Common Questions Well-nigh Cerebral Behavior Therapy for Psychiatric Disorders

SCOTT F. COFFEY, PhD, and ANNE North. BANDUCCI, PhD, University of Mississippi Medical Eye, Jackson, Mississippi

Am Fam Physician. 2015 Nov 1;92(ix):807-812.

Patient information: See related handout on cognitive behavior therapy, written by the authors of this article.

This clinical content conforms to AAFP criteria for continuing medical educational activity (CME). See the CME Quiz Questions.

Author disclosure: No relevant financial affiliations.

Article Sections

  • Abstruse
  • Which Patients Benefit from CBT?
  • How Does CBT Work?
  • How Does CBT Improve Depression?
  • How Does CBT Better Anxiety and Trauma-Related Disorders?
  • Is CBT Different When Used in Children vs. Adults?
  • Is CBT Constructive for Other Disorders?
  • When Can CBT Be Combined with Medications?
  • What Are the Potential Limitations of CBT?
  • How Can Family Physicians Integrate CBT into Practice and Provide Referrals to Effective Therapists?
  • References

Cognitive behavior therapy (CBT) is a fourth dimension-express, goal-oriented psychotherapy that has been extensively researched and has benefits in a number of psychiatric disorders, including feet, depression, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, autism, obsessive-compulsive and tic disorders, personality disorders, eating disorders, and insomnia. CBT uses targeted strategies to help patients adopt more adaptive patterns of thinking and behaving, which leads to positive changes in emotions and decreased functional impairments. Strategies include identifying and challenging problematic thoughts and behavior, scheduling pleasant activities to increase ecology reinforcement, and extended exposure to unpleasant thoughts, situations, or physiologic sensations to subtract avoidance and arousal associated with anxiety-eliciting stimuli. CBT tin can be helpful in the treatment of posttraumatic stress disorder past emphasizing safety, trust, control, esteem, and intimacy. Prolonged exposure therapy is a CBT technique that includes a variety of strategies, such as repeated recounting of the trauma and exposure to feared real-world situations. For attending-arrears/hyperactivity disorder, CBT focuses on establishing structures and routines, and clear rules and expectations within the dwelling and classroom. Early intensive behavioral interventions should be initiated in children with autism earlier three years of age; therapy consists of 12 to twoscore hours of intensive treatment per week, for at least i twelvemonth. In many disorders, CBT can be used alone or in combination with medications. Notwithstanding, CBT requires a significant commitment from patients. Family physicians are well suited to provide collaborative care for patients with psychiatric disorders, in concert with cerebral behavior therapists.

Cerebral behavior therapy (CBT) is a group of time-limited, goal-oriented psychotherapies that have been extensively researched for the treatment of psychiatric disorders. CBT targets changes in symptoms of psychiatric disorders to reduce functional impairments and improve patients' overall quality of life. This article aims to provide a concise overview of CBT, including the types of disorders it can treat, how it can be combined with pharmacotherapy, and how family physicians tin can utilise CBT principles in their do.

SORT: Cardinal RECOMMENDATIONS FOR Exercise

Clinical recommendation Evidence rating References

CBT is an effective treatment for mild to moderate low, anxiety disorders, posttraumatic stress disorder, obsessive-compulsive and tic disorders, autism, eating disorders, personality disorders, indisposition, and attention-arrears/hyperactivity disorder.

A

ane–18, 34–37

Psychiatric medications are the primary handling for schizophrenia and bipolar disorder, only CBT provides boosted benefits.

B

22, 23

For many psychiatric conditions, CBT provides similar outcomes or boosted benefits compared with psychiatric medications solitary.

A

v, nine–11, 18, 20, 22, 24–27

Benzodiazepine utilize should be avoided in patients who are receiving CBT because it can interfere with exposure therapy.

C

38–41

All-time PRACTICES IN PSYCHIATRY: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

Recommendation Sponsoring organization

Avoid utilize of hypnotics as primary therapy for chronic insomnia in adults; instead, offering cognitive behavior therapy, and reserve medication for adjunctive treatment when necessary.

American Academy of Slumber Medicine

Do not prescribe medication to care for childhood indisposition, which ordinarily arises from parent-child interactions and responds to behavioral intervention.

American University of Sleep Medicine

Which Patients Benefit from CBT?

