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Cognitive Behavioral Therapy

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) is a popular therapeutic approach that helps people manage their problems by changing the way people think and behave.

CBT is used, in most cases, for the treatment of mental disorders and psychological distress like anxiety and depression via cognitive factors. However, it is also applicable in treating physical health problems.

 

The Concept of CBT

CBT works on the principle that human actions, feelings, thoughts, and physical sensations are interconnected and experience a vicious cycle by allowing negative thoughts and feelings to control them.

The main aim of CBT is to control emotional or overwhelming problems more positively by breaking them down into smaller parts.

The therapy is designed to change negative patterns and improve the way a person feels. Its main focus is seeking practical ways to improve one’s state of mind daily. Given this, it concentrates on current problems rather than past issues.

 

Benefits of CBT

There are several benefits of CBT. A few will be highlighted here. It is an effective way of treating many mental health challenges associated. It helps people with depression, anxiety disorders, general stress and burnout.

It is highly applicable in instances where medicine alone has not worked. When compared to other talking therapies, CBT can be administered within a relatively short time. After the administering of the therapy, people have learned useful and practical strategies applicable in everyday life.

Other benefits include coping better with afflictions like bipolar disorder, phobias, borderline personality disorder, panic disorder, eating disorders, obsessive compulsive-disorder (OCD, anger, sleep problems, childhood depression, post-traumatic stress disorder (PTSD), schizophrenia, psychosis, marital conflict, substance abuse, and addiction, to mention a few.

While it is true that the physical symptoms of these conditions cannot be cured by CBT, the therapy assists people in coping better.

Apart from treating short-term health conditions, CBT can also treat long-term health conditions like fibromyalgia and irritable bowel syndrome (IBS and chronic fatigue syndrome (CFS). Afflicted people are taught how to identify their problems more clearly, develop an awareness of automatic thoughts and stop fearing the worst.

By applying CBT, an individual is not only able to differentiate between facts and irrational thoughts but is also able to perceive every situation from a different perspective.

Several kinds of research have been carried out over the years, leading to the development of disorder-specific CBT protocols that take care of many of the cognitive and behavioral maintenance factors of the common disorders.

 

Cognitive Behavioral Therapy and Scientific Discoveries

Research conducted in 2004 at the University of Pennsylvania and Beck Institute for Cognitive Therapy and Research reviewed meta-analyses of the empirical status of cognitive-behavioral therapy 1. The review, which covers a wide range of psychiatric disorders, summarized the current meta-analysis literature on treatment outcomes of CBT.

The study summarized 269 meta-analyses, comprising 332 clinical trials and covering 16 different disorders. For the various psychological disorders in the study, an overview of the effectiveness of CBT was made. Of note, there are instances of meta-analyses purposely examining CBT for disorders in elderly adults as well as children.

It was found that CBT was superior to antidepressants in the treatment of adult depression. In fact, it was discovered to be as effective as behavior therapy in treating adult depression and obsessive-compulsive disorder. The entire 16 meta-analyses were methodologically and rigorously researched and proved the efficacy of CBT for many disorders. The major groupings were:

 

– Addiction and substance use disorder

– Schizophrenia and other psychotic disorders

– Depression and dysthymia

– Bipolar disorder

Anxiety disorder

– Eating disorders

– Insomnia

– Anger and aggression

– Criminal behaviors

General stress

– Distress due to general medical conditions

– Chronic pain and fatigue

– Pregnancy complications and female hormonal conditions

 

The findings of all the meta-analyses are summarized below.

 

1. CBT vs. Addiction and Substance Use Disorder

Research has shown that CBT is highly effective in the treatment of cannabis dependence. Multi-session CBT has been proven to be a more effective session for people with this disorder than a single session 2.

CBT techniques were found to be highly effective in the cessation of smoking and the reduction of relapse 3. There was significant success recorded for gambling addiction 4.

 

2. CBT vs. Schizophrenia and Other Psychotic Disorders

Studies have shown that CBT treatment for schizophrenia has several beneficial effects 5. Findings also revealed that CBT aids pharmacotherapy for people suffering from schizophrenia 6. Unlike other interventions, not much of an  effect of CBT was seen on relapse or hospital admission 7.

 

3. CBT vs. Depression and Dysthymia

The efficacy of CBT in controlling depression was more effective than the control experiment with little or no treatment 8, 9.

CBT was compared with other psychological treatments like interpersonal psychotherapy, problem-solving therapy and psychodynamic treatment. The results show that it was equally effective when compared to these treatments 10, 11, 12, 13. CBT was seen as an effective tool for post-treatment and six-month follow-ups for combined symptoms of anxiety and depression 14.

Combining CBT with pharmacotherapy could yield effective results when CBT alone is administered to people with depression and dysthymia 15.

 

4. CBT vs. Bipolar Disorder

There is ample evidence that CBT can treat bipolar disorder alone 16. Meta-analyses carried out to determine how effective this therapy can be in treating bipolar disorder revealed a small-to- medium overall effect at post-treatment. At the follow-up stage, a diminishing effect was noticed.

Furthermore, several meta-analyses investigated whether CBT was able to prevent relapse in bipolar patients. In 2008, Beynon and his team ran a series of tests to measure the efficacy of CBT for preventing relapse. The results revealed that CBT was somewhat effective when compared to other forms of treatment 17.

In summary, CBT is an effective method of preventing or delaying relapses in cases of bipolar disorder 18, 19.

 

5. CBT vs. Anxiety Disorders

CBT is generally an acceptable approach for treating anxiety disorders 20. It is very effective for treating secondary symptoms like anxiety sensitivity and sleep dysfunction 21.

