Cognitive Therapy (CT)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Cognitive Therapy (CT) has been rated by the CEBC in the area of: Depression Treatment (Adult).

Target Population: Adults with mental health disorders including depression, anger, and anxiety among others - the program is also designed to include family members in the treatment

Brief Description

Cognitive Therapy (CT) has been rated by the CEBC in the area of Depression Treatment (Adult). CT is a form of psychotherapy proven in numerous clinical trials to be effective for a wide variety of disorders. The therapist and client work together as a team to identify and solve problems. Therapists help clients to overcome their difficulties by changing their thinking, behavior, and emotional responses. CT and Cognitive Behavioral Therapy are often used interchangeably. There are, however, numerous subsets of CBT that are narrower in scope than CT: e.g., problem-solving therapy, stress-inoculation therapy, motivational interviewing, dialectical behavior therapy, behavioral modification, exposure and response prevention, etc. Cognitive therapy uses techniques from all these subsets at times, within a cognitive framework. CT was developed by the Academy of Cognitive Therapy’s president, Aaron T. Beck, MD, in the early 1960s.

Program Goals:

The program representative did not provide information about the program’s goals.

Essential Components

The essentials components for Cognitive Therapy include:

  • Based on the cognitive model, which is, simply that the way a person perceives a situation influences how he/she feels emotionally
  • Focused on the present
  • Time-limited
  • Problem-solving oriented
  • Patients learn specific skills that they can use for the rest of their lives: identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors
  • Can be administered individually or in a group of 8-12 participants

Adult Services

Cognitive Therapy (CT) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Anger, anxiety, depression and other emotional problems
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Family can be involved as needed during therapy.

Delivery Setting

This program is typically conducted in a(n):

  • Outpatient Clinic

Homework

Cognitive Therapy (CT) includes a homework component:

Psychotherapy may be supplemented with cognitive therapy readings, workbooks, client pamphlets, etc. The patient may also be asked to prepare carefully for each session, thinking about what he/she learned in the previous session and jotting down what he/she wants to discuss in the next session. The patient is also encouraged to bring the therapy session into his/her everyday life. A good way to do this is to have the patient take notes at the end of each session. Other options include recording the session or providing a summary of the session on audiotape. The therapist can then discuss homework options for the coming week with the patient.

Languages

Cognitive Therapy (CT) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Private room where therapy can occur

Minimum Provider Qualifications

  • Master's degree (or international equivalent) in a mental health, medical, or allied health profession

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

State-of-the-art training for professionals in CBT provided at Beck Institute, in suburban Philadelphia. Training conducted by Aaron T. Beck, MD, and Judith S. Beck, PhD, and other senior faculty. Extramural supervision after the training is provided. Also, faculty travel to off-site locations around the U.S. and the world.

Number of days/hours:

Varying

Additional Resources:

There currently are additional qualified resources for training:

Implementation Information

Since Cognitive Therapy (CT) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

The program representative did not provide information about pre-implementation materials.

Formal Support for Implementation

The program representative did not provide information about formal support for implementation of Cognitive Therapy (CT).

Fidelity Measures

The program representative did not provide information about fidelity measures of Cognitive Therapy (CT).

Implementation Guides or Manuals

The program representative did not provide information about implementation guides or manuals for Cognitive Therapy (CT).

Research on How to Implement the Program

The program representative did not provide information about research conducted on how to implement Cognitive Therapy (CT).

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Numerous studies have been conducted of Cognitive Therapy (CT).. The studies described below (meta-analyses and peer-reviewed, published articles) are a selection of those that examined the long-term effects of CT.

