Cognitive Behavioural Therapy History and Modernity

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 Cognitive Behavioural Therapy (CBT) is a combination of behavioural and cognitive theories of human behaviour. CBT helps to build a set of skills that enables an individual to be aware of their thoughts and emotions; identify how situations, thoughts, and behaviours influence their emotions; and improve their feelings by changing the dysfunctional thoughts and behaviours.

Cognitive therapy enables the client to understand, how thinking patterns affect their emotional state and their behaviour. Cognitive therapy also encourages the client to change their irrational and negative thinking style to alleviate the emotional symptoms that these thoughts cause. Behavioural therapy on the other hand teaches the client how to change one’s learned reactions, which cause avoidance, escape and anxiety in specific situations.

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CBT is founded on Socrates’ dialogue that rational thought is based on fact, not assumption or opinion. It is the irrational/negative assumptions, which are seldom factual, that have such devastating effects on clients because they are very upsetting to the psychological wellbeing of the person. Clients usually do not understand the negative impacts of their thoughts. CBT therapists work with clients to show them what impact their thought patterns have on their psychological states and behaviour.

 Cognitive Behavioural Therapy is one of the main evidence-based treatments for mental health disorders which has achieved enormous support and acknowledgement by the UK Government and healthcare authorities even though there are many other evidence-based effective therapies available. Scientific research has shown that CBT is one of the best and most widely used mental health treatments, incorporating evidence-based practice, for treating various psychological problems including; anxiety, depression, stress and physical pain which helps individuals to conquer obstacles and difficulties that people might face at work, home or in relationship situations.

An advantage of CBT is that it is usually short term, only requiring from five to ten months for most emotional problems. Typically clients attend one session every couple of weeks. The session lasts for 60 minutes. During the session, the client and the therapist will work towards understanding the main problems and developing new coping skills to deal with the problems. CBT introduces clients to a set of strategies that they can apply whenever they need to, and that’ll last them a lifetime. 

The efficacy of CBT is supported by evidence from randomised controlled trials (RCTs), uncontrolled trials and case studies. CBT has been widely tested since the first outcome study was published in 1977. Currently, there have been more than 500 outcome studies that have shown the effectiveness of CBT for a wide range of mental health problems.

In this text we will look into CBT, its origination/background, application of CBT theory into practice and also will critically reflect on the CBT theory and practice.

Main Theories of CBT: CBT is based on the combination of the basic principles from behavioural and cognitive psychology. Its roots can be traced to these two models and their subsequent amalgamation.

Behavioural Theory: The father of behaviourism, American Psychologist John Broadus Watson (1878 – 1958), insisted that psychology should study only objective, observable behaviour. To this present day, behaviourism is practised widely by clinical psychologists for phobias, obsessive-compulsive disorders and appetitive problems.

Behavioural treatment for psychological disorders has been around since the early 1900s. Skinner, Pavlov, and Watson were all early advocates of behavioural treatments. Behaviourism is constructed on the idea that behaviours can be measured, trained, and even changed. It suggests that it is our responses to environmental stimuli that shape our behaviours.

The 1st wave of behavioural therapy started in the 1940s in response to the emotional adjustments faced by the many World War II veterans returning from the war. This required effective short-term therapy for depression and anxiety coincided with a build-up of behavioural research regarding how people learn to behave and react emotionally to life situations. This challenged the traditional psychoanalytic therapy that was popular at the time and is considered the “first wave” of CBT.

The different behavioural/learning approaches are as follows: Classical conditioning or respondent conditioning was developed by Russian physiologist Ivan Pavlov (1849 – 1936). Pavlov noted that the presentation of food – an unconditioned stimulus – was enough to make the dogs salivate –an unconditioned response. He then rang a bell – a conditioned stimulus – and gave them food. The salivation produced by the bell was now a conditioned response. Classical Conditioning involves repeated pairings of an Unconditioned Stimulus (UCS – bell) with the neutral Conditioned Stimulus (CS – food) until an association between them is learned or “conditioned”. Classical Conditioning has useful implications in the development and treatment of anxiety disorders like phobia, panic disorder and PTSD. Even though Pavlov himself did not develop Exposure Therapy as a treatment, his theory (Classical Conditioning) is a central feature of modern-day CBT. Operant conditioning is a process of learning that occurs through “rewards and punishments” for behaviour. According to operant conditioning, we make an association between a particular behaviour and a consequence (Skinner, 1938). Skinner is known as the father of Operant Conditioning, but his work was influenced by Thorndike’s (1898) law of effect. According to this principle, behaviour that is followed by pleasant consequences (reward) tends to be repeated, whereas behaviour followed by unpleasant consequences (punishment) tends to be less repeated. Skinner introduced a new term into the Law of Effect – Reinforcement. Behaviour which is reinforced (by adding something like praise/pain) is likely to be repeated (i.e., strengthened), whereas behaviour which is not reinforced (by removing something like removing praise/removing pain) is likely to die out or be extinguished (i.e., weakened). The treatment of depression is based on positive reinforcement and negative punishment. Through social isolation and withdrawal, the depressed individual can create a scenario where their usual reinforcers (i.e., positive social interaction) are removed (negative punishment).

And finally, Cognitive Theory: In the early 1900s, Austrian psychotherapist Alfred Adler’s concept of basic mistakes and their role in unpleasant emotions made him one of the first therapists to address cognition in psychotherapy. His work inspired American psychologist Albert Ellis to develop Rational Emotive Behaviour Therapy (REBT) in the 1950s. This is now considered one of the earliest forms of cognitive psychotherapy. It is based on the notion that a person’s emotional distress arises from their thoughts about an event rather than the actual event itself. In the 1950s and 1960s, American psychiatrist Aaron T. Beck observed that his clients had internal dialogues going on in their minds during sessions. He found that the clients appeared to almost be talking to themselves, but they only shared a small part of this kind of thinking with him. Based on this Beck proposed that cognitions influence experiences (I.e. behaviour) and that “therapeutic changes” are brought about through modifying and adapting “distorted beliefs”.  

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