Posts Tagged Cognitive behavioral therapy
Researchers from Emory University have found that specific patterns of activity on brain scans may help clinicians identify whether psychotherapy or antidepressant medication is more likely to help individual patients recover from depression.
The study, called PReDICT, randomly assigned patients to 12 weeks of treatment with one of two antidepressant medications or with cognitive behavioral therapy (CBT). At the start of the study, patients underwent a functional MRI brain scan, which was then analyzed to see whether the outcome from CBT or medication depended on the state of the brain prior to starting treatment. The study results are published as two papers in the March 24 online issue of the American Journal of Psychiatry.
The MRI scans identified that the degree of functional connectivity between an important emotion processing center (the subcallosal cingulate cortex) and three other areas of the brain was associated with the treatment outcomes. Specifically, patients with positive connectivity between the brain regions were significantly more likely to achieve remission with CBT, whereas patients with negative or absent connectivity were more likely to remit with antidepressant medication.
“All depressions are not equal and like different types of cancer, different types of depression will require specific treatments. Using these scans, we may be able to match a patient to the treatment that is most likely to help them, while avoiding treatments unlikely to provide benefit,” says Helen Mayberg, MD, who led the imaging study. Mayberg is a Professor of Psychiatry, Neurology and Radiology and the Dorothy C. Fuqua Chair in Psychiatric Imaging and Therapeutics at Emory University School of Medicine.
Mayberg and co- investigators Boadie Dunlop, MD, Director of the Emory Mood and Anxiety Disorders Program, and W. Edward Craighead, PhD, J. Rex Fuqua Professor of Psychiatry and Behavioral Sciences, sought to develop methods for a more personalized approach to treating depression.
Current treatment guidelines for major depression recommend that a patient’s preference for psychotherapy or medication be considered in selecting the initial treatment approach. However, in the PReDICT study patients’ preferences were only weakly associated with outcomes; preferences predicted treatment drop-out but not improvement. These results are consistent with prior studies, suggesting that achieving personalized treatment for depressed patients will depend more on identifying specific biological characteristics in patients rather than relying on their symptoms or treatment preferences. The results from PReDICT suggest that brain scans may offer the best approach for personalizing treatment going forward.
In recruiting 344 patients for the study from across the metro Atlanta area, researchers were able to convene a more diverse group of patients than other previous studies, with roughly half of the participants self-identified as African-American or Hispanic.
“Our diverse sample demonstrated that the evidence-based psychotherapy and medication treatments recommended as first line treatments for depression can be extended with confidence beyond a white, non-Hispanic population,” says Dunlop.
“Ultimately our studies show that clinical characteristics, such as age, gender, etc., and even patients’ preferences regarding treatment, are not as good at identifying likely treatment outcomes as the brain measurement,” adds Mayberg.
[BLOG POST] What’s the Difference Between Cognitive Rehabilitation Therapy and Cognitive Behavioral Therapy?
Neuro trauma can completely disrupt the way a person feels, thinks and behaves. Whether it’s from a mild concussion, severe traumatic brain injury, stroke or aneurysm – neuro trauma causes a wide variety of deficits including long and short term memory loss, impulsivity, mood swings and many other social, cognitive and behavioral issues. Two of the most commonly recommended treatments also happen to be the most commonly mistaken for each other: Cognitive Behavioral Therapy (CBT) and Cognitive Rehabilitation Therapy (CRT). So, what’s the difference?
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy is effective for treating a variety of conditions such as mood, anxiety, personality, eating, addiction, dependence and psychotic disorders. Cognitive Behavioral Therapy replaces distorted or negative thoughts with more realistic ones to decrease emotional distress and self-defeating behavior. Simply put: if you change the way you think, you can change the way you feel and behave.
Drug addiction is commonly treated with Cognitive Behavioral Therapy. The therapist helps enable the patient to see how their thoughts, feelings and behavior patterns interact to trigger their urge to use drugs. From here, the therapist can determine the source of the patient’s problematic relationship with drugs. For example, feelings of depression may lead to self-destructive thoughts which, in turn, may result in the patient using drugs. The therapist targets negative feelings that start the cycle of abuse by helping the patient develop a positive self-worth. By altering thoughts like negative self-talk and self-isolation that can lead to drug-seeking behavior, Cognitive Behavioral Therapy helps end the negative feedback loop of addiction in a patient’s life. Even when therapy is complete, patients are advised to continue practicing CBT so they can maintain a positive outcome.