  • Abstract
  • Which Patients Do good from CBT?
  • How Does CBT Piece of work?
  • How Does CBT Better Depression?
  • How Does CBT Amend Anxiety and Trauma-Related Disorders?
  • Is CBT Different When Used in Children vs. Adults?
  • Is CBT Constructive for Other Disorders?
  • When Can CBT Be Combined with Medications?
  • What Are the Potential Limitations of CBT?
  • How Tin Family Physicians Integrate CBT into Exercise and Provide Referrals to Effective Therapists?
  • References

CBT is effective for the treatment of anxiety, depression, posttraumatic stress disorder (PTSD), attention-arrears/hyperactivity disorder (ADHD), autism, obsessive-compulsive and tic disorders, personality disorders, eating disorders, and insomnia. CBT-based treatments for specific disorders are bachelor at http://www.abct.org/Information/?m=mInformation&fa=FactSheets.

Show SUMMARY

CBT effectively targets symptoms of anxiety,1–iv depression,v–7 PTSD,8,nine ADHD,10,11 autism,12,13 obsessive-compulsive and tic disorders,14 personality disorders,15,16 eating disorders,17 and insomnia18 in children, adolescents, and adults. Numerous meta-analyses and reviews have demonstrated that CBT reduces psychiatric symptoms and functional impairments, and improves quality of life.1–xviii The American Psychological Association lists CBT as an constructive treatment for numerous disorders.19 Moreover, CBT has been shown to be as constructive every bit or more constructive than medications for depression, feet, and trauma-related disorders,5,nine,twenty–29 and it is a useful adjunctive therapy for disorders such as ADHD, schizophrenia, and bipolar disorder.10–12,22,23

How Does CBT Work?

  • Abstract
  • Which Patients Benefit from CBT?
  • How Does CBT Piece of work?
  • How Does CBT Amend Depression?
  • How Does CBT Improve Anxiety and Trauma-Related Disorders?
  • Is CBT Different When Used in Children vs. Adults?
  • Is CBT Constructive for Other Disorders?
  • When Can CBT Be Combined with Medications?
  • What Are the Potential Limitations of CBT?
  • How Tin Family unit Physicians Integrate CBT into Practice and Provide Referrals to Constructive Therapists?
  • References

According to the cognitive behavioral model, psychopathology occurs because of problematic patterns in thinking and beliefs that lead to hard emotions and functional impairments (Figure 1). The aim of CBT is to help patients prefer more adaptive patterns of thinking and beliefs to ameliorate function and quality of life. Handling goals are selected collaboratively with patients to decide whether progress is being made. CBT involves 3 core strategies applied alone or in combination, depending on the patients' needs: (1) identifying and challenging problematic thoughts and behavior, with the goal of helping patients develop more realistic and adaptive thoughts and beliefs, (2) scheduling pleasant activities to increase ecology reinforcement, and (3) extended exposure to unpleasant thoughts, situations, or physiologic sensations to decrease avoidance and arousal associated with anxiety-eliciting stimuli.xxx

Cerebral Behavioral Model

Effigy 1.

The cognitive behavioral model illustrates problematic patterns in thoughts and behaviors that pb to emotional difficulties and functional impairments.

EVIDENCE SUMMARY

Inquiry demonstrates that problematic patterns of thinking and behavior underlie well-nigh forms of psychopathology.thirty Behavioral change has been shown to lead to cognitive changes, and vice versa; these changes atomic number 82 to reductions in psychopathology.5,half dozen

How Does CBT Amend Depression?

  • Abstract
  • Which Patients Benefit from CBT?
  • How Does CBT Work?
  • How Does CBT Ameliorate Low?
  • How Does CBT Improve Anxiety and Trauma-Related Disorders?
  • Is CBT Different When Used in Children vs. Adults?
  • Is CBT Effective for Other Disorders?
  • When Can CBT Exist Combined with Medications?
  • What Are the Potential Limitations of CBT?
  • How Tin Family Physicians Integrate CBT into Practice and Provide Referrals to Effective Therapists?
  • References

