Cognitive Behavior Therapy (CBT) in action

Mike is a 38-year-old gay man who had suffered disabling bouts of depression, on several occasions in his life, which caused him to make several career changes. He twice tried to commit suicide. He also suffered from a great deal of anxiety and stress, occasionally binged on alcohol to cope, and found it difficult to control his temper, especially when drinking.

Mike was referred for CBT after a typical episode was triggered by stress at work. At his first meeting with his therapist, Mike already knew what he wanted to work on. He had a great sense of failure over his history of depression and what he called his lack of success in his career (“I’ve really messed up”). He was anxious about his job prospects. He felt unattractive and was worried about aging and about further losing his physical appeal. He felt his angry impulses were in danger of getting out of control.

In therapy, Mike learned to monitor his actions and his emotional responses. He began to plan activities that gave him a boost and to deal with situations that he had avoided through fear. He learned to identify when he was being extreme or biased in his thinking. He became good at examining his emotion-driven thoughts and reasoning them out so that he got things into proper perspective. His mood noticeably improved, and he began to tackle long-standing problems. He began looking at job prospects, by planning a more realistic choice of career, and sending in applications. He dealt with social situations, without demanding attention and special treatment from friends.

Mike had to face up to problems that were difficult to take on board, such as his perfectionism and the unreasonable demands he made on other people. But Mike was highly motivated by the crisis in his life to find alternatives.

This is what he wrote towards the end of his therapy:
“I have had many painful episodes of depression in my life, and this has had a negative effect on my career and has put considerable strain on my friends and family. The treatments I have received, such as taking antidepressants and psycho-dynamic counseling, have helped to cope with the symptoms and to get some insights into the roots of my problems.”

“CBT has been by far the most useful approach I have found in tackling these mood problems. It has raised my awareness of how my thoughts impact on my moods. How the way I think about myself, about others and about the world can lead me into depression. It is a practical approach, which does not dwell so much on childhood experiences, whilst acknowledging that it was then that these patterns were learned. It looks at what is happening now, and gives tools to manage these moods on a daily basis.”

“The work has moved on to look at deeper beliefs, which can dominate one’s life and cause loads of problems. For example, I have found that I have a strong entitlement belief [a belief that he is entitled to expect certain things from other people]. This is characterized by low frustration tolerance, anger, and inability to control impulses or be told what to do. It has been a revelation to look back on one’s life and see how this pattern has dominated a lot of what I have done. CBT has given me a feeling of being more in control of my life. I am now coming off medication and, with the support of my therapist and partner, I am learning new ways of being in the world. The challenge remains to change these thoughts and behaviors. It will not happen overnight.”

Mike is a man who has applied himself very actively to change. As this quotation reveals, CBT offered him much more then the “quick” fix that it is sometimes portrayed as giving.

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