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History of Cognitive Behavioral Therapy (CBT)
INTRODUCTION
In its simplest form, Cognitive Behavioral Therapy (CBT) refers to the utilization of accuracy and understanding of ones thoughts to intentionally and purposefully influence the reactions of their behavior (Benjamin et al.180). It is the process of altering dysfunctional thoughts and behaviors to healthy and realistic behavior. This kind of treatment is usually goal oriented and can be accomplished within three to six months. Cognitive behavioral therapy can be thought of as a combination of behavioral therapy and psychotherapy. Psychotherapy concentrates on personal understanding of thoughts believed to develop from childhood whereas behavioral therapy puts emphasis on the relationship between personal problems and thoughts (Benjamin 180). Also, CBT focuses on cognitive process that trigger the reaction of feelings. Through the process, chances are a patient will gain a deeper understanding of their thoughts, a different image towards certain beliefs and attitudes and eventually help in changing the behavior associated with them (Benjamin 180). Hence, this kind of therapy is usually customized to suit every patient with regard to their personalities. The history and evolution of CBT is the main aim of this paper.
Cognitive Behavioral Therapy can be seen as umbrella term for other kind of therapies such as Rational Behavior Therapy (RBT), Cognitive Therapy (CT) and Rational Emotive Behavioral Therapy (REBT). All of those are aimed at correcting dysfunctional and maladaptive reactions of a patient. Generally, human beings have attitudes and behaviors developed from their neural pathways of childhood which become their automatic thoughts and beliefs. However, the daily life of a person involves different situations and occurrences where some of them may induce negative thoughts to someone. Cognitive behavioral therapy allows patients to have a deeper and clear understanding of the errors, mistakes or distortions that may be associated with the different types of thoughts (Miller). Therefore, the procedures of this therapy will help a patient to correct the misinterpretation of certain beliefs or thoughts that may have caused the disruption of their normal life.
THE HISTORY OF COGNITIVE BEHAVIRAL THERAPY
The human desire to understand the world we live in has been in existence since the beginning of time. According to Barker, unexamined life was not worth living which gave further credence to the beginning of cognition and behavior (qtd.in Miller). What is currently known as cognitive behavioral theory can be traced back to as early as 1913 from development of psychology. The foundation was laid by a behaviorist named John B. Watson. Behaviorism is a theory of learning on the basis that any kind of behavior of human beings is acquired through conditioning (qtd.in Miller). According to Watson, this conditioning occurs when people interact with their environment to shape their actions (qtd.in Miller). BF Skinner was also a theorist who had significant foundational influence over the advancement of cognitive behavioral therapy.
In the 1950s, Albert Ellis practiced Rational Emotive Therapy whose main goal was to help patients to recognize and identify their irrational thoughts. The therapy was then thought to give the patients more rational thoughts or to have a better view the world they live in. Albert’s model thought that a patient would shift to more rational thoughts or beliefs after being challenged and encouraged identify their irrational thoughts. Later in 1960, Dr. Aaron Beck decided to carry out some experiments to test some concepts regarding psychoanalytic at the University of Pennsylvania. His experiments resulted to some surprising outcomes as he found out that in every depressed patient, there existed some consistent instances of rational beliefs and thoughts that happened to emanate spontaneously. He went further and categorized those irrational thoughts and beliefs into three categories. According to Albert, the patients were having negative thoughts and ideas about themselves, the future and the world (Miller).
The findings led to an alternative ways of viewing problems related to depression. Also, the theory of irrational thinking by Albert and the theory of cognitive distortions by Beck aided in explaining and understanding of psychological disorders. Beck explained that the problems associated with depression were also attached to the development of maladaptive processes of childhood (Miller). Albert’s theory evolved around a set of defined negative thoughts and beliefs also referred to as irrational assumptions (Miller).
