Cognitive therapy is a widely used form of psychotherapy that focuses on changing dysfunctional cognitions (thoughts), emotions, and behavior. This computerized learning program emphasizes the form of cognitive therapy developed over the last thirty years by Aaron T. Beck and coworkers. Cognitive therapy is based on the theory that individuals with depression, anxiety, and other emotional disorders have maladaptive patterns of information processing and related behavioral difficulties.
One of the primary targets of cognitive therapy is the identification of negative or distorted automatic thoughts. These cognitions are the relatively autonomous thoughts that occur rapidly while an individual is in the midst of a particular situation or is recalling significant events from the past. Patients with depression and anxiety have many more negative or fearful automatic thoughts than control subjects, and these distorted cognitions stimulate painful emotional reactions. In addition, negative automatic thoughts can be associated with behaviors (e.g., helplessness, withdrawal, or avoidance) that make the problem worse. In depression or anxiety disorders, there is often a “vicious cycle” of dysfunctional cognitions, emotions, and behaviors.
Automatic thoughts are frequently based on faulty logic or errors in reasoning. Cognitive therapy is directed, in part, at helping patients recognize and change these cognitive errors (sometimes called cognitive distortions). Some of the commonly described cognitive errors include: all or nothing thinking, personalization, ignoring the evidence, and overgeneralization. In cognitive therapy, patients are usually taught how to detect cognitive errors and to use this skill in developing a more rational style of thinking.
Another focus of cognitive therapy is on underlying schemas. These cognitive structures are thought to be the templates, or basic rules, for interpreting information from the environment. Schemas (sometimes termed core beliefs) can be either adaptive or maladaptive. Cognitive therapists assist patients in modifying problematic schemas. Generally, cognitive therapy for dysfunctional schemas is more complex and demanding than therapeutic work with automatic thoughts.
Cognitive therapy also includes a number of behavioral interventions such as activity scheduling and graded task assignments. These procedures are used to reverse behavioral pathology and to influence cognitive functioning. The relationship between cognition and behavior is considered to be a “two way street.” If behavior improves, there is usually a salutatory effect on cognition. In a similar manner, cognitive changes can lead to behavioral gains. Thus, cognitive therapists often combine cognitive and behavioral techniques in clinical practice.
What is the research background of cognitive therapy?
Cognitive therapy is the most heavily researched form of psychotherapy. Multiple well controlled outcome studies have shown cognitive therapy to be an effective treatment for depression. Also, cognitive therapy has been found to be a particularly useful intervention for panic disorder and social phobia. Other conditions for which cognitive therapy has been proven useful include psychophysiological disorders, bulimia, and cocaine abuse. Research on cognitive therapy for a wide variety of disorders has been reviewed by Wright and Beck (1995).
How is cognitive therapy conducted?
Usually cognitive therapy is a short-term treatment lasting from 10-20 sessions. Therapists are more active than in many other types of treatment for emotional disorders. A strong therapeutic relationship is encouraged between clinician and patient. This relationship has been termed collaborative empiricism because therapist and patient work together as a team to examine: 1) the validity of cognitions and 2) the effectiveness of behavior patterns.
In the early phase of cognitive therapy, emphasis is placed on establishing a good working relationship and on teaching the patient the basic principles of this treatment approach. Usually, examples from the patient’s current life situation are used to demonstrate the effects of automatic thoughts and cognitive errors. Therapy is most often focused on the “here and now” and is directed at specific problems or areas of concern. Homework assignments are used from the beginning of treatment to reinforce learning and to encourage behavioral change.
The middle portion of therapy is devoted to modifying dysfunctional patterns of information processing and behavior. Frequently used cognitive interventions include thought recording, identifying cognitive errors, examining the evidence, and developing rational alternatives. A number of behavioral techniques may also be employed, such as activity scheduling, graded task assignments, or desensitization procedures. The therapist asks frequent questions designed to stimulate a more rational cognitive style. Also, self-help is encouraged by in vivo therapeutic exercises and continued homework assignments.
The final phase of treatment is concerned with reinforcing skills learned earlier in therapy and in preparing patients for managing problems on their own. One of the goals of cognitive therapy is to learn methods that will have positive effects in reducing the risk of relapse. Thus, many cognitive therapists help their patients prepare for stressful situations that might trigger the return of symptoms. During the later portions of therapy, more intensive work may be needed to revise deeply held schemas. Change in these underlying attitudes is thought to be an important factor in the long-term effects of cognitive therapy.
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