ArticlePDF Available

Cognitive behavior therapy

Authors:

Abstract

Cognitive behavior therapy (CBT) is one of the most extensively researched psychotherapeutic modalities which is being used either in conjunction with psychotropic drugs or alone in various psychiatric disorders. CBT is a short-term psychotherapeutic approach that is designed to influence dysfunctional emotions, behaviors, and cognitions through a goal-oriented, systematic procedure. Recent advances in CBT suggest that there is a fresh look on a "third wave" CBT that has a greater impact and newer application that may mitigate the sufferings of mentally ill patients.
132 Medical Journal of Dr. D.Y. Patil University | April-June 2013 | Vol 6 | Issue 2
Address for correspondence:
Dr. Daniel Saldanha, Department of Psychiatry, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune – 411 018, India.
E-mail: d_saldanha@rediffmail.com
Cognitive behavior therapy
Labanya Bhattacharya, Bhushan Chaudari, Daniel Saldanha, Preethi Menon
Department of Psychiatry, Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
ABSTRACT
Cognitive behavior therapy (CBT) is one of the most extensively
researched psychotherapeutic modalities which is being used
either in conjunction with psychotropic drugs or alone in various
psychiatric disorders. CBT is a short-term psychotherapeutic
approach that is designed to inuence dysfunctional emotions,
behaviors, and cognitions through a goal-oriented, systematic
procedure. Recent advances in CBT suggest that there is a
fresh look on a “third wave” CBT that has a greater impact and
newer application that may mitigate the sufferings of mentally
ill patients.
Key words: Cognitive behavior therapy, cognitive psychology,
third wave
Access this article online
Quick Response Code:
Website:
www.mjdrdypu.org
DOI:
10.4103/0975-2870.110294
Review Article
in the early 20th century and the development of Cognitive
School of thought in the 1960s, and subsequent integration
of the two.[6]
Since early 1920s, inspired works of Ivan Pavlov, John B.
Watson, Joseph Wolpe and B. F. Skinner, the science of
behavior therapy came into practice to treat neurotic disorders.
In behaviorism, learning theory played a signicant role.
e behaviorists shifted from science to technology and did
not show much interest in theory building. Although the
early behavioral methods successfully treated many neurotic
disorders like anxiety disorders, it had little success in treating
depression. All this led to a shift in focus of therapeutic
approaches from behaviorism to “cognitive theory of mental
disorders.
e so-called cognitive revolution was pioneered by the works
of Aaron T. Beck, psychiatrist at the University of Pennsylvania,
and Albert Ellis, Psychologist in 1960s. Aaron T. Beck, within
the course of his psychoanalytical treatment, observed the
fact that traditional psychoanalytical concepts for depression
“aggression directed inwards” could not be validated and
certain patterns were evident in the thoughts of depressed
individuals. He observed that their symptoms were the result
of negative bias in their cognitive processing. is led to the
development of “cognitive therapy.” Concurrently, “Rational
Emotive Behavior erapy” was developed by Albert Ellis,
stating the same notion that faulty cognition leads to emotional
disturbances.
Development of Cognitive Behavior
Therapy
e term cognitive behavior therapy (CBT) can be seen as
an umbrella term, generally used to refer a group of related
therapies that have theoretical basis in behavioristic learning
and cognitive psychology and are derived from scientically
proven theoretical models from these theories,[1] and is
currently a treatment of choice for various psychiatric disorders
including mood disorders, anxiety disorders, personality
disorders (PDs), eating disorders, substance abuse disorders,
and psychotic disorders.[2,3]
e origin of cognitive behavior therapies can be traced back
to various ancient philosophical traditions and thinkers of
the pre-classical and classical periods, particularly Stoicism.[4]
Epictetus, a Greek philosopher and stoic stated that “It is not
things themselves that disturb men, but their judgments about
these things.” It has been mentioned in Aaron T. Beck’s original
treatment manual for depression that “e philosophical
origins of cognitive therapy can be traced back to the Stoic
philosophers.”[5] However, the modern roots of CBT can be
traced to the development of Behavioral School of thought
[Downloaded free from http://www.mjdrdypu.org on Wednesday, September 28, 2016, IP: 83.86.55.11]
Bhattacharya, et al.: Cognitive behavior therapy
Medical Journal of Dr. D.Y. Patil University | April-June 2013 | Vol 6 | Issue 2 133
Earlier studies compared cognitive therapy and behavior
therapy to see which was more eective. Later cognitive
therapists started blending cognitive and behavior therapies
into a coherent whole to form CBT. us, the importance of
cognition was incorporated in behaviorism, while behavioristic
characteristics, like empiricism and conduction of outcome
research, were incorporated in cognitive therapy. It can be said
that the earliest form of CBT was observed in Ellis’ work in
early 1960s,[7] but the rst major texts on cognitive behavior
modication appeared in 1970s.[8-10]
Basic Principles of Cognitive
Behavior Therapy
Although the actual theoretical mechanism behind eectiveness
of CBT in various clinical disorders is not well understood,
CBT operates under the assumption that psychological
disorders are mediated by distorted cognitions and maladaptive
behaviors. To explain in simple terms, the distorted cognitions
lead to faulty emotions which in turn lead to maladaptive
behaviors and these behaviors will have negative impact on
cognitions as depicted in Figure 1.
CBT uses two basic approaches to bring about changes, i.e. (i)
restructuring the cognitive event which is based on cognitive
theory and (ii) social and interpersonal skill training which is
a behavioral arm of cognitive behavior theory.