A cerebral behavior therapist whose patient feels sad and hopeless might choose to target the patient's maladaptive thoughts ("I cannot connect with anyone.") or behaviors (isolating and watching television). Targeting changes in either domain leads to changes in the other and in the patient's emotions.5,6 For case, the therapist might challenge the patient's thoughts by eliciting examples of occasions when the patient was able to positively engage with others. This could cause the patient to feel less hopeless as he or she realizes that the thought was not accurate, and to phone call a friend to reconnect. Alternatively, the therapist could try to change the maladaptive behaviors by helping the patient schedule pleasant activities consistent with his or her values (calling a friend). This reconnection could boost the patient's mood and alter the belief that he or she volition always be lone. Although these examples misrepresent the amount of therapeutic work needed to alter entrenched patterns of thoughts and behaviors, they give a sense of what the therapeutic procedure might involve.

Prove SUMMARY

CBT can exist used to reduce symptoms of depression, with or without medication.5–7,xx–29,31–33 Although treatment guidelines from the American Psychiatric Association propose that medication should be used equally a outset-line treatment for depression, CBT should likewise exist considered. Evidence has shown that CBT and paroxetine (Paxil) produce equivalent outcomes in patients with severe low.34 Thus, family physicians must utilize their clinical judgment in determining which treatments to suggest for their patients.

How Does CBT Meliorate Anxiety and Trauma-Related Disorders?

  • Abstract
  • Which Patients Do good from CBT?
  • How Does CBT Piece of work?
  • How Does CBT Improve Low?
  • How Does CBT Ameliorate Anxiety and Trauma-Related Disorders?
  • Is CBT Different When Used in Children vs. Adults?
  • Is CBT Effective for Other Disorders?
  • When Can CBT Be Combined with Medications?
  • What Are the Potential Limitations of CBT?
  • How Tin can Family Physicians Integrate CBT into Practice and Provide Referrals to Effective Therapists?
  • References

Similar to the case above, therapists who are treating patients with anxiety and trauma-related disorders challenge problematic patterns of thoughts or behaviors. A more thorough clarification of CBT for PTSD is provided here as an case.

Evidence-based therapies for PTSD in adults include cognitive processing therapy and prolonged exposure therapy, whereas trauma-focused CBT is used in younger patients. Cerebral processing therapy includes psychoeducation about PTSD and focuses on challenging maladaptive thoughts and beliefs most safe, trust, control, esteem, and intimacy.35 Prolonged exposure therapy includes psychoeducation most PTSD, breathing retraining to decrease arousal, repeated recounting of the trauma to teach patients that the memories are non dangerous and practice not need to be avoided, and in vivo exposure to feared real-globe situations.8,nine In younger patients, trauma-focused CBT includes components similar to those for prolonged exposure and cerebral processing therapies, merely too includes parallel and joint parental sessions.36

EVIDENCE SUMMARY

CBT techniques for the treatment of PTSD can be applied beyond all anxiety and trauma-related disorders in children, adolescents, and adults.1–three,35–37

Is CBT Different When Used in Children vs. Adults?

  • Abstract
  • Which Patients Benefit from CBT?
  • How Does CBT Work?
  • How Does CBT Improve Depression?
  • How Does CBT Better Anxiety and Trauma-Related Disorders?
  • Is CBT Different When Used in Children vs. Adults?
  • Is CBT Constructive for Other Disorders?
  • When Tin CBT Exist Combined with Medications?
  • What Are the Potential Limitations of CBT?
  • How Tin Family unit Physicians Integrate CBT into Practice and Provide Referrals to Effective Therapists?
  • References

Parental involvement in therapy is necessary when children receive CBT. Parents can ensure that their child engages in behavioral exercises between therapy sessions (e.thousand., in vivo exposures, pleasant activities), can change the child's environment to promote more effective behaviors, and can help the child target changes in maladaptive thoughts. In full general, CBT for children focuses more on behavior changes and less on cerebral changes. Behavioral techniques used for children with ADHD and autism are described beneath.

