Cognitive behavioral therapy

# Cognitive behavioral therapy

## Abstract

Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions (such as thoughts, beliefs, and attitudes) and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

CBT is a common form of talk therapy based on the combination of the basic principles from behavioral and cognitive psychology. It is different from other approaches to psychotherapy, such as the psychoanalytic approach, where the therapist looks for the unconscious meaning behind the behaviors and then formulates a diagnosis. Instead, CBT is a "problem-focused" and "action-oriented" form of therapy, meaning it is used to treat specific problems related to a diagnosed mental disorder. The therapist's role is to assist the client in finding and practicing effective strategies to address the identified goals and to alleviate symptoms of the disorder. CBT is based on the belief that thought distortions and maladaptive behaviors play a role in the development and maintenance of many psychological disorders and that symptoms and associated distress can be reduced by teaching new information-processing skills and coping mechanisms.

When compared to psychoactive medications, review studies have found CBT alone to be as effective for treating less severe forms of depression, and borderline personality disorder. Some research suggests that CBT is most effective when combined with medication for treating mental disorders, such as major depressive disorder. CBT is recommended as the first line of treatment for the majority of psychological disorders in children and adolescents, including aggression and conduct disorder. Researchers have found that other bona fide therapeutic interventions were equally effective for treating certain conditions in adults. Along with interpersonal psychotherapy (IPT), CBT is recommended in treatment guidelines as a psychosocial treatment of choice.

## History

### Early roots

The prevailing body of research consistently indicates that maintaining a faith or belief system generally contributes positively to mental well-being. Religious institutions have proactively established charities, such as the Samaritans, to address mental health issues. Cognitive behavioral therapy has undergone scrutiny as studies investigating the impact of religious belief and practices have gained prominence. Numerous randomized controlled trials have explored the correlation of CBT within diverse religious frameworks, including Judaism, Taoism, and predominantly, Christianity.

### Buddhism

Principles originating from Buddhism have significantly impacted the evolution of various new forms of CBT, including dialectical behavior therapy, mindfulness-based cognitive therapy, spirituality-based CBT, and compassion-focused therapy.

### Philosophy

Precursors of certain fundamental aspects of CBT have been identified in various ancient philosophical traditions, particularly Stoicism. Stoic philosophers, particularly Epictetus, believed logic could be used to identify and discard false beliefs that lead to destructive emotions, which has influenced the way modern cognitive-behavioral therapists identify cognitive distortions that contribute to depression and anxiety. Aaron T. Beck 's original treatment manual for depression states, "The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers". Another example of Stoic influence on cognitive theorists is Epictetus on Albert Ellis. A key philosophical figure who influenced the development of CBT was John Stuart Mill through his creation of Associationism, a predecessor of classical conditioning and behavioral theory.

The modern roots of CBT can be traced to the development of behavior therapy in the early 20th century, the development of cognitive therapy in the 1960s, and the subsequent merging of the two.

### Behavioral therapy

Groundbreaking work of behaviorism began with John B. Watson and Rosalie Rayner 's studies of conditioning in 1920. Behaviorally-centered therapeutic approaches appeared as early as 1924 with Mary Cover Jones ' work dedicated to the unlearning of fears in children. These were the antecedents of the development of Joseph Wolpe 's behavioral therapy in the 1950s. It was the work of Wolpe and Watson, which was based on Ivan Pavlov 's work on learning and conditioning, that influenced Hans Eysenck and Arnold Lazarus to develop new behavioral therapy techniques based on classical conditioning.

During the 1950s and 1960s, behavioral therapy became widely used by researchers in the United States, the United Kingdom, and South Africa. Their inspiration was by the behaviorist learning theory of Ivan Pavlov, John B. Watson, and Clark L. Hull.

In Britain, Joseph Wolpe, who applied the findings of animal experiments to his method of systematic desensitization, applied behavioral research to the treatment of neurotic disorders. Wolpe's therapeutic efforts were precursors to today's fear reduction techniques. British psychologist Hans Eysenck presented behavior therapy as a constructive alternative.

At the same time as Eysenck's work, B. F. Skinner and his associates were beginning to have an impact with their work on operant conditioning. Skinner's work was referred to as radical behaviorism and avoided anything related to cognition. However, Julian Rotter in 1954 and Albert Bandura in 1969 contributed to behavior therapy with their works on social learning theory by demonstrating the effects of cognition on learning and behavior modification. The work of Claire Weekes in dealing with anxiety disorders in the 1960s is also seen as a prototype of behavior therapy.

The emphasis on behavioral factors has been described as the "first wave" of CBT.

### Cognitive therapy

One of the first therapists to address cognition in psychotherapy was Alfred Adler, notably with his idea of basic mistakes and how they contributed to creation of unhealthy behavioral and life goals. Abraham Low believed that someone's thoughts were best changed by changing their actions. Adler and Low influenced the work of Albert Ellis, who developed the earliest cognitive-based psychotherapy called rational emotive behavioral therapy, or REBT. The first version of REBT was announced to the public in 1956.

In the late 1950s, Aaron T. Beck was conducting free association sessions in his psychoanalytic practice. During these sessions, Beck noticed that thoughts were not as unconscious as Freud had previously theorized, and that certain types of thinking may be the culprits of emotional distress. It was from this hypothesis that Beck developed cognitive therapy, and called these thoughts "automatic thoughts". He first published his new methodology in 1967, and his first treatment manual in 1979. Beck has been referred to as "the father of cognitive behavioral therapy".

It was these two therapies, rational emotive therapy, and cognitive therapy, that started the "second wave" of CBT, which emphasized cognitive factors.

### Merger of behavioral and cognitive therapies

Although the early behavioral approaches were successful in many so-called neurotic disorders, they had little success in treating depression. Behaviorism was also losing popularity due to the cognitive revolution. The therapeutic approaches of Albert Ellis and Aaron T. Beck gained popularity among behavior therapists, despite the earlier behaviorist rejection of mentalistic concepts like thoughts and cognitions. Both of these systems included behavioral elements and interventions, with the primary focus being on problems in the present.

In initial studies, cognitive therapy was often contrasted with behavioral treatments to see which was most effective. During the 1980s and 1990s, cognitive and behavioral techniques were merged into cognitive behavioral therapy. Pivotal to this merging was the successful development of treatments for panic disorder by David M. Clark in the UK and David H. Barlow in the US.

Over time, cognitive behavior therapy came to be known not only as a therapy, but as an umbrella term for all cognitive-based psychotherapies. These therapies include, but are not limited to, REBT, cognitive therapy, acceptance and commitment therapy, dialectical behavior therapy, metacognitive therapy, metacognitive training, reality therapy / choice theory, cognitive processing therapy, EMDR, and multimodal therapy.

This blending of theoretical and technical foundations from both behavior and cognitive therapies constituted the "third wave" of CBT. The most prominent therapies of this third wave are dialectical behavior therapy and acceptance and commitment therapy. Despite the increasing popularity of third-wave treatment approaches, reviews of studies reveal there may be no difference in the effectiveness compared with non-third wave CBT for the treatment of depression.

## Medical uses

In adults, CBT has been shown to be an effective part of treatment plans for anxiety disorders, body dysmorphic disorder, depression, eating disorders, chronic low back pain, personality disorders, psychosis, schizophrenia, substance use disorders, and bipolar disorder. It is also effective as part of treatment plans in the adjustment, depression, and anxiety associated with fibromyalgia, and with post- spinal cord injuries.

In children or adolescents, CBT is an effective part of treatment plans for anxiety disorders, body dysmorphic disorder, depression and suicidality, eating disorders and obesity, obsessive–compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), as well as tic disorders, trichotillomania, and other repetitive behavior disorders. CBT has also been applied to a variety of childhood disorders, including depressive disorders and various anxiety disorders. CBT has shown to be the most effective intervention for people exposed to adverse childhood experiences in the form of abuse or neglect.

Criticism of CBT sometimes focuses on implementations (such as the UK IAPT) which may result initially in low quality therapy being offered by poorly trained practitioners. However, evidence supports the effectiveness of CBT for anxiety and depression.

Evidence suggests that the addition of hypnotherapy as an adjunct to CBT improves treatment efficacy for a variety of clinical issues.

The United Kingdom's National Institute for Health and Care Excellence (NICE) recommends CBT in the treatment plans for a number of mental health difficulties, including PTSD, OCD, bulimia nervosa, and clinical depression.

### Depression and anxiety disorders

Cognitive behavioral therapy has been shown as an effective treatment for clinical depression. The American Psychiatric Association Practice Guidelines (April 2000) indicated that, among psychotherapeutic approaches, cognitive behavioral therapy and interpersonal psychotherapy had the best-documented efficacy for treatment of major depressive disorder.

A 2001 meta-analysis comparing CBT and psychodynamic psychotherapy suggested the approaches were equally effective in the short term for depression. In contrast, a 2013 meta-analysis suggested that CBT, interpersonal therapy, and problem-solving therapy outperformed psychodynamic psychotherapy and behavioral activation in the treatment of depression.

According to a 2004 review by INSERM of three methods, cognitive behavioral therapy was either proven or presumed to be an effective therapy on several mental disorders. This included depression, panic disorder, post-traumatic stress, and other anxiety disorders.

CBT has been shown to be effective in the treatment of adults with anxiety disorders. In a 2020 Cochrane review it was determined that CBT for children and adolescents was probably more effective (short term) than wait list or no treatment and more effective than attention control.

Results from a 2018 systematic review found a high strength of evidence that CBT-exposure therapy can reduce PTSD symptoms and lead to the loss of a PTSD diagnosis. CBT has also been shown to be effective for post-traumatic stress disorder in very young children (3 to 6 years of age). A Cochrane review found low quality evidence that CBT may be more effective than other psychotherapies in reducing symptoms of posttraumatic stress disorder in children and adolescents.

