognitive Rehabilitation with Preliminary Evaluation

Abstract

In recent years Serious Games have evolved substantially, solving problems in diverse areas. In particular, in Cognitive Rehabilitation, Serious Games assume a relevant role. Traditional cognitive therapies are often considered repetitive and discouraging for patients and Serious Games can be used to create more dynamic rehabilitation processes, holding patients’ attention throughout the process and motivating them during their road to recovery. This paper reviews Serious Games and user interfaces in rehabilitation area and details a Serious Games platform for Cognitive Rehabilitation that includes a set of features such as: natural and multimodal user interfaces and social features (competition, collaboration, and handicapping) which can contribute to augment the motivation of patients during the rehabilitation process. The web platform was tested with healthy subjects. Results of this preliminary evaluation show the motivation and the interest of the participants by playing the games.

Source: A Serious Games Platform for Cognitive Rehabilitation with Preliminary Evaluation | SpringerLink

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 [BLOG POST] What’s the Difference Between Cognitive Rehabilitation Therapy and Cognitive Behavioral Therapy?

Neuro trauma can completely disrupt the way a person feels, thinks and behaves.  Whether it’s from a mild concussion, severe traumatic brain injury, stroke or aneurysm – neuro trauma causes a wide variety of deficits including long and short term memory loss, impulsivity, mood swings and many other social, cognitive and behavioral issues.  Two of the most commonly recommended treatments also happen to be the most commonly mistaken for each other: Cognitive Behavioral Therapy (CBT) and Cognitive Rehabilitation Therapy (CRT). So, what’s the difference?

Cognitive Behavioral Therapy
Cognitive Behavioral Therapy is effective for treating a variety of conditions such as mood, anxiety, personality, eating, addiction, dependence and psychotic disorders.  Cognitive Behavioral Therapy replaces distorted or negative thoughts with more realistic ones to decrease emotional distress and self-defeating behavior. Simply put: if you change the way you think, you can change the way you feel and behave.

Drug addiction is commonly treated with Cognitive Behavioral Therapy. The therapist helps enable the patient to see how their thoughts, feelings and behavior patterns interact to trigger their urge to use drugs.  From here, the therapist can determine the source of the patient’s problematic relationship with drugs. For example, feelings of depression may lead to self-destructive thoughts which, in turn, may result in the patient using drugs.  The therapist targets negative feelings that start the cycle of abuse by helping the patient develop a positive self-worth. By altering thoughts like negative self-talk and self-isolation that can lead to drug-seeking behavior, Cognitive Behavioral Therapy helps end the negative feedback loop of addiction in a patient’s life. Even when therapy is complete, patients are advised to continue practicing CBT so they can maintain a positive outcome.

Cognitive Rehabilitation Therapy
Cognitive Rehabilitation Therapy is the process of mentally redeveloping the cognitive skills and function lost due to brain injury. These skills include intellectual performance, problem solving, attention deficits, memory and language difficulties. The key measure of CRT is the patient’s level of cognitive function. If the patient cannot relearn the lost skills, then the therapists teaches compensatory strategies. These strategies can literally be anything that helps the patient redevelop and maintain their independence. For example, a patient with short term memory problems could learn to set an alarm on his phone to remind him to take his medication.

Basic Cognitive Rehabilitation Therapy (CRT) included four components:
1) Assessment, education and awareness development of cognitive strengths and weaknesses, 2) skill development concentrating on resolving defined cognitive deficits, 3) compensatory strategy training and 4) functional activities that involve applying the first three components of CRT to everyday life.

At Life Skills Village, our therapists assess and treat patients’ cognitive skills by focusing BOTH on building upon the patient’s strengths while strategically shoring up their weaknesses.  But what if a patient has a deficit that cannot be rebuilt? This is where the therapist’s list of compensatory strategies comes in – for every deficit, there is at least one compensatory strategy.  A patient experiencing difficulties with short-term memory will have several strategies for them to try: there are many smart phone apps to help organize schedules and act as a reminder for events. Patients can develop the habit of taking notes in doctor’s appointments.  They might keep a calendar on their refrigerator at home to know where they are scheduled to be on any particular day. Even maintaining a simple “thought” journal can aid patients in tracking their emotions in relation to daily events.

Although both Cognitive Behavioral Therapy and Cognitive Rehabilitation Therapy maintain a focus on cognition, they are distinct therapies designed to address specific cognitive concerns. Cognitive Behavioral Therapy is used to treat mental conditions such as anxiety or depression by focusing on an emotional or behavioral issue. The goal is to change a patient’s perception in order to decrease self-defeating behaviors, improve their mood and develop healthy thought patters. Cognitive Rehabilitation Therapy employs a broad range of cognition-based therapies to assist patients with cognitive deficits, such as memory, attention and executive function. The goal is to improve cognitive function and processes. Using these and a myriad of other therapies, Life Skills Village facilitates independence and a return to normal life for our clients after their injuries.

Source: Life Skills Village Blog – LifeSkillsVillage.com

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[WEB SITE] This could explain why people with OCD can’t overcome their urges – ScienceAlert

People with obsessive-compulsive disorder (OCD) struggle to overcome their repetitious urges due to an inability to learn what kinds of stimuli are actually safe, new research suggests.

OCD is a disorder where people feel compelled to repeatedly perform certain tasks or think particular thoughts. These insistent routines are called ‘rituals’, and scientists think the behaviours persist because those with OCD struggle to learn when situations aren’t threatening.

“Our study suggests that something is going wrong in the brains of people with OCD when they are learning what is safe, and this in turn affects how they perceive threats under updated circumstances,” says neuroscientist Annemieke Apergis-Schoute from the University of Cambridge in the UK.

Apergis-Schoute and her team conducted a learning experiment where they compared the brain activity and anxiety responses of OCD patients with measurements taken from people without the condition.

OCD is estimated to affect around 1 percent of the adult population in the US, with the disorder compelling people to do things like repeatedly wash their hands, or check that doors are locked and appliances are switched off.

“They’re not usually off-the-wall bizarre,” one of the team, Naomi Fineberg from the Hertfordshire Partnership University NHS Foundation Trust in the UK told New Scientist.

