Cognitive Behavior Therapy: Child Clinical Applications

Definition

Cognitive behavior therapy (CBT) has become one of the most widely used therapeutic protocols with child, adolescent, and adult populations. The diversity of treatment components emerging from cognitive and behavioral theories makes it somewhat difficult to define CBT as a single entity. In general, this treatment approach combines techniques from cognitive and behavioral principles, unified by the perspective that psychopathology development and maintenance is associated with reciprocal relations between mal-adaptive cognitions, learned behaviors, physiological signals, and emotional responding. This mode of treatment holds that interdependent relationships between cognitions, emotions, and behavior are also central to the eventual efficacy of any CBT procedure. Briefly, CBT may best be summarized as a therapeutic attempt to change undesirable emotions using strategies to alter both the behaviors and maladaptive cognitions associated with those emotions. CBT protocols for child populations typically focus on teaching children how to (a) recognize and monitor their own behaviors, thoughts, and feelings associated with psychopathology, (b) recognize the relationships between these three components of psychopathology, (c) examine the evidence supporting or refuting distorted thoughts, and (d) replace distorted thinking and maladaptive behaviors with more flexible and positive coping mechanisms.

History and Development of CBT

Although consideration of cognitive processes was evident in the writings of William James and other early psychologists, such covert processes were of little appeal to early behavior theorists and clinicians who generally preferred to focus upon the observable and more easily definable aspects of behavior. This school of behaviorism evolved from the combined influences of many scientists, including the initial work of Ivan Pavlov in the 1900s, as well as Edward Thorndike, John Watson, B. F. Skinner, and George Miller, among others. However, with the notable exception of vivid demonstrations regarding the evolution and reduction of childhood fears by John Watson and Mary Cover Jones, behaviorally informed interventions for children, largely based upon a well-developed set of classical and operant conditioning techniques, were not particularly popular prior to the 1950s.

In the meantime, CBT was born in the midst of an era when psychoanalytic principles appeared to be falling out of favor and behavior therapy techniques were being challenged for potential weaknesses in the [Page 768]treatment of psychological disorders with prominent, covert features. Important to the evolution of CBT, Albert Bandura and his research on vicarious learning and self-efficacy assisted in a shift around this time from a primary focus on purely behavioral techniques to acknowledgment of some greater cognitive influence in behavior change. In addition to the contributions of Bandura, several distinct treatment approaches and the theoretical views of their developers fueled an increasing interest and focus on CBT as a viable therapeutic alternative for clinicians, including Albert Ellis's rational-emotive therapy, Aaron Beck's cognitive therapy, the behavior modification contributions of Michael Mahoney's personal science, and Donald Meichenbaum's stress inoculation training. Cognitive models, such as Beck's and Ellis's, emphasized the role of irrational, distorted cognitions in the development and maintenance of psychological disorders. More behaviorally oriented researchers adapted existing behavioral strategies such as graduated task assignment, reinforcement, and modeling to modify both overt and covert problem behaviors. Although not often mentioned, the schools of psychoanalysis, phenomenology, philosophy, and neuroscience are also conceptual contributors to CBT as we know it today.

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