Talk:Cognitive behavioral therapy/Archive 1

This is an archive of past discussions about Cognitive behavioral therapy. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Archive 1

Archive 2

Problem?

PROBLEM: this is the same thing as http://www.wikipedia.org/wiki/Cognitive_behaviour_therapy. We need to integrate both pages into one somehow

I don't think we do, as I'm pretty sure that the reason they are the same is that when you go to that page, you just get redirected to this page. Of course, someone might have already changed it.... - Xgkkp 20:55, 2 Jun 2004 (UTC)

Rational Emotive Therapy

Cognitive therapy is broken down into many branches. Of two of those, Beck and Ellis, Ellis has his Rational Emotive Therapy and Beck has his Cognitive Behavioral Therapy. Cognitive Behavioral Therapy is redirected here, but this page doesn't give much information about it.

I think some of these need to be separated out, because I can't find information on Beck's therapy in itself.— Preceding unsigned comment added by 131.252.241.33 (talk • contribs) 02:04, 7 March 2004

Bad edits

68.54.45.35 made some bad edits. Does any know how to revert them? — Preceding unsigned comment added by 24.232.74.85 (talk • contribs) 05:09, 14 October 2004

I tried CBT. I didn't get on with it. I'm now with a therapist who is largely humanist in approach. Much better. I looked at some of the links from this page - they read like advertising copy for CBT. The first problem with CBT is that it starts off by telling the client that s/he is having 'irrational thoughts'. (Contrast Laing's thesis that however bizarre the patient's beliefs and behaviour seem, everything is perfectly rational from the perspective of the patient.) Sensitive clients are liable to be just a little bit insulted by being told they have irrational thoughts before the analysis has even begun, and so the relationship with the therapist starts in a bad way. Secondly, cognitivism and behaviourism don't really fit together that easily, since the first asserts the existence and accessibility of thoughts and feelings in the subject - something which the latter denies. The approach is therefore eclectic to the point of inconsistency - perhaps then it is the therapist who is not quite rational? Third, the cognitive part of CBT asserts that feelings follow thoughts, and thoughts are propositional attitudes which conform to Brentano's thesis: i.e. thoughts are essentially about things. Actually, I think the disposition to anxiety often comes first, and the thoughts and the 'aboutness' is more-or-less an epiphenomenon. Once I realised this, I have found it slightly easier to manage my anxiety. (Brentano's thesis is also part of the existentialist-humanist tradition - I think Sartre mentions it in Sketch for a Theory of the Emotions, but it turns out that the thing that thoughts and feelings are about can be 'everything in general and nothing in particular', which is as good as saying that the thoughts and feelings don't really have any content at all. I guess I must read Sketch in its entirety - it is not a long book - that is if I can keep myself calm enough for long enough to do so.) — Preceding unsigned comment added by 212.56.114.4 (talk • contribs) 21:16, 9 December 2004

These are rather simplistic comments on the 'family' of therapies loosely called CBT. Beckian forms of CBT tend to be 'rationalist', in that they do indeed assert that there are rational thoughts and dysfunctional ones. However a number of developments are far more 'constructivist' in that they assume that there are very good reasons why people think the way that they do in terms of previous experience. The terms 'cognitive' and 'behavioural' are more useful to consider as related more to practice rather then theoretical principles. CBT involves accessing beliefs about self, world and others, formulating how these relate to behaviours and emotions, and practicing new ways of behaving that may seek to disconfirm those beliefs (put very simply). CBT formulation techniques are also best considered as frameworks used to simplify the complexity of human experience. They do not seek to describe any kind of 'truth' about an individual. Hence the point about anxiety occurring before cognitions is - theoretically - correct, but most people who gain from CBT find the relationship described by the ABC framework helpful. — Preceding unsigned comment added by Nickmaguire (talk • contribs) 23:13, 23 August 2006

Clinical trial discussed in article is pretty out of date

The antidepressant chosen for the study has been withdrawn from the market.

How much of cognitive therapy has been investigated with PET scans?

How much of an influence have recent findings in evolutionary psychology had on cognitive therapy? See: Mean Markets and Lizard Brains: How to Profit from the New Science of Irrationality by Terry Burnham — Preceding unsigned comment added by 69.118.80.7 (talk • contribs) 00:36, 5 August 2005

Cognitive Analytic Therapy

I have added a wiki-link to Cognitive Analytic Therapy. There is empirical evidence in favour of this, which stands in marked contrast to Rational Emotive Behavioural Counselling (there may be a journal devoted to Rational Emotive Therapy, but as Yankura and Dryden point out in their book on Albert Ellis (published by Sage), few papers in this journal are actually reports of empirical research projects. — Preceding unsigned comment added by A. Carl (talk • contribs) 19:49, 25 January 2006

Were the developers of CBT proponents of Freud's theory?

— Preceding unsigned comment added by 69.118.80.7 (talk • contribs) 00:38, 5 August 2005

Most of the therapists of the first two thirds of the twentieth century were of the psychodynamic persuasion. Almost all early psychotherapists were trained as Freudians and later split off. Behavioral therapists were some of the strongest detractors of Freud and split with him fairly early (i.e. the 1920s). Beck, the developer of CT said at the 108th American Psychological Association (2000) that he, like many of his generation, spent years as a psychoanalyst before developing cognitive therapy. As the name implies, cognitive-behavioral therapy uses techniques from both modalities. As a result of the blending, the majority of Freud's influence has been lost.— Preceding unsigned comment added by 140.180.11.187 (talk • contribs) 02:27, 24 April 2006

And rightly so. Analytic theory has a great strength in that it made useful observations of human interactions and processes (e.g. transference, splitting). However from a scientific perspective, Freud's underpinning theories centred around psychosexual stages have absolutely no empirical value whatsoever, either prospective or retrospective. It was developed using a limited number of case studies, and does not stand up to replication. Despite nearly 100 years of practice, the efficacy literature is limited, and any benefit experienced may be explained by hermeneutics (a criticism made of all forms of psychotherapy), i.e. the client interprets the therapist's confidence as evidence that they should, and therefore will recover; the therapist interprets the client's recovery as an indication that the therapy is indeed effective. — Preceding unsigned comment added by Nickmaguire (talk • contribs) 23:45, 23 August 2006

Small Edits

I've made some small changes to the second section, as it was extremely confusing, and did not flow well. It should improve readability.— Preceding unsigned comment added by 69.47.136.120 (talk • contribs) 02:45, 2 December 2005

Three Articles

As a social work student, I must agree that the article is confusing both in the way it is written and in what is included. The suggestion of three articles would be, in my opinion, the most viable solution to the ambiguity. In searching "behavioral therapy," I was taken directly to the cognitive page which is potentially very misleading.

amgrimm — Preceding unsigned comment added by 12.203.42.93 (talk • contribs) 17:33, 9 May 2006

Triad with only two parts?

Under "Causes of Depression" the triad that is discussed has only 2 parts. 69.140.12.223 (talk) 04:57, 30 April 2008 (UTC)

CBT for Mood Disorders - Rigorous evaluative studies?

The statement:

"The American Psychiatric Association Practice Guidelines (April 2000) indicated that among psychotherapeutic approaches, cognitive behavioral therapy and interpersonal psychotherapy had the best-documented efficacy for treatment of major depressive disorder, although they noted that rigorous evaluative studies had not been published."

is misleading, as the guidelines clearly state that rigorous evaluative studies have not been published on psychodynamic psychotherapy only. This is a seperate treatment and has no bearing on CBT. I will therefore remove the suggestion that rigorous evaluative studies have not been published. —Preceding unsigned comment added by 82.41.105.161 (talk) 02:23, 30 November 2008 (UTC)

CBT use in patients with High Functioning Autism/Aspergers Syndrome

It is said that CBT can used to successfully treat persons on the higher functioning end of the autism spectrum who are suffering from depression, neagative thought patterns/suicidal thoughts. Can this be included in the article? —Preceding unsigned comment added by 69.164.183.81 (talk • contribs)

Well, it can be used with anyone suffering from depression, so autism-spectrum people are kind of already covered. I think it might be especially useful in AS people though, because of how logical it is. If there are references for something like that, it might be good to add (maybe in conditions comorbid to autism spectrum disorders if not in cognitive therapy). --Galaxiaad 02:35, 4 September 2006 (UTC)

Someone should also explain how and why poor attribution of causes for important events can cause other types of dysfunctional states. A good example might be paranoia which seems to the product of attribution to third parties. The eventually conclusion that all people are evil and to be mistrusted or else why would they keep doing these things to me? I have no references for this… At the moment the attribution section is limited to self blame/depression.

