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Cognitive Behavioral Therapy Information

Cognitive behavioral therapy (CBT) is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present. The title is used in diverse ways to designate behavior therapy, cognitive therapy, and to refer to therapy based upon a combination of basic behavioral and cognitive research.[1]

There is empirical evidence that CBT is effective for the treatment of a variety of problems, including mood, anxiety, personality, eating, substance abuse, and psychotic disorders.[2][3] Treatment is sometimes manualized, with specific technique-driven brief, direct, and time-limited treatments for specific psychological disorders. CBT is used in individual therapy as well as group settings, and the techniques are often adapted for self-help applications. Some clinicians and researchers are more cognitive oriented (e.g. cognitive restructuring), while others are more behaviorally oriented (in vivo exposure therapy). Other interventions combine both (e.g. imaginal exposure therapy).[4][5]

CBT was primarily developed through an integration of behavior therapy with cognitive therapy. While rooted in rather different theories, these two traditions found common ground in focusing on the "here and now", and on alleviating symptoms.[6] Many CBT treatment programs for specific disorders have been evaluated for efficacy; the health-care trend of evidence-based treatment, where specific treatments for symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments.[5][7] In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) recommends CBT as the treatment of choice for a number of mental health difficulties, including posttraumatic stress disorder, OCD, bulimia nervosa, and clinical depression.

Contents

History

Precursors of certain fundamental aspects of CBT have been identified in various ancient philosophical traditions, particularly Stoicism.[8] For example, Beck's original treatment manual for depression states, "The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers".[9] 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. Behavior therapeutical approaches appeared as early as 1924,[6] with Mary Cover Jones' work on the unlearning of fears in children.[10] In 1937 Abraham Low developed cognitive training techniques for patient aftercare following psychiatric hospitalization.[11][12][13][14][15] Low designed his techniques for use in his organization, Recovery International, which supports people recovering from mental illness.[16] Although Recovery International was originally led by Low, he later adapted the techniques for use in lay-run self-help groups operating under the same name.[17]

It was during the period 1950 to 1970 that behavioral therapy became widely utilized, with researchers in the United States, the United Kingdom and South Africa who were inspired by the behaviorist learning theory of Ivan Pavlov, John B. Watson and Clark L. Hull.[6] In Britain, this work was mostly focused on the neurotic disorders through the work of Joseph Wolpe, who applied the findings of animal experiments to his method of systematic desensitization,[18] the precursor to today's fear reduction techniques.[6] British psychologist Hans Eysenck, inspired by the writings of Karl Popper, criticized psychoanalysis in arguing that "if you get rid of the symptoms, you get rid of the neurosis",[19] and presented behavior therapy as a constructive alternative.[6][20] In the United States, psychologists were applying the radical behaviorism of B. F. Skinner to clinical use. Much of this work was concentrated towards severe, chronic psychiatric disorders, such as psychotic behavior[21] and autism.[6][22]

Although the early behavioral approaches were successful in many of the neurotic disorders, they had little success in treating depression.[6] Behaviorism was also losing in popularity due to the so-called "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 these systems included behavioral elements and interventions and primarily concentrated on problems in the present. Albert Ellis's system, originated in the early 1950s, was first called rational therapy, and can arguably be called one of the first forms of cognitive behavioral therapy. It was partly founded as a reaction against popular psychotherapeutic theories at the time, mainly psychoanalysis.[23] Aaron T. Beck, inspired by Albert Ellis, developed cognitive therapy in the 1960s.[24] Beck describes his therapeutic approach as originating in a realization he made while conducting free association with patients in the context of classical psychoanalysis—he noted that patients had not been reporting certain thoughts at the fringe of consciousness, thoughts which often preceded intense emotional reactions; this realization led Beck to begin viewing emotional reactions as resulting from cognitions, rather than understanding emotion within the abstract psychoanalytic framework.[25] He would go on to name these cognitions "automatic thoughts" because he believed that people were not necessarily aware that the cognitions existed, but that they could identify that the thoughts when questioned.[26] Beck believed that pushing his clients to identify these automatic thoughts was integral to overcoming a particular difficulty.[26]

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.[6]

