Mental and behavioural illnesses have had a long history of stigma, which has devastating effects on the lives of people with psychiatric disorders, their families, and those who care for them (Ben-Zeev et al.). Because of the stigma, and because of the adverse effects of mental and behavioural illnesses, there is a need for developing a cohesive treatment intervention for elevating the burden. Cognitive behavioural therapy (CBT) is a type of therapy that is aimed at helping patients manage their problems with the help of changing the way in which they behave and think.
In most cases, cognitive behavioural therapy is used by health professionals to deal with patients’ depression and anxiety; however, it has also proven to be helpful when managing other physical and mental health issues. As a practical tool for addressing emotional challenges, CBT can help be beneficial for:
- Managing symptoms associated with mental illness;
- Preventing relapses of those symptoms;
- Treating mental diseases that cannot be addressed through medication;
- Coping with loss and grief;
- Overcoming emotional trauma associated with violent or abusive events;
- Teaching techniques for coping.
Overview of Cognitive Behavioural Therapy
The efficacy of cognitive behavioural therapy has been extensively studied in the research literature. For instance, Hofmann et al. found that CBT was arguably the most widely studied type of psychotherapy that could be applied to a variety of settings and problems such as substance abuse, bipolar disease, schizophrenia, insomnia, general stress, and other conditions that cause suffering to patients.
Researchers concluded that the effect size of CBT on substance abuse ranged from small to medium and that the efficacy of CBT for treating psychotic disorders was high for secondary outcomes (Hogmann et al.). Some debates occurred regarding the effectiveness of CBT for treating depression and dysthymia, with some evidence pointing and the association of strong effects found in some studies and the overestimations of publication bias (Cuijpers et al.).
CBT efficacy for treating bipolar was also reported as small to medium in short-term, with uncertainties whether it would remain effective on a long term. Lastly, it is worth mentioning the effectiveness of CBT in treating anxiety disorders. According to Hogmann et al., many studies reported significant effect sizes for the treatment of OCD, and the smallest to medium effect sizes were associated with the treatment of such conditions as social anxiety disorder, panic disorder, and PTSD.
Otte had a more particular approach towards studying the effects of CBT and only focused on examining its effectiveness within the context of anxiety disorder therapy. The researcher found that overall, CBT showed efficacy in randomised control trials and was useful in naturalistic settings for the treatment of adult anxiety disorders. On the other hand, some methodological issues prevented Otte from determining the magnitude of CBT’s effect. Therefore, there is still room for improvement for studies and analysis of CBT, although it was identified as one of the most empirically supported psychotherapeutic options for treating anxiety disorders (Otte).
On the other hand, Johnsen and Friborg hypothesized that the effects of cognitive behavioural therapy as an anti-depressive treatment was falling, with CBT remaining effective for those patients with recurrent episodes of depression. Because such patients have a longer history of diagnosis and treatment, they tend to be more familiar with the CBT procedures and know what to expect from therapy, which significantly increases the chances of the treatment succeeding.
Furthermore, patients with recurring depression are acquainted with the methodological approaches (e.g. case conceptualisation), and thus have a higher likelihood to benefit from CBT interventions. Furthermore, Johnsen and Friborg found a direct relationship between the competence of the therapist and the efficacy of the CBT treatment: patients who received treatment from experienced psychologists usually reported better mental health outcomes after the intervention administration.
Cognitive behavioural therapy can have different effects depending on the age of patients, which presents a challenge for professionals working with psychotherapeutic interventions. For instance, Karlin et al. found that cognitive behavioural therapy for treating depression was more effective among older patients, although the results of interventions administered to younger patients were also positive. For both groups of participants, Karlin et al. found that there was an overall average decrease of around 40% in depression scores starting from the earliest and going into the latest stages of cognitive behavioural therapy intervention.
The results of the study addressed the problem of significant undertreatment of such issues as depression among older adults who showed to be less proactive in utilising mental health services compared to younger adults (Byers et al.). This issue ties in with the fact that primary care providers were more likely to refer their younger patients for specialty mental health care (Koenig). Moreover, mental health professionals exhibited limited interest in treating patients of older generations, which contributed to the shortage of geriatric mental health professionals (Institute of Medicine).
Efficacy of CBT for Depression
It is also worth distinguishing the research conducted by Huguet et al. that focused on studying cognitive behavioural therapy concerning behavioural activation applications for treating depression. As smartphone and tablet applications have become irreplaceable components of the society’s daily life, a strong case can be made in support of their usage for self-help interventions delivered through technology (Van’t Hof et al.).
Although such an approach towards behavioural therapy is unconventional, applications and technology, in general, can be especially beneficial for treating early stages of depression among young people that tend to show very high levels of smartphone use (“Report: More Youth Use Smartphones as Route to Web”). The usage of technology for administering self-help suggests that cognitive behavioural interventions can take many forms and should be aligned with the interests and values of potential patients for ensuring adherence to the program as well as the overall positive effect of the behavioural intervention.
