[5] When Should You Start Cognitive Behavioral Therapy? / Gauging Recovery Levels
▼Full Version of the Main Video
Timing for Starting and Stopping Cognitive Behavioral Therapy (CBT)
• 認知行動療法（CBT）を開始、中止するタイミング
■How Much Has the Patient Recovered?
So, how much of this person's cognitive ability, their ability to think logically, has recovered? And, to what extent do they possess these abilities in the first place? It's difficult to measure how much physical strength, mental recovery, and motivation this person currently has.
This is something that's hard to understand without experience.
Moreover, I think you can't understand it unless you've seen people ranging from severely ill to mildly ill.
In other words, people who work in inpatient wards, or psychologists working in inpatient wards.
Also, people with milder conditions. People who come to clinics near train stations, those with high motivation for treatment—I think you can't understand it unless you've seen a wide range of people, from severely ill to mildly ill.
When I was younger and working at university hospitals and places like that, I only saw severely ill patients, so I didn't know which patients were suitable for counseling.
If everyone has mild symptoms, you might think everyone can do it, so you need to look at the whole picture.
Some people improve with cognitive behavioral therapy, while others don't, or it's not a good fit for them. You need to see all sorts of people to understand the degree of difficulty.
Doctors see 40-50 patients a day, so they see a lot of patients and have a good intuitive understanding of the variation, from severe to mild.
However, psychologists, school counselors, and other social workers—those with less experience—have less experience in this area, so it's probably difficult for them to judge.
That's why experienced people need to assist them.
The guideline I recommend is to be mindful of this:
In other words, it's about which stage you're at, as I often explain.
When you sit in a Zen posture, close your eyes, and take deep breaths, I suggest using 5 minutes as a guideline.
Take deep breaths like this, close your eyes, and take deep breaths. It's relaxing, isn't it?
You think about something in your head. But then you tell yourself, "No, no," and return to your breathing.
Even while returning to your breathing, if you start thinking about something again, you return to your breathing.
When doing this kind of Zen meditation, people with severe depression can't even do it for 5 minutes.
They suddenly remember things.
They start thinking about trauma, or they're overwhelmed with anxiety, and they can't stay calm. In such cases, cognitive behavioral therapy can't even begin. So, it's about resting, obeying, and praising. I think it's best to start by praising them, and focus on praising them.
When they can do it for more than 5 minutes, it's a term of learning and confrontation, so you can start something similar to cognitive behavioral therapy.
However, doing full-fledged behavioral therapy is quite difficult.
The third phase is when you say, "Let's try this next."
That is, whether they can do 30 minutes of Zen meditation.
It's okay to start behavioral therapy even if you can't sit for 30 minutes, but I think people who can't sit in a chair for 30 minutes or can't ride a train for an hour probably aren't ready for behavioral therapy yet.
I think it's more about pointing out cognitive distortions or something like that.
▼Main channel "Psychiatrist Explains Mental Illness Channel" is here:
/ @masudatherapy
This channel is a YouTube short video channel of "Psychiatrist Explains Mental Illness Channel".
【Reference】
Ministry of Health, Labour and Welfare, Everyone's Mental Health https://www.mhlw.go.jp/kokoro/
Kaplan, Clinical Psychiatry Textbook, 3rd Edition
#mentalhealth #WasedaMentalClinic #psychiatry #worries #mentalillness #depression #developmentaldisorders