Concurrently with the contributions of Ellis and Beck, starting in the late 1950s and continuing through the 1970s, Arnold A. Lazarus developed what was arguably the first form of broad-spectrum cognitive behavioral therapy.[27] He later broadened the focus of behavioral treatment to incorporate cognitive aspects.[28]

Arnold Lazarus, desiring to optimize therapy's effectiveness and effect durable treatment, cognitive and behavioral methods, developed a new form of therapy called multimodal therapy, based on CBT, but also including physical sensations (as distinct from emotional states), visual images (as distinct from language-based thinking), interpersonal relationships, and biological factors.[29]

Samuel Yochelson and Stanton Samenow pioneered the idea that cognitive behavioral approaches can be used successfully with a criminal population. They are the authors of Criminal Personality Vol. I. This book has an extensive amount of information regarding the dynamics of criminal thinking and application of cognitive behavioral approaches.

CBT includes a variety of approaches and therapeutic systems; some of the most well known include cognitive therapy, rational emotive behavior therapy and ]. Defining the scope of what constitutes a cognitive–behavioral therapy is a difficulty that has persisted throughout its development Handbook of cognitive-behavioral therapies.Historical and Philosophical Bases of the Cognitive-Behavioral Therapies. There is also a subgroup of modified cognitive therapies for Christian, Muslim, and Taoist patients. These modified cognitive therapies have been at least as effective as the standard varieties.

The particular therapeutic techniques vary within the different approaches of CBT according to the particular kind of problem issues, but commonly may include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation, mindfulness and distraction techniques are also commonly included. Cognitive behavioral therapy is often also used in conjunction with mood stabilizing medications to treat conditions like bipolar disorder. Its application in treating schizophrenia along with medication and family therapy is recognized by NICE guidelines .

Going through cognitive behavioral therapy generally is not an overnight process for clients; a typical course consists of 12-16 hour-long sessions. A typical course of a modern talk therapy, such as cognitive behavioural therapy, consists of 12-16 hour-long sessions and is a reasonably efficient way of treating conditions like depression and anxiety Even after clients have learned to recognize when and where their mental processes go awry, it can in some cases take considerable time or effort to replace a dysfunctional cognitive-affective-behavioral process or habit with a more reasonable and adaptive one. Cognitive Behavioral Therapy is problem focused and structured towards the client. It requires honesty and openness between the client and therapist, as a therapist develops strategies for managing problems and guiding the client to a better life.

Computerized Computerized Cognitive Behavioral Therapy (CCBT) is described by NICE (2006) 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 therapist. While it cannot replace face-to-face therapy, this can provide an option for patients, especially in light of the fact that there are not always therapists available, or the cost can be prohibitive. For people who are feeling depressed and withdrawn, the prospect of having to speak to someone about their innermost problems can be off-putting. In this respect, computerized CBT can be an alternative option.

Randomized controlled trial have proven its effectiveness, and 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.

A new UK government initiative for tackling mental health issues has recently been launched by the Care Services Improvement Partnership. This confirms Primary Care Trust (PCT) responsibilities in delivering the NICE Technology Appraisal on CCBT. National Director for Mental Health has confirmed that by 31 March 2007 PCTs should have ST Solutions' "FearFighter" and ultrasis "Beating the Blues" CCBT products in place and the NICE Guidelines should be met. Some areas have developed, or are trialing, other CCBT products notably the Serenity Programme The more recent NICE guideline (2009) has recognised that there are likely to be a number of computerised CBT products that are useful to patients. They have therefore removed the endorsement of any specific product.'

Specific applications

CBT has been applied within many clinical and non-clinical environments and has been successfully used as a treatment for many clinical disorders, personality conditions and behavioral problems.[3] A systematic review concluded, "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." [30] However, cognitive behavioral therapy is unlikely to be effective in treating psychiatric problems caused solely by drug or alcohol abuse. It has been argued that the treatment of such patients should be directed at tackling their substance abuse problems (ideally aiming for complete abstinence) prior to the commencement of CBT.[31][32]

Anxiety disorders

A basic concept in some CBT treatments of anxiety disorders is in vivo exposure—a gradual exposure to the actual, feared stimulus. This treatment is based on the theory that the fear response has been classically conditioned and that avoidance negatively reinforces and maintains that fear. This "two-factor" model is often credited to O. Hobart Mowrer.[33] Through exposure to the stimulus, this conditioning can be unlearned; this is referred to as extinction and habituation. CBT also looks at an individual's way of thinking and the way that he or she reacts to certain habits or behaviors.[34] A specific phobia, such as fear of spiders, can often be treated with in vivo exposure and therapist modeling in one session.[35] Obsessive compulsive disorder is typically treated with exposure with response prevention.

