We have gone a long way from believing that the mind and the brain are two distinct systems, one being the repository of the soul, the other being purely a physical/mechanical mechanism. This duality has long ago been challenged and put to rest.

On the other hand, medical science has made such massive inroads in the understanding of brain function that many now have more or less come to the conclusion that there is no demonstrable distinction between the two entities, that what goes on in our mind is merely a physical response to electrical and chemical stimulations which can be tamed and corrected by physical or chemical means.

Whatever the true situation might turn out to be, it has become quite common to expect that doctors can currently or in the near future, provide a pill to cure all our problems, forgetting that psychological mechanisms may not only result from physical disorders, but may exaggerate our responses or even be the basic cause for them.

Over the years, psychological therapies have been proposed for various conditions. Perhaps most prominent among these has been psychoanalysis, first proposed by Sigmund Freud for neurotic patients, but later expanded, particularly in the US, to cover a whole conglomerate of real or imagined conditions.

While this technique, which was never scientifically tested, has now largely been debunked, there is still scope for psychological support for most patients with chronic disorders, support which the average medical practitioner has not got the time or the training to deal with.

Cognitive behavioural therapy (CBT) is one such psychotherapeutic technique which has been postulated as providing assistance to patients with conditions such as anxiety and depression, personality disorders, as well as other conditions including eating disorders or substance abuse. It has been proposed that it may also be of benefit in attention deficit hyperactivity disorder (ADHD), hypochondriasis, stuttering, etc.

CBT provides assistance to patients with anxiety and depression

CBT is based on the concept that the way we look at or respond to a symptom may actually influence or even aggravate our reaction to it. The role of the therapist is to weave out the various trends involved in this process and try to correct ‘errors in thinking’, including the tendency to ‘magnifying negatives and minimising positives’, and replace these with coping skills by teaching the subject a new way of dealing with these symptoms.

Unfortunately in Malta, we have very few practitioners qualified in this specialty. Like other alternative types of medicine, CBT should be considered not so much as a competitive with more classical medical therapy, but more as a complimentary type of approach to dealing with conditions for which currently there is no overwhelmingly successful modality of treatment.

A recent article published in the Journal of the American Medical Association (JAMA, December 25, 2013) recommends that CBT should be a first-line treatment (together with medication) for migraine in childhood.

Scott Powers, co-director of the Headache Centre, Cincinnati Children’s Hospital and chief author of this article, states: “Our trial demonstrates, for the first time, a clinically meaningful and durable improvement for youth with chronic migraine in a rigorous trial.”

In this study, children aged 10 to 17 years who suffered from severe migraine, underwent a course of CBT therapy. This resulted in halving the number of days with headache (from11.5 to 6.8 days per month).

Moreover, the results seemed to last after cessation of the treatment: patients still had significantly fewer attacks a year later compared with controls.

Particularly in chronic medical conditions, where long-term therapy is de rigueur, it is unlikely that dependence on one modality of therapy is going to be entirely successful. For better or worse, we are creatures where mind controls body in no uncertain way, and the way we react to disease may be a very important factor in our assessment of the severity of a particular condition.

Any procedure which is touted to make us perceive that a glass is half-full rather than half-empty should be rigorously and scientifically tested, and if proved to be successful, added to our constantly enlarging armamentarium.

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