“The obsessions are the sorts of things that most people would understand as being rational but exaggerated – for example, the need to wash your hands after going to the toilet.”

While these rituals aren’t necessarily harmful in themselves, they stem from intrusive and unwanted feelings that are usually associated with anxiety, and can have a considerable impact on carrying out day-to-day activities.

One of the ways of treating OCD is called exposure therapy, where people with the condition are made to confront the source of their anxiety – such as touching a dirty object – in an attempt to control their response.

But exposure therapy doesn’t work for every patient, and even in people who do learn to control their anxiety response, the effectiveness can be limited.

To find out why exposure therapy might only have limited success in treating OCD, the researchers recruited 78 people for a learning experiment – 43 of the volunteers had OCD, and 35 acted as a control group.

Each of the participants were asked to lie in a functional magnetic resonance imaging (fMRI) scanner, which measured their brain activity while they were shown one of two faces – a red face or a green face.

In the first experiment, the participants would receive a mild electric shock when shown the green face, but wouldn’t be shocked when viewing the red.

Sensors that measured tiny amounts of sweat produced by the participants showed that the group learned to associate anxiety with the green face (as a result of the electric shocks that came with it), but not with the red face.

But then the researchers swapped the green and red faces around, so that it was the red face that now came with an electric shock.

While the control group successfully learned the new associations – green is now safe, red is bad – the participants with OCD were less able to register that the green face no longer posed a threat.

Measurements of the participants’ brain activity when they were shown the now safe green face indicated that the OCD patients had less activity in the ventromedial prefrontal cortex – which is associated with processing safety signals in the brain, and decision making in relation to perceived risks.

According to the researchers, this could explain why people with OCD have difficulty overcoming their rituals, because their brains may find it significantly harder to unlearn negative associations, even when treatment such as exposure therapy attempts to directly counter them.

“This needs to be taken into consideration when we’re developing future therapies to tackle the disorder,” Apergis-Schoute explains in a press release.

“Current exposure therapies may help the patient take control over their compulsions, but our work suggests that they might never learn that their compulsions are unnecessary and they may return in times of stress.”

It’s worth pointing out that the researchers are drawing their conclusions from a very small sample of participants, so larger studies involving more patients affected by OCD will be needed to confirm the findings.

But if the results can be replicated, it could help explain some of the limitations of exposure therapy, and improve the delivery of the treatment in the future.

“The bit of their brain that should be telling them it’s safe isn’t working,” Fineberg explained to Clare Wilson at New Scientist.

“Now we can say to them this is why [exposure therapy is] taking so long and we should stick with it.”

The findings are reported in PNAS.

Source: This could explain why people with OCD can’t overcome their urges – ScienceAlert

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[WEB SITE] Lost & Found: Caps, Sunglasses, and Earplugs – Strategies for Coping with Sensory Hypersensitivity – brainline.org

If it seems like your sense of touch, taste, smell, hearing, or vision is extra sensitive or heightened after your brain injury, it’s not your imagination. Sensory hypersensitivities are another major, yet not as obvious, contributor to fatigue and overload after brain injury. What we experience with our senses is essentially more information for our injured brains to try to process and organize. You can have difficulties processing sensory information just like any other information in your brain. Some examples of sensory hypersensitivities are:

  • Sounds that you barely noticed before are alarming and startle you.
  • It feels like you have megaphones in your ears.
  • Background sounds and stimulating environments become overwhelming.
  • Fluorescent and bright lights give you headaches.
  • Clothing that was comfortable before feels irritating now.
  • Large gatherings of people feel overwhelming.

Pain and fatigue can intensify sensory hypersensitivities, putting you in a hyper-sensitive or hyper-vigilant state. When you are in a hyper-sensitive or hyper-vigilant state, even subtle stimulants feel overwhelming. Especially sights and sounds that didn’t bother you before, may now trigger anxiety and the fight-or-flight response where your whole being feels threatened and out of control. You may shut down and not be able to do any more or you may feel compelled to escape from the situation. It can be very taxing, physically and mentally.

Stress management, movement and using all of your senses can help your brain organize and integrate the senses. This is similar to what children do. Consider how physically active children are as they grow and develop!

See Brain Recharging Breaks at the end of this chapter for some basic meditation techniques. Meanwhile, following are suggestions for coping with sensory hypersensitivities.

General Coping Suggestions

Limit exposure to avoid sensory overload.

  • Avoid crowds and chaotic places where there are a lot of stimuli, like shopping malls.
  • Do shopping and errands early in the week and early in the day, when stores are less crowded and quieter.
  • Shop in smaller, quieter stores when possible.
  • Eat out in restaurants when they are quieter, in between regular meal times.
  • Hold conversations in a quiet place.
  • Ask people to please speak one at a time. Explain that you’d really like to hear what everyone has to say but you can only hear one person at a time.
  • Sleep during car trips.
  • If you want to attend a function that you expect will be taxing, plan to stay only a short while. Take your cap, sunglasses and earplugs. Sit towards the back to minimize the sound and where you can easily exit to a quieter place or the car.

Monitor your pain, stress and fatigue levels.

Lights and sounds will bother you the most when you are stressed or fatigued. If you are feeling especially sensitive, use it as a cue that you need to take a break and use some relaxation techniques.

Try avoiding nicotine, caffeine and alcohol.

They may make the symptoms worse. If you have vertigo, try limiting your salt intake, which can cause fluid retention. Consider strengthening exercises for your neck with the guidance of a physical therapist.

When you are starting to feel stressed or anxious, try incorporating another sense.

  • Put something in your mouth to chew or suck on. Strong flavors like peppermint or cinnamon are especially effective.
  • Put on some soothing music.
  • Apply some deep pressure. Give yourself a hug or press your palms firmly together or on the table. Squeeze the steering wheel if you are driving the car.

Experiment with activities and alternative therapies that involve your senses.

Listen to music, experiment with movement, dance, yoga, water, art, aromatherapy, etc.

Challenge your sensitivities.

Gradually increase your exposure and tolerance when using earplugs, sunglasses, etc.
Don’t eliminate the senses completely or you set yourself up for super-sensitivity.