Using Beck’s approach, patients who went through this therapy found themselves re-evaluating their thoughts and assumptions. By so doing, he discovered that the patients reported a better resilience for dealing with their challenges on daily life. The patients also found out that the treatment was offering a long-term solution to their challenges. Since the introduction of this therapy, its efficacy has been re-examined in various meta-analysis. As a result, it has evolved into a viable therapy modality for a number of mental health problems. Furthermore, some therapists have specialized in this therapeutic way of treatment to their patients.
Through trial and error and the advancement of areas related to behavioral therapy, the practice of cognitive behavioral therapy had no option but to gain more popularity. The practice mainly occurred and grew during the mid-1970s while being used for therapy of higher functioning patients. As people gained better understanding of their emotions and self-control, the transition to the practice of cognitive behavioral therapy was also being embraced by majority. Eventually, the practice of cognitive behavioral theory grew much stronger. As a result, it attracted more developments and expansion in its field. The Tripartite Model, for example, was among the advancement that emerged. This model emphasized that there existed a significant overlap in the negative automatic beliefs presented by a patient with his/her anxieties.
Also, the work of Cognitive Behavioral Therapy has been extended by Barlow in his triple vulnerability model of emotional disorders (Craske 80). The model concentrates on the children’s perception of control and understanding over their surroundings. Parents play a crucial role in this model and hence are trained to help their children to have a better understanding and role in their environments. The wisdom and knowledge of cognitive behavioral therapy and its application is displayed throughout psychology and the efficacy of treatment is as far-reaching as in children and adolescents. Cognitive behavioral therapy aids children to understand the environment and master their functions in it.
Today, Cognitive Behavioral Theory is the most practically accepted and empirically validated as well as wide-ranging therapeutic treatment available. More notably, it is recommended to effectively handle a different problems related to psychology such as anxiety and depression. Also, it is effective in solving substance abuse related problems, personality challenges as well as post-traumatic stress disorder.
FOUNDERS AND PIONEERS OF CBT
The history of development evolution of CBT cannot be complete without discussing its founders and pioneers. To start with, Dr. Albert Ellis was among the very crucial pioneers back in 1950s. His work on irrational thinking played a foundational role in the development and advancement of Cognitive Behavioral Theory. Also, his ABC technique of irrational beliefs played another significant role in the development which is still used in CBT up to date. The model consisted of three steps of analyzing whether has developed irrational beliefs and the outcome could also be recorded on a three-column table.
Table 1
The ABC model of irrational beliefs
A ACTIVATING EVENT
B BELIEF
C CONSEQUENCES
Source: Ellis, Albert. (2014) “Expanding the ABCs of RET.” Journal of Rational Emotive Therapy.
Ellis had a strong belief that the unrealistic interpretation of events was responsible irrational behavioral consequences contrary to the said activating events.
Table 2
The ABC of irrational beliefs
Negative Event (A) Negative Event (A)
Rational Belief (B) Rational Belief (B)
Healthy Negative Emotion (C) Healthy Negative Emotion (C)
Source: McLeod, S. A. (2019, Jan 11). Cognitive behavioral therapy. Simply psychology:
The work of Arnold Lazarus and Joseph Wolpe back in 1960s cannot be overlooked while looking at the evolution of Cognitive Behavioral theory. They play a significant as well as foundational role in their work in behavior therapy techniques to minimize the neuroses. They developed the theory of systematic desensitization. The theory is type of behavioral therapy which evolves around the principle of classical conditioning. The main goal of this theory was to eliminate fear as reaction of phobia and instead substitute it with a response of relaxation (Craske 80). If for example, a snake phobic client is repeatedly confronted with various situations involving a spider, the client would gradually and eventually get used to the situation.
Table 3
Systematic desensitization
BEHAVIOUR FEAR RATING
Imagine of a snake 5
Look at picture of a snake 15
Look at a snake inside a closed container 40
Hold the box with the snake 55
Let a snake slither on your table 65
Let a snake slither on your shoe 70
Let a snake slither on your pants leg 80
Let a snake slither on your sleeve 90
Let a snake slither on your sleeveless arm 100
Source: Researcher 2020
If the client’s fear is no longer evoked by either of the situations, it means the therapy was successful and vice versa. This theory has led to the development of a variety of techniques being used in cognitive behavioral therapy up to date.
