CBT

Cerebrum logo head with cogs inCognitive behavioral therapy (CBT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to behavior therapy, cognitive therapy, and to therapy based upon a combination of basic behavioral and cognitive principles and research.
CBT is thought to be effective for the treatment of a variety of conditions, including mood, anxiety, personality, eating, substance abuse, tic, and psychotic disorders. Many CBT treatment programs for specific disorders have been evaluated for efficacy; 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.[1]
CBT was primarily developed through an integration of behavior therapy (the term “behavior modification” appears to have been first used by Edward Thorndike) with cognitive psychology research, first by Donald Meichenbaum and several other authors with the label of cognitive-behavior modification in the late 1970s. This tradition thereafter merged with earlier work of a few clinicians, labeled as Cognitive Therapy (CT), developed by Aaron Beck, and Rational Emotive Therapy (RET) developed by Albert Ellis. While rooted in rather different theories, these two traditions have been characterised by a constant reference to experimental research to test hypotheses, both at clinical and basic level. Common features of CBT procedures are the focus on the “here and now”, a directive or guidance role of the therapist, a structuring of the psychotherapy sessions and path, and on alleviating both symptoms and patients’ vulnerability.
Psychotherapy is a general term referring to therapeutic interaction or treatment contracted between a trained professional and a client, 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, dialogue, 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).
Psychotherapy may also be performed by practitioners with a number of different qualifications, including psychiatry, clinical psychology, counseling psychology, clinical or psychiatric social work, mental health counseling, marriage and family therapy, rehabilitation counseling, school counseling, play therapy, music therapy, art therapy, drama therapy, dance/movement therapy, occupational therapy, psychiatric nursing, psychoanalysis and those from other psychotherapies. It may be legally regulated, voluntarily regulated or unregulated, depending on the jurisdiction. Requirements of these professions vary, but often require graduate school and supervised clinical experience. Psychotherapy in Europe is increasingly being seen as an independent profession, rather than being restricted to being practiced only by psychologists and psychiatrists as is stipulated in some countries.
Behaviour therapy or behavior therapy is an approach to psychotherapy in the behaviourism tradition that focuses on a set of methods designed for reinforcing desired and eliminating undesired behaviors without concerning itself with the psychoanalytic state of the subject. In its broadest sense the methods focus on behaviors, not the thoughts and feelings that might be causing them. Behavior therapy breaks down into two disciplines, a more narrowly defined sense of behavior therapy and behavior modification. Within the psychological theories of learning and conditioning, behavior therapy generally treats psychopathology with Pavlovian or respondent conditioning, while behavior modification makes use of operant or instrumental conditioning. These distinctions are not absolute with some crossover occurring in practice.[1]
Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one of the therapeutic approaches within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cognitive therapy seeks to help the patient overcome difficulties by identifying and changing dysfunctional thinking, behavior, and emotional responses. This involves helping patients develop skills for modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors.[1] Treatment is based on collaboration between patient and therapist and on testing beliefs. Therapy may consist of testing the assumptions which one makes and identifying how certain of one’s usually unquestioned thoughts are distorted, unrealistic and unhelpful. Once those thoughts have been challenged, one’s feelings about the subject matter of those thoughts are more easily subject to change. Beck initially focused on depression and developed a list of “errors” in thinking that he proposed could maintain depression, including arbitrary inference, selective abstraction, over-generalization, and magnification (of negatives) and minimization (of positives).
An example of how CT works is this: having made a mistake at work, a man may believe, “I’m useless and can’t do anything right at work.” Strongly believing this then tends to worsen his mood. The problem may be worsened further if the individual reacts by avoiding activities and then behaviorally confirming the negative belief to himself. As a result, any adaptive response and further constructive consequences become unlikely, which reinforces the original belief of being “useless.” In therapy, this example could be identified as a self-fulfilling prophecy or “problem cycle,” and the efforts of the therapist and client would be directed at working together to change it. This is done by addressing the way the client thinks and behaves in response to similar situations and by developing more flexible ways to think and respond, including reducing the avoidance of activities and the practicing of positive activities (called Mood repair strategies). If, as a result, the patient escapes the negative thought patterns and dysfunctional behaviors, the negative feelings may be relieved over time.

Behaviorism (or behaviourism), is an approach to psychology that combines elements of philosophy, methodology, and theory.[1] It emerged in the early twentieth century as a reaction to “mentalistic” psychology, which often had difficulty making predictions that could be tested using rigorous experimental methods. The primary tenet of behaviorism, as expressed in the writings of John B. Watson, B. F. Skinner, and others, is that psychology should concern itself with the observable behavior of people and animals, not with unobservable events that take place in their minds.[2] The behaviorist school of thought maintains that behaviors as such can be described scientifically without recourse either to internal physiological events or to hypothetical constructs such as thoughts and beliefs.[3]
From early psychology in the 19th century, the behaviorist school of thought ran concurrently and shared commonalities with the psychoanalytic and Gestalt movements in psychology into the 20th century; but also differed from the mental philosophy of the Gestalt psychologists in critical ways.[4] Its main influences were Ivan Pavlov, who investigated classical conditioning although he did not necessarily agree with behaviorism or behaviorists, Edward Lee Thorndike, John B. Watson who rejected introspective methods and sought to restrict psychology to experimental methods, and B.F. Skinner who conducted research on operant conditioning.[5]
In the second half of the 20th century, behaviorism was largely eclipsed as a result of the cognitive revolution.[6][7] While behaviorism and cognitive schools of psychological thought may not agree theoretically, they have complemented each other in practical therapeutic applications, such as in cognitive-behavioral therapy that has demonstrable utility in treating certain pathologies, such as simple phobias, PTSD, and addiction. In addition, behaviorism sought to create a comprehensive model of the stream of behavior from the birth of the human to his death (see Behavior analysis of child development).
