Cognitive Therapy

Developed by Dr. Aaron T. Beck, Cognitive Therapy (CT), or Cognitive Behavior Therapy (CBT), is a form of psychotherapy in which the therapist and the client work together as a team to identify and solve problems. Therapists help clients to overcome their difficulties by changing their thinking, behavior, and emotional responses.

A System of Psychotherapy

Cognitive therapy is a comprehensive system of psychotherapy, and treatment is based on an elaborated and empirically supported theory of psychopathology and personality. It has been found to be effective in more than 400 outcome studies for a myriad of psychiatric disorders, including depression, anxiety disorders, eating disorders, and substance abuse, among others, and it is currently being tested for personality disorders. It has also been demonstrated to be effective as an adjunctive treatment to medication for serious mental disorders such as bipolar disorder and schizophrenia. Cognitive therapy has been extended to and studied for adolescents and children, couples, and families. Its efficacy has also been established in the treatment of certain medical disorders, such as irritable bowel syndrome, chronic fatigue syndrome, hypertension, fibromyalgia, post-myocardial infarction depression, noncardiac chest pain, cancer, diabetes, migraine, and other chronic pain disorders.

In the mid-1960s, Dr. Aaron T. Beck developed cognitive therapy as a time-sensitive,  structured therapy that uses an information-processing model to understand and treat psychopathological conditions. The theory is based, in part, on a phenomenological approach to psychology, as proposed by Epictetus and other Greek Stoic philosophers and more contemporary theorists such as Adler, Alexander, Horney, and Sullivan. The approach emphasizes the role of individuals’ views of themselves and their personal worlds as being central to their behavioral reactions, as espoused by Kelly, Arnold, and Lazarus. Cognitive therapy was also influenced by theorists such as Ellis, Bandura, Lewinsohn, Mahoney, and Meichenbaum.

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The Cognitive Model

Cognitive therapy is based on a cognitive theory of psychopathology. The cognitive model describes how people’s perceptions of, or spontaneous thoughts about, situations influence their emotional, behavioral (and often physiological) reactions. Individuals’ perceptions are often distorted and dysfunctional when they are distressed. They can learn to identify and evaluate their “automatic thoughts” (spontaneously occurring verbal or imaginal cognitions), and to correct their thinking so that it more closely resembles reality. When they do so, their distress usually decreases, they are able to behave more functionally, and (especially in anxiety cases), their physiological arousal abates.

Individuals also learn to identify and modify their distorted beliefs: their basic understanding of themselves, their worlds, and other people. These distorted beliefs influence their processing of information, and give rise to their distorted thoughts. Thus, the cognitive model explains individuals’ emotional, physiological, and behavioral responses as mediated by their perceptions of experience, which are influenced by their beliefs and by their characteristic ways of interacting with the world, as well as by the experiences themselves. Therapists use a gentle Socratic questioning process to help patients evaluate and respond to their automatic thoughts and beliefs—and they also teach them to engage in this evaluation process themselves. Therapists may also help patients design behavioral experiments to carry out between sessions to test cognitions that are in the form of predictions. When patients’ thoughts are valid, therapists do problem solving, evaluate patients’ conclusions, and work with them to accept their difficulties.

The Goal of Cognitive Therapy

The goals of cognitive therapy are to help individuals achieve a remission of their disorder and to prevent relapse. Much of the work in sessions involves aiding individuals in solving their real-life problems and teaching them to modify their distorted thinking, dysfunctional behavior, and distressing affect. Therapists plan treatment on the basis of a cognitive formulation of patients’ disorders and an ongoing individualized cognitive conceptualization of patients and their difficulties. A developmental framework is used to understand how life events and experiences led to the development of core beliefs, underlying assumptions, and coping strategies, particularly in patients with personality disorders.

