Cognitive behavioral therapy (CBT) is a type of psychotherapy which has become a crucial part of psychology. While it was originally formulated as a treatment for depression, it is now involved in the treatment of many different disorders.
This article will define CBT, present a brief historical overview of CBT, and finally discuss how CBT is being used in the world of psychology today, including the development of positive CBT. Whether you have never heard of CBT or are very familiar with it as a treatment for depression, this article should help deepen your understanding of the practice.
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What Is Cognitive Behavioral Therapy? 5 Definitions
Before we begin discussing cognitive behavioral therapy, it is a good idea to define it first. Here are a few definitions of CBT from some different psychology organizations, and one traditional dictionary definition. The following definitions of CBT are in no particular order.
- According to the Mayo Clinic, CBT is “a common type of talk therapy (psychotherapy). You work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.”
- According to the Beck Institute, CBT is “a time-sensitive, structured, present-oriented psychotherapy directed toward solving current problems and teaching clients skills to modify dysfunctional thinking and behavior.”
- The National Alliance on Mental Illness (NAMI) says that “Cognitive behavioral therapy (CBT) focuses on exploring relationships among a person’s thoughts, feelings and behaviors. During CBT a therapist will actively work with a person to uncover unhealthy patterns of thought and how they may be causing self-destructive behaviors and beliefs.”
- According to the National Health Service (NHS) of England, “CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle. CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts. You’re shown how to change these negative patterns to improve the way you feel. Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past. It looks for practical ways to improve your state of mind on a daily basis.”
- Finally, according to the Merriam-Webster dictionary, CBT is “psychotherapy that combines cognitive therapy with behavior therapy by identifying faulty or maladaptive patterns of thinking, emotional response, or behavior and substituting them with desirable patterns of thinking, emotional response, or behavior.”
These definitions have a lot of overlap, and it seems in general that we can define CBT as a structured type of psychotherapy that involves dealing with a patient’s beliefs in order to change the way they think and react to the things happening around them. Several of these definitions also stress the fact that CBT is focused on current thoughts and events rather than those in the past.
So now that that is settled, how and why was CBT originally developed?
How Did CBT Come Into Existence?
Cognitive behavioral therapy as we know it first came about when Aaron Beck, a psychoanalyst at the University of Pennsylvania Medical School, attempted to find an empirical basis for the psychoanalysis treatments that were being used for depression at the time (Beck, 2011). While doing this, Beck could not find an empirical basis for psychoanalysis, but he did found out that cognition (and specifically negative thoughts) played a major role in depression.
This cognitive role was not reflected in contemporary psychoanalysis treatments at this time. Following this finding, Beck developed the then-called cognitive therapy, a:
“structured, short-term, present-oriented psychotherapy for depression, directed toward solving current problems and modifying dysfunctional thinking and behavior.”
The basic idea behind CBT is that people with depression have a set of beliefs about themselves. These beliefs cause them to automatically have negative thoughts in response to adversity, and these thoughts cause them to retreat within and become further depressed.
Beck felt that this contradicted contemporary thinking about depression, as he felt that treatments for depression at the time focused too much on previous experiences rather than on current day-to-day beliefs and experiences. By realizing the importance of cognition and day-to-day thinking in depression and depressive symptoms, Beck revolutionized the treatment of depression.
Eventually, this shift in thinking also made its way to other disorders as CBT started being used as a treatment for non-depression disorders, which we will discuss later in this article.
Beck shared his findings with his colleagues at the University of Pennsylvania, and they found similar success treating their patients with cognitive behavioral therapy (which was then just called cognitive therapy). This led Beck and his colleague John Rush to run a study comparing the efficacy of this new therapy to the drug imipramine, an antidepressant, and found the two treatments to be similarly effective.
From there, Beck and his colleagues were confident that CBT had potential as a treatment for depression, so they published a cognitive therapy treatment manual and (what would come to be known as) CBT started gaining acceptance beyond the University of Pennsylvania Medical School in the greater field of psychology.
Who Is The Founder?
