LogiMind Review of Psychotherapies

Vol. 1 · No. 1 · September 2026 Editor-in-chief: Édouard Alain de Boysson · Publisher: LogiMind · logimind.org ISSN: pending attribution (BnF) · Issue DOI: 10.5281/zenodo.21665912 (Zenodo) · Licence: CC BY 4.0

Theme of the month: cognitive-behavioural therapy (CBT)

Editorial — Why this journal
Theme: CBT — Aaron T. Beck and the birth of a therapy · Principles · Course of therapy, from first session to follow-up · The therapist's toolbox · Vocabulary and protocols · For whom, in which cases · What science says · What therapy changes in the body · Limitations and precautions · CBT around the world · In brief: CBT in ten points · CBT on screen
CBT and new technologies — internet-based therapy, applications, virtual reality, chatbots
CBT in times of war — what it offers soldiers and civilians, in Ukraine and Iran
ZOOM — Two CBT practitioners in Morocco
Insert — CBT in Tunisia
An emerging therapy — Zimbabwe's 'friendship bench'
CBT and its 'daughter therapies' — DBT, ACT, MBCT, schema therapy
LogiMind words — glossary and neologisms
Further reading · Colophon

Editorial

This first issue launches a simple bet: to make psychotherapies readable by all, without sacrificing any rigour. Each month, the Revue LogiMind des psychothérapies will devote its dossier to one therapeutic approach — its history, its principles, its concrete process, its level of evidence and its limitations — in a language accessible to the curious reader, student, clinician or simply those concerned.

The journal is published in full open access, under a Creative Commons CC BY 4.0 licence: anyone can read, share and freely translate it. This choice is not trivial. It primarily targets readers in countries where mental health training resources remain scarce and costly, for whom open access is not a luxury but a necessity. This is also why each issue will look beyond Europe and North America to see how therapies live and are invented elsewhere: two regular columns are devoted to practitioners and innovations in emerging countries. And because a therapy can only be understood in contact with the real world, this issue also examines what CBT can offer where war unravels lives — among soldiers and civilians, in Ukraine and Iran — and what new technologies change, for better and for worse, in its practice.

We open with cognitive-behavioural therapy, the most widely practised and most studied of contemporary psychotherapies. Happy reading.

Édouard Alain de Boysson

FEATURE — Cognitive-Behavioural Therapy

Milestones — Aaron T. Beck and the Birth of CBT

In the early 1960s, in the United States, a psychiatrist trained in psychoanalysis began to doubt what he had been taught. Aaron T. Beck, born 18 July 1921 in Providence, Rhode Island, graduated in medicine from Yale in 1946, and pursued a career in psychiatry at the University of Pennsylvania. Listening to his patients, he gradually turned away from unconscious conflicts and drives to focus on something more immediate: their conscious thoughts and beliefs, those automatic judgements that cross the mind and shape emotion as well as behaviour. He is credited with two famous phrases: 'the way we think determines the way we feel', and 'depression is a prison where you are both the suffering prisoner and the cruel jailer'.

CBT was born from the confluence of two traditions. On one side, behavioural therapy, rooted in the paradigms of classical and operant conditioning of Ivan Pavlov and B. F. Skinner, and dating back to the 1920s — Joseph Wolpe, with systematic desensitisation, Hans Eysenck and John Watson are among those who laid its foundation. On the other, the cognitive therapy formulated by Beck. The synthesis targets both dysfunctional behaviours and the irrational cognitions that maintain them. In parallel, Albert Ellis developed a related branch, rational emotive behaviour therapy, whose ABC framework (Antecedent, Belief, Consequence) remains an emblematic tool for tracing how our beliefs mediate the link between events and our emotional or behavioural reactions.

Beck also designed measurement instruments that have become classics — the Beck Depression Inventory, the Beck Anxiety Inventory — and left a foundational body of work on depression, personality disorders and suicide, from Cognitive Therapy and the Emotional Disorders (1976) to Cognitive Therapy of Depression (1979, with Rush, Shaw and Emery). Honoured notably with the Albert Lasker Award for Clinical Medical Research (2006), the Sigmund Freud Prize of the City of Vienna (2010) and the Prince Mahidol Award in Medicine (2011), he died in his sleep at his home in Philadelphia on 1 November 2021, shortly after his hundredth birthday. His daughter, Judith S. Beck, continues his legacy at the helm of the Beck Institute for Cognitive Behavior Therapy, founded in 1994, through which more than 60,000 clinicians have been trained worldwide. Around this core, successive generations have extended the approach: David D. Burns and Christine A. Padesky through influential clinical works, Donald Meichenbaum through stress inoculation training, Robert L. Leahy through protocols for anxiety and depression, David M. Clark by bringing CBT to anxiety disorders.

The approach is now known as Cognitive Behavioral Therapy (CBT) in English, Thérapie Cognitivo-Comportementale (TCC) in French, Kognitive Verhaltenstherapie (KVT) in German, Terapia Cognitivo-Conductual in Spanish, Terapia Cognitivo-Comportamentale in Italian and Cognitieve Gedragstherapie (CGT) in Dutch.

