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Cognitive behavioral therapy CBT is a psycho-social intervention [1] [2] that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Though it was originally designed to treat depression , its uses have been expanded to include the treatment of many mental health conditions, including anxiety , [5] [6] substance use disorders, marital problems, and eating disorders.

CBT is a common form of talk therapy based on the combination of the basic principles from behavioral and cognitive psychology. Instead, CBT is a “problem-focused” and “action-oriented” form of therapy, meaning it is used to treat specific problems related to a diagnosed mental disorder.

The therapist’s role is to assist the client in finding and practicing effective strategies to address the identified goals and to alleviate symptoms of the disorder.

When compared to psychoactive medications , review studies have found CBT alone to be as effective for treating less severe forms of depression, [15] anxiety, post-traumatic stress disorder PTSD , tics , [16] substance use disorders , eating disorders, and borderline personality disorder.

Precursors of certain fundamental aspects of CBT have been identified in various ancient philosophical traditions, particularly Stoicism.

Beck ‘s original treatment manual for depression states, “The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers”. The modern roots of CBT can be traced to the development of behavior therapy in the early 20th century, the development of cognitive therapy in the s, and the subsequent merging of the two.

Groundbreaking work of behaviorism began with John B. Watson and Rosalie Rayner ‘s studies of conditioning in During the s and s, behavioral therapy became widely used by researchers in the United States, the United Kingdom, and South Africa. Their inspiration was by the behaviorist learning theory of Ivan Pavlov , John B. Watson , and Clark L.

Wolpe’s therapeutic efforts were precursors to today’s fear reduction techniques. At the same time as Eysenck’s work, B. Skinner and his associates were beginning to have an impact with their work on operant conditioning. The emphasis on behavioral factors constituted the “first wave” of CBT.

One of the first therapists to address cognition in psychotherapy was Alfred Adler. Notably, his idea of basic mistakes and how they contributed to creation of unhealthy or useless behavioral and life goals. Around the same time that rational emotive behavioral therapy was being developed, Aaron T. Beck was conducting free association sessions in his psychoanalytic practice.

It was these two therapies, rational emotive therapy, and cognitive therapy, that started the “second wave” of CBT, which was the emphasis on cognitive factors. Although the early behavioral approaches were successful in many of the neurotic disorders, they had little success in treating depression. The therapeutic approaches of Albert Ellis and Aaron T. Beck gained popularity among behavior therapists, despite the earlier behaviorist rejection of mentalistic concepts like thoughts and cognitions.

In initial studies, cognitive therapy was often contrasted with behavioral treatments to see which was most effective.

During the s and s, cognitive and behavioral techniques were merged into cognitive behavioral therapy. Pivotal to this merging was the successful development of treatments for panic disorder by David M.

Clark in the UK and David H. Barlow in the US. Over time, cognitive behavior therapy came to be known not only as a therapy, but as an umbrella term for all cognitive-based psychotherapies.

This blending of theoretical and technical foundations from both behavior and cognitive therapies constituted the “third wave” of CBT. Despite the increasing popularity of third-wave treatment approaches, reviews of studies reveal there may be no difference in the effectiveness compared with non-third wave CBT for the treatment of depression.

Mainstream cognitive behavioral therapy assumes that changing maladaptive thinking leads to change in behavior and affect , [42] but recent variants emphasize changes in one’s relationship to maladaptive thinking rather than changes in thinking itself. Therapists or computer-based programs use CBT techniques to help people challenge their patterns and beliefs and replace errors in thinking, known as cognitive distortions , such as “overgeneralizing, magnifying negatives, minimizing positives and catastrophizing” with “more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior”.

Mainstream CBT helps individuals replace “maladaptive CBT can be seen as having six phases: [45]. These steps are based on a system created by Kanfer and Saslow. For example, “If the goal was to decrease the behavior, then there should be a decrease relative to the baseline. If the critical behavior remains at or above the baseline, then the intervention has failed. The re-conceptualization phase makes up much of the “cognitive” portion of CBT. There are different protocols for delivering cognitive behavioral therapy, with important similarities among them.

Some clinicians and researchers are cognitively oriented e. Interventions such as imaginal exposure therapy combine both approaches. CBT may be delivered in conjunction with a variety of diverse but related techniques such as exposure therapy , stress inoculation , cognitive processing therapy , cognitive therapy , metacognitive therapy , metacognitive training , relaxation training , dialectical behavior therapy , and acceptance and commitment therapy.

In adults, CBT has been shown to be an effective part of treatment plans for anxiety disorders , [58] [59] body dysmorphic disorder , [60] depression , [61] [62] [63] eating disorders , [7] [64] [63] chronic low back pain , [45] personality disorders , [65] [63] psychosis , [66] schizophrenia , [67] [63] substance use disorders , [68] [63] and bipolar disorder.

In children or adolescents, CBT is an effective part of treatment plans for anxiety disorders, [70] body dysmorphic disorder, [71] depression and suicidality , [72] eating disorders [7] and obesity , [73] obsessive—compulsive disorder OCD , [74] and posttraumatic stress disorder PTSD , [75] as well as tic disorders , trichotillomania , and other repetitive behavior disorders.