Specific Coping Strategies

Sensitivities to sound

  • Limit your exposure to noisy stores and loud situations like sporting events, the movie theatre and children’s school activities. Don’t participate or plan to stay for a limited amount of time. Sit on the outskirts so you can gracefully escape to a quieter place if needed.
  • Use earplugs, try different kinds, and carry them with you.
  • Use headphones for TV and music:
    • For others, when you don’t want to hear it.
    • For yourself, when you want to hear it better.
  • Minimize distractions from snacking while doing things like working in groups or playing games. Use bowls for food instead of eating directly from noisy bags.
  • Add some background sound – a fan, white noise machine, soothing music.
  • Remove yourself from the situation and go to a quieter place as soon as possible, even the bathroom, when you feel overwhelmed or anxious. Then try:
    • Closing your eyes
    • Taking slow deep stomach breaths
    • Putting an ice pack on your forehead and eyes
  • Gradually expose yourself to different sounds and louder sounds to increase your tolerances.

Sensitivities to light

  • Avoid bright light and fluorescent lights.
  • Use sunglasses or a cap with a brim, even indoors.
  • Try yellow tinted glasses if florescent lights are a problem.
  • Try polarized sunglasses if driving glare is a problem.
  • Try yellow tinted glasses if night driving is a problem.
  • Make sure you are getting plenty of vitamin A (but not too much!).
  • Eat orange colored fruits and vegetables like carrots, sweet potatoes, squash, and cantaloupe.
  • Take a moment to just close your eyes for a few minutes when you are starting to feel stressed or anxious. This blocks out the visual stimuli.

Sensitivities to touch, taste, and smell

  • Experiment! Cultivate an awareness of how things feel, taste and smell.
  • Rub different textures on your arms, increasing the intensity to gradually decrease sensitivities.
  • Add texture, contrasting temperatures and flavors to your food, like ice cream with crunchy nuts or chips with spicy taco sauce.
  • Notice the textures.
  • Pay attention to smells.
  • How do different aromas make you feel?

If your sense of smell is altered, make sure to have functioning smoke and gas detectors in your home.

Doing cognitive work

  • Plan to do cognitive work when your environment is quiet. Eliminate as many distractions and interruptions as possible.
  • Screen out distractions by using earplugs or headphones, playing soothing music, or using a fan or white noise machine if you have sensitivities to sound.
  • Turn down the volume on the phone and let the machine get it.
  • Work in an uncluttered space or use a three sided table screen, to help screen out visual distractions.
  • Give children headphones for the TV if you are having trouble screening it out.
  • Do your “thinking” work while children are in school or asleep.
  • Still having trouble concentrating? Try bringing in another sense.
    • Put on some soothing nature or instrumental music, something without words at a low volume.
    • Try chewing or sucking on something while you are working. Coffee stirrers can substitute for fingernails. Strong flavored or fizzy candies and gum can aid alertness.
    • Try using some deep pressure by giving yourself a hug, pressing your palms strongly against each other or on the table.
    • Try sitting on a large therapy ball while you work. A great strategy if you have trouble sitting still!
  • Take a physical break, every 15 min. at first. Resist the urge to push through. I know it feels counter-intuitive but taking breaks will actually help you work longer! Gradually you will find you can increase the time between breaks.
    • Use a timer – without a ticking sound!
    • Pause and stretch, drink some water or make a cup of tea, walk around the house or the yard, rock in a chair, walk the dog, pat the cat.

Visual Processing Problems

Vision is an extremely important and complex source of sensory information. What you see with your eyes travels through your brain to the back area of your brain, where it is processed in the occipital lobe. There is a lot of territory between the eyes and the back of the brain where an injury can occur. The occipital lobe may be damaged directly from impact to the back of the head or it may be damaged indirectly from the ricochet of the brain inside the skull when the front of the brain is impacted. Damage to the occipital lobe frequently occurs in car accidents, falls and sports injuries. Even subtle visual problems following a brain injury can have a significant impact on cognition and functioning.

I wish I had known about visual problems and visual therapy when I had my car accident. I thought I was really going crazy! Fortunately for me, my issues improved with time but not without mishaps, like falling off a curb!

Some common problems after a brain injury related to vision include:

  • Double vision
  • Trouble tracking words on a page
  • Impaired depth perception
  • Hypersensitivities to light
  • Difficulties remembering and recalling information that is seen
  • Difficulties “filling in the gaps” or completing a picture based on seeing only some of the parts
  • Trouble seeing objects to the side
  • Low tolerances to changing light or clutter
  • Impaired balance, bumping into objects
  • Feeling overwhelmed when there is a lot of visual stimuli

If you notice problems in areas related to visual processing, please consult a visual therapist or a neuroopthalmologist, they can help!

Tips:

  • Don’t eliminate any sense completely or you set yourself up for a super-sensitivity.
  • Gradually expose yourself to more light, sound, touch, smell, and taste.
  • Be patient, in many cases your sensory hypersensitivities will decrease in time!
  • Ask for physical therapy or occupational therapy with a therapist with a background in sensory integration for help with sensory sensitivities.

Some good news about sensory hypersensitivity is that it is also associated with a heightened sense of awareness and intuition. You may find that you feel more aware of your intuition and more creative since your brain injury. This is not uncommon. Enjoy!

Brain Recharging Breaks

If I had to choose one strategy that helped me the most after my brain injury, it would be learning to meditate. Meditation is especially helpful when you are experiencing sensory overload. It can help you calm yourself down from that hyper-sensitive state. It was also the only way I have found to give my brain a rest, to put it temporarily in a “cast”, like you would a broken limb. Often, after meditating for 15-20 minutes, the “logjam” in my brain clears up and I am somehow able to think again!

I recommend using some stress management or meditation techniques at least once a day. Plan it, schedule it in your planner, make it part of your daily routine. Meditation is not as mysterious as you might think. Try these basic steps:

  • Get in a comfortable position on the bed, in a recliner or even in the car; uncross your arms and legs. Cover yourself with a blanket if you are cool.
  • Close your eyes and do some slow deep breathing.
  • Slowly inhale, expanding your stomach and counting to 7.
  • Exhale gradually, contracting your stomach towards your spine, counting to 7.

