Cognitive-behavioral therapy Health Article

Definition

Cognitive therapy is a psychosocial (both psychological and social) therapy that assumes that faulty thought patterns (called cognitive patterns) cause maladaptive behavior and emotional responses. The treatment focuses on changing thoughts in order to solve psychological and personality problems. Behavior therapy is also a goal-oriented, therapeutic approach, and it treats emotional and behavioral disorders as maladaptive learned responses that can be replaced by healthier ones with appropriate training. Cognitive-behavioral therapy (CBT) integrates features of behavior modificationinto the traditional cognitive restructuring approach.

Purpose

Cognitive-behavioral therapy attempts to change clients' unhealthy behavior through cognitive restructuring (examining assumptions behind the thought patterns) and through the use of behavior therapy techniques.

Cognitive-behavioral therapy is a treatment option for a number of mental disorders, including depression, dissociative identity disorder, eating disorders, generalized anxiety disorder, hypochondriasis, insomnia, obsessive-compulsive disorder, and panic disorderwithout agoraphobia.

Precautions

Cognitive-behavioral therapy may not be appropriate for all patients. Patients with significant cognitive impairments (patients with traumatic braininjury or organic brain disease, for example) and individuals who are not willing to take an active role in the treatment process are not usually good candidates.

Origins of the two approaches

PsychologistAaron Beck developed cognitive therapy in the 1960s. The treatment is based on the principle that maladaptive behavior (ineffective, self-defeating behavior) is triggered by inappropriate or irrational thinking patterns, called automatic thoughts. Instead of reacting to the reality of a situation, an individual automatically reacts to his or her own distorted view of the situation. Cognitive therapy strives to change these thought patterns (also known as cognitive distortions), by examining the rationality and validity of the assumptions behind them. This process is termed cognitive restructuring.

Behavior therapy focuses on observable behavior and its modification in the present, in sharp contrast to the psychoanalytic method of Sigmund Freud (1856-1939), which focuses on unconscious mental processes and their roots in the past. Behavior therapy was developed during the 1950s by researchers and therapists who were critical of the prevailing psychodynamic treatment methods. The therapy drew on a variety of theories and research, including the classical conditioning principles of the Russian physiologist Ivan Pavlov (1849-1936), the work of American B. F. Skinner (1904-1990), and the work of psychiatristJoesph Wolpe (1915-1997). Pavlov became famous for experiments in which dogs were trained to salivate at the sound of a bell, and Skinner pioneered the concept of operant conditioning, in which behavior is modified by changing the response it elicits. Wolpe is probably best known for his work in the areas of desensitization and assertiveness training. By the 1970s, behavior therapy enjoyed widespread popularity as a treatment approach. Since the 1980s, many therapists have begun to use cognitive-behavioral therapy to change clients' unhealthy behavior by replacing negative or self-defeating thought patterns with more positive ones.

The combined approach

In cognitive-behavioral therapy, the therapist works with the patient to identify the thoughts that are causing distress, and employs behavioral therapy techniques to alter the resulting behavior. Patients may have certain fundamental core beliefs, known as schemas, that are flawed and are having a negative impact on the patient's behavior and functioning.

For example, a patient suffering from depression may develop a social phobiabecause he is convinced that he is uninteresting and impossible to love. A cognitive-behavioral therapist would test this assumption by asking the patient to name family and friends who care for him and enjoy his company. By showing the patient that others value him, the therapist exposes the irrationality of the patient's assumption and also provides a new model of thought for the patient to change his previous behavior pattern (i.e., I am an interesting and likeable person, therefore I should not have any problem making new social acquaintances). Additional behavioral techniques such as conditioning (the use of positive and/or negative reinforcements to encourage desired behavior) and systematic desensitization(gradual exposure to anxiety-producing situations in order to extinguish the fear response) may then be used to gradually reintroduce the patient to social situations.

Cognitive-behavioral therapy is usually administered in an outpatient setting (clinic or doctor's office) by a specially trained therapist. Therapy may be in either individual or group sessions. Therapists are psychologists (Ph.D., Psy.D., Ed.D., or M.A. degree), clinical social workers(M.S.W., D.S.W., or L.S.W. degree), counselors (M.A. or M.S. degree), or psychiatrists (M.D. trained in psychiatry).