A strong therapeutic alliance is a key feature of cognitive therapy. Therapists are collaborative and function as a team with patients. They provide rationales and seek patients’ agreement when undertaking interventions. They make mutual decisions about how time will be spent in a session, which problems will be discussed, and which homework assignments patients believe will be helpful. They engage patients in a process of collaborative empiricism to investigate the validity of the patient’s thoughts and beliefs.

Cognitive therapy is educative, and patients are taught cognitive, behavioral, and emotional-regulation skills so they can, in essence, become their own therapists. This allows cognitive therapy to be time-limited for many patients; those with straightforward cases of anxiety or unipolar depression often need only 6 to 12 sessions. Patients with personality disorders, comorbidity, or chronic or severe mental illness usually need longer courses of treatment (6 months to 1 year or more) with additional periodic booster sessions.

Cognitive therapists elicit patients’ goals at the beginning of treatment. They explain their treatment plan and interventions to help patients understand how they will be able to reach their goals and feel better. At every session, they elicit and help patients solve problems that are of greatest distress. They do so through a structure that seeks to maximize efficiency, learning, and therapeutic change. Important parts of each session include a mood check, a bridge between sessions, prioritizing an agenda, discussing specific problems and teaching skills in the context of solving these problems, setting of self-help assignments, summary, and feedback.

Cognitive Therapy Techniques

Therapists use a wide variety of techniques to help patients change their cognitions, behavior, mood, and physiology. Techniques may be cognitive, behavioral, environmental, biological, supportive, interpersonal, or experiential. Therapists select techniques based on their ongoing conceptualization of the patient and his or her problems and their specific goals for the session. They continually ask themselves, “How can I help this patient feel better by the end of the session and how can I help the patient have a better week?” These questions also guide clinicians in planning strategy.

There is no one typical client for this approach, as cognitive therapy has been demonstrated in numerous research studies to be effective for depression, anxiety disorders, substance abuse, eating disorders; for bipolar disorder and schizophrenia (as an adjunct to medication); and for a variety of medical problems with psychological components. Of course, treatment has to be varied for each disorder and therapists must not only understand the cognitive formulation of a specific disorder but also be able to conceptualize individual clients accurately and devise a treatment plan based on this formulation and conceptualization. Cognitive therapy interventions must also be adapted for older adults, children, and adolescents and for group, couples, and family treatment.

Effectiveness of Cognitive Behavior Therapy

In hundreds of clinical trials, CBT has been demonstrated to be an effective treatment for a wide variety of disorders. To name just a few, it has been found useful for:

  • psychiatric disorders such as depression, the full range of anxiety disorders, eating disorders, substance abuse, personality disorders, and (along with medication) bipolar disorder and schizophrenia;
  • medical disorders with a psychological component, including several conditions involving chronic or acute pain,  chronic fatigue syndrome, pre-menstrual syndrome, colitis, sleep disorders, obesity, Gulf War syndrome, and somatoform disorders; and
  • psychological problems such as anger, relationship difficulties, and compulsive gambling.

CBT is also used to address stress, low self-esteem, grief and loss, work-related problems and problems associated with aging.

Broad Application

Studies have shown that CBT is effective for children and adolescents, adults, and older adults. It is used in individual, couples, family, and group formats and in a wide variety of settings, such as schools, correctional facilities, outpatient, inpatient, and partial hospitalization units.

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13 Responses to Cognitive Therapy

  1. Pingback: Cognitive Therapy Today » Blog Archive » CT Buzz: Aaron Beck Montage on Youtube - in Spanish - “Aaron Beck: Una Historia de Pasion”

  2. Pingback: Cognitive Therapy Today » Blog Archive » October Extramural Workshop… just a few days away!

  3. Thanks for providing that fascinating little video clip. It helps shed some light on Dr. Beck’s influences, especially the debt he sees “schemas” as owing to “personal constructs”. I’m glad you also mention here the debt to Stoic philosophy. That’s an area I tried to explore further in my book The Philosophy of Cognitive-Behavioural Therapy, taking Dr. Beck’s published comments as a launching pad for comparisons between CBT and a range of classical philosophical concepts and techniques.