Repeat. Repeat. Repeat.

When you are feeling more relaxed, as you continue your slow deep breathing, experiment with the following suggestions to increase the effectiveness of the experience.

Do a body scan checking for areas of pain or stress.

  • Eyes closed, inhale deeply, picture your forehead and notice any stress or pain.
  • Exhale and imagine the pain floating away with your exhale.
  • Inhale, picture your eyebrows and notice any stress or pain. Exhale and release it, imagining the stress floating away.
  • Repeat for your eyes, ears, jaw, throat, back of neck, shoulders … down to your toes. Breathe in relaxation, breathe out stress and pain.

Notice how you feel after you get to your toes!

  • Visualize or imagine yourself in a warm, secure, relaxing, happy, peaceful place; floating on a cloud, floating in the water, or recalling a happy memory.
    • Continue slow deep breathing.
  • Focus on a picture or artwork that you like, noticing each detail.
    • Continue slow deep breathing.
  • Listen to music, any music that is soothing to you. Nature sounds or instrumental music is a good place to start experimenting.
    • Continue slow deep breathing.
  • Use aromatherapy – any scent that smells good to you. Favorite scents are often from childhood memories!
    • Continue slow deep breathing.

Strive to let go of that never-ending tape of worries and “shoulds” that plays in your head. Focus on your senses – your breath, the music, a relaxing place, a comforting aroma. If thoughts drift in, gently push them away. It gets easier with practice, you’ll find what works best for you and you’ll be amazed at how much it helps you!

Excerpted from Lost & Found: A Survivor’s Guide for Reconstructing Life After a Brain Injury by Barbara J. Webster. © 20ll by Lash & Associates Publishing/Training Inc. Used with permission. Click here for more information about the book.

Related Content

Source: Lost & Found: Caps, Sunglasses, and Earplugs

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[WEB SITE] 7 signs of executive dysfunction after brain injury

 ‘Executive dysfunction‘ is not, perhaps, a particularly well known term, but the effects of brain injury that it covers are very common indeed. It is used to collectively describe impairment in the ‘executive functions’ – the key cognitive, emotional and behavioural skills that are used to navigate through life, especially when undertaking activities and interacting with others.

Although executive dysfunction is a common problem among many brain injury survivors, it is most commonly experienced following an injury to the frontal lobe.

The importance of executive functions is shown by the difficulties caused when they don’t work properly and someone has problems with executive dysfunction. Since the executive functions are involved in even the most routine activities, frontal injuries leading to executive dysfunction can lead to problems in many aspects of life.

Here we list the most common effects of executive dysfunction, with some examples of common issues that brain injury survivors can face:

Difficulties with motivation and organisation

  • Loss of ‘get up and go’, which can be mistaken for laziness
  • Problems with thinking ahead and carrying out the sequence of steps needed to complete a task

Rigid thinking

  • Difficulty in evaluating the result of actions and reduced ability to change behaviour or switch between tasks if needed

Poor problem solving

  • Finding it hard to anticipate consequences
  • Decreased ability to make accurate judgements or find solutions if things are going wrong

Impulsivity

  • Acting too quickly and impulsively without fully thinking through the consequences, for example, spending more money than can be afforded

Mood disturbances

  • Difficulty in controlling emotions which may lead to outbursts of emotion such as anger or crying
  • Rapid mood changes may occur, for example, switching from happiness to sadness for no apparent reason

Difficulties in social situations

  • Reduced ability to engage in social interactions
  • Finding it hard to initiate, participate in, or pay attention to conversations
  • Poor judgement in social situations, which may lead to saying or doing inappropriate things

Memory/attention problems

  • Finding it harder to concentrate
  • Difficulty with learning new information
  • Decreased memory for past or current events, which may lead to disorientation

Find out more

If you or someone you care for is affected by executive dysfunction, it is important to seek support. Speak to your doctor about your symptoms, and ask about referral to specialist services such as counselling, neuropsychology and rehabilitation.

You can find out more and get tips and strategies to help manage your condition on our executive dysfunction after brain injury page.

Headway groups and branches can offer support in your area, and you can contact our helpline if you would like to talk things through.

Source: 7 signs of executive dysfunction after brain injury | Headway

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[ARTICLE] Effect of Whole Brain Radiation Therapy on Cognitive Function – Full Text

Brain metastases (BM) are common and can be detrimental in patients with primary cancers. Lung cancer accounts for over 40% of BM cases and breast cancer is responsible for 10% to 20% of BM. Typically, patients present with oligometastatic disease—1 to 3 intracranial metastases. Stereotactic radiosurgery (SRS) is often used to good effect in treating these tumors. To investigate intracranial tumor progression control, researchers have conducted randomized clinical trials (RCTs) in which whole brain radiotherapy (WBRT) was added to the clinical regimen following SRS. RCTs demonstrated that WBRT did in fact show improvement in intracranial tumor control; however, WBRT does not confer a survival advantage. In fact, previous RCTs have suggested that WBRT may cause deterioration of cognitive function and quality of life (QOL).13

Brown et al1 conducted the largest, multi-institutional study utilizing a plethora of cognitive and QOL assessments to determine the effects of WBRT. They enrolled 213 randomized participants with 1 to 3 BM at 34 participating institutions. One group underwent SRS alone and the second group had SRS plus WBRT that began within 14 days of SRS. The WBRT dose regimen was 30 Gy in 12 fractions and the SRS dose was 18 to 22 Gy in the SRS plus WBRT group, and 20 to 24 Gy in SRS alone. Baseline evaluations were made starting at week 6 and subsequently at months 3, 6, 9, and eventually, at month 60. QOL was assessed using the Functional Assessment of Cancer Therapy-Brain. Scores ranged between 0 and 200 where higher scores signified better QOL. The Barthel Index of Activities of Daily Living (ADL Index) was used to determine functional independence where a score of 100 indicated complete independence and a lower score demonstrated the need for supervision and assistance. Seven other assessments were used to evaluate immediate memory, fine motor control, delayed memory, and other cognitive abilities. The primary endpoint was deemed to be cognitive deterioration at 3 months after SRS defined as a decline in any of the cognitive tests. Secondary endpoints included time to intracranial failure, overall survival, QOL, as well as other parameters.

