Cognitive therapy/cognitive behavior therapy is a psychotherapy intended to ease feelings by working on cognition. Cognition means the process and its results to understand things. When under stress, we tend to be pessimistic and drive ourselves into a mental state in which we are unable to solve problems. Cognitive therapy produces a mental condition in which we can maintain a balance in thinking so that we can cope with stress.
We form subjective judgments of our surroundings, circumstances, and situations continuously. This process is normally adaptive, although cognition is distorted under special situations such as great stress or depression. As a result, depression and anxiety are enhanced, along with nonadaptive behaviors, further enhancing cognitive distortion. At present, we help patients to cope with problems via practical, realistic, and flexible thinking that is neither too pessimistic nor too optimistic. It has been demonstrated that cognitive therapy/cognitive behavior therapy is effective for many psychiatric disorders including depression, anxiety disorder (such as panic disorder, social anxiety disorder, post-traumatic stress disorder, and obsessive–compulsive disorder), insomnia, eating disorder, and schizophrenia, and has come into wide use.
Cognitive behavior therapy specifically assesses thoughts that cross a patient’s mind automatically when unsettled or feeling bitter, which are called automatic appraisal. The therapy then verifies the degree to which they differ from reality and restores a balance in thought. For the effective use of the process itself, the process supports problem-solving, which is indispensable to carry out processes not only in sessions, but also in daily life by utilizing homework.
Following is a simple introduction to specific methods of cognitive therapy/cognitive behavior therapy. Needless to say, it is important to value warm and good therapeutic relationships, to look at reality holistically, and to change the focus and solve some difficulties.
(1) In sessions, we work with a patient and understand him/her as an individual, ascertain his/her worries, difficulties, strengths, and advantages to set a treatment plan. Then we share it with the patient.
(2) Behavioral techniques are used to set the life rhythm. One method is behavioral activation, by which activities are rank-ordered reasonably, and looking back at everyday life, in (a) routine and fixed activities, (b) activities that must be conducted before others, and (c) activities that are enjoyable or fulfilling, to be conducted in order. It is particularly ineffective to increase enjoyable or fulfilling activities. Adaptability is enhanced by regaining self-confidence and a sense of control and having experiences of relationships with others through predetermined physical activities and exercise, and solving problems that affect symptoms using problem-solving techniques.
(3) Focusing on the automatic appraisal, cognitive distortion is corrected by verifying their bases and counterevidence. Books and websites might be helpful in this regard.
(4) Proceed to completion of the therapy.
For details of interview flow, see “Mental Health” (http://www.mhlw.go.jp/bunya/shougaihoken/kokoro/) in the website of the Ministry of Health, Labour and Welfare. In addition, the cognitive therapy utilization website (http://cbtjp.net for both PC and mobile) is useful for training methods, although it is not a treatment.
In addition to such regular cognitive therapy/ cognitive behavior therapy, simplified cognitive behavior therapy, which is effective while optimizing human resources and time to be used on each person, has been developed and come into use in community and vocational mental health and areas related to welfare, law, and education. Methods used here include (1) support group programs for patients and supporters to support one another, (2) consultation center and telephone consultation for short-time consultation, (3) individual self-help in accordance with the principles of cognitive therapy/ cognitive behavior therapy, (4) behavioral activation (to increase fulfilling activities and comfortable activities), (5) exercise therapy, (6) problem solving skills, and (7) computer-assisted cognitive behavior therapy.