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Cognitive therapy or cognitive behavior therapy is a kind of psychotherapy
used to treat depression, anxiety disorders, phobias, and other forms
of mental disorder. It involves recognising distorted thinking and learning
to replace it with more realistic substitute ideas. Its practitioners
hold that much (though not all) clinical depression is caused by irrational
thoughts. Cognitive therapy is often used in conjunction with mood stabilizing
medications to treat bipolar disorder. According to the U.S-based National
Association of Cognitive-Behavioral Therapists:
"There are several approaches to cognitive-behavioral therapy,
including Rational Emotive Behavior Therapy, Rational Behavior Therapy,
Rational Living Therapy, Cognitive Therapy, and Dialectic Behavior Therapy."
Thoughts as the cause of emotions
With thoughts stipulated as being the cause of emotions rather
than vice-versa, cognitive therapists reverse the causal order more generally
used by psychotherapists. The therapy is essentially, therefore, to identify
those irrational thoughts that are making one unhappy and what it is about
them that is irrational; this is done in an effort to reject the depressing
thoughts and replace them with more accurate and more cheering thoughts.
Cognitive therapy is not an overnight process. Even after a patient has
learned to recognize when and where his thought processes are going awry,
it can take months of concerted effort to replace an invalid thought with
a more suitable one. But with patience and a good therapist, cognitive
therapy can be a valuable tool in recovery.
Cognitive behavioral therapy
While similar views of emotion have existed for millennia, cognitive
therapy was developed in its present form by Albert Ellis and Aaron T.
Beck in the 1950s and 1960s. It rapidly became a favorite intervention
to study in psychotherapy research in academic settings. In initial studies
it was often contrasted with behavioral treatments to see which was most
effective. However, in recent years, cognitive and behavioral techniques
have often been combined into cognitive behavioral treatment. This is
arguably the primary type of psychological treatment being studied in
A sub-field of cognitive behavior therapy used to treat Obsessive Compulsive
Disorder makes use of classical conditioning through extinction and habituation.
Such a procedure has been used successfully by Dr. Steven Phillipson to
treat OCD. CBT has also been successfully applied to the treatment of
Generalized Anxiety Disorder and Panic Disorder.
Negative thinking in depression can result from biological sources (i.e.,
endogenous depression), modeling from parents, peers, or other sources.
The depressed person experiences negative thoughts as being beyond their
control. The cognitive therapist provides techniques to give the client
a greater degree of control over negative thinking by correcting "cognitive
distortions" or correcting thinking errors that abet such distortions,
in a process called cognitive restructuring.
Negative thoughts in depression are generally about one of three areas:
negative view of self, negative view of the world, and negative view of
the future. These constitute the cognitive triad.
The four column technique
A major technique in cognitive therapy is the four column technique.
It consists of a four step process. The first three steps analyze the
process by which a person has become depressed or distressed. The first
column records the objective situation. In the second column, the client
writes down the negative thoughts which occurred to them. The third column
is for the negative feelings and dysfunctional behaviors which ensued.
The negative thoughts of the second column are seen as a connecting bridge
between the situation and the distressing feelings. Finally, the fourth
column is used for challenging the negative thoughts on the basis of evidence
from the client's experience.
Treating depression with CBA
The newest and most effective cognitive and behavioral therapy for depression
is the cognitive behavioral-analysis system of psychotherapy (CBASP).
CBASP is a mix of several of the most successful techniques. When combined
with appropriate antidepressants, it can be extremely effective.
A study published by Martin Keller MD of Brown University and others
in the May 18, 2000 New England Journal of Medicine compared the antidepressant
Serzone with the talking therapy CBASP. CBASP is largely derivative of
other talking therapies such as cognitive, behavioral, and interpersonal
therapy. Six hundred eighty-one patients with severe chronic depression
(some with other psychiatric illnesses) were enrolled in the trial, and
were assigned to either Serzone, CBASP, or combination Serzone-CBASP for
12 weeks. The response rates to either Serzone or CBASP alone were rather
underwhelming - 55 percent and 52 percent, respectively, for the 76 percent
who completed the study. In other words, a little more than half of the
completers in those two arms of the trial reduced their depression by
50 percent or better.
The Serzone findings roughly correspond with many other trial results
for antidepressants, and underscore a major weakness in these drugs -
that while they are effective, the benefit is often marginal and the treatment
outcome problematic. Similarly, the CBASP findings validate other studies
finding talking therapy about equal in efficacy to taking antidepressants.
The results for the combination drug-therapy group, however, were surprising,
with 85 percent of the completing patients achieving a 50 percent reduction
in symptoms or better. Forty-two percent in the combination group achieved
remission (a virtual elimination of all depressive symptoms) compared
to 22 percent in the Serzone group and 24 percent in the CBASP group.
The authors of the study confessed to being caught by surprise by the
results, acknowledging that "the rates of response and remission
in the combined-treatment group were substantially higher than those that
might have been anticipated".
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