It may be useful to define what is meant by the various terms cognitive theory, behaviorism, cognitive therapy, and cognitive-behavioral therapy (CBT). Theories of cognition are as old as the original foundations of psychology. Cognitive psychology was originally the study of internal mental processes. Wilhelm Wundt, a German psychologist and arguably the founder of psychology, used a method, in 1879, called introspection in which his subjects would be asked to reflect inwardly on their thought processes and respond outwardly with their observations. Hermann Ebbinghaus, also a German psychologist and Wundt's contemporary, published seminal experimental studies of learning and memory beginning in 1885. For approximately the next 4 or 5 decades, these studies would be subsumed under the rubric experimental psychology.
Beginning in the 1920s, John Watson, an American psychologist, founded the theory of behaviorism, which formally rejected Wundt's method of introspection, psychoanalysis, and any theory or practice that addressed unobservable or unmea-sureable traits or processes. Watson and behaviorism's subsequent proponents, like American psychologist B. F. Skinner, argued that psychology could only advance scientifically if it confined itself to observable behaviors that can be readily measured or counted. Skinner maintained this uncompromising stance until his death in 1990. He is considered to be the progenitor of operant conditioning, which holds that an organism's behaviors can be created and controlled by contingent reinforcement and punishment. Behaviorism had also earlier adopted the work of Russian physiologist Ivan Pavlov (1849-1936) who observed that natural behaviors (like fear) could be brought under control by new (novel) stimuli. The study of these procedures was called classical conditioning. Operant and classical conditioning became the two main theoretical pillars of behaviorism, although role modeling and imitation were added later.
However, there was growing discontent with the behaviorism paradigm because important mental processes such as language and grammar production, attitudes, beliefs, and desires were all largely ignored or considered unscientific endeavors by radical behaviorists. Eventually, their harsh stance led to the development of the broader discipline, cognitive psychology, which reembraced the study of internal mental processes and broadened to include learning and memory, intellect, attention, perception, reasoning, problem solving, creativity, as well as mental representations and symbols. More recently, many in this paradigm have recognized that the empirical methods and experimental designs of cognitive psychology have great application to the study of any mental state, its representations, and such processes as the manifest productions of introspection and phenomenology. Perhaps most important, these practitioners developed a set of techniques and strategies to aid in the treatment of psychological distress and mental disorders.
188 Chapter 7 Cognitive, Psychoanalytic, and Interpersonal Cognitive Therapy Basics
Cognitive therapy is a type of short-term psychotherapy that involves the recognition of distorted, illogical, or unhealthy thoughts with the goal of replacing them with less distorted and more logical and adaptive ones. The approach was typified in the 1950s and 1960s by Albert Ellis, who created Rational Emotive Behavioral Therapy, and Aaron T. Beck, who claims the specific rubric Cognitive Therapy. With the adoption of many of the behavioral techniques applied to psychopathological behaviors (e.g., use of homework assignments, trying out and evaluating new behaviors, role-playing and behavioral rehearsal, exposure strategies, and using positive and negative reinforcement to increase adaptive behaviors) in the cognitive therapy paradigm, the term cognitive-behavioral therapy became the more general term in the field. Indeed, the overlap between cognitive therapy and cognitive-behavioral therapy is great.
Beck, Ellis, and other cognitive-behavioral therapy proponents make similar suppositions. For example, these approaches assume that an individual's thinking and thought patterns are intimately connected to his or her feelings and behaviors. The theory suggests that an event, in and of itself, is not the cause of an emotional response, but rather it is how the individual interprets or perceives that event (i.e., cognitive processes) that causes an emotional reaction. Consider the death of a loved one as an example. It might be assumed that this death would automatically make someone sad and despondent, but that is not always the case. An older person who has died of a long, painful, and debilitating disease might not provoke the same feelings in their respective loved ones as would the death of a young healthy person in the prime of life. Indeed, in this example, whether we experience relief or intense despair depends on the meaning that we attach to the death. Thus, according to the theory, our attitudes and beliefs about an event give rise to our emotions and not the events themselves. It should be emphasized that this central concept is by no means a recent one: Centuries ago, Phrygian Stoic philosopher Epictetus (circa 101 a.d.) expressed his view in The Enchiridion, stating that "Men are disturbed not by things, but by the view which they take of them" (Epictetus, c. 101/1955). Modern-day cognitive theorists embrace this ancient notion that our thoughts profoundly influence our affect and behavior. Two important corollaries to this central tenet are that (1) cognitions can be monitored and changed and (2) by changing our thinking patterns or our attitudes or perspectives about an event, we can exert desirable changes in emotions and behaviors, even in situations in which we have little or no control over the external precipitant (Dobson & Dozois, 2001).
Cognitive-behavioral therapy is a time-limited approach and is considered a short-term psychotherapy, particularly in contrast to much longer treatments such as psychoanalysis or Jungian therapy. Cognitive-behavioral therapy is highly instructional and patients are frequently given homework assignments outside of the therapy sessions, which can also shorten the therapeutic process. Cognitive-behavioral therapy is also more akin to those who practice behavioral therapy in that, although the therapeutic relationship is deemed important to therapeutic outcomes, the relationship itself is not seen as the primary curative factor. Cognitive-behavioral therapists do believe in a trusting relationship between therapist and patient; however, they believe that a successful therapeutic outcome occurs when their patients learn to identify unhealthy thinking patterns and then alter their thoughts accordingly. Cognitive-behavioral therapists, therefore, emphasize the recognition of irrational and harmful thinking and the learning of self-counseling skills. The therapist and patient set goals collaboratively and then monitor progress toward the goals. Cognitive-behavioral therapists listen, encourage, and help patients learn and apply methods to challenge negative thinking, whereas the patient's role is to express concerns and implement the self-counseling techniques learned in treatment.
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