Cognitive Rehabilitation Therapy
Cognitive Rehabilitation Therapy is the process of mentally redeveloping the cognitive skills and function lost due to brain injury. These skills include intellectual performance, problem solving, attention deficits, memory and language difficulties. The key measure of CRT is the patient’s level of cognitive function. If the patient cannot relearn the lost skills, then the therapists teaches compensatory strategies. These strategies can literally be anything that helps the patient redevelop and maintain their independence. For example, a patient with short term memory problems could learn to set an alarm on his phone to remind him to take his medication.
Basic Cognitive Rehabilitation Therapy (CRT) included four components:
1) Assessment, education and awareness development of cognitive strengths and weaknesses, 2) skill development concentrating on resolving defined cognitive deficits, 3) compensatory strategy training and 4) functional activities that involve applying the first three components of CRT to everyday life.
At Life Skills Village, our therapists assess and treat patients’ cognitive skills by focusing BOTH on building upon the patient’s strengths while strategically shoring up their weaknesses. But what if a patient has a deficit that cannot be rebuilt? This is where the therapist’s list of compensatory strategies comes in – for every deficit, there is at least one compensatory strategy. A patient experiencing difficulties with short-term memory will have several strategies for them to try: there are many smart phone apps to help organize schedules and act as a reminder for events. Patients can develop the habit of taking notes in doctor’s appointments. They might keep a calendar on their refrigerator at home to know where they are scheduled to be on any particular day. Even maintaining a simple “thought” journal can aid patients in tracking their emotions in relation to daily events.
Although both Cognitive Behavioral Therapy and Cognitive Rehabilitation Therapy maintain a focus on cognition, they are distinct therapies designed to address specific cognitive concerns. Cognitive Behavioral Therapy is used to treat mental conditions such as anxiety or depression by focusing on an emotional or behavioral issue. The goal is to change a patient’s perception in order to decrease self-defeating behaviors, improve their mood and develop healthy thought patters. Cognitive Rehabilitation Therapy employs a broad range of cognition-based therapies to assist patients with cognitive deficits, such as memory, attention and executive function. The goal is to improve cognitive function and processes. Using these and a myriad of other therapies, Life Skills Village facilitates independence and a return to normal life for our clients after their injuries.
In today’s society, doctors and psychiatrists are quick to prescribe psychotropic drugs that often come with dangerous side effects for any disorder that stems from thought patterns. But what if I told you there was a better, safer way to manage and treat stress and brain disorders? Enter cognitive behavioral therapy.
According to the National Association of Cognitive Behavioral Therapists, cognitive behavioral therapy (often just called CBT) is a popular form of psychotherapy that emphasizes the importance of underlying thoughts in determining how we feel and act. Considered to be one of the most successful forms of psychotherapy to come around in decades, cognitive behavioral therapy has become the focus of hundreds of research studies. (1)
CBT therapists work with patients to help them uncover, investigate and change their own thought patterns and reactions, since these are really what cause our perceptions and determine our behaviors. Using CBT therapists offers patients valuable perspective, which helps improve their quality of life and manage stress better than patients simply “problem-solving” tough situations on their own.
Something that might surprise you about CBT: A core principle is that external situations, interactions with other people and negative events are not responsible for our poor moods and problem in most cases. Instead, CBT therapists actually view the opposite as being true. It’s, in fact, our own reactions to events, the things we tell ourselves about the events — which are within our control — that wind up affecting our quality of life.
This is great news — because it means we have the power to change. Through cognitive behavioral therapy, we can learn to change the way we think, which changes the way we feel, which in turn changes the way we view and handle tough situations when they arise. We can become better at intercepting disruptive thoughts that make us anxious, isolated, depressed, prone to emotionally eating and unwilling to change negative habits.
When we can accurately and calmly look at situations without distorting reality or adding additional judgments or fears, we’re better able to know how to react appropriately in a way that makes us feel happiest in the long run.