The Principles

Three features define the approach. First, it is present-focused: whatever the origin of a problem, it is the thoughts and behaviours that maintain it today that are most accessible to change; assessment and treatment plan therefore start from current symptoms and present triggers, rather than from excavating historical origins. Second, it is collaborative and structured: therapist and patient form a working team that jointly defines the problem list, sets goals and evaluates progress; the patient is not the passive recipient of interpretations, but an active participant who tests hypotheses about their own mental functioning — which is thought to increase both engagement and the durability of gains. Each session follows a predictable format — agenda, review of homework exercises, work on current targets, new 'homework' — which makes therapy efficient and makes progress, or its absence, visible session by session to both parties. Third, it is time-limited: most protocols aim to achieve their goals in approximately ten to twenty sessions, which distinguishes it from open-ended approaches and makes it particularly suited to structured healthcare systems.

Underlying these three features is a premise: thoughts and behaviours are learned through experience, and can therefore be unlearned and replaced. Therapeutic change is treated less as a revelation than as the acquisition of new cognitive and behavioural habits through structured practice — training in skills that the patient retains after therapy: self-monitoring of thoughts, problem-solving, relaxation. This is the 'solution' orientation of CBT: rather than dwelling on the meaning or origin of a problem, it treats the reduction of suffering and dysfunction as the primary criterion of success, and explicitly aims to equip the patient with self-management skills that they will deploy independently, without fostering lasting dependence on the therapist.

Finally, two aspects work in concert. The cognitive aspect targets the content and process of thinking — automatic thoughts, distortions, deeper schemas that generate them — whose modification is treated as a lever for changing both emotional experience and behaviour. The behavioural aspect directly attacks maladaptive or self-sabotaging behaviours — avoidance, withdrawal, safety behaviours — through techniques derived from conditioning, primarily graded exposure and behavioural activation, to break the reinforcement cycles that maintain the disorder.

The Course of Therapy, from First Session to Follow-up

What actually happens when one 'does CBT'? The treatment follows an arc, each stage of which has its own success criterion — a transparency that is itself a signature of the approach.

It all begins with a thorough initial assessment: a structured interview, often supplemented by standardised questionnaires, through which the therapist gathers an overview of the patient's problems, history and goals. The stage is successful when it yields a shared and specific problem list from which both parties can work. Next comes psychoeducation: the therapist explains how thoughts, emotions and behaviours interact, and outlines the form the treatment will take. Again, the criterion is explicit — the patient's informed consent, attested by their ability to restate the logic of the treatment in their own words.

The cognitive core of the work then unfolds in three phases. The patient first learns to identify and name their negative automatic thoughts as they occur, often starting with thought records linked to episodes of distress; progress is measured by an increasing ability to capture these thoughts in real time rather than only retrospectively. They then learn to challenge them: using Socratic questioning and evidence gathering, they question the validity of these thoughts instead of accepting them at face value — a usable outcome appears when they begin to generate their own counter-questions spontaneously. Finally, they replace them with more balanced and fact-consistent alternatives, progress marked by a measurable shift in the tone of spontaneous inner speech, tracked by thought records.

In parallel, the patient acquires new coping skills — relaxation, problem-solving, communication — chosen jointly with the therapist based on the clinical case formulation, and then practises them between sessions as homework: lasting change depends on repetition outside the clinical setting, and improved self-rated stress management between sessions signals that practice is taking effect. At regular intervals, therapist and patient evaluate progress together, using symptom measures and homework results against the initial baseline — a transparent and shared reading of what is working or not — and then revise the goals: achieved targets are removed, new ones introduced if necessary, with the patient's explicit agreement as the criterion for continuing. Skills are then consolidated, until they can be applied with increasing efficiency and less conscious effort.

The end of treatment is prepared with the same care as its beginning. The patient develops a relapse prevention plan — learning to recognise their own early warning signs and rehearsing a concrete response: being able to name their risk indicators and the corresponding action is the practical test of this stage — and then a plan for the future, mapping how acquired skills will be applied to anticipated challenges. Termination is addressed deliberately, once the patient expresses confidence in managing their difficulties without ongoing sessions; preparation for ending is judged jointly, not unilaterally. One or more follow-up contacts follow, with formal reassessment using the same measures as during active treatment, to document whether improvement has been maintained. And if difficulties reappear, return to therapy is presented as an expected management mode — a 'booster' session, not a sign of failure — with reassessment of goals in light of the current situation rather than simply reinstating the original plan. For more persistent or complex difficulties, therapy continues in an extended or intermittent mode, until definitive closure: the moment when the patient expresses lasting confidence in their ability to manage future difficulties alone.

The Therapist's Toolkit

Ten families of techniques structure practice.

Cognitive restructuring is the central technique: identifying negative or irrational automatic thoughts, examining the evidence for and against them, substituting more accurate and adaptive alternatives — with the aim of modifying both the emotional and behavioural response to stressful situations. It relies on the thought record: recording one's thoughts and emotions, usually linked to specific triggering situations, in a structured diary, which externalises otherwise automatic mental content, makes recurrent negative patterns visible, and renders them available for restructuring work.

