Cognitive Behavioural Therapy: psychotherapy over pharmacotherapy

Video courtesy of Button Poetry

In her spoken word poem at the 2014 National Poetry Slam, Sabrina Benaim describes a conversation she had with her mother about what it is like to live with depression. Benaim describes depression as a shape-shifter. “One day it is as small as a firefly in the palm of a bear,” says Benaim. “The next it’s the bear.” On the days depression is a bear, Benaim says she plays dead until it leaves her alone. Benaim says she suffered a panic attack during this spoken word performance. Both poem and performance shed light on Benaim’s mental illness. But she is not alone.

Almost 30 per cent of students say they struggle with anxiety, and almost 20 per cent say they struggle with depression, according to a study done by the American College Health Association (ACHA) in 2013. However, there are many ways students can deal with these struggles. One is the use of psychotherapy. Cognitive Behavioural Therapy (CBT) is a psychological treatment that looks at the interactions between how we think, feel and behave, according to the Centre for Applied Research in Mental Health and Addiction (CARMHA). CBT is a type of psychotherapy, which can and has been used for everything from ADD to Bipolar Disorder. CBT is changing how people cope with mental health illnesses because of its accessibility, approach, and lack of side effects.

CBT was first studied in the 1960s. At first CBT was used to treat depression, but in recent years it has been used as a treatment for many other mental illnesses. The increase in CBT use began between the 1980’s and 1990’s as the benefits of this therapy became more widely known, according to Chris Williams and Marie Chellingsworth’s book CBT: A Clinician’s Guide to Using the Five Areas Approach. Though there are many options available for those battling mental health illnesses, lots have side effects. CBT does not. CBT helps people face their problems without medication.

Of the students surveyed by the ACHA, almost 90 per cent say they feel overwhelmed by all they have to do. Student life and workload leaves little time for self-care. There are many apps that help users apply mindfulness and self-love. These CBT apps allow students to work on mindfulness while on the bus, at home or school. Though motivation is a key factor in the success of CBT, students are more likely to continue with it over medication, and as a result avoid relapsing. Unlike medication, CBT also comes free of side-effects. Ritalin, which is used to treat uncontrollable sleepiness and ADHD, has side effects such as moodiness and sleeping issues. Cipralex, which is used to treat depression, OCD and Generalized Anxiety Disorder also has side-effects, such as weight gain and suicidal thoughts. Though CBT may increase anxiety in some patients, it will only last for a short period of time. This short-term effect with a long-term solution may seem more reasonable.

UOIT Forensic Science student, Stephanie Marinac, 18, was diagnosed with Generalized Anxiety in Gr. 10. The following year, Marinac experienced an anxiety attack in class while writing a Physics test. “ I began to shake really badly, I was loud and started hyperventilating,” she says, remembering the embarrassment she felt. “From then on I wrote tests in a private room.” Along with her anxiety, Marinac began to develop depression, which Benaim describes as a relative to anxiety.

“Anxiety holds me a hostage inside of my house inside of my head,” Benaim says to her mother in the spoken word poem she performed in 2014. Benaim’s mother asks where her anxiety came from. Benaim answers, “Anxiety is the cousin visiting from out of town that depression felt obligated to invite to the party.” Benaim says she is the party, but she is a party she doesn’t want to be at.

The unwelcoming party that Benaim describes in her poem is what led Marinac to search for help. She turned to medication and therapy. Almost 60 per cent of patients relapse on pharmacotherapy but only about 30 per cent relapse from psychotherapy, according to The Efficacy and Effectiveness of Psychological Treatments by Dr. John Hunsley, Katherine Elliott, and Zoé Therrien.

Marinac’s doctor recommended she see a CBT therapist. Marinac has since moved to using apps and the book Mind over Mood by Dennis Greenberger and Christine A. Padesky for her therapy while she attends school. The tools allow Marinac to complete her therapy even while living away from her therapist. “A good CBT therapist is going to help someone help themselves,” says Jeff Peron, the creator of a CBT app called TruReach. “Once the person understands then they are able to go off on their own.”

Originally from Bowmanville, Perron has a B.A. in psychology, and an MBA under his belt. Perron, however, wanted to be more involved with patients so he returned to school at the University of Ottawa for a Ph.D in Clinical Psychology. The TruReach app was created because Perron realized there was really nothing of the sort available for people who wanted to use CBT. The idea of the app came from extensive research he read on the benefits of online CBT. The TruReach app provides 12 free lessons teaching CBT, and following these you can purchase more for $7.99. Though there are apps to track moods or thought journals, there weren’t any CBT lesson-led apps. Though Perron says the app is not as helpful as seeing a CBT therapist, he says it is accessible, and cheaper.

Prior to seeing her therapist, Marinac worried about going to therapy but after attending a few sessions she realized CBT was not the type of therapy portrayed by the media. Instead of laying down on a chaise lounge talking about her problems, she was up and talking about how to solve them. Marinac’s therapist incorporated her love of soccer into her sessions. “She had me dribble a ball around the room just talking to her about my day and how things have been going,” Marinac says. “It was just different because I was up and doing something I loved while talking about something I wasn’t too happy about.”

Unlike medication, talking about how to change behaviour has no side effects. The Canadian Psychology Association says in fact there is both a lower rate of relapse and a lower drop-out rate when comparing therapy to medication. Marinac says, “I think it’s definitely something I should continue with maybe not as often as I used to do it but definitely at least once a week to re-evaluate myself.” Marinac says CBT has helped her to realize the issue is not that she has a mental illness but how she deals with it. Apps and books allow students not only to engage in CBT at anytime but as well to use technology in a beneficial way.

When Marinac first began experiencing issues with anxiety her parents thought that it was for attention. So did Benaim’s. “Mom still doesn’t understand,” says Benaim in her poem. “Mom, can’t you see, that neither can I,” responds Benaim.   Not all mental illness can be understood. But it can be explored. What CBT does is help students deal with problems such as anxiety and depression. CBT can help people struggling with mental illness to change their behaviours. Looking forward, the growth of psychotherapies may help to bring an end to the unnecessary use of some pharmaceuticals. CBT and Benaim’s poem, help people release their negative thoughts and change them. By talking about our problems, we can learn to reframe them. Benaim’s poem builds off of depression and anxiety to give an understanding of her mental illness to her mother and herself. Through talking, building, and understanding, we are one step closer to stopping the stigma around mental health and treating illnesses properly.