cognitive behavioral therapy cognitive behavioral therapy cognitive behavioral therapy (cbt) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. cbt focuses on challenging and changing cognitive distortions (such as thoughts, beliefs, and attitudes) and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. though it was originally designed to treat depression, its uses have been expanded to include the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, adhd, and eating disorders. cbt includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies. cognitive behavioral therapythe triangle in the middle represents cbt's tenet that all humans' core beliefs can be summed up in three categories: self, others, future.icd-10-pcsgz58zzzmeshd015928 cbt is a common form of talk therapy based on the combination of the basic principles from behavioral and cognitive psychology. it is different from historical approaches to psychotherapy, such as the psychoanalytic approach where the therapist looks for the unconscious meaning behind the behaviors, and then formulates a diagnosis. instead, cbt is a "problem-focused" and "action-oriented" form of therapy, meaning it is used to treat specific problems related to a diagnosed mental disorder. the therapist's role is to assist the client in finding and practicing effective strategies to address the identified goals and to alleviate symptoms of the disorder. cbt is based on the belief that thought distortions and maladaptive behaviors play a role in the development and maintenance of many psychological disorders and that symptoms and associated distress can be reduced by teaching new information-processing skills and coping mechanisms. when compared to psychoactive medications, review studies have found cbt alone to be as effective for treating less severe forms of depression, anxiety, post-traumatic stress disorder (ptsd), tics, substance use disorders, eating disorders, and borderline personality disorder. some research suggests that cbt is most effective when combined with medication for treating mental disorders, such as major depressive disorder. cbt is recommended as the first line of treatment for the majority of psychological disorders in children and adolescents, including aggression and conduct disorder. researchers have found that other bona fide therapeutic interventions were equally effective for treating certain conditions in adults. along with interpersonal psychotherapy (ipt), cbt is recommended in treatment guidelines as a psychosocial treatment of choice. history early roots precursors of certain fundamental aspects of cbt have been identified in various ancient philosophical traditions, particularly stoicism. stoic philosophers, particularly epictetus, believed logic could be used to identify and discard false beliefs that lead to destructive emotions, which has influenced the way modern cognitive-behavioral therapists identify cognitive distortions that contribute to depression and anxiety. aaron t. beck's original treatment manual for depression states, "the philosophical origins of cognitive therapy can be traced back to the stoic philosophers". another example of stoic influence on cognitive theorists is epictetus on albert ellis. a key philosophical figure who influenced the development of cbt was john stuart mill. the modern roots of cbt can be traced to the development of behavior therapy in the early 20th century, the development of cognitive therapy in the 1960s, and the subsequent merging of the two. first wave: behavior therapy roots john b. watson groundbreaking work of behaviorism began with john b. watson and rosalie rayner's studies of conditioning in 1920. behaviorally-centered therapeutic approaches appeared as early as 1924 with mary cover jones' work dedicated to the unlearning of fears in children. these were the antecedents of the development of joseph wolpe's behavioral therapy in the 1950s. it was the work of wolpe and watson, which was based on ivan pavlov's work on learning and conditioning, that influenced hans eysenck and arnold lazarus to develop new behavioral therapy techniques based on classical conditioning. during the 1950s and 1960s, behavioral therapy became widely used by researchers in the united states, the united kingdom, and south africa. their inspiration was by the behaviorist learning theory of ivan pavlov, john b. watson, and clark l. hull. in britain, joseph wolpe, who applied the findings of animal experiments to his method of systematic desensitization, applied behavioral research to the treatment of neurotic disorders. wolpe's therapeutic efforts were precursors to today's fear reduction techniques. british psychologist hans eysenck presented behavior therapy as a constructive alternative. at the same time as eysenck's work, b. f. skinner and his associates were beginning to have an impact with their work on operant conditioning. skinner's work was referred to as radical behaviorism and avoided anything related to cognition. however, julian rotter in 1954 and albert bandura in 1969 contributed behavior therapy with their respective work on social learning theory by demonstrating the effects of cognition on learning and behavior modification. the work of the australian claire weekes dealing with anxiety disorders in the 1960s is also seen as a prototype of behavior therapy. the emphasis on behavioral factors constituted the "first wave" of cbt. second wave: cognitive therapy roots one of the first therapists to address cognition in psychotherapy was alfred adler (1870–1937), notably with his idea of basic mistakes and how they contributed to creation of unhealthy or useless behavioral and life goals. abraham low (1891–1954) believed that someone's thoughts were best changed by changing their actions. adler and low influenced the work of albert ellis, who developed the earliest cognitive-based psychotherapy called rational emotive therapy (contemporarily known as rational emotive behavioral therapy, or rebt). the first version was announced to the public in 1956. in the late 1950s, aaron t. beck was conducting free association sessions in his psychoanalytic practice. during these sessions, beck noticed that thoughts were not as unconscious as freud had previously theorized, and that certain types of thinking may be the culprits of emotional distress. it was from this hypothesis that beck developed cognitive therapy, and called these thoughts "automatic thoughts". he first published his new methodology in 1967, and his first treatment manual in 1979. beck has been referred to as "the father of cognitive behavioral therapy". it was these two therapies, rational emotive therapy, and cognitive therapy, that started the "second wave" of cbt, which was the emphasis on cognitive factors. third wave: behavior and cognitive therapies merge although the early behavioral approaches