efficacy of cbt for bulimia nervosa and binging, the evidence is somewhat variable and limited by small study sizes. inserm's 2004 review found that cbt is an effective therapy for several mental disorders, including bulimia and anorexia nervosa. with autistic adults emerging evidence for cognitive behavioral interventions aimed at reducing symptoms of depression, anxiety, and obsessive-compulsive disorder in autistic adults without intellectual disability has been identified through a systematic review. while the research was focused on adults, cognitive behavioral interventions have also been beneficial to autistic children. dementia and mild cognitive impairment a cochrane review in 2022 found that adults with dementia and mild cognitive impairment (mci) who experience symptoms of depression may benefit from cbt, whereas other counselling or supportive interventions might not improve symptoms significantly. across 5 different psychometric scales, where higher scores indicate severity of depression, adults receiving cbt reported somewhat lower mood scores than those receiving usual care for dementia and mci overall. in this review, a sub-group analysis found clinically significant benefits only among those diagnosed with dementia, rather than mci. the likelihood of remission from depression also appeared to be 84% higher following cbt, though the evidence for this was less certain. anxiety, cognition and other neuropsychiatric symptoms were not significantly improved following cbt, however this review did find moderate evidence of improved quality of life and daily living activity scores in those with dementia and mci. other uses evidence suggests a possible role for cbt in the treatment of attention deficit hyperactivity disorder (adhd), hypochondriasis, and bipolar disorder, but more study is needed and results should be interpreted with caution. cbt has been studied as an aid in the treatment of anxiety associated with stuttering. initial studies have shown cbt to be effective in reducing social anxiety in adults who stutter, but not in reducing stuttering frequency. there is some evidence that cbt is superior in the long-term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia. computerized cbt (ccbt) has been proven to be effective by randomized controlled and other trials in treating insomnia. some research has found similar effectiveness to an intervention of informational websites and weekly telephone calls. ccbt was found to be equally effective as face-to-face cbt in insomnia. a cochrane review of interventions aimed at preventing psychological stress in healthcare workers found that cbt was more effective than no intervention but no more effective than alternative stress-reduction interventions. cochrane reviews have found no convincing evidence that cbt training helps foster care providers manage difficult behaviors in the youths under their care, nor was it helpful in treating people who abuse their intimate partners. cbt has been applied in both clinical and non-clinical environments to treat disorders such as personality disorders and behavioral problems. inserm's 2004 review found that cbt is an effective therapy for personality disorders. individuals with medical conditions in the case of people with metastatic breast cancer, data is limited but cbt and other psychosocial interventions might help with psychological outcomes and pain management. a 2015 cochrane review also found that cbt for symptomatic management of non-specific chest pain is probably effective in the short term. however, the findings were limited by small trials and the evidence was considered of questionable quality. cochrane reviews have found no evidence that cbt is effective for tinnitus, although there appears to be an effect on management of associated depression and quality of life in this condition. cbt combined with hypnosis and distraction reduces self-reported pain in children. there is limited evidence to support its use in coping with the impact of multiple sclerosis, sleep disturbances related to aging, and dysmenorrhea, but more study is needed and results should be interpreted with caution. previously cbt has been considered as moderately effective for treating chronic fatigue syndrome, however a national institutes of health pathways to prevention workshop stated that in respect of improving treatment options for me/cfs that the modest benefit from cognitive behavioral therapy should be studied as an adjunct to other methods. the centres for disease control advice on the treatment of me/cfs makes no reference to cbt while the national institute for health and care excellence states that cognitive behavioral therapy (cbt) has sometimes been assumed to be a cure for me/cfs, however, it should only be offered to support people who live with me/cfs to manage their symptoms, improve their functioning and reduce the distress associated with having a chronic illness." methods of access therapist a typical cbt programme would consist of face-to-face sessions between patient and therapist, made up of 6–18 sessions of around an hour each with a gap of 1–3 weeks between sessions. this initial programme might be followed by some booster sessions, for instance after one month and three months. cbt has also been found to be effective if patient and therapist type in real time to each other over computer links. cognitive-behavioral therapy is most closely allied with the scientist–practitioner model in which clinical practice and research are informed by a scientific perspective, clear operationalization of the problem, and an emphasis on measurement, including measuring changes in cognition and behavior and the attainment of goals. these are often met through "homework" assignments in which the patient and the therapist work together to craft an assignment to complete before the next session. the completion of these assignments – which can be as simple as a person with depression attending some kind of social event – indicates a dedication to treatment compliance and a desire to change. the therapists can then logically gauge the next step of treatment based on how thoroughly the patient completes the assignment. effective cognitive behavioral therapy is dependent on a therapeutic alliance between the healthcare practitioner and the person seeking assistance. unlike many other forms of psychotherapy, the patient is very involved in cbt. for example, an anxious patient may be asked to talk to a stranger as a homework assignment, but if that is too difficult, he or she can work out an easier assignment first. the therapist needs to be flexible and willing to listen to the patient rather than acting as an authority figure. computerized or internet-delivered (ccbt) computerized cognitive behavioral therapy (ccbt) has been described by nice as a "generic term for delivering cbt via an interactive computer