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What is Cognitive Behavioral Therapy?

There is yet another of those disconnections between the Europeans and our own medical profession. You would always hope that doctors would be doctors no matter where they were in practice. Yet even when you put aside Sarah Palin’s paranoid allegations about European hospitals as death camps, there are a number of key disagreements between the two groups of professions. The one we should be most worried about is that the European insistence on evidence-based practice is rejected in the US.


In the US, the FDA licenses drugs or medical devices, and then leaves it to the market to decide how it should all be used. The Europeans believe that all treatments and therapies should be tested. If there is no evidence a particular approach is effective, the national or international regulator issues a directive. The effect is to deny this treatment funding from the public purse. It’s always open to individuals to have their own private health insurance cover non-approved treatments, or they can pay for it out of their own pockets. In the US, doctors can decide to do whatever they like with what’s available. All they care about is whether they can charge patients for the treatment. Obviously, it’s bad for business if too many patients die, but this can usually be hushed up. Unlike Europe, American hospitals do not publish survival and death rates by department. In a perfect world, you would always have access to this information before deciding whether to trust a hospital.


Anyway, the latest disconnection covers Cognitive Behavioral Therapy (CBT). This is increasingly routine in Europe but still rare in the US. This is explained by the relative costs. One specialist doctor sees a given number of billable patients an hour. A CBT specialist may spend an hour with one patient deciding how best to treat him or her. One-to-one therapy is considered the most effective. Every major piece of published research confirms CBT as more effective than standard medical approaches to treatment. So the fact you may spend more money today on one patient today means you may not need to treat that patient again for months or years. Now you understand why this is not popular in the US.


“Cognitive” means you teach the patient about the physical and emotional problems. Control over pain comes from understanding more about it. The “behavioral” means you look carefully at how the patient moves when performing basic tasks. The “therapy” then devises better ways of performing those routine tasks. It teaches basic coping strategies so you move within the physical limitations with less pain. Exercises and activities are designed to improve your general mobility. Joints are eased and muscles toned up. The idea is to give you a mixture of physical strategies and relaxation techniques to give you control over the pain and the emotions associated with it. This does not deny a place for Tramadol and the other painkillers. But with longer use, there’s a real risk of dependence. You can keep a small supply of Tramadol to hand just in case the pain unexpectedly grows more intense. Otherwise, CBT teaches you to live without reliance on routine medication.