Origin and Development of Cognitive Behavioural Therapy (CBT)

Describe the origin and development of cognitive behavioural therapy, a CBT model for a specific emotional disorder, and discuss the evidence base for this psychological therapy and model

In recent years, emotional disorders have attracted an enormous amount of attention and publicity. Cognitive behavioural therapy is known to be one of the most popular approaches in treating mainly depression as well as other mental disorders. It’s a type of psychotherapeutic treatment which is generally short-term and focused on helping clients deal with a very specific problem. CBT is based on the idea that how we think, how we feel, and how we act all interact together. Specifically, our thoughts determine our feelings and our behaviour. Therefore, negative and unrealistic thoughts can cause a person great emotional distress which can also lead and expand to physical and financial problems too. This is because the way in which they would interpret situations becomes skewed which will have a negative impact on their behaviours. CBT aims to help people become more aware when they view certain situations negatively, and behavioural patterns which reinforce their distorted thinking. So cognitive therapy helps people to produce different ways of thinking and behaving in order to reduce their psychological distress.

Beck (1976) states Its relatively simple to state the formula for treatment: The therapist helps a patient to unravel his distortions in thinking and to learn alternative, more realistic ways to formulate his experiences. The cognitive approach brings the understanding and treatment of the emotional disorders closer to a patient’s everyday experiences. This is because the patient can regard his disturbance as related to the kinds of misunderstanding’s he has experienced numerous times during his life. So, the cognitive approach makes sense to a patient because it is somehow related to previous learning experiences and can stimulate confidence to learn how to effectively deal with cognitive misconceptions that are producing painful symptoms (Beck, 1976).

Cognitive behavioural therapy was first to be establishes by Beck in the 1960’s, which makes it a relatively new treatment. Beck institute (2016) states that “he carried out many experiments to test psychoanalytic concepts of depression and found other ways of conceptualising it. He found that depressed patients experienced a range of negative thoughts about themselves, the world and their future. So, his therapy involved helping patients to identify and evaluate these negative/irrational thoughts, in order for the clients thinking to become more positive and realistic. This was done by the therapist asking the client to provide homework for future sessions, like evidence to support or challenge their own negative beliefs. This gave the client more control over their sessions and made them feel like they were taking an active role in the therapy, like a ‘scientist.’ As a result, clients felt better emotionally which led to more functional behaviour with a long lasting change. (para.1)

Since its been introduced, cognitive behavioural therapy has been shown to be very effective in treating various mental disorders. Over 1000 studies have demonstrated this and it’s said the be the best form of talking therapy. Beck institute, 2016, Para.4) For example, it was found that depressed patients who received cognitive behavioural therapy continued to keep using the skills they learned in therapy a year later. This shows that negative beliefs do play a role in depression and challenging these thoughts to create rational thinking by teaching clients the skills they need to overcome these cognitive biases will improve mental health. This therefore makes cognitive behavioural therapy a valuable treatment to those with depression as its been proven to work and have a long-term effect on patients. However, a downfall of this type of therapy is that it is costly, meaning that it won’t be a very practical option for some people who are self-funded. Despite being deemed effective, this aspect makes it less popular to some people in the public so other options like medication may be used instead. Another limitation of cognitive behavioural therapy (as well as other talking therapies) is that the sessions can be quite intense, draining and time consuming. For example, a depressed patient would usually need to take many regular sessions with the therapist sometimes more than one a week, lasting up to a couple hours at a time going on for over a year sometimes, (depending on the client’s case). Therefore, this may also make it a less appealing therapy to the public, especially those who fear judgement and are majorly insecure- which many depressed people are.

In comparison, psychotherapy was first to be properly developed by Sigmund Freud, who developed the first talking therapy ‘psychoanalysis’. This comes under the psychodynamic branch of psychology, and it was introduced much earlier than cognitive behavioural therapy as Beck used it to make developments for his own therapy to treat depression. Psychoanalysis is also commonly used to treat depression and anxiety disorders. Freud argued that people could be treated by changing their unconscious thoughts and motivations to be conscious in order to gain deeper insight. Overall the aim of this therapy is to help release repressed emotions and experiences so that the client can deal with their unresolved conflicts. In practice Freud would create a relaxed environment for the client and ask them about their childhood experiences and current dreams whilst he recorded this information. It usually involves many regular sessions with the psychoanalyst. One of the techniques used in this therapy is called ‘free association.’ This is where the patient speaks about whatever is on their mind. The therapist would usually read out a word list and ask the client to recall the first word that comes to mind. This is done for parts of repressed memories to emerge at the same time.

