Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy focuses on identifying the relational patterns between our behaviors, thoughts and feelings that lead to psychological difficulties and to disfunctional interpersonal interactions. Often these patterns are rooted in a distorted interpretation of reality: Therapy aims at replacing negative perceptions with more positive and more realistic thoughts.
Schema Therapy
Besides Cognitive Behavioral Therapy (CBT), I practice Schema Therapy which has given very positive results in the treatment of many psychological and emotional difficulties.
Schema Therapy Premise
Schema Therapy is based on the premise that there are different aspects of ourselves which make us feel and behave differently in different situations. One of the main sources of psychological difficulties arise then from conflicts between these different parts of ourselves. For example, we might feel angry when we think others do not give us the respect and the space we feel to deserve. On the other hand, we might feel guilty when we think we might have dominated too much a conversation.
Cognitive Behavioral Therapy (CBT) vs. Schema Therapy
Sharing some common grounds with Cognitive Behavioral Therapy, Schema Therapy places greater emphasis on problematic emotions, childhood issues and therapeutic relationship.
Depression
Although it may happen to everyone to feel sad and downhearted from time to time, these feelings do not necessarily point to depression. Clinical depression is characterized by a consistent and profound feeling of pessimism and despair towards oneself, own life and the surrounding reality. The hope that the future may bring improvements disappears, and the individual loses all interest and ability to make sense of own life. The feeling of being useless and at the same time responsible for any failure can exacerbate in self-hate, eventually triggering thoughts of death in the mind of the suffering person.
Clinical depression reflects a complex picture that is diagnosed on the basis on the presence of at least one of the following symptoms:
- Depressed mood (sadness, despair, crying, sense of emptiness) present for most of the day and almost every day
- Absence or significant decrease of interest in all or almost all the activities from which the individual had previously taken pleasure
- Tiredness, lack of energy and lack of motivation
In addition, at least 3 of the following symptoms must be present:
- Significant increase or decrease in appetite
- Insomnia or hypersomnia most days
- Psychomotor impairments or restlessness
- Chronic fatigue
- Lack of energy
- Reduced ability to concentrate and pay attention
- Inability or reduced ability to make decisions
- Recurring thoughts of death or suicide
Symptoms from both groups must be present for at least 15 days (Major Depressive Disorder).
The clinical picture changes if the symptoms last for at least two years (Dysthymia or Persistent Depressive Disorder)
Cognitive-Behavioral Therapy has proven useful to help the depressed individual to identify and fight the vicious circles on which the disease is based and at the same time to acquire more functional thought-patterns.
Anxiety
Anxiety is the normal reaction with which we respond to a concrete threat (e.g., if we find ourselves in a life-threatening situation) or figurative (e.g., if we feel we are not respected). In both circumstances, a normal physiological response can lead to an increase in the production of adrenaline (stress hormone), and a decrease in both the production of serotonin (well-being hormone) and GABA (inhibitory neurotransmitter). If present only in particularly difficult and short-lived conditions, these reactions help us to deal promptly with the specific circumstance.
Pathological anxiety is instead a persistent dysfunctional condition in which physiological responses are determined by neutral events (present or hypothesized) and interfere with our psychological wellbeing.
Common psycho-emotional symptoms:
Sense of fear towards specific events or objects
Sense of general fear (the individual cannot indicate a specific cause)
Restlessness
Hypervigilance
Fear of losing control
General and diffuse emotional tension
Irritability
Difficulty concentrating
Poor attention
Inadequate perception of reality
Common somatic symptoms:Neurovegetative symptoms
Breathing problems
Excessive sweating
Hyperpnea (accelerated breathing)
Dizziness
Poor salivation
Arrhythmia (irregular heart beat)
Diarrhea
Tremors
Disorders associated with pathological anxiety: OCD, PTSD, Phobias, Panic Attacks
Trauma
The experience of a particularly tragic or dramatic event can generate trauma. The main symptoms of this mental health disorder involve four emotional and behavioral aspects:
1) (Intrusion) Images experienced at the moment of the events surface during the day (flashbacks) or even during sleep (nightmares). The emotional reaction can be intense to the point of making the individual lose track of time and place: In a matter of seconds, we relive the traumatic events as if they were happening at the precise moment;
2) (Mood disturbances) Insomnia, poor concentration, restlessness, sadness but also detachment from others and from normal daily activities occur frequently and persistently;
3) (Reactivity) The victim of the trauma lives in a state of pervasive agitation and irritation which often leads to unjustified and exaggerated reactions (behavioral and/or emotional);
4) (Physical, emotional and cognitive avoidance) The traumatized person does everything to avoid places, people, environments and circumstances that can be linked to the dramatic events. Sometimes, the intent to avoid any association with the past can cause amnesia for specific details and scenes.
PTSD
Post-traumatic stress syndrome occurs when the psychological and emotional consequences of trauma last for more than 4 weeks (see Trauma)
Impulse control disorders – OCD, Panic attacks
OCD (Obsessive Compulsive Disorder) and panic attacks are disorders closely associated with anxiety disorders (see above).
Controlled studies have demonstrated the effectiveness of Cognitive behavioral therapy and Scheme Therapy which are currently considered the best methods for dealing with impulse control disorders.
Substance abuse – Alcoholism
Compared to group therapy (e.g. anonymous alcoholics) and to other approaches that require the completion of specific phases, controlled studies have demonstrated the greater effectiveness of cognitive-behavioral therapy in the treatment of substance addictions. The main premise of this method is that the abuse of substances represents a way for the individual to find relief from psychological difficulties and negative emotions. In this context, cognito-behavioral approaches (CBT and Schema Therapy) are excellent tools to identify the roots of the internal problems and to suggest healthier and more functional ways to meet them.
Feeding and Eating Disorders
Feeding and Eating disorders are complex pathologies that can emerge already in early childhood. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) currently recognizes 8 categories of feeding and eating disorders:
- Pica – Ingestion of non-nutritive substances (e.g., soap, paper, cloth) for a period of at least one month.
- Rumination disorder – The regurgitation of food (which is consequently chewed or spitted out) for a period of at least one month (the eventual presence of a physical condition such as gastroesophageal reflux does not constitute basis for the diagnosis of the rumination disorder).
- Avoidant/Restrictive food intake disorder – Characterized by dietary restrictions or refusal of food based on three reasons: a) Specific characteristics of the food (e.g. consistency, color); b) Little or no interest in food; c) Possible negative consequences of eating.
- Anorexia nervosa – One of the essential features of anorexia nervosa is the occurrence of dietary restrictions or refusal of food in order to reduce significantly the intake of calories relative to needs; Refusal of food leads to a body weight below the established norms with respect to age, sex, developmental stage and physical health; The disorder is also characterized by excessive influence of weight and/or body shape on self-esteem levels and by extreme fear of gaining weight.
- Bulimia nervosa – Characterized by the consumption of significant amounts of food in relatively short periods of time (i.e., binge eating), by compensatory behaviors following the episodes of binge eating (e.g., self-induced vomiting, use of laxatives and/or diuretics), and by excessive influence of weight and/or body shape on self-esteem levels; Both binge eating and compensatory behaviors must occur at least once a week for at least three months.
- Binge-eating disorder – Characterized by the occurrence (at least once per week for three months) of eating episodes during which the individual consumes quantities of food that are significantly larger than those most people would eat in the similar period of time under similar circumstances. The individual also demonstrates a clear preference to isolate during binges to avoid embarrassment, as well as the tendency to self-loathing after the binge episode. The presence of episodes of binge eating must occur at least once a week for at least three months.
- Other Specified Feeding or Eating Disorder, and Unspecified Feeding or Eating Disorder – These last two categories are adopted when the individual experiences significant distress or impairment in psychological, social, or occupational areas, but the full criteria for any of the other feeding and eating disorders are not met.
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Cognitive Behavioral Therapy is usually the first-line treatment for eating disorders. In my practice, I merge CBT underlining premises with Schema Therapy emphasis on behavioral patterns, emotional disturbances and coping mechanisms emerged in early childhood and developed through the years.
I can also support you when dealing with:
- Feelings of sadness, meaninglessness and emptiness
- Interpersonal difficulties
- How and why to set boundaries
- Frustrations and anger
- Low self-esteem
- Life crises