Cognitive principle
Although dierent cognitive therapists use dierent theoretical
models of cognitive processes which may dier according to
psychological disorder, some basic cognitive structures and
processes have been described by early cognitive therapists.[5,11,12]
Automatic thoughts
Automatic thoughts are short-term cognitive events which
appear as a response to external events “without thought” or
“automatically. Aaron T. Beck rst described these automatic
thoughts which he observed, in patients of depressive disorders,
as often negatively tinged.[13,14] ese “Negative Automatic
oughts” or “Cognitive Distortions” are thought to exert a
direct inuence over mood and they are therefore of central
importance to any CBT therapy. ese cognitive distortions
can be classied according to their typical bias or illogic.
Examples include: “She thinks I’m an idiot” (Mind-reading),
“I’ll fail the test (Fortune-telling), “I’m a loser” (Labeling),
“I can’t stand it—it’s awful” (Catastrophizing), “My successes
are trivial” (Discounting positives), I fail at everything” (All-
or-nothing thinking), If I fail at this, I’ll fail at other things
too” (Overgeneralizing), and “e divorce was all my fault”
(Personalizing).[15]
Underlying assumptions and core beliefs
ese are long-term cognitive processes and are less available
to an individual’s consciousness than automatic thoughts.[16]
Underlying assumptions and core beliefs are more durable and
stable organizational system, that doesn’t change over a range
of situations or time. ese represent person’s basic rules or
values. Typical rules are “I should be perfect,” “I should be liked
by everyone,” “My worth depends on others’ approval,” “I need
to be certain,” and “My partner should understand and meet
my needs without my having to tell him.” ese underlying
assumptions and core beliefs structure a person’s automatic
thinking.[13] Most cognitive approaches start with helping the
client to identify automatic thoughts and cognitive distortions
and then addressing the long-term underlying core beliefs that
are associated with them.[7,14,17]
This represents the basic cognitive model of emotional
disorders underlying CBT. Over the years, generic models for
various psychiatric disorders, i.e. depression,[5] panic disorder,[18]
post-traumatic stress disorder (PTSD),[19] hypochondriasis,[20]
obsessive-compulsive disorder (OCD),[21] generalized anxiety
disorder,[22] and social phobia[23] have been developed.
Behavioral principle
e theoretical principle which is inherited from behavioral
theory assumes that person’s behavior is crucial in maintaining
– or in changing – psychological states of his mind. It states
that the person having cognitive distortions behave in such a
way that the subsequent behavior has negative impact on the
emotional states and further cognition. us, changing the
behavior of a person is a powerful way of changing thoughts
and emotions. ese behavioral methods include various
strategies of coping and social skill training. ese behavioral
techniques have proven to be an essential part for successful
therapy in various research studies.[24]
Event
Thought/ Belief /
Cognition
Feelings/ Emotion
Action/ Behavior
Figure 1: Distorted cognitions leading to maladaptive behaviors
[Downloaded free from http://www.mjdrdypu.org on Wednesday, September 28, 2016, IP: 83.86.55.11]
Bhattacharya, et al.: Cognitive behavior therapy
134 Medical Journal of Dr. D.Y. Patil University | April-June 2013 | Vol 6 | Issue 2
At the beginning of each session, review information is
gathered from the patient about events that occurred since
the previous session that is relevant to the patient’s goals for
treatment. Along with this, some part of treatment session
is also dedicated for diculties that may occur before next
treatment session. ese diculties then are discussed in
the context of problem solving and the implementation of
necessary cognitive and behavioral skills. Although the specic
intervention used during CBT may vary, the interventions
are based on cognitive and learning theories. rough these
cognitive and behavioral techniques, generally rst patient’s
negative automatic thoughts and dysfunctional beliefs
are identied and tested in reality. ere are a number of
specic cognitive and behavioral techniques used in the CBT
procedure, some of which are enumerated bellow although
they are not exclusive.[15]
Cognitive techniques
• Identifyingandmonitoringnegativethoughts
• Ratingthedegreethebeliefinsuchnegativethoughts
anddegreeofemotionassociatedwiththoughts
• Categorizingthenegativethoughtsinspeciccognitive
distortions
• Verticaldescent (Whatwoulditmean ifthethought
weretrue?)
• Whatistheunderlyingassumption?
• Whatarethecostsandbenetsofthethought?
• Listing the evidences supporting and refuting his
thoughts
• Placing the event in perspective by examining its
consequencesinpatient’sview
• Doublestandard(askingpatientifhewouldapplythe
samestandardsifeventoccurswithothers
• Roleswitchingandarguingbackatnegativethoughts
bypatient
• Patientisaskedtoexaminemanyalternativecausesand
consequencesofthethought,especiallylessnegative
alternatives
• Acceptance (Is there a reality that the patient can learn to
accept, rather than trying to x or struggle with it?)
Behavioral techniques
• Exposureorconfrontingthefearedstimuli
• Gradedexposure
• Modeling (e.g. therapist demonstrates in session an
appropriate assertive response that the patient then
imitates.)
• Imitation(e.g.patient“copies”andenactsthebehavior
thatheobservesinanotherperson.)
• Behavioralrehearsal(patientenactsthebehaviorwhich
heplanstoconductoutsideoftherapy.)
• Relaxationtechniques
• Activity scheduling (listing activities throughout the
day and rating them for various emotions associated
The “here and now” principle
In modern CBT, the main focus of therapy is on what is
happening in the present and main concerns of the therapy is
the processes currently maintaining the problem, rather than
the processes that might have led to its development years ago.