Graded exposure exposes the patient, in a progressive and controlled sequence, to the feared object or situation, from least to most anxiety-provoking. Repeated, non-avoidant contact allows fear responses to extinguish, as the patient discovers that anticipated catastrophes rarely materialise. Problem-solving therapy guides the patient through a step-by-step sequence — precisely defining the problem, generating candidate solutions, weighing their consequences, choosing the most promising option, implementing it — thereby developing a general coping skill applicable well beyond the initial complaint. Social skills training develops concrete skills — active listening, expressing feelings, negotiating conflict — through modelling, rehearsal and feedback, in session or outside.

Relaxation techniques — diaphragmatic breathing, progressive muscle relaxation, guided imagery — reduce the physiological arousal that accompanies anxiety and offer a somatic counterpoint to cognitive interventions. Mindfulness-based techniques train attention to present-moment experience without judgement, a practice integrated into several variants of CBT to reduce rumination, worry and the physiological correlates of chronic stress. Acceptance and commitment techniques, borrowed from acceptance-based approaches, help relate to difficult thoughts and emotions without immediate judgement or struggle, while redirecting effort toward values-consistent action. Dialectical behaviour therapy elements, originally developed for borderline personality disorder, combine validation of painful internal states with structured training in distress tolerance and emotion regulation skills. Finally, in children, play techniques allow expression and symbolic working through of emotions and conflicts that are difficult to verbalise directly, under the guidance of a trained clinician.

Vocabulary and Protocols

CBT possesses a vocabulary that sets it apart from other brief therapies. Its defining orientation is presentification — a sustained focus on the here and now, anchored in a functional analysis of the patient's current triggers, thoughts and behaviours. It is operationalised in the Trigger–Thought–Action model, which structures the process around an external or internal trigger, the negative automatic thought it provokes, and the resulting action, so that the patient learns to interrupt this chain. Beneath automatic thoughts lie cognitive schemas — deeply ingrained belief structures that shape how situations are interpreted — which CBT deconstructs by identifying distortions such as overgeneralisation, dichotomous thinking and catastrophising. Albert Ellis's ABC framework (Antecedent, Belief, Consequence) remains an emblematic tool for tracing how beliefs mediate the link between events and emotional or behavioural outcomes.

Reality testing invites the patient to confront their catastrophic predictions with real-world experience, while relapse prevention tools consolidate gains after treatment ends. Exposure can be conducted in vivo or in imagination — a contrast with trauma-focused approaches like EMDR, which relies on eye movement procedures. Finally, CBT relies on disorder-specific, empirically validated protocols — Clark and Wells's protocol for social anxiety, Barlow's for generalised anxiety are two classic examples — and emphasises patient empowerment, positioning the patient as an active agent throughout treatment.

For Whom, In Which Cases

The documented scope of CBT is vast: major depression; anxiety disorders — generalised anxiety, panic disorder, social anxiety, specific phobias; obsessive-compulsive disorder, treated notably by exposure and response prevention; post-traumatic stress disorder and acute stress; insomnia and other sleep disorders; eating disorders, including anorexia and bulimia; borderline personality disorder; attention deficit hyperactivity disorder. It is also used for symptom management in schizophrenia and bipolar disorder — a debated use, as will be seen — and, more preliminarily, in a range of personality disorders (avoidant, dependent, antisocial, narcissistic, histrionic, paranoid, schizoid, schizotypal).

Three vignettes illustrate what 'success' means. In generalised anxiety disorder, the patient with persistent and excessive worry is treated with relaxation training, cognitive restructuring and graded exposure, typically resulting in significant symptom reduction and improved stress management. In depression, persistent low mood, loss of interest and diminished self-esteem are worked on through cognitive restructuring, behavioural activation and problem-solving, with gains seen in mood improvement and re-engagement in social and occupational life. In obsessive-compulsive disorder, exposure and response prevention, combined with cognitive restructuring, breaks the cycle of intrusive thoughts and rituals and restores daily functioning.

CBT does not exclude medication — it works alongside it. In many disorders, it is delivered in conjunction with treatments prescribed by a psychiatrist or general practitioner: selective serotonin reuptake inhibitors (such as fluoxetine or sertraline) for depression, OCD or bulimia; serotonin-noradrenaline reuptake inhibitors (such as venlafaxine) for depression and anxiety; bupropion for depression and ADHD; benzodiazepines, more occasionally, for anxiety and panic disorder. These medications are never prescribed by the cognitive-behavioural therapist themselves, but their action on neurotransmitters can support the therapeutic work.

Beyond psychiatric indications, CBT is increasingly used to improve quality of life for patients managing chronic illnesses such as cancer or cardiovascular disease — less as a cure than as a means of building resilience and reducing the psychological amplification of physical symptoms. It also finds extensions in neurology, where it helps patients with Parkinson's disease or epilepsy develop coping strategies, in pain medicine and in psychosomatic medicine, where the same cognitive mechanisms shape the subjective experience of physical illness.

