Frank Albrecht, PhD

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Cognitive Behavioral Therapy

A March 11, 1997 Reuter's story discusses how CBT is
"a treatment based on the idea that the way people think about themselves
affects their emotions and behavior."

As a psychologist and mental health counselor myself I wish to comment on this.

I doubt anyone wants to argue that how we think influences our emotions and behavior. Thus Cognitive Behavioral Therapy (CBT) is widely used in the psychological treatment of depression, anxiety, and other emotional problems. For these kinds of problems the approach can be curative, or, at the very least, can produce extended remissions. There is ample data proving that.

It does turn out, however, that how we think also influences how our body works. CBT and related therapies thus are used with some success in cases of cancer and heart disease. This use is not curative but palliative. Less pain is felt. Disability is somewhat reduced. In some cases there is a longer life, that is, the physical disease process itself is slowed or impeded. I have not myself used this method with heart disease or cancer, but I have used similar methods with persons having pain of undeniably physical origin -- e.g. fractured vertebra. I have found it helpful in these cases.

Confusion arises when CBT is used for conditions which some people see as psychological rather than physical. Then we run into a problem with hidden agendas. The CBT practitioner may be using this method for the same reasons he would use it with cancer, as a method of palliation and as a way of improving functioning in spite of illness. On the other hand, the practitioner may be using it with a belief (often hidden from the client) that it will cure. Thus the PWC community, confronting people who recommend CBT, are never quite sure what the intent is, and what the underlying belief is. There is a tendency, I think, to throw out the baby (CBT) with the bathwater.

Another problem is that CBT is a relatively new approach whose advocates are very aggressive in proselytizing for it. In my opinion, they exaggerate its effectiveness with psychological and physical problems both, and are insufficiently aware of its limitations. This general attitude leads them to overstate the case for, and the effectiveness of, their kind of therapy with all conditions, including CFS. This kind of overstatement increases PWC suspiciousness about the approach.

CBT can help selected PWC (not all, probably not the majority) feel better and function better. It can be a big help with illness management. That should be true, on theory grounds. And it is true. The studies that have been done show that. My personal experience also shows it.

I don't think any PWC should go to a CBT practitioner who thinks CFS is an emotional condition, or that it is not, clearly, a physical illness. For this reason the PWC community is justified in asking CBT practitioners and advocate some blunt questions about their illness beliefs, and to expect some forthright answers. The approach itself, however, is useful in the right hands. Let's not throw it out because some of its advocates have unwarranted opinions.

© Frank Albrecht, 1998

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