Dr. Judith Beck as well had a significant impact on the cognitive behavioral theory. She was inspired by the work of her father, the founder of cognitive behavioral theory. She worked on the area of copping and mechanisms for change. Her research is attributed to have a progressive impact on the direction of science more specifically on therapy.
The founding father of cognitive behavioral therapy was Dr. Aaron Beck. He had a groundbreaking and radical approach towards psychology as he began as a clinician back in 1960s (Miller). His approach has been prove by scientific approaches time and again as well as the efficacy of his theories which have had great impact as far as psychology is concerned (Miller).
A CLOSER LOOK AT THE FOUNDIND FATHER OF CBT
Dr. Aaron Beck is also known as to as the father of CBT who was also said to be among the top five most influential psychotherapists in the world. He shaped the history of psychiatry in America. He has authored and co-authored twenty five books and also published more than six hundred articles. These resources are used in developing various scales for quantifying depression up to date (Miller).
The work of Dr. Beck on Cognitive Behavioral theory was influenced by the work of other psychologists like The Cognitive Constructs by George Kelly, the theory of schemas developed Fredric Bartlett and the theory of cognitive development by Jean Piaget. These vocabularies had very significant impact on the initial work of Aaron Beck. Also, being a clinician or rather a clinical psychologist (Miller), he had the ideal chance to note what was going on around his patients. He noticed a remission symptoms in his patients and with the realization came the understanding that his patients were presenting repetitive stories about activating events. Later, he labelled them as automatic negative beliefs and thoughts.
As Dr. Beck continued working with depressed patients, he came up with the Negative Cognitive Triad. This triad consisted of three kinds of dysfunctional thinking or beliefs that many patients of depression were going through. According to Beck, most peoples who suffered from depression had their thoughts dominated by, “I am defective and inadequate”, “and All of my experiences result in defeat and failure” and “the future is hopeless” (qtd.in Miller)).
From the findings of his experiences at work, Dr. Beck learnt that the close relationship with his patients was very important. He believed that developing a relationship and trust with patient would allow for necessary exploration of a patient’s negative thoughts and briefs since the mere acceptance and admission of these beliefs was sometimes unsettling (Miller). According to Beck, a significant number of patient’s self-reported improvement could be attributed from reframing the patient’s thoughts and beliefs (qtd.in Miller)).
Finally, Dr. Beck collaborated with his daughter Dr. Judith Beck to set up The Beck Institute for Cognitive Behavior Therapy. The institute was purposefully founded to further the investigations of his radical and groundbreaking theory (History of CBT). Also, he had the agenda of helping people suffering from depression and psychological problems.
KEY PRINCIPLES AND DISTORTIONS RELATED WITH THE HISTORY OF CBT
Talking of CBT, the concepts and principles of its approach as well as the various distortions solved via CBT cannot be ignored. The main key principle when administering cognitive behavioral therapy is patient’s active participation. Cognitive behavioral therapy is usually structured into sessions whose focus is on the client’s understanding his/her role of cognition in correcting behavioral dysfunctions (Craske 80). The understanding is vital and paramount to the success of the therapy. In the process, the relationship between the client and the therapist grows and deepens which is also am important principle during therapy.
Also, since the practice of cognitive behavioral therapy is time limited, it extends it functions outside the office which is crucial to the success of the therapy. More emphasis is put on adaptive thinking purposefully in prevention of a relapse. During this period, a patient is taught various techniques on how to change and adapt to positive thinking, as well as good understanding on their behavior since they are simple skills which would be of use in their future (Miller).
Psychological problems are believed to come from use of cognitive distortions. According to the findings of Aaron Beck, rectifying these distortions enhances the ability of a patient to develop skills that would give a better experience of life events (Miller). As a result, there are higher chances for a successful therapy. Some of the cognitive distortions highlighted by Beck while developing cognitive behavioral theory include;
Emotional reasoning. Emotional reasoning refers to the distortions where a patient perceives a given feeling as a fact (Miller).
