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Home , Albert Ellis, Behavior modification, Cognitive intervention, Cognitive therapy, Rational living therapy

University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln

Educational Papers and Publications Educational Psychology, Department of

2010

Cognitive Behavioral (CBT)

Rhonda Turner University of Nebraska-Lincoln

Susan M. Swearer Napolitano University of Nebraska-Lincoln, [email protected]

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Turner, Rhonda and Swearer Napolitano, Susan M., "Cognitive Behavioral Therapy (CBT)" (2010). Educational Psychology Papers and Publications. 147. https://digitalcommons.unl.edu/edpsychpapers/147

This Article is brought to you for free and open access by the Educational Psychology, Department of at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Educational Psychology Papers and Publications by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. Published in Encyclopedia of Cross-Cultural School Psychology (2010), p. 226-229. Copyright 2010, Springer. Used by permission.

Cognitive Behavioral Therapy (CBT) Therapy, , Focused Therapy and Dialectical Behavior Rhonda Turner and Susan M. Swearer Therapy.

Department of Educational Psychology, Uni- History of CBT versity of Nebraska-Lincoln, Lincoln, Nebraska, A precursor to the development of CBT U.S.A. was the emergence of ’s So- cial Learning Theory. Unlike the prevail- Cognitive Behavioral Therapy (CBT) is a ing psychodynamic or behavioral views form of that focuses on the of psychological disturbance, Bandura role of in the expression of emo- viewed people as consciously and actively tions and behaviors. CBT assumes that mal- interacting cognitively with their environ- adaptive feelings and behaviors develop ments. He introduced the notion that cog- through cognitive processes which evolve nitive mediation occurs in the stimulus-re- from interactions with others and experi- sponse cycle of human behavior. This sug- ences in the environment. The goal of ther- gestion that people think before they do of- apy is to identify the maladaptive cognitive fered a new target for therapeutic interven- process and to learn new ways of perceiv- tion and set the stage for the development ing and thinking about events. These new of CBT. ways of thinking will lead to more positive Cognitive Behavioral Therapy has its or- behavioral and emotional responses. igins in the work of and Aar- CBT is a general classification of psycho- on T. Beck in the late 1950’s and early therapy. It encompasses several different 1960’s. During that time, Albert Ellis, seek- approaches that share the same theoreti- ing an alternative to psychodynamic ther- cal underpinnings. Among the cognitive apy which he viewed as indirect and inef- behavioral approaches being practiced to- ficient, developed Rational Emotive - Ther day are Rational Emotive Behavior Thera- apy (RET). Later termed Rational Emotive py, , Rational Behavior Behavior Therapy (REBT), Ellis’ approach

