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Cognitive behavioural therapy (or cognitive behaviour therapy, CBT) is a psychotherapeutic approach that aims to influence problematic and dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure. CBT can be seen as an umbrella term for therapies that share a theoretical basis in behavioristic learning theory and cognitive psychology, and that use methods of change derived from these theories.
CBT treatments have received empirical support for efficient treatment of a variety of clinical and non-clinical problems, including mood disorders, anxiety disorders, personality disorders, eating disorders, substance abuse disorders, and psychotic disorders. It is often brief and time-limited. It is used in individual therapy as well as group settings, and the techniques are also commonly adapted for self-help applications. Some CBT therapies are more oriented towards predominately cognitive interventions while some are more behaviorally oriented. In cognitive oriented therapies, the objective is typically to identify and monitor thoughts, assumptions, beliefs and behaviors that are related and accompanied to debilitating negative emotions and to identify those which are dysfunctional, inaccurate, or simply unhelpful. This is done in an effort to replace or transcend them with more realistic and useful ones.
CBT was primarily developed through a merging of behaviour therapy with cognitive therapy. While rooted in rather different theories, these two traditions found common ground in focusing on the "here and now" and symptom removal. Many CBT treatment programs for specific disorders have been developed and evaluated for efficacy and effectiveness; the health-care trend of evidence-based treatment, where specific treatments for specific symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments. In the United Kingdom, the National Institute for Health and Clinical Excellence recommends CBT as the treatment of choice for a number of mental health difficulties, including post-traumatic stress disorder, OCD, bulimia nervosa and clinical depression.
Specific applications
CBT is applied to many clinical and non-clinical conditions and has been successfully used as a treatment for many clinical disorders, personality conditions and behavioral problems.
Anxiety disorders
A basic concept in CBT treatment of anxiety disorders is in vivo exposure. This means, gradual exposure to the actual, feared stimulus. The theory behind this is that the stimulus evokes the fear response because of classical conditioning, and is maintained because the avoidance of this particular is being positively reinforced – this "two-factor" model is often credited to O. Hobart Mowrer. Through exposure, this conditioning can be unlearned; this is referred to as extinction and habituation. A specific phobia, such as fear of spiders, can often be treated with in vivo exposure and therapist modeling in one session. Obsessive compulsive disorder is typically treated with exposure with response prevention.
Social phobia has often been treated with exposure coupled with cognitive restructuring, such as in Heimberg's group therapy protocol. Evidence suggests that cognitive interventions improve the result of social phobia treatment.
CBT has been shown to be effective in the treatment of generalized anxiety disorder, and possibly more effective than pharmacological treatments in the long term.
Mood disorders
One etiological theory of depression is Aaron Beck's cognitive theory of depression. 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. When the person with such schemata encounters a situation that in some way resembles the conditions in which the original schema was learned, the negative schemata of the person are activated.
Beck also described a negative cognitive triad, made up of the negative schemata and cognitive biases of the person; Beck theorized that depressed individuals make negative evaluations of themselves, the world, and the future. Depressed people, according to this theory, have views such as "I never do a good job," 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. This is the negative triad. Also, Beck 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.
Insomnia
Cognitive behavioral therapy has been found to be effective in reducing benzodiazepine usage in the treatment of insomnia. A large-scale trial utilizing CBT for chronic users of sedative hypnotics including nitrazepam, temazepam and zopiclone found the addition of CBT to improve outcome and reduce drug consumption in the treatment of chronic insomnia. Persisting improvements in sleep quality, sleep latency, and increased total sleep, as well as improvements in sleep efficiency and significant improvements in vitality and physical and mental health at 3-, 6- and 12-month follow-ups were found in those receiving cognitive behavioral therapy with hypnotics compared with those patients receiving hypnotics alone. A marked reduction in total sedative hypnotic drug use was found in those receiving CBT, with 33% reporting no hypnotic drug use. Authors of the study suggested that CBT is potentially a flexible, practical, and cost-effective treatment for the treatment of insomnia and that CBT administered coincident to hypnotic treatment leads to a reduction of benzodiazepine drug intake in a significant number of patients.
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, anxiety disorders, and symptoms related to trauma and posttraumatic 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. Paula Barrett and her colleagues have also validated CBT as effective in a group setting for the treatment of youth and child anxiety using the Friends Program she authored. This CBT program has been recognized as best practice for the treatment of anxiety in children by the World Health Organization. CBT has been used with children and adolescents to treat a variety of conditions with good success.. CBT is also used as a treatment modality for children who have experienced complex post traumatic stress disorder and chronic maltreatment.
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