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A '''Cognitive Behavioral Therapy''' ('''CBT''') is a [[psychotherapy]] that integrates the approaches of [[behavior therapy]] and [[cognitive therapy]]. It is based on modifying everyday thoughts and behaviors, with the aim of positively influencing emotions. The general approach developed out of [[behavior modification]] and [[cognitive therapy]], and has become widely used to treat [[mental disorders]]. The particular therapeutic techniques vary according to the particular kind of client or issue, but commonly include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing assumptions or habits of thoughts that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation and distraction techniques are also commonly included. CBT is widely accepted as an evidence-based, cost-effective psychotherapy for many disorders. It is sometimes used with groups of people as well as individuals, and the techniques are also commonly adapted for self-help manuals and, increasingly, for self-help software packages.
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:''This article is about cognitive therapy. For the behaviorist technique, see [[behavior modification]].''
  
   
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==The basics==
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'''Cognitive therapy''' or '''cognitive behavior therapy''' is a kind of [[psychotherapy]] used to treat [[Clinical depression|depression]], [[anxiety disorder]]s, [[phobia]]s, and other forms of [[psychological disorder|mental disorder]].
 
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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 - and unrealistic - thoughts can cause us distress and result in problems.
   
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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 [[Clinical depression|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.
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It involves recognising unhelpful patterns of thinking and reacting, then modifying or replacing these with more realistic or helpful ones. Its practitioners hold that typically clinical depression is associated with (although not necessarily caused by) negatively biased thinking and [[irrationality|irrational thoughts]]. Cognitive therapyis often used in conjunction with [[mood stabilizer|mood stabilizing]] medications to treat [[bipolar disorder]]. Its application in treating [[schizophrenia]] along with medication and family therapy is recognized by the [[National Institute for Clinical Excellence|NICE]] guidelines (see below) within the British NHS. According to the U.S.-based National Association of Cognitive-Behavioral Therapists:
  
   
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==Thoughts as the cause of emotions==
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:"There are several approaches to cognitive-behavioral therapy, including [[Rational Emotive Behavior Therapy]], Rational Behavior Therapy, Rational Living Therapy, Cognitive Therapy, and [[Dialectical behavior therapy|Dialectic Behavior Therapy]]." [http://www.nacbt.org/whatiscbt.htm].
 
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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, in a process sometimes referred to as [[cognitive-shifting]].
   
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Cognitive Behavioral 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.
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A related approach, [[Cognitive analytic therapy|Cognitive Analytic Therapy]], can be regarded as a form of integrative therapy, integrating insights of both psychodynamic (especially Kleinian) therapy with a broad cognitive approach to therapy.
 
   
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The cognitive model says that a person's core beliefs (often formed in childhood) contribute to 'automatic thoughts' that pop up in every day life in response to situations. Cognitive Therapy practitioners hold that [[clinical depression]] is typically associated with negatively biased thinking and [[irrationality|irrational thoughts]]. Cognitive Behavioral
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==The basics==
  
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Therapy is often used in conjunction with [[mood stabilizer|mood stabilizing]] medications to treat [[bipolar disorder]]. Its application in treating [[schizophrenia]] along with medication and family therapy is recognized by the [[National Institute for Health and Clinical Excellence|NICE]] guidelines (see below) within the British NHS.
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Cognitive Behaviour Therapy (CBT) is based on the idea that how we think (cognition), how we feel ([[emotion]]), and how we act (behaviour) all interact together. Specifically, our ''thoughts'' determine our feelings and our behaviour. Therefore negative thoughts can cause us distress and result in problems.
  
   
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==Cognitive Behavioral Therapy ==
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One example could be someone who, after making a mistake, thinks "I'm useless and can't do anything right." This impacts negatively on their mood and makes them feel [[Clinical depression|depressed]]; then they worsen the problem by reacting to avoid activities. As a result they reduce their chance of successful experience, which reinforces their 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 to work together to change this. This is done by addressing the way the client thinks in response to similar situations and by helping them think more flexibly, along with reducing their avoidance of activities. If as a result they escape the negative thought pattern, they will already feel less depressed. They may hopefully also then become more active, succeed more, and further reduce their depression.
  
   
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CBT can be seen as an umbrella term for many different therapies that share some common elements.<ref>[http://www.babcp.com/babcp/what_is_CBT.htm "A Guide to Understanding Cognitive and Behavioural Psychotherapies"] British Association of Behavioural and Cognitive Psychotherapies. Retrieved on 2007-1-11</ref> While similar views of emotion have existed for millennia, the earliest form of Cognitive Behavior Therapy was developed by [[Albert Ellis]] in the early [[1950s]]. Ellis eventually called his approach Rational Emotive Behavioral Therapy, or [[REBT]], as a reaction against popular psychoanalytic and increasingly humanistic methods at the time <ref name="ellis">{{cite book
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==Thoughts as the cause of emotions==
  
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| last=Ellis
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Some paralysis of thinking occurred in the debate in the 1970's and 1980's about which came first, thoughts or emotions. It is generally accepted now that thoughts and emotions are intertwined and occur simultaneously. The focus of therapy is on thoughts and behaviours as being the components of an emotional state amenable to review, reflection and change and consequently the most effective foci for intervention. In this way individuals are able to help themselves break unhelpful cycles, feel better and achieve their goals.
  