Fallacy of change. Fallacy of change is a distortion that occurs when one thinks that other people will change to suit ones expectations (Miller). For instance, one partner in a relationship may feel that if the significant other improved his cheating habit, he/she would be happier.
Overgeneralization. This kind of cognitive distortion occurs when someone draws negative conclusions based on minor insignificant event (Miller). For instance, telling yourself that you cannot drive a car just because you failed to ride a bicycle.
Catastrophizing. When someone always assumes that bad things will happen even after a minor errors, the person may be associated with the cognitive distortion of catastrophizing (Miller). An example would be when a person believes that he/she will be fired after arriving late at work for one day.
Filtering. Filtering refers to selective focus on a single aspect while ignoring others as an impetus to ruin your moods or other important activities (Miller). Filtering consists of both magnification and minimization of an event. Regarding the magnification of an event, one can exaggerate the significance of an undesirable occurrence to be the cause of his/her negative belief. For instance, allowing other people to queue in front of you as an impetus to ruin your day. If a person minimizes an event, it means he/she is underpaying the importance of that event. For example, an employee is praised for good work but sees it as trivial.
COMMON THERAPY TECHNIQUES IN THE HISTORY OF CBT
Cognitive behavioral therapy has a history of using various techniques to achieve a successive therapy administration to the patient. Some of the techniques can carried out with or without the presence of a therapist. Also, utilizing these techniques is an effective way to deal with psychological problems on real life situations. Some of the common techniques include;
Journaling for the understanding of cognitive distortions. Someone with good understanding with a good understanding of these distortions stands a better chance to better understand their personal cognition. Also, a person would be able to compare and contrast as well as keep track of their automatic thoughts. As a result, he/she would be able to detect and analyze the presence of any distortion. Due to the better understanding, an individual can use the knowledge to reevaluate his/her automatic thoughts with evidence. Cognitive behavioral therapy has a good history of helping people with difficulties to unravel their distortions (Miller).
As mentioned earlier, cognitive behavioral therapy has a history of utilizing the ABC technique which was developed by Albert Ellis. Ellis had a strong belief that the unrealistic interpretation of events was responsible for the irrational behavioral consequences contrary to the said activating events (McLeod). Hence, helping a patient to have a different positive interpretation of their negative thoughts and beliefs would go a long way to impact an alternative behavior.
Recently, cognitive behavioral theory has been utilizing a popular technique called Acceptance and commitment Therapy. Contrary to the traditional Cognitive Behavioral Therapy, this technique focuses on teaching patients to just notice accept and embrace the feelings and thoughts around the activating event (Miller). As a result, this approach would help the patient to free from the grip the events.
In summation and accumulation of the damning mountain of information, it is clear that the rate of psychological disorders is quite high. This calls for people to master the art of cognitive behavioral therapy which could in examination of various cognitive distortions to impact on reducing any possible stigma caused by the mental health problems.
Work Cited
Benjamin, Courtney L., et al. “History of cognitive-behavioral therapy in youth.” Child and Adolescent Psychiatric Clinics 20.2 (2011): 179-189.
Craske, M. G. (2014). Cognitive-behavioral therapy. In G. R. VandenBos, E. Meidenbauer, & J. Frank-McNeil (Eds.), Psychotherapy theories and techniques: A reader (p. 79–86). American Psychological Association. https://doi.org/10.1037/14295-009
History of Cognitive Behavior Therapy – CBT: Beck Institute. Beck Institute for Cognitive Behavior Therapy, beckinstitute.org/about-beck/team/our-history/history-of-cognitive-therapy/.
Ellis, Albert. “Expanding the ABCs of RET.” Journal of Rational Emotive Therapy 2.2 (2014): 20-24.
Miller, Kelly. “CBT Explained: An Overview and Summary of CBT (Incl. History).” PositivePsychology.com, 12 Feb. 2020, positivepsychology.com/cbt/.
