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

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.

A comprehensive overview of post-stroke depression treatment options

“…CBT is a psychosocial intervention aimed at reducing symptoms of various mental health conditions, primarily depression and anxiety disorders (Raggi et al ., 2007; Panerai et al ., 2016; Carson and McWhirter, 2022). CBT focuses on challenging and changing cognitive distortions, such as thoughts, beliefs, and attitudes, along with their associated behaviors.…”

Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response

“…124 It is worth mentioning that, even prepandemic, stress and adverse mental health were associated with inflammation and neuroinflammation, making the direction of causality difficult to determine. 8,[125][126][127][128][129] Brusaferri et al found in pandemic patients without having had COVID-19, "novel evidence of elevated neuro-inflammatory markers in cortical and subcortical regions . .…”

“…150,152 Treatment suggestions are similar to SSD in general, focusing on explanation and education, physical therapy/rehabilitation, and cognitive behavioral therapy (aiming to change maladaptive thoughts and behaviors). 127,145 An older study is particularly interesting. 153 Of those suffering from environmental hypersensitivity disorder, 90% reported suffering from at least one other so-called "fashionable" (i.e., media popularized) condition, including food allergy, candidiasis hypersensitivity, post-infectious neuromyasthenia, fibrositis, and temporomandibular joint syndrome.…”

“…implicates neuroimmune activation as a possible mechanism underlying the non-virally-mediated symptoms experienced by many during the COVID-19 pandemic.” 128 Reviews have written that if inflammation is found, this is “consistent with decades of psychoneuroimmunology research in patients with anxiety disorders, depression, and traumatic stress-related disorders,” 8 “inflammation and immune dysregulation may link psychological distress with post-COVID-19 conditions [e.g., distress is associated with chronic systemic inflammation, and “mental health disorders are associated with chronic low-grade inflammation and microglia activation” in the central nervous system],” 125 “psychosocial factors are also very important in regulating our immune system [e.g., immune abnormalities are found in chronic fatigue syndrome (CFS), fibromyalgia, chronic pain, depression and other mental health disorders, with increased peripheral inflammation and activation of glial cells with neuroinflammation],” 126 and suggesting that maladaptive behavioral responses are actually causing the abnormal immune findings. 127 Poor sleep health, which increased during the pandemic, is associated with chronic low-grade inflammation and immune abnormalities, COVID-19 risk and severity, and Long-COVID. 76 Anxiety and depression have been found to be associated with more severe acute respiratory infections, including COVID-19 (i.e., hospitalization, intensive care, and mortality), and it is possible this is mediated by the associated immune abnormalities.…”

“… 150 , 152 Treatment suggestions are similar to SSD in general, focusing on explanation and education, physical therapy/rehabilitation, and cognitive behavioral therapy (aiming to change maladaptive thoughts and behaviors). 127 , 145 …”