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 decrease 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  and anxiety , posttraumatic stress disorder PTSD , tics ,  substance abuse , eating disorders and borderline personality disorder.
Mainstream cognitive behavioral therapy assumes that changing maladaptive thinking leads to change in behavior and affect ,  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: . 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. CBT is used in both individual and group settings, and the techniques are often adapted for self-help applications. 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 , relaxation training , dialectical behavior therapy , and acceptance and commitment therapy.
In adults, CBT has been shown to have effectiveness and a role in the treatment plans for anxiety disorders ,   body dysmorphic disorder ,  depression ,   eating disorders ,  chronic low back pain ,  personality disorders ,  psychosis ,  schizophrenia ,  substance use disorders ,  in the adjustment, depression, and anxiety associated with fibromyalgia ,  and with post- spinal cord injuries.
In children or adolescents, CBT is an effective part of treatment plans for anxiety disorders,  body dysmorphic disorder,  depression and suicidality ,  eating disorders and obesity ,  obsessive—compulsive disorder OCD ,  and posttraumatic stress disorder ,  as well as tic disorders , trichotillomania , and other repetitive behavior disorders. CBT combined with hypnosis and distraction reduces self-reported pain in children. Cochrane reviews have found no evidence that CBT is effective for tinnitus , although there appears to be an effect on management of associated depression and quality of life in this condition.
According to a review by INSERM of three methods, cognitive behavioral therapy was either "proven" or "presumed" to be an effective therapy on several specific mental disorders. Some meta-analyses find CBT more effective than psychodynamic therapy and equal to other therapies in treating anxiety and depression. Computerized CBT CCBT has been proven to be effective by randomized controlled and other trials in treating depression and anxiety disorders,       including children,  as well as insomnia.
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. 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. Evidence suggests that the addition of hypnotherapy as an adjunct to CBT improves treatment efficacy for a variety of clinical issues. CBT has been applied in both clinical and non-clinical environments to treat disorders such as personality conditions and behavioral problems. Emerging evidence suggests a possible role for CBT in the treatment of attention deficit hyperactivity disorder ADHD ;  hypochondriasis ;  coping with the impact of multiple sclerosis ;  sleep disturbances related to aging;  dysmenorrhea ;  and bipolar disorder,  but more study is needed and results should be interpreted with caution.
CBT can have a therapeutic effects on easing symptoms of anxiety and depression in people with Alzheimer's disease. Initial studies have shown CBT to be effective in reducing social anxiety in adults who stutter,  but not in reducing stuttering frequency. In the case of people with metastatic breast cancer , data is limited but CBT and other psychosocial interventions might help with psychological outcomes and pain management. There is some evidence that CBT is superior in the long-term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia.
Cognitive behavioral therapy has been shown as an effective treatment for clinical depression. Beck 's cognitive theory of depression.
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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 , over-generalization, magnification, and minimization. These cognitive biases are quick to make negative, generalized, and personal inferences of the self, thus fueling the negative schema. A meta-analysis comparing CBT and psychodynamic psychotherapy suggested the approaches were equally effective in the short term.
CBT has been shown to be effective in the treatment of adults with anxiety disorders. A basic concept in some CBT treatments used in anxiety disorders is in vivo exposure. The term 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. Studies have provided evidence that when examining animals and humans that glucocorticoids may possibly lead to a more successful extinction learning during exposure therapy. 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 patients with anxiety disorders. A Cochrane review also found that CBT for symptomatic management of non-specific chest pain is probably effective in the short term.
However, the findings were limited by small trials and the evidence was considered of questionable quality. There is limited evidence of effectiveness for CBT in bipolar disorder   and severe depression. 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.
A systematic review investigated the effects of CBT compared with other psychosocial therapies for people with schizophrenia:. 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.
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. 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. Because 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 suffering from 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, 24 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.
Though many forms of treatment can support individuals with eating disorders, CBT is proven to be a more effective treatment than medications and interpersonal psychotherapy alone.
Cognitive behavioral therapy - Wikipedia
CBT therapists also work with individuals to regulate strong emotions and thoughts that lead to dangerous compensatory behaviors. Research has identified Internet addiction as a new clinical disorder that causes relational, occupational, and social problems. Cognitive behavioral therapy CBT has been suggested as the treatment of choice for Internet addiction, and addiction recovery in general has used CBT as part of treatment planning. A Cochrane review of interventions aimed at preventing psychological stress in healthcare workers found that CBT was more effective than no intervention but no more effective than alternative stress-reduction interventions.
