Cognitive therapy: principles and clinical applications

¶ … Evolution and Development of Cognitive Therapy

Psychology is a relatively young science. Though it has roots in philosophy and other humanities, it has only been an official science for a little over a century. Moreover, the different treatment modalities in psychology are also relatively new. However, in a short period of time, some treatments have grown to preeminence in the field, so much so that, even though they are relatively young, they are considered the standards by which other treatments are judged. These two approaches are psychoanalysis and behavior therapy, and they have been used, with some success for decades. However, in the 1960s, a new therapeutic approach emerged: cognitive therapy. Cognitive therapy focused on the role that thoughts played in behavior and disorders, with the premise that changing thoughts would result in behavior and symptom change.

Of course, like other areas of psychology, it is important to understand that cognitive therapy did not evolve in isolation. In fact, Robert Montgomery feels that there are a number of fundamental similarities between cognitive therapy and the Stoic philosophies of ancient Rome (1993). Most significantly, Montgomery highlights the idea that the "fundamental stoic belief that emotions arise from an interaction between reason and the world" anticipated Beck and Ellis's theories of cognitive therapy (1993).

Understanding whether or not cognitive therapy can be effective involves a basic understanding of cognitive neuroscience. "Cognitive neuroscience takes an integrative position and seeks to understand how mind emerges from brain. Connectionism is a facet of computational neuroscience that endeavors to show how psychology emerges from functioning networks" (Tryon, 2009). Neuroscience focus on how signals transmitted by neurotransmitters are processed by the brain. One of the interesting observations is that the brain is actually transformed by cognition. "Experience-dependent plasticity is the term used to refer to the ways in which the brain changes during learning and memory formation. Neurons that fire together wire together through the synthesis of new proteins resulting in long-term potentiation (LTP) and long-term depression (LTD). LTP enables incoming signals to produce a stronger response" (Tryon, 2009). Therefore, the belief is that cognitive therapy can actually help restructure the brain by impacting this experience-dependent plasticity.

Cognitive therapy was developed in the 1960s and 1970s to treat depression. It was developed by Aaron Beck. In "an attempt to verify aspects of psychoanalytic theory, Beck initially investigated the thoughts and dreams of depressed individuals, looking for signs of repressed hostility. Instead, he discovered a prominent theme of defeat and a pervasive negative bias. He then began to develop a theory centered on the premise that the symptoms of depression could be conceived of as a direct result of this negative cognitive bias" (Robins & Hayes, 1993). His belief was that by changing the negative cognitive bias, one could treat the depression. Beck's initial theory differentiated between automatic thoughts, schemata/underlying assumptions, and cognitive distortions (Robins & Hayes, 1993). By making targeted changes to negative cognitions in each of these areas, Beck believed he could provide a more effective therapy for depression than then-existing therapies.

Of course, when assessing a therapy, the most critical question may be "Does it work?" Aaron Beck first posed this question in 1976, and, in a 1993 article he examined the efficacy of cognitive therapy for treating various psychological disorders. He found mixed support for the treatment, but significant empirical support for its efficacy in a number of different disorders, with a wide range of populations, settings, and formats (Beck, 1993). For example, cognitive therapy has been shown to be very successful in treating depression. Not only does cognitive therapy outperform a number of treatment modalities, it also had a more durable effect after treatment was concluded (Beck, 1993). Cognitive therapy is an effective treatment for generalized anxiety disorder, leading to a substantial and significant reduction in anxiety and depression in patients suffering from anxiety alone and in patients suffering from a combination of anxiety disorders and personality disorders (Beck, 1993). Cognitive therapy is particularly effective in the treatment of panic disorders. Not only is it as if not more effective than a number of other approaches, but it also leads to a significant reduction in antipanic medication usage (Beck, 1993). Eating disorders also respond well to cognitive therapy, though a combination of cognitive therapy and imipramine is more effective than cognitive therapy alone (Beck, 1993).

What is even more interesting is that cognitive therapy has evolved alongside relatively new disorders, such as drug addiction. These are not new disorders, per se, but are disorders that have been newly identified. As such, there is not the same rigid adherence to the established protocols for treating these diseases. In 1993, investigators were studying the efficacy of cognitive therapy on drug abuse, bipolar disorder, HIV-specific depression, avoidant personality disorder, obsessive-compulsive disorder, sex offenders, posttraumatic stress disorders, multiple personality disorder, hypochondriasis, marital problems, family therapy, and even schizophrenic delusions and hallucinations (Beck, 1993). At that time, the impact of cognitive therapy in each of these areas was unknown, but it has become the standard in some areas. For example, default PTSD treatments now generally involve a strong cognitive component.