Cognitive Behavioral Therapy (CBT)
Definition of Cognitive Behavioral Therapy
Cognitive Behavior Therapy is a form of talk therapy that emphasizes the present, is structured, and goal focused. It is rooted in theories and techniques that have been scientifically tested.
Cognitive Behavioral Theory
Cognitive-behavioral therapy (CBT) is a form of treatment based on cognitive and behavioral theories of causes of emotions and what leads to particular self-defeating behaviors. The CBT tools that a client might learn may be based on classical conditioning, operant conditioning, or social learning (modeling). These are very behavioral tools. More cognitively focused techniques stress the role thoughts and beliefs might play in producing emotional suffering and maladaptive behaviors. These cognitive theories are based on a model that stresses the role thinking (our beliefs) play in producing emotional suffering and maladaptive behaviors.
Cognitive Behavioral Treatments
Traditional behavior therapies include Exposure plus Response Prevention (ERP, also called Flooding), Implosive Therapy, Systematic Desensitization, Shaping, Habit Reversal, Applied Behavioral Analysis, Role Playing, etc. Cognitive techniques evolved into forms of treatment including Rational Emotive Therapy (RET), which is now called Rational Emotive Behavior Therapy or REBT, Cognitive Therapy, Dialectical Behavior Therapy (DBT), Self-Instructional Training, etc.
Components of cognitive-behavioral therapy have been studied more than other psychotherapies, and have proven to be effective for many issues. In as little as 8-12 weeks, many techniques have shown promising results. Cognitive restructuring techniques, problem solving, relaxation training, communication skills, and combinations of these techniques have reduced both the experience of anger and many of the associated behaviors.
Cognitive Behavioral Techniques
Cognitive-behavior therapy (CBT) is a type of psychotherapy that reduces current symptoms by addressing the current causes of the issue. CBT theory proposes that emotional problems result not only because of a particular event, but also the individual’s interpretation and behaviors associated with the event. Certain interpretations, or beliefs, about the self, others, future, or even life in general can influence emotions and behaviors.
Albert Ellis’ ABC model is a helpful way to conceptualize how beliefs and interpretations are involved in emotional episodes. “A” represents Activating Events, “B” is for Beliefs, and “C” is for Consequences.
Activating events (A’s), are anything real or imagined that activates our belief system (B’s) and results in an emotional consequence (C). Emotional Consequences (Ce’s), set the stage for behavioral consequences (Cb’s).
If you were bumped by someone with a backpack while walking on the sidewalk, that could be an A. You may then believe (B), “He should watch where he is going, and at a minimum apologize.” The combination of this activating event (A) and belief (B), may result in anger, and an emotional consequence (C).
A x B = Ce
Activating event Belief Consequence emotional
(Inconsiderate behavior) (Others should always be considerate) (Anger)
Here is an REBT self-help form to allow you to challenge irrational beliefs by disputing them (asking challenging questions) and then writing new effective philosophies.
Irrational Beliefs and Cognitive Distortions
There are numerous schools of cognitive behavior therapy (CBT), each of which may have particular cognitions that are emphasized more than others. And over time, even one particular school makes changes. Below are a few examples.
Four Core Irrational Beliefs developed by Albert Ellis, founder of Rational Emotive Behavior Therapy (REBT)
- Demandingness (DEM) – Things should or have to occur as I prefer, like, or in the way that I believe is right. Some times demands are referred to as musts. Here are three major musts:
- i) I must do well or get approval (or I’m inadequate)
- ii) You must treat me nicely (or you’re inadequate)
- iii) The world (life) must give me what I want quickly, easily, and with great certainty (or it’s Awful)
- Awfulizing – Something is magnified to be 100% completely bad. It is also called catastrophizing. Words like awful, horrible, terrible, and catastrophic may indicate awfulizing is occurring, especially if the event is seemingly insignificant compared to other bad events in one’s life.
- Low-frustration Tolerance (LFT) – This is a thought that underestimates one’s capacity to tolerate or experience an event, situation, or experience. I can’t stand it, or this is unbearable, or I can’t take it may indicate that there is some LFT taking place.
- Global Evaluations of Worth – These beliefs are global ratings of worth placed on the self, others, or even life, the world, or the future. Examples would be calling oneself a loser, winner, success, or failure. Rather than rating particular behaviors, individuals may globally evaluate the worth of a particular subject in a way that does not accurately capture its value to different stakeholders.
Overview of Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) has evolved over decades. What has not changed is the emphasis on scientifically testing theories and clinical techniques. Behavior Therapy (BT) was developed first. Based on principles of learning from scientific laboratories, behavior therapists began applying techniques to patients. Learning principles established in the classical conditioning work of Pavlov and operant conditioning work of B.F. Skinner (psychologist) and others, could be applied to help people suffering with various disorders, such as anxiety. For example, Dr. Joseph Wolpe (psychiatrist) and his protege, Dr. Arnold Lazarus (psychologist) promoted the use of systematic desensitization.
