Cognitive Therapy: Current Status and Future Directions (Annual Review of Medicine Book 62)

Understanding the schematic representation of pain and general symptomatology: The contribution of the cognitive miser perspective. An appraisal of constructivist psychotherapies. Journal of Consulting and Clinical Psychology, 61, Telling more that we can know: Verbal reports on mental processes. Psychological Review, 84, Social cognition permeates social psychology: Motivated mental processes guide the study of human social behavior. Asian Journal of Social Psychology, 2, Vocal manifestations of internal mul-tiplicity: Oxford guide to behavioural experiments in cognitive therapy pp.

The central executive does not exist. Melancholy and schizophrenia] Madrid: Cognitive therapy in practice. A case formulation approach. The case formulation approach to cognitive-behavior therapy. Las funciones de la conciencia [Functions of consciousness]. American Psychologist, 4, Postmodernism and the social sciences. The un-making of a method: From rating scales to the study of psychological processes. The feeling of being a person. Philosophy, Psychiatry and Psychology, 16, Interpersonal processes in cognitive therapy.

Pinillos [Human activity and cognitive processes. Philosophical problems of consciousness. Behavior therapy and the ideology of modernity. American Psychologist, 39, The works published in this journal are subject to the following terms: The Publications Service of the University of Murcia the publisher retains the property rights copyright of published works, and encourages and enables the reuse of the same under the license specified in paragraph 2.

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1. Introduction

Cognitive therapy subject, introspection, consciousness, cognitive miser, trained scientist. Abstract This paper discusses the various subjects embedded in cognitive psychotherapy. Actual minds, possible worlds. The new mood therapy. The Philosophical Quarterly, 28, Surveiller et punir [Discipline and punish]. On some omissions of introspective psychology. Principles of psychology Vol. The psychology of personal constructs. The society of mind.

Contingencia y drama [Contingency and drama]. The subject in cognitive psychotherapy. In the first one, Rubin-Falcone and colleagues assessed fMRI changes in CBT-treated patients 14 sessions and healthy controls during the performance of a task consisting of a voluntary emotion regulation strategy while recalling negative autobiographical memories. The observed clinical improvement was associated with a decrease in the activity of the medial PFC cortex and subgenual ACC [ 50 ].

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In the second study, Dichter and colleagues assessed the biological mechanisms of BATD, a therapy that focuses on the behavioral activation component of CBT and entails reducing avoidance behaviors and increasing engagement with potentially rewarding behaviors [ 51 ]. Although inconsistent with previous findings, the results of both studies could be partly attributed to the choice of stimuli i.

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It is noteworthy that Dichter and colleagues also employed fMRI during reward processing and reported BATD related functional improvement in areas that are part of the reward circuit during reward selection i. These researchers employed fMRI during a task sensitive to sustained emotional information processing i. They focused on the baseline activity within the subgenual ACC based on previous studies that suggested this area as a modulator inhibitor of emotions via its connections with limbic regions i.

Although higher treatment effectiveness was observed among participants who had lower activity in the subgenual ACC prior to CBT which support previous findings, no significant changes in the activity of this structure were observed following CBT.

The subject in cognitive psychotherapy | Anales de Psicología / Annals of Psychology

The lack of such effects might be explained by methodological limitations i. Another issue would be the lack of sufficient sociodemographic and clinical information limiting the possibility to compare the results with those obtained in other studies. In a first study, Shou and colleagues assessed the resting-state functional amygdalo-cortical connectivity in CBT-treated patients 12 sessions and controls [ 57 ], based on their previous study that documented hypoconnectivity between these regions in patients with MDD [ 58 ].

Following CBT, patients exhibited an enhancement in resting-state functional connectivity between the amygdala and frontal regions that are believed to exert cognitive control. Furthermore, Yoshimura and colleagues have focused on functional connectivity between medial PFC and ACC during self-referential judgment of negative adjectives which was high at baseline and decreased following CBT [ 59 ]. Medial PFC and ACC are components of the DMN which was previously found to exhibit a hyperconnectivity pattern among its components in patients with MDD, possibly reflecting aberrant cognitive and affective processing and dysfunctional self-focus [ 37 , 60 ].

However, these results should be interpreted with caution admitting the major limitations of this study, namely the inadequate control group and the fact that patients were receiving concomitant pharmacological therapy. No significant changes a trend toward a decrease were observed with regards to resting state occipital cortex gamma-aminobutyric acid GABA following CBT. The absence of effects in this study might be also related to the small sample size and needs to be further explored.

