Patient, Fix Thyself: No Pills, No Shrink's Sofa, No Whining. Cognitive Behavioral Therapy Sheds Long-Winded Wallowing in Past Pain-And May Be Better Than Prozac-After Only 25 Sessions
Langreth, Robert, The Saturday Evening Post
Kerrin Gerson survived a traumatic and turbulent childhood growing up in the Deep South in the 1980s. Her mother died of breast cancer when Kerrin was 15; her relationship with her father disintegrated when he remarried soon after. She left home and spent her last two years of high school living out of her car or crashing with friends. "One moment I had a loving mother, and the next moment I had nothing. Absolutely nothing," she says.
She married at 26, divorced two years later, in 1996, and fell into even deeper depression. Antidepressants did little to ease her symptoms; Paxil made her anxiety worse. She had suicidal thoughts. "I was convinced I was worthless, unlovable and a fraud," says Gerson, now 39.
Today Gerson is off medication, out of therapy, and happier than she has ever been. She owes her rebound to a startling revolution in psychological counseling that has taken four decades to unfold--and which now is spreading to the farthest reaches of American medicine. She fixed herself with cognitive-behavioral therapy.
Gerson turned to CBT in 1997 after spotting an ad for a patient trial in a Nashville, Tennessee, newspaper. She was surprised when her therapist, Vanderbilt University psychologist Steven Hollon, didn't bother to dwell on her troubled childhood. Instead, he focused on fixing the present. He made her write a log of daily activities and gave her homework assignments, such as a night out with friends. He zeroed in on her negative thoughts about herself and slowly convinced her that they were distortions.
"It turned out to be the greatest gift," says Gerson, a first-grade teacher who has just opened a yoga studio with a friend. CBT, she says, "saved my life and gave me an entirely new worldview."
And that is the essence of CBT: Depression, anxiety and other ills aren't the cause of a cascade of debilitating thoughts and self-loathing--they are, instead, a result of the same. Eliminate bad thoughts and you can short-circuit bad feelings. CBT drops the endless search for past hurts, teaches patients how to prevent negative thoughts from creeping into their minds, and coaches them on how to cope. "We are starting to believe that what you think has a powerful influence on symptoms," says Harvard psychiatrist Arthur Barsky, who has tested CBT. "You first get the anxiety-producing ideas, and then you get the emotions." Boston University psychologist Michael Otto adds: "Now there is an alternative to being on the couch."
Moreover, CBT intentionally is finite in duration. It aims to push patients out of the shrink's office after only 10 to 25 visits, in sharp contrast to traditional psychotherapy that can run on for many years. (Some CBT patients need more.) That makes CBT particularly popular among employee health plans and insurers intent on reducing the costs of psychotherapy. "Woody Allen therapy is forever," says Hollon, Kerrin Gerson's shrink. "This is about taking action."
In dozens of small patient trials staged over three decades, cognitive behavioral therapy has been shown to be surprisingly effective in quelling an ever-expanding array of mental maladies: depression, anxiety, panic attacks, obsessive-compulsive disorder, post-traumatic stress syndrome, bulimia, hypochondria--even insomnia. Now almost 150 clinical trials are under way to learn whether CBT also can help patients with Tourette's syndrome, gambling addiction, obesity, irritable bowel syndrome and more; one trial studies the therapy in children who have been sexually abused.
The rise of cognitive therapy rankles psychotherapists and psychiatrists who ply the retrospective analysis and soulful conversation, whose origins date back to Sigmund Freud and the 1890s. CBT is "a simplistic method of treatment," it is "being oversold," and it appeals to health plans simply because it ends so quickly, says Charles Brenner, a psychoanalyst in New York and past president of the American Psychoanalytic Association. …