A Short History of Cognitive Behavioral Therapy

The basic assumption of Cognitive Behavioral Therapy (CBT) is that one's thoughts influence one's emotions and behaviors, and that if negative thoughts are altered, negative emotions and behaviors will be altered, as well. What follows is a brief history of CBT, and an explanation of what is done in this kind of therapy.

CBT's earliest originators were behaviorists, Pavlov, Watson, Skinner, and Eysenck, to name a few, who paved the way for the behavioral treatment of mental disorders. Behavioral modification is a technique that utilizes reinforcement and punishment, both positive and negative, to alter an individual's behavior and reaction to stimuli. Behavioral therapies, in their strictest form, do not allow for examination of an individual's thoughts, and focus only on behaviors that are directly observable.

However, in the 1960's and 1970's, others began to reconsider the role of cognition in psychiatric disorders. Albert Ellis developed rational emotive behavior therapy (REBT), which postulates that emotional distress primarily originates from one's evaluations of an event, not from the event itself. Similarly, Aaron T. Beck developed Cognitive Therapy, which theorizes that an individual's affect and behavior are determined largely from the way he or she "structures the world" based on attitudes and assumptions derived from previous experience. Subsequently, behavioral modification and cognitive therapy techniques were merged to form Cognitive Behavioral Therapy.

Beck's Cognitive therapy is considered a form of CBT because it has always included behavioral components. Beck postulates that a person's cognitions are based on his or her schemas; that is, stable cognitive patterns through which he or she interprets events. Individuals develop schemas about themselves, others, and the future based on early life experiences. Schemas may be relatively inactive for long periods of time, but can be triggered by specific environmental circumstances such as a stressful life event. Once activated, an individual will screen out and interpret information based on the underlying schema, which may lead to systemic errors in the person's thinking. For example, if one's early life experiences are characterized by negativity, he or she may develop a dysfunctional schema that calls attention to negative life events while dismissing positive ones. Such errors in thinking serve to maintain an individual's belief in the veracity of their maladaptive beliefs even in the face of incongruous evidence.

CBT generally begins with educating the client about the CBT model and the idea that one's emotions and behaviors are influenced by one's thoughts and perceptions of an event. Clients are then trained to identify and evaluate their cognitions, including automatic thoughts, intermediate beliefs, and core beliefs. Training in identifying cognitions begins by eliciting automatic thoughts in session and teaching the client how to do so. These thoughts are then evaluated for how true or adaptive they are, since many automatic thoughts are dysfunctional. This is done by use of disconfirming evidence and by identifying cognitive distortions. Then, the client is taught to identify adaptive responses to their maladaptive thoughts. These skills are taught in session and then are carried out by the client outside of session as homework. The ultimate goal of CBT is for the client to be able to independently be able to identify, challenge, and alter their maladaptive thoughts. For depressed clients, behavioral interventions such as pleasurable activity scheduling, to behaviorally activate the client and increase enjoyment, are often utilized. Skills training, such as assertiveness or communication training, and relaxation techniques are also used when appropriate.