Cognitive Therapy

Cognitive therapy is a type of psychotherapy which was developed in the 1960s by psychiatrist Aaron Beck.  At the time, Dr. Beck was practicing Freudian psychotherapy but was disgruntled with the lack of precision and goals in the practice.  To him, it seemed like psychotherapy was a constant delve into long-past memories in search of something significant – even though experts could not agree on what was significant or not.

Beck started to notice trends in patients; they would have automatic thoughts which seemed spontaneous.  These thoughts would cause the patient to act in a certain way.  This led Beck to develop his theory which is now practiced as cognitive therapy: if you challenge though processes, then you can overcome them and the negative actions associated with them.

The principles of cognitive therapy

The key concept to cognitive therapy is that our perceptions of situations influence our emotions.  For example, two people may receive free tickets to a movie.  The first person may be elated and excited to go to the movie.  The second person may become anxious and immediately start thinking negative thoughts like, “No one will go with me and I will get laughed at for watching a movie alone.”  While the situation is the same in both cases, the reaction is shaped by the person’s perception of the events.

Cognitive therapy takes a very pragmatic, rational approach to emotional recovery.  It believes that you can identify the distorted perceptions/thoughts and change them to live a better, more fulfilling life.

Cognitive therapy in practice

At the start of cognitive therapy, the therapist will ask the patient how he or she is feeling.  The patient may be given a questionnaire to fill out in order to assess mood.  Then, the therapist can use the mood assessment to see how the patient is feeling during the current week compared to other sessions.

Cognitive therapy sessions are oriented at solving problems. Thus, the therapist will ask the patient what problem he or she would like to discuss. Cognitive therapy will always focus on current situations rather than past events.  During the sessions, the patient will be challenged to identify his or her distorted thoughts, responses or feelings related to the problem.  Then the therapist will help the patient to challenge these distorted perceptions.

In patients who feel like they must always be perfect, for example, the therapist may bring forth a line of questioning such as:

  • Are these beliefs in your best interest?
  • What are the disadvantages to these thoughts?
  • Do you think that these thoughts could be ignored?

After the line if inquiry, the therapist and patient may discuss how the negative thoughts can be changed/removed and a rational plan of action for achieving this.

Patients undergoing cognitive therapy will often set clear, precise goals with their therapists.  These goals can outline a course of action or timeframe for dealing with specific problems.   Because of the goal-oriented nature of cognitive therapy, it can often bring about fast changes in modes of thinking.  Patients can be cured of their condition in less than 12 sessions.

What is the role of the therapist?

The relationship between the therapist and the patient is important in cognitive therapy.  While the therapist may retain the professional persona, the patient must still feel comfortable and secure in the setting to discuss emotional problems openly.  The therapist can help the patient discover problems and their related thought patterns through guided discovery. The therapist will often also use Socratic questioning to help the patient explore in depth ideas. Further, the therapist must be there for the patient on a rational level to help him/her devise a method for changing thought patterns.

How effective is cognitive therapy?

Cognitive therapy has been proven as very effective in treating a wide range of psychological disorders including major depressive disorder, anxiety, anorexia, bulimia, addictions, and panic attacks.  There is some evidence that cognitive therapy can also be effective in treating personality disorders.

Despite its efficacy in treating psychological disorders, cognitive therapy is not usually used by itself.  Rather, it is usually used as part of cognitive-behavior therapy.  This therapy will utilize the concepts of cognitive therapy but also focus on approaches which change behaviors. Cognitive and behavioral therapies are particularly effective when used together.  While the cognitive aspects of therapy help the patient recognize destructive thought patterns, the behavioral aspects can help the patients overcome these patterns.

Criticisms of cognitive therapy

As with all forms of psychotherapy, there are some criticisms of cognitive therapy.  Psychologists may disagree with the thought-based focus of cognitive therapy because thoughts cannot be measured.  Psychiatrists have criticized cognitive therapy as a quick-fix which does not actually treat depression but rather just alleviates symptoms temporarily.

The future of cognitive therapy

In today’s society, many people with psychological disorders are using medications instead of psychotherapy approaches.  Because of this preference to pharmaceuticals, there have been fewer patients utilizing cognitive therapy for treatment.  The patients who do come for therapy typically already tried medications like antidepressants unsuccessfully.  Their problems may be complex and longstanding.  Whereas most patients with depression are likely to experience improvement within 8-10 sessions, it could take over a year for severe cases of psychological problems.

Even though the push has been towards pharmaceutical remedies to problems, there will likely still always be a need for therapy.  Cognitive therapy has proven incredibly successful and already popular when combined with behavior therapy.


Beck Institute for Cognitive Behavior Therapy. Beck Institute.  Web

Goode, Erica.  “A Pragmatic Man and His No-Nonsense Therapy.” The New York Times 11 Jan 2000. <>


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