A systematic review of CBT in depression and anxiety disorders concluded that "CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists."

Some meta-analyses find CBT more effective than psychodynamic therapy and equal to other therapies in treating anxiety and depression.

#### Theoretical approaches

One etiological theory of depression is Aaron T. Beck 's cognitive theory of depression. His theory states that depressed people think the way they do because their thinking is biased towards negative interpretations. Beck's theory rests on the aspect of cognitive behavioral therapy known as schemata. Schemata are the mental maps used to integrate new information into memories and to organize existing information in the mind. An example of a schema would be a person hearing the word "dog" and picturing different versions of the animal that they have grouped together in their mind. According to this theory, depressed people acquire a negative schema of the world in childhood and adolescence as an effect of stressful life events, and the negative schema is activated later in life when the person encounters similar situations.

Beck also described a negative cognitive triad. The cognitive triad is made up of the depressed individual's negative evaluations of themselves, the world, and the future. Beck suggested that these negative evaluations derive from the negative schemata and cognitive biases of the person. According to this theory, depressed people have views such as "I never do a good job", "It is impossible to have a good day", and "things will never get better". A negative schema helps give rise to the cognitive bias, and the cognitive bias helps fuel the negative schema. Beck further proposed that depressed people often have the following cognitive biases: arbitrary inference, selective abstraction, overgeneralization, magnification, and minimization. These cognitive biases are quick to make negative, generalized, and personal inferences of the self, thus fueling the negative schema.

On the other hand, a positive cognitive triad relates to a person's positive evaluations of themself, the world, and the future. More specifically, a positive cognitive triad requires self-esteem when viewing oneself and hope for the future. A person with a positive cognitive triad has a positive schema used for viewing themself in addition to a positive schema for the world and for the future. Cognitive behavioral research suggests a positive cognitive triad bolsters resilience, or the ability to cope with stressful events. Increased levels of resilience is associated with greater resistance to depression.

Another major theoretical approach to cognitive behavioral therapy treatment is the concept of Locus of Control outlined in Julian Rotter's Social Learning Theory. Locus of control refers to the degree to which an individual's sense of control is either internal or external. An internal locus of control exists when an individual views an outcome of a particular action as being reliant on themselves and their personal attributes whereas an external locus of control exists when an individual views other's or some outside, intangible force such as luck or fate as being responsible for the outcome of a particular action.

A basic concept in some CBT treatments used in anxiety disorders is in vivo exposure. CBT-exposure therapy refers to the direct confrontation of feared objects, activities, or situations by a patient. For example, a woman with PTSD who fears the location where she was assaulted may be assisted by her therapist in going to that location and directly confronting those fears. Likewise, a person with a social anxiety disorder who fears public speaking may be instructed to directly confront those fears by giving a speech. This "two-factor" model is often credited to O. Hobart Mowrer. Through exposure to the stimulus, this harmful conditioning can be "unlearned" (referred to as extinction and habituation).

CBT for children with phobias is normally delivered over multiple sessions, but one-session treatment has been shown to be equally effective and is cheaper.

#### Specialized forms of CBT

CBT-SP, an adaptation of CBT for suicide prevention (SP), was specifically designed for treating youths who are severely depressed and who have recently attempted suicide within the past 90 days, and was found to be effective, feasible, and acceptable.

Acceptance and commitment therapy (ACT) is a specialist branch of CBT (sometimes referred to as contextual CBT). ACT uses mindfulness and acceptance interventions and has been found to have a greater longevity in therapeutic outcomes. In a study with anxiety, CBT and ACT improved similarly across all outcomes from pre- to post-treatment. However, during a 12-month follow-up, ACT proved to be more effective, showing that it is a highly viable lasting treatment model for anxiety disorders.

Computerized CBT (CCBT) has been proven to be effective by randomized controlled and other trials in treating depression and anxiety disorders, including children. Some research has found similar effectiveness to an intervention of informational websites and weekly telephone calls. CCBT was found to be equally effective as face-to-face CBT in adolescent anxiety.

#### Combined with other treatments

Studies have provided evidence that when examining animals and humans, that glucocorticoids may lead to a more successful extinction learning during exposure therapy for anxiety disorders. For instance, glucocorticoids can prevent aversive learning episodes from being retrieved and heighten reinforcement of memory traces creating a non-fearful reaction in feared situations. A combination of glucocorticoids and exposure therapy may be a better-improved treatment for treating people with anxiety disorders.

#### Prevention

For anxiety disorders, use of CBT with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes. In another study, 3% of the group receiving the CBT intervention developed generalized anxiety disorder by 12 months postintervention compared with 14% in the control group. Individuals with subthreshold levels of panic disorder significantly benefitted from use of CBT. Use of CBT was found to significantly reduce social anxiety prevalence.

For depressive disorders, a stepped-care intervention (watchful waiting, CBT and medication if appropriate) achieved a 50% lower incidence rate in a patient group aged 75 or older. Another depression study found a neutral effect compared to personal, social, and health education, and usual school provision, and included a comment on potential for increased depression scores from people who have received CBT due to greater self recognition and acknowledgement of existing symptoms of depression and negative thinking styles. A further study also saw a neutral result. A meta-study of the Coping with Depression course, a cognitive behavioral intervention delivered by a psychoeducational method, saw a 38% reduction in risk of major depression.

### Bipolar disorder

Many studies show CBT, combined with pharmacotherapy, is effective in improving depressive symptoms, mania severity and psychosocial functioning with mild to moderate effects, and that it is better than medication alone.

INSERM 's 2004 review found that CBT is an effective therapy for several mental disorders, including bipolar disorder. This included schizophrenia, depression, bipolar disorder, panic disorder, post-traumatic stress, anxiety disorders, bulimia, anorexia, personality disorders and alcohol dependency.

### Psychosis

In long-term psychoses, CBT is used to complement medication and is adapted to meet individual needs. Interventions particularly related to these conditions include exploring reality testing, changing delusions and hallucinations, examining factors which precipitate relapse, and managing relapses. Meta-analyses confirm the effectiveness of metacognitive training (MCT) for the improvement of positive symptoms (e.g., delusions).

For people at risk of psychosis, in 2014 the UK National Institute for Health and Care Excellence (NICE) recommended preventive CBT.

### Schizophrenia

INSERM 's 2004 review found that CBT is an effective therapy for several mental disorders, including schizophrenia.

A Cochrane review reported CBT had "no effect on long‐term risk of relapse" and no additional effect above standard care. A 2015 systematic review investigated the effects of CBT compared with other psychosocial therapies for people with schizophrenia and determined that there is no clear advantage over other, often less expensive, interventions but acknowledged that better quality evidence is needed before firm conclusions can be drawn.

### Addiction and substance use disorders

#### Pathological and problem gambling

CBT is also used for pathological and problem gambling. The percentage of people who problem gamble is 1–3% around the world. Cognitive behavioral therapy develops skills for relapse prevention and someone can learn to control their mind and manage high-risk cases. There is evidence of efficacy of CBT for treating pathological and problem gambling at immediate follow up, however the longer term efficacy of CBT for it is currently unknown.

#### Smoking cessation

CBT looks at the habit of smoking cigarettes as a learned behavior, which later evolves into a coping strategy to handle daily stressors. Since smoking is often easily accessible and quickly allows the user to feel good, it can take precedence over other coping strategies, and eventually work its way into everyday life during non-stressful events as well. CBT aims to target the function of the behavior, as it can vary between individuals, and works to inject other coping mechanisms in place of smoking. CBT also aims to support individuals with strong cravings, which are a major reported reason for relapse during treatment.

A 2008 controlled study out of Stanford University School of Medicine suggested CBT may be an effective tool to help maintain abstinence. The results of 304 random adult participants were tracked over the course of one year. During this program, some participants were provided medication, CBT, 24-hour phone support, or some combination of the three methods. At 20 weeks, the participants who received CBT had a 45% abstinence rate, versus non-CBT participants, who had a 29% abstinence rate. Overall, the study concluded that emphasizing cognitive and behavioral strategies to support smoking cessation can help individuals build tools for long term smoking abstinence.

Mental health history can affect the outcomes of treatment. Individuals with a history of depressive disorders had a lower rate of success when using CBT alone to combat smoking addiction.

A Cochrane review was unable to find evidence of any difference between CBT and hypnosis for smoking cessation. While this may be evidence of no effect, further research may uncover an effect of CBT for smoking cessation.

#### Substance use disorders

Studies have shown CBT to be an effective treatment for substance use disorders. For individuals with substance use disorders, CBT aims to reframe maladaptive thoughts, such as denial, minimizing and catastrophizing thought patterns, with healthier narratives. Specific techniques include identifying potential triggers and developing coping mechanisms to manage high-risk situations. Research has shown CBT to be particularly effective when combined with other therapy-based treatments or medication.

INSERM 's 2004 review found that CBT is an effective therapy for several mental disorders, including alcohol dependency.

#### Internet addiction

Research has identified Internet addiction as a new clinical disorder that causes relational, occupational, and social problems. Cognitive behavioral therapy (CBT) has been suggested as the treatment of choice for Internet addiction, and addiction recovery in general has used CBT as part of treatment planning. There is also evidence for the efficacy of CBT in multicenter randomized controlled trials such as STICA (Short-Term Treatment of Internet and Computer Game Addiction).

