in the form of abuse or neglect. criticism of cbt sometimes focuses on implementations (such as the uk iapt) which may result initially in low quality therapy being offered by poorly trained practitioners. however, evidence supports the effectiveness of cbt for anxiety and depression. evidence suggests that the addition of hypnotherapy as an adjunct to cbt improves treatment efficacy for a variety of clinical issues. the united kingdom's national institute for health and care excellence (nice) recommends cbt in the treatment plans for a number of mental health difficulties, including ptsd, ocd, bulimia nervosa, and clinical depression. patient age cbt is used to help people of all ages, but the therapy should be adjusted based on the age of the patient with whom the therapist is dealing. older individuals in particular have certain characteristics that need to be acknowledged and the therapy altered to account for these differences thanks to age. of the small number of studies examining cbt for the management of depression in older people, there is currently no strong support. depression and anxiety disorders further information: major depressive disorder § talking therapies, management of depression § psychotherapy, and anxiety disorder § treatment cognitive behavioral therapy has been shown as an effective treatment for clinical depression. the american psychiatric association practice guidelines (april 2000) indicated that, among psychotherapeutic approaches, cognitive behavioral therapy and interpersonal psychotherapy had the best-documented efficacy for treatment of major depressive disorder. a 2001 meta-analysis comparing cbt and psychodynamic psychotherapy suggested the approaches were equally effective in the short term for depression. in contrast, a 2013 meta-analyses suggested that cbt, interpersonal therapy, and problem-solving therapy outperformed psychodynamic psychotherapy and behavioral activation in the treatment of depression. according to a 2004 review by inserm of three methods, cognitive behavioral therapy was either proven or presumed to be an effective therapy on several mental disorders. this included depression, panic disorder, post-traumatic stress, and other anxiety disorders. cbt has been shown to be effective in the treatment of adults with anxiety disorders. results from a 2018 systematic review found a high strength of evidence that cbt-exposure therapy can reduce ptsd symptoms and lead to the loss of a ptsd diagnosis. cbt has also been shown to be effective for post-traumatic stress disorder in very young children (3 to 6 years of age). a cochrane review found low quality evidence that cbt may be more effective than other psychotherapies in reducing symptoms of posttraumatic stress disorder in children and adolescents. a systematic review of cbt in depression and anxiety disorders concluded that "cbt delivered in primary care, especially including computer- or internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists." some meta-analyses find cbt more effective than psychodynamic therapy and equal to other therapies in treating anxiety and depression. theoretical approaches one etiological theory of depression is aaron t. beck's cognitive theory of depression. his theory states that depressed people think the way they do because their thinking is biased towards negative interpretations. according to this theory, depressed people acquire a negative schema of the world in childhood and adolescence as an effect of stressful life events, and the negative schema is activated later in life when the person encounters similar situations. beck also described a negative cognitive triad. the cognitive triad is made up of the depressed individual's negative evaluations of themselves, the world, and the future. beck suggested that these negative evaluations derive from the negative schemata and cognitive biases of the person. according to this theory, depressed people have views such as "i never do a good job", "it is impossible to have a good day", and "things will never get better". a negative schema helps give rise to the cognitive bias, and the cognitive bias helps fuel the negative schema. beck further proposed that depressed people often have the following cognitive biases: arbitrary inference, selective abstraction, overgeneralization, magnification, and minimization. these cognitive biases are quick to make negative, generalized, and personal inferences of the self, thus fueling the negative schema. a basic concept in some cbt treatments used in anxiety disorders is in vivo exposure. cbt-exposure therapy refers to the direct confrontation of feared objects, activities, or situations by a patient. for example, a woman with ptsd who fears the location where she was assaulted may be assisted by her therapist in going to that location and directly confronting those fears. likewise, a person with a social anxiety disorder who fears public speaking may be instructed to directly confront those fears by giving a speech. this "two-factor" model is often credited to o. hobart mowrer. through exposure to the stimulus, this harmful conditioning can be "unlearned" (referred to as extinction and habituation). cbt for children with phobias is normally delivered over multiple sessions, but one-session treatment has been shown to be equally effective and is cheaper. specialised forms of cbt cbt-sp, an adaptation of cbt for suicide prevention (sp), was specifically designed for treating youths who are severely depressed and who have recently attempted suicide within the past 90 days, and was found to be effective, feasible, and acceptable. acceptance and commitment therapy (act) is a specialist branch of cbt (sometimes referred to as contextual cbt). act uses mindfulness and acceptance interventions and has been found to have a greater longevity in therapeutic outcomes. in a study with anxiety, cbt and act improved similarly across all outcomes from pre- to post-treatment. however, during a 12-month follow-up, act proved to be more effective, showing that it is a highly viable lasting treatment model for anxiety disorders. computerized cbt (ccbt) has been proven to be effective by randomized controlled and other trials in treating depression and anxiety disorders, including children. 