treatment about what CBT is and how, based on that, it could not be
applicable to treating a biologically based disorder except to assist
with comorbidities such as anxiety or depression.
I agree that, based on typical descriptions, it makes little sense to
expect a CBT based approach would be of benefit in a medical condition.
It appears this way, however, because the definition being used does not
fully describe what is being done by many who work with CBT based
approaches in behavioural medicine practice. Of course CBT can be used
to assist with comorbidities, but it can also be deployed directly as a
part of treatment for a chronic disease where there are components of
pain, fatigue, inflammation and mood change and sleep disruption
implicated in the disease process.
The CBT used in psychoneuroimmunological interventions is not limited to
changing 'irrational beliefs'. For instance there are demonstrated
changes in inflammatory cytokine production related to reduced
threat-based responding. CBT is currently being applied to treating
inflammatory bowel disease for this reason. Guided imagery used to
facilitate sensory-motor neural reprocessing in an affected body part is
demonstrating benefit in CRPS related pain problems. There are a host of
similar examples where CBT is used to address things other than beliefs.
The view that all those involved in CBT based treatments accept the idea
that irrational thinking has lead to a somataform disorder in a patient
who has a chronic disease is entirely unfortunate. There is little
support for a mind-body split in any area of health. The idea that
problems are either entirely physical or psychological cannot endure any
sustained scrutiny. For instance, there is evidence that a pathogen
initiated cytokine response can be exacerbated and maintained by
psychological factors (eg; Brydon, et al. (2009) Brain, Behavior, and
Immunity, 23, 217-224). Clearly, this demonstrates that having ongoing
symptoms following an infection is not evidence of a somataform disorder
but of an extended sickness response. A number of the issues that can
exacerbate and maintain a sickness response are absolutely susceptible
to behavioural interventions. None of this requires that a patient had
any kind of psychological or psychiatric disorder.
Lastly, and most importantly, there is no need for medical and
behavioural interventions to compete. The best possible benefit to
patients will be served by collaborative multidisciplinary treatment
approaches which address the complexity of the presenting disease
processes. It is essential to improved treatment that both health
professionals and patients are encouraged to abandon dualistic
perspectives which result in the politicising of health care. This is
important for the management of health disorders generally and for
chronic health problems in particular.