Overall this type of therapy is seen as time consuming, meaning that repressed emotions and experiences won’t be resolved straight away. This means that it may not be that useful in improving public health/ wellbeing as it requires the client’s full commitment and will to the therapy, as well as effort/ money. Therefore, this may make it less popular so increase the drop- out rates. Also, the nature of psychoanalysis can be seen to create an unsymmetrical power balance between the therapist and the client. As the therapist has more power by being the one who dictates the therapy and asks all the questions, so this can raise ethical issues and in turn make the therapy a less popular option for treating mental disorders. So this aspect contrasts to elements of CBT where the client has a certain extent of control in their sessions, for example by providing ‘homework’ for future sessions and being able to dictate it.[1]

(McLeod, 2019) states that the cognitive approach believes that abnormality stems from faulty cognitions about others, our world and us. This faulty thinking may be through cognitive distortions which is where people process information inaccurately. These cognitions cause distortions in the way we see things; Ellis suggested it’s through irrational thinking, while Beck proposed the cognitive triad. We interact with the world through our mental representation of it. If our mental representations are inaccurate or our ways of reasoning are inadequate, then our emotions and behaviour may become dysfunctional. Cognitive distortions are said to cause irrational/ negative beliefs. They create illogical thought patterns which become self-defeating and can cause great anxiety or depression for the individual. Examples are ‘Magnification,’ which is where someone exaggerates the importance of undesirable events. For example, if you scrape the side of your car you may then see yourself as a terrible driver. Another example is ‘Overgeneralization,’ which is where someone draws very negative conclusions based on a single minor occurrence. For example, if you fail one exam when you normally pass every single one you may label yourself as unintelligent. (McLeod, 2019).[2]

Moving on, one of the earliest forms of CBT was rational emotive behaviour therapy, developed by Albert Ellis in the 1950’s. it’s used to treat depression and focuses on resolving emotional and behavioural problems and the main goal of the therapy is to change irrational beliefs to more rational ones.

REBT encourages an individual to identify their general and irrational beliefs (e.g. everybody hates me”) and trues to persuade the person to challenge these false beliefs through reality testing. Eliss proposes that everyone holds a unique set of assumptions about ourselves and the world we live in that we use to guide us through life and determine our responses to the different situations we encounter. However, some people’s assumptions are irrational, which makes them act and react in ways that are inappropriate and interfere with their chances of happiness and success.  Albert Ellis calls these ‘basic irrational assumptions. For example, some people irrationally assume that they are failures if they are not loved by everyone they know – they constantly seek approval and always feel rejected.  All their interactions are affected by this assumption. It can become so extreme that a person could feel dissatisfied just because they don’t get enough compliments at a party.

Other common irrational assumptions are the idea that you should be thoroughly competent at everything and even slightly failing is just not good enough. The idea that is it catastrophic when things are not the way you want them to be, so you blow irrelevant happenings way out of proportion. Also, the idea that there is a perfect solution to your problems, and it’s a disaster if you don’t find it.

A major aid in cognitive therapy is what Albert Ellis (1957) called the ‘ABC Technique of Irrational Beliefs.’ A – stands for Activating Event. This is where an event or emotion which has previously been experienced (maybe during childhood) is experienced again. So, this triggers the return of any negative/irrational beliefs, this ultimately leads to some type of high emotional response or negative dysfunctional thinking. B – stands for beliefs so the activating event will lead to negative beliefs, including masturbatory thinking which is the belief that life is fair. During sessions, at this stage the client would be asked to write down the negative thoughts that occurred to them.  C – stands for consequence. This explains the negative feelings and dysfunctional behaviours that are ensued. The negative thoughts of stage two are seen as a connecting bridge between the situation and the distressing feelings. The third stage is explained by describing emotions or negative thoughts that the client thinks are caused by A. This could be anger, sorrow, anxiety, despair etc.[3]

A strength of REBT is that the client is given a lot of control throughout the sessions, for example they tend to dictate the topic of conversation over the therapist. Also its beneficial to the client that the therapy allows them to delve deep into the clients past, aspects like their childhood are explored in order to establish the root cause of negative beliefs and potential ‘activating events.’

