Cognitive
therapy or cognitive
behavior therapy is a kind of psychotherapy
used to treat depression, anxiety
disorders, phobias,
delusional disorder and other
forms of mental disorder.
It
involves recognizing unhelpful or destructive patterns of thinking and
reacting, then modifying or replacing these with more realistic or helpful
ones. Its practitioners hold that clinical depression is typically associated
with (although not necessarily caused by) negatively biased thinking and irrational
thoughts. Cognitive therapy is often used in conjunction with mood
stabilizing medications to treat 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. According to the U.S.-based
National Association of Cognitive-Behavioral Therapists:
"There are several approaches to
cognitive-behavioral therapy, including Rational Emotive Behavior Therapy,
Rational Living
Therapy, Cognitive Therapy, and Dialectic Behavior Therapy."[1]
Contents[hide] |
Cognitive
Behavior Therapy (CBT) is based on the idea that how we think
(cognition),
how we feel (emotion)
and how we act (behavior)
all interact together. Specifically, our thoughts determine our feelings
and our behavior. Therefore, negative thoughts can cause us distress and result
in problems.
One
example could be someone who, after making a mistake, thinks "I'm useless
and can't do anything right." This impacts
negatively on mood, making the person feel depressed; the problem may be worsened if the
individual reacts by avoiding activities. As a result, a successful experience
becomes more unlikely, which reinforces the original thought of being
"useless." In therapy, the latter example could be identified as a self-fulfilling prophecy or "problem
cycle," and the efforts of the therapist and client would be directed at
working together to change this. This is done by addressing the way the client
thinks in response to similar situations and by developing more flexible
thought patterns, along with reducing the avoidance of activities. If, as a
result, the client escapes the negative thought pattern, the feelings of
depression may be relieved. The client may then become more active, succeed
more often, and further reduce feelings of depression.
With
thoughts stipulated as being the cause of emotions rather than the outcome or by-product,
cognitive therapists reverse the causal order more generally used by
psychotherapists. Therefore, the therapy is to identify those irrational or
maladaptive thoughts that lead to negative emotion and identify what it is
about them that is irrational or just not helpful;
this is done in an effort to reject the distorted thoughts and replace them
with more realistic alternative thoughts.
Cognitive
therapy is not an overnight process. Even after patients have learned to
recognize when and where their thought processes go awry, it can take months of
concerted effort to replace an irrational thought process or habit with a more
reasonable, salutary one. With patience and a good therapist, however,
cognitive therapy can be a valuable tool in recovery.
While
similar views of emotion have existed for millennia, cognitive therapy was
developed in its present form by Albert Ellis,who developed his
Rational Emotive Behavioral Therapy, or REBT, in the early 1950s, as a reaction
against popular psychoanalytic and increasingly humanistic methods at the time [2], and Aaron T. Beck, who followed up Ellis' approach in the
1960s[3]. It rapidly became a favorite intervention to study in
psychotherapy research in academic settings. In initial studies, it was often
contrasted with behavioral treatments to see which was most effective. However,
in recent years, cognitive and behavioral techniques have often been combined
into cognitive behavioral treatment. This is arguably the primary type of
psychological treatment being studied in research today.
Cognitive
behavioral group therapy (CBGT) is a similar approach in treating mental illnesses,
based on the protocol by Richard Heimberg[4].
In this case, clients participate in a group and recognize they are not alone
in suffering from their problems.
A
sub-field of cognitive behavior therapy used to treat Obsessive Compulsive Disorder
makes use of classical conditioning through extinction (a type of conditioning) and habituation.
(The specific technique, Exposure with Response Prevention (ERP) has
been demonstrated to be more effective than the use of medication--typically SSRIs--alone.)
CBT has also been successfully applied to the treatment of Generalized Anxiety Disorder, health
anxiety, Social phobia and Panic
Disorder. In recent years, CBT has been used to treat symptoms of schizophrenia,
such as delusions
and hallucinations,
has been developed in the UK by Douglas Turkington
and David Kingdon.
CBT
has a good evidence base in terms of its effectiveness in reducing symptoms and
preventing relapse and has been recommended in the UK by the National
Institute for Health and Clinical Excellence as a treatment of choice for a
number of mental health difficulties, including post-traumatic stress disorder, OCD, bulimia
nervosa and clinical depression.
Cognitive
Therapy and/or Cognitive Behavioral Therapy most closely ally with the Scientist-Practitioner
Model of Clinical Psychology, in which clinical practice and research is
informed by a scientific perspective; clear operationalization
of the "problem" or "issue;" an emphasis on measurement
(and measurable changes in cognition and behavior); and measureable
goal-attainment.
Negative
thinking in depression can result from biological sources
(i.e., endogenous depression), modelling from
parents, peers or
other sources. The depressed person experiences negative thoughts as being
beyond their control: the negative thought pattern can become automatic and
self-perpetuating.
Negative
thinking can be categorized into a number of common patterns called "cognitive distortions." The cognitive
therapist provides techniques to give the client a greater degree of control
over negative thinking by correcting these distortions or correcting thinking
errors that abet the distortions, in a process called cognitive restructuring.
