The cognitive-behavioural theory is commonly viewed as an effective short intervention therapy for Psychotherapists and those in the Counselling field. This essay will explore the history and logical thinking leading up to the development of the theory and the theory itself in detail. It will include a biography of the founders and identify significant people of influence during its development. Furthermore, it will explore applications and techniques associated with it, in its modern form, (expressed by one expert as the “Third Wave”), (Foreman-Pollard 2011) and provide a brief review of its perceived effectiveness as well as my personal view of the theory based on my research.
Known as CBT, it is often described as a combined approach utilising the psychologies of both cognitive as well as behavioural therapeutic models. The underlying root principle that behaviours and feelings are because of thoughts. The approach primarily builds a portfolio of prioritised concerns with a client, highlighting the thoughts and feelings that are behind perceived issues, then develops a plan of goals and changes to assist them not only in their behaviour but in shaping their future thinking.
Cognitive Behavioural Theory seemingly grew out of an exercise to fulfil not only the changing needs in the field of psychology itself but from pressure on professional theorists and practitioners alike. It’s original formation, building on REBT or Rational Emotive Behavioural Therapy, (Drydan, Neenan 2004), and CT, Cognitive Therapy, (Beck, Clark 2010) progressed to CBT, to reconcile the ever-evolving development of cognitive and behavioural approaches in the therapeutic community, and create a zeitgeist; an agreed theoretical and inclusive behavioural and cognitive model.
Such was the state in the 1960’s and 70’s of a changing industry, in what Dr Keith Dobson, Professor of Clinical Psychology at the University of Calgary, referred to as the “cognitive revolution”. He states, “Taken together, the two research areas of general cognitive psychology and what may be termed “applied cognitive psychology” challenged behavioural theorists to account for accumulating data. In essence, the challenge amounted to a need for behavioural models to redefine their limits and incorporate cognitive phenomena into the models of behavioural mechanisms.” (Dobson, 2010)
Although a maturing theory in its beliefs and practices in the last 70 years, directly related to specific ideas by Dr Albert Ellis and Dr Aaron Beck, there are a number of contributors to the ongoing advancement of the development of therapeutic applications, many of whom directly influence the modern views of CBT and how it can be used with a plethora of conditions with clients, as demonstrated by the sheer volume of literature available using CBT for a particular targeted group of people ranging from schizophrenia to dementia. However, I would be remiss not to acknowledge the historical significance of the “grandfathers of both cognitive and behavioural theories, notably Ivan Pavlov, John Watson, Edward Thorndike, and B. F. Skinner, each contributing great insight and information to the human condition”. (SEP, 2015)
For the purposes of this essay, however, we will focus entirely on two of the most recognisable contributors. Albert Ellis, who is considered the founder of behavioural therapy, and his collaboration with the cognitive theorist, Aaron Beck.
Aaron T. Beck, M.D.
Dr Aaron Beck’s range of research, first as the Assistant Chief of Neuropsychiatry in Philadelphia, in the Department of Psychiatry, at Penn Behavioural Health, and subsequently at the University of Pennsylvania’s Psychiatry Department lent itself to the crux of his work in psychoanalysis. (Franks, 2015). From his work with people and depression in those roles, he developed the present day cognitive therapy and subsequently opened the Beck Institute for Cognitive Behavioural Therapy. (Weishaar, 1993). The most significant understanding from the numerous trials and research with Dr Beck was his experimentation with depressed people and his discovery of negative thought patterns he coined – ‘automatic thoughts’. (Beck, J., 2011) These thoughts incorporated a three-prong focus; the client, the world and the future. How these thoughts affected a client’s life is usually how they were lead to a diagnosis. These thoughts are integral to a person’s core belief systems and fundamental to a client’s existence. (Beck, 1997)
Albert Ellis, PhD.
In the 1950’s, Dr Albert Ellis introduced REBT after spending several years practising psychoanalysis. He started his career as the Chief Psychologist of the New Jersey State Diagnostic Centre, the Chief Psychologist of the New Jersey State Department of Institutions and Agencies and was a psychological consultant to several organizations including the Veterans Administration and the New York City Department of Education. He was the founder and Executive Director of the Albert Ellis Institute. He created the ABC model, which was later modified into A-B-C-D-E and developed Rational Emotive Behaviour Therapy. He was seen as a controversial yet brilliant figure and an extensive and prolific writer on the development and efficacy of the subject. (Bernard, 2011)
CBT is the consolidation of how negative thoughts influence our emotions and behaviours. Once aware, a client learns to deal with these thoughts in a way that doesn’t adversely affect their lives. “CBT is based on a model or theory that it’s not events themselves that upset us, but the meanings we give them” (Martin, 2007). As previously mentioned, these ‘automatic thoughts’ obstruct new thoughts, ideas and growth, as they are rooted in thinking that stems from belief systems from childhood.
Cognitive Behavioural Process
CBT views a client’s negative reaction to triggers as learned behaviour because of an experience stemming from the last encounter with that same stimuli. Ostensibly something negative happens and the client’s thoughts around that repeat itself. CBT attempts to change that negative response by demonstrating that the response to that exact stimuli does not have to be the same, nor does it have to be negative. Using what Pavlov referred to as “operant conditioning” (Whitfield, Davidson 2007) clients are inclined to act or behave more positively if the response to the stimuli over time becomes positive. Therefore, the behaviour can be changed to positive behaviour and over time they are less likely to experience the negativity once associated with that event.