The empirical principle
CBT believes in evaluating the theories and treatment
outcomeasrigorouslyaspossibleusingscienticevidence.
Thisisimportantforseveralreasons:
• Scientically– sothatthetreatmentscan befounded
onsound,well-establishedtheories
• Economically – so that the cost–benefit ratio of
treatmentisbenecialfortheclient
• Ethically – so that the clientsareprovidedwithsound
treatment.
Technique
Modern form of CBT includes variety of techniques
and approaches. These are exposure therapy, stress
inoculation training,cognitive processing therapy, cognitive
therapy,relaxation training,dialectical behavior therapy,
andacceptance and commitment therapy.[25] Therapeutic
techniques vary according to specic issues that have to be
dealt with. e current form of CBT targets core components
of a given disorder. CBT is typically delivered over the course
of 12 to 20 sessions; each session typically lasts from 45 min
to 1 h duration.
A key feature of CBT is the establishment of a strong,
collaborative working relationship with the patient. is will
be facilitated if there is a warm and trusting atmosphere.
Empathy and unconditional positive regard toward patient is
of utmost importance. e role of therapist in CBT should be
as a guide, catalyst, and teacher. e initiation of this working
relationship is done with psycho education of patient about
the nature of the disorder, explaining the CBT model of the
etiology and maintenance of the disorder and the intervention
derived from the model.
In initial few sessions, thorough evaluation of the presenting
problem of a patient is done and initial hypothesis and
treatment plan is formulated. is phase of treatment is called
“Cognitive Behavioral Assessment.” Patient’s current problem
is assessed through self-monitoring of symptoms of the patient,
behavioral interviewing, and direct observation of behavior
or objective assessment of patient’s symptoms through a
self-report questionnaire. e therapist helps to identify and
dierentiate between problems so the challenges are reduced
to manageable goals.
[Downloaded free from http://www.mjdrdypu.org on Wednesday, September 28, 2016, IP: 83.86.55.11]
Bhattacharya, et al.: Cognitive behavior therapy
Medical Journal of Dr. D.Y. Patil University | April-June 2013 | Vol 6 | Issue 2 135
withthem)
• Gradedtask assignments (planning and enacting
behaviorsthatareexpectedtoproducereward)
• Assertivenesstraining
• Communicationtraining
• Self reward to increase desirable behaviors
Homework is an essential part of CBT treatment, as patient
is not only transformed during sessions but a lot of change
in patient’s cognitive structuring and behavior is happening
between the sessions. This is catalyzed by a homework
assignment which usually follows from the problem solving
process in the treatment session. Successful completion
of homework assignment is a good predictor of success of
therapy. is inter-session practice also encourages the patient
to generalize skills learned in sessions to tackle problems
encountered in everyday life.
Group cognitive behavioral therapy
CBT can also be given in group therapy settings, in which
therapeutic benets of both CBT and group therapy can be
combined. is technique is found to be useful in patients with
substance use disorders,[26] depression,[27] anxiety disorders[28]
social phobia,[29] and also in children.[30] e group CBT
is cost eective, as well as it allows patients to learn about
their cognitive distortions by observing other patients and
it also provides a safe environment for them to learn and
practice communication and social learning skills as in real
life situations.
Computer-based cognitive behavior therapy
Computerized Cognitive Behavioral erapy (CCBT) has
been described by NICE as a “generic term for delivering CBT
via an interactive computer interface delivered by a personal
computer, internet, or interactive voice response system,”[31]
instead of face-to-face with a human therapist. It can be
used by patients where direct face-to-face CBT is dicult
to obtain because of unavailability of expert therapist or cost
issues. Studies have proved eectiveness of this computer based
therapy in mild to moderate depression and anxiety disorders.
[32] e usefulness of this method in our setting is questionable.
Application of CBT to Various
Disorders
After the development of CBT, in the initial few years it
primarily gained recognition as a treatment method for mood
disorders and anxiety disorders.[33] As CBT started gaining
popularity, the indications for its use was found in various
psychiatric as well as medical disorders by various workers.
Today some claim that CBT is probably the rst line of
psychological treatment for many disorders.[34]
Depression
Initially, CBT was considered a treatment of choice for mild
to moderate depression among psychological treatment
options. e ecacy of CBT in depression has been shown
by many empirical evidences in which it has been stated to
be superior or at least equally eective with other treatments
including antidepressants.[35,36] Studies have also shown that
combining CBT with medications shows greater eect than
medications alone.[36] CBT can be of particular importance
in chronic and recurrent depression in preventing relapses.[37]
Even in severe depression, CBT is shown to be as ecacious as
antidepressants[38] but this is questionable. CBT is also shown to
be eective in dealing with depressive symptoms in children.[39]
Anxiety disorders
Numerous studies have shown that CBT is eective in reducing
information processing biases and avoidance behaviors which
are characteristic of anxiety disorders and also that with CBT
stronger eects are observed for treatment of anxiety disorders
as compared to other disorders.[40] Several meta-analysis studies
have shown eectiveness of CBT across the range of anxiety
disorders including panic disorder,[41] specic phobia,[42] social
phobia,[43] and generalized anxiety disorder.[44]
Psychotic conditions
e current evidence from multiple randomized controlled
trials and meta-analyses suggests that CBT is a potent adjunct
to pharmacotherapy in psychotic conditions.[45,46] CBT is
eective in dealing with persistent positive as well as negative
symptoms of schizophrenia and also it improve medication
adherence. CBT has also shown its eectiveness in treatment
of acute psychoses.[47]
Obsessive-compulsive disorder
CBT is considered as eective psychological treatment for
OCD,[48] particularly in obsessional problems where intrusive
thoughts are considered as personal responsibility. CBT can
change responsibility beliefs and appraisals and thereby reduce
distress and neutralizing behaviors.[49] However, in compulsive
behaviors, behavioral component of exposure seems to be the
active component of therapy,[50] but cognitive component can
make patient more compliant to behavioral measures.