Brown et al1 showed that there was significantly more cognitive deterioration at the 3-month evaluation mark in the SRS plus WBRT group. Additionally, this group showed to have decline in immediate memory, delayed memory, and verbal fluency when compared to the SRS alone group. The SRS alone group demonstrated a significantly better QOL and functional well-being; however, time to intracranial tumor progression was significantly shorter for SRS alone vs SRS plus WBRT. Intracranial tumor control rates at 3 months were higher (93.7%) in SRS plus WBRT vs (75.3%) SRS alone. The 6- and 12-month control rates were also significantly higher in SRS plus WBRT vs SRS alone (32.4% vs 7.8%, respectively). For long-term survivors—defined as evaluable patients who survived past 12 months—the intracranial tumor control rate at 12 months in SRS plus WBRT vs SRS alone was 89.5% vs 20.0%, respectively. Cognitive deterioration, however, occurred more often in the SRS plus WBRT group. Decline in intermediate memory was most pronounced at 3 months; deterioration in fine motor control was most pronounced at 6 months.

The study by Brown et al1 gives some insight into the controversial issue of WBRT. Although the SRS plus WBRT group had a higher intracranial tumor control rate, patients experienced significant cognitive decline and no improvement in survival occurred. Chang et al2 (Figure) conducted a randomized controlled trial similar to Brown et al,1 where the study was forced to be halted due to the high probability (96%) that patients randomly assigned to receive SRS plus WBRT (n = 28), vs patients in the SRS alone group (n = 30), were likely to show a significant decline in learning and memory function at 4 months. Aoyama et al3 on the other hand believes that WBRT should be considered for patients’ BMs from nonsmall-cell lung cancer and has a favorable prognosis. Studies have been done to avoid the hippocampal neural stem-cell area during WBRT to preserve memory and cognitive functions. Gondi et al4 demonstrated that the mean relative decline in the Hopkins Verbal Learning Test–Revised Delayed Recall at 4 months was significantly lower when avoiding the hippocampal compartment, but QOL did not change.

Figure. A, Actuarial time to death (all causes). SRS: stereotactic radiosurgery; WBRT: whole brain radiotherapy. B, Actuarial freedom from local tumor progression. SRS: stereotactic radiosurgery; WBRT: whole brain radiotherapy. Reprinted from Lancet Oncology,2 Copyright (2009), with permission from Elsevier.

Figure. A, Actuarial time to death (all causes). SRS: stereotactic radiosurgery; WBRT: whole brain radiotherapy. B, Actuarial freedom from local tumor progression. SRS: stereotactic radiosurgery; WBRT: whole brain radiotherapy. Reprinted from Lancet Oncology,2 Copyright (2009), with permission from Elsevier.

The study by Brown et al1 lends more emphasis to the necessity to balance the need for tumor control and potential cognitive decline when deciding to administer WBRT. New, promising research in radiosensitizer drugs may allow for lower doses of radiation to normal brain while improving tumor control.5 Refinements in neuroimaging and increasing use of SRS in treating multiple metastases may offer benefit as well.6 Indeed, in patients with cancer, cognitive dysfunction can greatly lower patients’ abilities to carry out basic activities of daily living, increase strain on families and other support systems, and decrease eligibility in potentially effective clinical trials. These various treatment strategies should be carefully evaluated when considering SRS plus WBRT.

Julia R. Schneider, BS

Shamik Chakraborty, MD

John A. Boockvar, MD

Department of Neurosurgery Lenox Hill Hospital and Hofstra Northwell School of Medicine New York, New York

Source: Science Times | Neurosurgery | Oxford Academic

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[Abstract] Incorporating a Cognitive Strategy Approach into an Outpatient Stroke Physiotherapy Programme: Case Report

Purpose: Cognitive Orientation to daily Occupational Performance (CO-OP) has demonstrated an effect on skill performance, compared with the usual outpatient rehabilitation, in people living with stroke when implemented by occupational therapists. This study explored refining CO-OP for delivery by both occupational therapists and physiotherapists.

Method: Two cases were recruited and treated using the CO-OP approach, which augments task-specific training with cognitive strategies and guided discovery. Case 1 was a 79-year-old woman, 31 days after parietal stroke, and Case 2 was a 45-year-old man, 62 days after bilateral brain stem stroke. Case 1 withdrew from the study for medical reasons. Outcome measures applied were the Canadian Occupational Performance Measure, the Stroke Impact Scale (SIS), the Self-Efficacy Gauge, the Berg Balance Scale, the Box and Block Test, and the 2-minute walk test.

Results: After 10 sessions, Case 2 made gains in most measures, including a 22-point gain in the SIS mobility domain.

Conclusion:The therapists reported that the combined delivery required additional communication with the patients but was feasible. Case 2 reported physical and mobility gains larger than the mean changes seen in past CO-OP research. Although these results cannot be generalized, findings suggest that the inter-professional application of CO-OP warrants further investigation.

Source: Incorporating a Cognitive Strategy Approach into an Outpatient Stroke Physiotherapy Programme: Case Report: Physiotherapy Canada: Vol 0, No 0

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[WEB SITE] Cognitive Behavioral Therapy Benefits & Techniques

In today’s society, doctors and psychiatrists are quick to prescribe psychotropic drugs that often come with dangerous side effects for any disorder that stems from thought patterns. But what if I told you there was a better, safer way to manage and treat stress and brain disorders? Enter cognitive behavioral therapy.

According to the National Association of Cognitive Behavioral Therapists, cognitive behavioral therapy (often just called CBT) is a popular form of psychotherapy that emphasizes the importance of underlying thoughts in determining how we feel and act. Considered to be one of the most successful forms of psychotherapy to come around in decades, cognitive behavioral therapy has become the focus of hundreds of research studies. (1)

CBT therapists work with patients to help them uncover, investigate and change their own thought patterns and reactions, since these are really what cause our perceptions and determine our behaviors. Using CBT therapists offers patients valuable perspective, which helps improve their quality of life and manage stress better than patients simply “problem-solving” tough situations on their own.