Social phobia, also known as social anxiety, has often been treated with exposure coupled with cognitive restructuring, such as in Heimberg's group therapy protocol.[36] Evidence suggests that cognitive interventions improve the result of social phobia treatment.[37]

CBT has been shown to be effective in the treatment of generalized anxiety disorder, and possibly more effective than pharmacological treatments in the long term.[38] In fact, one study of patients undergoing benzodiazepine withdrawal who had a diagnosis of generalized anxiety disorder showed that those who received CBT had a very high success rate of discontinuing benzodiazepines compared to those who did not receive CBT. This success rate was maintained at 12-month follow up. Furthermore in patients who had discontinued benzodiazepines, it was found that they no longer met the diagnosis of general anxiety disorder and that patients no longer meeting the diagnosis of general anxiety disorder was higher in the group who received CBT. Thus CBT can be an effective tool to add to a gradual benzodiazepine dosage reduction program leading to improved and sustained mental health benefits.[39]

Mood disorders

One etiological theory of depression is Aaron 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. When the person with such schemata encounters a situation that in some way resembles the conditions in which the original schema was learned, the negative schemata of the person are activated.[40]

Beck also described a negative cognitive triad, made up of the negative schemata and cognitive biases of the person; Beck theorized that depressed individuals make negative evaluations of themselves, the world, and the future. Depressed people, according to this theory, 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. This is the negative triad. Also, Beck proposed that depressed people often have the following cognitive biases: arbitrary inference, selective abstraction, over-generalization, magnification and minimization. These cognitive biases are quick to make negative, generalized, and personal inferences of the self, thus fueling the negative schema.[40]

Cognitive behavioral therapy has been shown as an effective treatment for clinical depression.[41] A large-scale study in 2000[42] showed substantially higher results of response and remission (73% for combined therapy vs. 48% for either CBT or the antidepressant Nefazodone alone) when a form of cognitive behavior therapy and that particular discontinued anti-depressant drug were combined than when either modality was used alone.

For more general results confirming that CBT alone can provide lower but nonetheless valuable levels of relief from depression, and result in increased ability for the patient to remain in employment, see The Depression Report,[43] which states: 100 people attend up to sixteen weekly sessions one-on-one lasting one hour each, some will drop out but within four months 50 people will have lost their psychiatric symptoms.

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.[44]

Recently some CBT practitioners have returned to more behavioral approaches to the treatment of depression such as behavioral activation. A large-scale treatment study found behavioral activation to be more effective than cognitive therapy and on a par with medication for treating depression.[45]

Insomnia

Cognitive Behavioral Therapy for Insomnia (CBT-I) has been found to be effective in reducing benzodiazepine usage in the treatment of insomnia. A large-scale trial utilizing CBT-I for chronic users of sedative hypnotics including nitrazepam, temazepam and zopiclone found the addition of CBT-I to improve outcome and reduce drug consumption in the treatment of chronic insomnia. Persisting improvements in sleep quality, sleep latency, and increased total sleep, as well as improvements in sleep efficiency and significant improvements in vitality and physical and mental health at 3-, 6- and 12-month follow-ups were found in those receiving cognitive behavioral therapy for insomnia with hypnotics compared with those patients receiving hypnotics alone. A marked reduction in total sedative hypnotic drug use was found in those receiving CBT-I, with 33% reporting no hypnotic drug use. Authors of the study suggested that CBT-I is potentially a flexible, practical, and cost-effective treatment for the treatment of insomnia and that CBT-I administered coincident to hypnotic treatment leads to a reduction of benzodiazepine drug intake in a significant number of patients.[46] Chronic use of hypnotic medications is not recommended due to their adverse effects on health and the risk of dependence. A gradual taper is usual clinical course in getting people off benzodiazepines but even with gradual reduction a large proportion of people fail to stop taking benzodiazepines. The elderly are particularly sensitive to the adverse effects of hypnotic medications. A clinical trial in elderly people dependent on benzodiazepine hypnotics showed that the addition of CBT-I to a gradual benzodiazepine reduction program increased the success rate of discontinuing benzodiazepine hypnotic drugs from 38% to 77% and at 12-month follow-up from 24% to 70%. The paper concluded that CBT-I is an effective tool for reducing hypnotic use in the elderly and reducing the adverse health effects that are associated with hypnotics such as drug dependence, cognitive impairments and increased road traffic accidents.[47]

