Cognitive Therapy

Cognitive therapy is a relatively short-term form of psychotherapy based on a concept developed by psychologists Aaron Beck (1921–) and Albert Ellis (1913–2007) in the 1950s and 1960s. The underlying concept is that people's thought patterns influence their emotions and may, in turn, influence attitudes and behavior. The related treatment is based on the principle that ineffective, self-defeating behavior (maladaptive behavior) is triggered by inappropriate or irrational thought patterns called automatic thoughts. Instead of reacting to the reality of a situation, these individuals automatically react to their own distorted view of the situation. Cognitive therapy focuses on changing these thought patterns (cognitive distortions) by examining the rationality and validity of the assumptions behind them. This process is termed cognitive restructuring.

Cognitive therapy is a treatment option for a number of mental and behavioral disorders, including agoraphobia, Alzheimer's disease, anxiety or panic disorder, attention-deficit hyperactivity disorder (ADHD), eating disorders, mood disorders, obsessive-compulsive disorder (OCD), personality disorders, post-traumatic stress disorder (PTSD), psychotic disorders, schizophrenia, social phobia, and substance abuse disorders. It can be useful in helping individuals with anger management problems and has been reported to be effective in treating insomnia. It is also frequently prescribed as an adjunctive or complementary therapy for patients with back pain, cancer, polymyalgia, rheumatoid arthritis, and other chronic pain conditions.

Because cognitive therapy is a collaborative effort between therapist and patient, a comfortable working relationship is critical to successful treatment. During initial consultation, the therapist gathers information to assess the patient's condition and to recommend goals for treatment and suggest a specific treatment approach. In some managed-care settings, an intake interview is required before a patient can meet with a therapist. The intake interview is typically performed by a psychiatric nurse, counselor, or social worker, either face-to-face or over the phone. It is used to gather a brief background on treatment history and make a preliminary evaluation of the patient before assigning the patient to a therapist.

Cognitive therapy is usually administered in an outpatient setting (clinic or doctor's office) by a therapist trained or certified in cognitive therapy techniques. Therapy may be in either individual or group sessions, and the course of treatment is short compared to traditional psychotherapy; cognitive behavioral therapy can range from as few as four to eight sessions or as many as 12 to 20 sessions. Limiting the duration of therapy may actually provide an incentive for patients and therapists to work together efficiently. Cognitive therapists may be psychologists (Ph.D., Psy.D., Ed.D., or M.A. degree), clinical social workers (M.S.W., D.S.W., or L.S.W. degree), counselors (M.A. or M.S. degree), or psychiatrists (M.D. specialized in psychiatry).

Therapists use several different techniques in the course of cognitive therapy to help patients examine their thoughts and behaviors. Because cognitive therapy is a collaboration between patient and therapist, the patient is expected to participate fully by reading certain materials and doing homework to assist in therapeutic progress. The various techniques employed during therapy may include:

Cognitive therapy may not be appropriate for all patients. Patients with significant cognitive impairments (e.g., patients with traumatic brain injury or organic brain disease) and individuals who are not willing to take an active role in the treatment process are not usually good candidates.

Because cognitive therapy is employed for such a broad spectrum of illnesses and is often used in conjunction with medications and other treatment interventions, it is difficult to measure overall success rates for the therapy. However, efficacy is well-documented for certain symptoms, conditions, and behavior problems. For example, studies have shown that cognitive therapy can reduce relapse rates in depression and in schizophrenia, particularly in patients who respond only marginally to antidepressant medications. It has been suggested that this is because cognitive therapy focuses on changing the thoughts and associated behavior underlying these disorders rather than just relieving the distressing symptoms associated with them.

See also Cognition ; Psychoanalysis .