One of the first therapists to address cognition in psychotherapy was Alfred Adler with his notion of basic mistakes and how they contributed to creation of unhealthy or useless behavioral and life goals. Around the same time that rational emotive therapy, as it was known then, was being developed, Aaron T.
Beck was conducting free association sessions in his psychoanalytic practice. It was these two therapies, rational emotive therapy and cognitive therapy, that started the "second wave" of CBT, which was the emphasis on cognitive factors.
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Although the early behavioral approaches were successful in many of the neurotic disorders, they had little success in treating depression. The therapeutic approaches of Albert Ellis and Aaron T. Beck gained popularity among behavior therapists, despite the earlier behaviorist rejection of " mentalistic " concepts like thoughts and cognitions.
In initial studies, cognitive therapy was often contrasted with behavioral treatments to see which was most effective. During the s and s, cognitive and behavioral techniques were merged into cognitive behavioral therapy. Pivotal to this merging was the successful development of treatments for panic disorder by David M. Clark in the UK and David H. Barlow in the US. Over time, cognitive behavior therapy became to be known not only as a therapy, but as an umbrella term for all cognitive-based psychotherapies.
This blending of theoretical and technical foundations from both behavior and cognitive therapies constituted the "third wave" of CBT. Despite increasing popularity of "third-wave" treatment approaches, reviews of studies reveal there may be no difference in the effectiveness compared with "non-third wave" CBT for the treatment of depression. A typical CBT programme would consist of face-to-face sessions between patient and therapist, made up of sessions of around an hour each with a gap of 1—3 weeks between sessions. This initial programme might be followed by some booster sessions, for instance after one month and three months.
Cognitive behavioral therapy is most closely allied with the scientist—practitioner model in which clinical practice and research is informed by a scientific perspective, clear operationalization of the problem, and an emphasis on measurement , including measuring changes in cognition and behavior and in the attainment of goals. These are often met through " homework " assignments in which the patient and the therapist work together to craft an assignment to complete before the next session. Computerized cognitive behavioral therapy CCBT has been described by NICE as a "generic term for delivering CBT via an interactive computer interface delivered by a personal computer, internet, or interactive voice response system",  instead of face-to-face with a human therapist.
It is also known as internet-delivered cognitive behavioral therapy or ICBT. CCBT has been found in meta-studies to be cost-effective and often cheaper than usual care,   including for anxiety. CCBT is also predisposed to treating mood disorders amongst non-heterosexual populations, who may avoid face-to-face therapy from fear of stigma.
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However presently CCBT programs seldom cater to these populations. A key issue in CCBT use is low uptake and completion rates, even when it has been clearly made available and explained. A relatively new avenue of research is the combination of artificial intelligence and CCBT. It has been proposed to use modern technology to create CCBT that simulates face-to-face therapy. This might be achieved in cognitive behavior therapy for a specific disorder using the comprehensive domain knowledge of CBT.
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  that measure effectiveness and engagement of text-based smartphone chatbot apps for delivery of CBT using a text-based conversational interface.
Enabling patients to read self-help CBT guides has been shown to be effective by some studies.
Patient participation in group courses has been shown to be effective. Brief cognitive behavioral therapy BCBT is a form of CBT which has been developed for situations in which there are time constraints on the therapy sessions. This technique was first implemented and developed on soldiers overseas in active duty by David M. Rudd to prevent suicide. Breakdown of treatment . Cognitive emotional behavioral therapy CEBT is a form of CBT developed initially for individuals with eating disorders but now used with a range of problems including anxiety , depression , obsessive compulsive disorder OCD , post-traumatic stress disorder PTSD and anger problems.
It combines aspects of CBT and dialectical behavioral therapy and aims to improve understanding and tolerance of emotions in order to facilitate the therapeutic process.
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It is frequently used as a "pretreatment" to prepare and better equip individuals for longer-term therapy. SCBT also builds on core CBT philosophy by incorporating other well-known modalities in the fields of behavioral health and psychology : most notably, Albert Ellis 's rational emotive behavior therapy.
First, SCBT is delivered in a highly regimented format. Second, SCBT is a predetermined and finite training process that becomes personalized by the input of the participant. SCBT is designed with the intention to bring a participant to a specific result in a specific period of time. SCBT has been used to challenge addictive behavior, particularly with substances such as tobacco, alcohol and food, and to manage diabetes and subdue stress and anxiety.
SCBT has also been used in the field of criminal psychology in the effort to reduce recidivism. Moral reconation therapy, a type of CBT used to help felons overcome antisocial personality disorder ASPD , slightly decreases the risk of further offending. Groups usually meet weekly for two to six months. This type of therapy uses a blend of cognitive, behavioral and some humanistic training techniques to target the stressors of the client. This usually is used to help clients better cope with their stress or anxiety after stressful events.
