...The REsource for Advancing Children's Health

Cognitive Therapy

Cognitive therapy as it is practiced today was developed by Aaron Beck in the 1970s, and was based on underlying theoretical assumption that a person's feelings and behavior are shaped by the way that he or she thinks about the world. According to this theory, the structure of a person's world is based on insights or reasonings, known as cognitions developed from previous experiences. Disorders in which cognitions may play a great role include obsessive-compulsive disorder, paranoid personality disorder, major depressive disorder, and somatoform disorders.

Usually, cognitive therapy is a short-term therapy, lasting up to twenty-five weeks. Maintenance may be carried out for years to follow. It is a structured therapy in which there is an active collaboration between the patient and the therapist, usually on an individual basis (although it can be carried out in a group environment).

There are three elements in cognitive therapy:

1. the educational aspect;
2. the cognitive aspect; and
3. the behavioral aspect.

Initially, the therapist meets with the entire family in order to learn the environment in which the symptoms occur and to facilitate family involvement in the treatment.

In the educational component, the patient and therapist formulate a hypothesis together, which is thought to explain the relationship between the person's emotional difficulties (such as depression) and their thinking and behavior. This hypothesis is tested throughout the treatment process.

Once a hypothesis has been formulated, the relationship between an event or action and the patient's emotional reaction (so-called "automatic thoughts") must be identified. After identification, the youngster and therapist test whether the automatic thoughts actually make sense, in order to reject the wrong or exaggerated automatic thoughts. In this way, it becomes possible to identify patterns of overgeneralizations ("If anyone doesn't like me, no one likes me.") that have guided the youth's thinking and behavior.

Lastly, and the overall purpose of cognitive therapy, is for the patient to understand the inaccuracy of cognitive assumptions and to learn new ways of dealing with issues.