  4. Kourosh Gharagoz says:

    Dear Sir/ Madam ,
    I would like to ask you to give your response to one or both of the following questions please:

    1) What kind of treatment is good for a person with PTSD? Is Cognitive Behaviour Therapy is useful for people who have problem from PTSD?

    2) Could you please explain to me “why Cognitive Behaviour Therapy is useful” for somebody who suffers with PTSD?

    I would really appreciate it if you can response my question, because it is too important for me.

    Thank you in advance
    Kind regards,
    Kourosh Gharagoz

  5. Jackie O. says:

    Dear Kourosh,
    My guess is that he will not explain it to you. His interest might be in researching that area because he enjoys it, not in you specifically. I suggest you look for a therapist that learned with him but is IN practice.
    My reasons;
    p.s; I believe your question is not asking one specific thing.
    p.2; I might be wanting to know the same thing you asked as I also suffer from PTSD.
    Good luck on your search and stay well!

  6. Linwood Damewood says:

    Acute pain might be mild and last just a moment, or it might be severe and last for weeks or months. In most cases, acute pain does not last longer than six months, and it disappears when the underlying cause of pain has been treated or has healed. Unrelieved acute pain, however, might lead to chronic pain.

  7. Nahla alsalihi says:

    hi
    dr from baghdad university
    iam dr nahla alsalihi .a sking about cbt can u training iraqi researchers in ur institutes

    thanks alot

    drnahla alsalihi
    baghdad university
    college of education ibn rushd
    psycholoical and educational department

  8. Michelle says:

    I very interested in your views on c b t for young adults with Aspergers syndrome,The general advantages and disadvantages , the commitment levels needed . Thank you Michelle Carey Elwood

  9. Suzy Pollard says:

    HI,

    I am interested to know how CBT can assist with social anxiety and if there is anywhere that I could be located to , to find information on this?

  10. They may believe and psychologist will attack his environment in” Holistic Health” and are enacted through sexual assaults. The journal strives to foster her with everything that’s alive animals, plants, spirit-beings, ancestors, deities, or for any reason. It is also psychologist a lot of people leaving the Adolescent and Family Therapy program offers a lot of people leaving the house you know at least in part because psychoanalysis, which put an end.

  11. A letter of thanking to respected Dr Beck AT
    Sir, four years back I fell in love with your book ‘cognitive therapy and the emotional disorders’ while reading google book previews. Later I read all of your books and books by Burns, Pedesky and J.Beck. This enabled me to learn and do cognitive therapy(CT) for hundreds of panic patients and tens of ocd, depression, phobias very confidently and successfully. I presume that I have cleared level one in CT. Now I am working on chronic depression and personality problems using schema therapy and CBASP, as you have recomended in one of your writings. Dreaming of doing CT for psychosis on day. Thank for your clear and lovely writings. My reading of ACT, Ellis, dynamic therapies, MBCT, MCT of Wells helped me to become a better cognitive therapist. I fully agree with your approach of targeting beliefs using thoughts, attention focus, behavior, emotions and body sensations in CT. I could get 80% improvement in my stage fear using CT. In spite of not having any kind of training in therapy I could learn CT by using your books. I am a professor of psychiatry, age 45, living in Bangalore, India. I will be quite happy if you read this mail and would be exited if you reply.
    Thanking you again and wishing you Nobel award soon (possibly shared with Ellis!)
    Dr Sudhir Hebbar

  12. Bridgid Y. says:

    Thank you for providing this resource along with the video. I am a strong advocate for the use of CBT and admire the the changes Beck’s model made in psychotherapy.
    Thanks,
    Bridgid
    Sliding Scale Counseling

  13. Antonia says:

    I’m not that much of a internet reader to be honest but your blogs really nice, keep it
    up! I’ll go ahead and bookmark your website to
    come back later on. Cheers

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