Cognitive psychology is a subdiscipline of psychology exploring internal mental processes. It is the study of how people perceive, remember, think, speak, and solve problems.[1]
Cognitive psychology differs from previous psychological approaches in two key ways.
It accepts the use of the scientific method, and generally rejects introspection[2] as a valid method of investigation – in contrast with such approaches as Freudian psychology.
It explicitly acknowledges the existence of internal mental states (such as belief, desire, idea, knowledge and motivation).
In its early years, critics held that the empiricism of cognitive psychology was incompatible with its acceptance of internal mental states. However, the sibling field of cognitive neuroscience has provided evidence of physiological brain states that directly correlate with mental states – thus providing support for the central assumption of cognitive psychology.[3]
The school of thought arising from this approach is known as cognitivism. Cognitive psychology has also influenced the area of Cognitive Behavioral Therapy (CBT) where the combination of cognitive and behavioral psychology are used to treat a patient.
Mood disorder is the term designating a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR) classification system where a disturbance in the person’s mood is hypothesized to be the main underlying feature.[1] The classification is known as mood (affective) disorders in ICD 10.
English psychiatrist Henry Maudsley proposed an overarching category of affective disorder.[2] The term was then replaced by mood disorder, as the latter term refers to the underlying or longitudinal emotional state,[3] whereas the former refers to the external expression observed by others.[1]
Two groups of mood disorders are broadly recognized; the division is based on whether the person has ever had a manic or hypomanic episode. Thus, there are depressive disorders, of which the best-known and most researched is major depressive disorder (MDD) commonly called clinical depression or major depression, and bipolar disorder (BD), formerly known as manic depression and characterized by intermittent episodes of mania or hypomania, usually interlaced with depressive episodes. However, there are also forms of depression of MDD and BD that are less severe and are known as dysthymic disorder (in relation to MDD) and cyclothymic disorder (in relation to BD).[
Anxiety disorder is a blanket term covering several different forms of a type of common psychiatric disorder characterized by excessive rumination, worrying, uneasiness, apprehension and fear about future uncertainties either based on real or imagined events, which may affect both physical and psychological health. There are numerous psychiatric and medical syndromes which may mimic the symptoms of an anxiety disorder such as hyperthyroidism which is frequently misdiagnosed as generalized anxiety disorder.
True anxiety disorders seem to have a variety of psychosocial causes; and may involve a genetic predisposition. Individuals diagnosed with an anxiety disorder may be classified in one of two categories; based on whether they experience continuous or episodic symptoms.
Current psychiatric diagnostic criteria recognize a wide variety of anxiety disorders. Recent surveys have found that as many as 18% of Americans and 14% of Europeans may be affected by one or more of them.[1]
The term anxiety covers four aspects of experiences an individual may have: mental apprehension, physical tension, physical symptoms and dissociative anxiety.[2] Anxiety disorder is divided into generalized anxiety disorder, phobic disorder, and panic disorder; each has its own characteristics and symptoms and they require different treatment (Gelder et al. 2005). The emotions present in anxiety disorders range from simple nervousness to bouts of terror (Barker 2003).
Standardized screening clinical questionnaires such as the Taylor Manifest Anxiety Scale or the Zung Self-Rating Anxiety Scale can be used to detect anxiety symptoms, and suggest the need for a formal diagnostic assessment of anxiety disorder.[3]
Personality disorder refers to a class of personality types and enduring behaviors associated with significant distress or disability, which appear to deviate from social expectations particularly in relating to other humans.[1][2][3]
Personality disorders are included as mental disorders on Axis II of the diagnostic manual of the American Psychiatric Association and in the mental and behavioral disorders section of the ICD manual of the World Health Organization. Personality, defined psychologically, is the set of enduring behavioral and mental traits that distinguish human beings. Hence, personality disorders are defined by experiences and behaviors that differ from societal norms and expectations. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning or control of impulses. In general, personality disorders are diagnosed in 40-60 percent of psychiatric patients, making them the most frequent of all psychiatric diagnoses.[4]
These behavioral patterns in personality disorders are typically associated with substantial disturbances in some behavioral tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable personal and social disruption. Additionally, personality disorders are inflexible and pervasive across many situations, due in large part to the fact that such behavior may be ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are, therefore, perceived to be appropriate by that individual. This behavior can result in maladaptive coping skills, which may lead to personal problems that induce extreme anxiety, distress or depression.[5] The onset of these patterns of behavior can typically be traced back to early adolescence and the beginning of adulthood and, in some instances, childhood.[1]
Because the theory and diagnosis of personality disorders stem from prevailing cultural expectations, their validity is contested by some experts on the basis of invariable subjectivity. They argue that the theory and diagnosis of personality disorders are based strictly on social, or even sociopolitical and economic considerations.