were successful in many of the neurotic disorders, they had little success in treating depression. behaviorism was also losing in popularity due to the cognitive revolution. the therapeutic approaches of albert ellis and aaron t. beck gained popularity among behavior therapists, despite the earlier behaviorist rejection of mentalistic concepts like thoughts and cognitions. both of these systems included behavioral elements and interventions, with the primary focus being on problems in the present. in initial studies, cognitive therapy was often contrasted with behavioral treatments to see which was most effective. during the 1980s and 1990s, cognitive and behavioral techniques were merged into cognitive behavioral therapy. pivotal to this merging was the successful development of treatments for panic disorder by david m. clark in the uk and david h. barlow in the us. over time, cognitive behavior therapy came to be known not only as a therapy, but as an umbrella term for all cognitive-based psychotherapies. these therapies include, but are not limited to, rational emotive behavior therapy (rebt), cognitive therapy, acceptance and commitment therapy, dialectical behavior therapy, metacognitive therapy, metacognitive training, reality therapy/choice theory, cognitive processing therapy, emdr, and multimodal therapy. all of these therapies are a blending of cognitive- and behavior-based elements. this blending of theoretical and technical foundations from both behavior and cognitive therapies constituted the "third wave" of cbt. the most prominent therapies of this third wave are dialectical behavior therapy and acceptance and commitment therapy. despite the increasing popularity of third-wave treatment approaches, reviews of studies reveal there may be no difference in the effectiveness compared with non-third wave cbt for the treatment of depression. description mainstream cognitive behavioral therapy assumes that changing maladaptive thinking leads to change in behavior and affect, but recent variants emphasize changes in one's relationship to maladaptive thinking rather than changes in thinking itself. the goal of cognitive behavioral therapy is not to diagnose a person with a particular disease, but to look at the person as a whole and decide what can be altered. cognitive distortions therapists or computer-based programs use cbt techniques to help people challenge their patterns and beliefs and replace errors in thinking, known as cognitive distortions, such as "overgeneralizing, magnifying negatives, minimizing positives and catastrophizing" with "more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior". cognitive distortions can be either a pseudo-discrimination belief or an overgeneralization of something. cbt techniques may also be used to help individuals take a more open, mindful, and aware posture toward cognitive distortions so as to diminish their impact. skills mainstream cbt helps individuals replace "maladaptive ... coping skills, cognitions, emotions and behaviors with more adaptive ones", by challenging an individual's way of thinking and the way that they react to certain habits or behaviors, but there is still controversy about the degree to which these traditional cognitive elements account for the effects seen with cbt over and above the earlier behavioral elements such as exposure and skills training. phases in therapy cbt can be seen as having six phases: assessment or psychological assessment; reconceptualization; skills acquisition; skills consolidation and application training; generalization and maintenance; post-treatment assessment follow-up. these steps are based on a system created by kanfer and saslow. after identifying the behaviors that need changing, whether they be in excess or deficit, and treatment has occurred, the psychologist must identify whether or not the intervention succeeded. for example, "if the goal was to decrease the behavior, then there should be a decrease relative to the baseline. if the critical behavior remains at or above the baseline, then the intervention has failed." the steps in the assessment phase include: identify critical behaviors; determine whether critical behaviors are excesses or deficits; evaluate critical behaviors for frequency, duration, or intensity (obtain a baseline); if excess, attempt to decrease frequency, duration, or intensity of behaviors; if deficits, attempt to increase behaviors. the re-conceptualization phase makes up much of the "cognitive" portion of cbt. a summary of modern cbt approaches is given by hofmann. delivery protocols there are different protocols for delivering cognitive behavioral therapy, with important similarities among them. use of the term cbt may refer to different interventions, including "self-instructions (e.g. distraction, imagery, motivational self-talk), relaxation and/or biofeedback, development of adaptive coping strategies (e.g. minimizing negative or self-defeating thoughts), changing maladaptive beliefs about pain, and goal setting". treatment is sometimes manualized, with brief, direct, and time-limited treatments for individual psychological disorders that are specific technique-driven. cbt is used in both individual and group settings, and the techniques are often adapted for self-help applications. some clinicians and researchers are cognitively oriented (e.g. cognitive restructuring), while others are more behaviorally oriented (e.g. in vivo exposure therapy). interventions such as imaginal exposure therapy combine both approaches. related techniques cbt may be delivered in conjunction with a variety of diverse but related techniques such as exposure therapy, stress inoculation, cognitive processing therapy, cognitive therapy, metacognitive therapy, metacognitive training, relaxation training, dialectical behavior therapy, and acceptance and commitment therapy. some practitioners promote a form of mindful cognitive therapy which includes a greater emphasis on self-awareness as part of the therapeutic process. medical uses in adults, cbt has been shown to be an effective part of treatment plans for anxiety disorders, body dysmorphic disorder, depression, eating disorders, chronic low back pain, personality disorders, psychosis, schizophrenia, substance use disorders, and bipolar disorder. it is also effective as part of treatment plans in the adjustment, depression, and anxiety associated with fibromyalgia, and with post-spinal cord injuries. 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), and post-traumatic stress disorder (ptsd), as well as tic disorders, trichotillomania, and other repetitive behavior disorders. cbt has also been applied to a variety of childhood disorders, including depressive disorders and various anxiety disorders. cbt has shown to be the most effective intervention for people exposed to adverse childhood experiences