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Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is an umbrella term for a variety of structured, goal-oriented, and present-focused psychotherapy approaches and is also used to refer to therapy that is based on basic behavioral and cognitive research. Its origin lies in a merging of behavior therapy with cognitive therapy in the 1950s and 1960s, which was pioneered by Albert Ellis and Aaron Beck. CBT characteristically involves a clear operationalization of treatment goals, is based on empirical data, and involves ongoing measurement of changes in cognition and behavior. CBT has been shown to be effective for a large range of mental health problems at different levels of severity, including but not limited to mood and anxiety disorders, substance abuse, psychotic disorders, personality disorders, and eating disorders.
CBT adopts a biopsychosocial model in conceptualizing symptoms and formulating a treatment plan, addressing biological, psychological, and social dimensions of the origins and maintenance of psychopathology. CBT treatment manuals have been developed for different treatment modalities, including individual and group psychotherapy and, more recently, computerized interventions. CBT therapists tend to differ in the extent to which they emphasize cognitive versus behavioral orientations and their integration of techniques from both orientations. More recently, there has been increasing popularity of so-called third wave cognitive behavioral therapies such as acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT), which integrate established CBT techniques with mindfulness exercises and Eastern philosophies.
CBT is endorsed as a frontline treatment for post-traumatic stress disorder (PTSD) by the National Institute of Mental Health, National Academy of Sciences, United States Department of Veterans Affairs, and numerous national and international medical and mental health organizations. This entry describes the historical origin of CBT, outlines key theoretical principles and core therapeutic procedures, describes recent third-wave applications of CBT, and briefly reviews findings on the clinical efficacy of CBT for PTSD, including evidence for its efficacy in posttraumatic symptoms in ethnically diverse patient populations.
Key Theoretical Principles and Historical Origin
Although the cognitive components of CBT date back to the ideas of Stoic philosophers in the 3rd century B.C.E., modern applications of CBT are rooted in the fields of behaviorism, physiology, and classic learning theory. In 1927, Ivan Pavlov, a Russian physician, first demonstrated the principles of classical conditioning, a form of associative learning. In a landmark experiment, he presented a dog with a neutral or conditioned stimulus (CS), a ringing bell, while simultaneously exposing the dog to an unconditioned stimulus (US), food. He demonstrated that, with repeated pairing of the two stimuli, the CS came to evoke a conditioned response (salivation). A critical component in the pairing of the CS and US was their spatial and temporal proximity. Pavlov also found that, if the CS was repeatedly presented in absence of the US, over time the intensity of the conditioned response decreased and the conditioned behavior became extinguished.
Operant or instrumental conditioning was introduced by Edward Thorndike in 1911 and experimentally tested and popularized by B. F. Skinner in the 1950s and 1960s. Skinner studied the impact of reinforcement on learning in animals. The three categories of reinforcement he described included positive reinforcement, punishment, and negative reinforcement. Skinner found that positive reinforcements administered with variable ratio reinforcement schedules resulted in learning that was the most enduring and resistant to extinction.
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