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Mental health, fast and cheap

A low-cost treatment may be able to cure what ails your psyche.

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By Patricia B. Gray, Money Magazine

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(Money Magazine) -- What if you could get out from under what's been bothering you - anxiety, depression, low self-esteem - in three or four months for about $320? That's the promise of cognitive behavioral therapy (also called cognitive therapy or CT).

It's an intense, short-term treatment that helps you recognize and change harmful thoughts and behaviors. Peter G., 62, a former San Francisco broker and a 30-year veteran of conventional therapy, says it "worked in a very dramatic fashion" for him. "I changed my life within a couple of months. I'd been dealing with depression, panic attacks, issues of abandonment. CT helped me put that all in the past."

Beloved by insurance companies for its low cost and by patients for its fast results, CT is coming on like gangbusters. Some 50% of psychiatrists now use it in their practice, according to a 2006 study. They, as well as psychologists and social workers, believe it is effective in treating a broad array of conditions, including depression, anxiety, phobias, obsessions, compulsions and even addictions.

Unlike with conventional talk therapy, in which patients may get treatment for years, cognitive therapy's adherents claim that in most cases it can provide relief in about 16 sessions. "CBT isn't open-ended," says Aldo R. Pucci, president of the National Association of Cognitive-Behavioral Therapists. "We expect you to graduate from therapy, and we hope never to see you again."

Why shorter is cheaper. You'll pay about the same rate for cognitive therapy as for traditional therapy - $50 to $185 an hour. But most employer health plans limit you to 32 visits a year, and many have you pay higher deductibles and co-pays for mental-health treatment than you would for ordinary medical care.

Because CT takes only about 16 sessions, you're likely to be reimbursed for most of the costs under almost any health plan. If your insurer pays 80% of each $100 visit, your total outlay would be only $320.

CT can also be less expensive than drug therapy, which three out of four adults prefer for their mental maladies, says David Whitehouse, M.D., a medical director of OptumHealth Behavioral Solutions, a unit of United Healthcare. But with many of the newer brand-name pharmaceuticals like Cymbalta or Paxil, you could find yourself making co-pays of $40 to $50 a month for years on end.

When relief can be fast. Several recent studies have found that CT's quickie approach can be as effective as medication for certain conditions. The American Journal of Psychiatry recently published a study of people with mild to moderate depression whose symptoms were alleviated after cognitive therapy; MRI scans of their brains showed changes in the two regions associated with depression. Another study found CT to be much more effective than a drug commonly used to treat insomnia in older adults.

What to expect on the couch. No more waxing on about childhood traumas on a psychiatrist's divan. Cognitive therapy requires your active participation. Your therapist gives you the tools to overcome negative or irrational thoughts, including relaxation and breathing exercises that help allay anxieties and fears. Ultimately, you learn to be your own therapist.

Says Peter G.: "When I find myself awake and ruminating over some problem at 2 a.m., I grab a sheet of paper, analyze my troubling thoughts and come to the conclusion that everything isn't perfect in the universe but I can be happy."

Your therapist will likely assign reading between sessions, and you may be required to keep a daily log or map out a plan for handling situations that spark anxieties. "Like learning how to tie your shoe or ride a bike, cognitive therapy is based on practice, practice and more practice," says Michael R. Edelstein, a San Francisco clinical psychologist.

When faster isn't better. CT is no panacea. Many patients won't take the trouble to do homework or prefer the simplicity of drugs. Some mental-health experts believe that severe illnesses such as schizophrenia, chronic, relapsing depression and serious personality disorders require drug treatments to treat. But studies have shown that CT is effective in reducing symptoms of such illnesses.

How to find a therapist. Check the websites of the Academy of Cognitive Therapy (academyofct.org) and the National Association of Cognitive-Behavioral Therapists (nacbt.org) for CT practitioners in your area. If you can't find one in your health plan, you may want to go outside your network because the CT costs so much less than traditional therapy.

Once you find a therapist, interview him or her over the phone. You can ask how he or she would handle your problem and how long therapy will take. The answer should be between eight and 20 weeks. Edelstein goes so far as to suggest that you ask for a money-back guarantee. Finally, don't be a patient patient. If you don't see some improvement in three or four sessions - and you're doing your homework diligently - find another therapist.

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