Proven Benefits of Cognitive Behavioral Therapy
A 2012 meta-analysis published in the Journal of Cognitive Therapy and Researchidentified 269 studies that supported the use of CBT for the following problems: (2)
- substance abuse disorders
- schizophrenia and other psychotic disorders
- depression and dysthymia
- manic depression/bipolar disorder
- anxiety disorders
- somatoform disorders
- eating disorders
- sleep disorders, including insomnia
- personality disorders
- anger and aggression
- criminal behaviors
- general stress and distress due to general medical conditions
- chronic fatigue syndrome
- muscle pains and tension
- pregnancy complications and female hormonal conditions
Researchers found the strongest support for CBT in treating anxiety disorders, somatoform disorders, bulimia, anger control problems and general stress. After reviewing 11 review studies comparing improvement rates between CBT and other therapy treatments, they found that CBT showed higher response rates than the comparison treatments in seven of the 11 reviews (more than 60 percent). Only one of 11 reviews reported that CBT had lower response rates than comparison treatments, leading researchers to believe that CBT is one of the most effective therapy treatments there is.
Here are some of the major ways cognitive behavioral therapy benefits patients from different walks of life:
1. Lowers Symptoms of Depression
Cognitive behavioral therapy is one of the best-known, empirically supported treatments for depression. Studies show that CBT helps patients overcome symptoms of depression like hopelessness, anger and low motivation, and lowers their risk for relapses in the future.
CBT is believed to work so well for relieving depression because it produces changes in cognition (thoughts) that fuel vicious cycles of negative feelings and rumination. Research published in the journal Cognitive Behavioral Therapy for Mood Disordersfound that CBT is so protective against acute episodes of depression that it can be used along with, or in place of, antidepressant medications. CBT has also shown promise as an approach for helping handle postpartum depression and as an adjunct to medication treatment for bipolar patients. (3)
2. Reduces Anxiety
According to work published in Dialogues in Clinical Neuroscience, there’s strong evidence regarding CBT treatment for anxiety-related disorders, including panic disorders, generalized anxiety disorder, social anxiety disorder, obsessive compulsive disorder and post-traumatic stress disorder. Overall, CBT demonstrates both efficacy in randomized controlled trials and effectiveness in naturalistic settings between patients with anxiety and therapists. (4)
Researchers have found that CBT works well as a natural remedy for anxiety because it includes various combinations of the following techniques: psycho-education about the nature of fear and anxiety, self-monitoring of symptoms, somatic exercises, cognitive restructuring (for example disconfirmation), image and in vivo exposure to feared stimuli (exposure therapy), weaning from ineffective safety signals, and relapse prevention.
3. Helps Treat Eating Disorders
The Journal of Psychiatric Clinics of North America reports that eating disorders provide one of the strongest indications for cognitive behavioral therapy. CBT has been found to help address the underlying psychopathology of eating disorders and question the over-evaluation of shape and weight. It can also interfere with the maintenance of unhealthy body weights, improve impulse control to help stop binge eating or purging, reduce feelings of isolation, and help patients become more comfortable around “trigger foods” or situations using exposure therapy. (5)
Cognitive therapy has become the treatment of choice for treating bulimia nervosa and “eating disorders not otherwise specified” (EDNOS), the two most common eating disorder diagnoses. There’s also evidence that it can be helpful in treating around 60 percent of patients with anorexia, considered to be one of the hardest mental illnesses to treat and prevent from returning.
4. Reduces Addictive Behaviors and Substance Abuse
Research has shown that CBT is effective for helping treat cannabis and other drug dependencies, such as opioid and alcohol dependence, plus helping people quit smoking cigarettes and gambling. Studies published in the Oxford Journal of Public Health involving treatments for smoking cessation have found that coping skills learned during CBT sessions were highly effective in reducing relapses in nicotine quitters and seem to be superior to other therapeutic approaches. (6) There’s also stronger support for CBT’s behavioral approaches (helping to stop impulses) in the treatment of problematic gambling addictions compared to control treatments. (7)
5. Helps Improve Self-Esteem and Confidence
Even if you don’t suffer from any serious mental problems at all, CBT can help you replace destructive, negative thoughts that lead to low self-esteem with positive affirmations and expectations. This can help open new ways to handle stress, improve relationships and increase motivation to try new things. The Psychology Tools website provides great resources for using CBT worksheets on your own to work on developing affirmative communication skills, healthy relationships and helpful stress-reducing techniques. (8)
Facts About Cognitive Behavioral Therapy
- CBT was originally created to help people suffering from depression, but today it’s used to improve and manage various types of mental disorders and symptoms, including: anxiety, bipolar disorder, post-traumatic stress disorder, obsessive compulsive disorder, addictions and eating disorders. (9)
- CBT techniques are also beneficial for just about everyone else, including people with no form of mental illness but who have chronic stress, poor moods and habits they’d like to work on.
