Editing Cognitive behavioral therapy (section)

==Description==
Mainstream cognitive behavioral therapy assumes that changing [[maladaptive]] thinking leads to change in [[behavior]] and [[Affect (psychology)|affect]],<ref name="HassettAL" /> but recent variants emphasize changes in one's relationship to maladaptive thinking rather than changes in thinking itself.<ref name="HayesSC">{{cite journal |vauthors=Hayes SC, Villatte M, Levin M, Hildebrandt M |year=2011 |title=Open, aware, and active: contextual approaches as an emerging trend in the behavioral and cognitive therapies |journal=Annual Review of Clinical Psychology |volume=7 |issue=1 |pages=141–168 |doi=10.1146/annurev-clinpsy-032210-104449 |pmid=21219193 |s2cid=6529775}}</ref>

===Cognitive distortions===
Therapists use CBT techniques to help people challenge their patterns and beliefs and replace errors in thinking, known as [[cognitive distortions]] with "more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior".<ref name="HassettAL" /> Cognitive distortions can be either a pseudo-discrimination belief{{Clarify|date=October 2023}} or an overgeneralization of something.<ref>{{cite journal |vauthors=Dawes RM |date=April 1964 |title=Cognitive Distortion: Monograph Supplement 4-V14 |journal=Psychological Reports |volume=14 |issue=2 |pages=443–459 |doi=10.2466/pr0.1964.14.2.443 |s2cid=144381210}}</ref> 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.<ref name="HayesSC" />

Mainstream CBT helps individuals replace "maladaptive... coping skills, cognitions, emotions and behaviors with more adaptive ones",<ref name="GatchelRJ" /> by challenging an individual's way of thinking and the way that they react to certain habits or behaviors,<ref>{{cite book |url=https://books.google.com/books?id=_0_pRyy9McQC |title=Fundamentals of nursing: concepts, process and practice |vauthors=Kozier B |publisher=Pearson Education |year=2008 |isbn=978-0-13-197653-5 |page=187}}</ref> 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.<ref name="LongmoreRJ">{{cite journal |vauthors=Longmore RJ, Worrell M |date=March 2007 |title=Do we need to challenge thoughts in cognitive behavior therapy? |journal=Clinical Psychology Review |volume=27 |issue=2 |pages=173–187 |doi=10.1016/j.cpr.2006.08.001 |pmid=17157970}}</ref>

===Assumptions===
Chaloult, Ngo, Cousineau and Goulet<ref>{{Cite book |last1=Chaloult |first1=Louis |title=La thérapie cognitivo-comportementale: théorie et pratique |last2=Ngo |first2=Thanh-Lan |last3=Cousineau |first3=Pierre |last4=Goulet |first4=Jean |publisher=Gaëtan Morin |year=2008 |isbn=9782896320219 |pages=68–80}}</ref> have attempted to identify the main assumptions of cognitive therapy used in CBT based on the research literature (Beck;<ref>{{cite book | vauthors = Beck AT | date = 1979 | title = Cognitive Therapy and the Emotional Disorders | publisher = Plume | isbn = 978-0-452-00928-8 }}</ref> Walen and Wessler;<ref>{{Cite book |last1=Walen |first1=Susan R. |title=A practitioner's guide to rational-emotive therapy |last2=DiGiuseppe |first2=Raymond |last3=Wessler |first3=Richard L. |date=1980 |publisher=Oxford University Press |isbn=978-0-19-502667-2 |location=New York}}</ref> Beck, Emery and Greenberg,<ref>{{Cite book |last1=Beck |first1=Aaron |title=Anxiety Disorders And Phobias: A Cognitive Perspective |last2=Emery |first2=Gary |last3=Greenberg |first3=Ruth L |publisher=[[Basic Books]] |year=1985 |isbn=9780465003853}}</ref> and Auger<ref>{{Cite book |last=Auger |first=Lucien |title=La démarche émotivo-rationnelle |publisher=Éditions Ville-Marie |year=1986 |isbn=978-2891941532}}</ref>). They describe fourteen assumptions:
# Human emotions are primarily caused by people's thoughts and perceptions rather than events.
# Events, thoughts, emotions, behaviors, and physiological reactions influence each other.
# Dysfunctional emotions are typically caused by unrealistic thoughts. Reducing dysfunctional emotions requires becoming aware of irrational thoughts and changing them.
# Human beings have an innate tendency to develop irrational thoughts. This tendency is reinforced by their environment.
# People are largely responsible for their own dysfunctional emotions, as they maintain and reinforce their own beliefs.
# Sustained effort is necessary to modify dysfunctional thoughts, emotions, and behaviors.
# Rational thinking usually causes a decrease in the frequency, intensity, and duration of dysfunctional emotions, rather than an absence of affect or feelings.
# A positive therapeutic relationship is essential to successful cognitive therapy.
# Cognitive therapy is based on a teacher-student relationship, where the therapist educates the client.
# Cognitive therapy uses [[Socratic questioning]] to challenge cognitive distortions.
# Homework is an essential aspect of cognitive therapy. It consolidates the skills learned in therapy.
# The cognitive approach is active, directed, and structured.
# Cognitive therapy is generally short.
# Cognitive therapy is based on predictable steps.

These steps largely involve learning about the CBT model; making links between thoughts, emotions, behaviors, and physiological reactions; noticing when dysfunctional emotions occur; learning to question the thoughts associated with these emotions; replacing irrational thoughts with others more grounded in reality; modifying behaviors based on new interpretations of events; and, in some cases, learning to recognize and change the major beliefs and attitudes underlying cognitive distortions.