Several meta-analyses have been conducted on CT:

  • Dobson, K. S. (1989). A meta-analysis of the efficacy of Cognitive Therapy for depression. Journal of Consulting and Clinical Psychology, 57, 414-419.
  • Gaffan, E. A., Tsaousis, I., & Kemp-Wheeler, S. M. (1995) Researcher allegiance and meta-analysis: The case of Cognitive Therapy for depression. Journal of Consulting and Clinical Psychology, 63, 966–980.
  • Gloaguen, V., Cottraux, J., Cucherat, M., & Blackburn, I. (1998). A meta-analysis of the effects of Cognitive Therapy in depressed patients. Journal of Affective Disorders, 49, 59-72.

*Evans, M. D., Hollon, S. D., Garvey, M. J., Piasecki, J. M., Grove, W. M., Garvey, M. J., & Tuason, V. B. (1992). Differential relapse following Cognitive Therapy and pharmacotherapy for depression. Archives of General Psychiatry; 49, 802–808.

Type of Study: Randomized controlled trial
Number of Participants: 50

Population:

  • Age — Approximately 30-34 years
  • Race/Ethnicity — Primarily White
  • Gender — Primarily Female
  • Status — Participants were nonbipolar, nonpsychotic depressed outpatients requesting treatment for depression.

Location/Institution: Department of Psychology, University of Minnesota, Minneapolis and Department of Psychiatry St Paul – Ramsey Medical Center

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants successfully treated during a 3-month period with either imipramine hydrochloride pharmacotherapy, Cognitive Therapy (CT), or combined CT and pharmacotherapy were monitored during a 2-year posttreatment follow-up period. Half of the participants treated with pharmacotherapy alone continued to receive study medications for the first year of the follow-up. All other participants discontinued treatment at the end of the acute treatment phase. Measures included the Beck Depression Inventory, the Hamilton Rating Scale for Depression, and the Raskin Depression Scale. Participants treated with CT (either alone or in combination with medication) evidenced less than half the rate of relapse shown by participants in the medication--no continuation condition, and their rate did not differ from that of participants provided with continuation medication. It appears that providing CT during acute treatment prevents relapse. Limitations include small sample size and lack of generalizability to total population.

Length of postintervention follow-up: 2 years.

Blackburn, I. M., & Moore, R. G. (1997). Controlled acute and follow-up trial of Cognitive Therapy and pharmacotherapy in out-patients with recurrent depression. British Journal of Psychiatry, 171, 328–334.

Type of Study: Randomized controlled trial
Number of Participants: 75

Population:

  • Age — Mean=37.8–40.1 years
  • Race/Ethnicity — Not specified
  • Gender — 48 Females and 27 Males
  • Status — Participants were recruited from outpatient referrals to consultants in a large teaching psychiatric hospital and from two general practices.

Location/Institution: Department of Psychiatry. University of Edinburgh

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were allocated to three groups with 6 weeks of acute treatment and two years' maintenance treatment in the following ways: antidepressants and maintenance antidepressants; Cognitive Therapy (CT) and maintenance CT; or antidepressants and maintenance CT. Measures used included the Hamilton Rating Scale for Depression (HRSD) and Beck Depression Inventory (BDI). Both completers' and end-point data were analyzed. In the acute phase of treatment, all participants improved significantly and there was no significant difference among treatments, or in the pattern of improvement over time. In the maintenance stage of treatment, participants kept improving over time in all three groups and there was no significant difference among treatments. CT was consistently superior to medication. The results indicate that maintenance CT has a similar prophylactic effect to maintenance medication and is a viable option for maintenance after acute treatment with medication in recurrent depression. Limitations include small sample, no objective measure of compliance with medication was used, and lack of follow-up.

Length of postintervention follow-up: None.

*Paykel, E. S., Scott, J., Teasdale, J. D., Johnson, A. L., Garland, A., Moore, R., … Pope, M. (1999). Prevention of relapse in residual depression by Cognitive Therapy: A controlled trial. Archives of General Psychiatry, 56, 829-835.

Type of Study: Randomized controlled trial
Number of Participants: 158

Population:

  • Age — Mean=43 years
  • Race/Ethnicity — Not specified
  • Gender — 50% Male
  • Status — Participants were recruited from psychiatric outpatient clinics in Cambridge and Newcastle, England.