ADHD

A recent review showed that behavioral parent training, behavioral classroom management, and behavioral peer interventions are well-established treatments for ADHD.11 Behavioral parent training and behavioral classroom management focus on strategies implemented past adults to assist children with ADHD part more effectively, including creating structure and routines, setting clear rules and expectations, using effective commands, and rewarding or punishing the child based on his or her compliance. These techniques help reduce behavioral problems experienced past children with ADHD and decrease the need for polypharmacy to manage symptoms.11

AUTISM

Early intensive behavioral interventions are the only show-based handling that confers significant benefits in children with autism.12 These interventions should be initiated earlier three years of age and often consist of 12 to 40 hours of intensive treatment per week, for at least one twelvemonth. Parents and therapists engage in intensive exercises focused on reinforcing and rewarding adaptive behaviors. Behavioral treatments for autism produce significant improvements in IQ and adaptive behaviors.xiii

Evidence SUMMARY

Behavioral therapy is the simply effective treatment for autism12 and is an important adjunctive treatment for ADHD.10,11 In addition, CBT provides substantial benefits for children with low or anxiety.3,7

Is CBT Effective for Other Disorders?

  • Abstract
  • Which Patients Do good from CBT?
  • How Does CBT Work?
  • How Does CBT Improve Depression?
  • How Does CBT Better Feet and Trauma-Related Disorders?
  • Is CBT Different When Used in Children vs. Adults?
  • Is CBT Effective for Other Disorders?
  • When Can CBT Be Combined with Medications?
  • What Are the Potential Limitations of CBT?
  • How Tin Family unit Physicians Integrate CBT into Do and Provide Referrals to Effective Therapists?
  • References

CBT has been examined and tested across a wide range of psychiatric disorders. In addition, information technology has been examined every bit an adjunctive handling for medical issues in which beliefs change could enhance outcomes.

EVIDENCE SUMMARY

Although a thorough discussion of the effectiveness of CBT for all psychiatric disorders is across the scope of this article, information technology has been shown to have meaning benefits for patients with indisposition,xviii psychosis,23 bipolar disorder,22 eating disorders,17 and personality disorders.15,sixteen Family physicians are encouraged to seek adjunctive CBT for patients diagnosed with these disorders.

When Can CBT Be Combined with Medications?

  • Abstract
  • Which Patients Benefit from CBT?
  • How Does CBT Piece of work?
  • How Does CBT Improve Low?
  • How Does CBT Amend Feet and Trauma-Related Disorders?
  • Is CBT Dissimilar When Used in Children vs. Adults?
  • Is CBT Effective for Other Disorders?
  • When Can CBT Exist Combined with Medications?
  • What Are the Potential Limitations of CBT?
  • How Tin Family Physicians Integrate CBT into Practice and Provide Referrals to Effective Therapists?
  • References

CBT can be used alone or in combination with medications for a variety of psychiatric disorders. Medications tin can be used to stabilize patients and promote recovery, whereas CBT can exist used to encourage long-term changes in thoughts and behaviors.

EVIDENCE SUMMARY

CBT generally produces equivalent outcomes or provides additional benefits compared with the use of psychiatric medications lone.5,ix,12,20–23,26,34 Moreover, CBT is often more toll-effective, has more than enduring effects,9,21–23,27,28 and lacks the adverse furnishings associated with many psychiatric medications. The furnishings of CBT are reduced in patients who are receiving benzodiazepines38–twoscore; therefore, these medications should exist avoided in patients with anxiety and trauma-related disorders. Although a combination of CBT and benzodiazepines may initially seem beneficial (east.chiliad., reduced arousal, improved sleep), this approach may actually limit the gains made with CBT (eastward.thou., patients may not be able to appoint in exposure exercises when arousal is reduced as a result of medication apply).38,41

What Are the Potential Limitations of CBT?

  • Abstract
  • Which Patients Benefit from CBT?
  • How Does CBT Work?
  • How Does CBT Amend Depression?
  • How Does CBT Better Anxiety and Trauma-Related Disorders?
  • Is CBT Unlike When Used in Children vs. Adults?
  • Is CBT Effective for Other Disorders?
  • When Tin CBT Be Combined with Medications?
  • What Are the Potential Limitations of CBT?
  • How Can Family unit Physicians Integrate CBT into Practice and Provide Referrals to Effective Therapists?
  • References

CBT is almost effective when patients consummate therapeutic exercises outside of the treatment session; therefore, information technology requires a significant commitment from patients. Some of the therapeutic strategies may involve anxiety-eliciting stimuli, which tin can be distressing—although brusk-lived—for some patients. The structured nature of CBT is non a expert fit for patients who are seeking insight into the underlying causes of their distress. Lastly, CBT is non a substitute for pharmacotherapy for some disorders. For case, CBT should be considered an adjunctive treatment in the management of bipolar disorder, psychotic disorders, and depression with psychotic features.