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| first=Albert
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| authorlink=Albert Ellis
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| title=A New Guide to Rational Living
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| publisher=[[Prentice Hall]]
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| date=[[1975]]
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| id=ISBN 0-13-370650-8
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}}</ref>. [[Aaron T. Beck]] independently developed another CBT approach, called [http://www.beckinstitute.org/InfoID/220/RedirectPath/Add1/FolderID/237/SessionID/{0C85CDA1-D123-46DB-A468-39A6965B153A}/InfoGroup/Main/InfoType/Article/PageVars/Library/InfoManage/Zoom.htm Cognitive Therapy], in the 1960s<ref name="beck">[[Aaron T. Beck|Beck, Aaron T.]] ''Cognitive Therapy and the Emotional Disorders''. International Universities Press Inc., [[1975]]. ISBN 0-8236-0990-1</ref>. Cognitive Therapy 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.
   
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Cognitive Behavioral Group Therapy (CBGT) is a similar approach in treating mental illnesses, based on the protocol by [[Richard Heimberg]]<ref>{{cite web
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Therapists, therefore, help to identify those thoughts associated with the negative emotion and find alternative or more helpful perspectives; this is done in an effort to reject the original thoughts and replace them with more helpful or unbiased thoughts. Often, this may be in conjunction with identification of past experiences and underpinning beliefs that explain how the thought arose in the first place.
  
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| url=http://www.stressandanxiety.com/group-therapy.html
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| title=Group Therapy
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| publisher=Stress and Anxiety Services of New Jersey
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| accessdate=2006-06-25
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}}</ref>. In this case, clients participate in a group and recognize they are not alone in suffering from their problems.
   
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A sub-field of Cognitive Behavior Therapy used to treat [[OCD|Obsessive Compulsive Disorder]] makes use of [[classical conditioning]] through [[extinction (psychology)|extinction]] (a type of conditioning) and [[habituation]]. (The specific technique, [[Exposure and response|Exposure with Response Prevention (ERP)]] has been demonstrated to be more effective than the use of medication--typically [[SSRI]]s--alone.) CBT has also been successfully applied to the treatment of [[general anxiety disorder|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]]. This use has been developed in the [[United Kingdom|UK]] by Douglas Turkington and David Kingdon.
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Cognitive therapy is not an overnight process. Even after a patient has learned to recognise when and where his thought processes are going awry, it can take months of concerted effort to help someone gain a more helpful perspective and implement the changes that follow. With patience and a good therapist, however, cognitive therapy can be a valuable tool in recovery.
  
   
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Other types of Cognitive Behavioral Therapy include Dialectical Behavior Therapy, Self-Instructional Training, Schema-Focused Therapy and many others<ref>{{cite web
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==Cognitive behavioral therapy==
  
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| url=http://www.aabt.org/What%20are/What%20Are%20Behavioral%20and%20Cognitive%20Therapies.html
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While similar views of emotion have existed for millennia, cognitive therapy was developed in its present form by [[Albert Ellis]] and [[Aaron T. Beck]] in the [[1950s]] and [[1960s]]. 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.
  
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| title=What is CBT? …What’s in a Name?
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| publisher=Association for Behavioral and Cognitive Therapies
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| accessdate=2007-1-11
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}}</ref>.
   
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CBT has a good evidence base in terms of its effectiveness in reducing symptoms and preventing relapse. It has been clinically demonstrated in over 400 studies to be effective for [http://www.academyofct.org/Library/InfoManage/Guide.asp?FolderID=1061&SessionID={65EEF410-AED3-4298-8C78-69CCAF87F39A}/ many psychiatric disorders and medical problems] for both children and adolescents. It 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]].
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A sub-field of cognitive behavior therapy used to treat [[OCD|Obsessive Compulsive Disorder]] makes use of [[classical conditioning]] through [[extinction (psychology)|extinction]] (a type of conditioning) and [[habituation]]. CBT has also been successfully applied to the treatment of [[general anxiety disorder|Generalized Anxiety Disorder]], [[health anxiety]], [[Social phobia]], and [[Panic Disorder]].
  
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Cognitive Behavioral Therapy most closely allies 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 measurable goal-attainment.
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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 Clinical Excellence|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, and depression.
  
   
 
==Depression==
  
==Depression==
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Negative thinking in depression can result from biological sources (i.e., endogenous depression), modeling 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.
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Negative thinking in [[clinical depression|depression]] can result from biological sources (i.e., endogenous depression), modelling from parents, [[peer]]s or other sources. The depressed person experiences negative thoughts as being beyond their control: the negative thought pattern can become automatic and self-perpetuating.
   
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Negative thinking can be categorized into a number of common patterns called "[[cognitive distortion]]s". 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]].
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Negative thinking can be categorized into a number of common patterns called "[[cognitive distortion]]s." 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]].
   
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Negative thoughts in depression are generally about one 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".
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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."
   
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===Attributional style===
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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 (Abramson, Seligman & Teasdale, 1978). 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.
 
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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 <ref name="AbramsonSeligmanTeasdale">Abramson, L., Seligman, M.E.P. & Teasdale, J. (1978). Learned Helplessness in Humans: Critique and Reformulation. Journal of Abnormal Psychology, 87 pp49-74</ref>. 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.
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In 1989, this theory was challenged by Hopelessness Theory{{fact}}. 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.
 
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===The four column technique===
  
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A major technique in cognitive therapy is the four column technique. It consists of a four step process. The first three steps analyze the process by which a person has become depressed or distressed. The first column records the objective situation. In the second column, the client writes down the negative thoughts which occurred to them. The third column is for the negative feelings and dysfunctional behaviors which ensued. The negative thoughts of the second column are seen as a connecting bridge between the situation and the distressing feelings. Finally, the fourth column is used for challenging the negative thoughts on the basis of evidence from the client's experience.
  
