History
Cognitive behavioral therapy (CBT) is an approach to psychotherapy that involves solving problems dealing with dysfunctional behaviors, emotions and cognitions through a goal-oriented procedure (Lee & Edget, 2012). CBT is often criticized because it has somewhat of a cookie-cutter approach: if the client is experiencing this problem then use that technique (Kennerley, Kirk & Westbrook, 2016). CBT that clinicians use today has two main influences: behavior therapy which was developed in the 1950s and 1960s by Wolpe and others; and also cognitive therapy developed by A.T. Beck in the 1960s and 1970s (Kennerley, Kirk & Westbrook, 2016). Psychotherapy after the nineteenth century was mostly dominated by the Freudian psychodynamic until behavior therapy began to arise due to a lack of empirical evidence supporting Freud’s theory (Kennerley, Kirk & Westbrook, 2016). In the mid 1900s behavioral theories began to emerge with the work of Skinner (1953), Wolpe (1958), and Eysenck (1952) in which scientific developments derived from the laboratory and applied technologies (Herbert & Foreman, 2012). Behavioral therapy (BT) began to take a look into the processes and associations between observable events such as stimuli and responses (Kennerley, Kirk & Westbrook, 2016). BT did not focus on unconscious processes, hidden motivations and unobservable responses, instead it used the learning theories principle to modify unwanted behavior and emotional responses (Kennerley, Kirk & Westbrook, 2016). BT became rapidly successful in treatment for anxiety disorders such as phobias and obsessive-compulsive disorder (Kennerley, Kirk & Westbrook, 2016). However, there were limitations of a behavioral approach because mental processes such as thoughts, interpretations, and beliefs were being left out (Kennerley, Kirk & Westbrook, 2016). Behavioral therapists seemed to be underestimating the importance of thinking. The patient’s private world was not considered useful for treatment. Behaviorists did not take into consideration data and concepts that consisted of a man’s reflections on his own conscious experiences (Beck, 1979). Only behavior that could be physically observed by someone outside of self was used in forming explanations. The solution to this problem was the rich data that sit available in the person’s conscious ideas and ways of coping with psychological issues (Beck, 1979). The theory that eventually developed from looking into the thoughts behind the individual was cognitive therapy (CT). Psychological problems can often be accredited to processes such as faulty learning, making assumptions or inferences based off of incorrect or inadequate information (Beck, 1979). These psychological problems can often be mastered by correcting misconceptions and learning more adaptive attitudes. Essentially, introspection, insight, and learning are cognitive processes which is where cognitive therapy gets its basis (Beck, 1979). During the 1950s and 1960s, Aaron T. Beck, a psychiatrist and psychodynamic therapist, began to hone in on cognitive therapy (Kennerley, Kirk & Westbrook, 2016). In the 1970s, Beck began to find ways to merge both BT and CT because he felt as though there was more he could offer to clients other than a psychodynamic approach. Beck’s research with CT demonstrated that it could be just as effective in managing depression as anti-depressant medication (Kennerley, Kirk & Westbrook, 2016). As the 1970s approached, Beck’s ideas became more influential especially with the fusion of BT and CT. In the following years, BT and CT became more commonly used and ultimately became cognitive behavior therapy (Kennerley, Kirk & Westbrook, 2016).
View of Human Nature
Human beings are capable of experiencing a multitude of environmental events and have the ability to react adaptively (Beck, 1979). The emotional reactions and behaviors that humans express are strongly influenced by cognition. Cognition in this aspect can also be defined by thoughts, mental images, personal beliefs and interpretations that humans have about themselves (Kennerley, Kirk & Westbrook, 2016). Every human has a different reaction both cognitively and behaviorally when a stimulus is presented. These natural responses are part of our psychological development and a reflection of our maturity (Beck, 1979).