Systematic Desensitization as Behavior Therapy
Systematic desensitization involves the therapist helping the patient to identify different levels of what triggers their anxiety response. Then a fear or anxiety hierarchy is developed. The next step is for the psychotherapy patient to be taught and practice an effective relaxation technique. Once the therapy patient can effectively produce a relaxation response, the conditioning begins. The therapist or the psychotherapy patient may describe the trigger that will at first produce a lower level of anxiety. After the anxiety response has occurred in response to exposure to the anxiety stimulus, the therapy patient then produces a relaxation response. According to Wolpe, one cannot be simultaneously anxious and relaxed at the same time. He called this concept reciprocal inhibition. An incompatible response, e.g., relaxation is then to be selected to replace anxiety. With practice a therapy patient can learn to have a relaxation response follow the anxiety trigger. As the therapy progresses, the behavior therapist has the psychotherapy patient gradually work up the fear or anxiety hierarchy, until the patient can successfully cope with even the most intense anxiety trigger.
Behavior Therapy (BT) has been effectively applied to numerous disorders, e.g., Autism, major depression, and the clinical applications include prolonged exposure therapy, exposure with response prevention (ERP), assertiveness training, contingency management techniques, behavioral activation, Problem Solving Therapy, Functional Analytic Psychotherapy, Applied Behavior Analysis (ABA), and Acceptance and Commitment Therapy (ACT).
Rational Emotive Behavior Therapy (REBT) and Cognitive Therapy
Albert Ellis, a clinical psychologist, began conducting psychotherapy after being trained as a psychoanalyst. He eventually changed his approach and incorporated lessons from philosophy into a therapeutic technique, whereby he encouraged therapy patients to adopt more rational beliefs about themselves, a particular situation, others, the world and the future. He proposed that by changing changing irrational beliefs to more rational beliefs, therapy patients could change their emotions. For example, a client with the proper therapeutic intervention or tools learned in therapy, could challenge the belief that she would be a failure if she failed her cell biology final and it would be awful if she received a C in the course. She would then replace those irrational beliefs with something more realistic or rational like, “It may be accurate that I failed that final, but I don’t become a failure for failing an exam. And it may be really bad if I receive a C in the course, sense that will keep me from reaching my goal of an A average, but it is not truly awful.” With rational beliefs about a negative event, a negative emotional state will still occur. For example, irrational beliefs about a potential bad grade may produce anxiety, while rational beliefs would produce concern. Removing emotions or changing negative ones to positive ones as the consequence of a negative activating event is not the goal. It would not be adaptive to feel joyous after failing to meet a goal. According to Ellis’ Rational Emotive Behavior Therapy (REBT), healthy negative emotions, e.g., concern, disappointment, sadness, etc. can motivate adaptive behaviors. Disappointment after a poor grade may encourage more preparation before the next exam. But unhealthy emotions such as panic, depression, or rage are likely to be followed with self-destructive behaviors. Ellis called this model of events, beliefs, and consequences (emotional and behavioral) the ABC model. A stands for activating events, “B” for beliefs (rational and irrational), and “C” for consequences (emotional and behavioral). This ABC model has been adopted by many cognitive behavior therapists.
Aaron T. Beck, a psychiatrist, developed a similar therapy that emphasized the role of cognition on emotional states and behaviors. Beck’s original work focused on the clinical issue of depression. Beck helped his psychotherapy patients become keenly aware of different types of cognitions, e.g., automatic thoughts, cognitive distortions, core beliefs, and schemas. Again one of the targets emphasized in his cognitive therapy (CT) is challenging the cognitive distortions in order to make them more realistic and helpful. In the case of depression, he proposed therapists should focus on cognitive distortions about the self, world, and future. This is now called the Cognitive Triad. As is true with Ellis’ Rational Emotive Behavior Therapy (REBT), Cognitive Therapy (CT) also included more behavioral technique such as activity scheduling. Many proponents of Beck and Ellis’ cognitive theories of emotion believe the mechanism of change is cognitive restructuring, i.e., changes in cognitions produce changes in emotions in these treatments. While there is little argument that these treatments can be effective at reducing anxiety and depressive symptoms, many behaviorists believe the mechanisms of change are not solely cognitive, but rather rely on the behavioral learning principles identified above in the section on behavior therapy. The mechanism of change is one of the biggest reasons for disagreement between the more cognitive therapists and those who ascribe to behavioral therapy. Nonetheless, most people view cognitive and behavior therapists as operating under one large umbrella, Cognitive Behavior Therapy (CBT).
References for Cognitive Behavior Therapy (CBT)
Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.
Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Carol Publishing Group.
Walen, S. R., DiGiuseppe, R. A., & Dryden, W. (1992). A practitioner’s guide to Rational-
Emotive Therapy (2nd ed.). New York: Oxford University Press.
New York City Cognitive Behavior Therapy Practice
CBT Therapy and Research
CBT Therapy and Research
Dr. Fuller’s weekly psychotherapy sessions cover the areas of Anxiety Treatment, Anger Management, Cognitive Behavior Therapy for Depression, and Behavioral Weight Loss. He has published in the area of Positive Psychology, Weight Loss after Bariatric Surgery, Cognitive Behavior Therapy (CBT), and Rational Emotive Behavior Therapy (REBT). Clinically, Dr. Fuller seeks to reinforce adaptive behaviors; identify, understand, and enhance character strengths, and to improve the quality of relationships as well as to clarify values. Overall these steps are taken to improve life satisfaction, not exclusively reduce clinical symptoms, but rather help clients live meaningful lives.
Dr. Fuller’s private practice is located at 380 Lexington Avenue, Suite 1619, New York, NY 10168. Cognitive Behavior Therapy (CBT) sessions at this location take place between 10:00 am and 9:00 pm Monday through Friday. If weekends are of interest please call to inquire and a referral can be made.