Location/Institution: Departments of Psychiatry, University of Cambridge, Cambridge, England; University of Glasgow, Glasgow, Scotland; University of Newcastle, Newcastle, England; and MRC Cognition and Brain Sciences Unit and Medical Research Council Biostatistics Unit, University of Cambridge Institute of Public Health.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants with recent major depression, partially remitted with antidepressant treatment but with residual symptoms of 2 to 18 months’ duration, were randomized to receive clinical management alone or clinical management plus Cognitive Therapy (CT) for 16 sessions during 20 weeks, with 2 subsequent booster sessions. Subjects were assessed regularly throughout the 20 weeks’ treatment and for a further year; measures included the Hamilton Rating Scale for Depression and the Beck Depression Inventory. They received continuation and maintenance antidepressants at the same dose throughout. CT reduced relapse rates for acute major depression and persistent severe residual symptoms, in both intention to treat and treated per protocol samples. The cumulative relapse rate at 68 weeks was reduced significantly from 47% in the clinical management control group to 29% in the CT group. CT also increased full remission rates at 20 weeks but did not significantly improve symptom ratings. Limitations include lack of control group, selection bias, and medication doses that were higher than standard practice.

Length of postintervention follow-up: 1 year.

*Bockting, C. L. H., Schene, A. H., Spinhoven, P., Koeter, M. W. J., Wouters, L. F., Huyser, J., & Kamphuis, J. H. (2005). Preventing relapse/recurrence in recurrent depression with Cognitive Therapy: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 73, 647-657.

Type of Study: Randomized controlled trial
Number of Participants: 187

Population:

  • Age — Treatment: Mean=45.9 years, Control: Mean=43.4 years
  • Race/Ethnicity — Treatment: 98% White, Control: 99% White
  • Gender — Treatment: 73% Female, Control: 74% Female
  • Status — Participants were recruited from February 2000 through September 2000 at psychiatric centers (31% of the participants) and through media announcements (69% of the participants) in the Netherlands.

Location/Institution: Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article reports on the outcome of a randomized controlled trial of group Cognitive Therapy (CT) to prevent relapse/recurrence in high-risk participants diagnosed with recurrent depression. Recurrently depressed participants currently in remission and following various types of treatment were randomized to treatment as usual, including continuation of pharmacotherapy, or to treatment as usual augmented with brief CT. Relapse/recurrence to major depression was assessed over 2 years. Measures included the Structured Clinical Interview for DSM–IV, the Hamilton Rating Scale for Depression (HRSD), the Dysfunctional Attitude Scale, and the Everyday Problem Checklist. Augmenting treatment as usual with CT resulted in a significant protective effect, which intensified with the number of previous depressive episodes experienced. For participants with 5 or more previous episodes (41% of the sample), CT reduced relapse/recurrence from 72% to 46%. The findings extend the accumulating evidence that cognitive interventions following remission can be useful in preventing relapse/recurrence in participants with recurrent depression. Limitations include lack of control group, attrition, and unclear whether the beneficial effect was attributable to specific skills in CT or to a total package of the treatment as usual in combination with this CT.

Length of postintervention follow-up: 2 years.

*Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardon, J. P., … Gallop, R. (2005). Prevention of relapse following cognitive therapy vs. medications in moderate to severe depression. Archives of General Psychiatry, 62, 417-422.

Type of Study: Randomized controlled trial
Number of Participants: 104

Population:

  • Age — Mean=40 years
  • Race/Ethnicity — 82% White
  • Gender — 59% Female
  • Status — Participants were patients with moderate to severe unipolar depression aged 18 to 70 years who were recruited from outpatient psychiatric clinics.

