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Psychotherapy for mental illness
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{{stub}} '''Psychotherapy''' is form of "talking therapy" treatment for [[:Category:Mental disorders|mental disorders]], and not a treatment used to directly treat [[myalgic encephalomyelitis]]/[[chronic fatigue syndrome]], [[fibromyalgia]], [[irritable bowel syndrome]], [[multiple chemical sensitivity]], or any other physical illnesses. Psychotherapists are trained in the working of the mind, and do not have medical training.<ref name="webMD">{{Cite web|url=https://www.webmd.com/mental-health/guide-to-psychiatry-and-counseling| title = Psychiatry, Psychology, Counseling, and Therapy: What to Expect | last = Saling | first = Joseph|website=WebMD|language=en|access-date=2022-01-13}}</ref> ''Psychiatrists'' rather than psychotherapists are medical doctors trained in mental illness, and prescribe psychiatric medications or treatments.<ref name="webMD"/> ==Purpose== Psychotherapy is designed to treat mental illness, whether it impacts or occurs in people with physical illnesses or not. A person with [[ME/CFS]] might see a psychotherapist to treat either a pre-existing mental disorder, one caused as a reaction to the effects of living with ME/CFS, or an unrelated mental disorder that begins later, for example: * serious phobia * [[depression]] resulting from a bereavement * [[reactive depression]], which is depression resulting from the effects of an illness, such as the loss of friends or career * [[post-traumatic stress disorder]] due to [[Medical neglect and abuse|abuse from medical professionals]], [[trauma|childhood abuse]], and car accident or another psychological trauma<ref name="webMD" /><ref name="NHS-CBT">{{Cite web|url=https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/| title = Overview - Cognitive behavioural therapy (CBT) | last = | first = | authorlink = | date = 2021-02-10 | website = National Health Service|language=en|archive-url=|archive-date=|url-status=|access-date=2022-01-13}}</ref><ref name="Geraghty2016"/> ==Difference from counselling == Psychotherapy is different from counseling because: * psychotherapists have more extensive training * psychotherapists typically offer longer term work, counseling is often brief * counseling is sometimes delivered by people who ''aren't'' mental health professionals but have training in a particular method of counseling, this means that their understanding of more serious or long term difficulties in particular may be limited, and these "paraprofessionals" may not be registered with any counseling or psychotherapy professional body, and they may not work under a clear ethics framework or by licensed by a regulatory body for counseling or psychotherapy * counseling is often sought for issues unrelated to mental health, to allow someone to be able to work through feelings or difficult decisions, for example family matters or pregnancy counseling and life transitions<ref name="webMD" /><ref name="Mind">{{Cite web|url=https://www.mindinharingey.org.uk/our-services/counselling/| title = Counselling | last = | first = | authorlink = | date = 2020-05-12 | website = Mind in Haringey|language=en-GB|archive-url=|archive-date=|url-status=|access-date=2022-01-13}}</ref><ref>{{Cite web|url=https://www.bacp.co.uk/about-therapy/what-therapy-can-help-with/| title = What therapy can help with | last = | first = | authorlink = | date = |website=British Association of Counselling Professionals|archive-url=|archive-date=|url-status=|access-date=2022-01-13}}</ref><ref>{{Cite web|url=https://my.clevelandclinic.org/health/articles/4062-chronic-illness| title = Chronic Illness: Sources of Stress, How to Cope|website=Cleveland Clinic|access-date=2022-01-13}}</ref><ref>{{Cite book | title = Can paraprofessionals deliver cognitive-behavioral therapy to treat anxiety and depressive symptoms? | date = 2010 | publisher=Centre for Reviews and Dissemination (UK)|language=en|url=https://www.ncbi.nlm.nih.gov/books/NBK80017/ | last = Montgomery | first = E. C. | last2 = Kunik | first2 = M.E. | last3 = Wilson | first3 = N. | last4 = Stanley | first4 = M.A. | last5 = Weiss | first5 = B.