### Eating disorders

Though many forms of treatment can support individuals with eating disorders, CBT is proven to be a more effective treatment than medications and interpersonal psychotherapy alone. CBT aims to combat major causes of distress such as negative cognitions surrounding body weight, shape and size. CBT therapists also work with individuals to regulate strong emotions and thoughts that lead to dangerous compensatory behaviors. CBT is the first line of treatment for bulimia nervosa, and non-specific eating disorders. While there is evidence to support the efficacy of CBT for bulimia nervosa and binging, the evidence is somewhat variable and limited by small study sizes. INSERM 's 2004 review found that CBT is an effective therapy for several mental disorders, including bulimia and anorexia nervosa.

### With autistic adults

Emerging evidence for cognitive behavioral interventions aimed at reducing symptoms of depression, anxiety, and obsessive-compulsive disorder in autistic adults without intellectual disability has been identified through a systematic review. While the research was focused on adults, cognitive behavioral interventions have also been beneficial to autistic children. A 2021 Cochrane review found limited evidence regarding the efficacy of CBT for obsessive-compulsive disorder in adults with Autism Spectrum Disorder stating a need for further study.

### Dementia and mild cognitive impairment

A Cochrane review in 2022 found that adults with dementia and mild cognitive impairment (MCI) who experience symptoms of depression may benefit from CBT, whereas other counselling or supportive interventions might not improve symptoms significantly. Across 5 different psychometric scales, where higher scores indicate severity of depression, adults receiving CBT reported somewhat lower mood scores than those receiving usual care for dementia and MCI overall. In this review, a sub-group analysis found clinically significant benefits only among those diagnosed with dementia, rather than MCI.

The likelihood of remission from depression also appeared to be 84% higher following CBT, though the evidence for this was less certain. Anxiety, cognition and other neuropsychiatric symptoms were not significantly improved following CBT, however this review did find moderate evidence of improved quality of life and daily living activity scores in those with dementia and MCI.

### Post-traumatic stress

Cognitive behavioral therapy interventions may have some benefits for people who have post-traumatic stress related to surviving rape, sexual abuse, or sexual assault.

### Other uses

Evidence suggests a possible role for CBT in the treatment of attention deficit hyperactivity disorder (ADHD), hypochondriasis, and bipolar disorder, but more study is needed and results should be interpreted with caution. Moderate evidence from a 2024 systematic review supports the effectiveness of CBT and neurofeedback as part of psychosocial interventions for improving ADHD symptoms in children and adolescents.

CBT has been studied as an aid in the treatment of anxiety associated with stuttering. Initial studies have shown CBT to be effective in reducing social anxiety in adults who stutter, but not in reducing stuttering frequency.

There is some evidence that CBT is superior in the long-term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia. Computerized CBT (CCBT) has been proven to be effective by randomized controlled and other trials in treating insomnia. Some research has found similar effectiveness to an intervention of informational websites and weekly telephone calls. CCBT was found to be equally effective as face-to-face CBT in insomnia.

A Cochrane review of interventions aimed at preventing psychological stress in healthcare workers found that CBT was more effective than no intervention but no more effective than alternative stress-reduction interventions.

Cochrane Reviews have found no convincing evidence that CBT training helps foster care providers manage difficult behaviors in the youths under their care, nor was it helpful in treating people who abuse their intimate partners.

CBT has been applied in both clinical and non-clinical environments to treat disorders such as personality disorders and behavioral problems. INSERM 's 2004 review found that CBT is an effective therapy for personality disorders.

CBT has been used with other researchers as well to minimize chronic pain and help relieve symptoms from those suffering from irritable bowel syndrome (IBS).

#### Individuals with medical conditions

In the case of people with metastatic breast cancer, data is limited but CBT and other psychosocial interventions might help with psychological outcomes and pain management. A 2015 Cochrane review also found that CBT for symptomatic management of non-specific chest pain is probably effective in the short term. However, the findings were limited by small trials and the evidence was considered of questionable quality. Cochrane reviews have found no evidence that CBT is effective for tinnitus, although there appears to be an effect on management of associated depression and quality of life in this condition. CBT combined with hypnosis and distraction reduces self-reported pain in children.

There is limited evidence to support CBT's use in managing the impact of multiple sclerosis, sleep disturbances related to aging, and dysmenorrhea, but more study is needed and results should be interpreted with caution.

Previously CBT has been considered as moderately effective for treating myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), however a National Institutes of Health Pathways to Prevention Workshop stated that in respect of improving treatment options for ME/CFS that the modest benefit from cognitive behavioral therapy should be studied as an adjunct to other methods. The Centres for Disease Control advice on the treatment of ME/CFS makes no reference to CBT while the National Institute for Health and Care Excellence states that cognitive behavioral therapy (CBT) has sometimes been assumed to be a cure for ME/CFS, however, it should only be offered to support people who live with ME/CFS to manage their symptoms, improve their functioning and reduce the distress associated with having a chronic illness."

### Age

CBT is used to help people of all ages, but the therapy should be adjusted based on the age of the patient with whom the therapist is dealing. Older individuals in particular have certain characteristics that need to be acknowledged and the therapy altered to account for these differences thanks to age. Of the small number of studies examining CBT for the management of depression in older people, there is currently no strong support.

## Description

Mainstream cognitive behavioral therapy assumes that changing maladaptive thinking leads to change in behavior and affect, but recent variants emphasize changes in one's relationship to maladaptive thinking rather than changes in thinking itself.

### Cognitive distortions

Therapists use CBT techniques to help people challenge their patterns and beliefs and replace errors in thinking, known as cognitive distortions with "more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior". Cognitive distortions can be either a pseudo-discrimination belief or an overgeneralization of something. CBT techniques may also be used to help individuals take a more open, mindful, and aware posture toward cognitive distortions so as to diminish their impact.

Mainstream CBT helps individuals replace "maladaptive... coping skills, cognitions, emotions and behaviors with more adaptive ones", by challenging an individual's way of thinking and the way that they react to certain habits or behaviors, but there is still controversy about the degree to which these traditional cognitive elements account for the effects seen with CBT over and above the earlier behavioral elements such as exposure and skills training.

### Assumptions

Chaloult, Ngo, Cousineau and Goulet have attempted to identify the main assumptions of cognitive therapy used in CBT based on the research literature (Beck; Walen and Wessler; Beck, Emery and Greenberg, and Auger). They describe fourteen assumptions:

- Human emotions are primarily caused by people's thoughts and perceptions rather than events.

- Events, thoughts, emotions, behaviors, and physiological reactions influence each other.

- Dysfunctional emotions are typically caused by unrealistic thoughts. Reducing dysfunctional emotions requires becoming aware of irrational thoughts and changing them.

- Human beings have an innate tendency to develop irrational thoughts. This tendency is reinforced by their environment.

- People are largely responsible for their own dysfunctional emotions, as they maintain and reinforce their own beliefs.

- Sustained effort is necessary to modify dysfunctional thoughts, emotions, and behaviors.

- Rational thinking usually causes a decrease in the frequency, intensity, and duration of dysfunctional emotions, rather than an absence of affect or feelings.

- A positive therapeutic relationship is essential to successful cognitive therapy.

- Cognitive therapy is based on a teacher-student relationship, where the therapist educates the client.

- Cognitive therapy uses Socratic questioning to challenge cognitive distortions.

- Homework is an essential aspect of cognitive therapy. It consolidates the skills learned in therapy.

- The cognitive approach is active, directed, and structured.

- Cognitive therapy is generally short.

- Cognitive therapy is based on predictable steps.

These steps largely involve learning about the CBT model; making links between thoughts, emotions, behaviors, and physiological reactions; noticing when dysfunctional emotions occur; learning to question the thoughts associated with these emotions; replacing irrational thoughts with others more grounded in reality; modifying behaviors based on new interpretations of events; and, in some cases, learning to recognize and change the major beliefs and attitudes underlying cognitive distortions.

Chaloult, Ngo, Cousineau and Goulet have also described the assumptions of behavioral therapy as used in CBT. They refer to the work of Agras, Prochaska and Norcross, and Kirk. The assumptions are:

- Behaviors play an essential role in the onset, perpetuation and exacerbation of psychopathology.

- Learning theory is key in understanding the treatment of mental illness, as behaviors can be learned and unlearned.

- A rigorous evaluation (applied behavior analysis) is essential at the start of treatment. It includes identifying behaviors; precipitating, moderating, and perpetuating factors; the consequences of the behaviors; avoidance, and personal resources.

- The effectiveness of the treatment is monitored throughout its duration.

- Behavior therapy is scientific and the different forms of treatment are evaluated with rigorous evidence.

- Behavior therapy is active, directed, and structured.

Together, these sets of assumptions cover the cognitive and behavioral aspects of CBT.

### Phases in therapy

CBT can be seen as having six phases:

- Assessment or psychological assessment;

- Reconceptualization;

- Skills acquisition;

- Skills consolidation and application training;

- Generalization and maintenance;

- Post-treatment assessment follow-up.

These steps are based on a system created by Kanfer and Saslow. After identifying the behaviors that need changing, whether they be in excess or deficit, and treatment has occurred, the psychologist must identify whether or not the intervention succeeded. For example, "If the goal was to decrease the behavior, then there should be a decrease relative to the baseline. If the critical behavior remains at or above the baseline, then the intervention has failed."

The steps in the assessment phase include:

- Identify critical behaviors;

- Determine whether critical behaviors are excesses or deficits;

- Evaluate critical behaviors for frequency, duration, or intensity (obtain a baseline);

- If excess, attempt to decrease frequency, duration, or intensity of behaviors; if deficits, attempt to increase behaviors.

The re-conceptualization phase makes up much of the "cognitive" portion of CBT.