Eating disorders are conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual’s physical and mental health. Bulimia nervosa and anorexia nervosa are the most common specific forms in the United Kingdom.[1] Bulimia nervosa is a disorder characterized by binge eating and purging, and anorexia nervosa is characterized by immoderate food restriction and irrational fear of gaining weight. Though primarily thought of as affecting females (an estimated 5-10 million being affected in the U.K.), eating disorders affect males as well. An estimated 10 – 15% of people with eating disorders are males (Gorgan, 1999). (an estimated 1 million U.K. males being affected).[2][3][4] Although eating disorders are increasing all over the world among both men and women, there is evidence to suggest that it is women in the Western world who are at the highest risk of developing them and the degree of westernization increases the risk.[5] Nearly half of all Americans personally know someone with an eating disorder. The skill to comprehend the central processes of appetite has increased tremendously since leptin was discovered, and the skill to observe the functions of the brain as well.[6]Interactions between motivational, homeostatic and self-regulatory control processes are involced in eating behaviour, which is a key component in eating disorders.[7]
The precise cause of eating disorders is not entirely understood, but there is evidence that it may be linked to other medical conditions and situations. Cultural idealization of thinness and youthfulness have contributed to eating disorders affecting diverse populations. One study showed that girls with ADHD have a greater chance of getting an eating disorder than those not affected by ADHD.[8][9] Another study suggested that women with PTSD, especially due to sexually related trauma, are more likely to develop anorexia nervosa.[10] One study showed that foster girls are more likely to develop bulimia nervosa.[11] Some think that peer pressure and idealized body-types seen in the media are also a significant factor. Some research show that for certain people there are genetic reasons why they may be prone to developing an eating disorder.[12]
While proper treatment can be highly effective for many suffering from specific types of eating disorders, the consequences of eating disorders can be severe, including death[13][13][14] (whether from direct medical effects of disturbed eating habits or from comorbid conditions such as suicidal thinking)
Substance use disorders include substance abuse and substance dependence.[1] In DSM-IV, the conditions are formally diagnosed as one or the other, but it has been proposed that DSM-5 combine the two into a single condition called “Substance-use disorder”.[
Psychosis (from the Ancient Greek ???? “psyche”, for mind/soul, and -?s?? “-osis”, for abnormal condition or derangement) refers to an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a “loss of contact with reality”. People suffering from psychosis are described as psychotic. Psychosis is given to the more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur.[2]
The term psychosis is very broad and can mean anything from relatively normal aberrant experiences through to the complex and catatonic expressions of schizophrenia and bipolar type 1 disorder.[3][4] Moreover a wide variety of central nervous system diseases, from both external poisons and internal physiologic illness, can produce symptoms of psychosis. This led many professionals to say that psychosis is not specific enough as a diagnostic term. Despite this, “psychosis” is generally given to noticeable deficits in normal behavior (negative signs) and more commonly to diverse types of hallucinations or delusional beliefs (positive signs).
An excess in dopaminergic, and a deficit in glutamate(specifically NMDA) signalling correspond to positive and negative symptoms respectively. The NMDA antagonist MK-801 is used in animal models of schizophrenia,[5] while paranoid and persecutory delusions are typical of methamphetamine users.[6] In those with an organic psychosis, a complex cluster of genetic and environmental factors are involved in the creation of the endogenous imbalance of neurotransmitters observed in those with psychosis.[citation needed]
People experiencing psychosis may exhibit personality changes and thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out daily life activities.
Evidence-based practice (EBP) is an interdisciplinary approach to clinical practice that has been gaining ground following its formal introduction in 1992. It started in medicine as evidence-based medicine (EBM) and spread to other fields such as dentistry, nursing, psychology, education, library and information science and other fields. Its basic principles are that all practical decisions made should 1) be based on research studies and 2) that these research studies are selected and interpreted according to some specific norms characteristic for EBP. Typically such norms disregard theoretical studies and qualitative studies and consider quantitative studies according to a narrow set of criteria of what counts as evidence. If such a narrow set of methodological criteria are not applied, it is better instead just to speak of research based practice.[1]
Evidence-based behavioral practice (EBBP) “entails making decisions about how to promote health or provide care by integrating the best available evidence with practitioner expertise and other resources, and with the characteristics, state, needs, values and preferences of those who will be affected. This is done in a manner that is compatible with the environmental and organizational context. Evidence is comprised of research findings derived from the systematic collection of data through observation and experiment and the formulation of questions and testing of hypotheses” (www.ebbp.org).
Empirically supported treatments (ESTs) are defined as “clearly specified psychological treatments shown to be efficacious in controlled research with a delineated population” (Chambless & Hollon 1998).

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