What the Science Says

CBT is one of the most widely practised and best empirically supported psychotherapies. Its protocols are derived from a large body of controlled studies and are continually revised in their light — the meta-analytic synthesis published by Hofmann and colleagues in 2012 in Cognitive Therapy and Research is among the most cited. This evidence base earns it first-line recommendation from most national clinical guidelines — the American Psychological Association, the American Psychiatric Association and the UK's National Institute for Health and Care Excellence cite it depending on the disorder — and distinguishes it from therapies whose efficacy claims rest primarily on clinical consensus.

The evidence gradient, honestly. Not all indications are equal. Support is massive for depression and anxiety disorders; it is considerably more contested for severe psychiatric disorders. British psychologist Keith Laws concluded from a meta-analysis (2014) that the effect of CBT on schizophrenia and bipolar disorder was minimal, questioning its widespread adoption in these populations. CBT retains strong scientific support and extensive clinical validation, but debate about its comparative merits continues — and this review will report on its developments.

What Therapy Changes in the Body

Research documents measurable biological correlates of therapeutic change — one of the most distinctive aspects of CBT. Neuroimaging studies associate successful treatment with normalisation of prefrontal activity — the region involved in emotion regulation — and with reduced hyperactivation of the amygdala, a structure associated with fear, in response to threat stimuli; in obsessive-compulsive disorder, exposure and response prevention alters the cortico-striatal circuits involved in compulsive behaviour. Studies link CBT to increased neuroplasticity — the brain's capacity to remodel itself in response to experience — in emotion regulation circuits, to changes in cortisol regulation, the stress hormone, consistent with improved resilience, to modifications in serotonergic and dopaminergic signalling relevant to mood and motivation, and to reductions in pro-inflammatory cytokines frequently elevated in depression.

Physiologically, treated anxious patients show decreased resting heart rate and blood pressure, and a shift toward increased parasympathetic activity — often reduced in people under chronic stress — read as an indicator of improved stress regulation. Often, cognitive-behavioural change and its neurophysiological correlates appear more rapidly than with pharmacological treatment alone, making CBT a natural complement to medication. These mechanisms are also the breeding ground for future developments: EEG neurofeedback is being explored as an adjunct to standard protocols, functional neuroimaging is used to identify biomarkers predicting which patients will respond best to which intervention, and neuromodulation — from non-invasive transcranial magnetic stimulation to deep brain stimulation studied in OCD — is under investigation for resistant forms of depression and anxiety.

Limitations and Precautions

The substantive criticisms deserve to be heard. David Smail reproached CBT for excessive individualism, underestimating the socio-economic determinants of psychological suffering. Luciano L'Abate judged its protocols sometimes too mechanical and standardised, poorly suited to patients with deep or complex difficulties, and questioned whether its typically short duration suffices for these cases. Others believe its focus on symptom modification comes at the expense of underlying causes, potentially limiting its long-term efficacy for complex presentations.

It is also necessary to recall what success depends on. CBT does not act on a passive patient: it requires that the patient understand the link between thoughts, emotions and behaviours, actively engage in the joint work, and constantly practise acquired skills in daily life, well beyond the session. It is all the more effective when interventions are personalised rather than applied as an undifferentiated protocol, when work remains focused on current problems rather than drawn into rumination about the past, and when progress is continuously evaluated to adjust treatment. Finally, the practitioner's training matters — the following section details who trains and certifies therapists, country by country.

CBT Worldwide: Practitioners, Training, Certifications

In France, the main professional body is the Association Française de Thérapie Comportementale et Cognitive (AFTCC), which brings together approximately 2,500 practitioners — psychiatrists, psychologists, doctors and other trained mental health professionals — and provides training, supervision and quality assurance; it awards its own practitioner diploma, based on specific training, supervised practice hours and an examination. It is complemented by AFFORTHECC for post-university training, by AFTOC, a patient association focused on OCD, and by the Institut Français de Thérapie Cognitive et Comportementale; several universities — including Paris Descartes, Lyon and Bordeaux — offer clinical psychology degrees with a CBT specialisation. Among public figures, Christophe André has been a major promoter of CBT and mindfulness meditation, alongside Jean Cottraux, a pioneer of CBT in French psychiatry.

In the United States, the workforce is considerably larger: estimates range from approximately 28,000 formally trained practitioners (Beck Institute, National Association of Cognitive-Behavioral Therapists) to 40,000 including the broader population of psychologists, psychiatrists and social workers trained in CBT, according to the Association for Behavioral and Cognitive Therapies (ABCT), the main interdisciplinary body in the field, currently chaired by Carolyn Becker. The Academy of Cognitive and Behavioral Therapies — formerly the Academy of Cognitive Therapy, renamed to avoid acronym confusion with Acceptance and Commitment Therapy — certifies practitioners based on specific training, supervised clinical hours and a written examination. The National Institute of Mental Health funds research, and specialised centres such as the Center for Anxiety and Related Disorders at Boston University complete the landscape.

