Cognitive-Behavioral Therapy
- LAST REVIEWED: 27 June 2018
- LAST MODIFIED: 27 June 2018
- DOI: 10.1093/obo/9780195389678-0149
- LAST REVIEWED: 27 June 2018
- LAST MODIFIED: 27 June 2018
- DOI: 10.1093/obo/9780195389678-0149
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 the behavioral approaches: 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; Albert Bandura’s social-learning theory and social-cognitive theory, with a focus on observational or vicarious learning; and George Kelly’s personal-constructs theory. 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, acceptance, and mindfulness. CBT as an organized system of psychotherapy began to emerge in the 1950s and 1960s with the works of Albert Ellis’s rational-emotive behavior therapy (REBT) and Aaron Beck’s cognitive therapy (CT). Both 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 represented 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. The various cognitive-behavioral approaches share a number of 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 continues to generate voluminous research studies, articles, and books, discussing its application across various disorders and with diverse populations, making it one of the most empirically based systems of psychotherapy. Although an all-inclusive review of CBT-related works is not possible here, we have selected works that will either help the readers get a better understanding and insight into various aspects of CBT or pique their curiosity to seek additional information on their own. For this purpose, we have included newer material along with older works that we consider to be important in the context of the history and evolution of CBT and that have become essential readings for those interested in CBT.
Introductory Works
In this section, we have chosen to include works that either give the reader a broad perspective of CBT or focus in more detail on specific models that fall under the CBT umbrella. Any discussion of CBT needs to begin with an acknowledgment of the influence of Albert Ellis’s rational-emotive behavior therapy (REBT) (Ellis 1994) and Aaron T. Beck’s cognitive therapy (CT) (Beck 1979), which established the theoretical and practice foundations of this approach. In DiGiuseppe, et al. 2013, the authors offer an updated view of the theory and practice of REBT that is a useful resource for beginning and seasoned practitioners. Throughout the years, other influential approaches have expanded and broadened the CBT umbrella, including Donald H. Meichenbaum’s cognitive-behavior modification (Meichenbaum 1977), problem-solving therapy (PST) (D’Zurilla and Nezu 2007), acceptance and commitment therapy (ACT) (Hayes, et al. 2012), and mindfulness-based cognitive therapy (MBCT) (Segal, et al. 2013). Linehan 1993 offers a detailed discussion of dialectical behavior therapy (DBT) for the treatment of borderline personality disorders. Meichenbaum’s approach focuses on helping individuals inoculate themselves against the effects of anxiety and trauma and against future stressors through the use of skills such as self-instructions, relaxation strategies, behavioral rehearsals, and in vivo exposure, among others. PST focuses on training individuals in the effective use of a systematic approach to problem solving in order to increase healthful coping and adaptation to life challenges. Approaches such as DBT, ACT, and MBCT emphasize the role of mindfulness and acceptance in the healing process. Kazantzis, et al. 2010 provides an excellent overview that discusses these and other CBT models for clinical practice.
Beck, Aaron T. 1979. Cognitive therapy and the emotional disorders. New York: Meridian.
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.
DiGiuseppe, Raymond A., Kristene A. Doyle, Windy Dryden, and Wouter Backx. 2013. A practitioner’s guide to rational emotive behavior therapy. 3d ed. New York: Oxford Univ. Press.
DOI: 10.1093/med:psych/9780199743049.001.0001
An excellent resource with numerous case samples for clinicians who might want to learn about REBT or enhance their already existing skills. The narrative is divided into five sections that take the reader through the philosophy and theory of REBT, assessment strategies and the A-B-C model, therapeutic strategies and disputation and challenge of irrational beliefs, and the effective use of homework assignments. It could be used as a textbook for students.
D’Zurilla, Thomas J., and Arthur M. Nezu. 2007. Problem-solving therapy: A positive approach to clinical intervention. 3d ed. New York: Springer.
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.
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.
Hayes, Steven C., Kirk D. Strosahl, and Kelly G. Wilson. 2012. Acceptance and commitment therapy: The process and practice of mindful change. 2d ed. New York: Guilford.
ACT is clearly presented, including sections on the foundations of the model, with a discussion on functional contextualism and core clinical processes as well as sample dialogues and exercise, providing the reader with a clear and insightful perspective of ACT. Discussion of the research supporting ACT is also included.
Kazantzis, Nikolaos, Mark A. Reinecke, and Arthur Freeman, eds. 2010. Cognitive and behavioral theories in clinical practice. New York: Guilford.
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.
Linehan, Marsha M. 1993. Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford.
Offers a comprehensive discussion of the DBT model and its application to the treatment of borderline personality disorder. Includes a discussion of the theoretical foundation of DBT, behavioral targets and the structure of treatment around target behaviors, and specific treatment and case management strategies.
Meichenbaum, Donald H. 1977. Cognitive-behavior modification: An integrative approach. Plenum Behavior Therapy. New York: Plenum.
DOI: 10.1007/978-1-4757-9739-8
In this book Meichenbaum focuses on the role of self-instruction in problem solving and the relationship among speech, thought, and behavior. Self-instructional and stress-inoculation models are presented, with a focus on cognitive-restructuring techniques and the three-stage stress inoculation training (SIT) model: (1) educational phase, (2) rehearsal phase, and (3) application training.
Segal, Zindel V., J. Mark G. Williams, and John D. Teasdale. 2013. Mindfulness-based cognitive therapy for depression. 2d ed. New York: Guilford.
The authors provide a step-by-step approach to MBCT, with a detailed eight-session model that guides the clinician in the application of the model to treat depression. In addition, the authors include discussion on the increased interest, effectiveness, and advancements in MBCT since the publication of the original book in 2001.
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