Cognitive Behavioural Therapy (CBT)
Cognitive behavioural therapy (CBT) is the most widely used evidence-based psychotherapy for improving mental health.
Brief historic overview
Cognitive behavioural therapy is a fusion of the behavioural and cognitive theories of human behaviour and psychopathology.
Modern CBT development had three “waves”.
The first, or behavioural wave was inspired and developed by notable people such as John B. Watson, Joseph Wolpe, Ivan Pavlov, Hans Eysenck, Arnold Lazarus and B. F. Skinner and comes from learning theory (Skinner et Pavlov). Learning theory is a concept describing the process of gaining, keeping and recalling knowledge. Behavioural learning theory assumes that learning is built on responses to environmental stimuli. I. Pavlov introduced a concept of classical conditioning where behaviour is a reflexive and involuntary response to stimuli. The exposure, which originated from the works of Pavlov and Watson, is a widely used instrument in CBT. It is a process of changing the unwanted, learned response or behaviour to a more desirable response. In addition to this, B. F. Skinner later shaped a concept of operant conditioning, which is based on the voluntary behaviour that is modified through the use of positive and negative reinforcements. The foundation for the second or “cognitive wave” of CBT can be tracked to numerous ancient philosophical ideas, notably in Stoicism. Stoic philosophers, particularly Epictetus, believed that logic could be used to identify and discard false beliefs that lead to destructive emotions and that individuals are responsible for their own actions, which they can examine and control through rigorous self-discipline. These philosophical ideas inspired Alfred Adler, one of the first therapists who implemented cognition into a psychotherapeutic approach. He developed the concept of basic mistakes and showed how they create unhealthy behavioural and life goals. Albert Ellis, inspired by Adler's work, developed the earliest cognitive-based psychotherapy, known as rational emotive behaviour therapy (REBT). (See REBT chapter in this book)
Meanwhile, in the early 1960's Dr Aaron T. Beck (who was a fully trained and practising psychoanalyst), in his search of explanations for depression, identified distorted, negative cognitions as a primary feature of the disease. He developed a short-term treatment with a focus on reality testing of patients' depressed thinking. Both Aaron T. Beck and Albert Ellis, developed approaches which gained wide popularity among behavioural therapists.
The third wave is the evaluation and use of emotions with Mindfulness based therapies and acceptance based therapies, like Acceptance and Commitment therapy. (See Mindfulness chapter in this book p. 20)
CBT treatment is based on a cognitive formulation, the beliefs and behavioural strategies that characterise a specific disorder.
CBT has certain basic principles for treatment listed here:
CBT is based on an ever-evolving formulation of patients' problems and an individual conceptualisation of each patient in cognitive terms.
CBT requires a therapeutic alliance.
CBT emphasises collaboration and active participation.
CBT is goal-oriented and problem-focused.
CBT initially emphasises the present.
CBT is educational, and aims to teach the patient autonomy, how to be her own therapist and emphasises relapse prevention.
CBT aims to be time-limited.
CBT sessions are structured.
CBT teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs.
CBT uses a variety of techniques to change thinking, mood, and behaviour.
Main uses (indications)
CBT started as a therapy for patients with depression. Lately adapted and developed to diverse set of disorders and problems. CBT can be used with patients with divergent levels of education and income, various cultural background and ages, from children to seniors.
Partial List of Disorders Successfully Treated by Cognitive Behaviour Therapy
Medical problems with psychological components
Major depressive disorder
Generalized anxiety disorder
Anger and hostility
Body dysmorphic disorder
Bipolar disorder (with medication) Schizophrenia (with medication)
Adapted from Judith S. Beck Phd Cognitive Behavior Therapy Basics and Beyond, Second Edition
CBT has been widely tested since 1977, and today more than 1000 research studies (e.g., Hofmann 2012) have demonstrated the efficacy of CBT for various psychiatric disorders, psychological problems and medical problems with a psychological component.