Post-traumatic stress disorder and acute stress
disorder
Various meta-analyses have shown eectiveness of CBT in
treatment and prevention of PTSD.[51] e most studied
CBT approaches being prolonged exposure[52] and cognitive
processing therapy.[53] In acute stress disorder CBT is found
to be superior to supportive counseling[54] and also prevents
progression to PTSD.
[Downloaded free from http://www.mjdrdypu.org on Wednesday, September 28, 2016, IP: 83.86.55.11]
Bhattacharya, et al.: Cognitive behavior therapy
136 Medical Journal of Dr. D.Y. Patil University | April-June 2013 | Vol 6 | Issue 2
Substance use disorders
Numerous large-scale trials and quantitative reviews have
shown the efficacy of various CBT interventions in the
treatment of alcohol and other drug use disorders.[55,56]
Various CBT interventions used for substance use disorders
include contingency management, motivational interventions,
relapse prevention which can be given in individual as well as
group settings.
Personality disorders
CBT oers various specic therapeutic techniques which
depend on the core psychopathological symptoms of the
PD. Although there are supporting evidences for ecacy of
CBT interventions in PDs, most studied and widely adopted
technique is dialectical behavior therapy which is used in
patients of borderline personality disorder.[57]
Behavioral medicine
CBT can help variety of ill and at risk population by modifying
health and illness behavior and developing eective coping
skills, including patients suering from bulimia nervosa,[58]
cancer,[59] chronic pain,[60] cardiovascular diseases,[61] HIV
and AIDS.[62]
“New Wave” of Cognitive
Behavioral Therapy
Also called as a “ird Wave” of behavior and CBT, this new
wave of CBT has been described recently. It defers from
traditional CBT in a way that the focus of therapy is to change
the function of psychological events that people experience and
promote emotion regulation strategies, rather than to change
the perception of the event.[63] is therapeutic eect is achieved
through various approaches like acceptance, cognitive diusion,
or mindfulness. Psychotherapeutic interventions which are
included in this category include Acceptance and Commitment
erapy (ACT)[64] and Mindfulness-Based Cognitive erapy
(MBCT).[65] Although the present empirical evidence allows
these third wave therapies to be ecacious, further research is
warranted to prove their usefulness over the traditional ones.[66]
Conclusion
Cognitive therapy rst proposed by Beck in early 1960s
for depression has rapidly evolved into one of the major
psychotherapeutic methods in modern psychiatric treatment.
Its ecacy of treatment for depression, generalized anxiety
disorder, panic disorder, eating disorders, and other psychiatric
conditions has been well established by numerous outcome
studies. Most psychiatric illnesses now have well-organized
treatment guidelines based on cognitive therapy. e goals of
cognitive therapy include immediate relief from symptoms and
to acquire cognitive and behavioral skills that reduce the risk
for relapses. With fast-paced modern gadgets, future challenges
for this therapy include computer-assisted models of learning
that is easy and economically viable. In conclusion, it will not
be incorrect to state that whatever method of therapy one
uses it should address the relief of symptoms in that respect
cognitive behavior therapy has proved its utility in varieties of
mental disorders.
References
1. Deacon BJ, Abramowitz JS. Cognitive and behavioural
treatments for anxiety disorders: A review of meta-analytic
ndings. J Clin Psychol 2004;60:429-41.
2. Hollon SD, Beck AT. Cognitive and cognitive behavioural
therapies. In: Lambert MJ, editor. Bergin and Garfield’s
handbook of psychotherapy and behaviour change. 5th ed. New
York: Wiley; 2004.
3. Roth A, Fonagy P. What works for whom? A critical review
of psychotherapy research. 2nd ed. New York: Guilford; 2005.
4. Robertson D. The Philosophy of Cognitive-Behavioural
Therapy: Stoicism as Rational and Cognitive Psychotherapy.
London: Karnac; 2010.
5. Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive Therapy of
Depression. New York: Guilford Press; 1979. p. 8.
6. Kuruvilla K. Cognitive behaviour therapy yesterday, today and
tomorrow. Indian J Psychiatry 2000;42:114-24.
7. Dobson KS, Dozois DJ. Historical and philosophical bases of
cognitive-behavioural therapies. In: Handbook of cognitive-
behavioural therapies, 2nd ed. In: Dobson KS, editor. New York:
Guilford Press; 2001. p. 3-40.
8. Kendall PC, Hollon SD. Cognitive-behavioural interventions:
Overview and current status. In: Cognitive-behavioural
interventions: Theory, research and procedures, Kendall PC,
Hollon SD, New York: Academic Press; 1979. p. 445-54.
9. Mahoney MJ. Cognition and behavioural modification.
Cambridge, MA: Ballinger; 1974.
10. Meichenbaum D. Cognitive-behaviour modification:
An integrative approach. New York: Plenum; 1977.
11. Burns DD. The feeling good handbook. New York: William
Morrow; 1989.