CBT has shown to be the most effective intervention for people exposed to adverse childhood experiences in the form of abuse or neglect. Criticism of CBT sometimes focuses on implementations such as the UK IAPT which may result initially in low quality therapy being offered by poorly trained practitioners. Evidence suggests that the addition of hypnotherapy as an adjunct to CBT improves treatment efficacy for a variety of clinical issues.

CBT is used to help people of all ages, but the therapy should be adjusted based on the age of the patient with whom the therapist is dealing. Older individuals in particular have certain characteristics that need to be acknowledged and the therapy altered to account for these differences thanks to age. Cognitive behavioral therapy has been shown as an effective treatment for clinical depression.

A meta-analysis comparing CBT and psychodynamic psychotherapy suggested the approaches were equally effective in the short term for depression. According to a review by INSERM of three methods, cognitive behavioral therapy was either proven or presumed to be an effective therapy on several mental disorders.

CBT has been shown to be effective in the treatment of adults with anxiety disorders. A systematic review of CBT in depression and anxiety disorders concluded that “CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists.

Some meta-analyses find CBT more effective than psychodynamic therapy and equal to other therapies in treating anxiety and depression. One etiological theory of depression is Aaron T. Beck ‘s cognitive theory of depression. His theory states that depressed people think the way they do because their thinking is biased towards negative interpretations. According to this theory, depressed people acquire a negative schema of the world in childhood and adolescence as an effect of stressful life events, and the negative schema is activated later in life when the person encounters similar situations.

Beck also described a negative cognitive triad. The cognitive triad is made up of the depressed individual’s negative evaluations of themselves, the world, and the future. Beck suggested that these negative evaluations derive from the negative schemata and cognitive biases of the person. According to this theory, depressed people have views such as “I never do a good job”, “It is impossible to have a good day”, and “things will never get better”.

A negative schema helps give rise to the cognitive bias, and the cognitive bias helps fuel the negative schema. Beck further proposed that depressed people often have the following cognitive biases: arbitrary inference , selective abstraction , overgeneralization, magnification, and minimization. These cognitive biases are quick to make negative, generalized, and personal inferences of the self, thus fueling the negative schema.

A basic concept in some CBT treatments used in anxiety disorders is in vivo exposure. CBT-exposure therapy refers to the direct confrontation of feared objects, activities, or situations by a patient. For example, a woman with PTSD who fears the location where she was assaulted may be assisted by her therapist in going to that location and directly confronting those fears.

Hobart Mowrer. CBT-SP, an adaptation of CBT for suicide prevention SP , was specifically designed for treating youths who are severely depressed and who have recently attempted suicide within the past 90 days, and was found to be effective, feasible, and acceptable. ACT uses mindfulness and acceptance interventions and has been found to have a greater longevity in therapeutic outcomes. However, during a month follow-up, ACT proved to be more effective, showing that it is a highly viable lasting treatment model for anxiety disorders.

Computerized CBT CCBT has been proven to be effective by randomized controlled and other trials in treating depression and anxiety disorders, [59] [62] [94] [] [81] [] including children. Studies have provided evidence that when examining animals and humans, that glucocorticoids may lead to a more successful extinction learning during exposure therapy for anxiety disorders. For instance, glucocorticoids can prevent aversive learning episodes from being retrieved and heighten reinforcement of memory traces creating a non-fearful reaction in feared situations.

A combination of glucocorticoids and exposure therapy may be a better-improved treatment for treating people with anxiety disorders. For anxiety disorders, use of CBT with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes.

Many studies show CBT, combined with pharmacotherapy, is effective in improving depressive symptoms, mania severity and psychosocial functioning with mild to moderate effects, and that it is better than medication alone.

In long-term psychoses , CBT is used to complement medication and is adapted to meet individual needs. Interventions particularly related to these conditions include exploring reality testing, changing delusions and hallucinations, examining factors which precipitate relapse, and managing relapses.

CBT is also used for pathological and problem gambling. CBT looks at the habit of smoking cigarettes as a learned behavior, which later evolves into a coping strategy to handle daily stressors. Since smoking is often easily accessible and quickly allows the user to feel good, it can take precedence over other coping strategies, and eventually work its way into everyday life during non-stressful events as well.

CBT aims to target the function of the behavior, as it can vary between individuals, and works to inject other coping mechanisms in place of smoking. CBT also aims to support individuals with strong cravings, which are a major reported reason for relapse during treatment. In a controlled study out of Stanford University School of Medicine, suggested CBT may be an effective tool to help maintain abstinence.

The results of random adult participants were tracked over the course of one year. During this program, some participants were provided medication, CBT, hour phone support, or some combination of the three methods. Overall, the study concluded that emphasizing cognitive and behavioral strategies to support smoking cessation can help individuals build tools for long term smoking abstinence. Mental health history can affect the outcomes of treatment. Individuals with a history of depressive disorders had a lower rate of success when using CBT alone to combat smoking addiction.

A Cochrane review was unable to find evidence of any difference between CBT and hypnosis for smoking cessation. While this may be evidence of no effect, further research may uncover an effect of CBT for smoking cessation. Studies have shown CBT to be an effective treatment for substance use disorders.

 
 

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