Cognitive Behavior Therapy

A therapeutic approach based on the principle that maladaptive moods and behavior can be changed by replacing distorted or inappropriate ways of thinking with thought patterns that are healthier and more realistic.

Cognitive therapy is an approach to psychotherapy that uses thought patterns to change moods and behaviors. Pioneers in the development of cognitive behavior therapy include Albert Ellis (1929-), who developed rational-emotive therapy (RET) in the 1950s, and Aaron Beck (1921-), whose cognitive therapy has been widely used for depression and anxiety. Cognitive behavior therapy has become increasingly popular since the 1970s. Growing numbers of therapists have come to believe that their patients' cognitive processes play an important role in determining the effectiveness of treatment. Currently, almost 70% of the members of the Association for the Advancement of Behavior Therapy identify themselves as cognitive behaviorists.

Like behavior therapy, cognitive behavior therapy tends to be short-term (often between 10 and 20 sessions), and it focuses on the client's present situation in contrast to the emphasis on past history that is a prominent feature of Freudian psychoanalysis and other psychodynamically oriented therapies. The therapeutic process begins with identification of distorted perceptions and thought patterns that are causing or contributing to the client's problems, often through detailed record keeping by the client. Some self-defeating ways of thinking identified by Aaron Beck include all-or-nothing thinking; magnifying or minimizing the importance of an event; overgeneralization (drawing extensive conclusions from a single event); personalization (taking things too personally); selective abstraction (giving disproportionate weight to negative events); arbitrary inference (drawing illogical conclusions from an event); and automatic thoughts (habitual negative, scolding thoughts such as "You can't do anything right").

Once negative ways of thinking have been identified, the therapist helps the client work on replacing them with more adaptive ones. This process involves a repertoire of techniques, including self-evaluation, positive self-talk, control of negative thoughts and feelings, and accurate assessment of both external situations and of the client's own emotional state. Clients practice these techniques alone, with the therapist, and also, wherever possible, in the actual settings in which stressful situations occur (in vivo), gradually building up confidence in their ability to cope with difficult situations successfully by breaking out of dysfunctional patterns of response.

Today cognitive behavior therapy is widely used with children and adolescents, especially for disorders involving anxiety, depression, or problems with social skills. Like adult clients, children undergoing cognitive behavior therapy are made aware of distorted perceptions and errors in logic that are responsible for inaccurate or unrealistic views of the world around them. The therapist then works to change erroneous beliefs and perceptions by instruction, modeling, and giving the child a chance to rehearse new attitudes and responses and practice them in real-life situations. Cognitive behavior therapy has been effective in treating a variety of complaints, ranging from minor problems and developmental difficulties to severe disorders that are incurable but can be made somewhat more manageable. It is used either alone or together with other therapies and/or medication as part of an overall treatment plan.

Cognitive behavioral therapy has worked especially well, often in combination with medication, for children and adolescents suffering from depression. It can help free depressed children from the pervasive feelings of helplessness and hopelessness that are supported by self-defeating beliefs. Children in treatment are assigned to monitor their thoughts, and the therapist points out ways that these thoughts (such as "nothing is any fun" or "I never do anything right") misrepresent or distort reality. Other therapeutic techniques may include the completion of graded task assignments, and the deliberate scheduling of pleasurable activities.

Cognitive behavioral therapy is also used for children with conduct disorder, which is characterized by aggressive, antisocial actions, including hurting animals and other children, setting fires, lying, and theft. Through a cognitive behavioral approach (which generally works better with adolescents than with younger children because of the levels of thinking and control involved), young people with this disorder are taught ways to handle anger and resolve conflicts peacefully. Through instruction, modeling, role playing, and other techniques, they learn to react to events in socially appropriate, nonviolent ways. Other childhood conditions for which cognitive behavior therapy has been effective include generalized anxiety disorder and attention deficit/hyperactivity disorder. It can help children with ADHD become more controlled and less impulsive; often, they are taught to memorize and internalize the following set of behavior guidelines: "Stop—Listen— Look—Think—Act."

Cognitive behavioral therapy has also been successful in the treatment of adolescents with eating disorders, who, unlike those with conduct disorders, hurt themselves rather than hurting (or attempting to hurt) others. The cognitive approach focuses on the distorted perceptions that young women with anorexia or bulimia have about food, eating, and their own bodies. Often administered in combination with medication, therapy for eating disorders needs to be continued for an extended period of time—a year and a half or longer in the case of anorexia.

Cognitive therapy is generally not used for disorders, such as schizophrenia or autism, in which thinking or communication are severely disturbed.