Chaloult, Ngo, Cousineau and Goulet have also described the assumptions of behavioral therapy as used in CBT.<ref>{{Cite book |last1=Chaloult |first1=Louis |title=La thérapie cognitivo-comportementale: théorie et pratique |last2=Ngo |first2=Thanh-Lan |last3=Cousineau |first3=Pierre |last4=Goulet |first4=Jean |publisher=Gaëtan Morin |year=2008 |isbn=9782896320219 |pages=18–21}}</ref> They refer to the work of Agras,<ref>{{Cite book |last=Agras |first=WS |title=Kaplan & Sadock's Comprehensive Textbook of Psychiatry |publisher=Williams and Wilkins |year=1995 |isbn=978-1-4511-0047-1 |editor-last=Kaplan |editor-first=HI |edition=6th |location=Philadelphia |chapter=Behavior Therapy |editor-last2=Sadock |editor-first2=BJ }}</ref> Prochaska and Norcross,<ref>{{Cite book |last1=Prochaska |first1=James O. |title=Systems of psychotherapy: a transtheoretical analysis |last2=Norcross |first2=John C. |date=1994 |publisher=Oxford University Press |isbn=978-0-19-088041-5 |location=New York, NY}}</ref> and Kirk.<ref>{{Citation |last=Kirk |first=Joan |title=Cognitive–behavioural assessment |date=1989 |work=Cognitive Behaviour Therapy for Psychiatric Problems |pages=13–51 |url=http://dx.doi.org/10.1093/med:psych/9780192615879.003.0002 |publisher=Oxford University Press|doi=10.1093/med:psych/9780192615879.003.0002 |isbn=978-0-19-261587-9 }}</ref> The assumptions are:
# Behaviors play an essential role in the onset, perpetuation and exacerbation of psychopathology.
# [[behaviorism|Learning theory]] is key in understanding the treatment of mental illness, as behaviors can be learned and unlearned.
# A rigorous evaluation ([[applied behavior analysis]]) is essential at the start of treatment. It includes identifying behaviors; precipitating, moderating, and perpetuating factors; the consequences of the behaviors; avoidance, and personal resources.
# The effectiveness of the treatment is monitored throughout its duration.
# Behavior therapy is scientific and the different forms of treatment are evaluated with rigorous evidence.
# Behavior therapy is active, directed, and structured.

Together, these sets of assumptions cover the cognitive and behavioral aspects of CBT.

===Phases in therapy===
CBT can be seen as having six phases:<ref name="GatchelRJ" />
# 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.<ref name="Psychological Testing">{{cite book |title=Psychological Testing |vauthors=Kaplan R, Saccuzzo D |publisher=Wadsworth |page=415}}</ref> 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."<ref name="Psychological Testing" />

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.<ref>{{cite book |title=Psychological Testing |vauthors=Kaplan R, Saccuzzo D |publisher=Wadsworth |pages=415, Table 15.3}}</ref>

The re-conceptualization phase makes up much of the "cognitive" portion of CBT.<ref name="GatchelRJ" />

===Delivery protocols===
There are different protocols for delivering cognitive behavioral therapy, with important similarities among them.<ref name="HofmannSG">{{cite journal |vauthors=Hofmann SG, Sawyer AT, Fang A |date=September 2010 |title=The empirical status of the "new wave" of cognitive behavioral therapy |journal=The Psychiatric Clinics of North America |volume=33 |issue=3 |pages=701–710 |doi=10.1016/j.psc.2010.04.006 |pmc=2898899 |pmid=20599141}}</ref> 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]]".<ref name="GatchelRJ" /> Treatment is sometimes manualized, with brief, direct, and time-limited treatments for individual psychological disorders that are specific technique-driven.<ref>{{cite journal |vauthors=Pagano J, Kyle BN, Johnson TL |date=February 2017 |title=A Manual by Any Other Name: Identifying Psychotherapy Manuals for Resident Training |journal=Academic Psychiatry |volume=41 |issue=1 |pages=44–50 |doi=10.1007/s40596-016-0492-4 |pmid=27048607 |s2cid=26071140}}</ref> 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.<ref>{{cite journal |vauthors=Foa EB, Rothbaum BO, Furr JM |date=Jan 2003 |title=Augmenting exposure therapy with other CBT procedures |journal=Psychiatric Annals |volume=33 |issue=1 |pages=47–53 |doi=10.3928/0048-5713-20030101-08}}</ref><ref>{{cite book |url=http://www.goodreads.com/book/show/20553738-this-book-will-make-you-happy |title=This book will make you happy |vauthors=Jessamy H, Jo U |publisher=Quercus |year=2014 |isbn=978-1-84866-281-0 |access-date=15 July 2014}}</ref>

===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]].<ref>{{cite book |title=Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies |vauthors=Foa EB |publisher=Guilford |year=2009 |edition=2nd |place=New York}}{{page needed|date=April 2013}}</ref><ref name="KaczkurkinFoa2015">{{cite journal |vauthors=Kaczkurkin AN, Foa EB |date=September 2015 |title=Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence |journal=Dialogues in Clinical Neuroscience |type=Review |volume=17 |issue=3 |pages=337–346 |doi=10.31887/DCNS.2015.17.3/akaczkurkin |pmc=4610618 |pmid=26487814}}</ref> Some practitioners promote a form of mindful cognitive therapy which includes a greater emphasis on self-awareness as part of the therapeutic process.<ref>{{cite book |title=Facts of Life: ten issues of contentment |vauthors=Graham MC |date=2014 |publisher=Outskirts Press |isbn=978-1-4787-2259-5}}</ref>