226 Cognitive Behaviral Therapy (CBT) 227 emphasized the role of in deter- havioral experimentation, the therapist and mining a person’s feelings and behaviors. client work together to determine the accu- Ellis was particularly influenced by the Sto- racy (or inaccuracy) of the client’s ic which held that people are and beliefs. In the 1970’s Donald Meichen- upset not by events, but rather by the view baum developed a treatment approach he they take of them. He was also influenced termed Cognitive . by the psychotherapist , who Meichenbaum’s early research on the role posited that behavior stems from . of cognition in behavior originated in his REBT holds that psychological disturbanc- observation of persons with es stem from irrational beliefs. These irratio- engaging in self instruction in their efforts nal beliefs usually take the form of an indi- to maintain assigned “healthy talk” to re- vidual’s insistence that things should, ought, ceive . Stemming from this or must be different from the way they are. observation, much of Meichenbaum’s work Cognitive errors including overgeneraliza- centered on the internal dialog, or “self- tion, interpreting small events to have great talk” that underlies individual’s affect and meaning (i.e., believing that an everyday behavior and is the foundation for the de- mistake is evidence of complete incompe- velopment of skills. Meichenbaum tence), and catastrophizing, turning a small suggested that cognitive behavior modifi- problem into an insurmountable one, are cation was aimed at creating a bridge be- targets of therapy. In REBT, the therapist tween strictly behavioral and strictly cogni- directly confronts these irrational thoughts tive treatment modalities and has been suc- and unrealistic expectations. cessfully applied in the treatment of anxi- Also influenced by the Stoicists, and Adler, ety, , and stress. Aaron T. Beck developed a structured, short-term, present focused treatment for Applications of CBT . Beck’s approach, termed Cogni- Over the years, CBT has been used to treat tive Therapy was based on Beck’s observa- a wide variety of psychological disorders, tion that his patients with depression held across a variety of populations and set- idiosyncratic cognitive biases. From this, tings. Among adults, it has been proven Beck developed a model of depression de- effective in the treatment of major depres- picting a cognitive triad characterized by a sive disorder, generalized disorder, negative view of the self, the world and the social , , obsessive- future, along with a perception of the self compulsive disorder, and couples’/marital as inadequate, alone, and worthless. Beck problems. CBT has also been applied to the maintained that similar systematic biases treatment of post-traumatic stress disorder, in information processing are characteris- personality disorders, chronic pain, anti- tic of most psychological disorders. For ex- social behavior, hypochondria and schizo- ample, anxiety disorders are characterized phrenia. As previously noted, CBT uses per- by a pervasive sense of physical or psycho- formance-based procedures and structured logical danger while paranoid thinking in- sessions along with volves a bias assuming that others are prej- techniques to produce changes in thinking, udiced, abusive or critical. feeling and behavior. This model trans- Whereas the REBT therapist actively con- lates well to working with youth and their fronts and attempts to persuade the client families. Cognitive Behavioral approach- that his/her thinking is irrational, in Cogni- es adapt well to the demands of children’s tive therapy the client is engaged in a spirit of differing developmental levels. Although collaborative empiricism. That is, through a it provides structure for treatment, cogni- combination of and be- tive behavioral therapy is flexible allowing 228 Turner & Swearer in Encyclopedia of Cross-Cultural School Psychology (2010) for adaptations to meet individual client’s anxiety generally ranges from four to 14 developmental needs. With younger chil- sessions. The time-limited nature of thera- dren the treatment process will likely have py holds true in applications with children a behavioral emphasis, on operant and adolescents as well as adults, although techniques to modify behavior. As cogni- protocols adapted from adult therapy ap- tive abilities develop, the focus of therapy proaches may need to be extended to al- can shift to the mediating cognitions that low for development of the therapeutic al- determine and behavior. It has liance and to build skills in meta-cognition been suggested that children as young as and . Treatment protocols age 5 can benefit from cognitive behavior- for youth depression and obsessive com- al therapy. For children who are not devel- pulsive disorder generally entailing fewer opmentally ready for more abstract forms than 20 session have been empirically sup- of thinking, CBT focuses on concrete skills ported. including problem solving and rehearsal of Third, CBT recognizes the importance of positive coping statements. an effective therapeutic relationship be- Although the research is less extensive tween therapist and client although this is than in the adult literature, CBT has been not the focus of treatment. Factors contrib- proven effective with children and youth uting to a positive therapeutic relationship across a variety of presenting problems in a include warmth, empathy, caring, genuine variety of modalities. Youth ranging in age regard and, particularly with youth, a col- from preschool to college have benefited laborative spirit. The CBT therapist focus- from CBT approaches provided to the in- es on teaching the client to serve as his/her dividual, with their families, or in groups, own therapist by identifying and modify- and in outpatient or inpatient treatment set- ing distorted thought patterns. tings. The efficacy of CBT in the treatment Similarly, CBT emphasizes collaboration of childhood or adolescent aggression, anx- and active participation. Client and thera- iety, social anxiety, depression, obsessive- pist are viewed as a team. The client is ac- compulsive disorder, and tively engaged in the therapeutic process, eating disorders has been empirically sup- with input on session topics and home- ported in a number of studies. work. According to Judith Beck, cognitive therapy teaches patients to identify, eval- Principles of CBT uate and respond to their dysfunctional While there are mUltiple approach- thoughts and beliefs. In a spirit of collab- es to CBT, according to the National As- orative empiricism, the therapist helps the sociation of Cognitive Behavioral Thera- client evaluate his thoughts by examining pists (NACBT), they share several charac- the evidence that either supports or refutes teristics. First, CBT is based on the cogni- them. Cognitive behavioral therapists use tive model. That is, feelings and behaviors Socratic questioning to develop an under- stem from thoughts, not from external stim- standing of their clients’ concerns and en- uli. This sets the stage for CBT’s hopeful as- courage clients to question themselves. sumption that the individual can alter his/ In addition to being collaborative and ac- her feelings and behaviors, even in the face tive, CBT is based on an educational mod- of intractable situations. el. The aim of therapy is to teach the client Second, CBT is time limited. Unlike psy- to be his/her own therapist, emphasizing choanalysis which can last for years, CBT . Positing that maladap- extends for an average of 16 sessions, across tive behaviors and emotional reactions are types of presenting problems. Judith Beck learned, CBT aims to help the client unlearn notes that treatment for depression and the old reactions and develop new ones by Cognitive Behaviral Therapy (CBT) 229 altering his or her cognitive responses. Suggested Reading Cognitive behavioral therapy is goal ori- ented and problem focused. Unlike its psy- Beck, A.T., and M.E. Weishaar (1995). Cog- choanalytic predecessors, cognitive ther- nitive therapy. In: R.J. Corsini and D. Wed- apy maintains that the thoughts contrib- ding (editors), Current (5th uting to a patients’ distress are not deeply ed.) (pp. 229-261). Itasca, Ill.: F.E. Peacock. buried in the unconscious. As a result, CBT Beck, J.S. (1995). Cognitive Therapy: Basics emphasizes the present, and on ameliorat- and Beyond. New York: Guilford. ing symptoms in the here and now rather Friedberg, R.D., and J.M. McClure (2002). than on lengthy analysis of the client’s de- Clinical Practice of Cognitive Therapy with velopmental history. Children and Adolescents: The Nuts and A related principle of CBT is that it is Bolts. New York: Guilford. structured and directive. In keeping with its time-limited nature, CBT employs a spe- cific agenda for each session. This -consis Suggested Resources tency of structure facilitates generalization by providing a formula the client can use The for Behavioral and Cog- when acting as his or her own therapist af- nitive (ABCT)—http://www. ter termination of therapy. The therapist aabt.org/aabt. The website of the Associ- and client generate the agenda collabora- ation for Behavioral and Cognitive Ther- tively keeping the client’s goals for thera- apies provides an overview of the organi- py in mind. Further, CBT uses homework, zation as well as resources about CBT and tasks to be completed between therapy ses- therapist referrals. sions. The Beck Institute for Cognitive Thera- Conclusion py and Research—http://www.beckinsti- CBT has rapidly increased in populari- tute.org. The Beck Institute offers cognitive ty over the last forty years. It enjoys strong behavior therapy training programs, con- empirical support, and the body of research ducts research on the efficacy of CBT and into its efficacy is expanding with each pass- provides direct clinical services. ing year. Given symmetry between the time limited nature of CBT and the demands of National Association of Cognitive Behav- cost containment and managed care, this ioral Therapists—http://www.nacbt.org. growth seems likely to continue. The website of the National Association of Cognitive Behavioral Therapists provides See also: Childhood depression; Desensi- information on CBT and therapist refer- tization; Obsessive-Compulsive Disorder rals. (OCD)