A further study in older people with insomnia comparing the hypnotic drug zopiclone against CBT-I found that CBT-I actually improved EEG slow wave sleep as well as increased time spent asleep and found that the benefits were maintained at 6-month follow-up. Zopiclone however worsened sleep by suppressing slow wave sleep. A lack of slow wave sleep is linked to impaired functioning and sleepiness. Zopiclone reduced slow wave sleep and was similar to placebo in that it produced no lasting benefits after treatment had finished and at 6-month follow-up while CBT-I did have significant lasting benefits. The authors stated that CBT-I was superior to zopiclone both in the short term and in the long term.[48] A comparison of CBT-I and the hypnotic drug zolpidem (Ambien) found similar results with CBT-I showing superiority and sustained benefits after long term follow up. Interestingly the addition of CBT-I and zolpidem offered no benefit over CBT-I alone.[49]

Severe mental disorders

Several meta-analyses have shown CBT effective in schizophrenia[50][51] and the American Psychiatric Association includes CBT in its schizophrenia guideline as an evidence-based treatment. There is also some limited evidence of effectiveness for CBT in bipolar disorder and severe depression.[52]

However, in a 2010 article in Psychological Medicine entitled, "Cognitive behavioral therapy for the major psychiatric disorder: does it really work?",[53] the authors found that no trial employing both blinding and psychological placebo has found CBT to be effective in schizophrenia. The authors also found few well-controlled studies of CBT in depression that found the therapy to be effective, and in those found, the effect was small. CBT is also ineffective in preventing relapses in bipolar disorder.

Similarly, severe depression is not mediated by CBT. Evidence of cognitive mediation of cognitive behavioral therapy’s effects can be seen, according to a study by DeRubeis et al, when (1) cognitive therapy treats and limits the symptoms better than the alternative treatment; (2) cognitive therapy produces greater changes in a given cognitive variable than an alternative treatment would; (3) the cognitive variable changes along with symptom changes, even if the treatment is held constant statistically; and (4) inclusion of the cognitive variable as a co-variable reduces the treatment effect on symptom change.[54] In the case of depression, anti-depressants pills are still viewed as far more powerful and effective than the CBT and, as a result, it is unlikely that any kind of alternative would be seriously considered.[54] However, those opposed to anti-depressant pills began to find some success with CBT in the 1990s.[55]

Psychosis

An extension of the CBT concept of moderate, rational thinking can be applied to the thought processes which occur during psychotic or delusional episodes. Psychotic episodes can be viewed as panic gripping the mind. A type of chain reaction is occurring where one extreme thought is giving rise to another - fueling the panicked mental runaway (psychosis).

People experiencing psychotic episodes do have a large degree of control over their cascade of thoughts. CBT techniques and principles can help patients gain insight and identify patterns in their thought processes.[56] Awareness can be fostered that maintaining a calm state of mind is vital for the achievement of any resolution to delusional thinking. Overall developing an automatic, organic, personal response which is biased towards a moderate, more rational, interpretation of stimuli is very beneficial in the stabilisation of psychotic thinking.

