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Semin Neurol 2022; 42(02): 114-122
DOI: 10.1055/s-0042-1750851
Review Article

Cognitive Behavioral Therapy: Principles, Science, and Patient Selection in Neurology

Alan J. Carson
1   Neuropsychiatry Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland
,
Laura McWhirter
1   Neuropsychiatry Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland
› Author Affiliations Funding L.W. is currently funded by the Chief Scientist Office of the Scottish Government with a grant for examining cognitive phenotypes in long COVID.
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Abstract

Cognitive behavioral therapy (CBT) is a widely used therapeutic modality in general psychiatric practice. In this review, we consider its application to neurological disorders. We examine the basic framework of CBT—that symptoms, emotions, thoughts, and behaviors are all interrelated and that therapeutic interventions that lead to change in thoughts or behavior may have the potential to reduce symptoms or emotional distress. We also outline specific methodological issues to consider when reading or planning studies of CBT interventions, highlighting important topics pertaining to quality control, control group selection, dropouts, and generalizability. We then review the evidence base for CBT's use across a range of neurological disorders. In doing so, we highlight where there is a clear evidence base, and where it is a technique with potential. The review is targeted at a general neurology audience as introduction to the topic not as an advanced guide for expert practitioners.

Keywords

cognitive behavioral therapy - psychotherapy - neuropsychiatry - neurology


Publication History

Article published online:
08 June 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Beck AT. Thinking and depression: I. Idiosyncratic content and cognitive distortions. Arch Gen Psychiatry 1963; 9 (04) 324-333
    CrossrefPubMedGoogle Scholar
  • 2 Beck AT. Thinking and depression: II. Theory and therapy. Arch Gen Psychiatry 1964; 10 (06) 561-571
    CrossrefPubMedGoogle Scholar
  • 3 Epictetus. The Enchiridion. 2nd ed.. Liberal Arts Press; 1955
    Google Scholar
  • 4 Kant I. Lectures on Logic (The Cambridge Edition of the Works of Immanuel Kant). 2nd ed.. Cambridge University Press; 2009
    Google Scholar
  • 5 Nakao M, Barsky AJ. Clinical application of somatosensory amplification in psychosomatic medicine. Biopsychosoc Med 2007; 1: 17
    CrossrefPubMedGoogle Scholar
  • 6 Perez DL, Barsky AJ, Vago DR, Baslet G, Silbersweig DA. A neural circuit framework for somatosensory amplification in somatoform disorders. J Neuropsychiatry Clin Neurosci 2015; 27 (01) e40-e50
    CrossrefPubMedGoogle Scholar
  • 7 Dubois P. Les Psychonevroses et Leur Traitement Moral. Masson;; 1904
    Google Scholar
  • 8 Button KS, Munafò MR. Addressing risk of bias in trials of cognitive behavioral therapy. Shanghai Jingshen Yixue 2015; 27 (03) 144-148
    PubMedGoogle Scholar
  • 9 Jauhar S, McKenna PJ, Radua J, Fung E, Salvador R, Laws KR. Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. Br J Psychiatry 2014; 204 (01) 20-29
    CrossrefPubMedGoogle Scholar
  • 10 Walwyn R, Roberts C. Therapist variation within randomised trials of psychotherapy: implications for precision, internal and external validity. Stat Methods Med Res 2010; 19 (03) 291-315
    CrossrefPubMedGoogle Scholar
  • 11 Ysrraelit MC, Fiol MP, Gaitán MI, Correale J. Quality of life assessment in multiple sclerosis: different perception between patients and neurologists. Front Neurol 2018; 8 (JAN): 729
    CrossrefPubMedGoogle Scholar
  • 12 Ward NS, Brander F, Kelly K. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. J Neurol Neurosurg Psychiatry 2019; 90 (05) 498-506
    CrossrefPubMedGoogle Scholar
  • 13 Turner-Stokes L, Williams H, Bill A, Bassett P, Sephton K. Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: a multicentre cohort analysis of a national clinical data set. BMJ Open 2016; 6 (02) e010238
    CrossrefPubMedGoogle Scholar
  • 14 Sackley CM, Walker MF, Burton CR. et al; OTCH Trial Investigators. An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial. BMJ 2015; 350: h468
    CrossrefPubMedGoogle Scholar
  • 15 Furukawa TA, Noma H, Caldwell DM. et al. Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis. Acta Psychiatr Scand 2014; 130 (03) 181-192
    CrossrefPubMedGoogle Scholar
  • 16 National Collaborating Centre for Mental Health (UK).. Depression in Adults with a Chronic Physical Health Problem: Treatment and Management. Leicester, UK: British Psychological Society (UK);; 2010
    PubMedGoogle Scholar
  • 17 Fernie BA, Kollmann J, Brown RG. Cognitive behavioural interventions for depression in chronic neurological conditions: a systematic review. J Psychosom Res 2015; 78 (05) 411-419
    CrossrefPubMedGoogle Scholar
