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CBT in 2017

Cognitive Behavior Therapy in 2017

Reflections on recent developments in the application and formulation of cognitive therapy

Aaron T. Beck, MD from Remarks for the Greek Congress

In a large number of clinical trials, cognitive therapy has been shown to be an effective treatment for almost every condition stipulated in the Diagnostic and Statistical Manual of the American Psychiatric Association. In each case, specific dysfunctional beliefs have been elucidated for each of these conditions, and a treatment plan has been formulated to target these dysfunctional beliefs. In recent years, such challenging conditions as substance abuse and schizophrenia have also responded to cognitive interventions— although I will mention the treatment format has been modified to suit each of these conditions.

The most astounding application of cognitive therapy, however, has been in its application to medical conditions. Clinical trials have shown cognitive therapy to be effective in ameliorating hypertension, various gastrointestinal disturbances (ex. spastic colitis), various skin problems, and seizures. Cognitive approaches have also been adapted to provide symptomatic relief for a number of progressive conditions including Parkinson’s disease and other neurological disorders – although evidence is lacking that the cognitive interventions actually slowed down the progression of the disease. A research study showed that cognitive approaches can also improve the quality of life in terminal cancer patients. One of the most widely publicized approaches has been cognitive behavior therapy for insomnia. CBT has also been successfully utilized in the treatment of disorders involving non-compliance with medical regiments such as in the treatment of diabetes. CBT has shown some promising results in the treatment of asthma, although further studies are required.

In recent years, there has been an increased emphasis on activating the positive attitudes as well as reducing the dysfunctional negative attitudes in a variety of conditions. Padesky and Mooney have taken the lead in demonstrating the efficacy of strength-based CT in the non-psychotic conditions. My own team, headed by Paul Grant, has demonstrated the efficacy of Recovery Oriented Cognitive Therapy for Schizophrenia, an approach which is action-oriented and is directed towards activating positive beliefs and behaviors.

Finally, I would say that there needs to be further expansion of the basic cognitive model. The various approaches focusing on positive behaviors indicate the importance of the positive beliefs in recovery from the various disorders. At the present time, it appears that the negative beliefs and attitudes play the larger role as an individual becomes afflicted with a particular disorder, but that the positive attitudes play a major role in recovery.