### Delivery protocols

There are different protocols for delivering cognitive behavioral therapy, with important similarities among them. Use of the term CBT may refer to different interventions, including "self-instructions (e.g. distraction, imagery, motivational self-talk), relaxation and/or biofeedback, development of adaptive coping strategies (e.g. minimizing negative or self-defeating thoughts), changing maladaptive beliefs about pain, and goal setting ". Treatment is sometimes manualized, with brief, direct, and time-limited treatments for individual psychological disorders that are specific technique-driven. CBT is used in both individual and group settings, and the techniques are often adapted for self-help applications. Some clinicians and researchers are cognitively oriented (e.g. cognitive restructuring), while others are more behaviorally oriented (e.g. in vivo exposure therapy). Interventions such as imaginal exposure therapy combine both approaches.

### Related techniques

CBT may be delivered in conjunction with a variety of diverse but related techniques such as exposure therapy, stress inoculation, cognitive processing therapy, cognitive therapy, metacognitive therapy, metacognitive training, relaxation training, dialectical behavior therapy, and acceptance and commitment therapy. Some practitioners promote a form of mindful cognitive therapy which includes a greater emphasis on self-awareness as part of the therapeutic process.

## Methods of access

### Therapist

A typical CBT program would consist of face-to-face sessions between patient and therapist, made up of 6–18 sessions of around an hour each with a gap of 1–3 weeks between sessions. This initial program might be followed by some booster sessions, for instance after one month and three months. CBT has also been found to be effective if patient and therapist type in real time to each other over computer links.

Cognitive-behavioral therapy is most closely allied with the scientist–practitioner model in which clinical practice and research are informed by a scientific perspective, clear operationalization of the problem, and an emphasis on measurement, including measuring changes in cognition and behavior and the attainment of goals. These are often met through " homework " assignments in which the patient and the therapist work together to craft an assignment to complete before the next session. The completion of these assignments – which can be as simple as a person with depression attending some kind of social event – indicates a dedication to treatment compliance and a desire to change. The therapists can then logically gauge the next step of treatment based on how thoroughly the patient completes the assignment. Effective cognitive behavioral therapy is dependent on a therapeutic alliance between the healthcare practitioner and the person seeking assistance. Unlike many other forms of psychotherapy, the patient is very involved in CBT. For example, an anxious patient may be asked to talk to a stranger as a homework assignment, but if that is too difficult, he or she can work out an easier assignment first. The therapist needs to be flexible and willing to listen to the patient rather than acting as an authority figure.

### Computerized or Internet-delivered (CCBT)

Computerized cognitive behavioral therapy (CCBT) has been described by NICE as a "generic term for delivering CBT via an interactive computer interface delivered by a personal computer, internet, or interactive voice response system", instead of face-to-face with a human therapist. It is also known as internet-delivered cognitive behavioral therapy or ICBT. CCBT has potential to improve access to evidence-based therapies, and to overcome the prohibitive costs and lack of availability sometimes associated with retaining a human therapist. In this context, it is important not to confuse CBT with 'computer-based training', which nowadays is more commonly referred to as e-Learning.

Although improvements in both research quality and treatment adherence is required before advocating for the global dissemination of CCBT, it has been found in meta-studies to be cost-effective and often cheaper than usual care, including for anxiety and PTSD. Studies have shown that individuals with social anxiety and depression experienced improvement with online CBT-based methods. A study assessing an online version of CBT for people with mild-to-moderate PTSD found that the online approach was as effective as, and cheaper than, the same therapy given face-to-face. A review of current CCBT research in the treatment of OCD in children found this interface to hold great potential for future treatment of OCD in youths and adolescent populations. Additionally, most internet interventions for post-traumatic stress disorder use CCBT. CCBT is also predisposed to treating mood disorders amongst non-heterosexual populations, who may avoid face-to-face therapy from fear of stigma. However presently CCBT programs seldom cater to these populations.

In February 2006 NICE recommended that CCBT be made available for use within the NHS across England and Wales for patients presenting with mild-to-moderate depression, rather than immediately opting for antidepressant medication, and CCBT is made available by some health systems. The 2009 NICE guideline recognized that there are likely to be a number of computerized CBT products that are useful to patients, but removed endorsement of any specific product.

### Smartphone app-delivered

Another new method of access is the use of mobile app or smartphone applications to deliver self-help or guided CBT. Technology companies are developing mobile-based artificial intelligence chatbot applications in delivering CBT as an early intervention to support mental health, to build psychological resilience, and to promote emotional well-being. Artificial intelligence (AI) text-based conversational application delivered securely and privately over smartphone devices have the ability to scale globally and offer contextual and always-available support. Active research is underway including real-world data studies that measure effectiveness and engagement of text-based smartphone chatbot apps for delivery of CBT using a text-based conversational interface. Recent market research and analysis of over 500 online mental healthcare solutions identified 3 key challenges in this market: quality of the content, guidance of the user and personalisation.

A study compared CBT alone with a mindfulness-based therapy combined with CBT, both delivered via an app. It found that mindfulness-based self-help reduced the severity of depression more than CBT self-help in the short-term. Overall, NHS costs for the mindfulness approach were £500 less per person than for CBT.

### Reading self-help materials

Enabling patients to read self-help CBT guides has been shown to be effective by some studies. However one study found a negative effect in patients who tended to ruminate, and another meta-analysis found that the benefit was only significant when the self-help was guided (e.g. by a medical professional).

### Group educational course

Patient participation in group courses has been shown to be effective. In a meta-analysis reviewing evidence-based treatment of OCD in children, individual CBT was found to be more efficacious than group CBT.

## Types

### Brief cognitive behavioral therapy

Brief cognitive behavioral therapy (BCBT) is a form of CBT which has been developed for situations in which there are time constraints on the therapy sessions and specifically for those struggling with suicidal ideation and/or making suicide attempts. BCBT was based on Rudd's proposed "suicidal mode", an elaboration of Beck's modal theory. BCBT takes place over a couple of sessions that can last up to 12 accumulated hours by design. This technique was first implemented and developed with soldiers on active duty by Dr. M. David Rudd to prevent suicide.

Breakdown of treatment

- Orientation Commitment to treatment Crisis response and safety planning Means restriction Survival kit Reasons for living card Model of suicidality Treatment journal Lessons learned

- Commitment to treatment

- Crisis response and safety planning

- Means restriction

- Survival kit

- Reasons for living card

- Model of suicidality

- Treatment journal

- Lessons learned

- Skill focus Skill development worksheets Coping cards Demonstration Practice Skill refinement

- Skill development worksheets

- Coping cards

- Demonstration

- Practice

- Skill refinement

- Relapse prevention Skill generalization Skill refinement

- Skill generalization

- Skill refinement

### Cognitive emotional behavioral therapy

Cognitive emotional behavioral therapy (CEBT) is a form of CBT developed initially for individuals with eating disorders but now used with a range of problems including anxiety, depression, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and anger problems. It combines aspects of CBT and dialectical behavioral therapy and aims to improve understanding and tolerance of emotions in order to facilitate the therapeutic process. It is frequently used as a "pretreatment" to prepare and better equip individuals for longer-term therapy.

### Structured cognitive behavioral training

Structured cognitive-behavioral training (SCBT) is a cognitive-based process with core philosophies that draw heavily from CBT. Like CBT, SCBT asserts that behavior is inextricably related to beliefs, thoughts, and emotions. SCBT also builds on core CBT philosophy by incorporating other well-known modalities in the fields of behavioral health and psychology: most notably, Albert Ellis 's rational emotive behavior therapy. SCBT differs from CBT in two distinct ways. First, SCBT is delivered in a highly regimented format. Second, SCBT is a predetermined and finite training process that becomes personalized by the input of the participant. SCBT is designed to bring a participant to a specific result in a specific period of time. SCBT has been used to challenge addictive behavior, particularly with substances such as tobacco, alcohol and food, and to manage diabetes and subdue stress and anxiety. SCBT has also been used in the field of criminal psychology in the effort to reduce recidivism.

### Moral reconation therapy

Moral reconation therapy, a type of CBT used to help felons overcome antisocial personality disorder (ASPD), slightly decreases the risk of further offending. It is generally implemented in a group format because of the risk of offenders with ASPD being given one-on-one therapy reinforces narcissistic behavioral characteristics, and can be used in correctional or outpatient settings. Groups usually meet weekly for two to six months.

### Stress inoculation training

This type of therapy uses a blend of cognitive, behavioral, and certain humanistic training techniques to target the stressors of the client. This is usually used to help clients better cope with their stress or anxiety after stressful events. This is a three-phase process that trains the client to use skills that they already have to better adapt to their current stressors. The first phase is an interview phase that includes psychological testing, client self-monitoring, and a variety of reading materials. This allows the therapist to individually tailor the training process to the client. Clients learn how to categorize problems into emotion-focused or problem-focused so that they can better treat their negative situations. This phase ultimately prepares the client to eventually confront and reflect upon their current reactions to stressors, before looking at ways to change their reactions and emotions to their stressors. The focus is conceptualization.

The second phase emphasizes the aspect of skills acquisition and rehearsal that continues from the earlier phase of conceptualization. The client is taught skills that help them cope with their stressors. These skills are then practiced in the space of therapy. These skills involve self-regulation, problem-solving, interpersonal communication skills, etc.

The third and final phase is the application and following through of the skills learned in the training process. This gives the client opportunities to apply their learned skills to a wide range of stressors. Activities include role-playing, imagery, modeling, etc. In the end, the client will have been trained on a preventive basis to inoculate personal, chronic, and future stressors by breaking down their stressors into problems they will address in long-term, short-term, and intermediate coping goals.