12. Ellis A, Harper RA. A new guide to rational living. Englewood
Cliffs, NJ: Prentice-Hall; 1975.
13. Beck AT. Beyond belief: A theory of modes, personality, and
psychopathology. In Frontiers of cognitive therapy. Salkovskis
PM, editor. New York: Guilford Press; 1996. p. 1-25.
14. Beck JS. Cognitive therapy: Basics and beyond. New York:
Guilford Press; 1995.
15. Leahy RL. Introduction: Fundamentals of cognitive therapy, In:
Practicing cognitive therapy: A guide to interventions. Leahy RL,
editor. Northvale, NJ: Jason Aronson; 1997. p. 1-11.
16. Seligman ME, Walker EF, Rosenhan DL. Abnormal psychology,
4th ed. New York: W.W. Norton; 2001.
17. Freeman A, Pretzer J, Fleming B, Simon KM. Clinical
applications of cognitive therapy. New York: Plenum; 1990.
[Downloaded free from http://www.mjdrdypu.org on Wednesday, September 28, 2016, IP: 83.86.55.11]
Bhattacharya, et al.: Cognitive behavior therapy
Medical Journal of Dr. D.Y. Patil University | April-June 2013 | Vol 6 | Issue 2 137
18. Clark DM. A cognitive approach to panic. Behav Res Ther
1986;24:461-70.
19. Ehlers A, Clark DM. A cognitive model of posttraumatic stress
disorder. Behav Res Ther 2000;38:319-45.
20. Warwick HM, Salkovskis PM. Hypochondriasis. Behav Res
Ther 1990;28:105-17.
21. Salkovskis PM. Obsessional-compulsive problems: A cognitive-
behavioural analysis. Behav Res Ther 1985;23:571-83.
22. Riskind JH. Cognitive mechanisms in generalized anxiety
disorder: A second generation of theoretical perspectives.
Cognit Ther Res 2005;29:1-5.
23. Clark DM, Wells A. A cognitive model of social phobia. In:
Heimberg RG, Liebowitz M, Hope D, Schneier F, editors.
Social phobia: Diagnosis, assessment, and treatment. New York:
Guilford Press; 1995. p. 69-93.
24. Monti PM, Rohsenow DJ, Colby SM, Abrams DB. Coping and
social skills training. In: Handbook of alcoholism treatment
approaches: Effective alternatives, Hester RK, Miller WR,
editors. Boston: Allyn and Bacon; 1995. p. 221-41.
25. Foa EB. Effective Treatments for PTSD: Practice Guidelines from
the International Society for Traumatic Stress Studies, Guilford,
New York, NY, USA, 2nd ed, 2009.
26. Fisher MS, Bentley KJ. Two group therapy models for clients
with a dual diagnosis of substance abuse and personality
disorder. Psychiatr Serv 1996;47:1244-50.
27. Clarke GN, Rohde P, Lewinsohn PM, Hops H, Seeley JR.
Cognitive behavioural treatment of adolescent depression:
Efcacy of acute group treatment and booster sessions. J Am
Acad Child Adolesc Psychiatry 1999;38:272-9.
28. Dugas MJ, Ladouceur R, Leger E, Freeston MH, Langolis F,
Provencher MD, et al. Group cognitive behavioural therapy for
generalized anxiety disorder: treatment outcome and long term
follow up. J Consult Clin Psychol 2003;71:821-5.
29. Heimberg RG, Liebowitz MR, Hope DA, Schneier FR,
Holt CS, Welkowitz LA, et al. Cognitive behavioural group
therapy vs. phenelzine therapy for social phobia. Arch Gen
Psychiatry 1998;55:1133-41.
30. Silverman WK, Kurtines WM, Ginsburg GS, Weems CF,
Lumpkin PW, Carmichael DH. Treating anxiety disorders
in children with group cognitive-behavioural therapy:
A randomized clinical trial. J Consult Clin Psychol 1999;67:
995-1003.
31. Depression and anxiety computerized cognitive behavioural
therapy (CCBT). Available from: http://Nice.org.uk. [Last
accessed on 2012 Dec 01].
32. Hoifodt RS, Strom C, Kolstrup N, Eisemann M, Waterloo K.
Effectiveness of cognitive behavioural therapy in primary health
care: A review. Fam Pract 2011;28:489-504.
33. Brewin CR. Theoretical foundation of cognitive behavioural
therapy for anxiety and depression. Annu Rev Psychol
1996;47:33-57.
34. Rachman S. Psychological treatment of anxiety: The evolution
of behaviour therapy and cognitive behaviour therapy. Annu
Rev Clin Psychol 2009;5:97-119.
35. Dobson KS. A meta-analysis of the efcacy of cognitive therapy
for depression. J Consult Clin Psychol 1989;57:414-9.
36. Cuijpers P, van Straten A, Driessen E. Depression and dysthymic
disorders. In: Hersen M, Sturmey P, editors. Handbook
of evidence based practice in clinical psychology, Vol. II.
Adult disorders. Hoboken (NJ): Wiley; 2012.
37. Hollon SD, DeRubeis RJ, Shelton RC, Amsterdam JD, Salomon RM,
O’Reardon JP, et al. Prevention of relapse following cognitive
therapy vs medications in moderate to severe depression. Arch
Gen Psychiatry 2005;62:417-22.
38. De Rubeis RJ, Hollon SD, Amsterdam JD, Shelton RC, Young PR,
Salomon RM, et al. Cognitive therapy vs medications in the
treatment of moderate to severe depression. Arch Gen Psychiatry
2005;62:409-16.