   
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In [[1989]], this theory was challenged by Hopelessness Theory <ref name="Abramson-EtAl">Abramson, L. et al: Hopelessness depression: a theory-based subtype of depression, Psychol Rev 96:358, 1989.</ref>. 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 clinical depression as are causal attributions.
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==Treating depression with CBA==
  
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A relatively new version of cognitive behavioral therapy for depression is the cognitive behavioral-analysis system of psychotherapy (CBASP). When combined with appropriate [[antidepressant]]s, it can be extremely effective.
  
   
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===The ABCs of Irrational Beliefs===
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A study published by [[Martin Keller]] MD of [[Brown University]] and others in the [[May 18]], [[2000]] [[New England Journal of Medicine]] compared the antidepressant [[Serzone]] with the talking therapy CBASP. CBASP is largely derivative of other [[talking cure|talking therapies]] such as cognitive, behavioral, and [[interpersonal psychoanalysis|interpersonal therapy]]. Six hundred and eighty-one patients with severe chronic depression (some with other psychiatric illnesses) were enrolled in the trial, and were assigned to either Serzone, CBASP, or combination Serzone-CBASP for 12 weeks. The response rates to either Serzone or CBASP alone were rather underwhelming - 55 percent and 52 percent, respectively, for the 76 percent who completed the study. In other words, a little more than half of the completers in those two arms of the trial reduced their depression by 50 percent or better.
  
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A major aid in cognitive therapy is what Albert Ellis called the ABC Technique of Irrational Beliefs<ref name="ellis"/>. The first three steps ''analyse'' the process by which a person has developed irrational beliefs and may be recorded in a three-column table.
   
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* '''A - Activating Event''' or objective situation. The first column records the objective situation, that is, an event that ultimately leads to some type of high emotional response or negative dysfunctional thinking.
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The Serzone findings roughly correspond with many other trial results for antidepressants, and underscore a major weakness in these drugs - that while they are effective, the benefit is often marginal and the treatment outcome problematic. Similarly, the CBASP findings validate other studies finding talking therapy about equal in efficacy to taking antidepressants.
  
   
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* '''B - Beliefs'''. In the second column, the client writes down the negative thoughts that occurred to them.
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The results for the combination drug-therapy group, however, were surprising, with 85 percent of the completing patients achieving a 50 percent reduction in symptoms or better. 42 percent in the combination group achieved [[remission]] (a virtual elimination of all depressive symptoms) compared to 22 percent in the Serzone group and 24 percent in the CBASP group.
  
   
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* '''C - Consequence'''. The third column is for the negative feelings and dysfunctional behaviors that ensued. The negative thoughts of the second column are seen as a connecting bridge between the situation and the distressing feelings. The third column C is next explained by describing emotions or negative thoughts that the client thinks are caused by A. This could be [[anger]], [[sorrow]], [[anxiety]], etc.
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The authors of the study confessed to being caught by surprise by the results, acknowledging that "the rates of response and remission in the combined-treatment group were substantially higher than those that might have been anticipated."
  
