cognitive behavioural therapy

Obesity therapy can help family too!

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When obese people lose weight with behavioural therapy,it helps their families slim down too.

When obese people lose weight with behavioural therapy,their family members may grow a bit slimmer as well,according to an Italian study.

The study,published in the Journal of the American Dietetic Association,found that family members of the obese patients in a cognitive behavioral therapy (CBT) program also showed some changes for the better.

One option for managing obesity,CBT focuses on changing people’s thoughts and attitudes to eating and other lifestyle habits,and giving them practical ways to make improvements.

“CBT for weight loss positively influences the lifestyle habits of family members of participants,reducing energy intake and promoting a more favorable attitude toward physical activity”,wrote senior researcher Giulio Marchesini.

Marchesini and his colleagues surveyed the family members of 149 obese patients going through the CBT program at the University of Bologna,which consisted of 12 to 15 weekly group meetings.

Six months after their relatives started the program,family members,mainly spouses and adult children,were eating better. They cut more than 200 calories from their daily intake,ate a bit less fat and refined carbohydrates,and ate a bit more fruit.

It translated into a weight loss of just under 1 kg (2.2 lb),on average. But the 35 relatives who were obese themselves lost an average of 2.7 kg (6 lb),with seven losing enough to become officially overweight instead of obese.

“One reason”,Marchesini said,“could be that family members made positive changes to help the person in therapy,such as ridding the kitchen of sugary,fatty temptations.”

Even more likely was that the person in behavioral therapy instituted healthy changes at home,since 101 of the 149 patients were women — which meant,in Italy,that they were more likely to be in charge of meal planning.

“I do not know how much this possibility might translate into different cultures,but this is definitely the case among Italian families”,Marchesini added.

Researchers did note that since they tried to survey almost 500 family members but only got responses from 230,many of the responses might be from the more motivated and supportive families to start with.

But other studies have also noted that weight-loss treatments can have a positive impact on family members as well.

In October,surgeons at Stanford University found that the obese relatives of patients who underwent obesity surgery also lost weight in the year following the procedure,probably due to lifestyle changes for the whole family.

Talking therapy ‘eases hypochondria’

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An anxious patient
Health anxiety can cause terrible suffering

Cognitive behavioural therapy is more effective than standard care for people with hypochondria or health anxiety, say researchers writing in The Lancet.

In their study, 14% of patients given CBT regained normal anxiety levels against 7% given the usual care of basic reassurance.

It said nurses could easily be trained to offer the psychological therapy.

Between 10% and 20% of hospital patients are thought to worry obsessively about their health.

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Health anxiety is costly for healthcare providers and an effective treatment could potentially save money”

Prof Peter Tyrer Imperial College London

Previous studies have shown that CBT, which aims to change thought patterns and behaviour, is an effective treatment for other anxiety disorders.

But there is a shortage of specialists trained to deliver CBT, and as a result waiting lists can be long.

In this study, 219 people with health anxiety received an average of six sessions of cognitive behavioural therapy while 225 received reassurance and support, which is standard.

After periods of six months and 12 months, patients in the CBT group showed “significantly greater improvement in self-rated anxiety and depression symptoms” compared with standard care, the study showed.

There was also a particularly noticeable reduction in health anxiety in the CBT group straight after treatment began.

The therapy was delivered by non-CBT experts who had been trained in only two workshops.

Study author Prof Peter Tyrer, head of the Centre for Mental Health at Imperial College London, said the results showed that hypochondria could be successfully treated, in a “relatively cheap” way, by general nurses with minimal training in a hospital setting.

WHAT IS CBT?

Cognitive behavioural therapy is:

  • a way of talking about how you think about yourself, the world and other people
  • how what you do affects your thoughts and feelings

CBT can help you to change how you think (cognitive) and what you do (behaviour).

Unlike some other talking treatments, it focuses on the “here and now” instead of the causes of distress or past symptoms.

Reducing the anxiety levels of 14% of the CBT group might not seem a high figure, he said, but these were often people with serious problems who had sometimes spent thousands of pounds on private health assessments because of fears about their health.

“Health anxiety is costly for healthcare providers and an effective treatment could potentially save money by reducing the need for unnecessary tests and emergency hospital admissions,” Prof Tyrer said.

Writing about the study in The Lancet, Chris Williams from the University of Glasgow and Allan House from the University of Leeds, said the findings were “intriguing” but translating them into services was “problematic”.

They also questioned the cost-effectiveness of screening patients for health anxiety and CBT.

They wrote: “Health anxiety is only one of the problems noted in medical outpatients – depression, hazardous alcohol use, poor treatment adherence, and other forms of medically unexplained presentation all press for recognition and intervention.

“To develop multiple parallel services makes no sense, especially since the common emotional disorders overlap substantially.”

But Prof Tyrer said health anxiety was a hidden epidemic that required the correct treatment, not just reassurance.

Behavioral Therapy Prevents Recurrences of Cardiovascular Events in Trial

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Cognitive-behavioral therapy, with a focus on stress management, is associated with fewer recurrent cardiovascular events in patients with coronary heart disease, according to an Archives of Internal Medicine study.

Some 350 adults who had recently had a coronary heart disease event were randomized to either usual care alone or usual care plus cognitive-behavioral therapy. Psychologists and nurses led 20 2-hour group sessions over 1 year. The therapy emphasized ways to reduce daily stress, time urgency, and hostility.

Over 8 years’ follow-up, the intervention group experienced 41% fewer first recurrent cardiovascular events and 45% fewer recurrent myocardial infarctions, compared with the control group. All-cause mortality did not differ significantly between groups.

The authors speculate that the CBT group may have reduced their behavioral and emotional reactivity, “which would lead to less psychophysiologic burden on the cardiovascular system.” They estimate that roughly 10 people would need to be treated in order to prevent one cardiovascular event.

Source:Archives of Internal Medicine