Cognitive behavioral therapy is psychotherapy that focuses on the relationships between thoughts, feelings, and behavior. It does not focus on diagnosing an individual or on a specific diagnosis but considers the individual as a whole and determines what critical thinking or behaviors need changing. When cognitive behavioral therapy is applied to treat depression, anxiety, or other mental illnesses, it first identifies negative thought patterns and helps to change them to more positive thought patterns so that the patient can change negative moods and behaviors. The combination of behavior and cognitive principles is undertaken to address specific problems and is action oriented, using specific strategies to address the problems. It differs from psychoanalysis because it does not look for unconscious meanings that underlay the patient's moods and behaviors and instead looks at conscious thoughts that influence the patient's behavior directly. Cognitive behavioral therapy can be used alone or combined with other therapies and/or medication as part of an overall treatment plan.

Pioneers in the development of cognitive behavioral therapy include Albert Ellis (1929–), who developed rational-emotive therapy (RET) in the 1950s, and Aaron Beck (1921–), whose cognitive therapy has been widely used for depression and anxiety. Cognitive behavioral therapy combines principles of behavior therapy and cognitive therapy and has become increasingly popular as therapists recognize that cognitive processes can act alone to influence behavior.

A variety of conditions can benefit from cognitive behavioral therapy, including depression, mood disorders, anxiety, eating disorders and obesity, obsessive-compulsive disorder, post-traumatic stress, and substance abuse. In adults, cognitive behavioral therapy has been effective in treating chronic low back pain, personality disorders, psychosis, and schizophrenia. It has also been applied in treating repetitive behavior disorders such as tic disorder and trichotillomania, a condition in which the individual pulls hair from the scalp compulsively. Cognitive therapy is not typically used for disorders such as autism, in which thinking or communication is severely disturbed, but the technique is being investigated for treating more serious psychiatric disorders.

Cognitive behavior therapy tends to be short-term, often between 10 and 20 sessions, similar to other types of behavioral interventions. It focuses on the client's present thinking and behavior rather than the client's life-long history of thought patterns, behaviors, and experiences, which is the basis of Freudian psychoanalysis and other psychodynamically oriented therapies. The therapeutic process begins with identifying distorted perceptions and thought patterns that may be causing or contributing to the client's problems, often through detailed record keeping by Page 208  |  Top of Articlethe client. Self-defeating ways of thinking identified by Aaron Beck include all-or-nothing thinking; magnifying or minimizing the importance of an event; overgeneralization such as drawing extensive conclusions from a single event; taking events too personally (personalization); giving disproportionate weight to negative events (selective abstraction); drawing illogical conclusions from an event (arbitrary inference); and a pattern of negative, scolding thoughts that become ingrained beliefs (automatic thoughts).

After identifying negative thinking patterns, the therapist and client work together on replacing those negative thoughts with more adaptive ones. Various techniques may be employed, including self-evaluation, positive self-talk, control of negative thoughts and feelings, and accurate assessment of both external situations and of the client's own emotional state. Clients can practice these techniques alone, with the therapist, and also, when possible, in the actual settings in which stressful situations develop. As patients begin to break out of their habitual dysfunctional response patterns in specific situations, they gradually build up confidence in their ability to cope successfully with difficult situations.

Cognitive behavior therapy is widely used as an intervention for children and adolescents who are anxious, depressed, or have problems with social skills. As in treatment of adult clients, children undergoing cognitive behavior therapy are made aware of distorted perceptions and errors in logic that are responsible for inaccurate or unrealistic views of the world around them. The therapist then helps the child change erroneous beliefs and perceptions through instruction, modeling, and rehearsing new attitudes and responses, encouraging the child to practice these attitudes and responses in real-life situations.

Cognitive behavioral therapy has worked especially well, often in combination with medication, for children and adolescents with depression. It can help free depressed children from the pervasive feelings of helplessness and hopelessness that are supported by self-defeating beliefs. Children in treatment are assigned to monitor their thoughts, and the therapist points out ways that these repetitive thoughts (such as “Nothing is any fun” or “I never do anything right” ) misrepresent or distort reality. Other therapeutic techniques may include the completion of graded task assignments and the deliberate scheduling of pleasurable activities.

Children and adolescents with conduct disorder, which is characterized by aggressive, antisocial actions, including hurting animals and other children, setting fires, lying, and theft, may also benefit from cognitive behavioral therapy. Young people with this disorder are taught ways to handle anger and resolve conflicts peacefully. Through instruction, modeling, role playing, and other techniques, they learn to react to events in socially appropriate, nonviolent ways. Attention deficit/hyperactivity disorder has also been treated with cognitive behavioral therapy, which helps individuals control their emotions and avoid impulsive behavior. They are often taught to memorize and internalize a set of behavior guidelines that can be repeated when needed, such as “Stop—Listen— Look—Think—Act.”