Cognitive Therapy versus Cognitive Behaviour Therapy

Why does this article treat "cognitive therapy" and "cognitive therapy" as synonyms? I have always understood that cognitive behaviour therapy is a means of behaviour modification which takes cognizance of underlying cognitions, whereas cognitive therapy is a more purely "cognitive" approach to therapy. A. Carl 19:49, 25 January 2006 (UTC)

I think you mean "cognitive behavior therapy" and "cognitive therapy." Yes, one was developed beginning in the 60s by Aaron Beck, and it essentially deals with the underlying beliefs that cause thoughts, which lead to (among other things) observable behavior. While I don't know about CBT as much as I do cognitive therapy, I do know that they are different, and should therefore be discussed as different topics. In fact, it would be beneficial to have some sort of tree indicating the development of the many different theories which came about as a result of modifications to Beck's original Cognitive Therapy (referred to as a proper noun for clarity.) Strangely enough, the two disciplines are frequently confused in various web publications. Just try a search for "cognitive therapy" and see how many references you get for CBT. --Iamlima 07:15, 28 April 2006 (UTC)

The practice of Cognitive Behavioral Therapy has grown out of the original ideas of Albert Ellis, PhD and Aaron Beck, MD. The changing terminology follows the changing breadth of the research and practice that includes successful aspects of behavioral, emotive and cognitive methods. user:smoores 19:43 7/11/2006

Albert Ellis was first with Rational-Emotive Behavioral Therapy. Aaron Beck showed up in the 1960s with Cognitive Therapy. Generally, the whole sub-field of psychology is known as Cognitive-Behavioral Therapy, although textbooks tend to use Cognitive Therapy haphazardly when hey actually mean Cognitive-Behavioral Therapy. The reason that "behavioral" is in there is because the types of therapy used are offshoots of behavioral therapy. Dlmccaslin 03:35, 1 July 2006 (UTC)

Actually there are many precursors to both Beck and Ellis. Notably Abraham Low's Recovery Incorporated which is a clear predecessor of cognitive therapy in the 1930s and is cited by David Burns (author of Feeling Good, the bestselling CT self-help book) as a major influence on his work. CBT is a broader term that encompasses a range of different therapy approaches which draw on diverse cognitive and behavioural techniques of therapy, including the work of Beck and Ellis. CBT effectively superseded behaviour therapy in the 1970s as most therapists came to accept that behavioural learning was "cognitively mediated", i.e., client expectations, beliefs, and thinking patterns shaped their responses to therapy techniques, etc. It would be great if someone could sort out an article which distinguishes between the different schools and helps the public to make sense of the confusion of terminology. More information on behaviour therapy would help as a starting point. Please, though, not another article which portrays CBT as an amalgam of Beck and Ellis, there are also many other important influences on its development. HypnoSynthesis 23:40, 3 October 2006 (UTC)

I don't agree that "CBT effectively superseded behaviour therapy in the 1970s as most therapists came to accept that behavioural learning was cognitively mediated" - CBT still includes many behavioral techniques such as exposure and motivational interviewing. The article is narrow and inaccurate. CBT is the merging of Cognitive Therapy with Behavioral Psychotherapy, but the term is wrongly used today to refer only to Beck's Cognitive Therapy. I'm going to have a go at rewriting this article - I'll get back to you! 10:24 26 October 2006 Alec Brady

Terminology

I have seen this kind of therapy referred to as REBT (Rational-Emotive Behavioural Therapy) and RET (Rational-Emotive Therapy); I initially tried searching using 'REBT' and failed to find anything, only finding this later after trying 'therapy'. It would be nice to include these terms in the article (or perhaps put redirects to it; I'm new to Wikipedia so I don't know what's best) so it can be found via those names.

I'm not sure on the guidelines for redirecting acronyms, best thing I think would be to ask and then do it. Or just add a bit in the introduction mentioning the other names. Are they exactly the same? - Xgkkp 20:55, 2 Jun 2004 (UTC)

The thing that concerns me is that CBT and CT are lumped together as somehow being one in the same, which they are not. CT, which is what Beck devised, is slightly different than CBT, a more recent innovation. REBT, on the other hand, has numerous things in common with CBT and CT, but also differs somewhat. Namely, the theorist who developed it. Without getting too divisive, RET and REBT are also slightly different. It would be beneficial, in an academic sense, to at least include an explanation of how they differ, and discuss how these differences came about. At its most primitive, CBT includes elements of behavioral modification. That's also how RET and REBT differ, if memory serves. I'll end my rambling now, except to say that it's rare to find a Beck-centric clinician that employs straightup CT. Most use CBT. And studies involving the efficacy of cognitive approaches for the treatment of depression typically examine CBT.

Article Flow?

I found it difficult to read this article, it reads like many short paragraphs stuck together without any sense of flow or direction. I don't think that it could be easily solved without a complete re-write though, something that I'm certainly not knowledgeble enough about the subject to do.

Perhaps it should be changed to more resemble the style of the Clinical depression page, given how the two are linked - Xgkkp 01:30, 19 May 2004 (UTC)

Another Idea - Categorisation? - Xgkkp 20:56, 2 Jun 2004 (UTC)

claims of critics

This is arguably the primary type of psychological treatment being studied in research today, a fact that critics of CBT claim is due in part to its very rational, "scientific" methodology, rather than because it is more effective than any other modality.

I tend to be fairly loose about whether you need to cite sources in order to include a criticism in an article; too much stringency plays into the hands of POV warriors who feel they can deny their enemies the chance to be heard if they simply be unreasonable about demanding sources for the obvious. However, the above criticism is not obvious at all; I find it in fact very odd. Is it trying to say that CBT is not the most effective of the modalities? If so, that's a claim that needs some supporting evidence -- not necessarily proof, but at least indication of why someone would believe that. If it's trying to say "CBT would be popular even if it wasn't the most effective modality because it appeals to researcher personalities", well, that's a difficult statement to support since it's based on a counter-factual. I think we need to get some source for this criticism, find out who's saying it and exactly how they're saying it. -- Antaeus Feldspar 17:06, 8 Mar 2005 (UTC)

In fact, to support supporters of CBT is this article: http://www.medicalnewstoday.com/medicalnews.php?newsid=22319# "Cognitive therapy as good as antidepressants, effects last longer" 12.126.65.246 09:26, 6 Apr 2005 (UTC)

CBT is effective for treating depression, anxiety and also the delusional symptoms in schizophrenia. CBT does not treat treat the cognitive deficits nor the social cogntive deficits associated with schizophrenia. For this a cognitive rememdiation or a cogntive enhancement therapy is indicated. Hogarty and Flesher et al have published a report on Cogntive Enhancement Therapy in the 2004 Archives of General Psychiatry. Alice Medalia hosts an annual conference in Cognitive Remediation on the first weekend in June in New York. Those interested can check out the following link http://www.cognitive-remediation.org

these are very sweeping statements. The brain is the most complicated known entity in the universe. Individuals vary in larger degree than known therapies for mental illness. CBT may work for one population, but be a complete waste of time for another. Practitioners would do well to think a little about what they don't know.

Well said. This whole article has serious NPOV issues. There are quotations and external references which, when you follow them, end up to be links to sites that are effectively advertisements for a service and very biased, unscientific and, frankly, loaded with rubbish. It is important to stick to the Encyclopedic nature of the article and not drop into a kind of 'Tony Robbins late night infomercial' type style as this article does. Refer to academic research if you feel it is appropriate to explain the approach in a neutral way but don't try and come up with lots of references to dubious sites to try and impress and drop the idea that this page is an advertisement for CBT. 14:36, 10 October 2006 (UTC)

disambiguation line?

This article is about the Cognitive Therapy. For the Behavioralist technique, see Behavior Modification.

Does anyone know what this is supposed to mean? I have never heard of "the Behavioralist technique" called "cognitive therapy"; the only thing I have ever heard called "cognitive therapy" is "the Cognitive Therapy [sic]" of that name. And yet if there is nothing else called "cognitive therapy" there is no need for a disambiguation line. -- Antaeus Feldspar 15:47, 28 September 2005 (UTC)

Split into multiple articles

First of all, Beck's Cognitive Therapy (CT) and Cognitive Behaviour Therapy (CBT) are not the same damn thing (I can provide sources to support this if needed, don't have it on hand now). So I suggest that the CBT article describe the principles common to all CBT therapies (REBT, RET, CT, Cognitive Analytical), such as their belief that cognitions and emotions affect behaviour and psychopathology and that to relieve psychological problems cognitions are changed.

I'd be happy to do most of the work as I'm quite familiar with the literature behind Beck's CT

I have also noticed that behaviour therapy redirects to the CBT article. This is totally absurd considering that behavioural therapy and CBT are two very distinct therapies. I also think that the disambiguation should be removed and that a seperate behaviour therapy article needs to be started.

Not at all: behavior therapies are cognitive behavior therapies, just as CT is a cognitive behavior therapy. Otherwise, what's the word 'behavior' doing in there? By all means let's have a CBT article that describes the subcategories and gives links to articles on them; but don't treat CT as part of CBT unless you're going to treat BT as part of it as well. - Alec Brady 20:57, 15 February 2007 (UTC)

Split into three articles

I'm a psychiatrist. I agree with the last comment. "Cognitive behaviour therapy" should not redirect to "cognitive therapy". Have a separate page for each, plus a page on behaviour therapy. 62.6.139.11 16:18, 23 March 2006 (UTC)

dr.alf 09:56, 9 February 2006 (UTC)

There's a similar post up above saying what you're saying. I agree, this should be split. Westfall 05:04, 21 February 2006 (UTC)

Be bold Lumos3 09:04, 17 March 2006 (UTC)

Going to be bold this week, expect two new articles by the end of the week :-) dr.alf 12:48, 19 March 2006 (UTC)

Good luck. :) Gflores ^Talk 06:00, 20 March 2006 (UTC)

Let's do it already! I don't know enough about the subject otherwise I would. -- Barrylb 17:08, 10 June 2006 (UTC)

As a social work student, I must agree that the article is confusing both in the way it is written and in what is included. The suggestion of three articles would be, in my opinion, the most viable solution to the ambiguity. In searching "behavioral therapy," I was taking directly to the cognitive page which is potentially very misleading.