A 1997 study by Kuipers et al was influential in proving the effectiveness of CBT on patients with psychosis.[56] The study, which lasted nine months and featured sixty participants, ended with 80% of the subjects deeming the treatment satisfactory.[56] The control group fared much worse, with one participant even committing suicide.[56] Members of the experimental group saw great reductions in their symptoms and acted as proof that even patients who have suffered from psychosis for many years may find hope from CBT.[56]

There have been other breakthroughs in recent years, specifically with the use of the ABC Model. The model is used to give patients a strategy to organize their confusing experiences. The ABC Model consists of a therapist uses Socratic questioning to help establish links between emotional distress and the beliefs of the patient.[51]

Children and adolescents

The use of CBT has been extended to children and adolescents with positive results. CBT is one of the few empirically-supported psychosocial treatments for young people.[57] It is used to treat major depressive disorder, anxiety disorders, and symptoms related to trauma and posttraumatic stress disorder. CBT has been used with children and adolescents to treat a variety of conditions with good success.[58][59] CBT is also used as a treatment modality for children who have experienced complex post-traumatic stress disorder and chronic maltreatment.[60]

Cognitive and Behavioral Therapies for children and adolescents usually are short-term treatments (i.e., often between 6-20 sessions) that focus on teaching young people and their parents specific skills. CBT is different from many other therapy approaches by focusing on the ways that a person's cognitions (i.e., thoughts), emotions, and behaviors are connected and how they affect one another. Because emotions, thoughts, and behaviors are all linked, CBT approaches allow for therapists to intervene at different points in the cycle. Though approaches can differ somewhat, they have the following in common:[61]

Stuttering

Cognitive behavioral therapy is increasingly being used to help people who stutter or stammer, to overcome anxiety.[62] CBT teaches people to analyze how unhelpful thoughts may be contributing to their anxieties,[63] which can cause avoidance behaviors, and further stuttering. People can then learn to challenge such thoughts. It can also be used to help people who stutter change negative beliefs about themselves into positive ones. CBT can also be used to help people who stutter change negative beliefs about themselves into positive ones.[63] It is believed that the stuttering itself is a byproduct of anxiety.[63] This link is perhaps best established by the fact that many people who stutter only do so around certain people and in certain situations.[63] Therefore, it is assumed that certain situations and people create this anxiety and thus, stuttering.[63] CBT can help those who struggle with stuttering to identify these people and situations and pinpoint what is causing the stuttering. Such therapy can usually be obtained through speech and language therapists, trained in CBT.[63]

Such therapy can usually be obtained through speech and language therapists, trained in CBT. More recently, techniques offered by CBT are now available through computerized methods,[64] including online approaches such as Speech Bloom, which is a study program for stuttering.[65]

Posttraumatic Stress Disorder

Recent efforts have been made to develop models for using CBT with PTSD and in some cases complex trauma.[66][67][68][69] These models are still in their early stages but have strong promise.[70] Some of these models, specifically in one particular experiment by Cohen et al on children who suffered sexual abuse, have tried adding sertraline to Trauma-Focused-CBT, but this implementation has seen only moderate success.[71] A drawback of adding sertraline was determining whether TF-CBT or sertraline caused clinical improvement for children with comorbid depression.[71] Evidence supports an initial trial of TF-CBT for most children with PTSD symptoms before adding any kind of medication to ensure that both the CBT and the drugs are working.[71] In particular programs based on the use of exposure therapy[72] One example of a model being used is Cognitive Processing Therapy, which is used to treat posttraumatic stress disorder (PTSD) for veterans and sexual assault victims.[73][74]

Post-stroke depression

"There is moderate evidence that cognitive behavioural therapy is ineffective as a treatment for post-stroke depression."[75]

This evidence, however, is not necessarily concrete. Much of the research pointing in this direction was done in experiments with very small sample sizes.[71] While there is not yet a reason to believe that CBT is a solution, future research may lead back to CBT use among those suffering from post-stroke depression.[71]

Research

Cognitive behavioral therapy most closely allies with the scientist–practitioner model, in which clinical practice and research is informed by a scientific perspective, clear operationalization of the problem, an emphasis on measurement (and measurable changes in cognition and behavior) and measurable goal-attainment. These goals are often met through "homework" assignments in which the patient and the therapist will work together to craft an assignment to complete before the next session.[26] The completion of these assignments - which can be as simple as a person suffering from depression attending some kind of social event - shows a dedication and desire to change.[26] The therapists can then logically gauge the next step of treatment based on how thoroughly the patient completes the assignment.[26] While this is not as scientific as other forms of treatment, it still is very methodological in nature and requires a knowledgeable and understanding therapist.[26]