Negative
thoughts in depression are generally about one or more of three areas: negative
view of self, negative view of the world and negative view of the future. These
constitute what Beck called the "cognitive triad."
An
approach to depression based upon attribution theory in social
psychology is related to the concept of attributional
style. First put forth by Lyn Abramson and her colleagues in 1978, this approach
argues that depressives have a typical attributional
style —they tend to attribute negative events in their lives to stable and
global characteristics of themselves [5]. There is considerable evidence that depressives do
exhibit such an attributional style; but it is important
to remember that Abramson et al. do not claim that an attributional
style of this nature is necessarily going to cause depression — only that it
will lead to clinical depression if combined with a negative event. This theory
is sometimes known as a revised version of learned helplessness theory.
In 1989, this theory was
challenged by Hopelessness Theory
[6]. This theory emphasised
attributions to global and stable factors, rather than, as in the original
model, internal attributions. Hopelessness Theory also emphasises
that beliefs about the consequences of events and rated importance of events
may be at least as important in understanding why some people react to negative
events with clinicial depression as are causal
attributions.
A
major aid in cognitive therapy is what Albert Ellis called the ABC Technique of
Irrational Beliefs[2]. The first three steps analyse
the process by which a person has developed irrational beliefs and may be
recorded in a three-column table.
For
example, Gina is upset because she got a low mark on a math test. The
Activating event, A, is that she failed her test. The Belief, B, is that she must
have good grades or she is worthless. The Consequence, C, is that Gina feels
depressed.
From
the example above, a therapist would help Gina realize that there is no
evidence that she must have good grades to be worthwhile, or that
getting bad grades is awful. She desires good grades, and it would be
good to have them, but it hardly makes her worthless. If she realizes
that getting bad grades is disappointing, but not awful, and that it means she
is currently bad at math or at studying, but not as a person, she will feel sad
or frustrated, but not depressed. The sadness and frustration are likely
healthy negative emotions and may lead her to study harder from then on.
Another
way of viewing the ABC's of Cognitive Behavioral Therapy
The
way the treatment works is that by going back and thinking over what the
stimulus was and the irrational reaction to it and then try to follow the chain
events that led from one to another, thereby filling in the blank in between,
the person can identify what causes their thinking to become irrational.
For
example;
A
person walks out of his home and hears an ambulance siren. The person gets
anxious from this and runs back into his home. The Activating Stimulus was the
ambulance siren. The Conditioned Response was severe anxiety and running into
his home. The person now has to fill in the Blank and try to understand what was the exact thought process that went through his mind that
caused the irrational response to take place. By bridging this gap in his
thought, he is identifying the faulty thought process that caused the extreme
response. The person can now work on replacing these faulty thoughts with
realistic ones, thereby correcting the undesired chain of thoughts and
activating a functional one.
Main article: Cognitive
behavioral analysis system of psychotherapy
A
large-scale study in 2000[7]
showed substantially higher results of response and remission when a form of
cognitive behavior therapy and an anti-depressant drug were combined than when
either method was used alone.
The
effectiveness of combination therapy is endorsed by the Australian depressioNet group:
Currently the most effective treatment for major
(clinical) depression is considered to be a combination of antidepressant
medication and Cognitive Behavioral Therapy.[8]
For
more general results confirming that CBT alone can provide lower but
nonetheless valuable levels of relief from depression, and result in increased
ability for the patient to stay in employment, see The Depression Report[9],
which states:
The typical short-term success rate for CBT is
about 50%. In other words, if 100 people attend up to sixteen weekly sessions
one-on-one lasting one hour each, some will drop out but within four months 50
people will have lost their psychiatric symptoms over and above those who would
have done so anyway. After recovery, people who suffered from anxiety are
unlikely to relapse. . . . So how much depression can a course of CBT relieve,
and how much more work will result? One course of CBT is likely to produce 12
extra months free of depression. This means nearly two months more of work.
The American Psychiatric Association
Practice Guidelines (April 2000) indicated that among psychotherapeutic
approaches, cognitive behavioral therapy and interpersonal therapy had the best-documented
efficacy for treatment of major depressive disorder, although they noted that
rigorous evaluative studies had not been published [10].
The
use of CBT has been extended to children and adolescents with good results. It
is often used to treat depression, anxiety disorders, and symptoms related to
trauma and Post Traumatic Stress Disorder.
Significant work has been done in this area by Mark Reinecke
and his colleagues at
CBT
has been used with children and adolescents to treat a variety of conditions
with good success[11][12].
CBT is
also used as a treatment modality for children who have experienced Complex Post Traumatic Stress
Disorder, chronic maltreatment, and Post Traumatic Stress Disorder[13].
It would be one component of treatment for children with C-PTSD, along with a
variety of other components, which are discussed in the Complex Post Traumatic Stress
Disorder article. In addition, many approaches to treating such children,
such as Dyadic Developmental Psychotherapy
incorporate Cognitive therapy methods and principles into treatment[14]