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The history of cognitive behavior therapy

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Cognitive behavior therapy (CBT) is one of the major orientations of psychotherapy (Roth & Fonagy, 2005) and represents a unique category of psychological intervention because it derives from cognitive and behavioral psychological models of human behavior that include for instance, theories of normal and abnormal development, and theories of emotion and psychopathology. There are several available cognitive and behavioral psychotherapies of which are based on concepts, theories and principles obtained from psychological models of human emotion and behavior. Cognitive behavior therapy involve diverse range of care or treatment addressing emotional disorders, provision of self-help material and a structured individualized psychotherapy. The most common approaches to cognitive behavioral therapy employed by mental health professions include: rational emotive, cognitive and multimodal therapy (British Association for Behavioural and Cognitive Psychotherapies 2005.).

The concept underlying cognitive behavioral therapy is that human thoughts and feelings play a crucial in our behavior. For instance, persons who most often thinks about drowning in water, or involved in plane crash may finally affect their behavior of not going to swim or avoid travelling by airplanes. The main objective of cognitive behavior is to guide and teach clients or patients that despite it is impossible to control everything in their environment however they can take control and regulate how they understand, interpret and also deal with things in their environment. This concept is most often branded as self-regulation or self-control (Kanfer 1971.). Cognitive behavioral therapy is mostly employed to treat a wide range of mild disorders, including phobias, addiction, depression and anxiety. Contemporary research reveals cognitive behavioral therapy is very effective in treating mild, moderate, and severe mental health symptoms (DeRubeis et al., 2005.) and that it is equally as effective as administering psychotropic medications in the short term, and that it is significantly more effective than psychotropic medications in the long term period (Hollon, Stewart, & Strunk 2006.).

There basically two theoretical approaches that cement the foundation of cognitive behavioural theory, namely: cognitive theory and behavioral theory. The core focus of cognitive theory is on thinking and the manner in which our thought content and styles of information processing are associated with our mood, physiological responses, and behaviors. According to cognitive theory, the manner in which we think about, perceive, interpret, and/or assign judgment to particular situations in our lives affects our emotional experiences. Two people can be faced with similar situations, but because they think about those situations in different ways, they have very different reactions to them. The process of identifying and modifying problematic cognitions is only one way to achieve meaningful modification in patient’s mental disorder.

Cognitive behavioral therapists also focus their work directly on maladaptive or inappropriate behavior. According to Lewinsohn’s behavioral model (Lewinsohn, Sullivan, & Grosscup 1980.), there are two behavioral patterns associated with depression usually a low rate of response or contingent positive reinforcement and a high rate of punishment. Positive reinforcement is defined as person-environment interactions associated with positive outcomes or make a person feel good. One central principle of Lewinsohn’s behavioral theory is that depressed individuals do not receive sufficient positive reinforcement from interactions with their environment in order to maintain adaptive behavior. According to Addis and Martell 2004 lamented that this pattern results in a vicious cycle exhibited by less actively involved in their environment and they become depressed and symptoms such as fatigue and inability to experience pleasure from joyous activities (anhedonia). The more depressed they become, the less they engage in activities and interactions that they usually enjoy, which further strengthens depression and its related symptoms.

Cognitive behavior therapy is generally for a short period of time mostly organized meeting or sessions (short-term) and focused on supporting and assisting clients deal with very specific problem. CBT also focuses mainly on what the individual feels and how she is coping in the present. However, feelings and behavior are often determined by past experiences. For example, the present focus for the individual described in the goal-setting section would be the beliefs and fears she has about going out in public. During the course of treatment, clients learn to identify and change destructive or disturbing thought patterns that have negative effect on behavior. This stage, known as functional analysis, is important for learning how thoughts, feelings and situations can contribute to maladaptive behaviors. Cognitive behavioral therapy is also based on a conceptualization and understanding of individual patients especially their specific beliefs and patterns of behavior. The practitioner investigates in a variety of ways to produce cognitive modification in the patient’s thinking and belief system to induce lasting emotional and behavioral change. Many patients exhibit significant improvement after 4 to 18 sessions of CBT (Hirsch, Jolley, & Williams, 2000).

Clients and therapists work together, the moment a therapeutic alliance is formed, to identify and understand problems in terms of the relationship between thoughts, feelings and behavior. The relationship between a qualified cognitive behavioral therapy practitioner and individual seeking treatment is collaborative. They collaborate together to seek to understand the person’s difficulties and what may be triggering or affecting it. The practitioner is an expert on CBT whereas the individual is considered to be an expert on her own life and experiences. During therapy, both of them work together to generate and try out new ways for the person to think and behave.

After identifying the individual’s problems, it is essential for the responsible practitioner and client to set agreeable and achievable goals together to deal with these problems. The goals and strategies are continually monitored and evaluated. For instance, a depressed person with social phobia especially anxiety in public places, may set small goals like going out from the house 2-3times a week so as to gradually decrease anxiety and to reduce discomfort in public areas(Centre for Applied Research in Mental Health and Addictions 2007.). During cognitive behavioral therapy case conceptualization, the therapist and patient collaboratively choose specific behavioral and cognitive strategies that are most likely to be successful in addressing the patient’s key automatic thoughts, beliefs, or behaviors. Behavioral strategies include activity monitoring, activity scheduling, behavioral activation, graded task assignments, and relaxation and breathing strategies.

The second part of cognitive behavior therapy focuses on the actual behaviors that contribute to the problem. The client begins to learn and practice new skills that can then be put into use in real-world situations. For example, a person suffering from drug addiction might start practicing new coping skills and rehearsing ways to avoid or deal with social situations that might trigger a relapse. During the later phase of treatment, the CBT therapist and her patient review progress toward the treatment goals established during the initial phase of treatment, summarize and consolidate the skills learned during the middle phase of treatment, and plan for the continuation or termination of treatment

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