Cognitive Behavior Therapy

Description of the Strategy

Cognitive behavior therapy (CBT) is a form of psychotherapy that blends strategies from traditional behavioral treatments with various cognitively oriented strategies. It is different from other forms of [Page 187]psychotherapy (e.g., traditional psychodynamic psychotherapies) in that the focus of treatment is on changing the behaviors and cognitions that are thought to be currently maintaining a problem, rather than on helping a client to gain insight into the early developmental factors that may have initially set the stage for developing the problem.

The boundaries of CBT are somewhat unclear. Different practitioners and researchers often use terms such as cognitive behavior therapy, behavior therapy, and cognitive therapy in different ways. For some professionals, these terms are used interchangeably. For others, they have very different meanings. For the purpose of this entry, the term cognitive behavior therapy is used in its broadest sense, including strategies that are traditionally derived from a behavioral framework, as well as strategies developed by cognitive theorists. Relevant strategies include techniques such as exposurebased therapies for anxiety disorders, cognitive restructuring, behavioral experiments, relaxation training, reinforcement-based treatments, assertiveness training, and many others. Often, combinations of these treatments are used to target different aspects of a client's problem.

The marriage of cognitive and behavioral approaches makes sense in light of the many features they share. For example:

• Cognitive and behavioral therapies are both conceptually based on established principles from basic psychological science (e.g., learning theory, cognitive science).
• The effectiveness of cognitive and behavioral therapies can both be understood from a common conceptual framework. For example, exposure therapy (a traditional behavioral treatment for phobic disorders) and cognitive restructuring (teaching people to change negative patterns of thinking) may both work by changing ways in which clients process information.
• Cognitive and behavioral therapies are both action oriented. That is, they require clients to behave in new ways, in order to change maladaptive patterns of interacting with their environments.
• Cognitive and behavioral treatments are both typically brief, lasting several months.
• Both approaches to treatment are problem focused and goal driven. That is, they begin with identifying particular problems and goals for treatment, and the process of treatment is designed to alleviate the identified problem and to help the client achieve the changes he or she seeks. For example, treatment goals for a person with obsessive-compulsive disorder (OCD) might be to reduce the frequency and severity of obsessional thoughts and compulsive behaviors.
• Cognitive and behavioral treatments are both transparent. That is, the client is provided with an explanation of the conceptual foundations and practical steps underlying the strategies that are used.
• Structured homework assignments are an important component of both behavioral and cognitive treatments. Homework may include activities such as practicing particular techniques (e.g., relaxation training), conducting behavioral experiments, and completing cognitive-monitoring diaries.
• Both approaches to treatment have a strong empirical basis, having been studied in hundreds of controlled clinical trials for a wide range of problems. Therapists are also encouraged to collect data with each client, in order to assess the effectiveness of particular strategies that are being used.

Historical and Conceptual Foundations

Modern CBT has its roots in the 1950s and 1960s, when several psychologists and psychiatrists, working in South Africa, England, and the United States, began to study the use of interventions based on principles of learning theory. A growing dissatisfaction with psychoanalysis, as well as increased interest in learning theory among basic scientists in psychology, set the stage for the development and proliferation of behavior therapy. Before long, thanks to the work of pioneers such as Hans Eysenck, Cyril Franks, Arnold Lazarus, Isaac Marks, S. Rachman, G. Terence Wilson, and Joseph Wolpe, behavior therapy became an established form of treatment that included exposure-based strategies, techniques based on classical and operant conditioning, and other strategies aimed at directly changing problem behaviors.

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