St. John Fisher College Fisher Digital Publications Nursing Faculty/Staff Publications Wegmans School of Nursing 2015 Cognitive-Behavioral Therapy Robert H. Rice St. John Fisher College, [email protected] Follow this and additional works at: https://fisherpub.sjfc.edu/nursing_facpub Part of the Mental and Social Health Commons, and the Nursing Commons How has open access to Fisher Digital Publications benefited ou?y Publication Information Rice, Robert H. (2015). "Cognitive-Behavioral Therapy." The SAGE Encyclopedia of Theory in Counseling and Psychotherapy 1, 194-199. Please note that the Publication Information provides general citation information and may not be appropriate for your discipline. To receive help in creating a citation based on your discipline, please visit http://libguides.sjfc.edu/citations. This document is posted at https://fisherpub.sjfc.edu/nursing_facpub/73 and is brought to you for free and open access by Fisher Digital Publications at St. John Fisher College. For more information, please contact [email protected]. Cognitive-Behavioral Therapy Abstract Cognitive-behavioral therapy (CBT) is the merging of behavioral and cognitive therapies that mostly focuses on working with the client in the present. Although there are many approaches to CBT, there tend to be some common features. For example, CBT is generally a directive approach to psychotherapy that helps clients to challenge their problematic thoughts and to change the behaviors associated with those thoughts. In addition, most approaches to CBT are structured and time limited and include some type of homework where the client can practice the cognitive and behavioral strategies learned in the therapeutic setting. This entry focuses mostly on CBT as defined by Aaron Beck, one of the early founders of this approach. Disciplines Mental and Social Health | Nursing Comments This content was originally published in The SAGE Encyclopedia of Theory in Counseling and Psychotherapy © 2015 SAGE. It can be found on SAGE's website here: http://dx.doi.org/10.4135/ 9781483346502.n77 This content is posted with permission from SAGE. Distributing, reselling, or any repurposing of the content is not allowed and content is not to be used for commercial MOOCs or any other commercial purposes without permission. This article is available at Fisher Digital Publications: https://fisherpub.sjfc.edu/nursing_facpub/73 194 Cognitive-Behavioral Therapy Beck, J. S. (2010). Cognitive behavior therapy: Basics and associated with those thoughts. In addition, most beyond (2nd ed.). New York, NY: Guilford Press. approaches to CBT are structured and time limited Blagys, M., & Hilsenroth, M. (2002). Distinctive and include some type of homework where the cli­ activities of cognitive-behavioral therapy: A review ent can practice the cognitive and behavioral strat­ of the comparative psychotherapy process literature. egies learned in the therapeutic setting. This entry Clinical Psychology Review, 22, 671-706. focuses mostly on CBT as defined by Aaron Beck, doi:10.1016/S0272-7358(01)00117-9 one of the early founders of this approach. Crane, R. (2009). Mindfulness-based cognitive therapy. New York, NY: Routledge. Craske, M. G. (2010). Cognitive-behavioral therapy. Historical Context Washington, DC: American Psychological Association. Ellis, A., &c MacLaren, C. (2005). Rational emotive The first approach to CBT to achieve widespread behavior therapy: A therapist’s guide (2nd ed.). recognition was rational emotive therapy, origi­ Atascadero, CA: Impact. nated by Albert Ellis in the mid-1950s. Ellis devel­ Hayes, S. C., Strosahl, K., & Wilson, K. (2003). oped his approach in reaction to his disliking of Acceptance and commitment therapy: An experiential the inefficient nature of psychoanalysis. Ellis approach to behavior change. New York, NY: believed that how we act and how we feel are the Guilford Press. result of irrational thinking, and he proposed a Linehan, M. (1993). Cognitive-behavioral treatment of number of typical irrational thoughts that people borderline personality disorder. New York, NY: tend to have that will lead to dysfunctional ways Guilford Press. of being in the world (e.g., the need to be loved by McCullough, J. P. (2000). Treatment for chronic everyone on the planet, the idea that we must rely depression: Cognitive behavioral analysis system of on others for our happiness, etc.). His approach psychotherapy. New York, NY: Guilford Press. was widely used in the latter part of the 20th century Miller, A. L., Rathus, J., & Linehan, M. (2007). and continues to be used today. Dialectical behavior therapy with suicidal adolescents. Not too soon after Ellis developed his approach, New York, NY: Guilford Press. during the early1960s, Aaron Beck developed a