Intended for healthcare professionals

Clinical Review

Fortnightly review: Cognitive behaviour therapy–clinical applications

BMJ 1997; 314 doi: (Published 21 June 1997) Cite this as: BMJ 1997;314:1811


Although there are many variants of cognitive behaviour therapy, these are unified by the proposition that psychological problems arise as a direct consequence of faulty patterns of thinking and behaviour. Patients tend to misinterpret situations or symptoms in ways that undermine their coping. Their abnormal behavioural patterns exacerbate and consolidate these problems. The critical factor lies in how patients assess specific situations or problems–as summarised by Epictetus, a first century Greek philosopher: “Men are disturbed not by things, but the views they take of them.”1


This review of cognitive behaviour therapy is based on a literature search of all papers, books, and chapters related to its application in mental health and general medicine. In the search I used the following key words–cognitive, behaviour, behavioural, theory, therapy, treatment–and searched the following databases on the Embase CD ROM from September 1985 to September 1996–Healthplan, Psych-Lit, Excerpta Medica (psychiatry, drugs, pharmacology), Cinahl, Medline, and Social Science Citation Index. This review covers the major clinical applications of cognitive behaviour therapy, focusing on those aspects of psychology, psychiatry, and medicine where the research data are most substantial.

Cognitive behaviour theory

The link between psychological problems and faulty patterns of thinking and behaviour can be illustrated Beck's original model of depression.2 He proposed that negative thinking in depression has its origins in attitudes and assumptions arising from experiences early in life. Such assumptions can be positive and motivating, but they can also be too extreme, held too rigidly, and be highly resistant to revision.

Problems arise when critical incidents occur that contradict a person's goals and beliefs. For example, the assumption “My worth is dependent on my success” might cause a person to be vulnerable to an event like failing to get a job at interview. Once activated by the critical incident, the core assumption leads to …

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