Editing Cognitive behavioral therapy (section)

==Methods of access==
===Therapist===
A typical CBT program 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 program might be followed by some booster sessions, for instance after one month and three months.<ref>{{cite book|title=Cognitive behavioural therapy for the management of common mental health problems|url=http://www.nice.org.uk/media/878/F7/CBTCommissioningGuide.pdf|publisher=[[National Institute for Health and Care Excellence]]|year=2008|access-date=4 November 2013|archive-url=https://web.archive.org/web/20131105200545/http://www.nice.org.uk/media/878/f7/cbtcommissioningguide.pdf|archive-date=5 November 2013}}{{page needed|date=April 2013}}</ref> CBT has also been found to be effective if patient and therapist type in real time to each other over computer links.<ref>{{cite journal | vauthors = Kessler D, Lewis G, Kaur S, Wiles N, King M, Weich S, Sharp DJ, Araya R, Hollinghurst S, Peters TJ | display-authors = 6 | title = Therapist-delivered Internet psychotherapy for depression in primary care: a randomised controlled trial | journal = Lancet | volume = 374 | issue = 9690 | pages = 628–634 | date = August 2009 | pmid = 19700005 | doi = 10.1016/S0140-6736(09)61257-5 | s2cid = 13715933 }}</ref><ref>{{cite journal | vauthors = Hollinghurst S, Peters TJ, Kaur S, Wiles N, Lewis G, Kessler D | title = Cost-effectiveness of therapist-delivered online cognitive-behavioural therapy for depression: randomised controlled trial | journal = The British Journal of Psychiatry | volume = 197 | issue = 4 | pages = 297–304 | date = October 2010 | pmid = 20884953 | doi = 10.1192/bjp.bp.109.073080 | doi-access = free }}</ref>

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 [[goal]]s.<ref>{{Cite web |title=Cognitive Behaviour Therapy (CBT) and Relaxation Therapy Change Psychological and Biological Variables |url=https://www.ijirset.com/upload/may/49_Cognitive.pdf |website=IJIRSET}}</ref> These are often met through "[[Homework in psychotherapy|homework]]" assignments in which the patient and the therapist work together to craft an assignment to complete before the next session.<ref name="Martin">{{Unreliable medical source|date=April 2012}} {{cite web|author=Martin, Ben|title=In-Depth: Cognitive Behavioral Therapy|url=http://psychcentral.com/lib/2007/in-depth-cognitive-behavioral-therapy/all/1/|publisher=PsychCentral|access-date=15 March 2012|archive-date=3 July 2013|archive-url=https://web.archive.org/web/20130703112428/http://psychcentral.com/lib/2007/in-depth-cognitive-behavioral-therapy/all/1/}}</ref> The completion of these assignments&nbsp;– which can be as simple as a person with depression attending some kind of social event&nbsp;– indicates a dedication to treatment compliance and a desire to change.<ref name="Martin" /> The therapists can then logically gauge the next step of treatment based on how thoroughly the patient completes the assignment.<ref name="Martin" /> Effective cognitive behavioral therapy is dependent on a [[Therapeutic relationship|therapeutic alliance]] between the healthcare practitioner and the person seeking assistance.<ref name="CBT" /><ref name="BAT">{{cite book |vauthors=Bender S, Messner E |year=2003 |title=Becoming a therapist: What do I say, and why? |pages=24, 34–35 |location=New York|publisher=The Guilford Press}}</ref> Unlike many other forms of psychotherapy, the patient is very involved in CBT.<ref name="Martin" /> 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.<ref name="Martin" /> The therapist needs to be flexible and willing to listen to the patient rather than acting as an authority figure.<ref name="Martin" />