39. Harrington R, Whittaker S P. Psychological treatment of
depression in children and adolescents. Br J Psychiatry
1998;173:291-8.
40. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical
status of cognitive behavioural therapy: A review of meta-
analysis. Clin Psychol Rev 2006;26:17-31.
41. Gould RA, Otto MW, Pollack MH. A meta-analysis of treatment
outcome for panic disorder. Clin Psychol Rev 1995;8:819-44.
42. Wolitzky-Taylor KB, Horowitz JD, Powers MB, Telch MJ.
Psychological approaches in the treatment of specic phobias:
A meta-analysis. Clin Psychol Rev 2008;28:1021-37.
43. Acarturk C, Cuijpers P, van Straten A, de Graaf R. Psychological
treatment of social anxiety disorder: A meta-analysis. Psychol
Med 2009;39:241-54.
44. Mitte K. Meta-analysis of cognitive behavioural treatments
for generalized anxiety disorder: A comparison with
pharmacotherapy. Psychol Bull 2005;131:785-95.
45. Tarrier N, Wykes T. Is there evidence that cognitive behaviour
therapy is an effective treatment for schizophrenia? A cautious
or cautionary tale? Behav Res Ther 2004;2:1377-401.
46. Gould RA, Mueser KT, Bolton E, Mays V, Goff D. Cognitive
therapy for psychosis in schizophrenia; an effect size analysis.
Schizophr Res 2001;48:335-42.
47. Drury V, Birchwood M, Cochrane R, Macmillan F. Cognitive
therapy and recovery from acute psychosis: A controlled trial.
I. Impact on psychotic symptoms. Br J Psychiatry 1996;169:
593-601.
48. Hofmann SG, Smits JA. Cognitive behaviour therapy for adult
anxiety disorders: A meta-analysis of randomized placebo-
controlled trials. J Clin Psychiatry 2008;69:621-32.
49. Salkovskis PM, Forrester E, Richards C. Cognitive behavioural
approach to understanding obsessional thinking. Br J Psychiatry
1998;173(Suppl 35):53-63.
50. Deacon BJ, Abramowitz JS. Cognitive and behavioural
treatments for anxiety disorders: A review of meta-analytic
ndings. J Clin Psychol 2004;60:429-41.
51. Bradley R, Greene J, Russ E, Dutra L, Westen D.
A multidimensional meta-analysis of psychotherapy for PTSD.
Am J Psychiatry 2005;162:214-27.
52. Foa EB, Rothbaum BO, Riggs DS, Murdock TB. Treatment
of posttraumatic stress disorder in rape victims: A comparison
between cognitive behavioural procedures and counseling.
J Consult Clin Psychol 1991;59:715-23.
53. Resick PA, Schnicke MK. Cognitive processing therapy for
sexual assault victims. J Consult Clin Psychol 1992;60:748-56.
54. Bryant RA, Sackville T, Dang ST, Moulds M, Guthrie R.
Treating acute stress disorder, an evaluation of cognitive
behaviour therapy and supportive counseling techniques.
Am J Psychiatry 1999;156:1780-6.
55. Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB,
Otto MW. A meta-analytic review of psychosocial interventions
for substance use disorders. Am J Psychiatry 2008;165:179-87.
[Downloaded free from http://www.mjdrdypu.org on Wednesday, September 28, 2016, IP: 83.86.55.11]
Bhattacharya, et al.: Cognitive behavior therapy
138 Medical Journal of Dr. D.Y. Patil University | April-June 2013 | Vol 6 | Issue 2
56. Magill M, Ray L A. Cognitive behavioural treatment with adult
alcohol and illicit drug users: A meta-analysis of randomized
control trials. J Stud Alcohol Drugs 2009;70:516-27.
57. Lynch TR, Trost WT, Salsman N, Linehan MM. Dialectical
behaviour therapy for borderline personality disorder. Annu Rev
Clin Psychol 2007;3:181-205.
58. Walsh BT, Wilson GT, Loeb KL, Devlin MJ, Pike KM, Roose SP,
et al. Medication and psychotherapy in treatment of bulimia
nervosa. Am J Psychiatry 1997;154:523-31.
59. Devine EC, Westlake SK. The effects of psycho educational care
provided to adults with cancer: Meta-analysis of 116 studies.
Oncol Nurs Forum 1995;22:1369-81.
60. Marcus DA, Scharff L, Turk DC. Nonpharmacological
management of headaches during pregnancy. Psychosom Med
1995;57:527-35.
61. Gidron Y, Davidson K. Development and preliminary testing
of a brief intervention for modifying CHD-predictive hostility
components. J Behav Med 1995;198:203-20.
62. Eller LS. Effects of two cognitive behavioural interventions on
immunity and symptoms in persons with HIV. Ann Behav Med
1995;17:339-48.
63. Hofmann SG, Sawyer AT, Fang A. The empirical status of the
new wave of cognitive behavioural therapy. Psychiatr Clin North
Am 2010;33:701-10.
64. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance
and commitment therapy: model, processes and outcomes.
Behav Res Ther 2006; 44:1-26.
65. Segal ZV, Williams JM, Teasdale JD. Mindfulness-based
cognitive therapy for depression: A new approach to preventing
relapse. New York: Guilford Press; 2002.
66. Ost LG. Efficacy of third wave of behavioural therapies:
A systematic review and meta-analysis. Behav Res Ther 2008;
46:296-321.
How to cite this article: Bhattacharya L, Chaudari B, Saldanha D, Menon P.
