Cognitive Behavioral Theory

The Cognitive-Behavioral theory is a form of short-term therapy used by counselors in the psychology and social work fields. Cognitive-Behavioral Therapy (CBT) encourages a blending of behavioral and cognitive therapy models. The theory is based in the belief that the client’s behaviors and feelings are heavily influenced by their thoughts. A CBT therapist plays an active role in helping the client prioritize their problems, recognize the maladaptive thoughts that are behind their problems and feelings, and devise and implement goal-oriented changes in their thinking.

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Background

Cognitive-Behavioral Therapy (CBT) places significant importance on how negative thinking impacts our emotions and behaviors. Dr. Aaron Beck observed that many of his clients had ‘automatic thoughts’ – “emotion-filled thoughts that might pop up in the mind” (Martin, 2007). Many of these thoughts are not consciously known to the client; however through practice the client can learn to identify the negative and irrational thought. Upon identification the client can then learn to overcome the thoughts. “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). These ‘automatic thoughts’ can cause us to become blind to new ideas and have the ability to overcome obstacles. A person’s ‘automatic thoughts’ are rooted in belief systems that were embedded in their subconscious from childhood. When an event happens a person uses these belief systems to help them cope with their difficulties. If there is negative thinking in the person’s belief system, they are more likely to misconstrue the event or issue as too difficult to handle.

Cognitive Therapy

Cognitive therapy focuses on people’s thoughts and how they affect their emotional, behavioral, and physiological reactions to stressful situations. People often have difficulty thinking rationally when feeling pressured by disturbing life experiences. Through cognitive therapy, clients are able to identify and challenge their thoughts about themselves, the people around them, and the world around them.

Behavioral Therapy

Behavioral therapy in its most basic state is the encouragement of “clients to engage in adaptive behaviors and not to allow pathological internal experiences to dictate the ways in which they act” (Association for Behavioral and Cognitive Therapies, 2012). Solutions under the behavioral theory closely follow Pavlov’s classical and operant conditioning philosophies. A client’s negative responses to normal stimuli are typically learned behaviors, because something negative happened the last time the stimulus was present. Through a process called extinction, therapists often try to change a client’s negative responses by showing the client that the negative result does not always occur with the stimulus. Using operant conditioning a client will be more likely to engage in activities and behaviors in a positive manner, if they have previously received positive outcomes. If the consequences of their behavior have been negative, they are less like to repeat that behavior.

Rational-Emotive Behavior Therapy (REBT)

One form of behavioral therapy, founded in the 1950s by Albert Ellis, was Rational-Emotive Behavioral Therapy (REBT). REBT focuses on the “client’s current, irrational thoughts… and actively targets them for change” (Fraum, 2012). Through REBT the client confronts their irrational beliefs and expectations. After confrontation, the client and therapist are able to develop realistic thinking. Only after these two things are accomplished is the client able to change. “Epictetus wrote in The Enchiridion, “Men are disturbed not by things, but by the view which they take of them” (National Association of Cognitive-Behavioral Therapists, 2008).

Dialectical Behavior Therapy

Another behavioral therapy that is a form of cognitive-behavioral therapy is Dialectical Behavior Therapy. Based heavily in philosophy, the main tenet of this therapy looks at two opposing views and works through the therapeutic relationship to blend them together to find a ‘happy medium’. The counselor does not make the client feel that their thoughts are invalid or incorrect, but guides them to understanding that their behavior needs to change. This therapy is most often used for clients who have been diagnosed with Borderline Personality Disorder. (National Institute of Mental Health, 2012)

Commonalities of Cognitive Therapy and Behavioral Therapy

Although there are a few differences between cognitive and behavioral approaches, there are some similarities that allow these two methods to be blended into the cognitive-behavioral approach. In CBT, the client and the therapist work together as a team to help the client overcome their troubles. Often CBT is a short-term counseling method that, typically, only lasts a few months, but it is also a rigorous therapy, in that the clients must utilize their new skills in between sessions through ‘homework’. CBT therapists seldom dig deeply into why a client is having the irrational thoughts, but rather stay focused in the present and future. (Association for Behavioral and Cognitive Therapies, 2012)

Notable People

There are many notable people who have influenced Cognitive-Behavioral Therapy. Dr. Aaron Beck is considered the father of cognitive therapy. Another notable person in the field of cognitive therapy is Dr. Martin Seligman, who is known mostly for his development of learned helplessness. Some key players in the development of behavioral therapy include Ivan Pavlov, John Watson, and B. F. Skinner. In 1955, Albert Ellis developed Rational Emotive Behavior Therapy. He is considered the founder of cognitive-behavioral theory. Dr. Samuel Yochelson and Stanton Samenow are known for their collaborative research and findings in the treatment programs of juvenile and adult criminal offenders.

Aaron T. Beck, M.D.

Dr. Aaron Beck started his career with as the Assistant Chief of Neuropsychiatry in Philadelphia, Pennsylvania (Department Of Psychiatry, Penn Behavioral Health, n.d.). In 1954, he joined the University of Pennsylvania’s Psychiatry Department. While there, he explored psychoanalysis which led to his development of cognitive therapy. (Beck Institute for Cognitive Behavioral Therapy, n.d.) Through his research he realized that his clients had negative thoughts that popped into their heads – ‘automatic thoughts’. These ‘automatic thoughts centered on themselves, the world and the future. These ‘distorted thoughts’ then begin to affect the clients lives leading to the disorders they are diagnosed with. Ultimately they stem from a person’s core belief systems and are formed throughout the person’s life. (Beck, 1997)

Albert Ellis, Ph.D.