### Activity-guided CBT: Group-knitting

A recently developed group therapy model, based on CBT, integrates knitting into the therapeutic process and has been proven to yield reliable and promising results. The foundation for this novel approach to CBT is the frequently emphasized notion that therapy success depends on how embedded the therapy method is in the patients' natural routine. Similar to standard group-based CBT, patients meet once a week in a group of 10 to 15 patients and knit together under the instruction of a trained psychologist or mental health professional. Central for the therapy is the patient's imaginative ability to assign each part of the wool to a certain thought. During the therapy, the wool is carefully knitted, creating a knitted piece of any form. This therapeutic process teaches the patient to meaningfully align thought, by (physically) creating a coherent knitted piece. Moreover, since CBT emphasizes the behavior as a result of cognition, the knitting illustrates how thoughts (which are tried to be imaginary tight to the wool) materialize into the reality surrounding us.

### Mindfulness-based cognitive behavioral hypnotherapy

Mindfulness-based cognitive behavioral hypnotherapy (MCBH) is a form of CBT that focuses on awareness in a reflective approach, addressing subconscious tendencies. It is more the process that contains three phases for achieving wanted goals and integrates the principles of mindfulness and cognitive-behavioral techniques with the transformative potential of hypnotherapy.

### Unified Protocol

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is a form of CBT, developed by David H. Barlow and researchers at Boston University, that can be applied to a range of anxiety disorders. The rationale is that anxiety and depression disorders often occur together due to common underlying causes and can efficiently be treated together.

The UP includes a common set of components:

- Psycho-education

- Cognitive reappraisal

- Emotion regulation

- Changing behaviour

The UP has been shown to produce equivalent results to single-diagnosis protocols for specific disorders, such as OCD and social anxiety disorder. Several studies have shown that the UP is easier to disseminate as compared to single-diagnosis protocols.

Culturally adapted CBT The study of psychotherapy across races, religions, and cultures, or "ethno-psycho-therapy", is a relatively new discipline

## Criticisms

### Relative effectiveness

The research conducted for CBT has been a topic of sustained controversy. While some researchers write that CBT is more effective than other treatments, many other researchers and practitioners have questioned the validity of such claims. For example, one study determined CBT to be superior to other treatments in treating anxiety and depression. However, researchers responding directly to that study conducted a re-analysis and found no evidence of CBT being superior to other bona fide treatments and conducted an analysis of thirteen other CBT clinical trials and determined that they failed to provide evidence of CBT superiority. In cases where CBT has been reported to be statistically better than other psychological interventions in terms of primary outcome measures, effect sizes were small and suggested that those differences were clinically meaningless and insignificant. Moreover, on secondary outcomes (i.e., measures of general functioning) no significant differences have been typically found between CBT and other treatments.

A major criticism has been that clinical studies of CBT efficacy (or any psychotherapy) are not double-blind (i.e., either the subjects or the therapists in psychotherapy studies are not blind to the type of treatment). They may be single-blinded, i.e. the rater may not know the treatment the patient received, but neither the patients nor the therapists are blinded to the type of therapy given (two out of three of the persons involved in the trial, i.e., all of the persons involved in the treatment, are unblinded). The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in.

The importance of double-blinding was shown in a meta-analysis that examined the effectiveness of CBT when placebo control and blindness were factored in. Pooled data from published trials of CBT in schizophrenia, major depressive disorder (MDD), and bipolar disorder that used controls for non-specific effects of intervention were analyzed. This study concluded that CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates; treatment effects are small in treatment studies of MDD, and it is not an effective treatment strategy for prevention of relapse in bipolar disorder. For MDD, the authors note that the pooled effect size was very low.

### Declining effectiveness

Additionally, a 2015 meta-analysis revealed that the positive effects of CBT on depression have been declining since 1977. The overall results showed two different declines in effect sizes: 1) an overall decline between 1977 and 2014, and 2) a steeper decline between 1995 and 2014. Additional sub-analysis revealed that CBT studies where therapists in the test group were instructed to adhere to the Beck CBT manual had a steeper decline in effect sizes since 1977 than studies where therapists in the test group were instructed to use CBT without a manual. The authors reported that they were unsure why the effects were declining but did list inadequate therapist training, failure to adhere to a manual, lack of therapist experience, and patients' hope and faith in its efficacy waning as potential reasons. The authors did mention that the current study was limited to depressive disorders only.

### High drop-out rates

Furthermore, other researchers write that CBT studies have high drop-out rates compared to other treatments. One meta-analysis found that CBT drop-out rates were 17% higher than those of other therapies. This high drop-out rate is also evident in the treatment of several disorders, particularly the eating disorder anorexia nervosa, which is commonly treated with CBT. Those treated with CBT have a high chance of dropping out of therapy before completion and reverting to their anorexia behaviors.

Other researchers analyzing treatments for youths who self-injure found similar drop-out rates in CBT and DBT groups. In this study, the researchers analyzed several clinical trials that measured the efficacy of CBT administered to youths who self-injure. The researchers concluded that none of them were found to be efficacious.

### Philosophical concerns with CBT methods

The methods employed in CBT research have not been the only criticisms; some individuals have called its theory and therapy into question.

Slife and Williams write that one of the hidden assumptions in CBT is that of determinism, or the absence of free will. They argue that CBT holds that external stimuli from the environment enter the mind, causing different thoughts that cause emotional states: nowhere in CBT theory is agency, or free will, accounted for.

Another criticism of CBT theory, especially as applied to major depressive disorder (MDD), is that it confounds the symptoms of the disorder with its causes.

### Side effects

CBT is generally regarded as having very few if any side effects. Calls have been made by some for more appraisal of possible side effects of CBT. Many randomized trials of psychological interventions like CBT do not monitor potential harms to the patient. In contrast, randomized trials of pharmacological interventions are much more likely to take adverse effects into consideration.

A 2017 meta-analysis revealed that adverse events are not common in children receiving CBT and, furthermore, that CBT is associated with fewer dropouts than either placebo or medications. Nevertheless, CBT therapists do sometimes report 'unwanted events' and side effects in their outpatients with "negative wellbeing/distress" being the most frequent.

### Socio-political concerns

The writer and group analyst Farhad Dalal questions the socio-political assumptions behind the introduction of CBT. According to one reviewer, Dalal connects the rise of CBT with "the parallel rise of neoliberalism, with its focus on marketization, efficiency, quantification and managerialism ", and he questions the scientific basis of CBT, suggesting that "the 'science' of psychological treatment is often less a scientific than a political contest". In his book, Dalal also questions the ethical basis of CBT.

## Society and culture

The UK's National Health Service announced in 2008 that more therapists would be trained to provide CBT at government expense as part of an initiative called Improving Access to Psychological Therapies (IAPT). The NICE said that CBT would become the mainstay of treatment for non-severe depression, with medication used only in cases where CBT had failed. Therapists complained that the data does not fully support the attention and funding CBT receives. Psychotherapist and professor Andrew Samuels stated that this constitutes "a coup, a power play by a community that has suddenly found itself on the brink of corralling an enormous amount of money... Everyone has been seduced by CBT's apparent cheapness."

The UK Council for Psychotherapy issued a press release in 2012 saying that the IAPT's policies were undermining traditional psychotherapy and criticized proposals that would limit some approved therapies to CBT, claiming that they restricted patients to "a watered-down version of cognitive behavioural therapy (CBT), often delivered by very lightly trained staff".


Michael Wilson (director)

# Michael Wilson (director)

## Abstract

Michael Wilson (born 1964) is an American stage and screen director working extensively on Broadway, Off-Broadway, and at the nation's leading resident theaters.

He made his screen directorial debut with the 2014 Lifetime/Ostar television film adaptation of Horton Foote's The Trip to Bountiful, which was nominated for two 2014 Emmy Awards and six 2015 NAACP/Image Awards—including Outstanding Television Movie – as well as a DGA Award for Outstanding Direction of a Movie or Mini-Series for Television. The film won three 2015 NAACP/Image Awards (Outstanding Actress: Cicely Tyson; Outstanding Actor: Blair Underwood, and Outstanding TV Movie); the Black Reel Award for Outstanding TV Movie; and the Gracie Allen Award for Outstanding Ensemble Cast (in addition to Tyson and Underwood, the cast included Keke Palmer, Vanessa Williams and Clancy Brown).

Showing Roots – his first indie film produced by Michael Mailer Films in association with Bill Haber—starred Uzo Aduba, Maggie Grace, Elizabeth McGovern, Adam Brody and Cicely Tyson. It won Best Narrative Film awards at the 2015 Bahamas and 2016 Maryland International Film (Hagerstown) Festivals, and was subsequently acquired by Lifetime for broadcast in May 2016.

On Broadway, Wilson directed the 2013 Tony Award-winning revival of The Trip to Bountiful starring Cicely Tyson, Cuba Gooding Jr, Vanessa Williams and Condola Rashad. Other Broadway productions include the 2012 Tony nominated revival of Gore Vidal’s The Best Man (starring James Earl Jones, Angela Lansbury, Candice Bergen, John Larroquette, Eric McCormack, John Stamos, Kristin Davis, and Michael McKean); the Tony nominated Best Plays Dividing the Estate (starring Elizabeth Ashley and Gerald McRaney); and Enchanted April (starring Jayne Atkinson and Molly Ringwald).

Off-Broadway, he directed the 2015 Signature revival of Arthur Miller's Incident at Vichy starring Richard Thomas, which was subsequently filmed for television and broadcast in 2016 on Theater Close-Up by WNET 13 and BroadwayHD. In 2010, he received Drama Desk and Outer Critics Circle Awards for his direction of Foote's three-part, nine-hour epic The Orphans’ Home Cycle.

Internationally, he directed both parts of Tony Kushner's Angels in America for the 1995 Venice Biennale.

Most recently, he directed the acclaimed Los Angeles premiere of the musical Grey Gardens: starring Betty Buckley and Rachel York for CTG/Ahmanson Theater at the Music Center.