Something that might surprise you about CBT: A core principle is that external situations, interactions with other people and negative events are not responsible for our poor moods and problem in most cases. Instead, CBT therapists actually view the opposite as being true. It’s, in fact, our own reactions to events, the things we tell ourselves about the events — which are within our control — that wind up affecting our quality of life.

This is  great news — because it means we have the power to change. Through cognitive behavioral therapy, we can learn to change the way we think, which changes the way we feel, which in turn changes the way we view and handle tough situations when they arise. We can become better at intercepting disruptive thoughts that make us anxious, isolated, depressed, prone to emotionally eating and unwilling to change negative habits.

When we can accurately and calmly look at situations without distorting reality or adding additional judgments or fears, we’re better able to know how to react appropriately in a way that makes us feel happiest in the long run.


Proven Benefits of Cognitive Behavioral Therapy

A 2012 meta-analysis published in the Journal of Cognitive Therapy and Researchidentified 269 studies that supported the use of CBT for the following problems: (2)

  • substance abuse disorders
  • schizophrenia and other psychotic disorders
  • depression and dysthymia
  • manic depression/bipolar disorder
  • anxiety disorders
  • somatoform disorders
  • eating disorders
  • sleep disorders, including insomnia
  • personality disorders
  • anger and aggression
  • criminal behaviors
  • general stress and distress due to general medical conditions
  • chronic fatigue syndrome
  • muscle pains and tension
  • pregnancy complications and female hormonal conditions

Researchers found the strongest support for CBT in treating anxiety disorders, somatoform disorders, bulimia, anger control problems and general stress. After reviewing 11 review studies comparing improvement rates between CBT and other therapy treatments, they found that CBT showed higher response rates than the comparison treatments in seven of the 11 reviews (more than 60 percent). Only one of 11 reviews reported that CBT had lower response rates than comparison treatments, leading researchers to believe that CBT is one of the most effective therapy treatments there is.

Here are some of the major ways cognitive behavioral therapy benefits patients from different walks of life:

1. Lowers Symptoms of Depression

Cognitive behavioral therapy is one of the best-known, empirically supported treatments for depression. Studies show that CBT helps patients overcome symptoms of depression like hopelessness, anger and low motivation, and lowers their risk for relapses in the future.

CBT is believed to work so well for relieving depression because it produces changes in cognition (thoughts) that fuel vicious cycles of negative feelings and rumination. Research published in the journal Cognitive Behavioral Therapy for Mood Disordersfound that CBT is so protective against acute episodes of depression that it can be used along with, or in place of, antidepressant medications. CBT has also shown promise as an approach for helping handle postpartum depression and as an adjunct to medication treatment for bipolar patients. (3)

2. Reduces Anxiety

According to work published in Dialogues in Clinical Neuroscience, there’s strong evidence regarding CBT treatment for anxiety-related disorders, including panic disorders, generalized anxiety disorder, social anxiety disorder, obsessive compulsive disorder and post-traumatic stress disorder. Overall, CBT demonstrates both efficacy in randomized controlled trials and effectiveness in naturalistic settings between patients with anxiety and therapists. (4)

Researchers have found that CBT works well as a natural remedy for anxiety because it includes various combinations of the following techniques: psycho-education about the nature of fear and anxiety, self-monitoring of symptoms, somatic exercises, cognitive restructuring (for example disconfirmation), image and in vivo exposure to feared stimuli (exposure therapy), weaning from ineffective safety signals, and relapse prevention.

3. Helps Treat Eating Disorders

The Journal of Psychiatric Clinics of North America reports that eating disorders provide one of the strongest indications for cognitive behavioral therapy. CBT has been found to help address the underlying psychopathology of eating disorders and question the over-evaluation of shape and weight. It can also interfere with the maintenance of unhealthy body weights, improve impulse control to help stop binge eating or purging, reduce feelings of isolation, and help patients become more comfortable around “trigger foods” or situations using exposure therapy. (5)

Cognitive therapy has become the treatment of choice for treating bulimia nervosa and “eating disorders not otherwise specified” (EDNOS), the two most common eating disorder diagnoses. There’s also evidence that it can be helpful in treating around 60 percent of patients with anorexia, considered to be one of the hardest mental illnesses to treat and prevent from returning.

4. Reduces Addictive Behaviors and Substance Abuse

Research has shown that CBT is effective for helping treat cannabis and other drug dependencies, such as opioid and alcohol dependence, plus helping people quit smoking cigarettes and gambling. Studies published in the Oxford Journal of Public Health involving treatments for smoking cessation have found that coping skills learned during CBT sessions were highly effective in reducing relapses in nicotine quitters and seem to be superior to other therapeutic approaches. (6) There’s also stronger support for CBT’s behavioral approaches (helping to stop impulses) in the treatment of problematic gambling addictions compared to control treatments. (7)

5. Helps Improve Self-Esteem and Confidence

Even if you don’t suffer from any serious mental problems at all, CBT can help you replace destructive, negative thoughts that lead to low self-esteem with positive affirmations and expectations. This can help open new ways to handle stress, improve relationships and increase motivation to try new things. The Psychology Tools website provides great resources for using CBT worksheets on your own to work on developing affirmative communication skills, healthy relationships and helpful stress-reducing techniques. (8)