==={{anchor|Computerized}} Computerized or Internet-delivered (CCBT)===

Computerized cognitive behavioral therapy (CCBT) has been described by [[National Institute for Health and Clinical Excellence|NICE]] as a "generic term for delivering CBT via an interactive computer interface delivered by a personal computer, internet, or interactive voice response system",<ref name="NiceTA97">{{cite web|url = http://www.nice.org.uk/guidance/TA97|title = Depression and anxiety&nbsp;– computerised cognitive behavioural therapy (CCBT)|publisher = National Institute for Health and Care Excellence|date = 12 January 2012|access-date = 4 February 2012}}</ref> instead of face-to-face with a human therapist. It is also known as internet-delivered cognitive behavioral therapy or ICBT.<ref>{{cite journal | vauthors = Nordgren LB, Hedman E, Etienne J, Bodin J, Kadowaki A, Eriksson S, Lindkvist E, Andersson G, Carlbring P | display-authors = 6 | title = Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: a randomized controlled trial | journal = Behaviour Research and Therapy | volume = 59 | pages = 1–11 | date = August 2014 | pmid = 24933451 | doi = 10.1016/j.brat.2014.05.007 | doi-access = free }}</ref> 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.<ref>{{cite journal | vauthors = Marks IM, Mataix-Cols D, Kenwright M, Cameron R, Hirsch S, Gega L | title = Pragmatic evaluation of computer-aided self-help for anxiety and depression | journal = The British Journal of Psychiatry | volume = 183 | pages = 57–65 | date = July 2003 | pmid = 12835245 | doi = 10.1192/bjp.183.1.57 | doi-access = free }}</ref><ref>{{Cite journal |title=What is digital health technology and what can it do for me? |url=https://evidence.nihr.ac.uk/collection/what-is-digital-health-technology/ |website=NIHR Evidence|year=2022 |doi=10.3310/nihrevidence_53447 |s2cid=252584020 }}</ref> 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,<ref>{{cite journal | vauthors = Heeren A | title = Commentary: The Impact of Digital Technology on Psychological Treatments and Their Dissemination | journal = Frontiers in Psychology | volume = 9 | page = 1571 | date = August 2018 | pmid = 30210401 | doi = 10.3389/fpsyg.2018.01571 | pmc = 6122262 | doi-access = free }}</ref> it has been found in meta-studies to be cost-effective and often cheaper than usual care,<ref name="journals.cambridge.org">{{cite journal | vauthors = Musiat P, Tarrier N | title = Collateral outcomes in e-mental health: a systematic review of the evidence for added benefits of computerized cognitive behavior therapy interventions for mental health | journal = Psychological Medicine | volume = 44 | issue = 15 | pages = 3137–3150 | date = November 2014 | pmid = 25065947 | doi = 10.1017/S0033291714000245 | s2cid = 25303848 }}</ref><ref>MoodGYM was superior to informational websites in terms of psychological outcomes or service use</ref> including for anxiety<ref>{{cite journal | vauthors = Adelman CB, Panza KE, Bartley CA, Bontempo A, Bloch MH | title = A meta-analysis of computerized cognitive-behavioral therapy for the treatment of DSM-5 anxiety disorders | journal = The Journal of Clinical Psychiatry | volume = 75 | issue = 7 | pages = e695–e704 | date = July 2014 | pmid = 25093485 | doi = 10.4088/JCP.13r08894 | s2cid = 40954269 }}</ref> and PTSD.<ref name="NIHR Evidence_2023">{{Cite journal |date=27 January 2023 |title=Online CBT for post-traumatic stress disorder is as effective as face-to-face therapy |url=https://evidence.nihr.ac.uk/alert/online-cbt-for-ptsd-is-as-effective-as-face-to-face-therapy/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_56507 |s2cid=257844874 }}</ref><ref name="Bisson_2022">{{cite journal | vauthors = Bisson JI, Ariti C, Cullen K, Kitchiner N, Lewis C, Roberts NP, Simon N, Smallman K, Addison K, Bell V, Brookes-Howell L, Cosgrove S, Ehlers A, Fitzsimmons D, Foscarini-Craggs P, Harris SR, Kelson M, Lovell K, McKenna M, McNamara R, Nollett C, Pickles T, Williams-Thomas R | display-authors = 6 | title = Guided, internet based, cognitive behavioural therapy for post-traumatic stress disorder: pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID) | journal = BMJ | volume = 377 | pages = e069405 | date = June 2022 | pmid = 35710124 | doi = 10.1136/bmj-2021-069405 | pmc = 9202033 | s2cid = 249679685 }}</ref> Studies have shown that individuals with social anxiety and depression experienced improvement with online CBT-based methods.<ref>{{cite journal | vauthors = Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N | title = Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis | journal = PLOS ONE | volume = 5 | issue = 10 | pages = e13196 | date = October 2010 | pmid = 20967242 | pmc = 2954140 | doi = 10.1371/journal.pone.0013196 | bibcode = 2010PLoSO...513196A | doi-access = free }}</ref> 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.<ref name="NIHR Evidence_2023" /><ref name="Bisson_2022" /> 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.<ref name="Freeman2014" /> Additionally, most [[Internet Interventions for Posttraumatic Stress|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.<ref>{{cite journal | vauthors = Rozbroj T, Lyons A, Pitts M, Mitchell A, Christensen H | title = Assessing the applicability of e-therapies for depression, anxiety, and other mood disorders among lesbians and gay men: analysis of 24 web- and mobile phone-based self-help interventions | journal = Journal of Medical Internet Research | volume = 16 | issue = 7 | pages = e166 | date = July 2014 | pmid = 24996000 | pmc = 4115263 | doi = 10.2196/jmir.3529 | doi-access = free }}</ref>