The first phase is an interview phase that includes psychological testing, client self-monitoring, and a variety of reading materials.
This allows the therapist to individually tailor the training process to the client. This phase ultimately prepares the client to eventually confront and reflect upon their current reactions to stressors, before looking at ways to change their reactions and emotions in relation to their stressors. The focus is conceptualization. The second phase emphasizes the aspect of skills acquisition and rehearsal that continues from the earlier phase of conceptualization.
The client is taught skills that help them cope with their stressors. These skills are then practised in the space of therapy. These skills involve self-regulation, problem-solving, interpersonal communication skills, etc. The third and final phase is the application and following through of the skills learned in the training process.
This gives the client opportunities to apply their learned skills to a wide range of stressors. Activities include role-playing, imagery, modeling, etc. In the end, the client will have been trained on a preventative basis to inoculate personal, chronic, and future stressors by breaking down their stressors into problems they will address in long-term, short-term, and intermediate coping goals.
Mindfulness-based cognitive behavioral hypnotherapy MCBH is a form of CBT focusing on awareness in reflective approach with addressing of subconscious tendencies. It is more the process that contains basically three phases that are used for achieving wanted goals. Barlow and researchers at Boston University , that can be applied to a range of depression and anxiety disorders. The rationale is that anxiety and depression disorders often occur together due to common underlying causes and can efficiently be treated together.
The UP includes a common set of components: . The UP has been shown to produce equivalent results to single-diagnosis protocols for specific disorders, such as OCD and social anxiety disorder. The research conducted for CBT has been a topic of sustained controversy. While some researchers write that CBT is more effective than other treatments,  many other researchers      and practitioners   have questioned the validity of such claims.
For example, one study  determined CBT to be superior to other treatments in treating anxiety and depression.
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However, researchers  responding directly to that study conducted a re-analysis and found no evidence of CBT being superior to other bona fide treatments, and conducted an analysis of thirteen other CBT clinical trials and determined that they failed to provide evidence of CBT superiority. In cases where CBT has been reported to be statistically better than other psychological interventions in terms of primary outcome measures, effect sizes were small and suggested that those differences were clinically meaningless and insignificant.
Moreover, on secondary outcomes i. A major criticism has been that clinical studies of CBT efficacy or any psychotherapy are not double-blind i. They may be single-blinded, i. The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in.
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The importance of double-blinding was shown in a meta-analysis that examined the effectiveness of CBT when placebo control and blindedness were factored in. This study concluded that CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates; treatment effects are small in treatment studies of MDD, and it is not an effective treatment strategy for prevention of relapse in bipolar disorder. For MDD, the authors note that the pooled effect size was very low. Nevertheless, the methodological processes used to select the studies in the previously mentioned meta-analysis and the worth of its findings have been called into question.
Additionally, a meta-analysis revealed that the positive effects of CBT on depression have been declining since The overall results showed two different declines in effect sizes : 1 an overall decline between and , and 2 a steeper decline between and Additional sub-analysis revealed that CBT studies where therapists in the test group were instructed to adhere to the Beck CBT manual had a steeper decline in effect sizes since than studies where therapists in the test group were instructed to use CBT without a manual. The authors reported that they were unsure why the effects were declining but did list inadequate therapist training, failure to adhere to a manual, lack of therapist experience, and patients' hope and faith in its efficacy waning as potential reasons.
The authors did mention that the current study was limited to depressive disorders only. Furthermore, other researchers  write that CBT studies have high drop-out rates compared to other treatments. At times, the CBT drop-out rates can be more than five times higher than other treatments groups. Those treated with CBT have a high chance of dropping out of therapy before completion and reverting to their anorexia behaviors. Other researchers  conducting an analysis of treatments for youths who self-injure found similar drop-out rates in CBT and DBT groups.
In this study, the researchers analyzed several clinical trials that measured the efficacy of CBT administered to youths who self-injure. The researchers concluded that none of them were found to be efficacious . The methods employed in CBT research have not been the only criticisms; some individuals have called its theory and therapy into question. Slife and Williams  write that one of the hidden assumptions in CBT is that of determinism , or the absence of free will.
They argue that CBT holds that external stimuli from the environment enter the mind, causing different thoughts that cause emotional states: nowhere in CBT theory is agency, or free will, accounted for. Another criticism of CBT theory, especially as applied to major depressive disorder MDD , is that it confounds the symptoms of the disorder with its causes.