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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.
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* '''Reframing'''. After irrational beliefs have been identified, the therapist will often work with the client in challenging the negative thoughts on the basis of evidence from the client's experience by [[reframing]] it, meaning to re-interpret it in a more realistic light. This helps the client to develop more rational beliefs and healthy coping strategies.
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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.
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===Effectiveness of CBT with or without drugs for depression===
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{{main|Cognitive behavioral analysis system of psychotherapy}}
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A large-scale study in 2000<ref>Keller, M. et al. [http://content.nejm.org/cgi/content/abstract/342/20/1462 ''A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression'']. New England Journal of Medicine Volume 342:1462-1470 May 18, 2000.</ref> 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.
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The effectiveness of combination therapy is endorsed by the Australian depressioNet group:
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: Currently the most effective treatment for major (clinical) depression is considered to be a combination of antidepressant medication and Cognitive Behavioral Therapy.<ref>{{cite web
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| url=http://www.depressionet.com.au/treatments/talking/cbt.html
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| title=Treatments: Cognitive Behavioral Therapy
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| publisher=[http://www.depressionet.com.au/aboutus.html depresioNet]
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| date=2004-01-08
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| accessdate=2006-08-27
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}}</ref>
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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''<ref>{{cite web
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| title=The Depression Report: A New Deal for Depression and Anxiety Disorders
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| publisher=The Centre for Economic Performance's Mental Health Policy Group
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| url=http://cep.lse.ac.uk/research/mentalhealth/default.asp
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| date=[[2006-06-19]]
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| accessdate=2006-06-25
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}}</ref>, which states:
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: 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.
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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
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<ref>{{cite web
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| url=http://www.psych.org/psych_pract/treatg/pg/Depression2e.book-7.cfm#figure3
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| title=Treatment Recommendations for Patients with Major Depressive Disorder (Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition)
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| publisher=American Psychiatric Association
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| date=2000
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| accessdate=2006-07-02
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}}</ref>.
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==CBT with children and adolescents==
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The use of CBT has been extended to children and adolescents with good results. It is often used to treat depression<ref>Wilkes, T, Belsher, G., Rush, A., Frnk, E., & Associates. (1994). Cognitive therapy for depressed adolescents. NY: Guilford Press</ref> , 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 Northwestern University in the [[Clinical Psychology]] program in [[Chicago]].
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CBT has been used with children and adolescents to treat a variety of conditions with good success.<ref>{{cite book
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| editor=Kendall, Philip C. (ed).
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| title=Child and Adolescent Therapy: Cognitive-Behavioral Procedures, (3rd ed.)
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| publisher=Guilford Press
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| date=2005-12-05
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| id=ISBN 1-59385-113-8
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}}</ref><ref>{{cite book
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| editor=Reinecke, Mark A.; Dattilio, Frank M.; Freeman, A. (eds).
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| title=Cognitive Therapy with Children and Adolescents: A Casebook for Clinical Practice (2nd ed.)
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| publisher=Guilford Press
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| date=2003-05-02
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| id=ISBN 1-57230-853-2
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}}</ref>
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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]].<ref>{{ cite book
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| editor=Briere, John; Scott, Catherine (eds).
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| title=Principles of Trauma Therapy
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| publisher=Sage
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| date=2006
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| id=ISBN 0-7619-2921-5
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}} (see especially Chapter 7, "Cognitive Interventions", pp. 109-119).</ref> 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.
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While Dialectical Behavior Therapy has been shown to be an effective treatment for adults with personality disorders, it has not been tested with child or adolescent patients.<ref>Reinecke, M., & Freeman, M., (2007) Development and Treatment of Personality Disorder in Mark Freemand and Mark Reinecke (Eds.) (2007), Personality Disorders in Childhood and Adolescence. NY: Wiley</ref>
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The importance of relationship factors in effective CBT with adolescents is described by Aaron T. Beck, M.D., <blockquote>The authors have emphasized repeatedly the importance of a trusting, secure relationship with the therapist. This attitude reminds the reader of [[Bowlby]], who also developed the idea of an internal map of the world, a set of [[schemas]] in which self and others and their relationships are represented. This conceptualization clearly integrates will the cognitive model's concepts of core beliefs and primary and secondary assumptions about self and others and the future. As a result of the collaborative approach, the therapist shares the adolescent's perceptions of loss and pain. Therapist and patient are able to reconstruct [[narrative]], a process that facilitates for patients a more helpful view of their world, themselves, and their future.<ref>Beck, A., (1994). Forward. In T. Wilkes, G. Belsher, A. Rush, E. Frank, & Associates. (1994). Cognitive therapy for depressed adolescents. NY: Guilford Press</ref></blockquote>
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{{Main|CBT with children and adolescents}}
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==Computerised CBT==
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As the name suggests, this is a computerised form of CBT, 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.
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{{Main|Computerized CBT}}
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==Cognitive behavior therapy with different mental disorders==
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{{Main|CBT treatment for different problems}}
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Cognitive behavior therapy has been successfully applied in the treatment of a wide range of [[mental disorders]]] and [[symptoms]]. This would include
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*[[CBT for depression]]
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*[[GAD - CBT]]
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*[[OCD - CBT]]
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*[[Phobia - CBT]]
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*[[Social phobias - CBT]]
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==List of prominent theorists and researchers
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* [[Aaron T. Beck]]
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* [[Albert Ellis]]
   
 
==See also==
  
==See also==
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{{col-begin}}
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{{col-break}}
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* [[Acceptance and Commitment Therapy]]
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* [[Applied Behavioral Analysis]]
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* [http://tcp.sagepub.com/cgi/content/abstract/16/1/31 Anxiety Management Training]
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* [[Behavior Modification]]
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* [[Behavior therapy]]
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* [[David D. Burns]]
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* [[Cognitive analytic therapy]] (CAT)
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* [[Cognitive behavioural assessment]]
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* [[Cognitive behavioral analysis system of psychotherapy]]
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* [[Contingency Management]]
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* [[Cognitive restructuring]]
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* [[cognitive-shifting]]
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* [[Cognitive Therapy]] (CT)
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{{col-break}}
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* [[Dialectical Behavior Therapy]] (DBT)
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* [[Direct therapeutic exposure]]
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* [[Exposure and response prevention]]
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* [http://www.springer.com/west/home?SGWID=4-102-22-33168357-0&changeHeader=true&SHORTCUT=www.springer.com/978-0-306-43857-8 Functional Analytic Psychotherapy] (FAP)
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{{col-break}}
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* [http://www.psychpage.com/family/library/ibct.html Integrated Behavioral Couples Therapy]
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* [[Mindfulness-based Cognitive Therapy]]
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* [http://health.yahoo.com/topic/addiction/treatment/article/healthwise/popup/ty7166 Motivational Enhancement Therapy]
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* [[Parent-child interaction therapy]] (PCIT)
  +
* [http://www.oup.com/us/companion.websites/0195154290/?view=usa Parent Management Training] (PMT)
  +
* [http://www.amazon.com/dp/1572308389 Schema-Based Therapy]
  +
* [[Rational Emotive Behavior Therapy]] (REBT)
  +
* [[Reality Therapy]]
  +
* Self Instructional Training
  +
* [http://www.apa.org/divisions/div12/rev_est/sit_stress.html Stress Inoculation Training]
  +
* [[Systematic desensitization]]
  +
* [[Philosophical background to CBT]]
  +
* [[Historical development of CBT approaches]]
  +
* [[UK National Occupational Standards for Cognitive Behavioural Therapy]]
  +
{{col-end}}
   
  +
==Professional Organizations & Institutes==
  +
* [http://www.academyofct.org Academy of Cognitive Therapy]
  +
* [http://www.albertellis.org/ The Albert Ellis Institute]
  +
* [http://www.aabt.org/ Association for Behavioral and Cognitive Therapies] (ABCT)
  +
* [http://www.beckinstitute.org/ Beck Institute for Cognitive Therapy and Research]
  +
* [http://www.wglasser.com/ William Glasser Institute]
  +
* [http://www.thelazarusinstitute.com The Lazarus Institute]
  +
* [http://www.babcp.com The British Association of Behavioural and Cognitive Psychotherapies]
   