  • 18 Dolan N, Simmonds-Buckley M, Kellett S, Siddell E, Delgadillo J. Effectiveness of stress control large group psychoeducation for anxiety and depression: systematic review and meta-analysis. Br J Clin Psychol 2021; 60 (03) 375-399
    CrossrefPubMedGoogle Scholar
  • 19 Guttmacher JA, Birk L. Group therapy: what specific therapeutic advantages?. Compr Psychiatry 1971; 12 (06) 546-556
    CrossrefPubMedGoogle Scholar
  • 20 Noble AJ, Reilly J, Temple J, Fisher PL. Cognitive-behavioural therapy does not meaningfully reduce depression in most people with epilepsy: a systematic review of clinically reliable improvement. J Neurol Neurosurg Psychiatry 2018; 89 (11) 1129-1137
    CrossrefPubMedGoogle Scholar
  • 21 Reuber M. Cognitive-behavioural therapy does meaningfully reduce depression in people with epilepsy. J Neurol Neurosurg Psychiatry 2018; 89 (11) 1127
    CrossrefPubMedGoogle Scholar
  • 22 Carson AJ, Ringbauer B, MacKenzie L, Warlow C, Sharpe M. Neurological disease, emotional disorder, and disability: they are related: a study of 300 consecutive new referrals to a neurology outpatient department. J Neurol Neurosurg Psychiatry 2000; 68 (02) 202-206
    CrossrefPubMedGoogle Scholar
  • 23 Juang KD, Wang SJ, Fuh JL, Lu SR, Su TP. Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes. Headache 2000; 40 (10) 818-823
    CrossrefPubMedGoogle Scholar
  • 24 Pontone GM, Williams JR, Anderson KE. et al. Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson's disease. Mov Disord 2009; 24 (09) 1333-1338
    CrossrefPubMedGoogle Scholar
  • 25 Korostil M, Feinstein A. Anxiety disorders and their clinical correlates in multiple sclerosis patients. Mult Scler 2007; 13 (01) 67-72
    CrossrefPubMedGoogle Scholar
  • 26 Chun HYY, Whiteley WN, Dennis MS, Mead GE, Carson AJ. Anxiety after stroke the importance of subtyping. Stroke 2018; 49 (03) 556-564
    CrossrefPubMedGoogle Scholar
  • 27 Moonen AJH, Mulders AEP, Defebvre L. et al. Cognitive behavioral therapy for anxiety in Parkinson's disease: a randomized controlled trial. Mov Disord 2021; 36 (11) 2539-2548
    CrossrefPubMedGoogle Scholar
  • 28 Chun HYY, Carson AJ, Tsanas A. et al. Telemedicine cognitive behavioral therapy for anxiety after stroke: proof-of-concept randomized controlled trial. Stroke 2020; 51 (08) 2297-2306
    CrossrefPubMedGoogle Scholar
  • 29 Gil-González I, Martín-Rodríguez A, Conrad R, Pérez-San-Gregorio MÁ. Quality of life in adults with multiple sclerosis: a systematic review. BMJ Open 2020; 10 (11) e041249
    CrossrefPubMedGoogle Scholar
  • 30 Billones R, Liwang JK, Butler K, Graves L, Saligan LN. Dissecting the fatigue experience: a scoping review of fatigue definitions, dimensions, and measures in non-oncologic medical conditions. Brain Behav Immun Health 2021; 15: 100266
    CrossrefPubMedGoogle Scholar
  • 31 Penner IK, Paul F. Fatigue as a symptom or comorbidity of neurological diseases. Nat Rev Neurol 2017; 13 (11) 662-675
    CrossrefPubMedGoogle Scholar
  • 32 van Kessel K, Moss-Morris R. Understanding multiple sclerosis fatigue: a synthesis of biological and psychological factors. J Psychosom Res 2006; 61 (05) 583-585
    CrossrefPubMedGoogle Scholar
  • 33 Harrison AM, Safari R, Mercer T. et al. Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis. Mult Scler 2021; 27 (11) 1657-1678
    CrossrefPubMedGoogle Scholar
  • 34 Knoop H, van Kessel K, Moss-Morris R. Which cognitions and behaviours mediate the positive effect of cognitive behavioural therapy on fatigue in patients with multiple sclerosis?. Psychol Med 2012; 42 (01) 205-213
    CrossrefPubMedGoogle Scholar
  • 35 White PD, Goldsmith KA, Johnson AL. et al; PACE Trial Management Group. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 2011; 377 (9768): 823-836
    CrossrefPubMedGoogle Scholar
  • 36 Cousins S, Ridsdale L, Goldstein LH, Noble AJ, Moorey S, Seed P. A pilot study of cognitive behavioural therapy and relaxation for migraine headache: a randomised controlled trial. J Neurol 2015; 262 (12) 2764-2772
    CrossrefPubMedGoogle Scholar
  • 37 Harris P, Loveman E, Clegg A, Easton S, Berry N. Systematic review of cognitive behavioural therapy for the management of headaches and migraines in adults. Br J Pain 2015; 9 (04) 213-224
    CrossrefPubMedGoogle Scholar
  • 38 Okai D, Askey-Jones S, Samuel M. et al. Trial of CBT for impulse control behaviors affecting Parkinson patients and their caregivers. Neurology 2013; 80 (09) 792-799
    CrossrefPubMedGoogle Scholar
  • 39 Gutkin M, McLean L, Brown R, Kanaan RA. Systematic review of psychotherapy for adults with functional neurological disorder. J Neurol Neurosurg Psychiatry 2020; 92 (01) 36-44
    CrossrefPubMedGoogle Scholar
  • 40 Goldstein LH, Robinson EJ, Mellers JDC. et al; CODES Study Group. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. Lancet Psychiatry 2020; 7 (06) 491-505
    CrossrefPubMedGoogle Scholar
  • 41 Carson A, Ludwig L, Welch K. Psychologic theories in functional neurologic disorders. Handb Clin Neurol 2016; 139: 105-120
    CrossrefPubMedGoogle Scholar