|pmid=20235623}}</ref> ==Cognitive behavioral therapy == [[Cognitive behavioral therapy]] (CBT) is a form of talking therapy that was developed initially to treat depression, then later models were developed for [[anxiety]], [[post-traumatic stress disorder]] and other mental illnesses.<ref name="Geraghty2016">{{Cite journal | last = Geraghty | first = Keith J | author-link = Keith Geraghty | last2 = Blease | first2 = Charlotte | authorlink2 = Charlotte Blease | date = 2016-09-15| title = Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent|url=https://www.researchgate.net/profile/Keith_Geraghty/publication/308181085_Cognitive_behavioural_therapy_in_the_treatment_of_chronic_fatigue_syndrome_A_narrative_review_on_efficacy_and_informed_consent/links/5a15a37e4585153b546ca7c7/Cognitive-behavioural-therapy-in-the-treatment-of-chronic-fatigue-syndrome-A-narrative-review-on-efficacy-and-informed-consent.pdf|journal=Journal of Health Psychology|volume=23|issue=1|pages=127β138|doi=10.1177/1359105316667798|issn=1359-1053|via=}}</ref> CBT is an extremely popular form of therapy that can be delivered in either psychotherapy or [[counseling]]. In CBT, "homework" such as worksheets completed between sessions is often expected, which may mean that it is more demanding in terms of energy than some other types of therapy.<ref name="types">{{Cite web|url=https://www.westsidepsych.com/therapeutic-techniques| title = Therapy Techniques|website=WestSide Psychotherapy|language=en-US|access-date=2022-01-13}}</ref> Many people who deliver CBT counseling are not registered mental health professionals and do not work primarily in counseling or psychotherapy.<ref name="DwME" /> [[Acceptance and Commitment Therapy]] is also a form of CBT.<ref name="types" /> ===CBT for ME/CFS === Cognitive behavioral therapy has also been developed for [[ME/CFS]] based on a highly controversial [[cognitive behavioral model|biopsychosocial model]] of ME/CFS that does not accept that it has an underlying biological disease process, and views psychological factors such as [[illness beliefs|fear of exercise]] as a key part of the disease, something which has been found to be incorrect.<ref name="Tack2019/><ref name="Wilshire, 2018">{{Cite journal | last1 = Wilshire | first1 = C | authorlink1 = Carolyn Wilshire | last2 = Kindlon | first2 = T | authorlink2 = Tom Kindlon | last3 = Courtney | first3 = R | authorlink3 = Robert Courtney | last4 = Matthees | first4 = A | authorlink4 = Alem Matthees | last5 = Tuller | first5 = D | authorlink5 = David Tuller | last6 = Geraghty | first6 = K | authorlink6 = Keith Geraghty | last7 = Levin | first7 = B | authorlink7 = Bruce Levin | title = Rethinking the treatment of chronic fatigue syndromeβA reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT | journal = BMC Psychology|doi =10.1186/540359-018-0218-3 | volume = 6 | issue = 6 | page = | date = 2018| url = https://www.researchgate.net/publication/322568480_Rethinking_the_treatment_of_chronic_fatigue_syndrome-A_reanalysis_and_evaluation_of_findings_from_a_recent_major_trial_of_graded_exercise_and_CBT}}</ref><ref name="Tack2019">{{Cite web|url=https://blogs.bmj.com/medical-humanities/2019/07/04/why-graded-exercise-therapy-and-cognitive-behaviour-therapy-are-controversial-in-chronic-fatigue-syndrome/| title = Why Graded Exercise Therapy and Cognitive Behaviour Therapy are Controversial in Chronic Fatigue Syndrome | last = Michiel | first = Tack | authorlink = Michiel Tack| date = Jul 4, 2019 | website = BMJ Medical Humanities Blog|language=en-US|archive-url=|archive-date=|access-date=2019-07-09}}</ref><ref name="Spandler2017">{{Cite journal | last = Spandler | first=Helen | authorlink = Helen Spandler | last2 = Allen | first2 = Meg | author-link2 = Meg Allen | date = Aug 16, 2017| title = Contesting the psychiatric framing of ME/CFS|url=https://www.researchgate.net/profile/Helen_Spandler/publication/319157873_Contesting_the_psychiatric_framing_of_MECFS/links/599b082545851574f4ac5ba0/Contesting-the-psychiatric-framing-of-ME-CFS.pdf|journal=Social Theory & Health|language=en|volume=16|issue=2|pages=127β141|doi=10.1057/s41285-017-0047-0|issn=1477-8211|quote=|via=}}</ref> [[cognitive behavioral model|This form of CBT]], which is often delivered by the UK's '''Improving Access to Psychological Therapies''' (IATP) but may be delivered by any counselor in any country, aims to cure or significantly improve physical symptoms through encouraging the person to change their thoughts and behaviors.