Elsewhere, equivalent bodies certify practitioners according to the same training–supervision–examination triad: the British Association for Behavioural and Cognitive Psychotherapies in the United Kingdom, the Canadian Association of Cognitive and Behavioural Therapies in Canada, the Australian Association for Cognitive and Behaviour Therapy in Australia. National associations cover most of Europe — from the Deutsche Gesellschaft für Verhaltenstherapie in Germany to the Spanish, Italian, Swiss, Belgian, Dutch and Luxembourgish associations. CBT is delivered in a vast hospital network: in France, the Pitié-Salpêtrière and the university hospitals of Strasbourg, Marseille, Lyon, Bordeaux and Lille provide it within their psychiatry departments, alongside dedicated centres; a comparable offering exists in Geneva, Lausanne and Zurich, in Brussels and Liège, and in specialised centres in Montreal, Quebec City, Toronto and Vancouver, most often combining care and clinical training. To find a practitioner, patients typically use the directories of national professional associations and general appointment platforms — Doctolib in France, Germany and Italy, Zocdoc in the United States, Doctoralia in Spain and several European countries, the NHS e-Referral Service in the United Kingdom — confirming the practitioner's CBT training directly, as their presence on a given platform varies by region.

In Brief — CBT in Ten Points

Box. In the LogiMind framework, each therapy is described by ten fundamental principles — a convention of comparability, not a claim that each method 'really' has ten.

Present-focused — it treats the thoughts and behaviours that maintain the problem today, rather than excavating its origins.
Learning-based — what has been learned through experience can be unlearned and replaced, through structured training.
Patient-centred and collaborative — therapist and patient form a team that jointly defines problems, goals and progress.
Evidence-based — its protocols are derived from controlled research and continually revised in its light.
Structured — each session follows a predictable format: agenda, homework review, targeted work, new homework.
Solution-oriented — reduction of suffering and dysfunction is the primary criterion of success.
Develops self-management — it imparts self-help skills that the patient will deploy alone after therapy.
Cognition-focused — it targets automatic thoughts, distortions and deep schemas as levers for emotional and behavioural change.
Behaviour-focused — it directly attacks avoidance, withdrawal and safety behaviours, through graded exposure and behavioural activation.
Time-limited — most protocols aim to achieve their goals in approximately ten to twenty sessions.

CBT on Screen

Box. The general public has encountered CBT — or closely related approaches — more often than they might think. Good Will Hunting (1997, Gus Van Sant) follows a gifted young man confronting past trauma; Ordinary People (1980, Robert Redford) depicts an adolescent in therapy after his brother's death; A Beautiful Mind (2001, Ron Howard), inspired by mathematician John Nash, illustrates cognitive-behavioural strategies for managing schizophrenia; Silver Linings Playbook (2012, David O. Russell) follows a man grappling with bipolar disorder; As Good as It Gets (1997, James L. Brooks) features a writer with OCD in treatment. Even the animated film Inside Out (2015, Pete Docter) offers an accessible illustration of emotion regulation consistent with the CBT model — and its worldwide success (over $857 million in revenue) says something about the public's appetite for understanding their own emotions.

CBT and New Technologies

Few therapies lend themselves as well as CBT to digital delivery: structured protocols, codified exercises, repeated measures — everything that constitutes its clinical signature can be transposed online. Internet-based CBT (iCBT), where the patient follows a structured online programme with clinician support, is the best validated: meta-analyses of randomised trials report, for depression and anxiety disorders, medium to large effect sizes, and the efficacy of guided iCBT comparable to that of face-to-face CBT — human support, even minimal (email, telephone), makes a measurable difference compared to fully self-directed programmes. This represents a considerable lever for access where therapists are scarce or have waiting lists: several health systems use it in routine care.

Apps extend therapy between sessions: mood tracking and thought diaries (MoodKit, Moodnotes, CBT Thought Record Diary, CBT Pad, MindDoc — formerly Moodpath), CBT for insomnia (CBT-i Coach, with clinical support), personalised interventions shared by the therapist (Quenza), not to mention connected devices — sleep and activity trackers, EEG neurofeedback headbands like Muse — which help identify stress triggers. But this market moves fast, and caution is warranted: Pacifica, a once-popular CBT app, was rebranded as Sanvello in 2019 after its acquisition, before being withdrawn from the general public in 2024 and reserved for members of an insurer; other devices have been discontinued or repositioned as clinical products. The availability of any app must be verified at the time of recommendation.

Virtual reality exposure extends the most behavioural technique of CBT: it allows controlled, graded, and repeatable practice of feared situations, in session, under supervision — including where real-life exposure would be impractical. It is the subject of active clinical trials, including in the treatment of war-related post-traumatic stress disorder (see the following section).

Finally, there are chatbots. Several apps offer structured CBT exercises delivered by a conversational agent, and artificial intelligence is being explored for treatment personalisation, outcome prediction, and clinician training through simulated patients. But the closure, in 2025, of a well-known mental health chatbot — whose founders concluded that conversation via large language model could not reliably monitor patient risk over time — sets the limit: these tools are better positioned as adjuncts to structured self-help than as substitutes for care provided by a clinician, especially in high-risk presentations.