Splitting the article would make the material easier to follow. SamDavidson 19:52, 22 July 2006 (UTC)

I agree that there should be three articles. Personally I think it should be Cognitive therapy and Behavior modification (as it now exists) and Cognitive Behavioral Therapy. I imagine the first two having a more restricted (although the behavior modification page could potentially cover a vast body of work not directly related to psychotherapy) and historical focus than the latter. Most of what's here now would seem to belong to the CBT page. Since this organisation has been suggested by numerous people here & above over several months, would it be OK for anyone to effect this now? EverSince 01:44, 25 December 2006 (UTC) p.s. or cognitive behavior therapy as commonly known (I guess this usage implies behavior therapy as the core but then doing it in a cognitive way?)

I'm planning to move this page this weekend to Cognitive behavioral therapy. And then make this page a stub or start-class on the subject of cognitive therapy. I hope any objections or alternative suggestions can be raised beforehand, although they haven't been since March 2006 it looks like. The move can always be reverted afterwards of course. EverSince 18:48, 5 January 2007 (UTC)

I'm glad that this has been moved in this way. But I think we need more discussion of the categories. The way I would see it is that behavior modification shouldn't be treated as a psychotherapy, but behavior therapy should be(possibly referred to as behavioral psychotherapy - as in Isaac Marks' book of that name (ISBN 072360875X)). Then we treat behavioral psychotherapy and cognitive psychotherapy (in all their various flavors like habituation, reciprocal inhibition, CT, REBT etc) as subclasses of cognitive behavior therapy. Alec.brady 20:57, 15 February 2007 (UTC)

I agree that behavior modification isn't necessarily therapy. So I do think the intro should probably refer/link to behavior therapy rather than behavior modification. Although at the moment the behavior therapy page is very scant, such that it could probably be a subsection of behavior modification, and I previously added a merge suggestion tag to the former page for that reason. I would say behavioral therapy can be both a component of CBT and a separate self-contained therapy EverSince 22:31, 16 February 2007 (UTC)

The four column technique

Please expand the four column technique so it describes the techniques in a usable way.

I added a paragraph on teaching ABC's which is the same technique. (Deanbender 01:29, 19 May 2006 (UTC))

Nice, well done. Thanks! Do we have a citation with examples of completed Four Column exercises? basilwhite

I have added a citation, Ellis' "Guide to Rational Living" as the needed citation. Would anyone object to me changing the title of this section and doing a quick rewrite? In 3 years of working in cognitive therapy, I have never heard of this referred to as the four-column technique. We always called it the ABCs of Irrational Beliefs. Ellis called it the ABCs of emotional arrousal.Dlmccaslin 07:46, 2 July 2006 (UTC)

Be bold! And thanks for the reference ... but isn't ISBN 0-13-370650-8 Ellis's A New Guide to Rational Living, not Ellis and Harper's A Guide to Rational Living? See Amazon. I've changed the article to that. -- JimR 09:35, 2 July 2006 (UTC)

Treating depression with CBA

This section is confusing. What is CBA? And what is cognitive behavioral-analysis system of psychotherapy (CBASP)? And what are the implications of the study on combined Serzone-CBASP treatment? Does anyone use the technique as a result or is it just another study? --- Barrylb 16:59, 10 June 2006 (UTC)

I see the section has been removed and then replaced, adding a bit of an explanation of CBASP but it seem lives in a vaccum. Why isn't CBASP mentioned at the top of the article with other approaches? And I there is still nothing stating the implications or the significance of the study. -- Barrylb 11:45, 13 June 2006 (UTC)

The implications of the study are that a combination of one form of CBT and an anti-depressant drug can be highly effective. I've added a sentence to this effect to the article, and removed the importance-s tag. The point is that scientific study bears out the value of an appropriate combination of treatment including CBT, in line with the principles of evidence-based medicine. -- JimR 06:52, 25 June 2006 (UTC)

I am sure there are thousands of studies every year. Why does it deserve special mention? Has it "changed the world"? Is the technique now commonly used as a result of the study? If so it should be mentioned in the introduction of the article. If this is just discussing a study then I would like to put it in a 'Recent Research' section or something like that. -- Barrylb 07:00, 25 June 2006 (UTC)

To add to what I have just said, look at the prominence given to this section in the article: is it deserved? -- Barrylb 07:06, 25 June 2006 (UTC)

I'm not interested in the implications of the study in itself. I'd like to know why this study is so important in the big picture of cognitive therapy. -- Barrylb 07:10, 25 June 2006 (UTC)

It is important in the big picture because the results of 85% response and 42% remission are much better than other methods. I've again tried to point this out in the article, despite your previous reversion. These success rates suggest that the approach is highly beneficial to depression sufferers and deserves wide attention. Note that the paper has had at least 58 citations since it was published in May 2000. -- JimR 10:30, 25 June 2006 (UTC)

Ok, it seems to me the section should really be part of an 'emerging treatments' or 'recent research' section. Given that all the talk about CBASP and CBASP+medication is centered around this study, it is clearly not a widely accepted or used technique. Widely accepted techniques don't usually refer to particular studies to back them up. -- Barrylb 09:26, 26 June 2006 (UTC)

I'm not sure that May 2000 should be described as "recent", or the research as "emerging". There have been a number of other studies examining or touching on CBASP since; for example, see [1]. -- JimR 10:32, 26 June 2006 (UTC)

My point is that you are still talking about 'studies'. If the technique is still about 'studies' then we should have this in an appropriate section, perhaps 'ongoing research'. -- Barrylb 11:26, 26 June 2006 (UTC)

The message of evidence-based medicine is that all medical techniques should be backed up by ongoing systematic scientific studies, not just by tradition, long use, guesswork, or ex cathedra statements by medical experts. That CBASP plus medication has been validated as effective in this way is a positive thing. Somehow you seem to be seeing it as negative. -- JimR 10:43, 27 June 2006 (UTC)

No, this is not what I am saying. Of course every medical technique should be backed up by research. However, there are studies conducted all the time that validate all sorts of things but we don't report on them all. Why are we reporting on this one? -- Barrylb 03:49, 30 June 2006 (UTC)

Because the results of 85% response and 42% remission are unusually high, because the paper is so widely cited, and because it is (or at least was at the time) "the largest psychotherapy and medication clinical trial ever conducted in either psychology and [sic] psychiatry" [2]. We should be reporting stand-out studies more than we do: it's the lack of other reports like this that is the failure, not the presence of this one. -- JimR 06:48, 1 July 2006 (UTC)

I think my problewm here is that you're not explaining what CBASP is. How is it different than CBT, or DBT for that matter? The only thing you say is that a study in the New England Journal of Medicine found it highly effective when paired with one particular antidepressant (Which soulds strange for the Journal, picking one type of therapy and one specific drug, but that's beside the point). If CBASP is important, it deserves its own page along with DBT and other offshoots, in which case the information about the study should be removed. Otherwise, you should explain what CBASP is. Dlmccaslin 10:24, 1 July 2006 (UTC)

It wasn't me who added the original material about the Keller study. But I've put in some more detail and references about CBASP in line with your request. Sorry but what are you referring to by "DBT"? (I'm not sure why all the focus here is on CBASP. Note that the four-column technique a bit further up the article has no references, and there's not much visible about it on Google.) -- JimR 13:22, 1 July 2006 (UTC)

Needs importance tag?

I removed the tag for importance, but perhaps that was premature. Importance isn't a real guideline yet, only a proposed one. Therefore my thinking is that we should wait until there is consensus to start using it - before we start using it. But I'm a little new at the guideline proposal thing, so .. comments? Fresheneesz 19:33, 27 June 2006 (UTC)

The current version of Wikipedia:Importance does not specifically discuss importance of sections, but it does give three criteria for importance of articles. Taking these in turn, I think it's clear that if we apply them to the CBASP section, they all hold.

1. There is evidence that a reasonable number of people are, were or might be concurrently interested in the subject (eg. it is at least well-known in a community).

There are at least two communities likely to be interested in the effective treatment of depression by CBASP plus medication, namely: depression sufferers (for whom in some cases relief is so important as to be literally a matter of life or death); and psychiatrists, psychologists and other therapists, to many of whom the topic will already be well-known.

2. It is an expansion (longer than a stub) upon an established subject.

It not a stub, in that it has a reasonable level of detail, and it is on a subject established in McCullough's work and the Keller paper referenced.

3. Discussion on the article's talk page establishes its importance.

See above, where I've argued that the importance of this material is in line with the principles of evidence-based medicine.

So the section should not have an {{importance}} tag, and even if Wikipedia:Importance does become a guideline not just a proposal, that won't carry any implication that the material about CBASP shouldn't be on the page. -- JimR 11:27, 29 June 2006 (UTC)

Ellis and Beck

The way the article reads, it looks like Albert Ellis and Aaron Beck developed CBT together, when in reality, they were two seperate people working a decade apart on two different but related types of therapy. I'm going to edit to clarify.Dlmccaslin 03:41, 1 July 2006 (UTC)

CBT and Child Treatment

I don't see any material on the use off CBT with children and adolescents. I know that there is a deep and abundant body of literature on this. How would be the best way to include such material?