Theory of Illness
CBT acknowledges the fact that human beings all respond differently to stimuli. However, humans do not always respond consistently well to all problems and changes that occur (Beck, 1979). There are specific vulnerabilities that we possess which can accumulate stress and can set off a series of eruptions or often called overreactions (Beck, 1979). These excessive and often inappropriate emotional reactions point out the internal dramas that are created when humans experience challenges or problems. For example: a student who receives a lower grade than anticipated on a test may feel worthless and will consider himself a complete failure. Some people become so infatuated and overcome by these internal dramas and fantasies that it influences their behavior and emotion. When these reactions become excessive or go beyond a point in which is considered normal then it is likely that people will be labeled to have an emotional disorder, neurosis, or psychological disturbance (Beck, 1979). These labels can often be associated with depression, anxiety, or a paranoid state (Beck, 1979). Compared to some traditional medical perspectives, CBT sees mental health problems as occurring on a continuum rather than a whole different dimension altogether. CBT also does not see psychological problems as being extremely abnormal because it acknowledges that they can happen to anyone (Kennerley, Kirk & Westbrook, 2016).
Structure of Personality
CBT does not directly mention the structure of personality but it does believe that people have core beliefs. These core beliefs are a person’s fundamental beliefs about themselves, others, and the world in general (Kennerley, Kirk & Westbrook, 2016). They often are general and absolute statements or beliefs such as: “I am a good person” or “Other people cannot be trusted” and can apply in almost all situations. Core beliefs are often learned early on in a person’s life as a result of experiences during childhood and can sometimes be altered later in life (Kennerley, Kirk & Westbrook, 2016). Unlike automatic thoughts that a person might have, core beliefs are normally not accessible to consciousness which is why they often have to be inferred by observation of thoughts and behaviors (Kennerley, Kirk & Westbrook, 2016).
Major Constructs
CBT contains a few constructs that have mainly emerged from BT and CT. Cognitive therapy was mentioned earlier in the history section of this research paper but the cognitive principle is a core idea of CBT. The cognitive principle discusses how a person’s cognition (thoughts, mental imagery, core beliefs, and outlooks) affect emotional reactions and behavior (Kennerley, Kirk & Westbrook, 2016). These cognitions vary between individuals can drastically change emotional state depending on how each person reacts to a similar event (Kennerley, Kirk & Westbrook, 2016).
The behavioral principle has similar ideas from the cognitive principle but it also takes into account how behavior can have an impact on thought and emotion. The behavior that is expressed after an event occurs can influence if feelings of anxiety or depression persist. CBT believes that behavior can affect future events and responses (Kennerley, Kirk & Westbrook, 2016). This is why it is so important for clients to acknowledge that changing what they do is a powerful way to change thoughts and emotions (Kennerley, Kirk & Westbrook, 2016).
The here-and-now principle focuses on what is going on in the present rather than what has happened in the past. Traditional psychodynamic therapy tends to look more at the symptoms of an issue and the developmental processes behind that issue. Here-and-now principle allows for the client to view the processes that maintain those symptoms and to change them in the present moment (Kennerley, Kirk & Westbrook, 2016). This principle and CBT do not simply dismiss the past and the development of symptoms but instead focus on the processes behind those symptoms (Kennerley, Kirk & Westbrook, 2016).
Modern CBT will often make references to four internal systems between a person and their environment. The four internal systems include: cognition, affect, behavior, and physiology (Kennerley, Kirk & Westbrook, 2016). These four systems interact and respond to the given environment but give feedback to the individual. When these four systems are analyzed and broken down then it can be easier for a person to gain understanding and to maintain certain problems that are occurring (Kennerley, Kirk & Westbrook, 2016).
CBT focuses a great deal on cognition but there are different levels of cognition that deserve attention. These levels of cognition consist of automatic thoughts (AT s), core beliefs, and underlying assumptions (UAs) (Kennerley, Kirk & Westbrook, 2016). Humans are all aware of the signals and signs that we receive from our environment (Beck, 1979). These signals help people decide what to do and how to feel. The incoming signals are processed and interpreted by our internal systems that issue instructions and warnings but also indicate our emotions (Beck, 1979). However, these signals can only control the body and mind to the extent of how we perceive it. Humans have the ability to manipulate or misinterpret these signals which can cause psychological problems (Beck, 1979). These signals can otherwise be known as ATs. ATs can be interpreted differently between each individual and are known to have a direct influence on mood (Beck, 1979). ATs are often frequent and brief and can even be considered so habitual that they are not “heard”. Although they are short and are not often looked at, they are a main focus of CBT (Beck, 1979). Most people can be made aware of ATs and their importance which is why they are usually acknowledged early on in therapy (Kennerley, Kirk & Westbrook, 2016).