Sources: efficacy of iCBT — meta-analyses in routine care (JMIR, 2020: https://www.jmir.org/2020/8/e18100/) and of randomised trials of guided self-help (BMC Psychiatry, 2022: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-04325-z). Apps, VR and chatbots: CBT factsheet from the LogiMind Handbook (logimind.org).

CBT in Times of War — Ukraine, Iran

This section addresses war from a strictly humanitarian and clinical perspective: what cognitive-behavioural therapies can offer people — soldiers and civilians — whom conflicts wound psychologically. The figures come from the sources cited.

War produces en masse what CBT knows best how to treat: post-traumatic stress, acute stress, anxiety, depression, grief. For PTSD, the best-validated treatments belong largely to the cognitive-behavioural family — trauma-focused CBT (TF-CBT), prolonged exposure, cognitive processing therapy (CPT), narrative exposure therapy — alongside EMDR. Their logic is that of this issue’s dossier: progressively re-exposing the person, in a safe setting, to avoided memories and situations, and restructuring the cognitions that trauma has imposed (survivor guilt, the world perceived as entirely dangerous).

In Ukraine, these protocols have been deployed on a large scale since 2022, with one particularity: the accelerated training of local therapists. The “TF-CBT Ukraine” project (March 2022 – May 2024), conducted with local and international partners, engaged 138 Ukrainian therapists in a training programme in trauma-focused CBT for children and adolescents, of whom 44.9% went on to certification; among the young patients treated (aged 3 to 21), PTSD symptoms significantly decreased at the end of treatment, with large pre-post effect sizes. The other lever is task-shifting, already encountered in our section on the friendship bench: entrusting codified psychological interventions, derived from CBT and problem-solving, to trained and supervised non-specialists. The WHO’s “Problem Management Plus” (PM+) programme — five brief, transdiagnostic, structured sessions of problem management — was introduced in Ukraine even before the full-scale invasion and has been expanded since; a pilot project conducted with 38 beneficiaries reported an average reduction of half in their emotional distress and a 30% improvement in their functioning (Intervention, 2020). The European U-RISE project deploys PM+ and its variants among Ukrainian displaced persons in Poland, Slovakia and Romania. On the side of both soldiers and civilians, clinical research continues under bombardment: six Ukrainian institutions are currently testing virtual reality exposure combined with transcranial stimulation for PTSD in veterans and civilians — including transcultural adaptation, because generic combat scenes do not match the experience of the Ukrainian front. The number of PTSD diagnoses recorded in the country rose, according to the National Health Service of Ukraine, from 3,167 in 2021 to 12,494 in 2023 — a scale that makes these multiplication strategies indispensable.

In Iran, the experience of war-related psychotrauma is older: the Iran-Iraq war (1980-1988) left a generation of veterans and civilians exposed. According to the mental health centre of the Foundation of Martyrs and Veterans Affairs, more than 200,000 Iranian veterans suffer from psychiatric disorders; a recent study among residents of Mehran, a border city destroyed during the conflict, measured a PTSD prevalence of 35.1% nearly four decades after the events — highlighting that lack of social support and maladaptive coping strategies are among the strongest risk factors, and recommending precisely what CBT equips: problem-solving training and strengthening perceived control. Iranian research has also explored telepsychiatry for the follow-up of veterans with PTSD, in a randomised controlled trial — a valuable avenue in a vast country where access to specialists is uneven. Recent events have revived these needs: after the conflict of June 2025, local organisations describe a sharp increase in clinical anxiety and depressive episodes, and the Iranian Red Crescent reported more than 130,000 calls to its psychological support line by the end of March 2026. For hard-to-reach populations, internet-based cognitive-behavioural interventions have shown their relevance: a randomised trial of online CBT-inspired psychotherapy for Arabic-speaking patients traumatised by war reported significant reductions in PTSD symptoms — proof that structured therapy can cross lines that a therapist cannot cross.

Neither in Ukraine nor in Iran does CBT claim to repair what war destroys. Its contribution is more modest and more concrete: brief, codified protocols, transmissible to non-specialist caregivers, deliverable at a distance — that is, exactly the profile of tool needed when needs explode and clinicians are scarce.

Sources: TF-CBT Ukraine — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303773/ · PM+ in Ukraine — https://doi.org/10.4103/INTV.INTV_42_20 · PTSD diagnoses (National Health Service of Ukraine) — https://babel.ua/en/news/105057-in-ukraine-compared-to-2021-the-number-of-patients-diagnosed-with-ptsd-increased-almost-fourfold · U-RISE — https://pmc.ncbi.nlm.nih.gov/articles/PMC11869340/ · VR+stimulation trial (Ukraine) — https://clinicaltrials.gov/study/NCT06806267 and https://mhgcj.org/index.php/MHGCJ/article/view/245 · PTSD in Mehran (Iran) — https://pmc.ncbi.nlm.nih.gov/articles/PMC11390179/ · Telepsychiatry for Iranian veterans — https://pmc.ncbi.nlm.nih.gov/articles/PMC6661519/ · Mental health in Iran after June 2025 — https://www.thenationalnews.com/news/mena/2026/07/03/how-mental-health-toll-of-war-and-repression-has-caused-iranians-to-fall-apart-inside/ and https://prismreports.org/2026/04/09/iranian-mental-health-iran-war/ · Online psychotherapy for war-traumatised patients — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385175/

ZOOM — Two CBT Practitioners in Morocco

Each month, this column presents two practitioners or researchers of the therapy featured in the dossier working in an emerging country. The information below comes from public online sources.

