Cognitive Behavioral Therapy

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Essay written by Doug Berger, M.D., Ph.D., CBT Therapist in Tokyo Japan

CBT (Cognitive Behavioral Therapy) therapists in Tokyo at the Meguro Counseling Center are experienced in providing Cognitive Behavioral Therapy in Tokyo and Japan. CBT deals with changing one's dysfunctional cognitions (thoughts), emotions, and behavior. Identifying and correcting one's negative or distorted automatic thoughts is the key. These autonomatic thoughts occur rapidly while an individual is in the midst of a particular situation. The more the situation stresses the person's emotionally sensitive issues, the more they are likely to react with a distorted thought that will then affect their emotional state adversely. A brief list of these automatic thoughts includes: all-or-none thinking, magnification, personalization, selectively extracting the negative out of a situation, catastrophizing, minimizing, "should" statements, and labeling (self and/or others). Underlying (unconscious) cognitive schemas (e.g., "no one loves me") are thought to be at the crux of the propensity for development of cognitive distortions.

Patients with problems such as depression and anxiety, or interpersonal difficulties, have many negative and maladaptive automatic thoughts which can lead to behaviors (e.g., helplessness, withdrawal, aggression, or avoidance) that make the problem worse, resulting in more disturbed mood and leading to more dysfunctional thoughts, in other words a vicious cycle. Cognitive therapy attempts to help patients recognize and change these cognitive errors through discussion with the therapist, outlining and listing the situations and distortions in writing, and homework practice. Behavioral change may be necessary to modify long-standing maladaptive patterns of behavior that reinforce the distortions.

Cognitive therapy may be very useful as an adjunct to help patients see how their thoughts make thier mood bad or worse. It doesn't say anything about the causes of the distortions or the underlying schemas, however, or how they pan-out in interactions with others. Psychodynamic psychotherapy is usually required for a deeper understanding of oneself as it deals more with the unconscious concomitants of one's emotional life and how these impinge on relationships.

Some studies have shown that antidepressant medication can reverse the cognitive distortions of patients with serious depression. It may be that distortions are more likely the result of biological factors (i.e., one's neurochemicals controlling mood are disturbed) in severe depression, while distortions resulting from one's personality style may be more of a cause of disturbed mood in more milder conditions. So even though the jury is still out on the exact causes of one's distortions, it makes clinical sense to give patients an idea of how their distortions may be contributing to their emotional trouble. Combining a few forms of psychotherapy is usually the most helpful. Medication may be needed in combination with psychotherapy for more severe symptoms, or if the patient has not responded to a number of psychotherapies, depending on the problem.

Suggested Readings

Beck, J: Cognitive Therapy: Basics and Beyond. New York: Guilford, 1995.

Burns, D.D: Feeling Good. New York: Avon Books, 1980.

Fava M., Davidson K., Alpert JE., Nierenberg AA., Worthington J., O'Sullivan R. Rosenbaum JF: Hostility changes following antidepressant treatment: relationship to stress and negative thinking. Journal of Psychiatric Research. 30(6):459-67, 1996 Nov-Dec.

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Tokyo Meguro Counseling Center logo design by Burt Berger, AIA Emeritus, October 2008.

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The Meguro Counseling Center consists of Western-trained therapists able to provide face-to-face mental-health care for the international community in Tokyo. With extensive experience in Japan, these therapists have a deep understanding of the stresses of living in Japan.