Core beliefs tend to be at the opposite end of ATs and are more solid in their foundation. These core beliefs are a person’s fundamental beliefs about themselves, others, and the world in general (Kennerley, Kirk & Westbrook, 2016). They often are general and absolute statements or beliefs such as: “I am a good person” or “Other people cannot be trusted” and can apply in almost all situations. Core beliefs are often learned early on in a person’s life as a result of experiences during childhood and can sometimes be altered later in life (Kennerley, Kirk & Westbrook, 2016). Unlike automatic thoughts that a person might have, core beliefs are normally not accessible to consciousness which is why they often have to be inferred by observation of thoughts and behaviors (Kennerley, Kirk & Westbrook, 2016).
Underlying assumptions are considered to be a connecting piece between ATs and core beliefs. Core beliefs give human beings fundamental beliefs and perspectives while UAs often develop as a response to core beliefs (Kennerley, Kirk & Westbrook, 2016). These assumptions can shape the rules for which individuals live their lives and often can be described as conditional. When UAs are not positive they have the ability to hinder a person rather than improve. UAs can sometimes be culturally derived or the result of past experiences. UAs are not as easily recognized as ATs which is why they are often looked at later on in therapy after ATs can be easily acknowledged (Kennerley, Kirk & Westbrook, 2016).
Theory of Development and Goals
CBT has a main goal of helping people become more aware of the negative thoughts and interpretations that occur in everyday life and also the behaviors that cause distorted thinking. The acknowledgement of thought and the changing of behavior is what makes this theory of treatment so successful especially when it is conquered in increments (Kennerley, Kirk & Westbrook, 2016). With time and training, a person may be able to increase his or her own awareness of thoughts just as one would identify and reflect on a sensation such as pain (Beck, 1979).
Role of Therapist
CBT requires attention, listening skills, and patience from the therapist just like any other theory of counseling. The role of the therapist is to assist the patient in identifying his or her own distortions or negative behavior (Beck, 1979). Part of identifying these distortions includes the therapist helping the client become more aware of automatic thoughts that influence how the person acts, feels, and reacts to certain experiences (Beck, 1979). With time and patience the client should be able to acknowledge these thoughts with increased awareness. The client can also document the number of times they felt uncomfortable or upset with the reactions they had to certain events. Often times, homework assignments will be given to a client that involve them documenting their automatic thoughts and the emotion or response that follows (Beck, 1979). It is important that both the client and the therapist both agree that these automatic thoughts interfere with the clients overall well-being or life objectives (Beck, 1979). According to Beck, a common method to help clients identify automatic thoughts and reactions is the “A, B, C.” sequence. In this sequence “A” is the stimulus that presents itself to a person and “C” is the response. “B” would be the blank in the patients mind or belief system which acts as the connection between “A” and “C.” This method can help clients who are struggling with anxiety, anger, shame, or sadness (1979). Another method that may be enacted by therapist is cognitive rehearsal. Cognitive rehearsal is a process by which the client becomes more aware of the problems that prohibit success or goals (Beck, 1979). This method encourages the client to imagine themselves going through the specific steps involved in a certain activity and to note the specific obstacles anticipated (Beck, 1979). Acknowledgement of such obstacles can be a topic of discussion within session.
