Appu (name changed), now aged 19, was a very violent child. He regularly beat up classmates to within an inch of their lives. He also had severe learning disability. Appu's parents were at their wits' end. This is when Ravi Samuel, who practices cognitive behavior therapy (CBT), stepped in. Today, Appu is stable and holds his own in college.
Samuel is a Cognitive Behavior consultant trained in London. CBT has gained wide currency in the West in the last decade or so, but has yet to find a strong foothold in India, due mainly to the fact that training is available only abroad and costs are prohibitive. Samuel is keen on popularizing CBT in the country because his experience shows that the therapy works very well here.
CBT holds that distorted thought processes about stimuli - which in turn cause distressed emotions - are responsible for psychological distress. It aims to help the client become aware of the thought distortions, and of the behavioral patterns reinforcing it. Unlike traditional therapy, where the therapist is essentially the wise listener, the CBT therapist is 'active' and participates in solving the client's problem, helping him/her set treatment goals. "Basically, CBT is a way of getting patients to look at stressful situations from a different perspective," explains N Rangarajan, who holds an MRC Psych degree and runs The Clinic, Chennai, where Samuel practices.
A combination of cognitive therapy and behavior therapy, the effectiveness of CBT in treating various conditions - including chronic anxiety, insomnia, eating disorders, difficulty in establishing and sustaining relationships, job- and school-related problems and substance abuse - has been well researched and clinically proven by hundreds of studies. It started gaining popularity around the 1960s and '70s and its track record helped it to become widely used.
CBT is particularly useful for women, especially if they consult a therapist in the initial stages of a problem. If caught early, problems can be treated without recourse to medication. Medicines used to treat such problems often have a sedative effect, preventing the patient from performing daily activities, because of which women hesitate to seek treatment, says Rangarajan. Most mental problems which women are prey to stem from common factors, like verbal or physical abuse. These problems are aggravated by the educational and professional avenues that women take up now, adding burdens on one hand without lessening the load on the other, he says.
CBT has proved effective and less time-consuming than traditional treatment methods like Freudian Analysis. But early treatment is important. "If, as is often the case, help is sought only when the patient becomes dysfunctional, then the treatment has to be a mix of CBT and medication," says Rangarajan.
"A person's response to a situation depends on how he looks at it, processes it, interprets it and emotionally reacts to it," says Samuel. When emotional reaction goes haywire, it can affect learning, inter-personal relationships and professional competence.
Take the case of the CEO of a big company who is so low in self-esteem that he cannot delegate and ends up doing even mundane tasks. As a result, he is constantly stressed out. CBT is working wonders with him too; Samuel's goal is to tackle the root problem and raise the man's self-esteem.
Faulty thought processes is another danger factor. People who are prey to it skip steps in thinking - leading to wrong conclusions. For example, merely hearing of a couple of accidents can lead to travel phobia, where the patient believes that an accident is inevitable if s/he travels. Obsessive Compulsive Disorder - where a patient performs routine actions
like washing hands in a repetitive cycle - and depression are other common problems the world over; and for all these, CBT provides effective help and gives maximum results, assert Samuel and Rangarajan.
So how does CBT work? The therapist helps the client learn to test his/her thoughts and assumptions by checking them against reality. Mirroring and challenging thoughts are two techniques used. In the first, the therapist copies the abnormal reactions of the patient - often an eye-opener that puts the patient on guard against such actions. In the second, faulty thought processes are challenged. Patients are made to see the lack of logic in their assumptions, resulting in weaning them away from such beliefs.
In Appu's case, Samuel found that the child's learning disability exposed him to the ridicule of his classmates and uninformed staff members at school. His defence mechanism was to emulate the gory video games that he spent much time on. Samuel's first step was to impose a total ban on the games. Then he set about tackling the psychological problems using CBT.
The hyperactive child would refuse to sit still though, and Samuel had to conduct his therapy literally on the move - on long walks or at a cricket match. He tackled specific goals, as CBT dictates. For instance, the notion that dyslexia prevented him from performing well academically, leading to a refusal to put in any effort at studies, was gradually removed by urging him to put in some effort, the positive results acting as encouragement.
Samuel has worked with Appu for six years now, taking him through school to college. "He still needs monitoring because the problem could manifest in different ways in reaction to different situations," says Samuel. But the worst is over, thanks to CBT.
Due to many factors, including the stigma that dogs mental illness, and financial implications, both men and women hesitate to seek treatment. A Tata Consultancy Services website offers free treatment for various illnesses over e-mail. For those silently suffering from psychological problems, it is a godsend. Samuel, consultant therapist for the website, treats e-mail correspondents using CBT. He has been treating clients over the Internet for the last one year.
Many of his patients are NRIs, who are glad of a therapist who understands the Indian psyche and problems specific to Indian culture, he says. The patient mails him, outlining his/her problem, and he offers advice and exercises in reply. If the therapy is carried out intensely and frequently, it can be as effective as one-to-one therapy, says Samuel. Of course, face-to-face meetings are preferable where possible, he acknowledges.
Treatment over the Internet, possible only with CBT, has obvious advantages, like the fact that it can be conducted without the knowledge of even close relatives. Other forms of therapy involve more of analysis and are dependent on one-to-one meetings between the therapist and the patient. They are also more wide in range and scope as far a goals go, while CBT takes up goals one at a time and deals with each specifically, making communication over the Net easier. It also involves behavioral exercises which can be set out over e-mail. However, it has not been taken up in earnest, says Samuel, because it is not a paying proposition for the therapist.
Samuel has created a website (www.UrClinic.com), to be formally inaugurated by Union Minister Dayanidhi Maran next month. It will offer free treatment to those in psychological distress. So, those who are suffering in silence, take heart help is just a mouse-click away.