In February 2006 NICE recommended that CCBT be made available for use within the [[National Health Service|NHS]] across England and Wales for patients presenting with mild-to-moderate depression, rather than immediately opting for antidepressant medication,<ref name="NiceTA97" /> and CCBT is made available by some health systems.<ref>{{cite web|url=http://www.devonpartnership.nhs.uk/uploads/tx_mocarticles/CCBT_Leaflet.pdf |archive-url=https://web.archive.org/web/20090504084624/http://www.devonpartnership.nhs.uk/uploads/tx_mocarticles/CCBT_Leaflet.pdf |archive-date=2009-05-04 |url-status=live|title=Devon Partnership NHS Trust: Home|publisher=NHS UK}}</ref> 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.<ref>{{cite web |url = http://guidance.nice.org.uk/CG91/NICEGuidance/pdf/English|title = CG91 Depression with a chronic physical health problem|date = 28 October 2009|publisher = National Institute for Health and Care Excellence}}{{page needed|date = April 2013}}</ref>

===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<ref>{{cite journal | vauthors = Inkster B, Sarda S, Subramanian V | title = An Empathy-Driven, Conversational Artificial Intelligence Agent (Wysa) for Digital Mental Well-Being: Real-World Data Evaluation Mixed-Methods Study | journal = JMIR mHealth and uHealth | volume = 6 | issue = 11 | pages = e12106 | date = November 2018 | pmid = 30470676 | pmc = 6286427 | doi = 10.2196/12106 | doi-access = free }}</ref> 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.<ref>{{cite web|url=https://www.intelliprove.com/news/the-3-key-challenges-of-digital-mental-healthcare-2023/|title=The 3 key challenges of digital mental healthcare (2023)|date=21 February 2023 |access-date=1 March 2023}}</ref>

A study compared CBT alone with a mindfulness-based therapy combined with CBT, both delivered via an app. It found that mindfulness-based self-help reduced the severity of depression more than CBT self-help in the short-term. Overall, NHS costs for the mindfulness approach were £500 less per person than for CBT.<ref>{{cite journal | vauthors = Strauss C, Bibby-Jones AM, Jones F, Byford S, Heslin M, Parry G, Barkham M, Lea L, Crane R, de Visser R, Arbon A, Rosten C, Cavanagh K | display-authors = 6 | title = Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported Cognitive Behavioral Therapy Self-help for Adults Experiencing Depression: The Low-Intensity Guided Help Through Mindfulness (LIGHTMind) Randomized Clinical Trial | journal = JAMA Psychiatry | volume = 80 | issue = 5 | pages = 415–424 | date = May 2023 | pmid = 36947058 | pmc = 10034662 | doi = 10.1001/jamapsychiatry.2023.0222 }}</ref><ref>{{Cite journal |date=2023-10-11 |title=Mindfulness-based cognitive therapy, delivered as supported self-help, can help people with depression |url= https://evidence.nihr.ac.uk/alert/mindfulness-based-cognitive-therapy-delivered-as-supported-self-help-can-help-people-with-depression/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_59926 |s2cid=264068810 }}</ref>

