Cognitive Behavioral Therapy & Medical Uses

Cognitive-behavioral therapy (CBT) [???????????? ??????????? ????????] is a psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing unhelpful cognitive distortions e.g. thoughts, beliefs, and attitudes and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. Originally, it was designed to treat depression, but its uses have been expanded to include treatment of a number of mental health conditions, including anxiety. Siddha Spirituality of Swami Hardas Life System considers CBT useful for various mental disease, hence we request our valuable readers to go through this article.

Cognitive behavior therapy Definition (???????????? ??????? ???????? ?? ???????)

It is a type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behaviour patterns or treat mood disorders such as depression.

Cognitive behavior therapy Uses (???????????? ??????? ???????? ?? ?????)

Adults (?????)

Cognitive behavior therapy has been shown to have effectiveness in adults for the following:

• Anxiety disorders
• Body dysmorphic disorder
• Depression
• Eating disorders
• Chronic low back pain
• Personality disorders
• Psychosis
• Schizophrenia
• Substance use disorders, in the adjustment
• Depression and anxiety associated with fibromyalgia
• Post-spinal cord injuries

Children (?????)

In children or adolescents, CBT is an effective part of treatment plans for:

• Anxiety disorders
• Body dysmorphic disorder
• Depression and suicidality
• Eating disorders and obesity
• Obsessive-compulsive disorder (OCD)
• Posttraumatic stress disorder, as well as tic disorders
• Trichotillomania
• Other repetitive behavior disorders

CBT combined with hypnosis and distraction reduces self-reported pain in children.

Clinical and non-clinical uses (??????? ?? ???-??????? ?????)

A systematic review of CBT in depression and anxiety disorders concluded that “CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists.”

Emerging evidence suggests a possible role for CBT in the treatment of:

• Attention Deficit Hyperactivity Disorder (ADHD)
• Hypochondriasis
• Coping with the impact of multiple sclerosis
• Sleep disturbances related to aging
• Dysmenorrhea
• Bipolar disorder

In the case of people with metastatic breast cancer, data is limited but CBT and other psychosocial interventions might help with psychological outcomes and pain management.

Cognitive-behavioral therapy for Depression (????? ?? ??? ????????????-??????? ????????)

CBT has been shown as an effective treatment for clinical depression. 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 the major depressive disorder. 

Cognitive-behavioral therapy for Anxiety (????? ?? ??? ????????????-??????? ????????)

A basic concept in some CBT treatments used in anxiety disorders is in vivo exposure. The term refers to the direct confrontation of feared objects, activities, or situations by a patient.

Cognitive-behavioral therapy for Bipolar disorder (?????????? ????? ?? ??? ????????????-??????? ????????)

There is limited evidence of effectiveness for CBT in bipolar disorder and severe depression.

Cognitive-behavioral therapy for Psychosis (????????? ?? ??? ????????????-??????? ????????)

Interventions particularly related to these conditions include:

• Exploring reality testing
• Changing delusions and hallucinations
• Examining factors that precipitate relapse
• Managing relapses

Cognitive-behavioral therapy for Schizophrenia (?????? ?? ??? ????????????-??????? ????????)

Several meta-analyses suggested that CBT is effective in schizophrenia, Cochrane reviews reported CBT had no effect on long?term risk of relapse and no evidence that CBT had an additional effect above standard care.

Cognitive-behavioral therapy for older adults (????? ??????? ?? ??? ????????????-??????? ????????)

Older individuals have certain characteristics that need to be acknowledged and the therapy altered accordingly. Of the small number of studies examining CBT for the management of depression in older people, there is currently no strong support.

Prevention of mental illness (?????? ?????? ?? ??????)

For anxiety disorders, the use of CBT with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes. 

Pathological and problem gambling (?????????? ?? ?????? ???)

CBT is also used for pathological and problem gambling. The percentage of people who problem gamble is 1–3% around the world. Cognitive-behavioral therapy develops skills for relapse prevention and someone can learn to control their mind and manage high-risk cases. There is evidence of the efficacy of CBT for treating pathological and problem gambling at immediate follow-up, however, the longer-term efficacy of CBT for it is currently unknown.

Cognitive-behavioral therapy for Smoking cessation (???????? ??? ???? ?? ??? ????????????-??????? ????????)

