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I found my rationalization for the acceptance, and they were
pretty good rationalizations. Our oldest girl was then in col-
lege. She came home to visit and told us that her professor in the
first lecture of the school year said that if, at the end of four
years, she and her fellow students still admired their parents,
then the school would have failed. She came home to tell us that
she loved us and wanted to see us, but that we had to keep these
visits secret so that she did not fall out of favor with her
friends. Rough times were ahead; our children were growing
up, and life could be harsh, not what we had hoped it to be for
them. I was not only able to hold it together for myself, but also
able to keep the strength of our family s ability to communicate
intact and to help each other during stressful times. I was still
in analysis, and it proved worth everything I had invested in
it. I had made good decisions with my life. We drove second-
hand cars and still had no bedroom set. But the important
things, like love and understanding in our family, were
stronger than ever and still growing, even though life was
now more complicated with grown children, their spouses, and
grandchildren. I have never been sorry for the expense but
rather consider myself lucky to have been able to have afforded
this chance to rearrange formerly self-destructive patterns from
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my childhood. Today, the cost seems immaterial. But it would
be untruthful to say that it didn t matter. It did, and I had a lot
of feelings about it. I also made the right decision.
77. What is cognitive behavioral
treatment?
Cognitive behavioral treatment (CBT) is a rubric
CBT
that, loosely defined, attempts to treat different mental Cognitive behavioral
treatment. A form of
health struggles via a systematic examination of the
psychotherapy that
cognitive and the behavioral aspects of any particular
has been proven to
be particularly help-
disorder. In the example of panic attacks associated with
ful in anxiety and
flying, various distortions in thinking occur while nu-
depression.
merous distortions of behavior can occur. CBT assesses
these directly with the patient in 10 to 12 sessions, often
using a homework-style approach. The results can be
remarkable, as the patient learns to break down the vari-
ous components of his anxiety and thus becomes more
in control of it. A patient s thinking distortions would
include thoughts that the plane will likely crash or that
he would likely die from a panic attack while flying. Re-
assuring the patient against their feared likelihood of a
crash or heart attack versus the reported statistics can
begin to address these themes. Addressing the behav-
ioral avoidance of the airport and air travel by creating a
plan to desensitize the patient gradually to the idea of
air travel, traveling to the airport, and in time, purchas-
ing and taking a trip can help the patient regain confi-
dence. At the same time, you simulate fast heart rate,
shortness of breath, and dizziness by recreating those
symptoms in the office and teach the patient that they
learn to reassure themselves when symptomatic. Active
exposure to the panic-inducing situation is elemental to
the treatment, as is detailed record-keeping of different
physical symptoms and thoughts, with or without com-
bined medication. CBT can be very effective in helping
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a patient quickly gain control over what otherwise had
been crippling symptoms.
78. What do I do if I start to develop
anxiety about my treatment and/or
my doctor?
Patients commonly experience anxiety about their
treatments. These reasons range from reality to mani-
festations of the patient s anxiety.
Some of these issues have been addressed earlier (see
question 73, regarding inappropriateness of the thera-
pist). However, even with an entirely appropriate
therapist, anxiety can emerge as a function of the
treatment. This anxiety can be very painful and un-
comfortable, and one of the easiest ways for the mind
to trick itself is to attribute the cause of the discom-
fort to the therapist. One of the most common exam-
ples involves the increased closeness of the therapist
and the patient. As patients begin to discuss their
lives and their symptoms, it becomes clear why they
may not feel safe in the world, or they may come to
expect that the same traumas that have occurred be-
fore will happen again, this time in the room with
their therapist. Patients commonly become concerned
that the therapist will control them with medications,
make their sexual orientation homosexual, exploit
their financial resources, or take advantage of special
professional information (e.g., stock tips). These, as
general examples, show a fear of trusting the thera-
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