CBT or Psychotherapy?

Clients and companies often ask me if I offer CBT therapy (Cognitive Behavioral Therapy). Although CBT is a type of psychotherapy, there are some differences in focus between CBT and the more traditional “psychodynamic” psychotherapy.

In short, both CBT and psychotherapy usually have the same format: a conversation of approx. 1 hour between a client and a therapist, but CBT focuses on looking at the issue in the present only (the “here-and-now”). CBT does not delve into what caused the issue in the first place, which could stem from childhood or traumatic experiences earlier in life. So it focuses on “quick results” in a sense.

An example may illustrate this better: CBT is often used for fear of flying. The starting point is the assumption that it’s not the event of flying that causes fear, but a person’s interpretation of it. A negative interpretation of flying can therefore cause anxiety and/or depression. The CBT practitioner would work with the client on modifying those thoughts of danger that overwhelm a person who’s afraid of flying. This will involve challenging the irrational thought about crashing, trying to stop negative thoughts and look at ways to have positive, reassuring thoughts instead. Relaxation techniques may also be part of the therapy and even exposing the person to the feared situation. Psychotherapy, on the other hand, would go back and try to identify what event in the past caused the fear in the present, perhaps looking at patterns of similar behaviour in other situations, but accepting that the feeling of fear is real and trying to understand the cause of the fear.

So CBT is more about “positive thinking” where psychotherapy is more about accepting the thoughts you actually have and trying to understand them, which can often be very complex.

The obvious advantage of CBT is that it’s short-term and therefore financially more manageable, as it may require fewer sessions although this is not necessarily the case. My question mark over CBT is whether the issues are really resolved or if they will simply reappear later since the underlying issue has not be dealt with.

If you want to read more, there are numerous references on the web to CBT and psychotherapy. One of the best blogs I’ve noticed that explains (or at least comments on) the difference is Benjamin Fry’s site at http://www.benjaminfry.co.uk/index.html. Benjamin Fry has featured in various BBC television and radio programmes.

A particular thread on his blog has an interesting exchange on the difference between the two types of therapy - obviously a bit biased towards the type of psychotherapy that I also believe provides the best long-term results: http://www.wwwyou.org/index.php?showtopic=344

Here are a few other links that may be interesting to study:

http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
http://en.wikipedia.org/wiki/Psychotherapy

Comfort eating

Linda Higgens' "Life Lesssions" column, Evening Herald, 26 February 2008

Dilemma

“Please help me. I started the year with a vow that I’d lose weight and get fit this year. And of course it hasn’t happened. I need to shift at least two stone to be a healthy weight for my height. My problem is that I comfort eat in the evenings. I eat a good breakfast and lunch, and always cook a healthy dinner for my husband and three children. But by 9pm, I find that I’m ravenous again and I end up reaching for the biscuit tin. Or the kids’ sweets. Toast, cheese, chocolate are the other things I can’t resist.

I always feel disgusted at myself after my late-night supper, but it’s like I can’t help it. At the end of a long day, watching TV and having a snack is my way of relaxing. Sometimes I get strict with myself and I’ll be good for a week and shed a few pounds. However, then there’ll be a social occasion or a particularly stressful day – or some excuse – that causes me to start comfort eating again.

How can I break this cycle? I’ve tried just about every diet going, but I’ve never managed to stick to anything for very long. I want to get fit too. I don’t have the time or money to join a gym. And being overweight makes me self-conscious about joining any exercise classes. How can I start to improve my diet and fitness levels?”

Expert
Catherine Keers (MIACP, MIAHIP) offers counselling adn psychotherapy services at her Dun Laoghaire clinic. Contact Catherine on 01 284 3297 or www.catherinekeers.com.

I appreciate that you want to improve your diet and fitness levels and it’s important to seek help and support to do this, but as a psychotherapist I want to focus on what’s going on for you on an emotional level, what it is that makes you ‘comfort’ eat. Another name for this is ‘emotional eating’. People eat for all sorts of reasons other than feeling physically hungry. We often turn to food when we have feelings of stress, anxiety, loneliness or boredom to name just a few. When you think about it, we are taught to use food in this way from when we are young children, we receive food as treats for being good or for comfort when we hurt ourselves.

So the main question here is how do you feel? The key is to recognise that there is a very good chance that this is having an effect on your eating habits. Firstly, I suggest that when you feel the urge to reach for food, slow down, stop for a moment and rate on a scale of 1 to 10 how physically hungry you actually are (1, totally starving and 10 full up). Next take a few deep breaths and try to notice what you are feeling, you can probably sum it up in a word or two; for example, bored, sad, lonely, frustrated, then note this down in a journal. Once you’ve done this for a week you will have an idea of what feelings prompt you to eat.

Commonly people who comfort eat notice that they have a ‘hollow or empty’ feeling, in this case you could ask yourself, what’s missing, what do I need that I’m not getting? Tell yourself ‘I’m not hungry, I just want to eat because I’m feeling upset, lonely, bored’ or whatever it is you’re feeling. Remind yourself that if you eat, it will at the most be a temporary fix and that afterwards you will likely feel much worse because you will additionally feel guilty and beat yourself up for failing to keep to your diet. It won’t work to simply remove the food and use willpower to not eat, instead you need to replace it with something non-food to ‘fill the void’ and find other ways to deal with these feelings, for example if you notice it’s loneliness, then call a friend in the evenings for a chat, if it’s stress, then you need to find other ways to relieve your stress levels like meditation or yoga classes, if it’s boredom - find something other than food and TV and challenge your mind.

Many people find it easier to blame their physiology instead of doing the harder work of sorting out their emotions and taking care of those needs. Work on ways of filling your emotional needs instead of trying to ‘fill yourself up’ by filling your stomach.