 
==Bibliography==
  
==Bibliography==
  +
{{reflist|2}}
   
 
==Key Texts – Books==
  
==Key Texts – Books==
  +
*Albano, M. & Kearney, Ca., (2000) ''When children refuse school: a cognitive behavioral therapy approach: Therapist guide.'' Psychological Corporation.
  +
*Alford, B. A., & Beck, A. T. (1997). The integrative power of cognitive therapy. New York: The Guilford Press.
  +
*Beck, J. (1995). Cognitive Therapy: Basics and Beyond. London:Guildford.
  +
* Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.
  +
* Beck, A. T., Emery, G., & Greenberg, R. (1985). Anxiety disorders and phobias: A cognitive perspective. New York:Basic Books.
  +
* Beck, A. T., Freeman, A., & Associates. (1990). Cognitive therapy of personality disorders. New York: The Guilford Press.
  +
* Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.
  +
* Beck, A. T., Wright, F. D., Newman, C. F., & Liese, B. S. (1993). Cognitive therapy of substance abuse. New York: The Guilford Press.
  +
* Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: The Guilford Press.
 
*[[Aaron T. Beck|Beck, Aaron T.]] ''Cognitive Therapy and the Emotional Disorders''. International Universities Press Inc., [[1975]]. ISBN 0-82-360990-1
  
*[[Aaron T. Beck|Beck, Aaron T.]] ''Cognitive Therapy and the Emotional Disorders''. International Universities Press Inc., [[1975]]. ISBN 0-82-360990-1
  +
*Dryden, Windy. ''Ten Steps to Positive Living''. Sheldon Press, 1994.
  +
*[[Albert Ellis|Ellis, Albert]]. ''A Guide to Rational Living''. [[Prentice Hall]], [[1975]]. ISBN 0-13-370650-8
  +
*Deblinger, E. & Heflin, A. (1996) ''Treating sexually abused children and their non-offending parents: a cognitive behavioral approach.'' Thousand Oaks, CA: Sage Publication.
  +
*Kuyken, W., Padesy, C>A> & Dudley, D (2009) Colaborative case conceptualization:Working Efffectively with Clients in Cognitive-Behavioural Therapy. Guildford Press. ISBN:9781606230725
  +
*Wilson, P.H., Spence, S.H. & Kavanagh, D. J. (1989) Cognitive behavioural Interviewing for Adult Disorders: A Practical Handbook. London: Routledge.
   
 
==Additional material – Books==
  
==Additional material – Books==
  +
*Bennett-Levy,James ( ) Oxford Guide to Behavioural Experiments in Cognitive Therapy (Cognitive Behaviour Therapy: Science & Practice)
−
*McCullough Jr., James P. ''Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP)''. Guilford Press, [[2003]]. ISBN 1-57-230965-2
  
  +
*Beck,Judith S. ( ) Cognitive Therapy: Basics and Beyond
−  
  +
*Burns, D. D. (1980). Feeling good. New York: Avon Books.
  +
*Dobson, K. S. (Ed.). (2001). Handbook of cognitive-behavioral therapies (2nd ed.). New York: The Guilford Press.
  +
*Freeman, A., Pretzer, J., Fleming, B., & Simon, K. M. (1990). Clinical applications of cognitive therapy. New York: Plenum Press.
  +
*Greenberger, D., & Padesky, C. (1995). Mind over mood: Changing how you feel by changing the way you think. New York: The Guilford Press.
  +
*Hawton, Keith ( ) Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide
  +
* Leahy, R. (1996). Cognitive therapy: Basic principles and applications. Northvale, NJ: Jason Aronson.
  +
*Persons, J. B. (1989). Cognitive therapy in practice: A case formulation approach. New York: Norton.
  +
*Westbrook, D., Kennerley, H.& Kirk,J.(2007)An Introduction to Cognitive behaviour Therapy.Sage.
  +
 
==Key Texts – Papers==
 
==Key Texts – Papers==
 
*Abramson, L., Seligman, M.E.P. & Teasdale, J. (1978). Learned Helplessness in Humans: Critique and Reformulation. Journal of Abnormal Psychology, 87 pp49-74
  
*Abramson, L., Seligman, M.E.P. & Teasdale, J. (1978). Learned Helplessness in Humans: Critique and Reformulation. Journal of Abnormal Psychology, 87 pp49-74
  +
*Butler, A., & Beck, J. S. (2001). Cognitive therapy outcomes: A review of meta-analyses. Tidsskrift for Norsk Psykologforening, 38, 698–706.
  +
*Crits-Cristoph, P., Chambless, D. L., Frank, E., Brody, C., & Karp, J. (1995). Training in empirically validated treatments: What are clinical psychology students learning? Professional Psychology: Research and Practice, 26, 514–522.
  +
*Dattilio, F. M., & Padesky, C. A. (1990). Cognitive therapy with couples. Sarasota: Professional Resource Exchange.
  +
*Dobson, K. S., Shaw, B. F., & Vallis, T. M. (1985). Reliability of a measure of the quality of cognitive therapy. British Journal of Clinical Psychology, 24, 295–300.
  +
* Norcross, J. C., Hedges, M., & Prochaska, J. O. (2002). The face of 2010: A Delphi poll on the future of psychotherapy. Professional Psychology: Research and Practice, 33, 316–322.
  +
*Pedesky, C.A. & Mooney, K.A. (1990). Presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6,11-12.
   