A separate section?

SamDavidson 17:23, 1 July 2006 (UTC)

Citations and references are needed. When I get a moment I will try to add some. RalphLender 18:35, 18 July 2006 (UTC)

They have been added.

Criticism on grounds of fault attribution

207.38.162.227 added the following to the introduction of the article:

CBT is claimed to be a treatment for mental illness. CBT suggests that mental illness is within the control of the sufferer or that the sufferer is the cause of the mental illness. Many sufferers from chronic mental illness disorders such as bipolar or schizophrenia reject this approach since it implies that they are the fault of their biologically based disorder.

I've moved this to its own section called Criticisms, and marked it as POV and requiring citations. I agree that it may be the interpretation of some sufferers that CBT implies they are themselves to blame. However, I would argue that this interpretation is incorrect, and that neither CBT as a method, nor any reputable CBT practitioners, attribute blame to sufferers of bipolar illness or schizophrenia. I'm not knowledgeable about the latter case, but CBT can be of enormous benefit in treating the depression side of bipolar illness — not by saying that the sufferers are the cause, but by showing them how they can learn control techniques to limit or escape from depression. It would be a great pity if bipolar sufferers were put off trying CBT by an incorrect feeling that they would be found at fault. Therefore, unless the section is rewritten neutrally and provided with relevant references, I propose to remove it. -- JimR 04:52, 15 July 2006 (UTC)

I would agree. CBT can be useful in helping persons with severe mental illnesses cope better. It would not be a substitute for appropriate medication treatment but it would be an additional component of treatment. There is nothing in the literature I've read to suggest that CBT "blames" the suffer of severe mental illness or suggests it is "all in their head." DPeterson 22:00, 17 July 2006 (UTC)

Thanks for the confirmation. I've now removed the Criticisms section (still preserved above on this talk page). -- JimR 11:09, 19 July 2006 (UTC)

CBASP

This section was disproportionately long and read more like an advertisement for a patented form of therapy. In-depth details of individual studies are not appropriate for an article of such general appeal. —Preceding unsigned comment added by Count Caspian (talk • contribs) 24 July 2006

Please see the extensive discussion of this section above, where the importance of the material has been canvassed. -- JimR 10:48, 24 July 2006 (UTC)

I've now attempted to address your concern about proportion in this article by moving the bulk of the material about CBASP and the Keller study to a separate article. This is in line with the articles about REBT and DBT. I agree that the patenting of CBASP might be questioned, but nonetheless the strength of the Keller paper's results (emphasised by many citations) do bear reporting because they have the important point — more general than either CBASP or the now withdrawn Serzone — that combination therapy is of great value. -- JimR 11:18, 24 July 2006 (UTC)

Behavior v. Behaviour

Someone keeps changing "behaviour" to "behavior". This should probably be addressed. Normally, I would say that it should be "behaviour" as per WP:MOS rules about crosscultural spelling variations. However, because this is the title of a type of therapy, I don't really know. In Brittain, is "Behaviorism" spelled "Behaviourism" in books and such? If so, we should just keep it the way it was first written. Any suggestions?Dlmccaslin 23:56, 16 August 2006 (UTC)

It should be behavior. For example, the reference # 7 is now incorrect as the title is behavior not behaviour. In addition, all the other references use the spelling, behavior not behaviour. So, I suggest that the commonly accepted usage and spelling, as seen in the references and other publications, be used. Forthermore, the articles in Wikipedia are Behavior Modification and Behaviorism. I suggest that the word be changed to 'behavior' from behaviour. What do others think? Perhaps we could take a poll here? DPeterson^talk 01:44, 17 August 2006 (UTC)

'IN SUPPORT OF CHANGING BEHAVIOUR TO BEHAVIOR'

Only in some instances...see my comments below under 'NEUTRAL' RalphLender^talk 14:08, 17 August 2006 (UTC)

'IN SUPPORT OF KEEPING SPELLING BEHAVIOUR'

Original spelling in article should be kept per the MoS. References should be spelled correctly to their original titles ("behavior" as appropriate). There's no standard spelling for the therapy: it's "behaviXr therapy" where how "behaviXr" is spelled depends on whether the writer speaks BrE or AmE. — Saxifrage ✎ 02:28, 17 August 2006 (UTC)
WP:MOS --Clawed 02:53, 17 August 2006 (UTC)
Except when the article title or author uses the AE spelling DPeterson^talk 12:31, 18 August 2006 (UTC)

'NEUTRAL'

How about leaving the original spelling (Behaviour), but making a note at the top of the article about the different spellings? Then, someone should go through the article and correct the spellings to Behavior where that is in an article title or quote. Finally, someone should go through the article and change the spelling where it refers to Behavior not Behaviour; for example, when discussing Beck's work, Behavior and not Behaviour would be appropriate; 'Yes?' Comments would be appreciated. RalphLender^talk 14:07, 17 August 2006 (UTC)
I agree with this idea. See my note below. I've corrected spellings where the British spelling is incorrect, for example in an article title, and as the term is used by known individuals, for example, Ellis uses the spelling, Behavior not Behavioral. Other than those type of changes, the BE spelling should remain in all other instances. DPeterson^talk 12:31, 18 August 2006 (UTC)
I support this idea JonesRD_talk 17:58, 20 August 2006 (UTC)

'Note': I have changed behaviour to behavior in those instances where the term is used in that spelling...for example, Dr. Ellis writes about Rational Emotive 'Behavior' Therapy. In addition, several of the reference titles were changed to BE from AE but the articles titles are in AE. If my changing these back is a problem, please let me know and I will revert my edits. DPeterson^talk 12:26, 18 August 2006 (UTC)

What you've done seems reasonable to me. JonesRD_talk 17:58, 20 August 2006 (UTC)

Yes, might as well stick with that spelling. RalphLender^talk 19:25, 12 October 2006 (UTC)

CBT and Neuro Linguistic Programming

This is a complete layperson's comment but it would be really helpful to understand where CBT is different to NLP. To my ignorant mind it seems that both techniques (or at least an NLP-lite shorn of the mumbo-jumbo) rely on understanding, challenging and reforming the word-based mental model of the patient to change emotional states and create more helpful behavioural patterns. Within this idea are the NLP assumptions that people can do much more than they think they can by copying people who are successful at that thing and that people whom you find difficult are typically making choices that are rational and "good" to them. If the ideas are similar, why is NLP held in such ill repute (including by wiki) and CBT seen as such a great thing. Help me - I am confused!

There are several hugh differences. I will just briefly sketch out a few for you.

. Cognitive Behavioral Therapy is based on a very different set of theoretical assumptions. For example, that thinking, feeling, and acting are all related and that you can change how you feel by changing how you think.
. There is a HUGH body of empirical literature on the efficacy of CBT, but not for NLP.
. NLP seems to be just a technique. CBT is a more complete theory of behavior and treatment.

Just a few ideas. DPeterson^talk 01:56, 30 August 2006 (UTC) P.S. please sign your notes. DPeterson^talk 01:56, 30 August 2006 (UTC)

Does anyone else have any information on the distinctions? JonesRD_talk 20:05, 9 October 2006 (UTC)

For starts, NLP is based on the assumption that the brain has a "mental language", which is an old model of thought that has long since fallen into disfavour among researchers and theorists. CBT, on the other hand, is based on modern models of cognition in general. — Saxifrage ✎ 20:32, 9 October 2006 (UTC)

Excellent point! DPeterson^talk 00:29, 10 October 2006 (UTC)

CBT / CT and the Scientist-Practitioner Model of Training

I struggle a bit with the statement that CT is aligned very closely with the scientist-practitioner model. While I can certainly see where this statement comes from (and do not disagree with its general validity), I'm a little concerned about how this might be read by CT consumers. I am personally currently completing my internship in a strictly CBT setting under a relatively well-regarded cognitive behavioural therapist and researcher, and (I hope this doesn't sound arrogant!) consider myself very well trained and qualified in the use of CBT. However, I am completing a Psy.D. program that explicitly frames itself under the practitioner-scientist model. I'm concerned that the current article may suggest to mental health consumers that they must look for a scientist-practitioner psychologist in order to have "quality" cognitive therapy.

Good point. Perhaps you could suggest alternative language? Also, please sign posts with the four tildes DPeterson^talk 03:36, 5 November 2006 (UTC)

Ah yes, the four tildes.....thank you! Just joined Wikipedia today, so I'm still learning some of the details :-).