Facts About Cognitive Behavioral Therapy

  • CBT was originally created to help people suffering from depression, but today it’s used to improve and manage various types of mental disorders and symptoms, including: anxiety, bipolar disorder, post-traumatic stress disorder, obsessive compulsive disorder, addictions and eating disorders. (9)
  • CBT techniques are also beneficial for just about everyone else, including people with no form of mental illness but who have chronic stress, poor moods and habits they’d like to work on.
  • The term cognitive behavioral therapy is considered a general term for a classification of therapeutic approaches that have similarities, including: rational emotive behavior therapy, rational behavior therapy, rational living therapy, cognitive therapy and dialectical behavior therapy.
  • To date, more than 332 medical studies and 16 quantitative reviews have examined the effects of CBT. Interestingly, more than 80 percent of these studies were conducted after 2004. (10)
  • Studies have found that in people who have completed CBT programs and then undergone brain scans, CBT is actually capable of positively changing physical structures in the brain. (11)
  • CBT can work quickly, helping patients feel better and experience lessened symptoms within a short period of time (several months, for example). While many forms of therapy can take many months or even years to become very helpful, the average number of CBT sessions clients receive is only 16.
  • CBT often involves the patient completing “homework” assignments on their own between therapy sessions, which is one of the reasons benefits can be experienced so quickly.
  • In addition to homework being done by the patients while they’re alone, cognitive behavioral therapists also use instructions, questioning and “exposure therapy” during sessions. CBT is very interactive and collaborative. The therapist’s role is to listen, teach and encourage, while the patient’s role is to be open and expressive.
  • One of the biggest advantages for patients is that CBT can be continued even after formal sessions with a therapist are over. Eventually, formal therapy ends, but at this point the clients can continue to work on exploring CBT concepts, using techniques they’ve learned, journaling and reading to help prolong benefits and manage symptoms.

How Cognitive Behavior Therapy Works

CBT works by pinpointing thoughts that continuously rise up, using them as signals for positive action and replacing them with healthier, more empowering alternatives.

The heart of CBT is learning self-coping skills, giving patients the ability to manage their own reactions/responses to situations more skillfully, change the thoughts they tell themselves, and practice “rational self-counseling.” While it definitely helps for the CBT therapist/counselor and patient to build trust and have a good relationship, the power really lies in the patient’s hands. How willing a patient is to explore his or her own thoughts, stay open-minded, complete homework assignments and practice patience during the CBT process all determine how beneficial CBT will be for them.

Some of the characteristics that make cognitive behavioral therapy unique and effective include:

  • Rational approach: CBT theory and techniques are based on rational thinking, meaning they aim to identify and use facts. The “inductive method” of CBT encourages patients to examine their own perceptions and beliefs to see if they are in fact realistic. In CBT, there is an underlying assumption that most emotional and behavioral reactions are learned. Many times with a CBT therapists’s help, patients learn that their long-held assumptions and hypotheses are at least partially incorrect, which causes them unnecessary worrying and suffering. (12)
  • Law of entropy and impermanence: CBT rests on scientific assumptions, including the law of entropy, which is essentially the fact that “if you don’t use it, you lose it.” We always have the power to change how we feel because our feelings are rooted in our brains’ chemical interactions, which are constantly evolving. If we break cycles of thought patterns, our brains will adjust for the better. MRI scans show the human brain creates and sustains neural synapses (connections) between frequent thoughts and emotions, so if you practice positive thinking your brain will actually make it easier to feel happier in the future.
  • Accepting unpleasant or painful emotions: Many CBT therapists can help patients learn how to stay calm and clear-headed even when they’re faced with undesirable situations. Learning to accept difficult thoughts or emotions as being “simply part of life” is important, because this can help stop a vicious cycle from forming. Often we get upset about our tough feelings and add on even more suffering. Instead of adding self-blame, anger, frustration, sadness or disappointment to already-tough feelings, CBT teaches patients to calmly accept a problem without judgment in order to not make it even worse.
  • Questioning and expressing: Cognitive behavioral therapists usually ask patients many questions in order to help them gain a new perspective, see the situation more clearly and realistically, and help them undercover how they really feel.
  • Specific agendas and techniques: CBT is usually done in a series of sessions that each have a specific goal, concept or technique to work with. Unlike some other forms of therapy, sessions are not simply for the therapist and patient to talk openly without an agenda in mind. CBT therapists teach their clients how to better handle difficult thoughts and feelings by practicing specific techniques during sessions that can later be applied to life when they’re most needed.

Cognitive Behavioral Therapy vs. Other Types of Psychotherapy 

CBT is a type of psychotherapy, which means it involves open talking between patient and therapist. You might have heard of several other forms of psychotherapy in the past and are wondering what makes CBT stand apart. Many times there is some overlap between different forms of psychotherapy. A therapist might use techniques from various psychotherapy approaches to help patients best reach their goals and improve (for example, to help someone with a phobia, CBT might be coupled with exposure therapy).

According to the National Alliance on Mental Illness, here is how CBT differs from other popular forms of therapy: (13)

  • CBT vs. Dialectical Behavior Therapy (DBT): DBT and CBT are probably the most similar therapeutic approaches, however DBT relies more heavily on validation or accepting uncomfortable thoughts, feelings and behaviors. DBT therapists help patients find balance between acceptance and change by using tools like mindfulness guided meditation.
  • CBT vs. Exposure Therapy: Exposure therapy is a type of cognitive behavioral therapy that’s often used to help treat eating disorders, phobias and obsessive-compulsive disorder. It teaches patients to practice using calming techniques and small series of “exposures” to triggers (things that are most feared) in order to become less anxious about the outcome.
  • CBT vs. Interpersonal Therapy: Interpersonal therapy focuses on the relationships a patient has with his or her family, friends, co-workers, media and community to help evaluate social interactions and recognize negative patterns (such as isolation, blame, jealousy or aggression). CBT can be used with interpersonal therapy to help reveal underlying beliefs and thoughts driving negative behavior toward others.

Ways to Practice Cognitive Behavioral Therapy Techniques on Your Own

  • Identify your current obstacles: The first step is to identify what’s really causing you stress, unhappiness and unease. Maybe you’re feeling resentful toward someone, fearful of failure or worried about being rejected socially in some way. You might find that you have persistent anxiety, symptoms of depression or are struggling to forgive someone for a past event. Once you can recognize this and become more aware of your primary obstacle, then you have the power to start work on overcoming it.
  • Try “thought recording”: You can use a journal or even record your own voice on a tape recorder to help you identify recurring destructive thoughts you frequently tell yourself. Ask yourself questions to dig deeper and form connections you weren’t previously aware of. Then reread your entries as if you were not yourself, but a good friend. What advice would you give yourself? What beliefs of yours can you notice aren’t very accurate, only making matters worse and not overall helpful?
  • Form patterns and recognize your triggers: Think about what types of situations make you most likely to feel anxious, upset, critical or sad. Start to form patterns of behaving in certain ways or experiencing certain things (for example, maybe drinking too much alcohol or gossiping behind someone’s back) and how they leave you feeling, so you can start breaking the cycle.
  • Notice how things are always changing: Feelings come and go constantly (called impermanence), so knowing that fear, anger or other strongly unplesant emotions are only temporary can help you stay calm in the moment.
  • “Put yourself in their shoes”: It’s important to try and view situations as rationally, clearly and realistically as possible. It helps to consider other people’s perspectives, question your assumptions, and see if there’s something important you might be missing or ignoring.
  • Thank yourself and be patient: Even though CBT works quickly for many people, it’s an ongoing process that’s essentially lifelong. There’s always ways to improve, feel happier, and treat others and yourself better, so practice being patient. Remind yourself there is no finish line. Give yourself credit for putting effort into facing your problems directly, and try to view “slip-ups” as inevitable parts of the journey and learning process.

