Cognitive therapy is a system of psychotherapy that emphasizes the role of information processing in human behavior and psychological distress. It posits that how people perceive, interpret, and assign meanings to events strongly influences their emotional and behavioral reactions. It also maintains that significant
Cognitive Therapy life experiences shape core beliefs about the self and the world. These core beliefs, in turn, affect how new information is incorporated. Cognitive therapy is thus concerned with both the idiosyncratic meanings of events for people and the ways in which these meanings are generated and maintained. Although the content of cognitions (i.e., thoughts and images) may be highly personal, the mechanisms of cognitive processing are believed to be universal.
Cognitive therapy was developed in the 1960s by psychiatrist Aaron T. Beck. It is derived from empirical findings from studies of depressed patients. Beck found that depressed patients' thinking is saturated with themes of deprivation, defeat, and loss. Moreover, their judgments are absolute and rigid. Usually, information processing proceeds in a fairly flexible manner, so that initial impressions or primary appraisals may be checked and verified or adjusted. Beck observed that during depression this flexibility is lost, making it extremely difficult for depressed persons to generate alternative interpretations of events, solutions to problems, or new ways of behaving. Cognitive deficits, such as impaired perception, recall, and long-term memory, interfere with reasoning. Errors in logic, or cognitive distortions, become more apparent and create a negative bias to thinking.
Cognitive distortions are present in the thinking of nondepressed persons as well, for no one has perfect understanding. However, in the case of depression, anxiety, or other syndromes, these distortions are rigidly applied and initial impressions are not reeval-uated. Self-correction is limited. In addition, in psychological distress, errors in thinking are combined with maladaptive assumptions, leading the patient in a negative spiral. Cognitive distortions include over-generalization, dichotomous thinking, arbitrary inference, selective abstraction, personalization, and maximization and minimization. The goals of cognitive therapy are to return the person to more flexible thinking and to modify maladaptive beliefs and assumptions which may be risks for further depression. Cognitive therapy teaches people to identify and correct the distortions in their thinking to regain flexibility. It also teaches them to assess the utility of their beliefs and assumptions and to modify them if necessary. Beliefs are modified by examining them logically and considering alternative interpretations and through behavioral experiments designed to challenge specific assumptions.
The cognitive model of depression has found support for descriptive aspects of its theory and for its treatment efficacy. Cognitive therapy has also been applied to a number of other psychological disorders, including anxiety, personality disorders, substance abuse, eating disorders, stress, and marital conflict. More recently, it has been applied to nonclinical problems, such as management problems in business and conflict resolution in schools.
An important finding of treatment outcome studies in depression has been the apparent benefit of cognitive therapy in relapse prevention. This finding has generated studies of depression prevention with populations at risk. Thus, cognitive therapy may be helpful in preventing depression, not just in treating people once they have become depressed. Additionally, school intervention programs that teach cognitive skills such as problem solving, disputing negative self-talk, and improving self-esteem promote positive adjustment at a community level. In this sense, cognitive interventions may contribute to public health.
In theory and in practice, cognitive therapy addresses a spectrum of mental health, from treating psychiatric diagnoses to enhancing the functioning of those at risk for depression or poor social adjustment. This article reviews the cognitive model of psychopa-thology, describes characteristics of healthy cognitive functioning and presents information on how cognitive therapy may be used to promote mental health.
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