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cognitive-behavioral therapy
认知行为疗法
And combined treatment with drugs and cognitive-behavioral therapies is indicated, because it yields better results than drug therapy alone.
因而在治疗过程中，必须将药物和认知行为治疗相结合，这样才能获得长期的疗效并能预防复发。
The main therapies include cognitive-behavioral therapy, social learning theory and ecological theory, and then the paper makes a discussion.
西方较有影响的干预理论包括认知行为理论、社会学习理论和社会生态学理论，各个理论下的干预方案各有其独特之处。
A number of these therapies, including cognitive-behavioral coping skills treatment and motivational enhancement therapy, were developed by psychologists.
许多此类治疗，包括对抗技巧训练治疗（cognitive-behavioral coping skills treatment ）、动机强化疗法（motivational enhancement therapy），都是由心理医师发展的。
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Cognitive-behavioral therapy
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Definition
Cognitive therapy is a psychosocial (both psychological and social)
therapy that assumes that faulty thought patterns (called cognitive
patterns) cause maladaptive behavior and emotional responses. The
treatment focuses on changing thoughts in order to solve psychological and
personality problems. Behavior therapy is also a goal-oriented,
therapeutic approach, and it treats emotional and behavioral disorders as
maladaptive learned responses that can be replaced by healthier ones with
appropriate training. Cognitive-behavioral therapy (CBT) integrates
features of
into the traditional cognitive restructuring approach.
Cognitive-behavioral therapy attempts to change clients' unhealthy
behavior through cognitive restructuring (examining assumptions behind the
thought patterns) and through the use of behavior therapy techniques.
Cognitive-behavioral therapy is a treatment option for a number of mental
disorders, including depression,
, eating disorders,
hypochondriasis
Precautions
Cognitive-behavioral therapy may not be appropriate for all patients.
Patients with significant cognitive impairments (patients with traumatic
injury or organic brain disease, for example) and individuals who are not
willing to take an active role in the treatment process are not usually
good candidates.
Description
Origins of the two approaches
Psychologist
Aaron Beck developed cognitive therapy in the 1960s. The treatment is
based on the principle that maladaptive behavior (ineffective,
self-defeating behavior) is triggered by inappropriate or irrational
thinking patterns, called automatic thoughts. Instead of reacting to the
reality of a situation, an individual automatically reacts to his or her
own distorted view of the situation. Cognitive therapy strives to change
these thought patterns (also known as cognitive distortions), by examining
the rationality and validity of the assumptions behind them. This process
is termed cognitive restructuring.
Behavior therapy focuses on observable behavior and its modification in
the present, in sharp contrast to the psychoanalytic method of Sigmund
Freud (), which focuses on unconscious mental processes and their
roots in the past. Behavior therapy was developed during
the 1950s by researchers and therapists who were critical of the
prevailing psychodynamic treatment methods. The therapy drew on a variety
of theories and research, including the classical conditioning principles
of the Russian physiologist Ivan Pavlov (), the work of American
B. F. Skinner (), and the work of
Joesph Wolpe (). Pavlov became famous for experiments in which
dogs were trained to salivate at the sound of a bell, and Skinner
pioneered the concept of operant conditioning, in which behavior is
modified by changing the response it elicits. Wolpe is probably best known
for his work in the areas of desensitization and
. By the 1970s, behavior therapy enjoyed widespread popularity as a
treatment approach. Since the 1980s, many therapists have begun to use
cognitive-behavioral therapy to change clients' unhealthy behavior by
replacing negative or self-defeating thought patterns with more positive
The combined approach
In cognitive-behavioral therapy, the therapist works with the patient to
identify the thoughts that are causing distress, and employs behavioral
therapy techniques to alter the resulting behavior. Patients may have
certain fundamental core beliefs, known as schemas, that are flawed and
are having a negative impact on the patient's behavior and functioning.
For example, a patient suffering from depression may develop a
because he is convinced that he is uninteresting and impossible to love. A
cognitive-behavioral therapist would test this assumption by asking the
patient to name family and friends who care for him and enjoy his company.
By showing the patient that others value him, the therapist exposes the
irrationality of the patient's assumption and also provides a new model of
thought for the patient to change his previous behavior pattern (i.e., I
am an interesting and likeable person, therefore I should not have any
problem making new social acquaintances). Additional behavioral techniques
such as conditioning (the use of positive and/or negative reinforcements
to encourage desired behavior) and
(gradual exposure to anxiety-producing situations in order to extinguish
the fear response) may then be used to gradually reintroduce the patient
to social situations.
Cognitive-behavioral therapy is usually administered in an outpatient
setting (clinic or doctor's office) by a specially trained therapist.
Therapy may be in either individual or group sessions. Therapists are
psychologists (Ph.D., Psy.D., Ed.D., or M.A. degree), clinical
(M.S.W., D.S.W., or L.S.W. degree), counselors (M.A. or M.S. degree), or
psychiatrists (M.D. trained in psychiatry).
Techniques
Therapists use several different techniques in the course of
cognitive-behavioral therapy to help patients examine and change thoughts
and behaviors. These include:
Validity testing.
The therapist asks the patient to defend his or her thoughts and
beliefs. If the patient cannot produce objective evidence supporting his
or her assumptions, the invalidity, or faulty nature, is exposed.
