What is cognitive-behavioral therapy?
Cognitive–behavioral therapy is based on two separate theoretical models, both cognitive and behavioral. Cognitive models are based on the premise that cognitions, or thoughts, determine emotions and behavior. Automatic thoughts are one type of cognition that may be distorted by errors of thinking such as over-generalization, catastrophic thinking, jumping to conclusions, or personalization. Errors in thinking tend to be more frequent and intense in depression as well as in other psychiatric disorders. Behavioral models are based on theories of learning such as by modeling or by reinforcement to certain responses.
Cognitive-behavioral therapy is an approach that uses techniques based on the models described previously here. A greater emphasis on cognitive approaches or on behavioral approaches may be taken depending on the disorder and the stage of treatment. Cognitive techniques include:
- Modifying automatic thoughts
- Modifying schemas
Behavioral techniques include:
- Activity scheduling
- Breathing control
- Contingency contracting
- Desensitization/relaxation training
- Exposure and flooding
- Social skills training
- Thought stopping/distraction
Through many of these techniques, patients learn to manage their anxiety and reactions to stress appropriately. Exposure training is a technique that uses graded exposure to a high-anxiety situation by breaking the task into small steps that are focused on one by one.
Cognitive–behavioral therapy has been the best studied form of psychotherapy and has been shown to treat depression effectively. It is probably more appropriate in cases of mild to moderate depression that is acute. Treatment typically lasts 3 to 6 months with 10 to 20 weekly sessions. The patient is expected to be an active participant in trying new strategies and will be expected to do homework.