Pr Meriem El Yazaji (Morocco). A psychiatrist in Casablanca, she chairs the Moroccan Association of Cognitive and Behavioural Therapy (AMTCC), founded in 1999, whose mission is to disseminate CBT in Morocco and organise continuing education and conferences. The association is based at the Addiction Centre of the Ibn Rochd University Hospital in Casablanca, where she heads the addiction department; she also teaches on the university diploma in CBT at the Faculty of Medicine and Pharmacy of Casablanca (Hassan II University). With successive executive committees documented since the 1990s, the AMTCC is among the oldest structures promoting CBT in North Africa. Sources: amtcc.ma, "Bureaux" page: https://amtcc.ma/bureaux/ · interview Maroc Hebdo (head of addiction department, CHU Ibn Rochd): https://www.maroc-hebdo.com/article/meriem-elyazaji-addictologie-chu-ibnou-rochd-casablanca · practitioner profile DabaDoc: https://www.dabadoc.com/ma/psychiatre/casablanca/meriem-el-yazaji-psychiatre-casablanca

Pr Youssef El Hamaoui (Morocco). A psychiatrist and psychotherapist in Casablanca, with over twenty-five years of clinical and academic experience: around fifteen years in a university hospital setting (Faculty of Medicine of Casablanca, Hassan II University), including eight years heading the psychiatric emergency department, before moving into private practice in 2011 — a trajectory drawn from his professional biographies, corroborated by Moroccan medical directories (med.ma, DabaDoc). Trained in CBT techniques, which he offers in his practice, he also integrates EMDR, interpersonal therapy and medical hypnosis; he is the author of scientific publications and provides mental health training for professionals. Sources: https://coinpsy.ma/ · https://psychiatre-psychotherapeute.ma/tcc-casablanca · https://www.dabadoc.com/ma/psychiatre/casablanca/youssef-el-hamaoui-1 · https://www.med.ma/medecin/hypnotherapeute/casablanca/pr-youssef-el-hamaoui-183449

Box — CBT in Tunisia

In the eastern Maghreb, the structuring is more recent but rapid. The Association Tunisienne des Thérapies Comportementales et Cognitives (ATTCC), a scientific association founded in 2012 by a group of behavioural psychiatrists, has as its primary mission to promote and disseminate CBT in Tunisia — and, beyond, in North Africa and the Arab world. Since 2012, the members of its board have provided the bulk of teaching for Tunisian university degrees in CBT, delivered at the medical faculties of Tunis, Sousse and Sfax, which train psychologists, psychiatrists and non-psychiatrist physicians each year. Tangible result: the number of behavioural therapists in the country has, according to the association, risen from around fifteen in 2011 to more than one hundred in 2019. A sign of the spread of the approach beyond conventional care, the first "master class" in CBT in a prison setting — a pilot initiative in the MENA region, launched in 2021 and formalised in October 2022 by an agreement between the United Nations Office on Drugs and Crime (UNODC), the General Committee for Prisons and Rehabilitation and the Faculty of Medicine of Tunis — trains doctors and psychologists in Tunisian prisons in the use of CBT for mental health disorders, violence, addictions and the prevention of recidivism. Sources: https://attcc.net/ · https://tunisia.un.org/fr/201966-unodc%C2%A0-cr%C3%A9ation-en-tunisie-de-la-premi%C3%A8re-master-class-sur-les-th%C3%A9rapies-cognitives-et

An Emerging Therapy — Zimbabwe's "Friendship Bench"

What can be done when a country has only a handful of psychiatrists for millions of inhabitants? In Zimbabwe, psychiatrist Dixon Chibanda responded by taking care out of institutions. His programme, the Friendship Bench, initiated in 2006 in Harare after the suicide of one of his patients — whose mother could not afford the bus fare to bring her to consultation — trains older community health workers, "grandmothers", to deliver structured problem-solving therapy: a codified talking technique, directly from the cognitive-behavioural family, which the reader will encounter in our dossier. The sessions take place on simple wooden benches installed near clinics. It was the first fourteen grandmothers who refused the initially proposed name "mental health bench", too stigmatising, in favour of the "Friendship Bench".

This model falls under what global health calls task-shifting: entrusting codified psychological interventions to trained and supervised non-specialists where clinicians are scarce — Zimbabwe long had only about ten psychiatrists for over thirteen million inhabitants, i.e., fewer than one per million. The effectiveness of the programme was tested in a randomised controlled trial published in JAMA (Chibanda et al., "Effect of a Primary Care-Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe", JAMA, 2016, 316(24), 2618-2626), which reported a reduction in symptoms of common mental disorders significantly greater than usual care at six months. According to the programme, over 3,000 grandmothers have since been trained and over 300,000 people supported in Zimbabwe, and the model is now spreading to several other countries, as far as the United States.

