Dr. Mark R. Thelen, PSYD, LP, LMFT

CBT is one of the most widely studied forms of psychotherapy, and it has been shown to be extremely effective for a variety of mental illnesses. Some of the issues that respond well to CBT include mood disorders, personality disorders, eating disorders, substance abuse, sleep disorders, and psychotic disorders. In some cases, CBT has been shown to be as effective or even more effective than medication. One of the interesting things that the scientific study of CBT has shown is that CBT actually changes the way the brain works, physically improving its function.

CBT differs from traditional psychotherapy in a few key ways. One of the most important distinctions is the emphasis on the power and responsibility of the patient in CBT. The patient will be encouraged to be the one asking the questions in CBT therapy, and most patients are assigned homework to complete outside of therapy sessions. There is a concept in CBT that everyone has power the power to change how they feel, even if they cannot control the situation, and this can be very empowering for patients. Because of this power shift, the therapist-client relationship is not as critical to success in CBT as it is in other modes of therapy. Patients should still get along well with their therapists, but they do not need a deep, dependent emotional connection to them. Finally, because CBT often treats a specific issue or problem, it is usually shorter in duration than traditional therapy. While some therapies may continue for years, CBT lasts on average just 16 sessions.

Each family member can be affected by an issue in an individual and unique way, typically depending on age, maturity, and involvement. This means that family issues are often inequitable, with one or more family members bearing a disproportionate weight of the problem. A frequent example is parental divorce. While both parents may appreciate the immediate relief, divorce can rapidly threaten a developing child's sense of stability and self-confidence. Similarly, a mother who is subject to domestic abuse may conceal the issue in order to shield her children from her distress. In some cases, family issues are generational; a father may cause residual guilt or disagreements from his childhood to carry forward to his own son. While each family's experience is unique, common family issues can include:

• Financial disputes
• Divorce and separation
• Abuse and violence
• Narcissistic caretaker(s)
• Death
• Infidelity and relationship issues
• Sibling rivalry
• Religious and cultural conflicts
• Lifestyle disagreements
• Severe physical illness
• Mental health issues
• Neglect
• Retirement and older adulthood
• Unsafe or unstable household environment

Some family issues are inevitable – such as retirement and minor lifestyle disagreements – while others can be unexpected and dramatic. Unsafe household environments, abuse, and neglect can lead to severe trauma and intervention by social services or law enforcement.

Most common family issues can be addressed through therapy with one or more family members. Family therapy involves sessions led by a licensed mental health therapist. These sessions often include family discussion, resolution strategies, and other activities to promote family harmony. Another form of treatment for family issues is couples counseling, in which a couples counselor can help spouses communicate and employ problem-solving techniques to improve the strength of their relationship. For children, specialized child therapy can help children and adolescents manage and overcome family issues with age-appropriate methods.

Some people find individual therapy or counseling beneficial in resolving family issues, especially for those who are unable to attend family therapy with other family members. Therapists may encourage the creation of family boundaries. At an extreme, therapy may cause an adult to come to the conclusion that communication with a narcissistic parent must stop in order to preserve mental health and wellbeing.

• Accidents
• Sexual or physical assault
• Combat
• Childhood abuse
• Domestic abuse
• Natural disasters
• Torture and kidnapping

People who have experienced significant and repeated trauma are more likely to develop PTSD. Those who have disorders like depression or a family history of depression may also be more prone to PTSD. PTSD symptoms typically begin one month to one year following the traumatic event. There are four main categories of PTSD symptoms:

• Intrusive memories: Intrusive memories include unwanted memories, feelings of reliving the traumatic event, distressing nightmares, and emotional disturbances from triggers (signs that serve as reminders of the traumatic event). Intrusive memories can lead to elevated heart rate, anxiety, combativeness (fight), withdrawal (flight), and many other responses.
• Avoidance: Avoidance is an attempt to avoid speaking or thinking about an upsetting event. People with this response might also try to avoid certain people or locations that prompt memories of an event.
• Changes in physical and emotional reactions: These changes may include difficulty sleeping, hypervigilance, self-destructive behavior, and feelings of guilt and irritability.
• Alterations in cognition and mood: Alterations can cause negative self-beliefs, depression, shame, and detachment from others.

The intensity and frequency of these symptoms can vary over time. PTSD symptoms may suddenly return after disappearing for years. Many PTSD patients find treatment helps to gradually reduce their symptoms over time.

The most common treatments for PTSD are psychotherapy and oral medications. Psychotherapy for PTSD can include cognitive therapy (therapy to change thought patterns), exposure therapy (therapy to confront memories of the traumatic incident) and eye movement desensitization and reprocessing therapy (EMDR). EMDR integrates exposure therapy with guided eye movements to help patients confront and process their trauma. Certain oral medications may help with PTSD, such as antidepressants and anti-anxiety medications. Self-care, support groups, and relaxation may also benefit those with PTSD.

The path to overcoming PTSD can be long and challenging and people with PTSD can benefit greatly by seeking professional treatment from a mental health care provider. Treatment can reduce PTSD symptoms, provide essential coping strategies, and improve one's quality of life.