===Reading self-help materials===
Enabling patients to read self-help CBT guides has been shown to be effective by some studies.<ref>{{cite web|url=http://www.mindinbexley.org.uk/docs/E-self_help_guide.pdf|title=A Step By Step Guide to Delivering Guided Self Help CBT |access-date=9 April 2013|archive-url=https://web.archive.org/web/20121024054235/http://www.mindinbexley.org.uk/docs/E-self_help_guide.pdf|archive-date=24 October 2012}}</ref><ref>{{cite journal | vauthors = Williams C, Wilson P, Morrison J, McMahon A, Walker A, Andrew W, Allan L, McConnachie A, McNeill Y, Tansey L | display-authors = 6 | title = Guided self-help cognitive behavioural therapy for depression in primary care: a randomised controlled trial | journal = PLOS ONE | volume = 8 | issue = 1 | pages = e52735 | year = 2013 | pmid = 23326352 | pmc = 3543408 | doi = 10.1371/journal.pone.0052735 | veditors = Andersson G | doi-access = free | bibcode = 2013PLoSO...852735W }}</ref><ref>{{cite journal |doi = 10.1192/apt.7.3.233|title = Use of written cognitive-behavioural therapy self-help materials to treat depression|year = 2001| vauthors = Williams C |journal = Advances in Psychiatric Treatment|volume = 7|issue = 3|pages = 233–240|doi-access = free}}</ref> However one study found a negative effect in patients who tended to ruminate,<ref>{{cite journal | vauthors = Haeffel GJ | title = When self-help is no help: traditional cognitive skills training does not prevent depressive symptoms in people who ruminate | journal = Behaviour Research and Therapy | volume = 48 | issue = 2 | pages = 152–157 | date = February 2010 | pmid = 19875102 | doi = 10.1016/j.brat.2009.09.016 }}</ref> and another meta-analysis found that the benefit was only significant when the self-help was guided (e.g. by a medical professional).<ref>{{cite journal | vauthors = Gellatly J, Bower P, Hennessy S, Richards D, Gilbody S, Lovell K | title = What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression | journal = Psychological Medicine | volume = 37 | issue = 9 | pages = 1217–1228 | date = September 2007 | pmid = 17306044 | doi = 10.1017/S0033291707000062 | hdl-access = free | s2cid = 12980225 | hdl = 10036/46773 }}</ref>

===Group educational course===
Patient participation in group courses has been shown to be effective.<ref>{{cite journal | vauthors = Houghton S, Saxon D | title = An evaluation of large group CBT psycho-education for anxiety disorders delivered in routine practice | journal = Patient Education and Counseling | volume = 68 | issue = 1 | pages = 107–110 | date = September 2007 | pmid = 17582724 | doi = 10.1016/j.pec.2007.05.010 }}</ref> In a meta-analysis reviewing evidence-based treatment of OCD in children, individual CBT was found to be more efficacious than group CBT.<ref name="Freeman2014">{{cite journal | vauthors = Freeman J, Garcia A, Frank H, Benito K, Conelea C, Walther M, Edmunds J | title = Evidence base update for psychosocial treatments for pediatric obsessive-compulsive disorder | journal = Journal of Clinical Child and Adolescent Psychology | volume = 43 | issue = 1 | pages = 7–26 | date = 2014 | pmid = 23746138 | pmc = 3815743 | doi = 10.1080/15374416.2013.804386 }}</ref>