As mentioned above, Beck was the psychologist who first conceptualized what we now know as cognitive behavioral therapy. Like all scientists, however, he did not do this without help, and he was inspired by a wide range of thinkers, from ancient philosophers like Epictetus to psychoanalysts before him like Karen Horney, Alfred Adler, and many others (Beck, 2011).
Within the University of Pennsylvania, Beck’s colleagues Rush, Brian Shaw and Gary Emery were crucial in helping develop and define CBT, particularly helping define it for a wider audience with the cognitive therapy treatment manual they published.
It should also be noted that behavior therapy far preceded Beck, as John B. Watson and Rosalie Rayner were doing work involving behavior therapy as far back as 1920 with their landmark “Little Albert” experiment (Watson & Rayner, 1920).
Behavioral therapy continued to be researched by many psychologists including B.F. Skinner (Skinner, 1974) and Joseph Wolpe (Wolpe, 1976), to name just a few. Behavioral therapy and related research included varying levels of integration with cognition, with some behaviorists trying to merge cognitive and behaviorist schools of thought and others outright rejecting cognition.
Therapy focusing on cognition itself also pre-dated Beck, including such work as Albert Ellis’s rational emotive therapy (Ellis & Sagarin, 1965). It was Beck’s cognitive therapy, however, which came to be embraced by behaviorists, eventually leading to the therapy being called CBT rather than just cognitive therapy.
Since the line from modern-day CBT can most easily be drawn back to Beck’s work, it is fair to consider him the founder of CBT, though it is also important to understand that he did not conceptualize cognitive therapy by himself out of thin air.
How Is CBT Being Applied?
Although it was originally intended as talk therapy for depression, CBT is now widely applied in other situations. For example, it is increasingly common for studies looking at CBT to examine CBT delivered in an online setting rather than an in-person setting (Noguchi et al., 2017, Spence et al., 2017, Vigerland et al., 2017). CBT can also be administered through telephone interactions (Sockalingam et al., 2017), showing the diverse delivery methods CBT has been applied to beyond the originally-intended in-person therapy session.
Aside from being applied in different settings than it was initially developed for, CBT is also being applied to all sorts of disorders beyond the original target of treatment, which was depression. One recent pilot study looked at using CBT either pre- or post-bariatric surgery to control eating pathology and general well-being (Sockalingam et al., 2017).
Another recent study looked at using CBT to help cancer patients increase their levels of cognitive function (Kucherer & Ferguson, 2017). CBT has also been used for the treatment of anxiety, particularly anxiety among youth (Spence et al., 2017, Vigerland et al., 2017). Finally, CBT has even been looked at as a possible treatment for auditory hallucinations among patients with schizophrenia (Kennedy & Xyrichis, 2017).
One of the most exciting and promising areas of application for CBT is in schools. It is easy to imagine how harmful unchecked beliefs can be for children, such as the idea “I’m just bad at math, I can’t help it”. One interesting study looked at using CBT in primary schools as a preventative measure to reduce anxiety (Stallard et al., 2014). The authors found that teaching CBT-inspired skills to elementary school children helped them have lower levels of anxiety, regardless of their initial anxiety level. This indicates that even introducing CBT into schools indiscriminately can help students with anxiety.
As CBT has been applied into the school environment, it follows that CBT can be useful in a work environment as well. One study looked at using CBT to help office workers who were having trouble with insomnia (Yamamoto et al., 2016). The authors found that even a single 90-minute intervention could help reduce both insomnia levels and general levels of distress for the workers in this study. For this 90-minute intervention, the study used a sleep education program based on a specific type of CBT developed for insomnia (CBT-i), which shows how CBT can be customized for very particular purposes.
CBT has even been investigated as a possibly useful tool for prisoners. One study looked at using CBT among smokers in prison and found that a 10-week CBT program was more effective in helping prisoners quit smoking than a traditional counseling program of the same length (Onyechi et al., 2017).
