Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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It is useful in children with specific phobias and has been used successfully in cases of agoraphobia by having a therapist accompany a patient into the feared situation. Eye movement desensitization and reprocessing Eye movement desensitization and reprocessing (EMDR) involves saccadic eye movements, which are rapid oscillations of the eyes that occur when a person tracks an object that is moved back and forth across a line of vision. If the saccades are induced while the person is imagining or thinking about an anxiety-producing event, a few studies have demonstrated that a positive thought or image can be induced, which results in decreased anxiety. Some research also supports its use in the treatment of symptoms associated with posttraumatic stress disorder (PTSD). Cognitive Behavioral Therapy Cognitive behavioral therapy (CBT) is based on the theory that behavior is deter mined by the way in which individuals think about themselves and their roles in the world. Maladaptive behavior is secondary to ingrained, stereotyped thoughts, which can lead to cognitive distortions or errors in thinking. The theory is aimed at correcting cognitive distortions and the self-defeating behaviors that result from them. Therapy is on a short-term basis, generally lasting for 15 to 20 sessions during a period of 12 weeks. Patients are made aware of their own distorted cognitions and the assumptions on which they are based. Homework is assigned; patients are asked to record what they are thinking in certain stressful situations (eg, “I’m no good” or “No one cares about me”) and to ascertain the underlying, often relatively unconscious, assumptions that fuel the negative cognitions. This process has been referred to as “recognizing and correcting automatic thoughts.” As one example, the cognitive model of depression includes the cognitive triad, which is a description of the thought distortions that occur when a person is depressed. The triad includes (1) a negative view of the self, (2) a negative interpretation of present and past experience, and (3) a negative expectation of the future ( Table 29-3 ). Cognitive therapy has been most successfully applied to the treatment of mild to moderate nonpsychotic depression. It also has been effective as an ad junctive treatment in substance use disorders and in increasing compliance with medication. CBT has also been used with some success as an adjunctive therapy with antipsychotic medications for schizophrenia. Family Therapy Family therapy is based on the theory that a family is a system that attempts to maintain homeostasis, regardless of how maladaptive the system may be. This theory has been referred to as a “family systems orientation,” and the techniques include focusing on the family rather than on the identified patient. The family therefore becomes the patient, rather than the individual family member who has been identified as sick.

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