Rational-Emotive Behaviour Therapy (REBT)
The most recognisable form of behavioural therapy, founded in the 1950s by Albert Ellis, was Rational Emotive Behavioural Therapy (REBT). REBT focuses on the “client’s current, irrational thoughts and actively targets them for change” (Fraum, 2012). Through REBT a client confronts their beliefs and working with the therapist devises a plan for more realistic and positive thinking.
Dialectical Behaviour Therapy
Another form of behavioural therapy that is more in line with cognitive-behavioural therapy is Dialectical Behaviour Therapy. Philosophically, it brings opposing views together through a client’s relationship with their therapist to find an acceptable path forward. Thoughts are validated and a client is directed to a process of change.
Linking Cognitive Therapy to Behavioural Therapy
CBT is a collaborative effort between client and therapist. Although in many ways robust it is viewed as effective in short-term treatment plans. Most of the growth is up to the client to do between sessions, developing new skills and coping mechanisms. CBT doesn’t delve into why a client feels the way they do but is very focused on the present behaviour and the future of change.
CBT is highly structured and usually takes place weekly for only a few months or a year. Once issues are identified and prioritised a plan for change is developed and implemented. Throughout the process, homework is assigned to help the client identify triggers for their anxiety or problems and the feelings that surround those events. As the process moves forward the assignments will coincide with whatever step the client is currently working on.
Ostensibly there are dozens of techniques used by therapists. Each having elements of cognitive, emotive, and behavioural underpinnings and each being adequate for bespoke therapy for each client. The ABC, also known as the ABCDE Technique developed by Dr Ellis, is closely associated with the REBT techniques which include cognitive reconstruction, exposure, reframing, and journal writing and controversially, self-disclosure.
ABC/ABCDE Technique or Rational Self-Analysis
The ABC/ABCDE approach distinguishes why clients act a certain way to Activating Events. This Activating Event is known as A, often referred to as a “trigger” but typically the Antecedent. The client’s emotions and behaviours associated with A, for example, depression is what is called Consequences” or C. Beliefs or B is the system of thoughts and thought process. While the A triggers the C, the B is what causes C.
Ellis was prolific in his attempts to perfect the technique and later introduced Disputing or D, New Effect or E, and Further Action, F as continuing elements of the technique. The premise being a client must identify the A, B, and C, only then can they move forward and challenge their Beliefs by Disputing. This leads them to evaluate what they want in terms of new behaviour or the New Effect, E. Finally, the client improves their behaviour by implementing a Further Action plan. (Eysenk, 2015)
Rational Self-Analysis is part of Cognitive Restructuring. Cognitive Restructuring uses the ABCDE model to help a client recognise, confront, and change their ‘distorted’ thoughts. Distorted thoughts are often pepped with negative words that are finite like always, must, and never, stemming from Ellis’s list of irrational beliefs combined with the cognitive distortions list by Dr Beck. (Dobson. 2009)
Exposure Therapy is most often used with clients with anxiety disorders. Sessions involve the client being exposed to triggers that cause anxiety. It’s a form of desensitisation, often used in conjunction with relaxation techniques.
Self-disclosure is controversial but entails a therapist telling a client something personal that may be effective in helping the client understand something significant. As a technique, it is viewed as risky with boundaries or it not achieving its original goal. This approach can swing the focus away from the client, therefore it can affect the relationship, or make it uncomfortable.
Critique of the approach
Cognitive Behavioural Therapy has no doubt shouldered a plethora of success cases in its history and for some the most effective. My research has included a few interesting cases to support this statement. (Taylor, 2006) There could arguably be a case made for using it exclusively in some environments and with clients with particular concerns, for example, those with chronic disabilities. However, I am of the belief there are several pitfalls if it is not combined, or at the very least integrated, with other therapies.
It focuses specifically on the client and their desire to change. Thus, it does not appear to consider the elements of family history, historical experiences or traumas that underpin why a client got to their present state. The focus on change means a client must be motivated to want to change, if they are not, the therapy itself could be wasted. It takes commitment and engagement with CBT to be effective.
It is also clear that the rigidity of in terms of techniques, and focus on thinking rather than emotional state or a client’s history leave a fundamental part of the client, “untouched” in my opinion.
My personal view
Initially, I was drawn to exploring this theory due to its popular nature and ostensibly modern approach to counselling. I was of the belief that it would likely be an integral part of a therapeutic toolkit of methodologies I would regularly use, as I went forward in my career. Considering the plethora of outlooks and techniques available for a client, it underpinned my belief that it was a customisable and client-driven approach that could be bespoke and therefore incorporate a targeted approach. What I now understand, through the process of researching this paper; however, is that CBT leaves little room to go deeper, and in my opinion, more meaningful work about the origins of a person’s issues and or thoughts. I have always been attracted to that aspect of one’s psychological makeup and initially, it was the reason I considered moving my career in the direction of Psychotherapy. However, I firmly believe that other therapeutic models may, in fact, be more cohesive with my own beliefs and likely would serve me better should I find myself working directly with clients in this capacity. This is not to say I don’t have a great deal of respect for the work cognitive-behavioural therapy can achieve. It would be difficult to predict if it would be something I would employ to any great degree considering the type of work I am most interested in.
Cognitive Behaviour Therapy is for all intents and purposes the “go to” therapy of a modern age for treating a multitude of client issues and including some illnesses and diseases. The range of application is quite extensive. This essay looked only at the most understood elements yet, there exists a great deal of literature delving into the theory in minute detail, which has spurred an interest for future research.
Having grasped the fundamentals, it is still unconvincing that it would work without an integrative approach to some of the more challenging elements of psychotherapy and client issues and one would benefit greatly to see and experience it with practised therapists to understand it with any degree of proficiency.