interface delivered by a personal computer, internet, or interactive voice response system", instead of face-to-face with a human therapist. it is also known as internet-delivered cognitive behavioral therapy or icbt. ccbt has potential to improve access to evidence-based therapies, and to overcome the prohibitive costs and lack of availability sometimes associated with retaining a human therapist. in this context, it is important not to confuse cbt with 'computer-based training', which nowadays is more commonly referred to as e-learning. although improvements in both research quality and treatment adherence is required before advocating for the global dissemination of ccbt, it has been found in meta-studies to be cost-effective and often cheaper than usual care, including for anxiety and ptsd. studies have shown that individuals with social anxiety and depression experienced improvement with online cbt-based methods. a study assessing an online version of cbt for people with mild-to-moderate ptsd found that the online approach was as effective as, and cheaper than, the same therapy given face-to-face. a review of current ccbt research in the treatment of ocd in children found this interface to hold great potential for future treatment of ocd in youths and adolescent populations. additionally, most internet interventions for post-traumatic stress disorder use ccbt. ccbt is also predisposed to treating mood disorders amongst non-heterosexual populations, who may avoid face-to-face therapy from fear of stigma. however presently ccbt programs seldom cater to these populations. in february 2006 nice recommended that ccbt be made available for use within the nhs across england and wales for patients presenting with mild-to-moderate depression, rather than immediately opting for antidepressant medication, and ccbt is made available by some health systems. the 2009 nice guideline recognized that there are likely to be a number of computerized cbt products that are useful to patients, but removed endorsement of any specific product. smartphone app-delivered another new method of access is the use of mobile app or smartphone applications to deliver self-help or guided cbt. technology companies are developing mobile-based artificial intelligence chatbot applications in delivering cbt as an early intervention to support mental health, to build psychological resilience, and to promote emotional well-being. artificial intelligence (ai) text-based conversational application delivered securely and privately over smartphone devices have the ability to scale globally and offer contextual and always-available support. active research is underway including real-world data studies that measure effectiveness and engagement of text-based smartphone chatbot apps for delivery of cbt using a text-based conversational interface. recent market research and analysis of over 500 online mental healthcare solutions identified 3 key challenges in this market: quality of the content, guidance of the user and personalisation. reading self-help materials enabling patients to read self-help cbt guides has been shown to be effective by some studies. however one study found a negative effect in patients who tended to ruminate, and another meta-analysis found that the benefit was only significant when the self-help was guided (e.g. by a medical professional). group educational course patient participation in group courses has been shown to be effective. in a meta-analysis reviewing evidence-based treatment of ocd in children, individual cbt was found to be more efficacious than group cbt. types brief cognitive behavioral therapy brief cognitive behavioral therapy (bcbt) is a form of cbt which has been developed for situations in which there are time constraints on the therapy sessions and specifically for those struggling with suicidal ideation and/or making suicide attempts. bcbt was based on rudd's proposed "suicidal mode", an elaboration of beck's modal theory. bcbt takes place over a couple of sessions that can last up to 12 accumulated hours by design. this technique was first implemented and developed with soldiers on active duty by dr. m. david rudd to prevent suicide. breakdown of treatment orientation commitment to treatment crisis response and safety planning means restriction survival kit reasons for living card model of suicidality treatment journal lessons learned skill focus skill development worksheets coping cards demonstration practice skill refinement relapse prevention skill generalization skill refinement cognitive emotional behavioral therapy main article: cognitive emotional behavioral therapy cognitive emotional behavioral therapy (cebt) is a form of cbt developed initially for individuals with eating disorders but now used with a range of problems including anxiety, depression, obsessive compulsive disorder (ocd), post-traumatic stress disorder (ptsd) and anger problems. it combines aspects of cbt and dialectical behavioral therapy and aims to improve understanding and tolerance of emotions in order to facilitate the therapeutic process. it is frequently used as a "pretreatment" to prepare and better equip individuals for longer-term therapy. structured cognitive behavioral training main article: structured cognitive behavioral training structured cognitive-behavioral training (scbt) is a cognitive-based process with core philosophies that draw heavily from cbt. like cbt, scbt asserts that behavior is inextricably related to beliefs, thoughts, and emotions. scbt also builds on core cbt philosophy by incorporating other well-known modalities in the fields of behavioral health and psychology: most notably, albert ellis's rational emotive behavior therapy. scbt differs from cbt in two distinct ways. first, scbt is delivered in a highly regimented format. second, scbt is a predetermined and finite training process that becomes personalized by the input of the participant. scbt is designed to bring a participant to a specific result in a specific period of time. scbt has been used to challenge addictive behavior, particularly with substances such as tobacco, alcohol and food, and to manage diabetes and subdue stress and anxiety. scbt has also been used in the field of criminal psychology in the effort to reduce recidivism. moral reconation therapy moral reconation therapy, a type of cbt used to help felons overcome antisocial personality disorder (aspd), slightly decreases the risk of further offending. it is generally implemented in a group format because of the risk of offenders with aspd being given one-on-one therapy reinforces narcissistic behavioral characteristics, and can be used in correctional or outpatient settings. groups usually meet weekly for two to six months. stress inoculation training this type of therapy uses a blend of cognitive, behavioral, and certain humanistic training techniques to target the