Location/Institution: Outpatient clinics at the University of Pennsylvania and Vanderbilt University.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants who responded to Cognitive Therapy (CT) in a randomized controlled trial were withdrawn from treatment and compared during a 12-month period with medication responders who had been randomly assigned to either continuation medication or placebo withdrawal. Participants who survived the continuation phase without relapse were withdrawn from all treatment and observed across a subsequent 12-month naturalistic follow-up. Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression or Hamilton Rating Scale for Depression scores of 14 or higher during the continuation phase. Recurrence was defined in a comparable fashion during the subsequent naturalistic follow-up. Participants withdrawn from CT were significantly less likely to relapse during continuation than participants withdrawn from medications, and no more likely to relapse than participants who kept taking continuation. There were also indications that the effect of CT extends to the prevention of recurrence. Limitations include lack of generalizability of results due to race/ethnicity.

Length of postintervention follow-up: 2 years.

*Floyd, M., Rohen, N., Shackelford, J. A. M., Hubbard, K. L., Parnell, M. B., Scogin, F., & Coates, A. (2006). Two-year follow-Up of bibliotherapy and individual Cognitive Therapy for depressed older adults. Behavior Modification, 30, 281-294.

Type of Study: Randomized controlled trial
Number of Participants: 23

Population:

  • Age — 60 years or older
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were older adults recruited from the community.

Location/Institution: Tuscaloosa and Birmingham, Alabama

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the stability of treatment gains after receiving either cognitive bibliotherapy or individual Cognitive Therapy (CT) for depression in older adults. A 2-year follow-up of participants was conducted by comparing pre- and posttreatment scores with follow-up scores on the Hamilton Rating Scale for Depression (HRSD) and the Geriatric Depression Scale (GDS). Results indicated that treatment gains from baseline to the 2-year follow-up period were maintained on the HRSD and GDS, and there was not a significant decline from posttreatment to follow-up. There were no significant differences between the treatments on the GDS or HRSD at the 2-year follow-up; however, bibliotherapy participants had significantly more recurrences of depression during the follow-up period. Limitations include small sample size, attrition and reliance on self-reported measures.

Length of postintervention follow-up: 2 years.

Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., ... & Atkins, D. C. (2006). Randomized trial of behavioral activation, Cognitive Therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658–670.

Type of Study: Randomized controlled trial
Number of Participants: 241

Population:

  • Age — 16-60 years (Mean=39.90 years)
  • Race/Ethnicity — 197 White
  • Gender — 159 Female
  • Status — Participants were individuals who suffered from depression.

Location/Institution: Seattle, Washington

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in adults with major depressive disorder. Participants were randomly assigned to one of four acute treatment conditions: behavioral activation (BA), Cognitive Therapy (CT), antidepressant medication (ADM), or pill placebo (PLA). Measures included the Cognitive Therapy Scale (CTS), Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hamilton Rating Scale for Depression (HRSD), and the Beck Depression Inventory - 2nd Edition (BDI-II). Results indicate that that BA is comparable in efficacy to ADM, and more efficacious than CT among more severely depressed participants. Additionally, among more severely depressed participants in this trial, ADM significantly outperformed placebo through 8 weeks of treatment. There were no significant differences in outcome between ADM and placebo for the less severely depressed participants. Limitations include lack control group, missing data, and lack of follow-up.

Length of postintervention follow-up: None.

*Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J., Rizvi, S. L., … Jacobson, N. S. (2008). Randomized trial of behavioral activation, Cognitive Therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology, 76(3), 468-477.

Type of Study: Randomized controlled trial
Number of Participants: 241

Population:

  • Age — Mean=39.9 years
  • Race/Ethnicity — 81.7% Caucasian
  • Gender — 66% Female and 34% Male
  • Status — Participants for this study consisted of adult outpatients who responded to acute phase treatment for depression from the Dimidjian et al. (2006) study.