Efficacy of CBT for Eating Disorder Treatment
It has been widely accepted that eating disorders are strong indications for cognitive behavioural therapy for two reasons. First, the over-evaluation of weight and shape is cognitive in nature. Second, CBT is the most popular tool for treating bulimia nervosa, and there is evidence that it can be as effective in treating other eating disorders, as mentioned by Murphy et al. It can be reported that some major advancements were made regarding the incorporation of CBT for treating eating disorders, with the transdiagnostic approach to treatment being the most prominent among others.
Nevertheless, empirically supported treatment approach is the most flexible and can be suitable for all types of eating disorders since it is individual-oriented. Nevertheless, some challenges remain with regards to CBT for eating disorder treatment. Most importantly, treatment outcome needs must be enhanced, specifically for extremely underweight patients (Kazdin and Nock). Moreover, there is a need in getting a better understanding of the manner in which treatment works, as well as the active ingredients of those treatments (Murphy et al.).
Cognitive Behavioural Therapy and Conduct Management
Conduct disorders in adolescents can present a variety of challenges to both health care professionals and parents, so there is a need for developing a treatment to address the problems. It is important to mention the symptoms of conduct disorders:
- Overall aggression or threats to cause harm to animals and people;
- Intentional destruction or damage of property;
- Recurring cases of household and school rules’ violation;
- Repeated lying in order to avoid the implications of violent behaviour (Busari).
Cognitive behavioural training has shown to be effective for helping patients improve new thinking skills and decrease the likelihood of relapse (Busari). CBT challenges patients to be conscious of their decisions and accept complete responsibility for their actions. Stealing, recidivism, delinquent behaviour, faulty thinking, and socially undesirable behaviour are forms of antisocial behaviour that can be effectively managed with the help of CBT.
Cognitive Behavioural Therapy and PTSD
PTSD (post-traumatic stress disorder) is a “psychiatric sequel” (Kar) to a stressful event or situation that was exceptionally dangerous and threatening to the life of the survivor. There is robust evidence suggesting that cognitive behavioural therapy is a safe and effective treatment choice for treating both and acute PTSD that follows a variety of traumatic events that patients of all ages can experience. Despite this, non-adherence and non-response to treatment can be as high as 50% (Kar), to which factors like comorbidity and the nature of the study population usually contribute.
CBT is a type of treatment that was supported across many cultures and has been used by community therapists in both group and individual settings for decades. It was found that CBT could have a preventive role in some settings; although, definite recommendations remain to be discovered. Mostly, the effect of cognitive behavioural therapy has been mostly mediated by changes in maladaptive cognitive malfunctions seen in patients with PTSD. Also, some studies reported physiological, electroencephalographic changes, and functional neuroimaging (Kolassa et al.).
Cognitive Behavioural Therapy and Substance Addiction
Cognitive behavioural therapy targeted at elevating the burden of substance abuse has demonstrated efficacy in the context of monotherapy as well as a part of treatment strategies combination. Substance use disorders (SUDs) are heterogeneous conditions characterised by “recurrent maladaptive use of a psychoactive substance associated with distress and disability” (McHugh et al. 511). Numerous small and large-scale trials, as well as quantitative reviews, provided evidence for the support of CBT for treating alcohol and drug abuse.
Nevertheless, larger treatment effect sizes for substance abuse were found in the treatment of cannabis use, then followed by cocaine and opioids addiction, and then followed by smaller effect sizes for the dependence on poly-substance. Regarding individual treatment sizes, it was found that contingency management approaches associated with relapse prevention showed greater effect sizes (McHugh et al.).
Cognitive Behavioural Therapy and ADHD
As ADHD (attention deficit hyperactivity disorder) is a prevalent and impairing condition among adolescents; therefore, CBT has been extensively used to mitigate the challenges and possibly elevate the burden of disease. Key behavioural changes associated with the effective of CBT interventions included parenting, catering skills to school and homework, use of technology, as well as less focus on cognitive restructuring strategies (Sprich et al.). It was found that the most effective behavioural interventions were associated with building strong connections with patients and working with them independently. Assessing the home environment of patients was another strategy used during CBT interventions for parents to get a better idea how they could contribute to the reduction of ADHD symptoms through coping and executive functioning training (Sprich et al.).
Cognitive behavioural therapy has proven to be an effective intervention that can address a variety of psychological challenges patients face on a regular basis. The review of research literature provided strong evidence in support of the CBT usage for dealing with issues ranging from depression to ADHD. Although some points regarding the efficacy of cognitive behavioural therapy remain to be discovered, research literature pointed to the effectiveness of the therapy with regards to many challenges. Nevertheless, it is important to conclude that there is no unified approach towards CBT; interventions should be structured in accordance with the needs of patients, their history of mental illness, as well as the desired treatment outcomes.
Furthermore, all procedures included in the behavioural therapy should be based on the preliminary assessment and diagnosis since some patients may require types of treatment other than cognitive behavioural therapy. Further research can include the examination of CBT as a preventive measure to avoid the adverse implications of behavioural and psychological challenges; moreover, there is a need in assessing the differences in efficacy of therapy between female and male patients since it has been found that there are differences in adherence to clinical therapy (de Fatima Bonolo et al.).
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