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January 11, 2000 A Therapy Modified for Patient and Times PHILADELPHIA -- Cognitive therapy was developed 40 years ago to treat people suffering from depression. But in the age of Prozac and other newer antidepressants, said Dr. Judith Beck, director of the Beck Institute for Cognitive Therapy and Research, "we don't see them in our offices anymore." The patients who do seek cognitive therapy these days tend to have more longstanding, and more complicated, problems. And in response, the therapy is being modified and adapted to meet their needs. In treating borderline personality disorder, for example, a cognitive therapist may ask patients more about their childhoods, hoping to find the "early conditioning experiences" that helped nourish their distorted beliefs about themselves and others. And where someone with simple depression is likely to improve in 8 to 10 sessions with a therapist, said Dr. Aaron T. Beck, the founder of cognitive therapy and Dr. Judith Beck's father, patients whose problems are more global may remain in therapy for several months, a year, or longer. One goal in such cases, he said, is "to try to teach them self-control, how to control their impulses." The relationship with the therapist also becomes more important than in shorter-term therapies. For example, Dr. Beck said that a woman who sought help at the Beck Institute's clinic initially saw him both as an authority figure who would try to control her, and as a helper who had her best interests at heart. His strategy in such cases, he said, is to talk to patients about their beliefs, and invite them to test out their perceptions, to see if they mesh with reality. If the patient believed Dr. Beck was trying to control her, for instance, he might ask: "How would you expect me to behave if that were case," and "What is the evidence in favor of this; what is the evidence against it?" It is a method that Dr. Beck argues can help even with patients with severe psychotic disorders, like schizophrenia. In the United States, treatment for schizophrenia is generally limited to the use of antipsychotic drugs, perhaps with addition of supportive counseling to help patients and family members cope. But Dr. Beck and other researchers are finding that when added to drug treatment, cognitive therapy can help psychotic patients, giving them more control over hallucinations and delusions. Seven studies in England, Canada and Italy, Dr. Beck noted, have shown cognitive therapy to be effective for chronically ill patients who do not respond to drugs and for patients in the throes of acute psychotic symptoms. In a review of the research, not yet published, Dr. Beck and Dr. Neil A. Rector, of the University of Toronto, concluded that patients with schizophrenia who improved through cognitive therapy "continue to experience fewer distressing symptoms, have lower relapse rates, spend less time in the hospital, and appear to have greater skills to negotiate setbacks than patients receiving routine care alone." Cognitive therapists use many of the same techniques to treat psychotic patients as they do to treat less severely ill patients. But therapy sessions tend to be shorter and treatment is extended over a longer period, homework tasks are more focused and goals are more flexible, Dr. Beck and Dr. Rector noted. The therapy, they pointed out, is not intended to "cure" delusions or hallucinations, but to reduce the distress they cause; for example, by challenging patients' beliefs that the voices they hear are omnipotent and cannot be disobeyed. "The goal is to render the experience less threatening by altering the meanings associated with voices, rather than diminishing the hallucinatory behavior itself," the researchers wrote. Cognitive therapy may work in schizophrenia, Dr. Beck speculated, because it helps patients gain access to their abilities to think logically and to organize their mental processes. By ERICA GOODE Copyright 2000 The New York Times Company janet paterson 52 now / 41 dx / 37 onset a new voice: http://www.geocities.com/janet313/ 613 256 8340 PO Box 171 Almonte Ontario Canada K0A 1A0