My wheels are turning regarding alternate language...perhaps a brief explanation that CBT is closely aligned with the movement toward evidence-based practice in psychotherapy? This may directly address the concept of scientifically informed practice without singling out a particular psychology training model as superior in terms of service delivery.Noktavejo 07:01, 5 November 2006 (UTC)

That sounds very good. If you want to take a stab at that by either editing the article directly...or if you prefer, putting your suggested edit here, that would be great. DPeterson^talk 16:32, 5 November 2006 (UTC)

a question

If I think that Cognitive Therapy is what is needed to help someone, should I suggest to him that he sees any psychologist? Or should I find out "one by one" who uses this kind of treatment? Or should I send the patient to search on his own, door-by-door? --Guruclef 10:01, 2 December 2006 (UTC)

If that is the specific treatment the individual is seeking, then asking the therapist about the therapist's approach is appropriate. JonesRD_talk 19:03, 3 December 2006 (UTC)

Cognitive behavioral therapy

I've moved the content to this title, as per suggestions discussed above. I've had a go at establishing a stub back on the page about Beck's Cognitive therapy. Going to try editing this one in line with the title. EverSince 18:01, 21 January 2007 (UTC)

Criticisms

I added the fact tag to this. While the statements may be true, there really should be citations to support the statements. DPeterson^talk 20:07, 20 June 2007 (UTC)

One month is long enough, I have removed it... anyone feel free to put it back in, with a citation. Sethie 16:54, 24 July 2007 (UTC)

DDP

I have removed Dyadic Developmental Psychotherapy from this page. This little known therapy has been extensively advertised on Wiki as evidence based, sometimes the only evidence based treatment for a variety of disorders affecting attachment. (Theraplay, also little known and not evidence based has also been advertised in this way.) A range of attachment articles including attachment therapy are currently before ArbCom. In the course of ArbCom it has transpired that of the 6 users promoting DDP and Theraplay and controlling these pages, User:DPeterson, User:RalphLender, User:JonesRD, User:SamDavidson, User:JohnsonRon, and User:MarkWood, the latter four are definitely socks and have been blocked, and the other two have been blocked for one year. The attachment related pages are in the course of being rewritten.Fainites ^barley 20:55, 1 August 2007 (UTC)

Criticisms of CBT

There should be a second listing criticisms against CBT in this article, to give it more balance. Unfortunately I am not up to gathering articles and references myself, as I don't really know enough about the topic to properly research them.

I can however offer a philosophical argument against CBT, which may be of interest. CBT looks for errors in thinking, events which are misinterpreted and which lead to negative thoughts...

Certainly Beck's CT sometimes does so. Other forms of CBT either don't address thinking styles at all (e.g. Exposure with Response Prevention] or focus on different types of cognition (e.g. REBT, which addresses faulty value judgements rather than faulty inferences). Alec.brady 13:12, 18 October 2007 (UTC)

...However, it could be argued that in some cases, it is reasonable and rational to have negative thoughts as a reaction to things which perhaps even the majority of people might not find depressing. This is because not everyone experiences the world in the same way, or feels the way way about it.

Even Beck's CT doesn't address individual thoughts in the way you describe; rather, it addresses faulty thinking styles - e.g. a tendency to personalise events. Alec.brady 13:12, 18 October 2007 (UTC)

A good example would be belief in god. People who honestly believe in, for example, fairies are considered to be somewhat abnormal. Most people do not believe in fairies, and there is no known scientifically valid evidence to suggest that they exist. However, a belief in god, an entity for whom there is a similar lack of scientific evidence, is considered normal because very large numbers of people hold that belief. In other words, sanity is defined by the majority, and if the majority is irrational then irrationality is considered sanity.

CT doesn't address the truth or falsity of beliefs, but only their contribution to a person's emotional problems. Belief in God (or fairies, or Iraqi WMDs) is not the sort of belief that CBT addresses. Alec.brady 13:12, 18 October 2007 (UTC)

CBT is very much about trying to change your way of thinking so that things which you find depressing but which most people do not are no longer depressing to you.

Um. I disagree that CBT is 'very much about trying to change your way of thinking'. Changing inferential style is an important strand of some approaches to CBT, but it's not definitive of CBT, and much CBT ignores it. Alec.brady 13:12, 18 October 2007 (UTC)

However, it may be possible that to do so would be an error in thinking, as for that person it is reasonable to be depressed as a reaction to those things, given their views, life experiences and beliefs. From a philosophical point of view, CBT could be considered deluding one's self.

I'm intrigued by your idea that it could ever be 'reasonable to be depressed' - are you, perhaps, confusing depression with unhappiness? Alec.brady 13:12, 18 October 2007 (UTC)

Anyway, aside from that some more medical criticism would helpful, to give some opposing views for balance. Mojo-chan 16:03, 15 October 2007 (UTC)

If anyone who has studied CBT (or CT or BT) properly has a criticism, that would indeed be helpful. Alec.brady 13:12, 18 October 2007 (UTC)

Interesting comments Alec.brady. I understand what you are saying, but it doesn't really match my own experience of CBT. Well, at least I was told it was CBT, but I can't really vouch for the quality of it. It is what is being provided on the NHS anyway, so presumably meets some sort of national guidelines.Mojo-chan 09:19, 20 October 2007 (UTC)

There is an article by J. Grave and J. Blisset in "Clinical Psychology Review" (Vol: 24 Issue: 4, August, 2004 pp: 399-420, "Is cognitive behavior therapy developmentally appropriate for young children? A critical review of the evidence")that discusses the inappropriateness of CBT for children between the ages of 5 and 8. —Preceding unsigned comment added by 69.158.159.132 (talk) 23:09, 29 March 2008 (UTC)

There are a lot of criticisms possible that should be included. It should definitely be in a separate section. 1) CBT is often no better than BT for some disorders. So what exactly does focusing on cognition bring to the table? 2)It encourages a hedonic value system 3)It poorly engages existential questions 4) It is poor on acceptance. -Montreal Psycho July 29-08

Xris0, you have removed the following piece on the basis of "inappropriate citation - should at minimum be mainstream news source, best would be peer-reviewed journal article" :

Research shows that CBT can bring fast improvement to patients, but the same research shows that not all patients improve, those who improve usually still exhibit symptoms, in the long run (2+ years after treatment) CBT effects erode, CBT is not more effective than other forms of psychotherapy.^[1]

I assume that this is a valid reason. This statement was a very dense synopsis of the article, which in my opinion is exceptional and very well researched. What I did (trying to stay within the rules of Wikipedia), I added an external link to this article. But I am asking all interested contributors for some better way to present this idea, and give credit to the source.Leontaurus (talk) 18:54, 7 July 2009 (UTC)

I just realized the citation link does not point anywhere. This is the source article: Cognitive Behavioral Therapy (CBT) Efficacy: Fact or Fiction? Leontaurus (talk) 23:41, 9 July 2009 (UTC)

Don't we need a citacion for this?

In a 2009 article in Psychological Medicine,2009; 1 DOI entitled " Cognitive behavoural therapy for the major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials" the authors found that not a single trial employing both blinding and psychological placebo has found CBT to be effective in schizophrenia and surprisingly few well-controlled studies of CBT in depression. The authors found that CBT is also ineffective in preventing relapses in bipolar disorder.

Leontaurus (talk) 21:48, 13 July 2009 (UTC)

CBT vs REBT

Just noted a small error in the page. Though CBT and REBT are very close, there is still a large difference in their theoretical underpinnings and practical applications. ABC theory is a part of REBT, not CBT. —Preceding unsigned comment added by 99.245.230.242 (talk) 21:19, 8 November 2007 (UTC)

duplicate section

it seems that the "Cognitive Behavioral Therapy" section appears twice in the text. I don't have the time right now to check if the two sections are exactly identical, but they are certainly very similar. --87.2.232.16 (talk) 07:58, 12 December 2007 (UTC)

Thought Control

I notice that one of the “symptoms” treated by CBT is “irrational thoughts”. Elsewhere I find the linked article on “irrational thoughts” to be a hodge podge of arbitrary judgements. Other articles on rationality lack coherence.

I understand CBT is used by Drug Courts in the U.S. If so, it strikes me as being a reinforcement of an already existing form of thought control.

For example, regarding “irrational thoughts”, the “therapist” may say to the “sufferer” (for example, a marijuana user sentenced to Drug Court), “You must give up your use of marijuana, because if you don’t you will always be in trouble with the law, and it is irrational to purposely harm yourself in this way. This irrational behavior is evidence of your sickness.” In other words, your use of marijuana is evidence of mental illness. However, the criminal prohibition that gets you into trouble in the first place is itself a form of thought control by thought prohibition: the thought created by marijuana use is prohibited. Then the “therapy” reinforces this prohibition by showing you how destructive your marijuana use is in view of the criminal prohibition.

However, it is the criminal prohibition that is destructive, not the marijuana use. That many people use marijuana, specifically for the thought created by the use of marijuana, in spite of the criminal prohibition of marijuana use, is evidence not of mental illness among the users but of thought control by the law. The thought prohibition itself may be a factor in causing actual mental illness in marijuana users.

I notice that CBT is considered most successful when used in conjunction with anti-depressant drugs. It sounds to me like the powers who control the drug industry have succeeded in replacing an uncontrollable drug with one they can control.

I believe there needs to be a critical point of view in the article. Thought control may be useful to some people in a society plagued by poverty, chaos and state violence, but is it good? Is it not useful to attempt to improve living conditions for the underclass? —Preceding unsigned comment added by Ngeo (talk • contribs) 02:30, 3 March 2008 (UTC)

CBT certainly isn't about thought control - but it does question the validity of thoughts, explores a client's beliefs, and the resulting consequences of those beliefs. As such, a therapist doesn't say whether drug use is bad - just works with the client to explore what they are wanting to change (the consequences) and how they get there, to find an alternative. Of course it could be considered "government-controlled-thoughts" if the goal is to 'help' a client act in a socially acceptable way. Focussing on helping a client feel and think in a way that is more likely to bring consequences they desire is giving them more of what THEY want though, not what others want. Greg (talk) 12:16, 27 May 2008 (UTC)

(Proviso: I'm not CBT trained - I belong to a CBT association & am trained in psychotherapy & NLP. CBTers please feel free to correct me.)