## Career

In an interview in 2008, Wilson noted:

Like most directors, I want to show a variety of work. I've done Shakespeare, Chekhov, and O'Neill, as well as new work. Some people have defined my body of work as being dominated by female characters, and this play is no exception. I have collaborated many times with Elizabeth Ashley, who plays the matriarch in Dividing, I don't necessarily subscribe to the notion that I am "a woman's director." But I would say that I am drawn to plays that deal with family situations. In the plays I work on I want there to be a real moment of catharsis. I am always looking to let the audience have some kind of emotional connection. That's one of the reasons why I love Horton's plays so much: they allow that connection.

### Hartford Stage

As artistic director from 1998 to 2011, Wilson commissioned and developed numerous new works, including the 2012 Pulitzer Prize-winning play Water By the Spoonful by Quiara Alegria Hudes. He directed seventeen productions for Hartford Stage, including the premiere of Enchanted April (which subsequently transferred to Broadway, garnering a 2003 Best Play Tony nomination, and 9 Outer Critics Circle nominations, including Best Director). He directed the premieres of Horton Foote ’s The Orphans' Home Cycle (2010 Drama Desk and Outer Critics Circle Awards); The Carpetbagger’s Children (2002 Best Play, American Theater Critics Award) and Eve Ensler ’s Necessary Targets, all which subsequently transferred Off-Broadway; Williams's The Glass Menagerie (which subsequently toured to Houston and Boston where it won the 2002 Elliot Norton Award for Outstanding Visiting Production); O’Neill's Long Day’s Journey Into Night; and Shakespeare's Macbeth.

Under his leadership, in addition to the Tennessee Williams Marathon—the first national, multi-year retrospective of the American playwright—Hartford Stage focused on the development of new work, a vast expansion of its education and outreach programs, and helped raise 17 million dollars which accomplished among many things the company's first major renovation of its John W. Huntington Theater home since that facility opened in 1977.

Wilson also forged new collaborations with Houston's Alley Theatre, Harvard's American Repertory Theater, the Dallas Theater Center, the Guthrie Theater, The Shakespeare Theatre, and Chicago's Steppenwolf Theatre.

### Broadway

- The Trip to Bountiful by Horton Foote, 2013 (Stephen Sondheim Theatre)

- The Best Man, by Gore Vidal, 2012 (Schoenfeld Theater)

- Dividing the Estate, by Horton Foote, 2008, (Lincoln Center Theater at the Booth)

- Old Acquaintances, by John Van Druten, 2007 (Roundabout Theatre at the American Airlines Theater)

- Enchanted April, by Matthew Barber, 2003 (Belasco Theatre)

### Off-Broadway (selected)

Source: IOBDB

Arthur Miller's Incident at Vichy, 2015 (Signature Theater Company)

Horton Foote's The Old Friends, 2013 (STC)

Lanford Wilson's Talley's Folly 2013 (RTC)

Christopher Shinn's Picked 2011 (Vineyard Theater)

Tennessee Williams' The Milk Train Doesn't Stop Here Anymore 2011 (RTC)

- Horton Foote's The Orphans' Home Cycle, 2010 (STC)

- Horton Foote's Dividing The Estate, 2007 (Primary Stages)

- Horton Foote's The Day Emily Married, 2004 (Primary Stages)

- Horton Foote's The Carpetbagger’s Children, 2002 (Lincoln Center Theater)

- Christopher Shinn's What Didn’t Happen, 2002 (Playwrights Horizons)

- Necessary Targets, by Eve Ensler, 2002 (Variety Arts)

- Jane Anderson's Defying Gravity, 1997 (Laura Pels Theatre)

- Tennessee Williams's The Red Devil Battery Sign, 1996 (WPA Theatre)

### Resident

- The Alley Theatre (associate director, 1990–98)

- American Repertory Theatre

- Berkeley Repertory Theatre

- Center Theater Group/Ahmanson

- Goodman Theatre

- Guthrie Theatre

- Huntington Theater

- La Jolla Playhouse

- Long Wharf Theatre

- New York Stage and Film

- Old Globe Theater

- Philadelphia Theatre Company

- PlayMakers Repertory Company

- Wallis

### International

- Angels in America Parts I & II, 1995 Venice Biennale

## Personal

Wilson grew up in Winston-Salem, North Carolina and attended the University of North Carolina at Chapel Hill, where he graduated a Morehead scholar in 1987. Since 2015, he has served as Treasurer of the Stage Directors and Choreographers Society (SDC).

### Other

- 2001–2003, Connecticut Commission on the Arts

- 2003 Citizen of the Year by the Greater Hartford Civitan Club

## Honors and awards

Source for certain honors: American Theatre Wing

- 2010 Drama Desk and Outer Critics Circle Awards for his direction of Horton Foote's The Orphans' Home Cycle

- Daryl Roth 2002 Creative Spirit Award, Lincoln Center Theater

- Princess Grace Foundation, 2001 Statue Award and 1992 Theatre fellowship

- Edward Albee Foundation 1992 fellowship

- Connecticut Critics Circle (various), including the 2005 Tom Killen Award


Acid (YouTuber)

# Acid (YouTuber)

## Abstract

Nathan Vandergunst (born 29 June 1999), known professionally as Acid (pronounced as), is a Belgian YouTuber. He started his YouTube channel at the age of 13 in January 2013. He lives in Blankenberge, a seaside city in the Belgian province of West Flanders. He makes videos in Dutch.

## Biography

Vandergunst began posting videos on the video platform YouTube, mainly videos about the third-person shooter game Qpang. At the age of 13, he started his channel "YaDsAcid", which is also the name visible on his Twitch channel. He reportedly named his channel after the character "Acid Burn" from the 1995 film Hackers.

Since the start of his career, Vandergunst has had a majority Dutch audience. In order to make his videos understandable for all his viewers, he taught himself to speak Standard Dutch. As a result, his accent on the internet is considered a blend of Flemish and Dutch.

In late 2021, he released the single "Go, Acid!" together with Joost Klein and Apson, which was his debut single. The song spent 3 weeks in the Flemish Ultratop 50 charts, peaking at position 41.

## Controversy

In June 2023, Acid sparked controversy by publishing a YouTube video that revealed the names, photographs, and occupations of certain members of the Reuzegom student club. Just days earlier, several Reuzegom members had been convicted by a Belgian court for their involvement in the 2018 death of fellow student Sanda Dia during a hazing ritual. However, Acid argued that the sentences handed down were too lenient.

Subsequently, Acid was sued in criminal court by a restaurant owner for harassment, slander, libel, defamation, discrimination and cyberbullying. The catalyst was Acid's accusation that the restaurant owner's son was partly responsible for Dia's death, accompanied by a flood of negative fake reviews and false reservations targeting the family's restaurant.

In February 2024, Acid was found guilty of electronic harassment. He was sentenced to a fine, provisional damages, and a three-month suspended prison sentence. Acid did not appeal his conviction. He started a crowdfunding campaign to cover the fines, damages, and legal costs, raising €160,000 within a few days. He committed to donate any surplus funds to the Sanda Dia Foundation, established by Sanda's father, Ousmane.


Michelle Edwards (basketball)

# Michelle Edwards (basketball)

## Abstract

Michelle Edwards (born March 6, 1966) is an American retired professional women's basketball player. She was a member of the United States women's national basketball team, that claimed the bronze medal at the 1991 Pan American Games in Havana, Cuba. Edwards was inducted into the Women's Basketball Hall of Fame in 2014.

Edwards was born and raised in Boston, Massachusetts.

Allocated to the Cleveland Rockers in the 1997 WNBA draft, the 5'9" guard out of the University of Iowa played for Cleveland and the Seattle Storm during her career. She also coached at Rutgers University.

## Early years

Unlike many notable basketball players, Edwards did not pick up the game at a young age. She was athletic, but her court of choice was a tennis court. She also skied, and dreamed of becoming the first black Olympic racer, although a case of frostbite cooled her interest in skiing. She spent a lot of time with her older brother Rodney, visiting a local park. He would go to the basketball court, but Edwards usually stopped to play with other girls where the swings were located. As she became a teenager, she started noticing boys, and would head over to the basketball court, not to play, but just to watch.

At first, she was too shy to join in, but eventually she did and soon was challenging some of the boys to one-on-one contests. She didn't always win, but she won more than she lost. Her skill soon earned her a nickname "Ice" because of her cool moves.

Edwards played high school basketball for Cathedral High in Boston, where she would score over 2000 points in her high school career, the first girl in Massachusetts history to reach that level. Her career earned her a spot in the high school Hall of Fame

While in high school she was noticed by Alfreda Harris, a Boston educator who had founded the Shelburne Center in Roxbury Massachusetts, place where Edwards played. Harris would later go on to become the first female head coach at the university of Massachusetts, Boston campus, and later would be inducted into their Hall of Fame. Harris noticed Edwards, and persuaded her to join a local AAU basketball team. College coaches learned about Edwards, and both Virginia and USC showed interest. Virginia sent a young assistant, Geno Auriemma to recruit her.

## College career

C. Vivian Stringer had cultivated a relationship with Harris while Stringer was at Cheyney State. This relationship continued, even after Stringer moved to take the head coaching position in Iowa. A women interviewing for an assistant coaching position told Stringer about a player she had seen in the Boston area. Stringer had no contact information, and started calling the high school, even though it was summer, trying to contact her. One day, she reached a janitor. She asked if he knew Edwards and he responded, "Who, Ice? Are you kidding me? That girl is the 'truth'." He explained that her coach was Alfreda Harris, so Stringer called Harris. She wasn't sure that Harris would remember her, but she did, and responded, "It's about time, Stringer. She's only the best damn player in America." Stringer began to recruit Edwards. On a recruiting visit, Edwards was embarrassed to admit she didn't know where Iowa was, so Stringer pulled out a map to show her. Stringer convinced her to enroll at Iowa. She was sympathetic, as she had not known where Iowa was, confusing it with Idaho, when Stringer had first been approached for the job.