For a journal founded to make psychotherapies accessible beyond wealthy countries, the Friendship Bench is more than a curiosity: it is a demonstration that a cognitive-behavioural technique, rigorously simplified and entrusted to the community, can cross the resource barrier — and that innovation in psychotherapy does not flow only one way from the North to the South.

Sources: https://www.friendshipbench.org/the-founder · https://en.wikipedia.org/wiki/Friendship_bench · JAMA 2016 trial: https://pubmed.ncbi.nlm.nih.gov/28027368/ · profile of D. Chibanda (WHO Bulletin, via PubMed Central): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5996204/ · https://www.pbs.org/newshour/amp/world/watch-this-friendship-bench-is-pulling-on-the-healing-power-of-grandmothers

CBT and Its "Daughter Therapies"

CBT's success can also be measured by its offspring: several therapies now recognised are direct extensions of it, designed for populations or problems that the standard protocol served poorly.

Dialectical behaviour therapy (DBT), developed by Marsha M. Linehan, emerged as a variant of CBT for borderline personality disorder: it combines the acceptance and validation of painful emotional states with structured training in distress tolerance and emotion regulation skills — precisely where directly challenging thoughts alone had failed.

Acceptance and commitment therapy (ACT), by Steven C. Hayes, shares CBT's behavioural roots but adds a layer grounded in mindfulness and values: rather than disputing the content of difficult thoughts, it teaches people to welcome them without immediate struggle, while redirecting effort toward action consistent with what matters to the person.

Mindfulness-based cognitive therapy (MBCT), by John Teasdale, Zindel Segal and Mark Williams, integrates meditative practice with CBT's cognitive techniques; it was developed specifically for preventing depressive relapse, by teaching people to spot nascent ruminations without getting caught up in them.

Schema therapy, by Jeffrey E. Young, extends Beck's model in depth: it targets not primarily automatic thoughts but the cognitive schemas themselves — those deeply ingrained belief structures that generate them — for patients with enduring, complex difficulties that short protocols address poorly.

The October issue will inaugurate with EMDR another branch of the trauma therapies' family tree; each of CBT's "daughters" will be the subject of a future dossier.

The Words of LogiMind

Lexicon of the Month

Automatic thoughts. Spontaneous, often negative, judgements that cross the mind in response to a situation — so rapid that they are barely noticed, yet they shape emotion and behaviour. CBT first teaches how to spot them in real time rather than retrospectively.

Cognitive distortion. A systematic bias in the way situations are interpreted: overgeneralisation ('it always goes wrong'), dichotomous thinking ('all or nothing'), catastrophising ('it will be a disaster'). Distortions stem from cognitive schemas, deeply ingrained belief structures that shape how situations are read.

Cognitive restructuring. A central technique of CBT: identifying an automatic thought, examining the evidence for and against it — notably through Socratic questioning — then substituting a more accurate and adaptive alternative.

Graded exposure. Progressive, controlled and repeated contact with the feared object or situation, from the least to the most anxiety-provoking, until the fear response extinguishes. In obsessive-compulsive disorder, it is combined with response prevention: exposing oneself without performing the ritual.

Behavioural activation. Planned re-engagement in activities that provide meaning or pleasure, in order to break the spiral of withdrawal and inactivity that maintains depression.

Neologisms of the Month

Each month, the journal presents three neologisms from the Dictionnaire LogiMind des 395 néologismes thérapeutiques (Édouard Alain de Boysson, LogiMind — ISBN 9798285281467, also deposited on HAL), chosen for their affinity with the therapy featured in the dossier. The three terms in this issue each illuminate a facet of the cognitive work specific to CBT.

Reflux thought. The involuntary and cyclical return of an incomplete idea, always in the same form, stuck between emergence and repression: 'I'm going round in circles', rumination without deepening. It is precisely this frozen cognitive loop that the thought diary and cognitive restructuring target.
Floating metacognition. A vague awareness of an ongoing thought process, without the ability to observe or name it clearly — 'I sense that I am thinking, but I don't know what'. CBT works to convert this fuzzy awareness into precise self-observation of automatic thoughts.
Latent conceptual dissociation. A cognitive inconsistency that the subject does not perceive as such: contradictions maintained without discomfort, vague rationalisations, present in beliefs or partial narratives ('I'm not afraid… it's just that I never open the door'). The examination of facts and Socratic questioning are its natural revealers.

Colophon

How to cite this issue: Revue LogiMind des psychothérapies, vol. 1, no. 1, September 2026, LogiMind, logimind.org.

Editor-in-chief: Édouard Alain de Boysson · Contact: contact@logimind.org

ISSN pending (BnF) · Issue DOI: 10.5281/zenodo.21665912 (Zenodo) · Published under Creative Commons CC BY 4.0 licence: free reproduction, distribution and translation with attribution. The sections “ZOOM”, “Box — CBT in Tunisia”, “CBT in Times of War” and “An Emerging Therapy” are based on public online sources, cited at the end of each section.

In the next issue (October 2026): EMDR, eye movement therapy.