CBT looks at the habit of smoking cigarettes as a learned behavior, which later evolves into a coping strategy to handle daily stressors. Because smoking is often easily accessible and quickly allows the user to feel good, it can take precedence over other coping strategies, and eventually work its way into everyday life during non-stressful events as well. CBT aims to target the function of the behavior, as it can vary between individuals, and works to inject other coping mechanisms in place of smoking. 

Cognitive-behavioral therapy for Eating disorders (???? ?? ??????? ?? ??? ????????????-??????? ????????)

Though many forms of treatment can support individuals with eating disorders, CBT is proven to be a more effective treatment than medications and interpersonal psychotherapy alone. CBT aims to combat major causes of distress such as negative cognitions surrounding body weight, shape and size. 

CBT is the first line of treatment for Bulimia Nervosa, and Eating Disorder Non-Specific. While there is evidence to support the efficacy of CBT for bulimia nervosa and binging, the evidence is somewhat variable and limited by small study sizes.

Cognitive-behavioral therapy for Internet addiction (??????? ?? ?? ?? ??? ????????????-??????? ????????)

Research has identified Internet addiction as a new clinical disorder that causes relational, occupational, and social problems. Cognitive-behavioral therapy has been suggested as the treatment of choice for Internet addiction, and addiction recovery.

Cognitive-behavioral therapy Methods (????????????-??????? ???????? ???????)

Therapist (????????)

A typical CBT program would consist of face-to-face sessions between patient and therapist, made up of 6-18 sessions of around an hour each with a gap of 1–3 weeks between sessions. 

Computerized or Internet-delivered CBT (????????????? ?? ??????? ?????? ?????? ??????)

Computerized cognitive behavioral therapy (CCBT) has been described by NICE as a “generic term for delivering CBT via an interactive computer interface delivered by a personal computer, internet, or interactive voice response system”, instead of face-to-face with a human therapist. 

CCBT has the potential to improve access to evidence-based therapies and to overcome the prohibitive costs and lack of availability sometimes associated with retaining a human therapist. In this context, it is important not to confuse CBT with ‘computer-based training’, which nowadays is more commonly referred to as e-Learning.

CCBT has been found in meta-studies to be cost-effective and often cheaper than usual care, including for anxiety. Studies have shown that individuals with social anxiety and depression experienced improvement with online CBT-based methods. 

Smartphone app-delivered CBT (?????????? ????????? ?????? ??????)

Another new method of access is the use of the mobile app or smartphone applications to deliver self-help or guided CBT. Active research is underway including real-world data studies that measure the effectiveness and engagement of text-based smartphone chatbot apps for delivery of CBT using a text-based conversational interface.

Reading self-help CBT materials (?????-?????? ?????? ??????? ?????)

One study found a negative effect in patients who tended to ruminate, and another meta-analysis found that the benefit was only significant when the self-help was guided e.g. by a medical professional.

Cognitive-behavioral therapy Types (????????????-??????? ???????? ?? ??????)

BCBT (????????? ????????????-??????? ????????)

Brief cognitive-behavioral therapy (BCBT) is a form of CBT which has been developed for situations in which there are time constraints on the therapy sessions. BCBT takes place over a couple of sessions that can last up to 12 accumulated hours by design. This technique was first implemented and developed on soldiers overseas in active duty by David M. Rudd to prevent suicide.

Breakdown of treatment:

1. Orientation
   • Commitment to treatment
   • Crisis response and safety planning
   • Means restriction
   • Survival kit
   • Reasons for living card
   • Model of suicidality
   • Treatment journal
   • Lessons learned
2. Skill focus
   • Skill development worksheets
   • Coping cards
   • Demonstration
   • Practice
   • Skill refinement
3. Relapse prevention
   • Skill generalization
   • Skill refinement

Cognitive emotional behavioral therapy (???????????? ????????? ??????? ????????)

Cognitive emotional behavioral therapy (CEBT) is a form of CBT developed initially for individuals with eating disorders but now used with a range of problems including:

• Anxiety
• Depression
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Anger problems

It combines aspects of CBT and dialectical behavioral therapy and aims to improve the understanding and tolerance of emotions in order to facilitate the therapeutic process. 

Structured cognitive-behavioral training (?????? ????????????-??????? ?????????)

Structured cognitive-behavioral training (SCBT) is a cognitive-based process with core philosophies that draw heavily from CBT. Like CBT, SCBT asserts that behavior is inextricably related to beliefs, thoughts, and emotions. SCBT also builds on core CBT philosophy by incorporating other well-known modalities in the fields of behavioral health and psychology.

