Cognitive Therapy in Poland

Article excerpt

Until recently, cognitive therapy's (CT) presence in Poland was limited to information gleaned from the professional literature as well as in theoretical lectures at major universities. Such noted texts as Beck's Cognitive Therapy of Depression (1979), as well as several casebooks produced by Dattilio and Freeman (1994) and Freeman and Dattilio (1992) have been the most influential in educating mental health professionals about cognitive therapy in Poland. In fact, one of the first books to be translated into Polish is Dattlio and Padesky's (1990) popular text Cognitive therapy with Couples. Aside from this, only a few articles and book chapters have appeared in the Polish literature in depression and anxiety. It is anticipated that, with time, other major works will be translated as CT becomes more popular.

Cognitive therapy first became known in Poland at the latter part of the 1980s when several articles appeared in the Polish literature. Prior to this introduction, the predominant modalities were mainly psychodynamic, systemic and humanistic approaches. Of course, the psychobiological model dominated psychiatry and for the most part still does. Cognitive therapy only appears to maintain its popularity among the younger generation of mental health professionals.

The cognitive therapy center in Kracow is the most popular center for CT in Poland. In 1994, we hosted Melanie Fennell and Jan Scott for a workshop which was very instructive. We have also invited Frank Dattilio to conduct training for our group in the upcoming year. One of his articles on anxiety has also been recently published in Polish and will appear in the Journal Psychiatria Polska.

In some mental health centers throughout Poland attempts have been made to combine certain therapeutic techniques in the management of patients with depression and anxiety. Most recently, these techniques have included cognitive and behavioral strategies combined with pharmacotherapy.

For the past 5 years we in the Department of Psychiatry at Jagiellonian University School of Medicine in Kracow have been using a combined model of treatment for severe depression, in which cognitive psychotherapy plays a central role. From our experience we have learned that several weeks of pharmacotherapy alone serve only to reduce the vegetative symptoms of depression. This remediation of symptoms, however, does not constitute a full or permanent recovery. Patients frequently withdraw from their families and their occupational and social life, and generally relapse once their medication is titrated or eliminated. Even while on medication, they still suffer from relapses, and present a dysfunctional style of thinking with low self-esteem and feelings of hopelessness (Jawor, Dudek, & Zieba, 1996; Zieba, Dudek, & Jawor, 1996). Consequently, a pure biological approach appears unsatisfactory and inadequate as a sole modality of treatment. In our institution we have made an attempt to combine pharmacological treatment with cognitive therapy in order to modify changes in the patients' style of thinking. The following is a description of our program which illustrates how cognitive therapy has been integrated into our general treatment modality.

Patients age 20 to 55, who meet the diagnostic criteria for unipolar endogenous depression (Spitzer, Endicott, & Robins, 1978) and require psychiatric hospitalization are selected for participation in the program.

Depressed subjects with medical disorders, organic brain syndrome, schizophrenia, drug or alcohol dependence or other psychiatric disorders are excluded from the program during the intake process.

Patients are randomly assigned into two groups- a study group (SG) and a control group (CG). All patients are administered antidepressant medication, and if necessary, neuroleptics or benzodiazopines. These compounds are used in combination with supportive psychotherapy in the control group. The study group, apart from conventional treatment, involves a strong component of cognitive therapy. …