Please remember, this column is designed to help the consumer seeking behavioral-health information, and not intended to be any form of psychotherapy or a replacement for professional, individualized services. Opinions expressed in the column are those of the columnist and do not represent the position of other SelfhelpMagazine.com staff.

Question

My family doctor has advised me to learn about cognitive therapy for help with my depression and anxiety. Even after years of therapy for abuse I suffered as a child, I still have very low self esteem. I haven't been able to work for months, now. If you could explain cognitive therapy to me, I would appreciate it.

Answer

Congratulations on your effective steps in finding help for your depression and anxiety. Your family physician has given you some useful direction here. Depression with anxiety are labels for a set of symptoms that often occur in response to traumatic incidents in life. Of course, such symptoms often strike us "out of the blue" too. But with your issues, cognitive therapy can be very helpful.

Research studying depression has tended to explore the ways we think, the ways we behave, and the the brain's biochemistry. The mental health researchers identified with cognitive therapy think that all of these topics are related. Their experience indicates that therapy focused on depressive thinking can influence behavior and mood in overcoming depression and anxiety.

A cognitive therapist approaches your depression and anxiety as a co-investigator with you; as a scientific ally. Rather than spending years exploring your history, a cognitive therapist will assist you in learning just how current patterns of thinking create an atmosphere for depressive symptoms. Such therapists often refer to those symptoms as "disturbances." By clearly labeling the thinking connected to such disturbances, an action plan is created, using any number of useful strategies. The course of therapy is usually brief.

In your situation, for instance, years of abuse experienced as a child may have left you with very deeply held beliefs about yourself. You had to be tough and resourceful to survive, yet these thoughts are not positive. How could they be! These ideas often are self accusing, full of shame, alienation; wounding thoughts of failure, incompetence, and vulnerability.

Cognitive therapists work with you to label, understand, dispute, and extinguish such thoughts, in a compassionate, empathic, caring partnership. They encourage you to become an expert in your self management of disturbing cognition's. They help you learn to be in control.

There is no blame attached to having these thoughts, by the way. You did not create them. What better way to deal with the pain an outsider created in your life than learn how to effectively command, dispute, and move them from your life.

Dr. David Burns, now at Stanford University, has written about cognitive therapy in his book "Feeling Good" and its Handbook. I recommend this book wholeheartedly. It is based upon scientific evidence, is readable, and offers clear guidelines for self help from a cognitive therapy perspective. The Center for Cognitive Therapy at the University of Pennsylvania maintains a "home page" on the internet that offers specific information about their technique (it was developed there primarily, by Dr. Aaron Beck).

To find a trained cognitive therapist in your area, you might call your local or state psychology association. Your physician may know of someone using these techniques, or be able to consult with a mental health professional who would know.

Finally, you can trust that cognitive therapy is effective. In clinical studies, cognitive therapy is at least as effective in the treatment of typical depression as are the major antidepressant medications. It is especially useful for depression resulting from abusive experiences in childhood. So good luck in your journey to help with your pain.

02/20/98

Dr. Kenneth Dutro is a licensed psychologist in California. He is a member of the faculty at Humboldt State University, Arcata, California. He has been faculty member of a medical school, and worked for years as a psychologist in university-affiliated teaching hospitals.