MBCT seems to enhance the function of ACC, a region involved in cognitive, affective and default mode networks that were reported to be dysfunctional in the context of MDD [ 18 ]. Results of PET studies derive from the same team, are inconsistent with the above seen results and partly support the abovementioned data linking CBT with the cognitive model of depression.

In the second trial, patients were randomized to receive either CBT 15—20 sessions or antidepressant medications i. However, unlike the majority of fMRI studies except [ 50 , 51 ] , PET scan studies revealed a decreased metabolism in frontal regions [ 66 , 67 ] and increased activity in limbic regions i. Although these findings are intriguing and may not support the cognitive model discussed earlier, several factors could have contributed to their occurrence. First, these results could be interpreted as a treatment-related decrease of ruminations and maladaptive associative memories.

Second, the discrepancy between these outcomes and those observed with fMRI could be due to the differences in the measured outcomes of each technique fMRI vs. PET , but also to the type of control chosen, that consisted of untreated healthy controls in fMRI studies, and of depressed patients pharmacologically-treated in above-cited PET studies. Interestingly, although both treatments CBT vs. It is worth noting that, in both studies, in addition to CBT effects on the cognitive and affective networks, the authors observed a decrease in the metabolic activity of the inferior parietal cortex [ 66 ] and PCC [ 66 , 67 ], both of which are components of the DMN that displays enhanced connectivity in the context of MDD.

Therefore, CBT might have acted by deactivating this hyperfunctioning network. In a third study which was based on the serotonin hypothesis of depression, the authors employed a pharmacologically-based PET scanning using 5-hydroxytryptamine 1B 5-HT1B , an autoreceptor selective ligand [ 68 ]. This could be interpreted as a downregulation of 5-HT1B receptor messenger RNA, which has been previously observed in rodents chronically treated with antidepressant medications [ 70 ].

Such a downregulation may remove the inhibition on DBS serotoninergic neurons and therefore induce an increase in serotonin release from its projections in mood-related brain areas i. However, given the absence of correlation between the PET reported changes and clinical improvement and in the absence of a control group, results should be interpreted with caution. It might be better to consider these PET changes as parallel findings rather than mediators of the clinical response. The authors employed a radiopharmaceutical, the 2- 2- Dimethylamino methyl phenyl thio I-iodophenylamine I-ADAM , which selectively binds to serotonin transporters in the central nervous system [ 73 ].

The authors compared a group of depressed patients treated with CBT 16 sessions over twelve weeks to a group of untreated healthy controls. Patients were found to have low SERT standardized uptake ratios at baseline as seen in some but not all studies assessing depression [ 74 , 75 , 76 , 77 , 78 ].

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This baseline result could reflect low brain serotonin levels, a finding that seems to improve in the midbrain, right and left medial temporal lobes following CBT. Although only few data are available on the biological effects of CBT in patients with depression, there is some evidence regarding CBT-effects on activity or metabolism in specific cortical and subcortical areas, mainly in prefrontal regions, cingulate regions, amygdala and hippocampus fMRI and PET scan data. However, the direction of changes varied across the studies as will be discussed in this section.

The main issue that challenges formal comparisons of findings across the studies is the heterogeneity in the cohorts, type of psychotherapy, protocol designs and employed techniques. To start, the mean age ranged from 30 to The majority of trials included patients with moderate depressive symptoms, while two studies included patients with mild depressive symptoms [ 44 , 59 ].

In the majority of studies, patients were drug free at the time of intervention, except in two studies where patients were drug-resistant, treated with one or more antidepressant drugs for a minimum of eight weeks prior to inclusion and continued to receive medications during the study period [ 44 , 59 ]. Second, the protocols also differed in the type of therapy methodological differences between conventional CBT, MBCT and BATD [ 82 , 83 , 84 ] , the duration of sessions ranging from 8 sessions in the MBCT protocol [ 64 ] and up to 35 sessions in some CBT protocols [ 43 ] , the application milieu individual versus group therapy , and the mode of delivery single therapist versus multiple therapists versus internet-based intervention.

Third, regarding protocol design, an ideal study would take the form of a randomized controlled trial that would include several treatment arms: However, such a design is very challenging and would raise ethical concerns that would prohibit or discourage including untreated group of patients with acute symptoms. Most of the available studies were nonrandomized or open label trials, with or without a control group of untreated healthy controls.

Only one of them was randomized [ 67 ] and only two included a treatment control arm which consisted of antidepressant medications [ 66 , 67 ]. For instance, regarding the adopted technique, while fluorine labelled deoxy-glucose and 5-HT1B auto-receptor selective radioligand based PET scans work by measuring glucose metabolism or serotonin distribution respectively, fMRI measures deoxyhemoglobin concentration. In addition, admitting that the employed techniques measure different physiological parameters, and differ in spatial and temporal resolutions, findings could considerably differ among the studies.