Cognitive behavior therapy. Med J DY Patil Univ 2013;6:132-8.
Source of Support: Nil. Conict of Interest: None declared.
[Downloaded free from http://www.mjdrdypu.org on Wednesday, September 28, 2016, IP: 83.86.55.11]
... CBT is a type of psychotherapy that is based on the idea that all psychological problems are due to defective thinking. CBT aims to modify thoughts, beliefs, and perceptions, and change behavioral pattern (31) . Studies have documented that CBT has established benefits (29)(30)(31) . ...
... CBT aims to modify thoughts, beliefs, and perceptions, and change behavioral pattern (31) . Studies have documented that CBT has established benefits (29)(30)(31) .  Yoga: Stress reduction or relaxation is one of the most widely discussed advantages by yoga practitioners. ...
... Esta experiência guarda semelhanças às relatadas na literatura norte-americana (Kelly, 2006), em que negros americanos dirigem sua raiva contra terapeutas brancos, entendidos como representantes da cultura dominante, e contra familiares por incidentes racistas ocorridos em contatos com parentes. Concordando com Kelly (2006), o uso de exemplos, expressões e metáforas que a princípio pareçam inofensivas à população branca pode ser interpretada como ofensa grave para a população negra. ...
... Esta experiência guarda semelhanças às relatadas na literatura norte-americana (Kelly, 2006), em que negros americanos dirigem sua raiva contra terapeutas brancos, entendidos como representantes da cultura dominante, e contra familiares por incidentes racistas ocorridos em contatos com parentes. Concordando com Kelly (2006), o uso de exemplos, expressões e metáforas que a princípio pareçam inofensivas à população branca pode ser interpretada como ofensa grave para a população negra. O terapeuta precisa estar ciente de que neste processo de reconhecimento racial, negras e negros podem se tornar profundamente desconfiados e agressivos em relação às pessoas identificadas como brancas, o que é absolutamente justificável diante de gerações de experiências negativas. ...
Article
Full-text available
Resumo No Brasil, não há produção sistemática de conhecimentos, métodos ou estratégias para o manejo clínico das repercussões do racismo sobre a saúde mental da população negra. Esta é uma lacuna teórica e prática relevante, pois, quando o terapeuta não reconhece o racismo como produtor de iniquidades sociais, preconceito e discriminação, contribui para aumento de sofrimento psíquico de seu paciente negro e para a manutenção das desigualdades raciais. Neste relato, apresentamos a experiência de atendimento clínico de duas mulheres autodeclaradas negras, universitárias, através de técnicas da Psicoterapia Analítico Funcional (FAP) e Terapia de Aceitação e Compromisso (TAC). Na análise, buscou-se destacar aspectos gerais da condução dos atendimentos que pudessem auxiliar ou suscitar reflexão entre psicólogos de orientações teóricas diversas. O relato de experiência é apresentado em três partes: a) acolhimento e estabelecimento de aliança terapêutica; b) identificação do racismo como origem do sofrimento psíquico; e c) resultados das intervenções. Os principais resultados referem-se ao estabelecimento de vínculo seguro e saudável, ao aumento do repertório de habilidades sociais, à elevação da autoestima e ao desenvolvimento de capacidade de autocompaixão/autocuidado pelas pacientes. Recomenda-se desenvolvimento de sensibilidade e competência cultural entre os profissionais da saúde mental para diminuir as disparidades na quantidade e qualidade do atendimento psicoterápico prestado a esta população.
... Bandelow and Michaelis state that it is more common for people with panic attacks to seek help because it is deemed as a physical illness rather than a psychological one [19] which indicate to the authors that people still find it difficult to admit to having psychological challenges. Conventional treatment for anxieties is to face your fears [20], but for people with social anxieties, seeking treatment for their condition would mean to expose themselves for in-person interactions before the treatment even starts [21]. Students who have chosen to study on campus could be aware of their challenges and have already decided to face their fears by going to campus. ...
Article
Pendekatan cognitive behavior therapy (CBT) adalah pendekatan psikoterapi jangka pendek yang dirancang untuk memengaruhi emosi, perilaku, dan kognisi disfungsional, melalui prosedur sistematis yang berorientasi pada tujuan. Pendekatan ini memiliki karakteristik unik yang membedakannya dari sebagian besar pendekatan kelompok lain, karena bergantung pada prinsip dan prosedur metode ilmiah, dan prinsip pembelajaran yang diperoleh secara eksperimental. Pendekatan ini semakin banyak digunakan untuk masalah kesehatan mental, dan diterapkan dalam layanan bimbingan dan konseling kelompok sebagai intervensi untuk penanganan perilaku-perilaku maladaptive. Hasil penelitian mengungkapkan bahwa pendekatan CBT merupakan suatu metode terapi perilaku kognitif yang bertujuan untuk mengurangi tekanan dan disfungsi psikologis dengan mengeksplorasi dan mengatasi integrasi pikiran, perasaan, dan perilaku yang berkontribusi pada munculnya suatu masalah. Tujuan dan manfaat pendekatan CBT dalam bimbingan dan konseling kelompok sebagai preventif dan perbaikan perilaku maladaptive melalui penguasaan keterampilan praktis untuk membuat perubahan dalam pikiran, perilaku, dan emosi serta cara mempertahankannya dari waktu ke waktu. Peran pemimpin dalam kelompok CBT yaitu sebagai guru dan pendorong bagi anggotanya untuk mempelajari dan mempraktikkan keterampilan sosial dalam kelompok yang dapat diterapkan dalam kehidupan sehari-hari. Tahapan pelaksanaan CBT dilakukan melalui tiga tahap yaitu; tahap awal, tahap kerja, dan pengakhiran
Article
Full-text available
The immediate transitioning of instructional delivery from the traditional face-to-face teaching to online learning prompted college instructors to design pedagogical strategies and assessment tools appropriate for the online learning environment. Instructional strategies and assessments in teaching Social Science general education courses online in the context of state universities and colleges (SUCs) however have not been previously established. Anchoring on social constructivism, post-positivism, and pragmatism, this qualitative inquiry was conducted to determine the teaching methods and assessments employed by social science instructors in SUCs in teaching Readings in Philippine History and Life and Works of Rizal online. Semi-structured interviews were conducted with 7 social science instructors from 6 SUCs. Member checking and audit trail by a qualitative research expert were used for data trustworthiness and Lichtman’s 3 Cs was used for data analysis. The qualitative inquiry revealed 7 major themes for online instructional strategies: blended learning activities; synchronous online activities; interactive lecture discussion; group reporting; short videos and films presentation; use of modules in print and soft copy; and advanced readings. Likewise, 5 themes for online assessment were identified: objective test; subjective test; term examination; group projects; and output-making. Results of the study revealed that the instructional strategies and assessments used are constructively aligned with the learning outcomes set in the CHED-prescribed course syllabus but are still the traditional types. Instructors therefore only migrated their teaching practice from the in-person classroom instruction to the online mode.
