Common Questions About Cognitive Behavior Therapy for Psychiatric Disorders

 


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Cognitive behavior therapy (CBT) is a time-limited, goal-oriented psychotherapy that has been extensively researched and has benefits in a number of psychiatric disorders, including anxiety, 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 beliefs, scheduling pleasant activities to increase environmental reinforcement, and extended exposure to unpleasant thoughts, situations, or physiologic sensations to decrease avoidance and arousal associated with anxiety-eliciting stimuli. CBT can be helpful in the treatment of posttraumatic stress disorder by 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 attention-deficit/hyperactivity disorder, CBT focuses on establishing structures and routines, and clear rules and expectations within the home and classroom. Early intensive behavioral interventions should be initiated in children with autism before three years of age; therapy consists of 12 to 40 hours of intensive treatment per week, for at least one year. In many disorders, CBT can be used alone or in combination with medications. However, CBT requires a significant commitment from patients. Family physicians are well suited to provide collaborative care for patients with psychiatric disorders, in concert with cognitive behavior therapists.

Cognitive 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 can use CBT principles in their practice.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

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

A

118, 3437

Psychiatric medications are the primary treatment for schizophrenia and bipolar disorder, but CBT provides additional benefits.

B

22, 23

For many psychiatric conditions, CBT provides similar outcomes or additional benefits compared with psychiatric medications alone.

A

5, 911, 18, 20, 22, 2427

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

C

3841


CBT = cognitive behavior therapy.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

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

A

118, 3437

Psychiatric medications are the primary treatment for schizophrenia and bipolar disorder, but CBT provides additional benefits.

B

22, 23

For many psychiatric conditions, CBT provides similar outcomes or additional benefits compared with psychiatric medications alone.

A

5, 911, 18, 20, 22, 2427

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

C

3841


CBT = cognitive behavior therapy.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

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BEST PRACTICES IN PSYCHIATRY: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

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

American Academy of Sleep Medicine

Do not prescribe medication to treat childhood insomnia,

The Authors

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

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

CHRISTINE VINCI, PhD, is a postdoctoral research fellow in the Department of Health Disparities Research at the University of Texas M.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-mail: scoffey@umc.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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