<ref name="NHS-CBT" /> In this model of CBT the person assumed to have an "unhelpful" (irrational) beliefs that [[exercise intolerance|exercise is harmful]] or to be engaging in a [[viscous circle]] of thoughts and behaviors that are claimed to make the illness worse.<ref name="Geraghty2016"/><ref name="Spandler2017" /> This extremely controversial model of CBT,<ref name="Twisk2009">{{Cite journal | last = Twisk | first = Frank N. M. | last2 = Maes | first2 = Michael| date = 2009| title = A review on cognitive behavioral therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS|url=https://www.ncbi.nlm.nih.gov/m/pubmed/19855350/|journal=Neuro Endocrinology Letters|volume=30|issue=3|pages=284β299|issn=0172-780X|pmid=19855350|quote= | author-link = Frank Twisk | authorlink2 = Michael Maes|via=}}</ref> which is typically delivered by nurses, occupational therapists and sometimes counselors, treats ME/CFS as [[medically unexplained physical symptoms]] (MUS) and may be treat symptoms as "bothersome" or as if they can be "reversed" by altered behaviors rather than acknowledging ME/CFS as a serious, neurological disease with a very low recovery rate; this cognitive behavioral and [[biopsychosocial model]] of ME/CFS was abandoned by the [[Centers for Disease Control|CDC]] in 2017, and by the UK's [[NICE guidelines|NHS guidelines]] in 2021 due to the evidence that is was ineffective and often harmful,<ref name="CDC-drops-GET">{{Cite web |url = http://www.virology.ws/2017/07/10/trial-by-error-the-cdc-drops-cbtget/| title = Trial By Error: The CDC Drops CBT/GET|website = [[Virology blog]] | date = 2017-07-10 | last = Tuller | first=David | authorlink = David Tuller}}</ref><ref name="DwME">{{Cite web|url = https://doctorswith.me/nice-2021-a-triumph-of-science-over-discrimination/?| title = NICE 2021: A Triumph of Science over Discrimination | date = November 1, 2021 | last = Doctors with M.E. | author-link = Doctors with M.E.|quote=The new guideline discards discredited psychological theories and therapies in favour of a more patient centred approach, driven by improved scientific understanding. It represents a positive and total paradigm change, uniting around the science, official disease classification and medico-legal compliance implications.}}</ref><ref name="SEID-IOM2015">{{Cite book | last=Institute of Medicine | authorlink = Institute of Medicine| title = Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness|location=Washington, DC|publisher=The National Academies Press | date = 2015 | url=https://www.ncbi.nlm.nih.gov/books/NBK284902/ |isbn=0309316898|pmid = 25695122|doi = 10.17226/19012 }}</ref> Some people experiencing this form of CBT have reported that they felt like they were experiencing [[Medical gaslighting|gaslighting]], which is a form of emotional abuse, and that their experiences of illness were not believed, and that medical facts were disputed by their counselor: in the UK, a significant minority of people found that CBT for ME/CFS made their mental health worse. {{See also|Cognitive behavioral therapy|Cognitive behavioral therapy|Illness beliefs|Illness beliefs}} == Forms of therapy == Many different types of therapy exist, including: * '''EMDR''', which is mostly used for post-traumatic stress disorder after abuse or trauma, and is based on a mixture of eye movements and addressing distressing and intrusive memories and feelings * '''Person-centered therapy''', which is based on fully accepting you as you are, and does not attempt to challenge your thoughts or beliefs, developing self-compassion and self-acceptance is encouraged. Typically not a fixed number of sessions. * '''Dialectic behavioral therapy''' - while this is derived from CBT and is very structured rather led by the patient it