**3.1 Cognitive therapy**

Cognitive therapy is organised around the idea that behaviour is based on schemas and that these are shaped by early experiences. Schematic thoughts consist of memories, attitudes, core beliefs and assumptions and are factors that, when occurring in certain circumstances, can result in individuals spiralling into negativity and consequential psychological problems [31]. Implicit memories (memories no longer consciously perceived) and explicit negative memories of past experiences can trigger latent patterns of thoughts, emotions and behaviour, resulting in a vicious cycle that maintains and exacerbates the non-helpful behaviour. It is argued that implicit memory is the unconscious remembering of thoughts that accompanied specific events. If negative thoughts have been encoded, implicit feelings are brought into conscious awareness causing both physiological and psychological symptoms [32]. It has been concluded that interventions should focus on problematic over-activation of safety behaviours [33]. This research was extended when the common elements in different anxiety disorders (dysfunctional thinking, physiological reactions, and behavioural responses based on the 'fight or flight syndrome', the body's reaction to unpleasant experiences) were reviewed, and a process map of treatment formulated enabling therapists to adhere to a treatment plan [34].

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*Cognitive Hypnotherapy*

**3.2 Behavioural therapy**

*DOI: http://dx.doi.org/10.5772/intechopen.91327*

**3.3 Cognitive behavioural therapy (CBT)**

Behavioural therapy, in contrast to cognitive therapy, is based on the premise that undesirable behaviours are learned and as such can be 'unlearned' through a process of systematic desensitisation. It is argued that desired behaviours can be taught and reinforced and unwanted behaviours eliminated [35]. Behavioural therapy was expanded when the theory of shaping behaviour by a system of rewards and punishment was first postulated [36]. Behavioural theorists consider that specific phobias and anxiety conditions are acquired through a process of classical conditioning, and that all learned responses derive from innate behavioural patterns, the stimulus/response paradigm [37]. The basis of behavioural therapy encouraged therapists to use techniques aimed at changing the negative affect,

While behavioural therapy is based primarily on learning theory and cognitive therapy is rooted more in cognitive theory, the two systems have much in common [39]. Both behavioural and cognitive therapy focus on changing dysfunctional behaviour that occurs in feared situations and both concentrate on positive visual imagery of the environment and situation in which the maladaptive behaviour occurs. Other commonalities are management of physiological and somatic symptoms of anxiety and verbalassisted coping strategies. However, there are differences in the techniques used in each therapy: the behaviourists concentrate on systematic desensitisation and sequencing of negative images [40], whereas cognitive therapists target the patient's unhelpful reported thoughts [39]. However, the methodologies of behavioural therapists were integrated with cognitive therapies, resulting in a heterogeneous set of techniques and procedures that distinguished between conscious beliefs and unconscious representations in memory [41]. This was a new concept developed from behavioural therapy and became known as cognitive behavioural therapy, resulting in specific cognitive behavioural treatments being developed for a variety of psychological problems [42].

Since the 1960s, cognitive behavioural theory has gained popularity. CBT uses a combination of behavioural and cognitive interventions aimed at changing negative thinking patterns and behaviours and is one of the most researched psychological interventions [43]. CBT is frequently used in the clinical environment and its practice is evidence-based. It focuses on the way individuals think and act in specific circumstances and how emotional and behavioural problems may be overcome. It adopts a formulation of protocols and procedures that are used to treat psychological conditions, and enables development of flexible realistic beliefs [22]. Individuals are helped in the pursuit of goals, and emotional problems are aided and overcome by directing cognitions towards memories, images, thoughts and attention [42]. Specific patterns of thinking are associated with a range of psychological problems and through its development, CBT has adopted treatments for anxiety conditions and emotional disorders such as depression, generalised anxiety disorder, panic disorder, post-traumatic stress and specific phobias [44]. There are a number of distinctive diktats and protocols that contribute to an effective model of CBT. Various longitudinal formulations have been devised to aid the management and treatment of problems. However, for the purpose of this review, the formulation devised by Persons [45] is used, as this diagram is most usually associated with CBT and bridges the gap between behavioural and cognitive formulations [38]. An adaptation of the

diagram illustrates the relationship to the root cause and effect of anxiety.

introducing positive cognitions through the use of language [38].