Effective cognitive behavioral therapy is also dependent on a therapeutic alliance between the health care practitioner and the person seeking assistance. (See Therapeutic relationship) The relationship found between a patient and a therapist is often very unique. Unlike many other forms of therapy, the patient is very involved in what he or she is doing in order to change.[26] 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 before working up to talking to a stranger.[26] The therapist needs to be flexible and willing to listen to the patient rather than acting as an authority figure.[26]

Criticism

CBT has come under fire from non-CBT therapists who claim that the data does not fully support the extent of attention and funding it receives nor its extension beyond psychotherapy into matters such as reducing unemployment, and that the limitations of the CBT model when used to blanket-address psychological suffering are unrecognized. Psychotherapist and professor Andrew Samuels stated that this constitutes "a coup, a power play by a community that has suddenly found itself on the brink of corralling an enormous amount of money. Science isn't the appropriate perspective from which to look at emotional difficulties. Everyone has been seduced by CBT's apparent cheapness."[76]

In 2009, clinical psychologist Dr. Oliver James said that CBT simply “does not work”[77] and criticized the British government for claiming that CBT would cure half of 900,00 people of their depression and anxiety. James would go on to say that "being cheap, quick and simplistic, CBT naturally appeals to the government. Yet the fact is, it doesn’t work.”[77]

Presenters at a psychotherapy conference at the University of East Anglia (UEA) in July 2008 criticized the increased spending on CBT and the widespread belief that CBT is more effective than other forms of psychotherapy.[78] In this conference professors Mick Cooper and Robert Elliott (both at University of Strathclyde), William B Stiles (Miami University) and Art Bohart (Saybrook University) issued a joint statement, which briefly stated:

At the same conference,[78] professors Robert Elliott and Beth Freire presented their unpublished meta-analysis of more than 80 studies where person-centered psychotherapy was shown to be as effective as other forms of psychotherapy, including CBT.[79]

In a 2010 article in Psychological Medicine entitled, "Cognitive behavioral therapy for the major psychiatric disorder: does it really work?", the authors found that no trial employing both blinding and psychological placebo has found CBT to be effective in schizophrenia.[80] The authors also found few well-controlled studies of CBT in depression that found the therapy to be effective, and in those found, the effect was small. CBT is also ineffective in preventing relapses in bipolar disorder.[80]

A 2011 study by Florida International University's Yasmin Rey, Carla E. Marin, and Wendy K. Silverman attacked CBT's success with children.[81] The study points to the fact that even with CBT's relatively high success rate, it still leaves between 20% and 40% of children unaffected.[81] The authors of the study point to several factors that cause CBT to work ineffectively with the youth, including symptom severity, cognitive factors, comorbidity, parents who also suffer from anxiety or depression, treatment processes such as the relationship between the child and the therapist, and parental actions such as fear among mothers.[81]

See also

References

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Psychotherapy and counselling (ICD-9-CM V3 94.3-4, ICD-10-PCS GZ5-GZB)
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Psychodynamic Psychoanalysis · Adlerian therapy · Analytical therapy
Cognitive & Behaviorist Behavior therapy · Cognitive therapy · Cognitive behavioral therapy · Rational emotive behavior therapy
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People Aaron T. Beck · Albert Ellis · Alfred Adler · Carl Gustav Jung · Carl Rogers · Erik H. Erikson · Fritz Perls · Jacques Lacan · Irvin Yalom · Joseph Wolpe · Karen Horney · Martin Seligman · Melanie Klein · Milton H. Erickson · Paul Watzlawick · R. D. Laing · Rollo May · Salvador Minuchin · Sigmund Freud · Viktor Frankl · Virginia Axline · Virginia Satir

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Cognitive behavioral therapy (list)
Acceptance and Commitment Therapy · Applied Behavioral Analysis · Behavioral activation · Behavior Modification · Behavior therapy · Cognitive Therapy · Computerised Cognitive Behavioral Therapy · Cognitive analytic therapy · Cognitive behavioral analysis system of psychotherapy · Contingency Management · Dialectical Behavior Therapy · Direct therapeutic exposure · Exposure and response prevention · Functional Analytic Psychotherapy · Mindfulness-based Cognitive Therapy · Multimodal Therapy · Rational Emotive Behavior Therapy · Reality Therapy · Relapse Prevention · Systematic desensitization · Prolonged Exposure Therapy ·

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