is based on the principle that you/the patient are doing the best you can, and is very focused on skills training and coping strategies * '''Interpersonal therapy''', which is based on how you interact with others and how other people's actions affect you, and vice-versa, and icreasing support from others * '''Mindfulness-based therapies''' - based around stress reduction, increased self-awareness, and regular practice of mindfulness * '''Art therapy''', in which feelings or difficulties are expressed creatively, and the value is on emotional benefits with no need for artistic skills * '''Solution-focused''' - a short term therapy where you work towards a particular goal you have * '''Group therapy''' - attending regular sessions with others who have similar difficulties to share problems and thoughts, with a therapist acting as a facilitator == Somatization and Somatic Symptom Disorder or Bodily Distress Disorder == These are a group of mental disorders in which emotional problems are converted into physical symptoms in place of emotions, sometimes called Conversion Disorder. For example, a child might have abdominal pain whenever they are sad but not be able to recognize their sadness, or an adult survivor of rape may experience chronic pain in their genitals which is not caused by physical illness, and that resolves or improves with psychological support to work through the emotional consequences of the rape.<ref>{{Cite book | title = DSM-5|trans-title=|chapter=Somatoform Symptom Disorders| date = 2013 |publisher=American Psychiatric Press|location=Washington, D.C.|isbn=|edition=|volume= | url = |chapter-url=|pages = | last = APA | first = | authorlink = |veditors=|others=|quote=}}</ref> The symptoms of ME/CFS, [[fibromyalgia]] and [[irritable bowel syndrome]] are not caused by this ''somatization'' process but some professionals may view the symptoms as "unexplained" or "having no medical cause" and assume that psychotherapy for a somatization disorder and/or [[Antidepressant|antidepressants]] might help.<ref name="Sykes2002">{{Cite journal| title = Letter to the British Journal of General Practice | date = Sep 2002|url=https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC1314421&blobtype=pdf|journal=The British Journal of General Practice|volume=52|issue=482 | pages = 762β763 | last = Skyes | first = Richard | authorlink = |doi=|pmc=PMC1314419|pmid=12236282|quote=|via=}}</ref> Historically, this approach has been used for many illnesses that [[Medically unexplained physical symptoms|medicine was not able to recognise properly]] or not able to understand at the time, for example [[multiple sclerosis]] was treated under this model as a "hysterical paralysis".<ref name="Hooper2002BJGM">{{Cite web| date = Jun 21, 2002|url=https://www.margaretwilliams.me/2002/letter-to-bjgp_hooper.pdf| title = Letter to The British Journal of General Practice | last = Hooper | first = Malcolm | authorlink = Malcolm Hooper|quote=|via=}}</ref> [[Jennifer Brea]] was misdiagnosed with conversion disorder, and as a result tried to [[Pushing through symptoms|push through]] her symptoms, causing her physical to decline dramatically.<ref name="BBC2017">{{Cite web|url=https://www.bbc.co.uk/news/stories-41888146| title = I made a film from my bed to show my illness is real| date = November 9, 2017|publisher=BBC News}}</ref> ==See also == *[[Anxiety]] *[[Depression]] *[[Supportive counselling]] *[[Suicide]] *[[Mental health]] ==Learn more == * [https://www.webmd.com/mental-health/guide-to-psychiatry-and-counseling Guide to psychiatry and counseling] - WebMD * [https://www.bacp.co.uk/about-therapy/what-therapy-can-help-with/ What Therapy Can Help With] - British Association of Counselling Professionals * [https://my.clevelandclinic.org/health/articles/4062-chronic-illness Chronic Illness - Sources of Stress and How to Cope] - Cleveland Clinic * [https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/ Overview - Cognitive Behavioural Therapy] - NHS ==References == {{Reflist}} [[Category:Potential treatments]] [[Category:Psychological and behavioral therapies]]
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