Psy­chother­apy is a fancy term for talk­ing over anx­i­eties and de­pres­sions

The Weekend Australian - Travel - - Health - DOC­TOR’S PER­SPEC­TIVE SI­MON COWAP

‘ GEE, Doc, you reckon I might need some psy­chother­apy? I dunno, that all sounds a bit weird to me.’’ In Novem­ber, 2006, a new Medi­care ini­tia­tive called Bet­ter Ac­cess to Men­tal Health was launched. The aim was to im­prove ac­cess to a range of men­tal health prac­ti­tion­ers, in­clud­ing GPs, psy­chi­a­trists and psy­chol­o­gists. Fol­low­ing a de­tailed as­sess­ment by their GP, pa­tients can now be re­ferred to psy­chol­o­gists un­der a men­tal health plan which en­ti­tles them to claim Medi­care re­bates for their psy­chol­o­gist con­sul­ta­tions.

This change has been very pop­u­lar. Around 600,000 ser­vices have al­ready been pro­vided by reg­is­tered and clin­i­cal psy­chol­o­gists un­der th­ese new ar­range­ments.

While there is some con­cern that th­ese ser­vices may be dis­trib­uted un­evenly, with mid­dle-aged metropoli­tan peo­ple who al­ready had rel­a­tively good ac­cess to psy­chol­o­gists be­ing the big­gest users rather than young peo­ple in the re­gions, there is no doubt the ini­tia­tive has been a suc­cess.

None­the­less, many peo­ple are still hes­i­tant when you sug­gest they might ben­e­fit from a brief course of psy­chother­apy. Thanks to count­less movies such as Anal­y­seThis and TV shows such as Frasier , many peo­ple still think of dream anal­y­sis, ink blots, Oedi­pus com­plexes and Sig­mund Freud when they think about psy­chother­apy.

Freud de­vel­oped and prac­tised a spe­cific type of psy­chother­apy called psy­cho­anal­y­sis. But while he re­mains an enor­mously fas­ci­nat­ing and in­flu­en­tial fig­ure in the his­tory of psy­chi­a­try, pure psy­cho­an­a­lytic prac­tice is now much more com­mon on the screen than it is in the con­sult­ing rooms of psy­chol­o­gists or psy­chi­a­trists.

So if not dream anal­y­sis, what can my pa­tient ex­pect?

There are many dif­fer­ent types of psy­cho­log­i­cal ther­apy — which may be de­liv­ered by a GP, a psy­chi­a­trist or a psy­chol­o­gist. In prac­tice it re­ally means just about any type of talk­ing-based ther­apy.

This in­cludes such sim­ple, non-spe­cific in­ter­ven­tions as ac­tiv­ity plan­ning, sleep/wake cy­cle man­age­ment, re­lax­ation ex­er­cises and struc­tured prob­lem solv­ing. If you can im­prove some­one’s sleep, get them to ex­er­cise more and en­gage in so­cial and usu­ally plea­sur­able ac­tiv­i­ties, and help them to re­lax and de­velop strate­gies for deal­ing with seem­ingly over­whelm­ing ‘‘ real life’’ prob­lems, you’re well on the way to im­prov­ing their men­tal health.

Of the more spe­cific ‘‘ brands’’ of psy­cho- log­i­cal ther­apy avail­able, the most widely prac­tised in Aus­tralia th­ese days is cog­ni­tive be­hav­ioral ther­apy, or CBT for short. Its pop­u­lar­ity stems both from the fact that it takes rel­a­tively lit­tle time — typ­i­cally six to 12 ses­sions — and it has a ro­bust ev­i­dence base. Many stud­ies have shown it to be at least as ef­fec­tive as med­i­ca­tion in treat­ing mild to mod­er­ate de­pres­sion and anx­i­ety.

Al­though two US psy­chol­o­gists, Aaron Beck (born 1921) and Al­fred El­lis (1913-2007), are widely re­garded as the fa­thers of cog­ni­tive ther­apy, its ba­sic par­a­digm can be traced back to the First Cen­tury stoic philoso­pher Epicte­tus, who claimed: ‘‘ We are dis­turbed not by events, but by the views which we take of them’’. Shake­speare echoed this thought in Ham­let when he wrote ‘‘ there is noth­ing ei­ther good or bad, but think­ing makes it so.’’

While an anx­ious mood begets anx­ious thoughts, it’s also true that anx­ious thoughts can beget an anx­ious mood, and the same goes for de­pres­sion. We of­ten imag­ine the ‘‘ voice in our heads’’ pass­ing judg­ment on our­selves and the world is the im­par­tial mouth­piece of our au­then­tic self, when it can be a highly bi­ased pro­pa­gan­dist for our mood dis­or­der.

This bi­ased, un­re­al­is­tic think­ing can trig­ger neg­a­tive emo­tions, fa­cil­i­tate dys­func­tional cop­ing styles and ex­press it­self in coun­ter­pro­duc­tive be­hav­iours. By look­ing crit­i­cally at our au­to­matic re­ac­tions to dis­tress­ing sit­u­a­tions in terms of emo­tions, thoughts and sub­se­quent be­hav­iours, CBT of­fers the chance to de­velop flexible, re­al­is­tic, less dis­tress­ing re­sponses.

CBT can be used in con­junc­tion with med­i­ca­tion or with­out. It’s not the only ef­fec­tive psy­cho­log­i­cal treat­ment, nor does it work for ev­ery­thing or ev­ery­body. But if you have anx­i­ety or de­pres­sion, you’re more likely to start off deal­ing with an old Stoic than an old Vi­en­nese. Si­mon Cowap is a GP prac­tis­ing in New­town, Syd­ney

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