 
==Additional material - Papers==
  
==Additional material - Papers==
Line 74: Line 256:
 
* [http://www.cognitivetherapynyc.com/ American Institute for Cognitive Therapy]
  
* [http://www.cognitivetherapynyc.com/ American Institute for Cognitive Therapy]
 
* [http://www.beckinstitute.org/ The Beck Institute for Cognitive Therapy and Research]
  
* [http://www.beckinstitute.org/ The Beck Institute for Cognitive Therapy and Research]
  +
* [http://www.nacbt.org/whatiscbt.htm NACBT fact sheet what is CBT].
 
* [http://www.academyofct.org/ The Academy of Cognitive Therapy]
  
* [http://www.academyofct.org/ The Academy of Cognitive Therapy]
 
* [http://www.rebt.org/ The Albert Ellis Institute]
  
* [http://www.rebt.org/ The Albert Ellis Institute]
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[[Category:Cognitive therapy| ]]
  
[[Category:Cognitive therapy| ]]
 
[[Category:Psychotherapy]]
  
[[Category:Psychotherapy]]
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[[Category:Psychology]]
 +
[[Category:CBT]]
−
[[Category:Therapy]]
  
−
[[de:Verhaltenstherapie]]
  
−
[[es:Terapia cognitiva]]
  
−
[[is:Atferlismeðferð]]
  
−
[[ja:認知療法]]
  
−
[[no:Kognitiv terapi]]
  
−
[[sv:Kognitiv terapi]]
  
−
{{enWP|Cognitive therapy}}
  
   
−
These references need to go elsewhere
  
−
*[[Albert Ellis|Ellis, Albert]]. ''A Guide to Rational Living''. [[Prentice Hall]], [[1975]]. ISBN 0-13-370650-8
  
   
  +
* [http://counsellingresource.com/types/cognitive-therapy/index.html An Introduction to Cognitive Therapy & CBT]
−
*Dryden, Windy. "Ten Steps to Positive Living." Sheldon Press, 1994.
  
  +
* [http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx The Royal College of Psychiatrists' cognitive therapy leaflet]
−
*[[David D. Burns|Burns, David D.]] ''Feeling Good: The New Mood Therapy''. Revised Edition. Avon, [[1999]]. ISBN 0-38-081033-6
  
  +
* [http://www.rebtnetwork.org/ REBT Network]
−
 
  +
* [http://www.rebt-cbt.net/ REBT-CBT NET- The Internet Guide to Rational Emotive Behavior Therapy and Cognitive Behavior Therapy]
−
*Tanner, Susan and Ball, Jillian. ''Beating the Blues: a Self-help Approach to Overcoming Depression''. [[1989]]/[[2001]]. ISBN 064636622X [http://www.successcentre.com.au/catalogue/titles.cfm?cur_titleID=1867]
  
  +
* {{cite web
  +
| url=http://bjp.rcpsych.org/cgi/content/full/182/2/179-a
  +
| title=Review of ''Introducing Cognitive Analytic Therapy. Principles and Practice'' by Ryle and Kerr
  +
| last=Marks
  +
| first=Isaac
  +
| publisher=British Journal of Psychiatry
  +
| year=2003
  +
| accessdate=2006-07-12
  +
}}
  +
* {{cite web
  +
| url=http://moodgym.anu.edu.au/
  +
| title=Moodgym
  +
| publisher=[http://www.anu.edu.au/ Australian National University]
  +
| accessdate=2006-07-04
  +
}} (Free online CBT training program for preventing depression.)
  +
* {{cite web
  +
| url=http://www.livinglifetothefull.com/elearning
  +
| title=Living Life to the Full
  +
| accessdate=2006-07-04
  +
}} (Free online CBT life skills course, sponsored by [http://cci.scot.nhs.uk/ Scottish Executive Health Department Centre for Change and Innovation])
  +
*[http://www.mentalhealth.org.uk/information/news/?EntryId=31598 Mental Health Foundation report on the use of CCBT]
  +
*[http://www.psychotherapy.ro/ International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health]
  +
*[http://cbtexplained.com/ Guide to using CBT to treat depression]
  +
* [http://www.kpchr.org/feelbetter/ Free guide to learning skills to overcome depression]
  +
  +
[[Category:CBT]]
  +
[[Category:Psychotherapy]]
  +
  +
{{enWP|Cognitive behavioral therapy}}

Revision as of 23:40, 21 July 2012

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A Cognitive Behavioral Therapy (CBT) is a psychotherapy that integrates the approaches of behavior therapy and cognitive therapy. It is based on modifying everyday thoughts and behaviors, with the aim of positively influencing emotions. The general approach developed out of behavior modification and cognitive therapy, and has become widely used to treat mental disorders. The particular therapeutic techniques vary according to the particular kind of client or issue, but commonly include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing assumptions or habits of thoughts that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation and distraction techniques are also commonly included. CBT is widely accepted as an evidence-based, cost-effective psychotherapy for many disorders. It is sometimes used with groups of people as well as individuals, and the techniques are also commonly adapted for self-help manuals and, increasingly, for self-help software packages.

The basics

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 - and unrealistic - 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.

Thoughts as the cause of emotions

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, in a process sometimes referred to as cognitive-shifting.

Cognitive Behavioral 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.

The cognitive model says that a person's core beliefs (often formed in childhood) contribute to 'automatic thoughts' that pop up in every day life in response to situations. Cognitive Therapy practitioners hold that clinical depression is typically associated with negatively biased thinking and irrational thoughts. Cognitive Behavioral 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.