Comment from an expert and or quote from a famous psychotherapist
"What matters is our attitude toward facts rather than the facts themselves. This also applies to the facts of our inner life.”
Comment from a trainee with experience
CBT is a comprehensive psychotherapy focusing pragmatically on how to help the patient. Many specific tools can be useful in everyday practice: for instance exposure, assertiveness techniques, role-plays, motivational interviewing, and cognitive restructuring. The functional analysis and the vicious circles taken from learning theory helps to conceptualize the functioning of the patients, destigmatise their symptoms and help them to understand better how to have more distance with their functioning and change it.
Books, manual, videos, application, published online courses or international association
Research possibilities and Courses Beck Institute online training https://beckinstitute.org/get-training/online-training/
MOOC Understanding Anxiety, Depression and CBT https://www.futurelearn.com/courses/anxiety-depression-and-cbt
The European Psychiatric Association organise a Massive Open Online course about CBT
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), 427-440.
Beck, J.S. (2011). Cognitive Behavior Therapy, Second Edition: Basics and Beyond. The Guilford Press: New York
Cully, J.A., Teten, A.L. (2008). A Therapist’s Guide to Brief Cognitive Behavioral Therapy. Gully and Teten Behavioral Therapy. Department of Veterans Affairs South Central MIRECC: Houston.
Riggenbach, J. (2012). The CBT Toolbox: A Workbook for Clients and Clinicians. Premier Publishing & Media.
Manning, J., Ridgeway, N. (2016). CBT Worksheets. Create Space (2016).
Carlson, M. (2014). CBT for Chronic Pain and Psychological Well-Being. Wiley-Blackwell: Hoboken, New Jersey.
Tolin, D.F. (2016). Doing CBT: A Comprehensive Guide to Working with Behaviors, Thoughts, and Emotions. The Guilford Press: New York.
Knaus, W.J. (2014). The Cognitive Behavioral Workbook for Anxiety, Second Edition: A Step-By-Step Program. New Harbinger Publications: Oakland, California
Bunge, E.L., Mandil, J., Consoli, A.J., Gomar, M. (2017). CBT Strategies for Anxious and Depressed Children and Adolescents. The Guilford Press: New York.
Wallace, L. (2016). Cognitive Behavioural Therapy. Independently published.
Greenberger, D., Padesky, C.A. (2015). Mind Over Mood, Second Edition: Change How You Feel by Changing the Way You Think The Guilford Press: New York.
Joseph, A. (2017). Cognitive Behaviour Therapy: Your Route out of Perfectionism, Self-Sabotage and Other Everyday Habits with CBT [Audiobook]. Audible Studios
Bill, Y. (2016). Cognitive Behavioral Therapy: CBT Techniques to Manage Your Anxiety, Depression, Compulsive Behavior, PTSD, Negative Thoughts and Phobias [Audiobook]. John Leddy
Thrive: The Power of Evidence-Based Psychological Therapies - Richard Layard, David M. Clark -Book, ALLEN LANE HB collection, 2014
Links to Societies
European Association for Behavioural and Cognitive Therapies http://www.eabct.eu/
National CBT associations can be found here
The EABCT organize a yearly congress to present the recent developments of CBT.
International Association of Cognitive Behavioral Therapy
Association for Behavioral and Cognitive Therapies
International Union of Psychological Science
Private Centers and Institutes
American Institute for Cognitive Therapy
Albert Ellis Institute
Beck Institute for Cognitive Therapy and Research, they organize online training http://www.beckinstitute.org/
Cognitive Behaviour Therapy
Journal of Behavior Therapy and Experimental Psychiatry https://www.journals.elsevier.com/journal-of-behavior-therapy-and-experimental-psychiatry/
Olga Sidorova - Psychiatry Trainee from Rīga Stradiņš University – Department of Psychiatry and Addiction Medicine – Riga, Latvia