The Current State of Cognitive Therapy: A 40-Year Retrospective
The Current State of Cognitive Therapy: A 40-Year Retrospective
The Current State of Cognitive Therapy: A 40-Year Retrospective
T
he basic framework of the cognitive theory of psychopathology and cognitive therapy
of specific psychiatric disorders was developed more than 40 years ago. Since that time,
there has been continuing progress in the development of cognitive theory and therapy
and in the empirical testing of both. A substantial body of research supports the cog-
nitive model of depression and, to a somewhat lesser extent, the various anxiety disorders. Cognitive
therapy (CT), often labeled as the generic term cognitive behavior therapy, has been shown to be ef-
fective in reducing symptoms and relapse rates, with or without medication, in a wide variety of psy-
chiatric disorders. Suggestions for future research and applications are presented.
Arch Gen Psychiatry. 2005;62:953-959
Recent evaluations of the cognitive ap- tic approach; (2) to investigate empirical
proach have characterized it as “the fastest support for the theory; and (3) to conduct
growing and most heavily researched ori- empirical studies that tested the efficacy of
entation on the contemporary scene.”1(p369) the therapy.4 This theoretical and therapeu-
Approximately 40 years after the initial pub- tic set of principles was systematically ap-
lication in Archives of General Psychiatry of plied to a sequence of disorders starting with
the formulation of the role of cognition in depression,5,6 suicide,7 then anxiety disor-
depression2 and in therapy,3 it is appropri- ders and phobias,8 panic disorder,9 fol-
ate to review the evolution of the cognitive lowed by personality disorders,10 and sub-
models of psychopathology and CT from stance abuse.11 I also made brief forays into
their earliest description to their current the areas of interpersonal problems12 and an-
status. ger, hostility, and violence.13 More re-
From the beginning, the formulation of cently, this approach was used to clarify the
a coherent conceptual framework pre- psychological structure and CT of schizo-
ceded the development of therapeutic strat- phrenia.14,15
egies. Although my original focus was on
depression, I considered that this ap- EVOLUTION OF
proach could also clarify other disorders.3 THE COGNITIVE MODEL
My research strategy thus involved several
stages: to try to identify the idiosyncratic My formulation of the theoretical struc-
cognitive elements derived from clinical data ture of CT was influenced in part by the
in various disorders, to develop and test cognitive revolution in psychology in the
measures to systematize these clinical ob- 1950s and 1960s, especially the writings
servations, and to formulate guidelines for of George Kelly, PhD,16 and Albert Ellis,
therapy. My guidelines for developing and PhD.17 The original cognitive approach to
evaluating a novel system of psychopathol- psychopathology was based on an infor-
ogy and psychotherapy consisted of the fol- mation-processing model. Simply stated,
lowing plan: (1) to construct a comprehen- the cognitive model of psychopathology
sive theory of psychopathology that stipulates that the processing of external
articulated well with the psychotherapeu- events or internal stimuli is biased and
therefore systematically distorts the indi-
Author Affiliations: Department of Psychiatry, University of Pennsylvania, vidual’s construction of his or her expe-
Philadelphia. riences, leading to a variety of cognitive
FUTURE DIRECTIONS
Accepted for Publication: March 21, 2005.
Several official reports in the United Kingdom and the Correspondence: Aaron T. Beck, MD, 3535 Market St,
United States have recommended the use of CT/CBT for a Room 2032, Philadelphia, PA 19104 (abeck@mail.med
variety of the common psychiatric disorders. In the guide- .upenn.edu).
lines of the National Institute for Clinical Excellence (NICE) Additional Information: Dr Beck is the recipient of the
of the British Health Service, CBT has been recommended 2003 Bernard and Rhoda Sarnat International Prize in Men-
as a treatment of choice for mild depression, as an option tal Health from the Institute of Medicine, Washington, DC.
for moderate depression, and in combination with ADM
for severe depression.118 The NICE guidelines also recom- REFERENCES
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