If you're living with a chronic illness, you're in the right place.

Friday, November 15, 2013

Does Therapy Really Work?

8:30 AM Posted by Tiffany Taft , , , , , ,
Being a psychologist in the medical world, I'm often met with some skepticism about what I do.  This can come from patients, their families, physicians - you name it.  There is good reason for questioning if psychotherapy is helpful for people living with a chronic medical illness.  Hell, there's good reason to question if psychotherapy is helpful for anyone.  Not because it isn't, but because questioning things is good practice.

Question the evidence...maybe without all the yelling.
The great news is psychotherapy is helpful for a slew of problems, and specific types of therapy are more effective than others.  I personally trained in Cognitive Behavioral Therapy and this is what I use most of the time.  I was also trained in other major approaches - existential/humanistic, psychodynamic, and family systems - which I may borrow from from time to time if it will benefit the person I'm working with.

A popular buzzword in medicine is evidence based treatment.  That is what it sounds like:  is there evidence based in sound, peer-reviewed research to backup the claim that a treatment will help relieve symptoms.  So, is psychotherapy an evidenced based treatment for chronic illness?

Lots of this floating around out there.
The answer is Yes - with an asterisk.  The reason for the caveat is that the research on psychotherapy for chronic illness and what it exactly helps with is evolving, and depending on the research study it may or may not do much.  Such is the nature of clinical research.  There are some swell people out there who like to review a lot of research studies in one area and write a comprehensive review so we don't have to read each study independently, unless you want to.

In the November issue of the journal Inflammatory Bowel Diseases there is such a review article on if psychotherapy is helpful for people with Crohn's Disease and ulcerative colitis.  They looked at 16 studies that used a variety of approaches to treatment and found:

  • Cognitive Behavioral Therapy (CBT) and Psychodynamic (PD) Therapy both help with anxiety and depression related to life with IBD, but did not help as much with physical symptoms or quality of life.  Of the two approaches, CBT was more convincing as an evidence based treatment than PD.
  • Medical hypnotherapy works well to treat physical symptoms and improve quality of life.  There are only a few studies in this area, so the results are positive but preliminary.
  • Stress management interventions (like relaxation training) don't do much on their own for psychological or physical symptoms.
Based on these findings, a combination of CBT and Hypnotherapy would be best for people living with IBD who are looking to feel better emotionally and physically.  Personally, I've used this approach and find it really is helpful for most people.

Got Stress?
Another emerging area of psychotherapy for chronic illness is the use of Mindfulness, a concept that really stems from Eastern religions like Buddhism and was applied to psychology by John Kabat Zinn.  A study in the November issue of the journal Health Psychology found that mindfulness-based stress reduction treatment reduces the stress response in the body, including heart rate, blood pressure, and levels of cortisol (aka the stress hormone) in the body.  This is an important consideration for people living with chronic autoimmune diseases as stress influences how the immune system functions.  This study didn't specifically evaluate the mindfulness intervention in people with chronic illness.

If you're interested in mindfulness, here's a nice resource on the topic with some exercises you can try on your own.

So yes, dear reader, therapy really can help.  The key is using evidence based treatments and recognizing what they do and do not seem to change.

Dr. T