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 adolescent anxiety. combined with other treatments studies have provided evidence that when examining animals and humans, that glucocorticoids may lead to a more successful extinction learning during exposure therapy for anxiety disorders. for instance, glucocorticoids can prevent aversive learning episodes from being retrieved and heighten reinforcement of memory traces creating a non-fearful reaction in feared situations. a combination of glucocorticoids and exposure therapy may be a better-improved treatment for treating people with anxiety disorders. prevention for anxiety disorders, use of cbt with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes. in another study, 3% of the group receiving the cbt intervention developed generalized anxiety disorder by 12 months postintervention compared with 14% in the control group. individuals with subthreshold levels of panic disorder significantly benefitted from use of cbt. use of cbt was found to significantly reduce social anxiety prevalence. for depressive disorders, a stepped-care intervention (watchful waiting, cbt and medication if appropriate) achieved a 50% lower incidence rate in a patient group aged 75 or older. another depression study found a neutral effect compared to personal, social, and health education, and usual school provision, and included a comment on potential for increased depression scores from people who have received cbt due to greater self recognition and acknowledgement of existing symptoms of depression and negative thinking styles. a further study also saw a neutral result. a meta-study of the coping with depression course, a cognitive behavioral intervention delivered by a psychoeducational method, saw a 38% reduction in risk of major depression. bipolar disorder many studies show cbt, combined with pharmacotherapy, is effective in improving depressive symptoms, mania severity and psychosocial functioning with mild to moderate effects, and that it is better than medication alone. inserm's 2004 review found that cbt is an effective therapy for several mental disorders, including bipolar disorder. this included schizophrenia, depression, bipolar disorder, panic disorder, post-traumatic stress, anxiety disorders, bulimia, anorexia, personality disorders and alcohol dependency. psychosis in long-term psychoses, cbt is used to complement medication and is adapted to meet individual needs. interventions particularly related to these conditions include exploring reality testing, changing delusions and hallucinations, examining factors which precipitate relapse, and managing relapses. meta-analyses confirm the effectiveness of metacognitive training (mct) for the improvement of positive symptoms (e.g., delusions). for people at risk of psychosis, in 2014 the uk national institute for health and care excellence (nice) recommended preventive cbt. schizophrenia inserm's 2004 review found that cbt is an effective therapy for several mental disorders, including schizophrenia. a cochrane review reported cbt had "no effect on long‐term risk of relapse" and no additional effect above standard care. a 2015 systematic review investigated the effects of cbt compared with other psychosocial therapies for people with schizophrenia and determined that there is no clear advantage over other, often less expensive, interventions but acknowledged that better quality evidence is needed before firm conclusions can be drawn. pathological and problem gambling cbt is also used for pathological and problem gambling. the percentage of people who problem gamble is 1–3% around the world. cognitive behavioral therapy develops skills for relapse prevention and someone can learn to control their mind and manage high-risk cases. there is evidence of efficacy of cbt for treating pathological and problem gambling at immediate follow up, however the longer term efficacy of cbt for it is currently unknown. smoking cessation cbt looks at the habit of smoking cigarettes as a learned behavior, which later evolves into a coping strategy to handle daily stressors. since smoking is often easily accessible and quickly allows the user to feel good, it can take precedence over other coping strategies, and eventually work its way into everyday life during non-stressful events as well. cbt aims to target the function of the behavior, as it can vary between individuals, and works to inject other coping mechanisms in place of smoking. cbt also aims to support individuals with strong cravings, which are a major reported reason for relapse during treatment. in a 2008 controlled study out of stanford university school of medicine suggested cbt may be an effective tool to help maintain abstinence. the results of 304 random adult participants were tracked over the course of one year. during this program, some participants were provided medication, cbt, 24-hour phone support, or some combination of the three methods. at 20 weeks, the participants who received cbt had a 45% abstinence rate, versus non-cbt participants, who had a 29% abstinence rate. overall, the study concluded that emphasizing cognitive and behavioral strategies to support smoking cessation can help individuals build tools for long term smoking abstinence. mental health history can affect the outcomes of treatment. individuals with a history of depressive disorders had a lower rate of success when using cbt alone to combat smoking addiction. a cochrane review was unable to find evidence of any difference between cbt and hypnosis for smoking cessation. while this may be evidence of no effect, further research may uncover an effect of cbt for smoking cessation. substance use disorders studies have shown cbt to be an effective treatment for substance use disorders. for individuals with substance use disorders, cbt aims to reframe maladaptive thoughts, such as denial, minimizing and catastrophizing thought patterns, with healthier narratives. specific techniques include identifying potential triggers and developing coping mechanisms to manage high-risk situations. research has shown cbt to be particularly effective when combined with other therapy-based treatments or medication. inserm's 2004 review found that cbt is an effective therapy for several mental disorders, including alcohol dependency. internet addiction research has identified internet addiction as a new clinical disorder that causes relational, occupational, and social problems. cognitive behavioral therapy (cbt) has been suggested as the treatment of choice for internet addiction, and addiction recovery in general has used cbt as part of treatment planning. eating disorders though many forms of treatment can support individuals with eating disorders, cbt is proven to be a more effective treatment than medications and interpersonal psychotherapy alone. cbt aims to combat major causes of distress such as negative cognitions surrounding body weight, shape and size. cbt therapists also work with individuals to regulate strong emotions and thoughts that lead to dangerous compensatory behaviors. cbt is the first line of treatment for bulimia nervosa, and eating disorder non-specific. while there is evidence to support the