- The term cognitive behavioral therapy is considered a general term for a classification of therapeutic approaches that have similarities, including: rational emotive behavior therapy, rational behavior therapy, rational living therapy, cognitive therapy and dialectical behavior therapy.
- To date, more than 332 medical studies and 16 quantitative reviews have examined the effects of CBT. Interestingly, more than 80 percent of these studies were conducted after 2004. (10)
- Studies have found that in people who have completed CBT programs and then undergone brain scans, CBT is actually capable of positively changing physical structures in the brain. (11)
- CBT can work quickly, helping patients feel better and experience lessened symptoms within a short period of time (several months, for example). While many forms of therapy can take many months or even years to become very helpful, the average number of CBT sessions clients receive is only 16.
- CBT often involves the patient completing “homework” assignments on their own between therapy sessions, which is one of the reasons benefits can be experienced so quickly.
- In addition to homework being done by the patients while they’re alone, cognitive behavioral therapists also use instructions, questioning and “exposure therapy” during sessions. CBT is very interactive and collaborative. The therapist’s role is to listen, teach and encourage, while the patient’s role is to be open and expressive.
- One of the biggest advantages for patients is that CBT can be continued even after formal sessions with a therapist are over. Eventually, formal therapy ends, but at this point the clients can continue to work on exploring CBT concepts, using techniques they’ve learned, journaling and reading to help prolong benefits and manage symptoms.
How Cognitive Behavior Therapy Works
CBT works by pinpointing thoughts that continuously rise up, using them as signals for positive action and replacing them with healthier, more empowering alternatives.
The heart of CBT is learning self-coping skills, giving patients the ability to manage their own reactions/responses to situations more skillfully, change the thoughts they tell themselves, and practice “rational self-counseling.” While it definitely helps for the CBT therapist/counselor and patient to build trust and have a good relationship, the power really lies in the patient’s hands. How willing a patient is to explore his or her own thoughts, stay open-minded, complete homework assignments and practice patience during the CBT process all determine how beneficial CBT will be for them.
Some of the characteristics that make cognitive behavioral therapy unique and effective include:
- Rational approach: CBT theory and techniques are based on rational thinking, meaning they aim to identify and use facts. The “inductive method” of CBT encourages patients to examine their own perceptions and beliefs to see if they are in fact realistic. In CBT, there is an underlying assumption that most emotional and behavioral reactions are learned. Many times with a CBT therapists’s help, patients learn that their long-held assumptions and hypotheses are at least partially incorrect, which causes them unnecessary worrying and suffering. (12)
- Law of entropy and impermanence: CBT rests on scientific assumptions, including the law of entropy, which is essentially the fact that “if you don’t use it, you lose it.” We always have the power to change how we feel because our feelings are rooted in our brains’ chemical interactions, which are constantly evolving. If we break cycles of thought patterns, our brains will adjust for the better. MRI scans show the human brain creates and sustains neural synapses (connections) between frequent thoughts and emotions, so if you practice positive thinking your brain will actually make it easier to feel happier in the future.
- Accepting unpleasant or painful emotions: Many CBT therapists can help patients learn how to stay calm and clear-headed even when they’re faced with undesirable situations. Learning to accept difficult thoughts or emotions as being “simply part of life” is important, because this can help stop a vicious cycle from forming. Often we get upset about our tough feelings and add on even more suffering. Instead of adding self-blame, anger, frustration, sadness or disappointment to already-tough feelings, CBT teaches patients to calmly accept a problem without judgment in order to not make it even worse.
- Questioning and expressing: Cognitive behavioral therapists usually ask patients many questions in order to help them gain a new perspective, see the situation more clearly and realistically, and help them undercover how they really feel.
- Specific agendas and techniques: CBT is usually done in a series of sessions that each have a specific goal, concept or technique to work with. Unlike some other forms of therapy, sessions are not simply for the therapist and patient to talk openly without an agenda in mind. CBT therapists teach their clients how to better handle difficult thoughts and feelings by practicing specific techniques during sessions that can later be applied to life when they’re most needed.