Location/Institution: Seattle, WA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior Cognitive Therapy (CT), or continued medication. Measures included the Beck Depression Inventory II and the Hamilton Rating Scale for Depression. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the 2nd year of follow-up. Specific comparisons indicated that patients previously exposed to CT were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to patients withdrawn from medication, although the difference was not significantly different. Differences between behavioral activation and CT were small in magnitude and not significantly different across the full 2-year follow-up, and each therapy was at least as efficacious as the continuation of medication. These findings suggest that behavioral activation may be nearly as enduring as CT and that both psychotherapies are less expensive and longer lasting alternatives to medication in the treatment of depression. Limitations include possible researcher bias and lack of generalizability to overall population due to race and gender.

Length of postintervention follow-up: 2 years.

Hollon, S. D., DeRubeis, R. J., Fawcett, J., Amsterdam, J. D., Shelton, R. C., Zajecka, J., ... Gallop, R. (2014). Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: A randomized clinical trial. JAMA Psychiatry, 71(10), 1157-1164.

Type of Study: Randomized controlled trial
Number of Participants: 452

Population:

  • Age — Mean=43.2 years
  • Race/Ethnicity — 388 White, 27 Hispanic, and 37 Not Specified
  • Gender — 266 Female
  • Status — Participants for this study consisted adult outpatients with chronic or recurrent major depressive disorder.

Location/Institution: Outpatient clinics at the University of Pennsylvania, Philadelphia; Rush Medical Center, Chicago, Illinois; and Vanderbilt University, Nashville, Tennessee

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study attempts to determine the effects of combining Cognitive Therapy (CT) with Antidepressant Medication (ADM) versus ADM alone on remission and recovery in major depressive disorder (MDD). The participants were randomly assigned to ADM treatment alone or CT combined with ADM treatment. Measures included the Structured Clinical Interviews for DSM-IVII and the Hamilton Rating Scale for Depression (HRSD). Results indicate that CT combined with medication treatment enhanced rates of recovery relative to medications alone, with the effect limited to participants with severe nonchronic depressions. Combined treatment also reduced the frequency of severe adverse events, but largely because it reduced time in episode. Limitations include high attrition rate, lack of follow-up, and the absence of another psychotherapy or psychotherapy control, in combination with medications, to test for the specificity of CT in accounting for the combined treatment advantage.

Length of postintervention follow-up: None.

Adler, A. D., Strunk, D. R., & Fazio, R. H. (2015). What changes in Cognitive Therapy for depression? An examination of Cognitive Therapy skills and maladaptive beliefs. Behavior Therapy, 46(1), 96-109.

Type of Study: Pretest-Posttest with a comparison group
Number of Participants: 88

Population:

  • Age — Mean=37.8 years
  • Race/Ethnicity — 88.5% White
  • Gender — 100% Female
  • Status — Participants were individuals who suffered from depression.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined effortful cognitive skills and underlying maladaptive beliefs among participants treated with Cognitive Therapy (CT) for depression. Measures included the Ways of Responding Scale, (WOR), Implicit Association Test, (IAT), Patient Health Questionnaire (PHQ), Generalized Anxiety Disorder Questionnaire- IV (GAD-Q-IV), Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hamilton Rating Scale for Depression (HRSD), Beck Depression Inventory - 2nd Edition (BDI-II), and the Dysfunctional Attitude Scale (DAS). Results indicate that among participants in the CT , large improvements in CT skills were significantly related to symptom improvement. Combined treatment also reduced the frequency of severe adverse events, but largely because it reduced time in episode. Limitations include lack of randomization of participants, small sample size, and lack of follow-up

Length of postintervention follow-up: None.

References

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive Therapy of depression. New York: Guilford.

Clark, D. A., & Beck, A. T. (1999). Scientific foundations of Cognitive Theory and therapy of depression. New York: John Wiley.

Contact Information

Name: Michelle O'Connell, MGA
Title: Executive Director
Agency/Affiliation: Academy of Cognitive Therapy
Website: www.academyofct.org
Email:

Date Research Evidence Last Reviewed by CEBC: December 2015

Date Program Content Last Reviewed by Program Staff: March 2010

Date Program Originally Loaded onto CEBC: March 2010