Final Thoughts on Cognitive Behavioral Therapy

  • CBT techniques are also beneficial for just about everyone else, including people with no form of mental illness but who have chronic stress, poor moods and habits they’d like to work on.
  • Some of the major ways cognitive behavioral therapy benefits patients from different walks of life includes lowering symptoms of depressions, reducing anxiety, treating eating disorders, reduces addictive behaviors and substance abuse, and helps improve self-esteem and confidence.
  • You can practice cognitive behavioral therapy by identifying your current obstacles, trying thought recording, forming patterns and recognizing your triggers, noticing how things are always changing, putting yourself in others’ shoes, and thanking yourself and being patient.

Source: Cognitive Behavioral Therapy Benefits & Techniques – Dr. Axe

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[WEB SITE] ‘CBT is a scam and a waste of money’, says leading psychologist | Daily Mail Online

‘CBT is a scam and a waste of money’: Popular talking therapy is not a long-term solution, says leading psychologist

 

  • Cognitive Behavioural Therapy (CBT) is the most popular talking therapy
  • Oliver James argues research shows it does not have a lasting benefit
  • After 5 to 20 sessions those with anxiety or depression appear to recover
  • 2 years later they are no different to those who had no treatment, he said
  • Says proponents have mis-sold CBT to the Government and policymakers  
  • He is calling on the Government to fund other types of treatment
  • Psychodynamic therapy focuses on root cause of problems, he said
Leading psychologist Oliver James say 'extensive evidence' shows that CBT is a quick fix with no lasting benefits 

Leading psychologist Oliver James say ‘extensive evidence’ shows that CBT is a quick fix with no lasting benefits.  

People with mental health problems are victims of  a ‘scam’ therapy that is wasting vast sums of money, a leading psychologist has warned.

They are being misled because the short-term fix offered by Cognitive Behavioural Therapy (CBT) does not have a lasting benefit, says Oliver James.

The most popular of the ‘talking therapies’ CBT aims to help people manage their problems by changing the way they think and behave to become more positive.

It is frequently recommended for people with problems ranging from anxiety and depression to eating disorders.

In the short-term, 40 per cent of those who complete a course of CBT, typically five to 20 sessions of up to an hour, are said to have recovered.

But ‘extensive evidence’ shows that two years on, depressed or anxious people who had CBT were no more likely to have recovered than those who had no treatment, said Mr James.

He said: ‘As a treatment, rafts of studies have shown it to be ineffective in delivering long-term therapeutic benefits to patients with anxiety and depression.

‘While studies show that in the short-term – six to 12 months – patients who have received CBT are more likely to report themselves as ‘recovered’ compared to those who have received no treatment, these results are not sustained in the long-term.

‘CBT is largely ineffective for the majority of patients. It is in essence a form of mental hygiene.

‘However filthy the kitchen floor of your mind, CBT soon covers it with a thin veneer of ‘positive polish’.

‘Unfortunately, shiny services tend not to last. CBT fails to address the root cause of many people’s problems, which often stem from traumatic experiences during their childhood.

The UK Government has pledged up to £400 million on treatment programmes which mostly use CBT and it is recommended as frontline NHS treatment for many mental health issues.

Mr James, a chartered psychologist, author and broadcaster, delivered his argument to the CBT industry at the Limbus Critical Psychotherapy Conference in Devon this weekend.

WHAT IS CBT?

  • CBT, or Cognitive Behaviour Therapy, is a talking therapy.
  • It has been proved to help treat a wide range of emotional and physical health conditions in adults, young people and children.
  • CBT looks at how a person thinks about a situation and how this affects the way they act.
  • In turn actions can affect how a person thinks and feels.
  • The therapist and client work together in changing the client’s behaviours, or their thinking patterns, or both of these.

He and other psychotherapists are calling on the Government and policymakers to refocus funding into alternative talking treatments, such as psychodynamic therapy, which focus on addressing the root cause of people’s cognitive problems.

The NHS has been advised that CBT may be offered to patients with a range of conditions by the National Institute for Health and Clinical Excellence (NICE), the guideline body.

It is free on the NHS after referral by a GP but not available in all areas and there can be long waiting lists.

The cost of private therapy sessions varies, but it is usually £40 – £100 a session.

Many mental health groups welcome the shift in emphasis in recent years away from medication towards personalised therapy.

But Mr James says research shows CBT is no more effective than placebo in treating anxiety or depression

He says proponents have ‘mis-sold’ the treatment to policymakers and the public, who are wasting their time.

Mr James says CBT has been mis-sold to policymakers because it is cheap. He is campaigning for  treatments such as psychodynamic therapy - which focus  on addressing the root cause of people’s problems - to be made available instead

Mr James says CBT has been mis-sold to policymakers because it is cheap. He is campaigning for treatments such as psychodynamic therapy – which focus on addressing the root cause of people’s problems – to be made available instead

‘CBT appeals to politicians and NICE because it is quick and cheap.

‘The therapies proven to work long-term, such as psychodynamic therapy, would not be so cheap because they require more sessions’ he said.

But, he added: ‘Working as a psychotherapist, I rarely encounter patients who haven’t been subjected to CBT, which failed to help them.’

The British Association for Behavioural & Cognitive Psychotherapies was unavailable for comment.

 

Source: ‘CBT is a scam and a waste of money’, says leading psychologist | Daily Mail Online

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