Introduction

Cognitive therapy (CT) has been applied to a diverse range of clinical problems, including depression, anxiety, eating disorders, personality disorders, addictive behaviors, and marital distress (DeRubeis et al., 2001). CT is one of the most widely studied psychotherapies, as recent decades have witnessed a proliferation of research investigating its efficacy. Outcome data attest to the efficacy of CT across the broad range of clinical problems, including those noted above.

Unfortunately, while there are many studies investigating the outcome of CT, the volume of research examining the process of change in CT has been more modest. In fact, only recently have researchers systematically begun to address questions regarding the active ingredients of CT and particular mediators or moderators of change. These areas of research, however, have profound practical and theoretical implications and will likely be an increasing focus of attention in the future. Greater knowledge about particular process variables has the potential to enhance treatment development efforts, and point the way toward interventions that are more powerful and efficient than those of today. Additionally, the impact on clinician training and the treatment and service delivery and dissemination could have significant public health relevance.

This chapter focuses on the process of change in CT. Towards this end, we first propose a basic model of therapeutic change, which we use to elucidate the particular components of the cognitive theory of clinical change. Next, we present an integrative review of the empirical literature on the process of change in CT.