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What Constitutes Cognitive Behavioral Therapy?
Cognitive-behavioral therapy is a method of psychotherapy that uses a goal-directed, systematic approach to teach new skills in how to deal with dysfunctional emotional, behavioral, and cognitive problems. This title is used variously to distinguish between behavioral therapy, cognitive therapy, and treatments that rely on both behavioral and cognitive therapies. There is empirical evidence showing that cognitive behavioral therapy is quite effective in treating a number of conditions, including personality, anxiety, mood, eating, substance abuse, and psychiatric disorders. Specific psychological commands are treated with brief, direct, time-limited therapy guided by specific techniques, so therapy is often manualized.
Cognitive behavioral therapy can be used both individually and in groups. Techniques are often adapted for self-help courses. As these three approaches are used today, it is up to the individual clinician or researcher to decide whether a cognitive orientation, a behavioral orientation, or a combination of both predominates. Cognitive behavioral therapy is a combination of behavioral therapy and cognitive therapy. Although these two treatments are very different, they have found common ground in focusing on the “here and now” and relieving symptoms.
Evaluation of cognitive behavioral therapy has led many to believe that it is more effective than psychodynamic therapy and other methods. The United Kingdom supports the use of cognitive-behavioral therapy over other modalities for many mental health disorders including post-traumatic stress disorder, obsessive-compulsive disorder, bulimia nervosa, clinical depression, neurodegenerative disorders, and chronic fatigue syndrome/myalgic encephalomyelitis. Cognitive behavioral therapy has its roots in various ancient philosophical traditions, particularly Stoicism. The modern roots of CBT can be traced back to the development of behavior therapy in the 1920s and cognitive therapy in the 1960s, and the subsequent integration of the two therapies. The first behavioral therapy methods were published in 1924 by Mary Cover Jones, whose work dealt with fear training in children.
Early behavioral techniques worked well for many neurological disorders, but not so much for depression. Behavior therapy was also losing popularity due to the ‘cognitive revolution’. This eventually led to the founding of cognitive therapy by Aaron T. Beck in the 1960s. The first form of cognitive behavioral therapy was developed by Arnold A. Lazarus between the late 1950s and 1970s. In the 1980s and 1990s, cognitive and behavioral therapy were combined by the work of David M. Clarke in the UK and David H. Barlow in the US. Cognitive behavioral therapy includes the following systems: cognitive therapy, rational emotive behavioral therapy, and multidisciplinary therapy. One of the biggest challenges is defining exactly what cognitive behavioral therapy is. Specific treatment methods vary among different CBT approaches depending on the type of problem being addressed, but these methods often focus on:
- Keep a journal of important events and related feelings, thoughts, and behaviors.
- Questioning and testing cognitions, evaluations, assumptions, and beliefs that may be unrealistic or unhelpful.
- Confronting activities you’ve been avoiding.
- Experiment with new ways of behaving and reacting.
In addition, cognitive behavioral therapy often uses distraction, focus, and relaxation techniques. Mood stabilizers are often combined with treatments for conditions such as bipolar disorder. British NHS NICE guidelines recognize the use of cognitive behavioral therapy in the treatment of schizophrenia in combination with medication and therapy. Cognitive behavioral therapy often takes time for patients to effectively apply it to their lives. Even knowing when and where mental processes go wrong, replacing dysfunctional cognitive-affective-behavioral processes or habits with more reasonable and adaptive ones often requires focused effort. Cognitive behavioral therapy is used in many different situations, including:
- Anxiety disorders (obsessive-compulsive disorder, social phobia or social anxiety, generalized anxiety disorder)
- Depression (clinical depression, depression, psychotic symptoms)
- Insomnia (more effective than zopiclone)
- Severe mental illness (schizophrenia, bipolar disorder, major depression)
- Children and adolescents (symptoms of depression, anxiety disorders, trauma, post-traumatic stress disorder)
- Coping (helping them overcome anxiety, avoidant behaviors, and negative thoughts about themselves)
Cognitive behavioral therapy involves teaching a person new skills to cope with dysfunctional emotions, behaviors, and cognitions in a goal-directed, systematic way. There is empirical evidence that cognitive-behavioral therapy is effective in the treatment of many conditions, including obsessive-compulsive disorder, generalized anxiety disorder, major depressive disorder, schizophrenia, anxiety, and negative thoughts about the self. The tremendous success achieved with this treatment makes it one of the most important tools for researchers and clinicians in the treatment of mental disorders today.
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