Segal, Z. V., Williams, J., & Teasdale, J. (2013). similar approach he called cognitive therapy. Mindfulness-based cognitive therapy for depression Initially applying his approach to those with (2nd ed.). New York, NY: Guilford Press. depression. Beck’s ideas eventually spread to a Sperry, L. (2015). Cognitive behavior therapy of DSM-5 whole range of other diagnostic categories. Beck personality disorders (3rd ed.). New York, NY: stayed away from the use of the word irrational Routledge. and instead suggested that core beliefs and deep Wolpe, J. (1990). The practice of behavior therapy schemas, or embedded ways by which we tend to (4th ed.). New York, NY: Pergamon Press. view the world, lead to dysfunctional behaviors Young, J. E., Klosko, J., & Weishaar, M. (2003). Schema and negative feelings. His approach was outlined therapy: A practitioner’s guide. New York, NY: Guilford Press. in a classic series of articles published in the 1960s. Beck’s early writings focused primarily on pathology in information processing styles in clients with depression or anxiety, but he also incorpo­ rated behavioral methods to prevent feelings of Cognitive-Behavioral Therapy helplessness. After the work of Ellis and Beck, a number of Cognitive-behavioral therapy (CBT) is the merging others developed related theories that became of behavioral and cognitive therapies that mostly widely used. For instance. Max Maultsby developed focuses on working with the client in the present. rational emotive imagery, rational self-analysis, Although there are many approaches to CBT, there and the five criteria for rational behavior, which tend to be some common features. For example, included an emphasis on client rational self­ CBT is generally a directive approach to psycho­ counseling skills and therapeutic homework. therapy that helps clients to challenge their prob­ Another example is Donald Meichenbaum, who lematic thoughts and to change the behaviors developed stress inoculation therapy, an attempt to Cognitive-Behavioral Therapy 195 integrate the research on the roles of cognitive and the behavioral level, using practical methods affective factors in coping processes with the of interrupting the cycle and encouraging more emerging technology of cognitive-behavioral adaptive responses. modification. More recently, CBT has been influenced by new theories and associated assessment, treatment, and Major Concepts prevention technologies that highlight psychologi­ cal acceptance and mindfulness. One of the most Cognitive Concepts prominent examples is Marsha Linehan’s dialecti­ Three major levels of cognition that are often cal behavior therapy (DBT), which incorporated identified in the practice of CBT include (1) full CBT with mindfulness and balancing acceptance consciousness, (2) automatic thoughts, and with change. DBT was originally developed by (3) schema. Full consciousness is defined as a state Linehan for clients with borderline personality of full awareness and optimized judgment. In con­ disorder and related parasuicidal behaviors. It has trast, automatic thoughts are cognitions that flow since been modified for use with other popula­ rapidly in the stream of everyday thinking and may tions, including those with substance abuse and not be carefully examined for correctness or ratio­ depression. nality. Usually out of consciousness, they are Today, CBT comes in many shapes and forms readily accessible once a person is made aware of and has become a dominant force in psychother­ them. Everyone has automatic thoughts, but in the apy in much of the world. This is largely due to the case of pathology such as obsessive-compulsive increased focus on evidence-based practice and disorder (OCD) or generalized anxiety disorder, related demands for accountability in the delivery these cognitions are often full of errors in logic. of mental health services. Throughout its history, These are called cognitive distortions and include CBT has been committed to a scientific perspec­ distorted thinking such as overgeneralization, all- tive to the study of psychopathology and its treat­ or-nothing thinking, mind reading, fortune telling, ment. Hundreds of studies have evaluated various and discounting the positive, to name a few. For cognitive-behavioral theories of psychopathology, example, someone with OCD might overestimate and hundreds more have assessed the efficacy of the risk involved with refusing to engage in a com­ CBT interventions. pulsion such as hand washing or checking. Likewise, in generalized anxiety disorder, people might Theoretical Underpinnings underestimate their ability to cope with a potential threat. For example, someone might choose to CBT is applied in many different ways today, and avoid holiday shopping altogether because she or