Another study looked to use CBT as a way to reduce the extremely high rates of suicides among male prisoners (Pratt et al., 2016). The authors only looked at three cases from a larger randomized controlled trial, but concluded that CBT may help reduce suicide among male prisoners and that further research is warranted. These two studies investigating two very different situations that may occur in a prison show how CBT can be adapted for different purposes even within a community.
The above studies, which are just a fraction of the work currently being done with CBT, show how there are almost an infinite number of applications for CBT. These applications have grown far beyond the originally-intended use of CBT as a treatment for depression. Since CBT appears to have so much potential as a treatment plan, we should examine the value it could present for the field of psychology.
What Is Its Role In Psychology?
As mentioned above, CBT has expanded its reach beyond the traditional psychotherapy session, and it has also expanded its reach beyond depression. CBT is now considered a treatment option for several different types of disorders, and it is increasingly being looked to as an alternative to and a supplement to pharmacological interventions, with one example (beyond depression) being instances of attention deficit hyperactive disorder (ADHD) (Rajeh et al., 2017). As we saw above in the elementary school example, CBT has even been advocated as a preventative measure for anxiety.
Taken together, this means that CBT can be applied to a wide range of disorders (and even in cases where there is no disorder), and delivered in a variety of ways. It is clear that CBT has become a mainstream psychological treatment, and any practicing psychologist should have some knowledge of CBT.
CBT’s role in psychology is a major one, and it appears that its role will only continue to expand as more potential uses of CBT are researched and studied. It is not hard to imagine that eventually CBT could even be delivered in the form of a smartphone app (well, at least one developed by psychologists).
Aside from CBT’s present and future roles, we should also look to CBT’s past role in psychology. Specifically, CBT played a crucial role in redefining how depression is examined and treated. This role grew beyond depression, and CBT helped uncover the idea that mental health disorders can stem from very personal issues and specific conditions, so the treatment of various disorders should also be individualized to the patient being treated. This was part of an important movement in psychology that started focusing on personalized treatment plans rather than the “one size fits all” approach that is sometimes taken when treating physical illnesses.
Traditional vs. Positive CBT
The difference between traditional CBT and positive CBT is similar to the difference between traditional psychology and positive psychology. Where traditional psychology and traditional CBT focus on treating pathology, positive psychology and positive CBT focus on increasing well-being independent of pathology. This also means that positive CBT, like positive psychology, has a higher number of people that could potentially benefit from it.
On top of not focusing on treating any sort of disorder or pathology, positive CBT also has a slightly different method than traditional CBT. For example, while CBT traditionally focuses on maladaptive thoughts and beliefs and adjusting those thoughts and beliefs, positive CBT focuses on strengths and making the most of those strengths (Prasko et al., 2015). This focus on an individual’s strengths is in line with the more personalized-approach taken by CBT as opposed to earlier treatments for depression.
Although this section is headed “Traditional vs. Positive CBT”, one interesting thing is that positive CBT can actually be incorporated into a traditional CBT treatment program. That is, a traditional CBT program that is attempting to remedy dysfunctional thought patterns can also incorporate a positive CBT focus on strength finding.
In other words, not only can positive CBT help people increase their well-being independent of any sort of disorder or pathology, but it can also strengthen the treatment plan of someone who is dealing with a particular disorder. This further underscores the idea that positive CBT (much like positive psychology) can be beneficial to anyone.
A Take Home Message
The development of CBT revolutionized the treatment of depression by focusing on how people think about themselves and how they respond to external events. It did not take long for people to realize that this shift in thinking could be useful outside of depression, and today CBT is used for the treatment of all sorts of disorders.
As CBT continues to be applied in more and more situations, we can expect people with mental health disorders to develop healthier patterns of thinking about themselves, their abilities, and the world around them.
The development of positive CBT further increases the already wide reach of CBT by allowing it to be used by anyone who wants to increase their levels of well-being. As traditional CBT and positive CBT continue to grow alongside each other, it is hard to imagine an arena of life where CBT teachings would not be helpful, from school to work to home lives. What was once a re-imagining of the way that depression is treated might eventually become an important tool in daily life for just about everyone.
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