Hi, I just removed this because it's hard to fulfil this request without any idea of what kind of diagram is desired. If you just want a simple flow-chart, that is quite easy, you just have to say what you want in it. If you re-add this template please add more detail about what you want. thanks --pfctdayelise (talk) 09:56, 27 July 2008 (UTC)

'Poetry'

Is it appropriate to have the distracting link of Tao Lin (the relatively young and unknown e-commerce 'poet') at the start of this Wiki? Surely it opens up Wikipedia to other distracting cross-referencing of dubious value. —Preceding unsigned comment added by Wikijuice (talk • contribs) 01:59, 3 August 2008 (UTC)

This is routine Wikipedia practice, please see Wikipedia:Disambiguation. The purpose is so that the person looking for the poetry collection will find it under the place where they would logically look. /skagedal^... 16:48, 8 November 2008 (UTC)

Cleanup

The article was in a terrible mess, I have taken the liberty to clean-up the article and created a few new headlines. The previous text has of course been kept, but placed under more appropriate headings. I hope others can help clean up the article futher to improve quality of the article. —Preceding unsigned comment added by 139.117.10.100 (talk) 08:41, 3 October 2008 (UTC)

I have cleaned up the insomnia section which contained redundant phrases, repeated sentences, and splintering of the subject under discussion across multiple paragraphs. Hoodathunkit (talk) 14:23, 23 October 2008 (UTC)

More cleanup

This is article was and is in a terrible mess, so I decided to do some radical cleaning up:

Wrote a bit on the history of CBT, needs a lot more work
Capitalization (Cognitive Behavioral Therapy -> Cognitive behavioral therapy) per MOS:CAPS
Attempt at showing that some therapies within the "CBT" umbrella do not specifically deal with cognitions, but are directly aimed at behaviors.
Tightening of prose at various places
Removed lots of POV and weasel wording
Removed various cognitive theories on depression: in-depth explanations of Beck's cognitive theory, "hopelessness" theory, attributional style - too detailed and it's not clear how it relates to treatment.
Removed the REBT "ABC" model, too detailed
Removed excessive detail on computerized CBT
Removed lists of people in CBT, list of therapeutic systems within CBT
Re-arranging content

This is the latest version before my changes, if anyone wants to save the removed content. I hope to keep working on this article as I find the time. /skagedal^... 20:19, 9 November 2008 (UTC)

Merged the list of people in CBT into List of clinical psychologists. /skagedal^... 21:26, 9 November 2008 (UTC)
List of therapeutic systems within CBT moved to List of cognitive–behavioral therapies, with some additions, descriptions and referencing. /skagedal^... 13:00, 20 November 2008 (UTC)

Reduntant wording or not?

An anonymous editor changed the first sentence from "[CBT] is an umbrella-term for goal-oriented psychotherapeutic systems that aim to influence problematic emotions, behaviors and cognitions" to "[CBT] is an umbrella-term for goal-oriented psychotherapeutic systems and approaches that aim to influence problematic and dysfunctional emotions, behaviors and cognitions". Do these words really add anything? What's the difference between a "system" and an "approach" Doesn't "systems" include "approaches"? And, if emotions, behaviors are cognitions are "dysfunctional", they are surely problematic? /skagedal^... 19:06, 13 November 2008 (UTC)

...later, s/he added "[...] while some are more behaviorally aligned and oriented", which is clearly redundant—maybe this editor thought that those were better word choices, and that it would be rude to remove anything. That's probably what happened. Just trying to understand, sorry for talking to myself. :) /skagedal^... 19:11, 13 November 2008 (UTC)

Work in progress and definition problem

I'm slooowly working on this article, you can see some ideas on what I think the article should cover under Wikipedia:WikiProject Psychology/Psychotherapy and my notepad on User:Skagedal/Notepad.

One problem I have is trying to define what CBT is. All sources agree that CBT is an umbrella term that include a variety of approaches, but they differ in what the inclusion critera should be. Dobson's "Hanbook of Cognitive–Behavioral Therapies" is one source I've found that takes a theoretical approach to this problem and argues that all cognitive–behavioral therapies are based on a common assumption that cognitive events mediate behavioral change; thus, neither "pure behavior therapy" (where "cognitive mediation" is seen as irrelevant mentalism) or "pure cognitive therapy" (where cognitive change in itself is the goal of therapy) are included under the umbrella. A wider definition is, it seems, often used by CBT organizations, for example in the "What is CBT" text from the British association that is linked in this article, where it says: "The term 'Cognitive–Behavioural Therapy' (CBT) is variously used to refer to behaviour therapy, cognitive therapy, and to therapy based on the pragmatic combination of principles of behavioural and cognitive theories". This more closely follows the "popular use" of the term, according to my experience.

This could of course be handled by stating in the article that different definitions exist, but the bigger problem is to decide what goes in the article and what does not. Should the article in general take an inclusive approach (that might better reflect what readers are expecting to find in this article) or follow the stricter approach (that might make more theoretical sense)? /skagedal^... 20:50, 27 November 2008 (UTC)

Efficacy?

I can't see anything on it's efficacy? Eg a summary of studies, or any meta-studies, on the effectiveness of CBT? Ie, how effective is it for common disorders such as anxiety etc, versus untreated controls or other therapeutic methods? —Preceding unsigned comment added by 222.154.238.36 (talk) 03:41, 11 December 2008 (UTC)

Maybe you can have a look at this: Cognitive Behavioral Therapy (CBT) Efficacy: Fact or Fiction? Leontaurus (talk) 18:15, 7 July 2009 (UTC)

Blogspot link

This was moved from Talk:Cognitive behavioral therapy/Comments /skagedal^talk 08:37, 11 December 2008 (UTC)

i ablog spot containing articles on CBT on Wikepedia which was reverted. http://cognitivebehavioureltherapy.blogspot.com/ i think it contains up to date information on CBT. Shall we undo the revert? —Preceding unsigned comment added by Shandithrt (talk • contribs) 07:09, 11 December 2008

No, sorry – Wikipedia is not a collection of links (see [[external links style guideline), and blogspot is not considered a reliable source. /skagedal^talk 08:37, 11 December 2008 (UTC)

Criticism and controversies

Here's a good source for the criticism and controversies concerning EBPs including CBT. [3] ----Action potential ^{discuss contribs} 03:59, 23 June 2009 (UTC)

anti-cbt views

Wingnuts who hate cbt will be interested in the news articles about Professor Keith Laws, and in the research from one psychologist at one minor university that discredits CBT for schizophrenia (not too controversial apart from UK NICE guidelines) and also for depression (a lot more controvrsial, especially given the amount of evidence showing CBT is effective for depression.)

People need to be careful to note he hasn't done new real research, he has done a meta review. ETC ETC. I'm not editing because i: I have pro-CBT pov and ii:I hate Professor Keith Laws. 82.33.48.96 (talk) 13:46, 26 June 2009 (UTC)

Ex-pedophiles

I've read sources that claim that cognitive behavioral therapy has been used to try to re-habilitate convicted pedophiles. There should maybe be additional material on that in the article. ADM (talk) 07:57, 23 July 2009 (UTC)

there is good evidence for this with W. Marshall being the main author (Marshall WL, Marshall LE, Serran GA, O'Brien MD (2008). "Sexual offender treatment: a positive approach". Psychiatr. Clin. North Am. 31 (4): 681–96. doi:10.1016/j.psc.2008.06.001. PMID 18996307. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)). go ahead and add something. Earlypsychosis (talk) 09:32, 24 July 2009 (UTC)

merge from Computerised CBT?

Do you want to merge Computerised CBT into this article? It would probably be best covered as a subsection here rather than a separate article. ----Action potential ^{t c} 07:12, 10 November 2008 (UTC)

I think there is enough work being done on computerized CBT and Internet therapy for this field to warrant its own article. I removed some content from this article, that I find too detailed for the main article. That could be moved to computerised CBT. There is a lot of content we should add to this article on "regular" CBT, so we need to be careful about length, I think... /skagedal^... 07:26, 10 November 2008 (UTC)

Skagedal, thanks for that. I copied the old text that you alerted me to into the article on CCBT. If the computerized CBT article was elaborated then it might stand as an article on its own. I am still leaning towards one article that covers both topics. ----Action potential ^{t c} 08:30, 10 November 2008 (UTC)

I think we need to consider WP:DUE. Typical textbooks on CBT (e.g. Dobson "Handbook of Cognitive-Behavioral Therapies", Clark & Fairburn "Science and Practice of Cognitive Behaviour Therapy) don't discuss computerized CBT at any length. Considering the lack of discussion of other important modalities, such as group therapy, and the lack of explanation of common CBT techniques in this article, merging in more content on computerized CBT would make the article even less balanced. Anyway, the real problem is of course that this article fails to discuss important aspects of CBT, I'm slowly trying to remedy this...

