Methods for treating neuroses (psychotherapy)

Psychotherapy

There are many different types of psychotherapy.

In this section, we divide them into three general categories to examine in detail: Morita therapy, cognitive behavioral therapy, and other therapies.

Morita therapy

Morita therapy is a novel system of psychotherapy founded by the Japanese psychiatrist Shoma Morita in 1919.

It is widely considered an appropriate targeted treatment for what Morita termed shinkeishitsu — an anxiety syndrome in people with sensitive predispositions. Specifically, Morita therapy has proven highly effective in treating interpersonal phobia, agoraphobia, obsessive-compulsive disorder, anxiety disorders (panic disorder, generalized anxiety disorder) and hypochondriacal disorder, among other conditions.

In the years since its introduction, Morita therapy has extended far beyond neuroses, finding application in cases such as chronic depression, and in improving the mental health of cancer patients.

Morita therapy is founded on the view that while anxiety underlies neurotic conditions, this anxiety should not be interpreted as abnormal. Rather, anxiety exists on the other side of desire: the more intense the desire, the greater the corresponding anxiety. Thus, the human desire to live a full life also engenders its reverse, the fear of death, and that is the source of numerous anxieties. Seen in this light, anxious feelings are a normal feature of human emotion, but some people grow intensely self-aware of their anxiety. Morita therapy holds that since the duality of desire and anxiety is the natural state of mental existence, when we overlook positive desires and instead grow preoccupied with our fears and anxieties, and the battle to eliminate them, we end up developing a mental attachment to those very emotions, which only serves to exacerbate them. Morita described this vicious cycle as “psychic interaction.” It is the mental conflict that arises from a person’s impossible effort to intellectually alter what is real.

Morita therapy treats the neurotic conditions that develop from these internal contradictions by encouraging patients to develop a natural and unguarded stance, in which they can experience and embrace their reality as it is. Morita termed this attitude of accepting and living in the here and now arugamama. In order to restore arugamama, we simply leave our symptoms and our experience of anxiety as they are, without trying to fight, eliminate, or escape them. Shifting from preoccupation with our own thoughts to simply seeing what is, and what is in front of us, allows us to actively respond to what needs doing. Morita therapy applies these precepts in guiding patients toward constructive living and the practical action needed to achieve it.

Outpatient therapy is used in milder cases, while an inpatient treatment program can be implemented in more severe cases.

Cognitive behavioral therapy

In the cognitive behavioral therapy model, anxiety is seen as a response to trauma, in the form of situations or events perceived as frightening, threatening or dangerous. If a person was overcome with anxiety during a train ride, for example, the associated behavior – getting on the train – could become an object of fear, causing the person to avoid the behavior, and, in this case, eventually resulting in a chronic inability to ride again.

Behavioral therapy posits that this cycle of associative fear and avoidance learning is central to the maintenance of neurosis. Thus, the treatment is utilized for a range of conditions caused by such maladaptive behavior. Two representative methods employed in behavioral therapy are systematic desensitization and exposure therapy. Systematic desensitization involves deep relaxation techniques that first put the patient in a relaxed state. The patient is instructed to create a list of circumstances that will trigger anxiety, in a hierarchy beginning with stimuli that create the least fear. Then, they are asked to repeatedly imagine encountering each fear-inducing situation in ascending order, practicing the muscle relaxation technique as they go. When their fear and anxiety are calmed at the first level, they move up to the next stage in the hierarchy. The process is repeated until the patient can work through the list to the most anxiety-provoking situation.

Exposure therapy, which has found widespread application in recent years, is similar. Again, patients create a fear hierarchy, starting with the least unpleasant stimuli, and working up to their more challenging fears, as they grow more comfortable with each anxiety-provoking situation. However, in this case, the goal is to have the patients face directly whatever it is they fear and have learned to avoid. This direct exposure may last for a prolonged period of time, and may be used in conjunction with a “response prevention” component, where escape from the situation is rendered impossible. In a typical exposure and response prevention session, a patient with mysophobia (fear of germs or contamination) might be made to directly handle a doorknob, then prevented from washing their hands for some period of time.

Cognitive therapy, as originally developed by A.T. Beck and his contemporaries, was devised to treat depression. It employs cognitive restructuring to help patients to identify their depression. Specifically, patients are taught to recognize the irrational thoughts, inaccurate perceptions and negative internal dialogue that drive their condition. They can then replace these maladapted thought patterns (cognitive distortions) with a more realistic perspective. The Beck model has been revised over time, however. Today, treatment focuses on the cycle of mutual influence between thoughts, emotions and behaviors, and current therapy incorporates behavioral therapy techniques together with cognitive therapy into a hybrid approach. While cognitive therapy and behavioral therapy each have slightly different points of emphasis, over time they have developed as virtual twins. Thus, this area of therapy is now generically referred to as cognitive behavioral therapy.

Other therapies

Within psychotherapy, a variety of other treatment modalities are also available, such as psychosocial therapy, family therapy, group therapy, and autogenic therapy.

Family therapy seeks to change the family dynamic in order to reduce a patient’s symptoms and/or problematic behavior. It is widely employed to address eating disorders, for example, or adolescent problems.

Group therapy, as the name implies, is a form of psychotherapy that involves a group (ranging from a few people to more than a dozen) that meets to talk about common issues, such as interpersonal problems and inner conflicts. Group therapy is designed to help participants grasp the meaning of their circumstances and gain insight through the process of sharing their ideas with one another. Sessions may involve one or more therapists working with the group, but there are also other types of group therapy, such as the “self-help group” – a self-directed or peer-led gathering – where discussion between the participants themselves is the vehicle for mutual support and advice.

Autogenic therapy, designed by German psychiatrist Johannes Schultz, is a technique of mental exercises involving deep relaxation and auto-suggestion, derived from self-hypnosis. Using autogenic therapy, people can control their physical and emotional responses to psychological stress. Typically, a participant will perform the exercises three times a day, for about five minutes per session. The autogenic therapy method operates in several phases. Patients master one step before proceeding to the next stage of training, in a course that takes approximately two to three months. Autogenic therapy can be used effectively with patients dealing with insomnia and other psychosomatic and neurotic symptoms.