Cognitive behavioral therapy (or cognitive behavioral therapies or CBT ) is a psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure. The title is used in diverse ways to designate behavior therapy, cognitive therapy, and to refer to therapy based upon a combination of basic behavioral and cognitive research.
There is empirical evidence that CBT is effective for the treatment of a variety of problems, including mood, anxiety, personality, eating, substance abuse, and psychotic disorders. Treatment is often manualized, with specific technique-driven brief, direct, and time-limited treatments for specific psychological disorders. CBT is used in individual therapy as well as group settings, and the techniques are often adapted for self-help applications. Some clinicians and researchers are more cognitive oriented (e.g. cognitive restructuring), while others are more behaviorally oriented (in vivo exposure therapy). Other interventions combine both (e.g. imaginal exposure therapy).
CBT was primarily developed through a merging of behavior therapy with cognitive therapy. While rooted in rather different theories, these two traditions found common ground in focusing on the "here and now", and on alleviating symptoms. Many CBT treatment programs for specific disorders have been evaluated for efficacy and effectiveness; the health-care trend of evidence-based treatment, where specific treatments for symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments. In the United Kingdom, the National Institute for Health and Clinical Excellence recommends CBT as the treatment of choice for a number of mental health difficulties, including post-traumatic stress disorder, OCD, bulimia nervosa and clinical depression, and for the neurological condition chronic fatigue syndrome/myalgic encephalomyelitis.
History
The roots of CBT can be traced to the development of behavior therapy in the early 20th century, the development of cognitive therapy in the 1960s, and the subsequent merging of the two. Behavior therapeutical approaches appeared as early as 1924, with Mary Cover Jones' work on the unlearning of fears in children. In 1937 Abraham Low developed cognitive training techniques for patient aftercare following psychiatric hospitalization. Low designed his techniques for use in his organization, Recovery International, which supports people recovering from mental illness. Although Recovery International was originally led by Low, he later adapted the techniques for use in lay-run self-help groups operating under the same name.
It was during the period 1950 to 1970 that CBT became widely utilized, with researchers in the United States, the United Kingdom and South Africa who were inspired by the behaviorist learning theory of Ivan Pavlov, John B. Watson and Clark L. Hull. In Britain, this work was mostly focused on the neurotic disorders through the work of Joseph Wolpe, who applied the findings of animal experiments to his method of systematic desensitization, the precursor to today's fear reduction techniques. British psychologist Hans Eysenck, inspired by the writings of Karl Popper, criticized psychoanalysis in arguing that "if you get rid of the symptoms, you get rid of the neurosis", and presented behavior therapy as a constructive alternative. In the United States, psychologists were applying the radical behaviorism of B. F. Skinner to clinical use. Much of this work was concentrated towards severe, chronic psychiatric disorders, such as psychotic behavior. and autism
Although the early behavioral approaches were successful in many of the neurotic disorders, it had little success in treating depression. Behaviorism was also losing in popularity due to the so-called "cognitive revolution". 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. Both these systems included behavioral elements and interventions and primarily concentrated on problems in the present. Albert Ellis's system, originated in the early 1950s, was first called rational therapy, and can arguably be called one of the first forms of cognitive behavioral therapy. It was partly founded as a reaction against popular psychotherapeutic theories at the time, mainly psychoanalysis. Aaron T. Beck, inspired by Albert Ellis, developed cognitive therapy in the 1960s. Cognitive therapy rapidly became a favorite intervention technique to study in psychotherapy research in academic settings. In initial studies, it was often contrasted with behavioral treatments to see which was most effective. During the 1980s and 1990s, 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.
Concurrently with the contributions of Albert Ellis and Beck, starting in the late 1950s and continuing through the 1970s, Arnold A. Lazarus developed what was arguably the first form of broad-spectrum cognitive behavioral therapy. He later broadened the focus of behavioral treatment to incorporate cognitive aspects. When it became clear that optimizing therapy's effectiveness and effecting durable treatment outcomes often required transcending more narrowly focused cognitive and behavioral methods, Arnold Lazarus expanded the scope of CBT to include physical sensations (as distinct from emotional states), visual images (as distinct from language-based thinking), interpersonal relationships, and biological factors.
Samuel Yochelson and Stanton Samenow pioneered the idea that cognitive behavioral approaches can be used successfully with a criminal population. They are the authors of, Criminal Personality Vol.I. This book has an extensive amount of information regarding the dynamics of criminal thinking and application of cognitive behavioral approaches.
Approaches and systems
Further information: List of cognitive–behavioral therapiesCBT includes a variety of approaches and therapeutic systems; some of the most well known include cognitive therapy, rational emotive behavior therapy and multimodal therapy. Defining the scope of what constitutes a cognitive–behavioral therapy is a difficulty that has persisted throughout its development.
The particular therapeutic techniques vary within the different approaches of CBT according to the particular kind of problem issues, but commonly may include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation, mindfulness and distraction techniques are also commonly included. Cognitive behavioral therapy is often also used in conjunction with mood stabilizing medications to treat conditions like bipolar disorder. Its application in treating schizophrenia along with medication and family therapy is recognized by the NICE guidelines (see below) within the British NHS.
Going through cognitive behavioral therapy generally is not an overnight process for clients. Even after clients have learned to recognize when and where their mental processes go awry, it can in some cases take considerable time or effort to replace a dysfunctional cognitive-affective-behavioral process or habit with a more reasonable and adaptive one.
Computerized CBT
Main article: Computerised CBTThere are cognitive behavioral therapy sessions in which the user interacts with computer software (either on a PC, or sometimes via a voice-activated phone service), instead of face to face with a therapist. This can provide an option for patients, especially in light of the fact that there are not always therapists available, or the cost can be prohibitive. For people who are feeling depressed and withdrawn, the prospect of having to speak to someone about their innermost problems can be off-putting. In this respect, computerized CBT (especially if delivered online) can be a good option.
Randomized controlled trials have proven its effectiveness, and in February 2006 the UK's National Institute for Health and Clinical Excellence recommended that CCBT be made available for use within the NHS across England and Wales, for patients presenting with mild to moderate depression, rather than immediately opting for antidepressant medication.
Specific applications
CBT is applied to many clinical and non-clinical conditions and has been successfully used as a treatment for many clinical disorders, personality conditions and behavioral problems. Whilst CBT is highly effective for a number of disorders it is important to note that cognitive behavioral therapy is unlikely to be effective in patients with substance dependence and/or abuse problems as cognitive behavioral therapy itself cannot change drug or alcohol induced mental health symptoms.
Anxiety disorders
A basic concept in CBT treatment of anxiety disorders is in vivo exposure—a gradual exposure to the actual, feared stimulus. This treatment is based on the theory
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