Cognitive Therapy

Rating

Category: Allied Health Options

What is it?

Cognitive therapy aims to identify and correct dysfunctional thinking patterns that can lead to negative feelings and behaviour. The goal is to replace such thinking with a more appropriate view. This in turn, leads to more fulfilling and productive behaviour.

How does it work?

Cognitive therapy assists clients to explore their thinking and identify thought processes that are inappropriate and unhelpful. Cognitive therapists teach clients tools to discover, using their own experiences, ways of thinking that make them feel distressed and unable to cope. By learning to test their thoughts, clients can discover more balanced and accurate ways of thinking. This will enable clients to control disturbing and overwhelming emotions in the future.

Is it effective?

Cognitive therapy has been found to be effective in reducing PTSD symptoms. In a randomised controlled trial undertaken in 2003, cognitive therapy led to large reductions in PTSD symptoms. A similar result was obtained in another trial conducted in 2006.

When compared to self-help booklet and repeated assessments, cognitive therapy was found to be more effective in reducing PTSD symptoms 3 months after treatment. On follow-up at 9 months, there were fewer patients with PTSD in the cognitive therapy group compared to those who received the other two treatments. In another trial, comparing cognitive therapy with imaginal exposure, whilst both interventions showed significant improvement over treatment and at follow-up, there was no indication that one was more effective than the other.

Are there any disadvantages?

There is no evidence to suggest that there are disadvantages associated with cognitive therapy. However, it is advisable to assess a client’s suitability for cognitive therapy. Clients who are less rigid and dogmatic in their thinking and are open to identifying unhelpful thoughts are more likely to benefit.

Where do you get it?

Cognitive therapy can only be administered by a registered mental health professional with training in cognitive therapy.

What are the evidence limitations?

The diagnostic criteria used in some studies were not based on DSM-IV. Some of the clients who participated in the trial failed to attend some of their appointments and including their data in the results may reduce the ability to apply the findings as a generalisation.

Recommendations

In light of the evidence presented, cognitive therapy may be considered for those diagnosed with PTSD.

Key References

Duffy M, Gillespie K, Clark DM 2007, ‘Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: randomised controlled trial’, BMJ, 334:1147 doi:10.1136/bmj.39021.846852.BE

Ehlers A, Clark DM, Hackmann A, et al 2005, ‘Cognitive therapy for post-traumatic disorder: development and evaluation’, Behaviour Research and Therapy, vol. 43, pp. 413-431.

Ehlers A, Clark DM, Hackmann A, et al 2000, ‘A randomised controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for post-traumatic stress disorder’, Archives of General Psychiatry, vol. 60, pp. 1024-1032.

Tarrier N, Pilgrim H, Sommerfield C, et al 1999, ‘A randomised trial of cognitive therapy and imaginal exposure in the treatment of chronic post-traumatic stress disorder’, Journal of Consulting and Clinical Psychology, vol. 67, no. 1, pp. 13-18.

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