Some studies have shown immediate relief from these symptoms short term. However, treatment with CBT remains unclear long term 22.

CBT treatments like social skills training, cognitive restructuring and exposure for individuals or groups have been proven to be very effective 23. They were found to be superior to psychopharmacology long term 24. CBT treatment in conjunction with applied relaxation was proven to yield positive results similar to either therapy approach alone. CBT alone or both were found to yield better results than the use of medications 25.

 

6. CBT vs. Eating Disorders

Bulimia nervosa is an eating disorder and a form of mental illness in which a person is unable to control his or her eating habits and consumes large amounts until vomiting. Meta-analyses showed that CBT is effective in treating this disorder 26, 27.

Some studies attempted to compare CBT to other psychotherapies like dialectical behavioral therapy, interpersonal therapy, self-monitoring, hypno-behavioral therapy, behavioral weight-loss treatment, and supportive psychotherapy. It was found that CBT remission response rates were superior for bulimia nervosa 28.

A meta-analysis recently carried out for binge eating disorder showed that a combination of structured self-help and psychotherapy helps in the treatment of binge eating disorder 29. While the study was silent on the ability of CBT to control this disorder, most of the trials in the research for psychotherapy involved CBT.

In 2008, research by Reas and Grilo suggested that combining psychotherapy and medications did not treat binge eating disorder. However, they agreed that both treatments positively enhanced weight loss 30.

 

7. CBT vs. Insomnia

Insomnia is a disorder in which a person often finds it difficult to sleep for some time. Several types of research have shown the efficacy of CBT in treating this disorder. Recently, a meta-analysis revealed that CBT was a highly effective therapy for treating primary insomnia, using both subjective and objective sleep parameters 31, 32.

 

8. CBT vs. Anger and Aggression

Some meta-analytic reviews have revealed the effects of CBT on anger and aggression. Research has shown that that CBT can moderately reduce anger problems 33, 34. This research has also revealed that CBT is most effective for people vulnerable to anger.

Besides, CBT is likely a better option for controlling anger and aggression than psychosocial treatments and control conditions 35.

 

9. CBT vs. Criminal Behaviors

The efficacy of CBT in the control of criminal behaviors is presented in four separate meta-analytic studies highlighted here 36, 37, 38, 39. Among several psychological interventions and theoretical orientations for reducing criminal activity, the two superior interventions are CBT and behavior therapy 40, 41.

Studies have also shown that sexual recidivism treatment recorded a higher success rate with physical treatments like hormonal treatment and surgical castration than CBT 42. Among the numerous psychological therapies for sexual offenders, CBT and classical behavioral proved to be the most effective 43.

 

10. CBT vs. General Stress

CBT interventions in employees with a concentration on psycho-social outcomes were more effective than other treatments like organization-focused therapies. Four meta-analyses investigated occupational stress, yielding similar results 44, 45, 46, 47.

Further studies have shown that CBT alone is more effective for treating stress when combined to additional psychological components 48.

CBT was found to work positively for parents, who have children with developmental disabilities 49. Singer, Ethridge, and Aldana carried out a study in 2007, with an outcome in contrast to earlier reports presented by others.

It was discovered that multiple component therapies comprising a combination of CBT, behavioral parent training and other forms of support services have a better effect than CBT alone 50.

 

11. CBT vs. Distress Due to General Medical Conditions

A study carried out by Kangas, Bovbjerg, and Montgomery in 2008 revealed that CBT was highly effective as exercise therapy for cancer-related fatigue treatment 51a.

Further research confirmed the efficacy of CBT in the treatment of secondary symptoms like stress and anxiety that are often experienced by people infected by HIV. It has been proven to yield a higher success rate than supportive therapy 51b.

Furthermore, the research of Dorstyn and his team in 2011 ascertained the efficacy of CBT in treating secondary spinal cord injuries. The results showed that CBT was the best treatment for depression, assertiveness skills, coping and quality of life 52. CBT was found to perform better than using a placebo or diet/exercise alone 53.

Another study compared its performance to yoga/education in treating depressive symptoms 54.

For the treatment of irritable bowel syndrome, CBT proved to be slightly more effective than conventional care. However, peppermint oil has shown more efficiency in providing relief for this disorder 55.

 

12. CBT vs. Chronic Pain and Fatigue

A meta-analysis that examined psychological treatments for fibromyalgia revealed the superiority of CBT over other psychological treatments for decreasing pain intensity 56. In 2008, Malouff and his team discovered that the treatment of chronic fatigue syndrome using CBT was more effective in control conditions 57.

 

13. CBT vs. Pregnancy Complications and Female Hormonal Conditions

A meta-analysis confirmed the efficacy of CBT in treating perinatal depression 58. The beneficial effects of CBT for postnatal depression were analyzed in another study 59.

However, there is a need to exercise caution here since the research did not scientifically show a verifiable relationship between depression and pregnancy with hormonal changes 60.

Research conducted by Bledsoe and Grote in 2006 revealed that depression symptoms were significantly lowered in women suffering from non-psychotic major depression in pregnancy and postnatal periods when given combined treatment compared to treatment with antidepressant medication alone 61. This treatment was deemed more effective than using CBT alone.

CBT was also discovered to significantly reduce depressive and anxiety symptoms in women suffering from premenstrual syndrome 62.

 

Conclusion

The efficacy of Cognitive Behavioral Therapy in the treatment of general stress, anxiety disorders, burnout, depression and a range of psychological issues has been investigated.

CBT has been discovered in several studies, proof of its efficacy. Those desiring this form of therapy can consult their physician or check out the nearest professional nearest via a directory of certified therapists, a website of the National Association of Cognitive-Behavioral Therapists.

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