Cognitive Behavioral Therapy

CBT can be seen as an umbrella term for many different therapies that share some common elements.[1] While similar views of emotion have existed for millennia, the earliest form of Cognitive Behavior Therapy was developed by Albert Ellis in the early 1950s. Ellis eventually called his approach Rational Emotive Behavioral Therapy, or REBT, as a reaction against popular psychoanalytic and increasingly humanistic methods at the time [2]. Aaron T. Beck independently developed another CBT approach, called Cognitive Therapy, in the 1960s[3]. Cognitive Therapy 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. This use has been developed in the UK by Douglas Turkington and David Kingdon.

Other types of Cognitive Behavioral Therapy include Dialectical Behavior Therapy, Self-Instructional Training, Schema-Focused Therapy and many others[5].

CBT has a good evidence base in terms of its effectiveness in reducing symptoms and preventing relapse. It has been clinically demonstrated in over 400 studies to be effective for many psychiatric disorders and medical problems for both children and adolescents. It 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 Behavioral Therapy most closely allies 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 measurable goal-attainment.

Depression

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."

Attributional style

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 [6]. 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 [7]. 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 clinical depression as are causal attributions.

The ABCs of Irrational Beliefs

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.

  • A - Activating Event or objective situation. The first column records the objective situation, that is, an event that ultimately leads to some type of high emotional response or negative dysfunctional thinking.
  • B - Beliefs. In the second column, the client writes down the negative thoughts that occurred to them.
  • C - Consequence. The third column is for the negative feelings and dysfunctional behaviors that ensued. The negative thoughts of the second column are seen as a connecting bridge between the situation and the distressing feelings. The third column C is next explained by describing emotions or negative thoughts that the client thinks are caused by A. This could be anger, sorrow, anxiety, etc.

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.

  • Reframing. After irrational beliefs have been identified, the therapist will often work with the client in challenging the negative thoughts on the basis of evidence from the client's experience by reframing it, meaning to re-interpret it in a more realistic light. This helps the client to develop more rational beliefs and healthy coping strategies.

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.

Effectiveness of CBT with or without drugs for depression

Main article: Cognitive behavioral analysis system of psychotherapy

A large-scale study in 2000[8] 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.[9]

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[10], 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 [11].

CBT with children and adolescents

The use of CBT has been extended to children and adolescents with good results. It is often used to treat depression[12] , 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 Northwestern University in the Clinical Psychology program in Chicago.

CBT has been used with children and adolescents to treat a variety of conditions with good success.[13][14]

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.[15] 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. While Dialectical Behavior Therapy has been shown to be an effective treatment for adults with personality disorders, it has not been tested with child or adolescent patients.[16]


The importance of relationship factors in effective CBT with adolescents is described by Aaron T. Beck, M.D.,

The authors have emphasized repeatedly the importance of a trusting, secure relationship with the therapist. This attitude reminds the reader of Bowlby, who also developed the idea of an internal map of the world, a set of schemas in which self and others and their relationships are represented. This conceptualization clearly integrates will the cognitive model's concepts of core beliefs and primary and secondary assumptions about self and others and the future. As a result of the collaborative approach, the therapist shares the adolescent's perceptions of loss and pain. Therapist and patient are able to reconstruct narrative, a process that facilitates for patients a more helpful view of their world, themselves, and their future.[17]

Main article: CBT with children and adolescents

Computerised CBT

As the name suggests, this is a computerised form of CBT, 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.

Main article: Computerized CBT


Cognitive behavior therapy with different mental disorders

Main article: CBT treatment for different problems

Cognitive behavior therapy has been successfully applied in the treatment of a wide range of mental disorders] and symptoms. This would include

==List of prominent theorists and researchers

See also

Professional Organizations & Institutes

Bibliography

  1. ↑ "A Guide to Understanding Cognitive and Behavioural Psychotherapies" British Association of Behavioural and Cognitive Psychotherapies. Retrieved on 2007-1-11
  2. ↑ 2.0 2.1 Ellis, Albert (1975). A New Guide to Rational Living, Prentice Hall. ISBN 0-13-370650-8.
  3. ↑ Beck, Aaron T. Cognitive Therapy and the Emotional Disorders. International Universities Press Inc., 1975. ISBN 0-8236-0990-1
  4. ↑ Group Therapy. Stress and Anxiety Services of New Jersey. URL accessed on 2006-06-25.
  5. ↑ What is CBT? …What’s in a Name?. Association for Behavioral and Cognitive Therapies. URL accessed on 2007-1-11.
  6. ↑ Abramson, L., Seligman, M.E.P. & Teasdale, J. (1978). Learned Helplessness in Humans: Critique and Reformulation. Journal of Abnormal Psychology, 87 pp49-74
  7. ↑ Abramson, L. et al: Hopelessness depression: a theory-based subtype of depression, Psychol Rev 96:358, 1989.
  8. ↑ Keller, M. et al. A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression. New England Journal of Medicine Volume 342:1462-1470 May 18, 2000.
  9. ↑ Treatments: Cognitive Behavioral Therapy. depresioNet. URL accessed on 2006-08-27.
  10. ↑ The Depression Report: A New Deal for Depression and Anxiety Disorders. The Centre for Economic Performance's Mental Health Policy Group. URL accessed on 2006-06-25.
  11. ↑ Treatment Recommendations for Patients with Major Depressive Disorder (Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition). American Psychiatric Association. URL accessed on 2006-07-02.
  12. ↑ Wilkes, T, Belsher, G., Rush, A., Frnk, E., & Associates. (1994). Cognitive therapy for depressed adolescents. NY: Guilford Press
  13. ↑ (2005-12-05) Kendall, Philip C. (ed). Child and Adolescent Therapy: Cognitive-Behavioral Procedures, (3rd ed.), Guilford Press. ISBN 1-59385-113-8.
  14. ↑ (2003-05-02) Reinecke, Mark A.; Dattilio, Frank M.; Freeman, A. (eds). Cognitive Therapy with Children and Adolescents: A Casebook for Clinical Practice (2nd ed.), Guilford Press. ISBN 1-57230-853-2.
  15. ↑ (2006) Briere, John; Scott, Catherine (eds). Principles of Trauma Therapy, Sage. ISBN 0-7619-2921-5. (see especially Chapter 7, "Cognitive Interventions", pp. 109-119).
  16. ↑ Reinecke, M., & Freeman, M., (2007) Development and Treatment of Personality Disorder in Mark Freemand and Mark Reinecke (Eds.) (2007), Personality Disorders in Childhood and Adolescence. NY: Wiley
  17. ↑ Beck, A., (1994). Forward. In T. Wilkes, G. Belsher, A. Rush, E. Frank, & Associates. (1994). Cognitive therapy for depressed adolescents. NY: Guilford Press