REBT was developed by Dr. Ellis in the 1950’s. After spending several years practicing psychoanalysis, he found the he disliked “the in-efficient and in-directive nature” (National Association of Cognitive-Behavioral Therapists, 2008). Dr. Ellis established the ABC model of emotions, which was later modified into A-B-C-D-E approach.

Sessions

Cognitive-behavioral therapy sessions have a structure. Structure is important, because it allows for the most effective use of time. CBT sessions are usually only about 50 minutes long, happen once a week or once every two weeks, and only continue for a few months to a year. In the beginning of therapy the client and counselor discuss what issues and trouble the client is having. Next, they work on prioritizing the issues. These activities fall under stage I of the Egan Model. Under stage II, the client discusses their ideal self or what they want. This allows the client, with the guidance of the helper, to set realistic goals for themselves. In the final stage, the client and counselor explore the options available – and there are always options – and find the option or options that best work for the client. The last step is to produce an action plan.

Throughout the process the client often has ‘homework’. This homework is usually meant to help the client identify the “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.

Techniques

Due to the blending of theories and therapies, there are more than three dozen techniques available to cognitive-behavioral therapists. The selection includes cognitive, emotive, and behavioral techniques that make a well-rounded selection that can be tailored to the individual clients needs and wants. The ABC (also known as the ABCDE) Technique is most closely identified by its creator, Dr. Ellis, and under REBT. Other major techniques include cognitive reconstruction, exposure, reframing, and journal writing. Another widely used, yet somewhat controversial technique is self-disclosure.

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ABC/ABCDE Technique or Rational Self-Analysis

Dr. Ellis created this technique to help people identify and understand why they are behaving the way they are to certain ‘Activating Events’. The ‘Activating Event’ ((A)) is often seen as the reason for the client’s initial emotions and behaviors (Consequences or (C)). In reality there is another step in between — the client’s ‘Beliefs’ ((B)). While the (A) triggers the (C), the (B) is what actually causes the (C).

Dr. Ellis went continued to develop this technique and it was later modified to include three additional steps – ‘Disputing’ ((D)), ‘New Effect’ ((E)), and ‘Further Action’ ((F)). Once the client has been able to identify the (A), (B), and (C), they are then able to move forward and challenge their ‘Beliefs’ through ‘Disputing’. They, also, evaluate how they would prefer to feel or behave – the ‘New Effect’. Finally, the client develops their ‘Further Action’ plan to avoid a relapse.

Cognitive Restructuring

While Rational Self-Analysis is part of the process of Cognitive Restructuring, it is not the whole process. Cognitive Restructuring is a set of techniques that helps the client identify, challenge, and change their ‘distorted’ thoughts. Common thought distortions often include words like: always, must, and never. They also stem from Dr. Ellis’s list of irrational beliefs (appendix A) and a list of cognitive distortions influenced by Dr. Beck (appendix B). There is a Cognitive Restructuring Worksheet (Appendix C) that counselors and clients may find useful in when utilizing this technique.

Exposure

Exposure Therapy is an emotionally intense, yet effective way for clients to confront their fears, especially those with anxiety disorders. Through a series of extremely carefully planned sessions, the client is introduced or exposed to the trigger (stimuli) that is causing the anxiety (classically conditioned response). Over time the client is able to see and comprehend that nothing bad will happen and the anxiety lessens. The therapist often uses Exposure Therapy in conjunction with relaxation skills and cognitive reconstruction techniques. In addition to anxiety disorders, an adaptation of Exposure Therapy is sometimes used for people with sexual disorders.

Self-disclosure

Self-disclosure is when the therapist briefly tells the client something personal about themselves that may be of value to the client and the therapeutic relationship. This technique can be difficult to manage effectively and is somewhat controversial. If the therapist is going to utilize this technique, they must use it carefully and sparingly. Where this technique can become problematic is when the focus shifts from the client to counselor. Too much divulging of information can lead to the client being uncomfortable or feeling like the relationship has changed. When used appropriately; however it can show the therapists empathy to the situation the client is facing.

Case Study Synopsis

Client is a 52-year-old female widower with two daughters. Her husband died seven years ago. Her relatives live 50 miles away. Client was accused of a work-related incident, after which she became anxious. Client is currently on medication with effects consistent with an antidepressant. Presenting problems included poor memory, lack of concentration, confusion and slowness. The client met the DSM-IV criteria for a major depressive episode. The client was given several clinical scales to rate herself on. These scales were completed prior to every session and discussed briefly during the session.as a means of verifying efficacy. The therapist used the five systems model to help the client analyze her thoughts and recognized negative automatic thoughts and behaviors. She was given daily activity monitoring sheets, although she was successful at many activities very few gave her any pleasure. Due, in part, to years of sexual abuse by her father, the client felt that something was wrong with her. She felt like she didn’t fit into her family. By using a more detailed variation of the ABC Technique, the client and therapist were able to identify stressful situations; discuss the emotions, behavior and physical reactions to the situations; and recognized the underlying negative beliefs. The therapist utilized behavioral experiments to help the client challenge her core beliefs and recognize the differences in how she felt.

Final Thoughts

I chose this theory because I felt that it is the one I was most likely going to use, when I become a licensed psychologist. The multiple views and varied techniques available for the client make it seem like the one theory that can be tailor fit for each individual. What I found out through my research; however, is that the cognitive-behavioral approach does not dig deeply into the ‘why’ someone has the beliefs they do. The ‘why’ is what drew me to the field of psychology and human services in the first place, so I need to investigate other theories, career opportunities, and techniques to find ‘my right fit’. Ideally, I would like to investigate the criminal mind more closely and help the prison population overcome their psychopathological issues. I still feel that many of the cognitive-behavioral techniques can be useful in discovering the ‘why’, so I will likely use them in my ultimate career field.