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Thursday, February 23, 2012

The History and Approach of Cognitive Behavior Therapy

After an initial flush of enthusiasm, discontent with Behavior Therapy grew. There was a number of reasons for this, an important one which was the fact that behavioral therapy did not deal with the internal thoughts which were obviously central to the distress that patients were experiencing. In this context, the fact that behavioral therapy proved so inadequate when it came to the treatment of depression highlighted the need for major revision.

In the late 1960s and early 1970s a treatment was developed specifically for depression called cognitive therapy. The pioneer in this enterprise was an American psychiatrist, Professor Aaron T. Beck, who developed a theory of depression which emphasized the importance of peoples depressed styles of thinking. He also specified a new form of therapy. It would not be and exaggeration to say that Beck's work has changed the nature of psychotherapy, not just for depression but for a range of psychological problems.
In recent years the cognitive techniques introduced by Beck has been merged with the techniques developed earlier by the behavioral therapist to produce a body of theory and practice which has come to be known as cognitive behavioral therapy. There are two main reasons why this form of treatment has come to be so important within the field of psychotherapy. First, cognitive therapy for depression, as originally described by Beck and developed by his successors, has been subjected to the strictest scientific testing, and it has been found to be a highly successful treatment for a significant proportion of cases of depression. Not only has it proved to be an effective as the best alternative treatments except in the most severe cases, where medication is required, but some studies suggested that people treated successfully with cognitive behavioral therapy are less likely to experience a later currents of their depression than people treated successfully with other forms of therapy such as anti-depressant medication. Second, it has become clear that specific patterns of thinking are associated with a range of psychological problems and that treatment which deal with the styles of thinking are highly effective. So, specific cognitive behavioral treatments have been developed for anxiety disorders like panic disorder, generalized anxiety disorder, specific phobias and social phobia, obsessive compulsive disorders, and hypochondriasis (healthy anxiety), as well as for other conditions such as compulsive gambling, alcohol and drug addiction, and eating disorders like bulimia nervosa and binge – eating disorder. Indeed, cognitive behavioral techniques have a wide application be on the narrow categories of psychological disorders: they have been applied effectively for example, to helping people with low self-esteem and those with marital difficulties.
Although effective treatments have been developed, they are not widely available; and when people try to help themselves they often make matters worse. In recent years the community of cognitive behavioral therapist have responded to the situation. What they have done is to take the principles and techniques of specific cognitive behavioral therapies for particular problems and represent them in self-help manuals. These manuals specify a specific program of treatment which the individual suffer is advised to work through to overcome their difficulties. In this way, the cognitive behavioral therapeutic techniques of proven value are being made available on the widest possible basis.

Self-help manuals are never going to replace therapist. Many people will need individual treatment from a qualified therapist. It is also the case that, despite the widespread success of cognitive behavioral therapy, some people will not respond to it and will need one of the other treatments available. Nevertheless, although research on the use of cognitive behavioral self help manuals is at an early stage, the work done to date indicates that for a very great many people such manuals will prove sufficient for them to overcome their problems without professional help. Many people suffer silently and secretly for years. Sometimes appropriate help is not forthcoming despite their efforts, to find it. Sometimes they feel too ashamed or guilty to reveal their problems to anyone. For many of these people the cognitive behavioral self-help manuals will provide a lifeline to recovery and a better future.
Prof. Peter Cooper
the University of Reading, 1997

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