Cognitive rehearsal.
The patient is asked to imagine a difficult situation he or she has
encountered in the past, and then works with the therapist to practice
how to cope successfully with the problem. When the patient is
confronted with a similar situation again, the rehearsed behavior will
be drawn on to manage it.
Guided discovery.
The therapist asks the patient a series of questions designed to guide
the patient towards the discovery of his or her cognitive distortions.
Writing in a journal.
Patients keep a detailed written diary of situations that arise in
everyday life, the thoughts and emotions surrounding them, and the
behaviors that accompany them. The therapist and patient then review the
journal together to discover maladaptive thought patterns and how these
thoughts impact behavior.
In order to encourage self-discovery and reinforce insights made in
therapy, the therapist may ask the patient to do homework assignments.
These may include note-taking during the session, journaling, review of
an audiotape of the patient session, or reading books or articles
appropriate to the therapy. They may also be more behaviorally focused,
applying a newly learned strategy or coping mechanism to a situation,
and then recording the results for the next therapy session.
Role-playing exercises allow the therapist to act out appropriate
reactions to different situations. The patient can then model this
Systematic positive reinforcement.
Human behavior is routinely motivated and rewarded by positive
, and a more specialized version of this phenomenon (systematic positive
reinforcement) is used by behavior-oriented therapists. Rules are
established that specify particular behaviors that are to be reinforced,
and a reward system is set up. With children, this sometimes takes the
form of tokens that may be accumulated and later exchanged for certain
privileges. Just as providing reinforcement strengthens behaviors,
withholding it weakens them. Eradicating undesirable behavior by
deliberately withholding reinforcement is another popular treatment
method called extinction. For example, a child who habitually shouts to
attract attention may be ignored unless he or she speaks in a
conversational tone.
Aversive conditioning.
This technique employs the principles of classical conditioning to
lessen the appeal of a behavior that is difficult to change because it
is either very habitual or temporarily rewarding. The client is exposed
to an unpleasant stimulus while engaged in or thinking about the
behavior in question. Eventually the behavior itself becomes associated
with unpleasant rather than pleasant feelings. One treatment method used
with alcoholics is the administration of a nausea-inducing drug together
with an alcoholic beverage to produce an aversion to the taste and smell
of alcohol by having it become associated with nausea. In
counterconditioning, a maladaptive response is weakened by the
strengthening of a response that is incompatible with it. A well-known
type of counterconditioning is
, which counteracts the anxiety connected with a particular behavior or
situation by inducing a relaxed response to it instead. This method is
often used in the treatment of people who are afraid of flying.
Preparation
Because cognitive-behavioral therapy is a collaborative effort between
therapist and patient, a comfortable working relationship is critical to
successful treatment. Individuals interested in CBT should schedule a
consultation session with their prospective therapist before starting
treatment. The consultation session is similar to an interview session,
and it allows both patient and therapist to get to know one another.
During the consultation, the therapist gathers information to make an
initial assessment of the patient and to recommend both direction and
goals for treatment. The patient has the opportunity to learn about the
therapist's professional credentials, his/her approach to treatment, and
other relevant issues.
In some managed-care settings, an intake interview is required before a
patient can meet with a therapist. The intake interview is typically
performed by a psychiatric nurse, counselor, or social worker, either
face-to-face or over the phone. It is used to gather a brief background on
treatment history and make a preliminary evaluation of the patient before
assigning them to a therapist.
Because cognitive-behavioral therapy is employed for such a broad spectrum
of illnesses, and is often used in conjunction with medications and other
treatment interventions, it is difficult to measure overall success rates
for the therapy. However, several studies have indicated that CBT:
may reduce the rate of rehospitalization and improve social and
occupational functioning for
patients, when combined with pharmacotherapy (treatment with medication)
is an effective treatment for patients with bulimia nervosa
can help generalized anxiety patients manage their worry, when combined
with relaxation exercises
is helpful in treating hypochondriasis
may be effective for treating depression, especially when combined with
pharmacotherapy, and may also prevent depression in at-risk children
is one of the first-line treatments for obsessive-compulsive disorder
that focuses on education and provides some exposure and coping skills
is effective for treating panic disorder without agoraphobia
is effective for helping to treat insomnia, and its effects may be
sustained longer than the effects of medications alone
Alford, B. A., and A. T. Beck.
The integrative power of cognitive therapy.
New York: Guilford, 1997.
Beck, A. T.
Prisoners of hate: the cognitive basis of anger,
hostility, and violence.
New York: HarperCollins Publishers, 1999.
Craighead, Linda W.
Cognitive and Behavioral Interventions:
An Empirical Approach to Mental Health Problems.
Boston: Allyn and Bacon, 1994.
Nathan, Peter E., and Jack M. Gorman.
A Guide to Treatments
that Work.
2nd edition. New York: Oxford University Press, 2002.
Weishaar, Marjorie. "Cognitive Therapy." In
Encyclopedia of
Mental Health,
edited by Howard S. Friedman. San Diego, CA: Academic Press, 1998.
Wolpe, Joseph.
The Practice of Behavior Therapy.
Tarrytown, NY: Pergamon Press, 1996.
Paula Ford-Martin, M.A.
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