Cognitive Behavioral Therapy

by

A. Antonio González-Prendes

Introduction

Cognitive-behavioral therapy (CBT) encompasses various psychotherapeutic approaches that are rooted in the fundamental principle that a person’s thinking is the prime determinant of emotional and behavioral responses to life situations. The historical influences of CBT can be found in behavioral approaches such as John Watson’s classical conditioning and B. F. Skinner’s operant conditioning, with their focus on antecedents and reinforcers of behavior and an empirical approach to evaluating behavior, and Albert Bandura’s social learning theory and social cognitive theory, with a focus on observational or vicarious learning. Other influences that shaped the philosophical foundations of CBT include Greek and Roman Stoicism and the Eastern philosophies of Buddhism and Taoism, with their emphasis on reason, logic, and acceptance. Nonetheless, CBT as an organized system of psychotherapy, which originated during the 1950s and 1960s with the works of Albert Ellis’s rational-emotive behavior therapy (REBT) and Aaron Beck’s cognitive therapy (CT). Both of these models stress that cognitions, in the form of judgments, meanings, attributions, and assumptions tied to life events, are the primary factors that influence how individuals respond to environmental cues. The CBT emphasis on internal, private, conscious thought represents a departure from psychoanalytic theory, which emphasizes unconscious motivation of behavior, as well as from behaviorism, with its focus on external observable and measurable behaviors. Although there are differences among the various cognitive-behavioral approaches, there are fundamental similarities that include a focus on conscious thinking; the importance laid on information processing and the role that cognitions play in how we process information from our environment and respond to situations; and the assumption that, by changing irrational or maladaptive thoughts in a more rational, logical, realistic, and balanced perspective, people are capable of increasing healthy functioning. CBT is a present-oriented, relatively brief, structured, problem-focused, empirically driven form of psychotherapy. In CBT both the clinician and the client take an active approach in addressing the client’s problem. In a nutshell, the therapeutic work revolves around identifying maladaptive thinking; assessing the validity and functionality of such thoughts by evaluating available evidence for or against the thoughts; and formulating a more rational, logical, realistic, and balanced approach to interpreting one’s reality. In the late 20th and early 21st centuries various models of CBT have been applied to a wide range of mental health problems, substance abuse issues, and other disorders. More importantly, CBT has generated voluminous research studies, making it one of the most empirically based systems of psychotherapy.

Introductory Works

Any discussion of CBT should acknowledge the influence of works by Albert Ellis (Ellis 1994) and Aaron T. Beck (Beck 1979) that established the philosophical, theoretical, and practice foundations of this approach. Besides Beck’s cognitive therapy (CT) and Ellis’s rational-emotive behavior therapy (REBT), other popular therapeutic approaches under the CBT umbrella include Donald H. Meichenbaum’s stress inoculation training (SIT) (Meichenbaum 1985), problem-solving therapy (PST) (D’Zurilla and Nezu 2007), Marsha M. Linehan’s dialectical behavior therapy (DBT) (Dimeff and Koerner 2007), and acceptance and commitment therapy (ACT) (Hayes, et al. 2006). SIT helps individuals develop skills to inoculate themselves against the effects of anxiety and trauma and against future stressors. Skills such as using self-instructions to cope with stress, relaxation strategies, behavioral rehearsals, and in vivo exposure are part of the SIT approach. PST focuses on training individuals in the effective use of problem-solving skills to increase healthy coping and adaptation to life challenges. DBT and ACT are part of the “third wave” of behavioral therapies that emphasize the role of mindfulness and acceptance in the healing process. Kazantzis, et al. 2010 provides an overview of various CBT models in clinical practice. Freeman 2005 examines key aspects of CBT, with contributions from noted experts in the field.

• Beck, Aaron T. 1979. Cognitive therapy and the emotional disorders. New York: Meridian.

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  This book elucidates the principles of Beck’s CT approach, underscoring the relationship between cognitions and emotions and discussing the cognitive content of various emotional disorders. It also presents techniques of CT with a special chapter on the cognitive therapy of depression.

• Dimeff, Linda A., and Kelly Koerner, eds. 2007. Dialectical behavior therapy in clinical practice: Applications across disorders and settings. New York: Guilford.

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  An overview of Linehan’s DBT that examines its practical application across various scenarios (e.g., outpatient, inpatient, residential, assertive community treatments, individuals, and families) and with various disorders (e.g., eating disorders, substance abuse, depression). Presents specific tools and strategies to help the practitioner enhance DBT skills.

• D’Zurilla, Thomas J., and Arthur M. Nezu. 2007. Problem-solving therapy: A positive approach to clinical intervention. 3d ed. New York: Springer.

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  The authors discuss the five-dimensional ADAPT model for problem solving (i.e., Attitude, Defining the problem, Alternatives, Predict outcomes, and Try out). This practical resource discusses the theoretical foundation of the model, its application to various psychopathologies and medical concerns, clinicians’ tools, case samples, and the empirical basis and support of the model.

• Ellis, Albert. 1994. Reason and emotion in psychotherapy: A comprehensive method of treating human disturbances. Rev. ed. New York: Citadel.

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  An updated version of the seminal work by the founder of REBT that describes the principles and practice of REBT. Includes key philosophical assumptions of the theory, application of REBT to various issues (e.g., marital problems, schizophrenia, and psychopathy), and objections to and limitations of the psychotherapy.

• Freeman, Arthur, ed. 2005. Encyclopedia of cognitive behavior therapy. New York: Plenum.

  DOI: 10.1007/b99240E-mail Citation »

  A comprehensive, inclusive, and multidisciplinary volume that serves as an educational and reference source for practitioners, educators, and students. Includes discussions of common psychological disorders, specific components of CBT treatment, different models of CBT, CBT with specific populations, and CBT approaches with emerging problems (e.g., Internet addiction, pain).

• Hayes, Steven C., Jason B. Luoma, Frank W. Bond, Akihiko Masuda, and Jason Lillis. 2006. Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy 44.1: 1–25.

  DOI: 10.1016/j.brat.2005.06.006E-mail Citation »

  This journal article offers an introductory overview of ACT for students and practitioners. The authors discuss the philosophical and theoretical background, theory of psychopathology, core processes of ACT, and a detailed examination of research associated with ACT. Available online for purchase or by subscription.

• Kazantzis, Nikolaos, Mark A. Reinecke, and Arthur Freeman, eds. 2010. Cognitive and behavioral theories in clinical practice. New York: Guilford.

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  Presents ten models of CBT used in clinical practice. For each model there is an introduction and historical background; philosophical and theoretical underpinnings; empirical evidence; the application to clinical practice with case illustrations; and summary and conclusions addressing in some cases future directions, challenges, and limitations of the model.

• Meichenbaum, Donald H. 1985. Stress inoculation training. New York: Pergamon.

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  Provides an overview of the theory and practice of SIT, including a description of the three-stage process of SIT: (1) development of therapeutic collaboration and problem conceptualization, (2) cognitive and behavioral skills acquisition and rehearsal, and (3) application of skills to specific problems.