Care trumps pills for peace of mind

CHENNAI: Government employee Sudheer Ramakrishnan, 37, was a stickler in many ways. He would step out of his house with a box containing precisely nine betel leaves and one painkiller. Those, he believed, relieved him of his frequent migraines.

One day, on his way to work, he was shocked to find that he had only seven leaves in the box. He asked the bus driver to stop the vehicle but when the driver refused, he turned violent. “Seven leaves instead of nine,” he shouted.

A psychiatrist diagnosed Ramakrishnan’s problem as obsessive compulsive disorder (OCD) and put him on medication which left him drowsy and weak. But Ramakrishnan recently discovered cognitive behaviour therapy (CBT) when he visited a new psychiatrist. The doctor found that his frequent headaches were linked to panic attacks he had as a child in the dark.

The psychiatrist put him through a series of goal-oriented and systematic procedures that rid Ramakrishnan of the connection with the ‘dark’ memory from his childhood. Ramakrishnan now goes to work without the betel leaves and painkiller.

Welcome the new shrink, who does not prescribe medicines. A growing number of psychiatrists in the city are using CBT instead of drugs to cure psychological problems.

Experts say the development will benefit mental healthcare because psychiatrists in the country have all but abandoned talk therapy, the form popularised by Sigmund Freud, and embraced multiple drug treatment. The drugs they prescribe include sedatives, antipsychotics and inhibitors of dopamine, a chemical that acts as the brain’s neurotransmitter. The doctor spends much less time with each patient, and the medicines only stupify patients.

On the other hand, say psychiatrists, CBT is a psychotherapeutic approach that addresses emotional stress and maladaptive behaviour without the ill-effects of drugs. “It helps tone down aggressiveness, fight fears and depression,” says Dr B S Virudhagiri Nathan, director of CARE Institute of Behavioral Sciences, Chennai.

The therapy has been found to be effective for mood swings, psychotic disorders, phobias and attention deficit hyperactivity. “Through conversation and interactive audio-visual tools, CBT specialists help patients think positively,” says Dr Nathan, who runs a CBT training programme in the city in collaboration with University of Manchester.

Psychologists say teachers, doctors and parents should be trained in CBT, which evolved since the 70s. “The training helps when dealing with children who may have fears,” says Dr Deborah McNally, acting director of Salford cognitive therapy training centre, University of Manchester.

However, the city has few CBT specialists. “Our focus should be to teach CBT to counsellors and psychologists, teachers and parents,” says Dr S Karunanidhi, head of the department of psychology, Madras University.

Nearly 7% of India’s population suffers from some form of mental disorder, and doctors estimate more than 7 lakh people in Tamil Nadu require periodic psychiatric care.

Latest cure

What is CBT?

Cognitive behaviour therapy focuses on SUBHEAD changing HERE illogical thought patterns that trigger mental disorder

Symptoms of OCD

Obsessive compulsive disorder is an anxiety disorder characterised by unwanted thoughts and repetitive behaviors, which are often irrational. For example, repeatedly washing of hands fearing contamination, repeatedly checking if the doors are locked and being obsessed with order and symmetry

What does the therapy entail?

The therapist follows the ‘ABC’ pattern – activating event, beliefs about the event and consequences. The therapist traces the event that triggered the disorder and the client’s immediate interpretation of the event, which can be rational or irrational. The train of thoughts and the behavioural disorder triggered by the event is also assessed by the therapist, who then strives to help the client challenge their thought patterns and beliefs through intensive counselling

Symptoms of behavioural disorders among children

Lack of concentration, fear of going to school, temper tantrums, hyperactivity, irrational fears, frequent defiance, low self-esteem

Symptoms of depression

Mood swings, irritability, loss of appetite, loss of weight, fatigue, absent-mindedness, lack of libido, sleeplessness, frustration, suicidal thoughts and magnifying vague physical pains