Key Texts – Books

  • Albano, M. & Kearney, Ca., (2000) When children refuse school: a cognitive behavioral therapy approach: Therapist guide. Psychological Corporation.
  • Alford, B. A., & Beck, A. T. (1997). The integrative power of cognitive therapy. New York: The Guilford Press.
  • Beck, J. (1995). Cognitive Therapy: Basics and Beyond. London:Guildford.
  • Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.
  • Beck, A. T., Emery, G., & Greenberg, R. (1985). Anxiety disorders and phobias: A cognitive perspective. New York:Basic Books.
  • Beck, A. T., Freeman, A., & Associates. (1990). Cognitive therapy of personality disorders. New York: The Guilford Press.
  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.
  • Beck, A. T., Wright, F. D., Newman, C. F., & Liese, B. S. (1993). Cognitive therapy of substance abuse. New York: The Guilford Press.
  • Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: The Guilford Press.
  • Beck, Aaron T. Cognitive Therapy and the Emotional Disorders. International Universities Press Inc., 1975. ISBN 0-82-360990-1
  • Dryden, Windy. Ten Steps to Positive Living. Sheldon Press, 1994.
  • Ellis, Albert. A Guide to Rational Living. Prentice Hall, 1975. ISBN 0-13-370650-8
  • Deblinger, E. & Heflin, A. (1996) Treating sexually abused children and their non-offending parents: a cognitive behavioral approach. Thousand Oaks, CA: Sage Publication.
  • Kuyken, W., Padesy, C>A> & Dudley, D (2009) Colaborative case conceptualization:Working Efffectively with Clients in Cognitive-Behavioural Therapy. Guildford Press. ISBN:9781606230725
  • Wilson, P.H., Spence, S.H. & Kavanagh, D. J. (1989) Cognitive behavioural Interviewing for Adult Disorders: A Practical Handbook. London: Routledge.

Additional material – Books

  • Bennett-Levy,James ( ) Oxford Guide to Behavioural Experiments in Cognitive Therapy (Cognitive Behaviour Therapy: Science & Practice)
  • Beck,Judith S. ( ) Cognitive Therapy: Basics and Beyond
  • Burns, D. D. (1980). Feeling good. New York: Avon Books.
  • Dobson, K. S. (Ed.). (2001). Handbook of cognitive-behavioral therapies (2nd ed.). New York: The Guilford Press.
  • Freeman, A., Pretzer, J., Fleming, B., & Simon, K. M. (1990). Clinical applications of cognitive therapy. New York: Plenum Press.
  • Greenberger, D., & Padesky, C. (1995). Mind over mood: Changing how you feel by changing the way you think. New York: The Guilford Press.
  • Hawton, Keith ( ) Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide
  • Leahy, R. (1996). Cognitive therapy: Basic principles and applications. Northvale, NJ: Jason Aronson.
  • Persons, J. B. (1989). Cognitive therapy in practice: A case formulation approach. New York: Norton.
  • Westbrook, D., Kennerley, H.& Kirk,J.(2007)An Introduction to Cognitive behaviour Therapy.Sage.

Key Texts – Papers

  • Abramson, L., Seligman, M.E.P. & Teasdale, J. (1978). Learned Helplessness in Humans: Critique and Reformulation. Journal of Abnormal Psychology, 87 pp49-74
  • Butler, A., & Beck, J. S. (2001). Cognitive therapy outcomes: A review of meta-analyses. Tidsskrift for Norsk Psykologforening, 38, 698–706.
  • Crits-Cristoph, P., Chambless, D. L., Frank, E., Brody, C., & Karp, J. (1995). Training in empirically validated treatments: What are clinical psychology students learning? Professional Psychology: Research and Practice, 26, 514–522.
  • Dattilio, F. M., & Padesky, C. A. (1990). Cognitive therapy with couples. Sarasota: Professional Resource Exchange.
  • Dobson, K. S., Shaw, B. F., & Vallis, T. M. (1985). Reliability of a measure of the quality of cognitive therapy. British Journal of Clinical Psychology, 24, 295–300.
  • Norcross, J. C., Hedges, M., & Prochaska, J. O. (2002). The face of 2010: A Delphi poll on the future of psychotherapy. Professional Psychology: Research and Practice, 33, 316–322.
  • Pedesky, C.A. & Mooney, K.A. (1990). Presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6,11-12.

Additional material - Papers

  • Keller, M. et al. 2000A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression].New England Journal of Medicine Volume 342:1462-1470 [http://content.nejm.org/cgi/content/abstract/342/20/1462 Full text

External links


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