However, a limitation is that the success of this specific model may be solely down to the client’s relationship with the therapist, and not because of the therapy itself. This therefore makes the effiency of the therapy unclear as well as what exactly leads to results. Also it may mean that this isn’t a long term option for treating depression, because if success is really due to the client-therapist relationship, then it means that after the sessions are over the symptoms will return and the patient will go back to experiencing feelings of anxiety/ sadness.

Moving on, the Cognitive approach can be seen to contrast with the Behaviourist approach. The Behaviourist approach emphasizes scientific and objective methods of investigation. The approach is only concerned with observable stimulus-response behaviours, and states that all behaviours are learned through interaction with the environment. Behaviourists reject the idea of studying the mind because they argue that internal mental processes can’t be observed and objectively measured, as thought processes are private to the individual.

However, it is seen as highly important to analyse the mental processes of individuals in order to observe their chosen behaviours. They state that Information processing in humans resembles that in computers and that the two are very similar. It involves a person transmitting information from their senses and then storing it in the appropriate memory store so that they can retrieve this information when needed.

Its claimed that mental processes like memory follow a set pattern. For example, the multi store model of memory (introduced by Atkinson and Shiffrin) consists of three stores: sensory register, short term memory and long- term memory. It supports the idea that Information passes in a linear way, meaning from one store to another, and has been described as an information processing model much like a computer, this is because they are seen to be similar, both involve an input, process and output. The sensory organs like the eyes detect information which enters the sensory memory. If you pay attention this will get transferred to your short- term memory.

Then, if this information is repeated it will transfer from your short- term memory to your long term memory. If maintenance rehearsal doesn’t happen then the information will be forgotten, due to decay or displacement by new information from the senses.

However, Behaviourists like Skinner believed that we do have such thing as a mind which does play a part, but its simply more productive to study observable behaviour as opposed to internal events. He favoured and researched a method called operant conditioning, as he wanted to understand an individuals behaviour by observing its cause and its consequences . According to this principle, behaviour followed by unpleasant consequences is less likely to be repeated. There are two main types of conditioning: positive and negative. To study both these types he used what he called the ‘Skinner box’ on rats in a controlled lab environment. To test positive conditioning he placed a hungry rat in a Skinner box and every time it accidentally touched a lever placed inside the box a food pellet would drop inside. He found that the rat quickly learned to go straight to the lever, this shows an example of a reward positively reinforcing behaviour. He tested negative reinforcement by placing a rat in a Skinner box and giving it electric shocks, whenever the rat accidentally touched the lever it switched off the electric current and removed any unpleasant feelings. Skinner found that the rat quickly learned to go straight to the lever which shows that the consequence of escaping the electric current ensured that the rat would repeat the action. Overall both approaches employ different aspects to study as well as different methods.[4]

In conclusion cognitive behavioural therapy is a very high in demand treatment for depression. It focuses on the past as well as present experiences of the client and is tailored to be very specific in suiting every person’s individual needs/ situation. Its seen to have advanced a lot since the middle ages where ‘homemade remedies’ and spiritual techniques were used to get rid of any cognitive distortions. To psychoanalytic methods developed by Freud which mainly focuses on the unconscious distortions. Overall a great deal of research support has shown it to be a very valuable therapy and one which is constantly adapting in order to improve the psychological wellbeing of others.

[1] McLeod, S. A. (2007). Psychoanalysis.

[2] McLeod, S. A. (2019, Jan 11). Cognitive behavioral therapy. Retrieved from https://www.simplypsychology.org/cognitive-therapy.html

[3] McLeod, S. A. (2015). Cognitive behavioural therapy.

[4] McLeod, S. A. (2018, Jan, 21). Skinner – operant conditioning