Departments  Psychotherapy  General information  Cognitive behavioral therapy

Cognitive behaviour therapy (CBT) was developed by Beck in 1960s and described in „Cognitive Therapy of Depression”. Its development was prompted by the observation that patients referred for psychotherapy often held ingrained, negatively skewed views of themselves, their future, and their environment. Treatment is based on the idea that disorder is caused not by the events, but by the view the patient takes of events. It is a short-term collaborative therapy, focused on current problems, whose goals are symptom relief and development of new skills.

Behaviours and emotions are determined by the person’s cognitions. Some pathological emotions are as a result of „cognitive errors” While underlying emotions are not amenable to examination and behavioural change, the cognitions are. If a person can be helped to understand the connection between cognitive errors and distresing emotion, they can try methods of change. CBT aims to „change to way you feel by changing the way you think”

How illness is viewed In mental illness there are errors in the perception of risk, logical errors, and errors in the processing of information (cognitive distortions). These distorsions relate to self, world, and future (Beck’s cognitive triad). The model is events>faulty cognitive appraisal>emotional response> maldapative behaviour> (behaviours/emotions) = pathology. Cognitive errors thus lead to dysphoria and maladaptive behaviour. These errors originate in childhood learning, internalised family/cultural attitude, and early traumatic experiences. The cognitive model is a guide for therapy, not a comprehensive model of illness causation, and does not preclude neurochemical or other factors as important in symptom development, nor preclude the use of pharmacological treatments.

Techniques The therapist is very active in CBT. The patient and the therapist are viewed as working together in spirit of scientific enquiry to explore the problem and solutions – „collaborative empiricism”. The therapist aims to assist the patient to: monitor cognitions, identify cognitive errors, understand maladapative schema, and explore with them strategies to challenge and change these and examine the resultant symptomatic effects. CBT makes use of behavioural, cognitive and experimental techniques to treat pacients
Behavioural techniques – Activity scheduling; exposure; response prevention; distraction; relaxation training; assertiveness/social skills training.

Cognitive techniques – Psychoeducation, including reading assignments, identifying automatic thoughts, Socratic questioning, role play, thoughts diary.

Phases of treatment A short-term treatment, with the initial assessment being followed by 6-20, hour-long sessions. Clinical attention is primarily focused on events in the „here and now”. Each session generally proceeds as follows: deal with emergencies, jointly set agenda, review homework, feedback, focus on specific items guided by current problems, suggestion of cognitive or behavioural techniques to challenge automatic thoughts/core schema; give homework.

Indications and contraindications CBT is considered as an active treatment requiring patient understanding and collaboration. Patients should therefore be motivated and be able to link thought and emotions. CBT is contraindicated in LD (learning disability), mental retardation and dementia. Indicated in: mild and moderate depressive illness, eating disorders (anorexia nervosa and bulimia nervosa), anxiety disorders, in selected patients, may have a role in personality disorder, substance abuse and in the management of chronic psychotic symptoms.

Efficacy There is good evidence for effectiveness in depressive illness, eating disorders and anxiety disorders. CBT is at least as effective as pharmacotherapy in mild to moderate depression and may be more effective in long-term follow-up (at preventing relapse).