Moral reconation therapy (????? ???????? ????????)

Moral reconation therapy, a type of CBT used to help felons overcome antisocial personality disorder (ASPD), slightly decreases the risk of further offending. It is generally implemented in a group format because of the risk of offenders with ASPD being given one-on-one therapy reinforces narcissistic behavioral characteristics, and can be used in correctional or outpatient settings. Groups usually meet weekly for two to six months.

Stress inoculation training (???? ??????? ?????????)

This type of therapy uses a blend of cognitive, behavioral and some humanistic training techniques to target the stressors of the client. This usually is used to help clients better cope with their stress or anxiety after stressful events. This is a three-phase process that trains the client to use skills that they already have to better adapt to their current stressors.

First phase (????? ???)

The first phase is an interview phase that includes:

• Psychological testing
• Client self-monitoring
• Variety of reading materials

This allows the therapist to individually tailor the training process to the client. This phase ultimately prepares the client to eventually confront and reflect upon their current reactions to stressors, before looking at ways to change their reactions and emotions in relation to their stressors. The focus is conceptualization.

Second phase (????? ???)

The second phase emphasizes the aspect of skills acquisition and rehearsal that continues from the earlier phase of conceptualization. These skills involve self-regulation, problem-solving, interpersonal communication skills, etc.

Third phase (????? ???)

The third and final phase is the application and following through of the skills learned in the training process. This gives the client opportunities to apply their learned skills to a wide range of stressors. Activities include role-playing, imagery, modeling, etc. 

Mindfulness-based cognitive behavioral hypnotherapy (????? ?????? ???????????? ??????? ???????)

Mindfulness-based cognitive behavioral hypnotherapy (MCBH) is a form of CBT focusing on awareness in a reflective approach with addressing of subconscious tendencies. 

Unified Protocol (?????? ??????)

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is a form of CBT, developed by David H. Barlow and researchers at Boston University, that can be applied to a range of depression and anxiety disorders. The rationale is that anxiety and depression disorders often occur together due to common underlying causes and can efficiently be treated together.

The UP (United Protocol) includes a common set of components:

• Psycho-education
• Cognitive reappraisal
• Emotion regulation
• Changing behaviour

The UP has been shown to produce equivalent results to single-diagnosis protocols for specific disorders, such as OCD and social anxiety disorder. The UP is disseminated by the Unified Protocol Institute.

Criticisms (??????)

Relative effectiveness (??????? ???????????)

The research conducted for CBT has been a topic of sustained controversy. While some researchers write that CBT is more effective than other treatments, many other researchers and practitioners have questioned the validity of such claims. For example, one study determined CBT be superior to other treatments in treating anxiety and depression.

Declining effectiveness (??????????? ??? ??????)

A 2015 meta-analysis revealed that the positive effects of CBT on depression have been declining since 1977. The overall results showed two different declines in effect sizes:

• An overall decline between 1977 and 2014, and
• A steeper decline between 1995 and 2014

Cognitive-behavioral therapy Drop-out rates (????????????-??????? ???????? ?? ?????-???  ????)

Furthermore, other researchers write that CBT studies have high drop-out rates compared to other treatments. At times, the CBT drop-out rates can be more than five times higher than other treatment groups. This high drop-out rate is also evident in the treatment of several disorders, particularly the eating disorder anorexia nervosa, which is commonly treated with CBT. Those treated with CBT have a high chance of dropping out of therapy before completion and reverting to their anorexia behaviors.

Philosophical concerns with CBT methods (?????? ??????? ?? ??? ???????? ???????)

The methods employed in CBT research have not been the only criticisms; some individuals have called its theory and therapy into question.

Another criticism of CBT theory, especially as applied to major depressive disorder (MDD), is that it confounds the symptoms of the disorder with its causes.

Cognitive-behavioral therapy Socio-political concerns (???????????? ??????? ???????? ?? ???????-???????? ?????)

The writer and group analyst Farhad Dalal questions the socio-political assumptions behind the introduction of CBT, connecting the rise of CBT with ‘the parallel rise of neoliberalism, with its focus on marketization, efficiency, quantification, and managerialism’. Dalal also questions both the scientific and the ethical basis of CBT.

Reference: https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy