Cognitive Behavior Therapy:
Cognitive behavior therapy (CBT) is a pragmatic, action-oriented treatment approach that has become a widely used psychotherapy for major mental disorders. CBT methods were initially developed for depression and anxiety disorders (1–3), and later they were modified for many other conditions, including personality disorders, eating disorders, and substance abuse; they have also been adapted for use as an adjunct to medication in the management of schizophrenia and bipolar disorder (3, 4–7). This article delineates the core principles of CBT, describes procedures used in clinical practice, and notes some of the recent advances that have been made in this treatment method. The extensive research supporting the efficacy of CBT is briefly reviewed.
Jesse H. Wright, M.D., Ph.D.
Basic Principles and Recent Advances
A two-way relationship between cognition and behavior is posited in which cognitive processes can influence behavior, and behavioral change can influence cognitions. A brief clinical example of a patient with an anxiety disorder will illustrate how the basic CBT model can be used to understand symptoms and plan treatment.
Mr. A, a 35-year-old computer programmer who lives and works in a suburb of a large city, requested treatment for panic disorder with agoraphobia. He had been symptomatic for at least 5 years. His condition had deteriorated to the point where he was largely housebound, although he was able to drive about half a mile to his workplace, where he worked in a cubicle and had little social contact. When Mr. A considered driving to the city to see an old friend or to a mall near his home, he would have thoughts such as “I can’t do it . . . I’ll faint or I’ll have a heart attack . . . I’ll panic and lose control . . . I’ll have a wreck and kill everyone in my path.” As might be expected, he had intense anxiety and autonomic arousal associated with these thoughts. His behavioral response was to avoid driving...