Cognitive Behavioral Therapy vs. Other Types of Psychotherapy
CBT is a type of psychotherapy, which means it involves open talking between patient and therapist. You might have heard of several other forms of psychotherapy in the past and are wondering what makes CBT stand apart. Many times there is some overlap between different forms of psychotherapy. A therapist might use techniques from various psychotherapy approaches to help patients best reach their goals and improve (for example, to help someone with a phobia, CBT might be coupled with exposure therapy).
According to the National Alliance on Mental Illness, here is how CBT differs from other popular forms of therapy: (13)
- CBT vs. Dialectical Behavior Therapy (DBT): DBT and CBT are probably the most similar therapeutic approaches, however DBT relies more heavily on validation or accepting uncomfortable thoughts, feelings and behaviors. DBT therapists help patients find balance between acceptance and change by using tools like mindfulness guided meditation.
- CBT vs. Exposure Therapy: Exposure therapy is a type of cognitive behavioral therapy that’s often used to help treat eating disorders, phobias and obsessive-compulsive disorder. It teaches patients to practice using calming techniques and small series of “exposures” to triggers (things that are most feared) in order to become less anxious about the outcome.
- CBT vs. Interpersonal Therapy: Interpersonal therapy focuses on the relationships a patient has with his or her family, friends, co-workers, media and community to help evaluate social interactions and recognize negative patterns (such as isolation, blame, jealousy or aggression). CBT can be used with interpersonal therapy to help reveal underlying beliefs and thoughts driving negative behavior toward others.
Ways to Practice Cognitive Behavioral Therapy Techniques on Your Own
- Identify your current obstacles: The first step is to identify what’s really causing you stress, unhappiness and unease. Maybe you’re feeling resentful toward someone, fearful of failure or worried about being rejected socially in some way. You might find that you have persistent anxiety, symptoms of depression or are struggling to forgive someone for a past event. Once you can recognize this and become more aware of your primary obstacle, then you have the power to start work on overcoming it.
- Try “thought recording”: You can use a journal or even record your own voice on a tape recorder to help you identify recurring destructive thoughts you frequently tell yourself. Ask yourself questions to dig deeper and form connections you weren’t previously aware of. Then reread your entries as if you were not yourself, but a good friend. What advice would you give yourself? What beliefs of yours can you notice aren’t very accurate, only making matters worse and not overall helpful?
- Form patterns and recognize your triggers: Think about what types of situations make you most likely to feel anxious, upset, critical or sad. Start to form patterns of behaving in certain ways or experiencing certain things (for example, maybe drinking too much alcohol or gossiping behind someone’s back) and how they leave you feeling, so you can start breaking the cycle.
- Notice how things are always changing: Feelings come and go constantly (called impermanence), so knowing that fear, anger or other strongly unplesant emotions are only temporary can help you stay calm in the moment.
- “Put yourself in their shoes”: It’s important to try and view situations as rationally, clearly and realistically as possible. It helps to consider other people’s perspectives, question your assumptions, and see if there’s something important you might be missing or ignoring.
- Thank yourself and be patient: Even though CBT works quickly for many people, it’s an ongoing process that’s essentially lifelong. There’s always ways to improve, feel happier, and treat others and yourself better, so practice being patient. Remind yourself there is no finish line. Give yourself credit for putting effort into facing your problems directly, and try to view “slip-ups” as inevitable parts of the journey and learning process.
Final Thoughts on Cognitive Behavioral Therapy
- CBT techniques are also beneficial for just about everyone else, including people with no form of mental illness but who have chronic stress, poor moods and habits they’d like to work on.
- Some of the major ways cognitive behavioral therapy benefits patients from different walks of life includes lowering symptoms of depressions, reducing anxiety, treating eating disorders, reduces addictive behaviors and substance abuse, and helps improve self-esteem and confidence.
- You can practice cognitive behavioral therapy by identifying your current obstacles, trying thought recording, forming patterns and recognizing your triggers, noticing how things are always changing, putting yourself in others’ shoes, and thanking yourself and being patient.