Empirical Data & Limits
According to Kennerly, Kirk & Westbrook, they report that CBT is well a suited tactic for many different kinds of mental health issues. Some of these issues include: depression, agoraphobia, generalized anxiety disorder (GAD), social phobias, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bulimia, and some personality disorders. There are three main problems that CBT is not effective in and those are anorexia, schizophrenia, and bipolar disorder (2016). This resource does not give a specific reason as to why CBT is not as effective in treating anorexia, schizophrenia, and bipolar disorder other than the fact that there is not as much research. One can infer that these mental health issues are difficult to treat and require the client to be able to acknowledge their own thoughts. This might be difficult for someone with schizophrenia and bipolar disorder because there is often a distortion of reality which would make it hard for a client to identify real automatic thoughts. Being able to identify and alter automatic thoughts and behaviors is essential to CBT which could make it more difficult in these situations. Kennerly, Kirk & Westbrook cite a few guidelines in their book about the treatment of depression and other disorders. People with persistent or mild to moderate depression should be offered more individual self guided help based on CBT. Those with moderate to severe depression should be given a treatment plan that includes antidepressant medication and a more intense version of CBT. Clients with PTSD should be offered CBT with a focus on trauma and possibly also eye movement desensitization and reprocessing. A treatment plan for OCD and body dysmorphic disorder should include CBT, either in an individual or group setting depending on the severity of the disorder and also medication (2016). According to Beck, CBT meets all the requirements of a successful psychotherapeutic system for a variety of reasons. CBT presents itself in a comprehensible manner and explains with simple concepts that are easy for the client to understand. When the treatment is easy for the client to understand it makes it easier on the therapist to integrate it into session and the clients life. This theory of psychopathology is also so closely related to its principles of therapy that it is easy to see how the treatment derives from the actual theory. Essentially, CBT is effective because it is simple, consistent, and easy to make changes to if necessary (1979). There is no cited evidence that CBT does not work for a certain ethnic group but it is recommended that it be used with mainly adults as it may be difficult for children to understand some of the tactics (Kennerley, Kirk & Westbrook, 2016).
Reflection
I personally find CBT very interesting. Before writing this research paper I did not know a lot of information about it. I had heard about CBT but I never knew about the history and tactics behind the theory. Reading and learning about the history was probably one of the most interesting parts about this assignment. The combination of both cognitive and behavioral theory integrating into one method of therapy was fascinating. This theory of treatment was easy for me to understand and I can see how it would be relatively easy for the client to understand as well. Beck explains how simple CBT is especially because it comes directly from the theory and it is clear that this is the truth. I think that this theory relates to me and my identity as a person because I am someone who has many automatic thoughts that might not always be positive. I never really stopped to think about how these automatic thoughts and the emotional reactions and behaviors behind them affected my everyday life. Even just learning more about this method of therapy helped me to realize just how many automatic thoughts we have throughout the entire day. I feel as though I have more negative automatic thoughts when I am tired or when it is late at night. I think that there are other people who can relate to this. Being able to take a step back and realizing what is rational and irrational is rather helpful when these automatic thoughts occur. Acknowledging these automatic thoughts and how they affect my mood is very interesting and eye-opening to say the least.
I think that humans are naturally curious and insightful beings. I normally tend to believe that environment has a rather large impact on a person’s life but that being successful depends on how the person responds to that environment. This theory supports my thinking because the environment and the experiences we have impact how we think and act. Although we often cannot control our environment, one thing that we can control is our thoughts and behaviors. I often have this idea that everything in life happens for a reason but other times I really think that humans have the ability to create their own fate. This theory further the supports the idea that we are in control of our responses but not the stimuli. Looking at life with this mindset allows me to believe that we as humans really do have a lot more control then we may think.
I cannot think of any criticisms that I have of this theory especially because it has proven to be effective in the treatment of so many mental health problems. I believe that counseling for a majority of people is considered a last resort. For this reason, clients put a lot of hope and trust in counseling and their therapist. I have personally never gone through counseling but from what I have seen and experienced through others, it works. Counseling works because it allows for clients to reflect on themselves and to talk with someone who has no prior biases or preconceived notions about their life. The counselor does not take sides in a situation but instead offers insight into the clients life. I think that CBT is a great way for a client to gain insight especially when it comes to the thoughts and behaviors that they have that influence their life goals. It seems as though it is easy for people to go through the motions and not really stop to think and analyze the thoughts they have on a daily basis. These automatic thoughts can often become habitual which can be good but also bad when those habitual thoughts are negative. Having the ability to acknowledge and change those thoughts and behaviors is a skill that I think every person should have. When I think about CBT there is another reference that comes to mind. The old saying that talks about teaching a man how to fish is a better decision than just feeding him. I think that CBT somewhat embodies this message. Sure, medication can be effective and great in some situations but it is often only a temporary solution. I feel as though CBT and the methods that it uses can be compared to teaching the man how to fish. A client can leave therapy and take the things that he or she has learned and incorporate them into everyday life. When the client learns how the change the thoughts and behaviors they have then it can be a great tool that may stick with them for the rest of their life.