Mental Health: Thinking man's treatment

Move over Freud. Think twice about the Prozac if it is possible to consult a trained cognitive behavioural therapist instead.

Cognitive behavioural therapy is as effective at treating anxiety, depression, substance abuse and other mental disorders as drugs and psychotherapy, major studies and meta-analyses show. For certain mental illnesses, combining CBT with medicines work best.

CBT focuses on modifying habitual thoughts and behaviours to improve people's coping skills. In South Africa, roughly one in five South Africans is, or will be, living with depression or other mental illnesses.

Dr Stefan Hofmann, president of the International Association of Cognitive Psychotherapy, said in Johannesburg: "We have a here-and-now focused approach on what the problem is and how to help. What we care about is the maintaining factors and triggers for behaviours. We don't care much about the past."

This short-term therapy is more affordable than other treatments.

"It's the first line of treatment for most mental disorders in many developed countries. People here need to demand it," said Hoffman, speaking at a South African Depression and Anxiety Group/Discovery Mental Health Summit last week.

"We judge ourselves and base our success on whether [patients] feel better. Insight is not enough," said Hofmann, a psychology professor at Boston University.

Therapists trained in CBT assist patients to work out alternative beliefs and reactions to triggers in their lives. The results can be dramatic, particularly for anxiety disorders.

Khanya's life has swung from one of social isolation to speaking at the mental health summit. A good-looking scientist from King William's Town, Khanya, 33, couldn't talk to people in the past without distress.

"I was fearful. I would panic or freeze, or avoid people," he said. As a boy he was bullied and teased. When he studied microbiology at Wits University and his post-grad degree at Rhodes he found interacting with others stressful.

"Luckily all these years I never abused substances and never considered suicide. I read a lot of self-help books," he said.

A year ago he started CBT, backed up by medication and support groups. Now he's made friends, is ''working on" his first ever relationship and is open with strangers.

He said: "In the black community there is a lot of stigmatisation. At first I was reluctant to explain my situation to my family but I showed them videos and they understood."

Hoffman said CBT is an evolving therapy and there are many strategies within this broad model which can, for instance, be tailored to take into account a person's cultural background.

SA Depression and Anxiety Group 0800-212-223 or sadag.org