[ARTICLE] Anxiety — Is There an App for That? Considering Technology, Psychiatry, and Internet-Assisted Cognitive Behavioral Therapy – Full Text PDF
Across Western countries, more than a third of people will have a mental health disorder over their lifetime; mood and anxiety disorders are the most common. The effectiveness of psychological interventions is well established. Cognitive Behavioural Therapy (CBT), for example, is as effective for mild and moderate anxiety as medica‐ tions; combined psychopharmacology and CBT is superior to either modality alone, suggesting a synergistic effect. However, CBT requires a major investment of time and resources. Thus, in public systems, CBT has limited availability and is subject to long waiting times; primary-care physicians and psychiatrists may not offer CBT.
Can technology address the deficiency of psychological interventions for mental illness? Internet therapies (including smart phone apps) have been developed, offering CBT and other psychological interventions. In this chapter, we focus on Internet-assisted CBT (ICBT).
ICBT allows patients to receive ongoing CBT with easier and quicker access, at reduced cost, and with increased convenience over traditional CBT. We review evidence from randomized trials and meta-analyses, which strongly support the use of ICBT in clinical practice, especially in combination with ongoing therapist support. We consider government experimentation with ICBT, with a particular focus on Australia. We also present a case demonstrating the clinical application of ICBT. Finally, with an eye to the future, we will look at potential research questions.
What is CBT?
Cognitive Behavioral Therapy (CBT) is a type of psychotherapy based upon the theory that our thoughts affect how we think and feel. This video gives an overview of CBT including the theoretical underpinning, and how it is actually applied in session. CBT has been found to be effective in the treatment of many disorders such as depression, anxiety, addictions, phobias, and more.
[REVIEW] Systematic Review of Interventions for Fatigue After Traumatic Brain Injury: A NIDRR Traumatic Brain Injury Model Systems Study
Objective: To conduct a systematic review of the evidence on interventions for posttraumatic brain injury fatigue (PTBIF).
Methods: Systematic searches of multiple databases for peer-reviewed studies published in English on interventions targeting PTBIF as a primary or secondary outcome through January 22, 2014. Reference sections were also reviewed to identify additional articles. Articles were rated using the 2011 American Academy of Neurology Classification of Evidence Scheme for therapeutic studies.
Results: The searches yielded 1526 articles. Nineteen articles met all inclusion criteria: 4 class I, 1 class II/III, 10 class III, and 4 class IV. Only 5 articles examined fatigue as a primary outcome. Interventions were pharmacological and psychological or involved physical activity, bright blue light, electroencephalographic biofeedback, or electrical stimulation. Only 2 interventions (modafinil and cognitive behavioral therapy with fatigue management) were evaluated in more than 1 study.
Conclusions: Despite areas of promise, there is insufficient evidence to recommend or contraindicate any treatments of PTBIF. Modafinil is not likely to be effective for PTBIF. Piracetam may reduce it, as may bright blue light. Cognitive behavioral therapy deserves additional study. High-quality research incorporating appropriate definition and measurement of fatigue is required to explore the potential benefits of promising interventions, evaluate fatigue treatments shown to be effective in other populations, and develop new interventions for PTBIF.
Cognitive behavioral therapy (CBT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to behavior therapy, cognitive therapy, and therapy based upon a combination of basic behavioral and cognitive principles and research. Most therapists working with patients dealing with anxiety and depression use a blend of cognitive and behavioral therapy. This technique acknowledges that there may be behaviors that cannot be controlled through rational thought. CBT is “problem focused” (undertaken for specific problems) and “action oriented” (therapist tries to assist the client in selecting specific strategies to help address those problems).
CBT has been demonstrated to be effective for the treatment of a variety of conditions, including mood, anxiety, personality, eating, substance abuse, tic, and psychotic disorders. Many CBT treatment programs for specific disorders have been evaluated for efficacy; the health-care trend of evidence-based treatment, where specific treatments for symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments.
CBT was primarily developed through an integration of behavior therapy (the term “behavior modification” appears to have been first used by Edward Thorndike) with cognitive psychology research, first by Donald Meichenbaum and several other authors with the label of cognitive behavior modification in the late 1970s. This tradition thereafter merged with earlier work of a few clinicians, labeled as Cognitive Therapy (CT), developed first by Albert Ellis as Rational Emotive Therapy (RET) and later Aaron Beck. While rooted in rather different theories, these two traditions have been characterised by a constant reference to experimental research to test hypotheses, both at clinical and basic level. Common features of CBT procedures are the focus on the “here and now”, a directive or guidance role of the therapist, a structuring of the psychotherapy sessions and path, and on alleviating both symptoms and patients’ vulnerability.