There are generally considered to be two main theoretical bases for psychotherapy.

Psychoanalytic – based off of the work of Sigmund Freud, and has evolved since the late 1800s. The underlying idea is that there is an unconscious part of everyone’s mind that has a powerful and meaningful effect on our thoughts and everyday actions. By trying to examine the unconscious, a person can better understand their life and gain more control over the things they think, feel and do.

Cognitive Behavioral – focuses more on the present, accessible thoughts and behaviors of people rather than the subconscious and seeks to address them directly in order to make positive change.

Cognitive-behavioral therapy falls in the second category. It is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. The benefit of this fact is that we can change the way we think to feel and act better even if the situation does not change.

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. In fact, one study of patients undergoing benzodiazepine withdrawal who had a diagnosis of generalized anxiety disorder showed that those who received CBT had a very high success rate of discontinuing benzodiazepines compared to those who did not receive CBT. This success rate was maintained at 12 month follow up. Furthermore in patients who had discontinued benzodiazepines it was found that they no longer met the diagnosis of general anxiety disorder and that patients no longer meeting the diagnosis of general anxiety disorder was higher in the group who received CBT. Thus CBT can be an effective tool to add to a gradual benzodiazepine dosage reduction program leading to improved and sustained mental health benefits.

Cognitive behavioral therapy has been shown as an effective treatment for clinical depression. A large-scale study in 2000 showed substantially higher results of response and remission (73% for combined therapy vs. 48% for either CBT or the antidepressant Nefazodone alone) when a form of cognitive behavior therapy and that particular discontinued anti-depressant drug were combined than when either modality was used alone. The American Psychiatric Association Practice Guidelines (April 2000) indicated that among psychotherapeutic approaches, cognitive behavioral therapy and interpersonal psychotherapy had the best-documented efficacy for treatment of major depressive disorder.

Several meta-analysis have shown CBT effective in schizophrenia and the American Psychiatric Association includes CBT in its schizophrenia guideline as an evidence-based treatment. There is also some limited evidence of effectiveness for CBT in bipolar disorder and severe depression.

CBT can help patients with severe mental disorders to make sense of experiences that lead to symptoms, and to associate key thoughts and feelings with factors that predispose to or precipitate them. For instance, it can help to make rational connections between precipitating causes such as stimulants or hallucinogenic drugs and symptoms such as psychotic episodes. With the help of a therapist, patients may even devise and carry out behavioral experiments that can help them to learn how to improve their quality of life.

The use of CBT has been extended to children and adolescents with positive results. It is often used to treat major depressive disorder, anxiety disorders, and symptoms related to trauma and post-traumatic 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.

CBT includes a variety of approaches and therapeutic systems; some of the most well known include cognitive therapy, rational emotive behavior therapy and multimodal therapy. Defining the scope of what constitutes a cognitive–behavioral therapy is a difficulty that has persisted throughout its development.

The particular therapeutic techniques vary within the different approaches of CBT according to the particular kind of problem issues, but commonly may include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation, mindfulness and distraction techniques are also commonly included. Cognitive behavioral therapy is often also used in conjunction with mood stabilizing medications to treat conditions like bipolar disorder. Its application in treating schizophrenia along with medication and family therapy is recognized by the NICE guidelines  within the British NHS.

Going through cognitive behavioral therapy generally is not an overnight process for clients; a typical course consists of 12-16 hour-long sessions. Even after clients have learned to recognize when and where their mental processes go awry, it can in some cases take considerable time or effort to replace a dysfunctional cognitive-affective-behavioral process or habit with a more reasonable and adaptive one. Cognitive Behavioral Therapy is problem focused and structured towards the client, it requires honesty and openness between the client and therapist, as a therapist develops strategies for managing problems and guiding the client to a better life.

Pros for this therapy

There is empirical evidence that CBT is effective for the treatment of a variety of problems, including mood, anxiety, personality, eating, substance abuse, and psychotic disorders. Treatment is often manualized, with specific technique-driven brief, direct, and time-limited treatments for specific psychological disorders. CBT is used in individual therapy as well as group settings, and the techniques are often adapted for self-help applications. Some clinicians and researchers are more cognitive oriented (e.g. cognitive restructuring), while others are more behaviorally oriented (in vivo exposure therapy). Other interventions combine both (e.g. imaginal exposure therapy).

Cons for this therapy

Cognitive behavioral therapy is unlikely to be effective in treating psychiatric problems caused solely by drug or alcohol abuse. It has been argued that the treatment of such patients should be directed at tackling their substance abuse problems (ideally aiming for complete abstinence) prior to the commencement of CBT. 

CBT was primarily developed through a merging of behavior therapy with cognitive therapy. While rooted in rather different theories, these two traditions found common ground in focusing on the "here and now", and on alleviating symptoms. Many CBT treatment programs for specific disorders have been evaluated for efficacy and effectiveness; the health-care trend of evidence-based treatment, where specific treatments for 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, and for the neurological condition chronic fatigue syndrome/myalgic encephalomyelitis.

Psychotherapy is a general term referring to therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group. The problems addressed are psychological in nature and of no specific kind or degree, but rather depend on the specialty of the practitioner.

Psychotherapy aims to increase the individual's sense of his/her own well-being. Psychotherapists employ a range of techniques based on experiential relationship building, dialog, communication and behavior change that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family).

Cognitive behavior therapy (or cognitive behavioral therapies or CBT) is a psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure.

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Review Date: 
February 15, 2012