Moreover, using the same technique i. Furthermore, tasks also varied across studies and might account for the discrepancy in the observed changes. Similar findings were obtained in other brain areas such as the PFC, the activity of which was found to be i decreased when adapting resting state PET scan [ 66 , 67 ], or when employing fMRI during the processing of negative stimuli self-referential processing of negative stimuli or processing of negative autobiographical memories [ 44 , 50 ] ; and ii increased during when responding to emotional and neutral pictures [ 43 ], during self-referential processing of positive stimuli [ 44 ], or when engaging in a cognitive control task [ 45 ].

The same applies to the AHC activity which was found to be i increased hippocampus during resting state PET scan [ 66 ] or ii decreased when adapting fMRI during an affect processing task [ 42 ].

INTRODUCTION

Despite the above-described incongruence in the activity pattern, the identified regions appear to play a key role in the fronto-limbic system involved in emotional experience and control. This suggests that CBT-modulatory effects lie within the previously mentioned dorsal cognitive and ventral limbic networks. However, facing the dearth of the available data, future randomized controlled trials are highly needed in order to draw formal conclusion on CBT mechanisms of action in large MDD cohorts.

Neuroimaging studies assessing cerebral changes following cognitive behavioral therapy. Anterior cingulate cortex; BATD: Behavioral activation therapy for depression; BDI: Beck depression inventory; CBT: Cognitive behavioral therapy; ECT: Hamilton Depression Rating Scale score; M: Mindfulness based cognitive therapy; MRS: Positron emission tomography; PFC: Single photon emission computed tomography. National Center for Biotechnology Information , U. Journal List Brain Sci v. Published online Aug 9. Ayache 1, 2, 3.

Author information Article notes Copyright and License information Disclaimer. Received Jul 12; Accepted Aug 8. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution CC BY license http: Introduction Major depressive disorder MDD stands among the most prevalent psychiatric disorders and accounts for a considerable part of mental health disease burden in Western countries [ 1 ]. A Brief Overview of the Depressed Brain Current evidence supports the involvement of several cerebral regions in the pathophysiology of depression, and in the generation of various symptoms observed in patients with MDD.

Neuroimaging Data Results Seventeen studies were identified. PET Studies Results of PET studies derive from the same team, are inconsistent with the above seen results and partly support the abovementioned data linking CBT with the cognitive model of depression. Discussion Although only few data are available on the biological effects of CBT in patients with depression, there is some evidence regarding CBT-effects on activity or metabolism in specific cortical and subcortical areas, mainly in prefrontal regions, cingulate regions, amygdala and hippocampus fMRI and PET scan data.

Conclusions Despite the above-described incongruence in the activity pattern, the identified regions appear to play a key role in the fronto-limbic system involved in emotional experience and control. Appendix A Table A1 Neuroimaging studies assessing cerebral changes following cognitive behavioral therapy. Open in a separate window. Funding This research received no external funding.

Conflicts of Interest S. Cognitive theory and therapy of anxiety and depression: Convergence with neurobiological findings. Phil marked it as to-read Dec 12, Filosofia Stine Nordskov Hansen marked it as to-read Jan 14, Nataliia Myronchuk added it Sep 26, There are no discussion topics on this book yet.

Aaron Temkin Beck is an American psychiatrist who is professor emeritus in the department of psychiatry at the University of Pennsylvania. He is regarded as the father of cognitive therapy, and his pioneering theories are widely used in the treatment of clinical depression. Beck also developed self-report measures of depression and anxiety, notably the Beck Depression Inventory BDI which became Aaron Temkin Beck is an American psychiatrist who is professor emeritus in the department of psychiatry at the University of Pennsylvania.

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Beck also developed self-report measures of depression and anxiety, notably the Beck Depression Inventory BDI which became one of the most widely used instruments for measuring depression severity. Beck is noted for his research in psychotherapy, psychopathology, suicide, and psychometrics.

He has published more than professional journal articles, and authored or co-authored 25 books. He has been named one of the "Americans in history who shaped the face of American Psychiatry," and one of the "five most influential psychotherapists of all time" by The American Psychologist in July His work at the University of Pennsylvania inspired Martin Seligman to refine his own cognitive techniques and later work on learned helplessness.

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Beck is currently the President Emeritus of the non-profit Beck Institute for Cognitive Behavior Therapy which he set up with his daughter in Books by Aaron T.