Stringer had taken over a program at Iowa that had produced losing records for the prior three years. In Stringer's first season 1983–84, the record improved to 17–10. Edwards was one of the first recruits, and joined Stringer in her second year at Iowa. The team would go 20–8 in her freshman year, and improved that record each of the four years Edwards was at Iowa. The team finished second in the Big Ten in her freshman and sophomore years, then in a tie for first place as a junior, and sole possession of first place in her senior year.

In her freshman year, Iowa played Ohio State. The Ohio State team was unbeaten in conference play, while Iowa had just a single loss. The game was at Carver–Hawkeye Arena which had 15,500 seats, but over 20,000 showed up. They had to close the doors and turn away many fans, but the turnstiles recorded 22,157. a record number of fans to watch a women's basketball game at the time. Fans sat in the aisles, and the fire marshal sent a letter of reprimand to Christine Grant, who was then the director of women's athletics at Iowa. The letter still hangs prominently on Grant's wall. Ohio State won the game 56–47, but it is the attendance record that the two coaches remember. At Stringer's press conference, when she was announced as the new coach, she promised she would sell out the arena, which prompted audible snickers among the reporters. Edwards recalls missing a layup badly, because she was trying too hard. Coach Stringer consoled her, saying to her"'Do you see that picture? That is how intense that game was and that is the level of play we need to operate on every time we hit the floor."

In Edward's senior year, Iowa agreed to play in the Burger King/Orange Bowl Classic, held in Miami, Florida on 28–30 December 1987. The opening game was against Auburn, ranked among the top ten teams in the nation. Iowa won the game 73–69, which set up a game the next day against Virginia, also ranked in the top ten. The Hawkeyes beat Virginia 75–59, which set up a game the following day against Texas. The Longhorns were ranked first in the country, had Clarissa Davis, who had won national Player of the Year honors the previous year, and would go on to win National Player of the Year and Wade Trophy honors in 1989. Texas also had Beverly Williams, a Kodak Al_American. Coach Stringer was very concerned about how to convince her team that they could defeat Texas. She spent the whole night working on a pre-game speech, which would include references to a woman who swam the English Channel with no arms, and Glenn Cunningham (athlete), who set records for the mile run after he had been told that a childhood burn incident would not let him walk again. She talked about faith and a woman who was able to lift a car to save a child. She closed by pointing to the black blackboard, and declared it was green. The entire team was caught up in her passion and agreed that it really was green. After the team prayer, the team headed to the court, and defeated the number one team in the country. The following week, Iowa was ranked number one in the country 75–65.

Edwards was the leading scorer for her team in her sophomore, junior and senior years, scoring a total of 1821 points. She has the third highest scoring total among all Iowa players, and her 235 steals is also third best. She had 431 career assists, which is the second best in school history.

### Iowa statistics

Source

## USA Basketball

Edwards played with the USA team at the 1991 Pan American Games. The team finished with a record of 4–2, but managed to win the bronze medal. The USA team lost a three-point game to Brazil, then responded with wins over Argentina and Cuba, earning a spot in the medal round. The next game was a rematch against Cuba, and this time the team from Cuba won a five-point game. The USA beat Canada easily to win the bronze. Edwards averaged 4.7 points per game.

## Professional career

Two years after she graduated, the school honored her by retiring her jersey. Although she appreciated it at the time, the honor did not sink in until years later, when she reflected on all the players that have played at Iowa, and she realized she is the only one to have her jersey retired.

After graduation, there were no major professional options for women in the United States. She wanted to play basketball, so decided to head to Italy to play for one of the club teams. Edwards had mixed feelings and cried on her trip over to Italy. However, she ended up play for nine seasons, earning All-Star Game MVP of the Italian League on three occasions. Over the nine years, she played for club teams Faenza, Pistoia, Ferrara and Pavia.

### WNBA

Being selected by the Cleveland Rockers in the initial player allocation of the 1997 WNBA draft, Edwards debut game was played on June 21, 1997 in a 56 - 76 loss to the Houston Comets where she recorded 7 points, 2 rebounds, 2 assists and 3 steals. She would play for the Rockers for three years, averaging 8.1 points, 2.5 rebounds and 3.1 assists for the team.

Edwards was traded to the Seattle Storm on June 11, 2000 for Nina Bjedov. Speaking on the trade, then Head Coach of the Rockers, Dan Hughes stated "Michelle Edwards has meant a lot to this franchise both on the court and off. She has been with the team since the beginning. We owe her the opportunity to be somewhere where she will play". The trade happened after only playing 3 games for the Rockers in the 2000 season. Edwards finished the 2000 season with the Storm, playing in 20 games while averaging 6.6 points, 2.0 assists and 1.7 rebounds.

Edwards would only play 3 games in the 2001 season due to having a chronic left foot injury and would announce her retirement the next year on April 17, 2002. Because of this, her final WNBA game ever was the 3rd game she played with the Storm during her shortened 2001 season. That game was played on June 7, 2001 with the Storm falling 57 - 70 to the Miami Sol and Edwards only playing for less than 2 minutes (recording 1 rebound and no other stats).

## Awards and honors

- 1988—Big Ten Player of the Year

- 1988—Kodak All-American

- 1988—USBWA All-American

- 1988—Naismith All-American

- 1988— WBCA Player of the Year

- 2014— Women's Basketball Hall of Fame

## WNBA career statistics


Xenix

# Xenix

## Abstract

Xenix is a discontinued version of the Unix operating system for various microcomputer platforms, licensed by Microsoft from AT&T Corporation in the late 1970s. The Santa Cruz Operation (SCO) later acquired exclusive rights to the software, and eventually replaced it with SCO UNIX (now known as Xinuos OpenServer).

In the mid-to-late 1980s, Xenix was the most common Unix variant, measured according to the number of machines on which it was installed. Microsoft chairman Bill Gates said at Unix Expo in 1996 that, for a long time, Microsoft had the highest-volume AT&T Unix license.

## History

Bell Labs, the developer of Unix, was part of the regulated Bell System and could not sell Unix directly to most end users (academic and research institutions excepted); it could, however, license it to software vendors who would then resell it to end users (or their own resellers), combined with their own added features. Microsoft, which expected that Unix would be its operating system of the future when personal computers became powerful enough, purchased a license for Version 7 Unix from AT&T in 1978, and announced on August 25, 1980, that it would make the software available for the 16-bit microcomputer market. Because Microsoft was not able to license the "Unix" name itself, the company gave it an original name.

Microsoft called Xenix "a universal operating environment". It did not sell Xenix directly to end users, but licensed the software to OEMs such as IBM, Intel, Management Systems Development, Tandy, Altos Computer, SCO, and Siemens (SINIX) which then ported it to their own proprietary computer architectures.

In 1981, Microsoft said the first version of Xenix was "very close to the original Unix version 7 source" on the PDP-11, and later versions were to incorporate its own fixes and improvements. The company stated that it intended to port the operating system to the Zilog Z8000 series, Digital LSI-11, Intel 8086 and 80286, Motorola 68000, and possibly "numerous other processors", and provide Microsoft's "full line of system software products", including BASIC and other languages. The first port was for the Z8001 16-bit processor: the first customer ship was January 1981 for Central Data Corporation of Illinois, followed in March 1981 by Paradyne Corporation's Z8001 product. The first 8086 port was for the Altos Computer Systems ' non-PC-compatible 8600-series computers (first customer ship date Q1 1982).

Intel sold complete computers with Xenix under their Intel System 86 brand (with specific models such as 86/330 or 86/380X); they also offered the individual boards that made these computers under their iSBC brand. This included processor boards like iSBC 86/12 and also MMU boards such as the iSBC 309. The first Intel Xenix systems shipped in July 1982. Tandy more than doubled the Xenix installed base when it made TRS-Xenix the default operating system for its TRS-80 Model 16 68000-based computer in early 1983, and was the largest Unix vendor in 1984. Seattle Computer Products also made (PC-incompatible) 8086 computers bundled with Xenix, like their Gazelle II, which used the S-100 bus and was available in late 1983 or early 1984. There was also a port for IBM System 9000.

SCO had initially worked on its own PDP-11 port of V7, called Dynix, but then struck an agreement with Microsoft for joint development and technology exchange on Xenix in 1982. Microsoft and SCO then further engaged Human Computing Resources Corporation (HCR) in Canada, and a software products group within Logica plc in the United Kingdom, as part of making further improvements to Xenix and porting Xenix to other platforms. In doing so, Microsoft gave HCR and Logica the rights to do Xenix ports and to license Xenix binary distributions in those territories.

In 1984, a port to the 68000-based Apple Lisa 2 was jointly developed by SCO and Microsoft and it was the first shrink-wrapped binary product sold by SCO. The Multiplan spreadsheet was released for it.

In its 1983 OEM directory, Microsoft said the difficulty in porting to the various 8086 and Z8000-based machines had been the lack of a standardized memory management unit and protection facilities. Hardware manufacturers compensated by designing their own hardware, but the ensuing complexity made it "extremely difficult if not impossible for the very small manufacturer to develop a computer capable of supporting a system such as Xenix from scratch," and "the Xenix kernel must be custom-tailored to each new hardware environment."

A generally available port to the unmapped Intel 8086/8088 architecture was done by The Santa Cruz Operation around 1983. SCO Xenix for the PC XT shipped sometime in 1984 and contained some enhancement from 4.2BSD; it also supported the Micnet local area networking.