One idea would be to widen the scope for the Computerised CBT article; move it to computerized therapy and discuss all approaches to psychological treatment using computers. From memory training programs designed for patients with ADHD to Internet therapy for social phobia – this field is huge. /skagedal^... 15:47, 27 November 2008 (UTC)

I think there should be a separate article, as there are likely to be a growing number of these programs available that it would be a good place to list them. There are already a few free ones on the web. And the lack of actual human interaction as with individual or group CBT would seem to be worth talking about in the article also. ffangs (talk) 19:17, 6 May 2009 (UTC)

As a psychologist, I think it should be within the article, including information on the accredited NICE CCBT programmes. —Preceding unsigned comment added by 62.31.240.220 (talk) 17:17, 10 August 2009 (UTC)

Is it Computerised CBT or Computerized CBT? The "computerised" is used in the title for the article and "computerized" is used in the article itself. The link from the "CBT" article is spelled the former way, but the sub-heading in the same article is spelled by the latter way. Is it computer -ise or -ize? —Preceding unsigned comment added by Mslitchfield (talk • contribs) 02:57, 10 January 2009 (UTC)

"computerised" is a (very common) misspelling. Unfortunately any attempt to change this to the more correct (Yes, more correct EVEN IN THE UK) ...ize will result in pig-ignorant tantrums of people claiming ...ize is always american and that .ise is always British and thus ...ise is as valid as ...ize. tl:dr - feel free to make all uses consistent (pick one form, go with it all through this article) but be prepared for fierce and sometimes incorrect opposition. 82.33.48.96 (talk) 13:53, 26 June 2009 (UTC)

removed comment in intro

I removed the text:

However most of the research data suffers from lack of proper controls and blinding. A recent review of the literature has concluded that the better designed studies show less or no effect in some of the above mentioned modalities ("Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials." Psychol Med. 2009 May 29:1-16).

The source can be found by link here: [4]. The text I removed seemed to be a very negative POV. I removed it on the following grounds:

It was not directly supported by the source. The source found CBT to be ineffective for treating schizofrenia and ineffective for preventing relapses in bipolar disorder, but found it weakly effective (less effective than previously thought) for treating major depression, but it found it to have a greater effect in preventing relapses of major depression. These are mixed results, but the comment made the source sound more negative by omitting specificity.

The source is specifically about major psychiatric disorders, and does not address all or even most of the list in the previous sentence "mood, anxiety, personality, eating, substance abuse, and psychotic disorders".

I think strong statements in the introduction, when controversial, generally require multiple sources.

I'd like to add this sentence back in...can we make it more NPOV and more accurately reflect the source? And are there any other independent sources covering the same thing? Considering others here would be ideal; it's also problematic that the previous sentence (which I left, and which is weakly positive about the effectiveness of CBT) only references a single source. Cazort (talk) 03:07, 18 August 2009 (UTC)

good remove. Dont add it back. CBT is well supported by good randomised control trials, even for major psychiatric disorders. See the meta analysis by Wykes on schizophrenia cited in the article Wykes T, Steel C, Everitt B, Tarrier N (2008). "Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor". Schizophr Bull. 34 (3): 523–37. doi:10.1093/schbul/sbm114. PMID 17962231. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)(2009). Earlypsychosis (talk) 08:00, 18 August 2009 (UTC)

found a general reference supporting CBT Butler AC, Chapman JE, Forman EM, Beck AT (2006). "The empirical status of cognitive-behavioral therapy: a review of meta-analyses". Clin Psychol Rev. 26 (1): 17–31. doi:10.1016/j.cpr.2005.07.003. PMID 16199119. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) and a good depression meta analysis Dobson KS (1989). "A meta-analysis of the efficacy of cognitive therapy for depression". J Consult Clin Psychol. 57 (3): 414–9. PMID 2738214. {{cite journal}}: Unknown parameter |month= ignored (help) both showing good evidence. Earlypsychosis (talk) 08:27, 18 August 2009 (UTC)

Thanks for confirming my intuition. I checked the edit history and it was added by the anonymous user 84.20.234.163, who also added the word "some" in "There is (some) empirical evidence"...I just removed this word too. The edit history showed no justification for the edits. Cazort (talk) 18:43, 18 August 2009 (UTC)

Superior to other modalities?

This quotation from para 3 "where specific treatments for symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments[5]" surely overreaches. The reality to date is that no head-to-head trial over active therapies has ever shown one to be superior. Yes, CBT is superior to wait-list controls, but so is every psychotherapeutic modality so-tested. CBT has more evidence (meaning more trials have been conducted), but it has *no* evidence of *superiority.*

For a very broad and deep survey of the current state of all psychotherapies, I draw your attention to:

[5]

Four years old now, but I'm not aware of any trial, meta-analysis or systematic review which refutes the essential findings.

Certainly, in the 80's, CBT did look superior to psychodynamic therapy in some trials, but those have long since come under heavy criticism and refutation due to the now widely acknowledged problem of bias due to investigator allegiance. All psychotherapy research has methodologically improved since that time, and it behooves this Wikipedia article to reflect the best state of current evidence.

Rtarzwell (talk) 04:18, 18 September 2009 (UTC)

removed correctional insitution material from lead

removed this from the introduction. not broad enought for opening paragraph and not sourced. added here for future use if needed.

In recent years, cognitive behavioral approaches have become widespread in correctional settings. These programs are designed to teach offenders cognitive skills that may reduce criminal behaviors. In many countries, it has become commonplace to find cognitive behavioral program strategies in use in prisons and jails. In cognitive orientated therapies, the objective is typically to identify and monitor thoughts, assumptions, beliefs and behaviors that accompany and are related to negative emotions, and to identify those which are dysfunctional, inaccurate, or unhelpful. The aim is to replace or transcend them with those which are more realistic and useful. Earlypsychosis (talk) 02:27, 23 August 2009 (UTC)

CBT v IPT

In my CBT for eating disorders lectures the lecturer mentioned that IPT was more effective longer term (at tweleve months). The researchers argued that CBT was just treating the symptoms and while still beneficial was less effective than IPT over the longer term. This effect was attributed to IPT dealing with the interpersonal relationships. Does anyone have the source for this research? Should we include some comparisons with other forms of psychotherapy? ----Action potential ^{discuss contribs} 14:34, 5 October 2009 (UTC)

Eating disorder

Currently eating disorders is not covered in this article. We could cover typical interventions. ----Action potential ^{discuss contribs} 14:41, 5 October 2009 (UTC)

CBT v. behavioural activation

There is an ongoing debate in the literature that it is more cost effective to train psychologists in behavioural only (e.g. behavioral activation) treatments. Cognitive therapy had no additive benefit over behavioral only. This is a recent finding, these treatments have not been compared like this before. Researchers believe that the behavioral intervention (exposure) was so powerful such the cognitive + exposure group had no additive benefit. The research in the current article is quite selective, I think the article would benefit from discussing some of these recent issues. ----Action potential ^{discuss contribs} 01:42, 6 October 2009 (UTC)

could you specify what literature outlines the debate? Cheers Earlypsychosis (talk) 18:46, 6 October 2009 (UTC)

EP, here are some references as a start. I'm not an expert on the topic. It was recently discussed in recent lectures on psychopathology and evidence-based treatments. The evidence from dismantling studies which looks at the active ingredients of CBT suggested that behavioral activation was so powerful that there was no need for the cognitive therapy part of CBT. The counter-argument was that cognitive restructuring is still useful for reducing drop-out rates, etc. I think we should also cover debate concerning CBT v. SSRI/SSNRI medication for treatment of depression.

Jacobson, N., Martell, C., & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8(3), 255-270.
Dimidjian, S., Hollon, S., Dobson, K., Schmaling, K., Kohlenberg, R., Addis, M., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658.
Ekers, D., Richards, D., & Gilbody, S. (2007). A meta-analysis of randomized trials of behavioural treatment of depression. Psychological Medicine, 38(05), 611-623.

Action potential ^{discuss contribs} 06:40, 7 October 2009 (UTC)

CBT Criticism

Cognitive Behavioral Therapy (CBT) Efficacy: Fact or Fiction?

This article is a comprehensive overview, plus it is a Systematic review of CBT (scholar source, although not published in a peer review journal). It shows (from a collection of scholar sources) that CBT is very effective in the short term, but has several drawbacks. a) Not all patients improve. b) Most patients that do improve, still have negative symptoms. c) The effects of CBT disappear in the long run (2-4 years after treatment). d) CBT overall is not more effective than other forms of psychotherapy.