How Tin Family Physicians Integrate CBT into Practice and Provide Referrals to Effective Therapists?

  • Abstract
  • Which Patients Benefit from CBT?
  • How Does CBT Work?
  • How Does CBT Improve Depression?
  • How Does CBT Better Feet and Trauma-Related Disorders?
  • Is CBT Different When Used in Children vs. Adults?
  • Is CBT Effective for Other Disorders?
  • When Tin CBT Be Combined with Medications?
  • What Are the Potential Limitations of CBT?
  • How Tin can Family Physicians Integrate CBT into Practice and Provide Referrals to Effective Therapists?
  • References

When discussing psychiatric disorders with patients, family physicians are well suited to help patients decide which services to seek. In add-on to asking almost patients' personal and family histories of psychiatric disorders, family physicians can help patients identify thoughts and behaviors that are contributing to their problems. For example, abstention behaviors (e.g., avoiding crowded stores, avoiding interacting with the opposite sex) help maintain anxiety disorders and PTSD. Family physicians can encourage patients to face safe stimuli and, if possible, seek condom fear-eliciting stimuli. For patients with depressive symptoms, encouraging engagement in a daily pleasant activity is helpful.32

Family unit physicians are on the front line when it comes to treatments for psychiatric disorders and can be influential when recommending treatments to their patients. Building a collaborative relationship with community-based beliefs therapists enables family physicians to provide comprehensive intendance. Table one provides resource for CBT, including websites for locating therapists and information to help patients select a therapist. For patients who are already engaged in therapy, family physicians can help determine whether they would do good from CBT, especially if the alternative is a potentially longer-term, less cost-constructive form of psychotherapy. Table two lists central features of CBT that physicians tin comprise into discussions to optimize their patients' care.

Table 2.

Core Components and Characteristics of Cognitive Behavior Therapy

One 60- to 90-minute session per week, typically for eight to 12 weeks

Symptom measures are nerveless frequently

Treatment is goal-oriented and collaborative; patient is expected to be an active participant

Handling is focused on changing electric current problematic or maladaptive thoughts or behaviors

Weekly homework assignments

Data Sources: A PsycINFO search was completed using the central terms cerebral behavioral therapy, cognitive therapy, and behavior therapy. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Search dates: October and November 2014. In improver, we used an show summary from Essential Testify Plus.

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The Authors

show all author info

SCOTT F. COFFEY, PhD, is the director of the Division of Psychology and vice chair for research in the Department of Psychiatry and Homo Behavior at the University of Mississippi Medical Center, Jackson....

ANNE N. BANDUCCI, PhD, is a postdoctoral research fellow at the National Heart for PTSD at the VA Palo Alto (Calif.) Health Intendance Organisation. At the time the article was written, she was a resident in the Section of Psychiatry and Human Behavior at the University of Mississippi Medical Middle.

CHRISTINE VINCI, PhD, is a postdoctoral research fellow in the Department of Health Disparities Inquiry at the Academy of Texas One thousand.D. Anderson Cancer Center, Houston.

Address correspondence to Scott F. Coffey, PhD, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216 (e-post: scoffey@umc.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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35. Monson CM, Schnurr PP, Resick PA, Friedman MJ, Young-Xu Y, Stevens SP. Cognitive processing therapy for veterans with military machine-related post-traumatic stress disorder. J Consult Clin Psychol. 2006;74(v):898–907.

36. de Arellano MA, Lyman DR, Jobe-Shields L, et al. Trauma-focused cerebral-behavioral therapy for children and adolescents: assessing the evidence. Psychiatr Serv. 2014;65(five):591–602.

37. Foa EB, McLean CP, Capaldi S, Rosenfield D. Prolonged exposure vs supportive counseling for sexual abuse-related PTSD in boyish girls: a randomized clinical trial. JAMA. 2013;310(24):2650–2657.

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40. Bernardy NC. The function of benzodiazepines in the treatment of posttraumatic stress disorder (PTSD). PTSD Res Q. 2013;23(4):1–nine. http://www.quantumunitsed.com/get-textile.php?id=316. Accessed June 1, 2015.

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