The later 286 version of Xenix used the integrated MMU present on this chip, by running in 286 protected mode. The 286 Xenix was accompanied by new hardware from Xenix OEMs. For example, the Sperry PC/IT, an IBM PC AT clone, was advertised as capable of supporting eight simultaneous dumb terminal users under this version.

While Xenix 2.0 was still based on Version 7 Unix, version 3.0 was upgraded to a Unix System III code base, a 1984 Intel manual for Xenix 286 noted that the Xenix kernel had about 10,000 lines at this time. It was followed by a System V R2 codebase in Xenix 5.0 (a.k.a. Xenix System V).

"Microsoft hopes that Xenix will become the preferred choice for software production and exchange", the company stated in 1981. Microsoft referred to its own MS-DOS as its "single-user, single-tasking operating system", and advised customers who wanted multiuser or multitasking support to buy Xenix. It planned over time to improve MS-DOS so it would be almost indistinguishable from single-user Xenix, or XEDOS, which would also run on the 68000, Z8000, and LSI-11; they would be upwardly compatible with Xenix, which Byte in 1983 described as "the multi-user MS-DOS of the future". Microsoft's Chris Larson described MS-DOS 2.0's Xenix compatibility as "the second most important feature". His company advertised DOS and Xenix together, describing MS-DOS 2.0 (its "single-user OS") as sharing features and system calls with Xenix ("the multi-user, multi-tasking, Unix-derived operating system"), and promising easy porting between them.

After the breakup of the Bell System in 1982, AT&T started selling System V. Microsoft, believing that it could not compete with Unix's developer, decided to abandon Xenix. The decision was not immediately transparent, which led to the term vaporware. It agreed with IBM to develop OS/2, and the Xenix team (together with the best MS-DOS developers) was assigned to that project. In 1987, Microsoft transferred ownership of Xenix to SCO in an agreement that left Microsoft owning slightly less than 20% of SCO (this amount prevented both companies from having to disclose the exact amount in the event of an SCO IPO). And SCO would acquire both of the other companies that had Xenix rights, Logica 's software products group in 1986 and HCR in 1990. When Microsoft eventually lost interest in OS/2 as well, the company based its further high-end strategy on Windows NT.

In 1987, SCO ported Xenix to the 386 processor, a 32-bit chip, after securing knowledge from Microsoft insiders that Microsoft was no longer developing Xenix. Xenix System V Release 2.3.1 introduced support for i386, SCSI and TCP/IP. SCO's Xenix System V/386 was the first 32-bit operating system available on the market for the x86 CPU architecture.

Microsoft continued to use Xenix internally, submitting a patch to support functionality in Unix to AT&T in 1987, which trickled down to the code base of both Xenix and SCO Unix. Microsoft is said to have used Xenix on Sun workstations and VAX minicomputers extensively within their company as late as 1988. All internal Microsoft email transport was done on Xenix-based 68000 systems until 1995–1996, when the company moved to its own Exchange Server product.

SCO released its SCO Unix as a higher-end product, based on System V R3 and offering a number of technical advances over Xenix; Xenix remained in the product line. In the meantime, AT&T and Sun Microsystems completed the merge of Xenix, BSD, SunOS and System V R3 into System V R4. The last version of SCO Xenix/386 itself was System V R2.3.4, released in 1991.

## Features

Aside from its AT&T Unix base, Xenix incorporated elements from BSD, notably the vi text editor and its supporting libraries (termcap and curses). Its kernel featured some original extensions by Microsoft, notably file locking and semaphores, while to the userland Microsoft added a "visual shell" for menu-driven operation instead of the traditional UNIX shell. A limited form of local networking over serial lines (RS-232 ports) was possible through the "micnet" software, which supported file transfer and electronic mail, although UUCP was still used for networking via modems.

OEMs often added further modifications to the Xenix system.

## Trusted Xenix

Trusted Xenix was a variant initially developed by IBM, under the name Secure XENIX; later versions, under the Trusted Xenix name, were developed by Trusted Information Systems. It incorporated the Bell–LaPadula model of multilevel security, and had a multilevel secure interface for the STU-III secure communications device (that is, an STU-III connection would be made available only to those applications running at the same privilege level as the key loaded in the STU-III). It was evaluated by formal methods and achieved a B2 security rating under the DoD 's Trusted Computer System Evaluation Criteria (examples of A1-class systems are Honeywell's SCOMP, Aesec's GEMSOS, and Boeing's SNS Server). Version 2.0 was released in January 1991, version 3.0 in April 1992, and version 4.0 in September 1993. It was still in use as late as 1995.


Kaitoke railway station

# Kaitoke railway station

## Abstract

Kaitoke railway station was a single-platform rural railway station on the Wairarapa Line between Upper Hutt and Featherston in the Wellington region of New Zealand 's North Island. Initially it was the railhead of the Wairarapa Line, at a point where the railway met the main road between Upper Hutt and the Wairarapa. Later it was a point at which locomotives were changed, steam engines were watered, trains could cross, and passengers could make use of the refreshment room.

The station was closed along with the old route via the Rimutaka Incline on which the Fell system was used over the Rimutaka Ranges when the Rimutaka Deviation opened in 1955.

## History

The Mungaroa Contract for the construction of the Wairarapa Line between Upper Hutt and the Pakuratahi Valley included a station near the terminus of the contract, originally called Pakuratahi Station. The contractor for this section was Charles McKirdy, who was to have completed the contract between 3 June 1874 and 3 March 1876 but, as was common with contracts for the construction of the Wairarapa Line, work was not completed on time. Having run out of money with two months of work left to complete, the contract was picked up by McKirdy's guarantors, Walter Turnbull and John McKenzie. They applied for and received further funds to continue the work, which was completed on 16 December 1877.

When work was nearing completion, the Government called for tenders to erect a fourth-class station building and stationmaster's house. The contract was let to W. H. Ridler for the sum of £1,778. This contract also possibly included the erection of the goods shed on a siding 12 chains (240 metres) to the north of the station (the goods shed was demolished in 1882). A separate contract for the sum of £1,514 was let to Messrs. Fraser and Lyon for the construction of an access road to the station and the levelling of the site for the station and house.

By early December 1877, the Public Works Department had advanced platelaying as far as Pakuratahi Station, by this time renamed Kaitoki, later (probably in the 1880s) to become Kaitoke. As Kaitoke was expected to be the railhead for two years, there was some consternation over the siting of the station, with complaints particularly from the Wairarapa that the site was unsuitable for the trans-shipment of goods between road and rail. The Government stood firm and the station stayed where it was intended to be.

The line to Kaitoke Station was officially opened on 28 December 1877 by the Governor, the Marquis of Normanby. A special train was run from Wellington to Kaitoke for the occasion under the supervision of District Engineer Mr. Hales and General Manager Mr. Stone. After speeches and an inspection of the station, by which time had had a refreshments room added, the Governor and party boarded the train again to return to Wellington. Over the next few days, excursion trains were run from Wellington to Kaitoke to satiate the curiosity of those who had heard of the fearsome reputation the line had gained during its construction.On 1 January 1878 the line to Kaitoke was opened to the public, becoming the railhead for the Wairarapa for nearly ten months.

Kaitoke Station proceeded to enter the busiest phase of its existence as the railhead of the Wairarapa Line, which lasted only until the opening of the line as far as Featherston on 16 October 1878, after which it was of minor significance. Initially, two daily mixed trains were timed to connect with road coaches from the Wairarapa. There was a limited amount of flat land available, so the station retained its original configuration of the main line plus one crossing loop throughout its life. There was also a locomotive siding to the south of the station until the practice of changing locomotives ceased, at which time the siding was lifted.

The refreshment rooms were extended in 1896, and, except for the addition of the signal box in 1902, the station buildings remained the same until the refreshment rooms were closed about 1952.

In 1883 the station handled 759 outbound passengers, a level of patronage that remained steady for many years. Traffic increased steadily right from the start, with average goods tonnage at around the same time of 457 tons inward and 1,978 outward. The growth in business led to the introduction of a third mixed train a month after the station opened.

The Working Timetable of 1887 lists Kaitoke as one of the first stations on the section to receive signals. Instructions for crossing trains required down (southbound) trains to take the siding or loop and up (northbound) trains to take the main line.

Soon after the installation of the first full mechanical interlocking system at Lambton Station in Wellington, a smaller system was installed at Kaitoke. A signal box was built at the south end of the platform, and two arm bracket signals for both "home" and "starting" were provided for trains travelling in both directions. Later, up and down "distant" signals were added. Balanced arm semaphore signals replaced the earlier slotted-post design.

With the completion of the Rimutaka Deviation, Kaitoke station was closed on 30 October 1955 along with the rest of the old line over the Rimutaka Ranges, followed by the opening of the new line on 3 November.

## Today

Station Drive, the access road to the former station off State Highway 2, still exists and provides access to several private dwellings that have been constructed on the terrace that was cut into the hillside to form the station yard. The terrace can easily be seen from the old State Highway where it intersects with the new State Highway, and there is public access up to the south end of the former station yard via the old railway line, a public walking/cycling track between Kaitoke and Mangaroa.

## Future

The 'Rimutaka Incline Railway', the project of the Rimutaka Incline Railway Heritage Trust, aims to re-establish a railway line on the former Wairarapa Line formation between Maymorn and Featherston. This includes new track past Kaitoke, utilising an easement created by Transit New Zealand when they built the State Highway 2 deviation through Kaitoke. The trust does not propose to acquire former railway formation now in private ownership at Kaitoke, or establish a new station at or near the original Kaitoke Station for its own operations.