Article
The study investigated the social representations of Psychology students on Cognitive-Behavioral Therapy (CBT). The 196 students indicated three to five words that came to their minds when thinking about CBT. The results were treated on the Evoc Software and distributed in four quadrants in order of expressiveness: 1) behaviors, beliefs and reinforcement; 2) thoughts; 3) emotion, objective, cognition, short-term, scientific and tests; 4) techniques, tasks and changes. The students' social thinking is in line with the basic structure of the theory and the results contribute to the understanding of CBT in Psychology training.
Article
Full-text available
Child abuse has become prevalent in the society and has reached an alarming state. An experience of abuse creates a domino effect on a child’s learning and socialization in school, and consequently impacts their holistic development. Anchoring on B.F. Skinner’s Operant Conditioning Theory, this study investigates the undesirable school behaviour of abused children and formulates an intervention program for behaviour modification. This case study documented the school behaviour of three primary school children identified as psychologically, physically, and sexually abused by the local Department of Social Welfare and Development. These abused children were selected using purposive sampling. Data collection was conducted through pre, and post-observation using a validated research-made Student Behaviour Inventory, in-depth interview, triangulation, and validated Student Behaviour Intervention Program (SBIP) anchored on Cognitive Behavioural approaches. Data were analysed using recursive textual analysis using Lichtman’s framework: coding, categorizing, and conceptualizing. Results of the study revealed that abused children have opposition, refusal, and resistance to orders; sensitiveness; tendency towards social withdrawal, aloofness, and melancholy; feelings of inferiority; and non-compliance to school requirements. Administration of SBIP to abused children produced slight modification in their behaviour. This study implies a consideration of the SBIP and its administration to children who have experienced abuse as an intervention to modify their school behaviour.
Article
Full-text available
As practical and insightful as its predecessor, the second edition of this acclaimed text gives students of cognitive and cognitive-behavioral therapy a solid grounding in principles while modeling an integrative approach to the problems they will encounter most. The same quartet of knowledgeable clinicians who authored the original have updated and restructured their work to take readers through the best of contemporary cognitive practice, from intake interview and case conceptualization to the crucial final meetings. Their goal is to offer empirically valid interventions that truly address the complex problems of today’s clients, and this straightforward volume presents these strategies with maximum utility for trainee and clinician alike. • Clinical vignettes and verbatim transcripts illustrating interventions in action. • Guidelines for assessing clients throughout the course of therapy. • Effective ways to strengthen the therapeutic relationship. • Equal coverage on treatment of Axis I and personality disorders. • New chapters on treatment of children, adolescents, couples, and groups. • Techniques for getting past roadblocks, dealing with non-compliance, and avoiding relapses. Uncovering new clinical possibilities, debunking common misconceptions, and encouraging readers to sharpen their skills, the authors show why, decades after its inception, cognitive therapy continues to get results. The second edition of Clinical Applications of Cognitive Therapy is an invaluable source of knowledge for researchers and advanced students of behavior therapy, clinical and counseling psychology, psychiatry, and psychiatric social work, and for clinicians at all levels of practice.
Article
Full-text available
This review summarizes the current meta-analysis literature on treatment outcomes of CBT for a wide range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically rigorous meta-analyses. Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT.
Article
Full-text available
In meta-analysis format the effectiveness of Beck's cognitive therapy for depression was reviewed. Twenty-eight studies were identified that used a common outcome measure of depression, and comparisons of cognitive therapy with other therapeutic modalities were made. The results document a greater degree of change for cognitive therapy compared with a waiting list or no-treatment control, pharmacotherapy, behavior therapy, and other psychotherapies. The degree of change associated with cognitive therapy was not significantly related to the length of therapy or the proportion of women in the studies, and although it was related to the age of the clientele, a lack of adequate representativeness of various age groups renders these results equivocal. Implications for further outcome and process studies in cognitive therapy are discussed.
Article
Full-text available
Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or ist sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualisation, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies provided preliminary support for several aspects of the model.