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 utilized by 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.
Wolpe's therapeutic efforts were precursors to today's fear reduction techniques. At the same time of 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 with his notion of basic mistakes and how they contributed to creation of unhealthy or useless behavioral and life goals.
Around the same time that rational emotive therapy, as it was known then, 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 became 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 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. A typical CBT programme would consist of face-to-face sessions between patient and therapist, made up of sessions of around an hour each with a gap of 1—3 weeks between sessions. This initial programme might be followed by some booster sessions, for instance after one month and three months. Cognitive behavioral therapy is most closely allied with the scientist—practitioner model in which clinical practice and research is informed by a scientific perspective, clear operationalization of the problem, and an emphasis on measurement , including measuring changes in cognition and behavior and in the attainment of goals.
These are often met through " homework " assignments in which the patient and the therapist work together to craft an assignment to complete before the next session. Computerized cognitive behavioral therapy CCBT has been described by NICE as a "generic term for delivering CBT via an interactive computer interface delivered by a personal computer, internet, or interactive voice response system",  instead of face-to-face with a human therapist.
It is also known as internet-delivered cognitive behavioral therapy or ICBT. CCBT has been found in meta-studies to be cost-effective and often cheaper than usual care,   including for anxiety. CCBT is also predisposed to treating mood disorders amongst non-heterosexual populations, who may avoid face-to-face therapy from fear of stigma. However presently CCBT programs seldom cater to these populations. A key issue in CCBT use is low uptake and completion rates, even when it has been clearly made available and explained.
A relatively new avenue of research is the combination of artificial intelligence and CCBT. It has been proposed to use modern technology to create CCBT that simulates face-to-face therapy. This might be achieved in cognitive behavior therapy for a specific disorder using the comprehensive domain knowledge of CBT. Another new method of access is the use of mobile app or smartphone applications to deliver self-help or guided CBT.
Technology companies are developing mobile-based artificial intelligence chatbot applications in delivering CBT as an early intervention to support mental health , to build psychological resilience and to promote emotional well-being. Artificial intelligence AI text-based conversational application delivered securely and privately over smartphone devices have the ability to scale globally and offer contextual and always-available support. Active research is underway including real world data studies  that measure effectiveness and engagement of text-based smartphone chatbot apps for delivery of CBT using a text-based conversational interface.
Enabling patients to read self-help CBT guides has been shown to be effective by some studies.
Comprehensive Handbook of Cognitive Therapy
Patient participation in group courses has been shown to be effective. Brief cognitive behavioral therapy BCBT is a form of CBT which has been developed for situations in which there are time constraints on the therapy sessions. This technique was first implemented and developed on soldiers overseas in active duty by David M. Rudd to prevent suicide. Breakdown of treatment . Cognitive emotional behavioral therapy CEBT is a form of CBT developed initially for individuals with eating disorders but now used with a range of problems including anxiety , depression , obsessive compulsive disorder OCD , post-traumatic stress disorder PTSD and anger problems.
It combines aspects of CBT and dialectical behavioral therapy and aims to improve understanding and tolerance of emotions in order to facilitate the therapeutic process. It is frequently used as a "pretreatment" to prepare and better equip individuals for longer-term therapy. SCBT also builds on core CBT philosophy by incorporating other well-known modalities in the fields of behavioral health and psychology : most notably, Albert Ellis 's rational emotive behavior therapy. First, SCBT is delivered in a highly regimented format.
Second, SCBT is a predetermined and finite training process that becomes personalized by the input of the participant. SCBT is designed with the intention to bring a participant to a specific result in a specific period of time. SCBT has been used to challenge addictive behavior, particularly with substances such as tobacco, alcohol and food, and to manage diabetes and subdue stress and anxiety.
SCBT has also been used in the field of criminal psychology in the effort to reduce recidivism. Moral reconation therapy, a type of CBT used to help felons overcome antisocial personality disorder ASPD , slightly decreases the risk of further offending. Groups usually meet weekly for two to six months. Measurement and modification of delusional beliefs. Journal of Consulting and Clinical Psychology, 58, Freeman A. Eds Comprehensive handbook of cognitive therapy.
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Emotion and two kinds of meaning: cognitive therapy and applied cognitive science. Behaviour Research and Therapy, 31, Related Papers. By Phuong Pham.
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