This should go under the “criticism” section. But since I do not know how to enter it in the article, I added it as an external link. OK, I just looked at the regulations for external links: "Links to be considered -> Sites which fail to meet criteria for reliable sources yet still contain information about the subject of the article from knowledgeable sources." 94.68.16.252 (talk) 21:59, 26 October 2009 (UTC)

The external link was removed by user Scarpy, so I placed this note for extra consideration. 94.68.16.252 (talk) 22:03, 26 October 2009 (UTC)

soultherapynow.com is not a reliable source. -- Scarpy (talk) 22:28, 26 October 2009 (UTC)

Yes, it is not a reliable source since it is not a peer reviewed journal. So then it qualifies for External links, under "Links to be considered -> Sites which fail to meet criteria for reliable sources yet still contain information about the subject of the article from knowledgeable sources", as I mentioned above? 94.68.16.252 (talk) 22:46, 26 October 2009 (UTC)

It meets the first criteria of links normally to be avoided (Any site that does not provide a unique resource beyond what the article would contain if it became a Featured article). Having a closer look it also meets the second, fourth and fifth criteria on that list. While there may be a weak argument for considering it, we have four reasons to avoid it. -- Scarpy (talk) 23:28, 26 October 2009 (UTC)

the fact or ficton article is a very poor source. It is an unpublished website page with a selection of articles to push a bias agenda. The question is not whether or not CBT is an effective treatment per se, but for what conditions CBT has been shown to be effective, and how it compares to other forms of treatment. Earlypsychosis (talk) 08:35, 27 October 2009 (UTC)

CBT generally is effective, otherwise it would not be so popular. But even the Wiki-CBT-Criticism article says CBT is not more effective than other forms of Psychotherapy:"At the same conference,[51] professors Robert Elliott and Beth Freire presented their unpublished meta-analysis of more than 80 studies where person-centered psychotherapy was shown to be as effective as other forms of psychotherapy, including CBT.[52]". I have not encountered any study where CBT would be sufficienty effective after 5-10-20 years. 94.68.16.252 (talk) 10:51, 27 October 2009 (UTC)

Effective or Ineffective in Depression ?

I am confused about how the last sentence should be read:

"The authors also found few well-controlled studies of CBT in depression that found the therapy to be effective, and that CBT is also ineffective in preventing relapses in bipolar disorder."

Doesn't the second "also" imply that CBT in depression was found to be ineffective ?

Marq au (talk) 02:23, 2 March 2010 (UTC)

Check out this edit: [6]. - Tekaphor (TALK) 01:07, 9 March 2010 (UTC)

there are plenty of reviews that find CBT with good effect sizes - so maybe the authors of the cited article didnt look hard enough! For example, Dobson KS (1989). "A meta-analysis of the efficacy of cognitive therapy for depression". J Consult Clin Psychol. 57 (3): 414–9. PMID 2738214. {{cite journal}}: Unknown parameter |month= ignored (help) and Dobson KS, Hollon SD, Dimidjian S; et al. (2008). "Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression". J Consult Clin Psychol. 76 (3): 468–77. doi:10.1037/0022-006X.76.3.468. PMC 2648513. PMID 18540740. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) Earlypsychosis (talk) 07:10, 9 March 2010 (UTC)

why is there no table of contents on this talk page

?? Earlypsychosis (talk) 07:12, 9 March 2010 (UTC)

CBT may also be helpful to smokers -- majority are depressed, and depression makes quitting much harder.

Depressed Adults are Nearly Twice as Likely to Smoke as Those Not Depressed

Pratt LA, Brody DJ. Depression and smoking in the U.S. household population aged 20 and over, 2005-2008. NCHS data brief, no 34. Hyattsville, MD: National Center for Health Statistics. 2010. http://www.cdc.gov/nchs/data/databriefs/db34.htm#ref5

Depressed People Smoke More, Quit Less As Depression Deepens, Cigarette Smoking Increases By Daniel J. DeNoon WebMD Health News Reviewed by Laura J. Martin, MD http://www.webmd.com/depression/news/20100414/depressed-people-smoke-more-quit-less

Survey shows how depression and smoking intertwine http://www.reuters.com/article/idUSTRE63D48O20100414

Many Smokers Suffer from Depression By Psych Central News Editor Reviewed by John M. Grohol, Psy.D. on April 14, 2010 http://psychcentral.com/news/2010/04/14/many-smokers-suffer-from-depression/12846.html

Many smokers are depressed April 14, 2010 | 8:54 am "Among men ages 40 to 54, a whopping 55% of those who smoke have depression. Among women ages 20 to 39 who smoke, 50% have depression." http://latimesblogs.latimes.com/booster_shots/2010/04/smoking-depression.html

Looks like CBT is also being used to help smokers, many of whom are depressed.

At least a couple of antidepressants are already marketed as smoking-cessation aids, with demonstrable benefits.

Could be a really interesting CBT study. —Preceding unsigned comment added by 68.165.11.102 (talk) 15:13, 15 April 2010 (UTC)

WP:Weasel Words and Arnold Lazarus's Work

I see a problem in this article with weasel words, surrounding the work of Arnold Lazarus. There are several highly WP:POV sentences that are unsourced or not properly source. This sentence was not sourced:

"When it became clear that optimizing therapy's effectiveness and effecting durable treatment outcomes often required transcending more narrowly focused cognitive and behavioral methods^{[clarification needed]}, Arnold Lazarus expanded the scope of CBT to include physical sensations (as distinct from emotional states), visual images (as distinct from language-based thinking), interpersonal relationships, and biological factors."

The "weasel words" here are "it became clear"...according to whom? And "narrowly focused" also has a negative connotation...whereas "expanded the scope" has a positive connotation. Really, what Lazarus did was to develop a new method / approach to therapy...we need to be careful to maintain WP:NPOV here. This next sentence is sourced by a work of Lazarus himself:

Concurrently with the contributions of Ellis and Beck, starting in the late 1950s and continuing through the 1970s, Arnold A. Lazarus developed what was arguably the first form of broad-spectrum cognitive behavioral therapy.

The "Weasel word" here is "arguably" ...arguably according to whom? This needs to be sourced with a third-party source (i.e. not Lazarus or another developer or proponent of the theory) who can be identified by name. It looks like someone has been editing this article in such a way as to introduce a favorable perspective on this particular approach or person. Cazort (talk) 00:56, 26 September 2010 (UTC)

Misleading paragraph

"In a 2010 article in Psychological Medicine entitled, "Cognitive behavioral therapy for the major psychiatric disorder: does it really work?",^[2] the authors found that no trial employing both blinding and psychological placebo has found CBT to be effective in schizophrenia. The authors also found few well-controlled studies of CBT in depression that found the therapy to be effective, and in those found, the effect was small. CBT is also ineffective in preventing relapses in bipolar disorder."

This paragraph is very misleading. More details should be provided or should be removed outright. It mentions only schizophrenia in the first sentence, and that is far too specific. I agree with the statement, despite NICE's suggestions, but I think it is misleading to some extent. More important is the following sentence, which does not properly synthesize the findings of the study, and the final sentence which seems to be simply a statement of fact, while it clearly is not a fact. Sorry for bad spelling/mistakes, I wish I had more time to fix this section and explain myself, but alas!— Preceding unsigned comment added by 64.110.237.63 (talk • contribs) 22:01, 13 November 2010

Added back the above paragraph because the removal was absurd and unsupported. I have removed the reference tha followed it by Kingdon and colleagues regarding the (assumed) efficacy of CBT as it contains no data and is an anecdotal description of some individual cases — Preceding unsigned comment added by Sjadd (talk • contribs) 07:02, 27 January 2011 (UTC)

Merging Article Into Full CBT Article

Strong Support This basic article and its subject matter are covered in CBT's main article, but this article is more detailed. Suggest supplanting this for the material in the CBT section, using any non-redundant matter to strengthen this section. Cesium 133 (talk) 08:15, 22 December 2010 (UTC)

suggested textual change: 'manualized' to using a manual - as 'manualized' as a term is confusing

Google 'manualized' to see pages discussing this word.

fjgseyferth 83.117.110.100 (talk) —Preceding undated comment added 10:44, 15 January 2011 (UTC).

I was just about to make a post here about the confusing nature of the "manualized" term, but saw one was already made. Twipley (talk) 20:32, 26 March 2011 (UTC)

Yup, agree with this. The term threw me and I thought it meant "converted to a process of manual labour". Never heard the word manualized before. What alternatives? Systematized? "Using a manual" is fine I guess —Preceding unsigned comment added by 2.25.6.107 (talk) 18:26, 22 May 2011 (UTC)

Emotional edits

Please try to keep the definition clinical and not inject your personal feelings into the definition of the item itself. Thank you! — Preceding unsigned comment added by 216.67.20.109 (talk) 23:52, 16 July 2011 (UTC)

No mention of CFS?

We should add a section on CFS to the article. --sciencewatcher (talk) 16:10, 7 August 2011 (UTC).

what is CFS ? Earlypsychosis (talk) 07:56, 8 August 2011 (UTC)

Chronic fatigue syndrome. CBT is the only treatment that has been shown to be (somewhat) effective for CFS. --sciencewatcher (talk) 14:19, 8 August 2011 (UTC)

post stroke depress

We should add some of the studies that show where CBT is ineffective too... we should not cherry pick successes. --122.108.140.210 (talk) 01:27, 6 November 2011 (UTC)

Assessment comment

The comment(s) below were originally left at Talk:Cognitive behavioral therapy/Comments, and are posted here for posterity. Following several discussions in past years, these subpages are now deprecated. The comments may be irrelevant or outdated; if so, please feel free to remove this section.

== Superior to other modalities? ==

This quotation from para 2 "where specific treatments for symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments[5]" surely overreaches. The reality to date is that no head-to-head trial over active therapies has ever shown one to be superior. Yes, CBT is superior to wait-list controls, but so is every psychotherapeutic modality so-tested. CBT has more evidence (meaning more trials have been conducted), but it has *no* evidence of *superiority.*