What is CBT?
The American Psychological Association defines cognitive behavior therapy (CBT) as:
[A] form of psychotherapy that integrates theories of cognition and learning with treatment techniques derived from cognitive therapy and behavior therapy. CBT assumes that cognitive, emotional, and behavioral variables are functionally interrelated. Treatment is aimed at identifying and modifying the client’s maladaptive thought processes and problematic behaviors through cognitive restructuring and behavioral techniques to achieve change.
Techniques of this psychotherapeutic modality were what I began using, albeit without education or training, when I started life coaching in the ‘90s. As well, many of these techniques were present when modifying how I coached people through my military service in the Marine Corps.
Noteworthy, the National Alliance on Mental Illness states of CBT:
The core principles of CBT are identifying negative or false beliefs and testing or restructuring them. Oftentimes someone being treated with CBT will have homework in between sessions where they practice replacing negative thoughts with more realistic thoughts based on prior experiences or record their negative thoughts in a journal.
My rudimentary CBT skills were refined when receiving formal education while working toward a Master of Arts in Counseling Degree (2011). At that time, I focused mainly on Rational Emotive Behavior Therapy (REBT) which was developed by the late psychologist Albert Ellis.
Importantly, there are a number of modalities which fall under the umbrella of CBT. Discussing this matter, one source states:
There are a number of different Cognitive Behavior Therapies, and a number of Behavior Therapies which may be included by some under CBT as well, even if their developers believe they are more accurately identified as Behavior Therapies, like Acceptance and Commitment Therapy (ACT). Some forms of Cognitive Behavior Therapy (CBT) you may encounter include:
· Cognitive Processing Therapy (CPT)
· Cognitive Therapy (CT)
· Dialectical Behavior Therapy (DBT)
· Rational Emotive Behavior Therapy (REBT)
· Self-Instructional Training
· Stress Inoculation Training, etc.
Although some may disagree with the comparison, I think of CBT like the Department of Defense under which I once served. Under that umbrella is the Army, Navy, Air Force, Marines, etc. As disputed as this example may be, it has nothing on how contested the origin story of CBT is.
Contested origin story of CBT
Per a statement from the Albert Ellis Institute, “REBT is the pioneering form of cognitive behavior therapy developed by Dr. Albert Ellis in 1955.” This claim is contrary to what another source asserts, “In the 1960s, Aaron Beck developed cognitive behavior therapy (CBT).”
Regarding this discrepancy, Ellis stated in a 1996 interview:
[…] REBT which was the first of the major cognitive behavioral therapies since I created it in 1955 and then about ten years later Aaron Beck came along and Donald Meichenbaum, and then William Glasser and others who have somewhat similar systems. But they don’t emphasize the musts, the shoulds, and the oughts as much as we do. They go after irrational beliefs but they often miss the core beliefs, “I must do well, you must treat me well, and things must be easy.”
Nevertheless, per a statement from the Beck Institute for Cognitive Behavior Therapy, “Dr. Aaron T. Beck is globally recognized as the father of Cognitive Behavior Therapy (CBT).” As such, there appears to be some manner of disagreement as to who actually initiated the development of CBT. According to Wikipedia:
One of the first therapists to address cognition in psychotherapy was Alfred Adler, notably with his idea of basic mistakes and how they contributed to creation of unhealthy behavioral and life goals. Abraham Low believed that someone’s thoughts were best changed by changing their actions. Adler and Low influenced the work of Albert Ellis, who developed the earliest cognitive-based psychotherapy called rational emotive behavioral therapy, or REBT. The first version of REBT was announced to the public in 1956.
In the late 1950s, Aaron T. Beck was conducting free association sessions in his psychoanalytic practice. During these sessions, Beck noticed that thoughts were not as unconscious as Freud had previously theorized, and that certain types of thinking may be the culprits of emotional distress. It was from this hypothesis that Beck developed cognitive therapy, and called these thoughts “automatic thoughts”. He first published his new methodology in 1967, and his first treatment manual in 1979. Beck has been referred to as “the father of cognitive behavioral therapy”.
It was these two therapies, rational emotive therapy, and cognitive therapy, that started the “second wave” of CBT, which emphasized cognitive factors.
Worth noting, after earning a Master of Science in Social Work degree (2014), I continued exploration into REBT literature until receiving training for the modality from the Albert Ellis Institute in 2021. At that time, REBT trainers declared that REBT was the original form of CBT.
What are the tenets of CBT?
Given mixed responses concerning the origins of CBT, and regarding how irrelevant this matter likely is to some people, I find value in instead discussing the tenets of CBT. According to one source, the three levels of cognition in CBT are as follows:
1. Core beliefs
Our core beliefs are informed by our childhood experiences. They are deeply rooted in how we view ourselves, our environment, and the future, along with our beliefs about these factors.
2. Dysfunctional assumptions
Humans tend to hold onto the negative more easily than the positive. However, these cognitive distortions are irrational thought patterns that distort our perceptions of reality.
3. Automatic negative thoughts
Automatic negative thoughts are involuntary negative perceptions of reality that occur out of habit. They can be difficult to recognize since they are brief and cause negative emotions.
Essentially, cognitions (thoughts or beliefs) impact the manner in which a person feels (emotions or bodily sensations) and behaves (acts). This is precisely how REBT functions, as well.
Still, one source elucidates, “CBT aims to change how a person thinks (‘cognitive’) and what they do (‘behaviour’). CBT therefore uses both cognitive and behavioural techniques. The specific interventions chosen depend on the individual’s formulation.”
Rather than addressing healthy negative emotions (e.g., sorrow with the loss of a loved one), CBT targets unhealthy negative emotions (e.g., despair associated with loss of an intimate partner). In particular, CBT addresses cognitions which create these emotions. According to one source:
CBT is based on several core principles, including:
1. Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
2. Psychological problems are based, in part, on learned patterns of unhelpful behavior.
3. People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.
Thus, CBT isn’t a passive psychotherapeutic modality in which a clinician uses minimal encouragers (i.e., mhmm, uh huh, go on, etc.) as a client spends the entire session discussing grievances. Expanding upon this assertion, one source states:
· CBT is based on an ever-evolving formulation of the patient and her problems in cognitive terms.
· CBT requires a good client-therapist relationship.
· CBT emphasizes collaboration and active participation.
· CBT is goal-oriented, and problem focused.
· CBT initially emphasizes the present.
· CBT is educative; it aims to teach the client to be his/her own therapist and emphasizes relapse prevention.
· CBT aims to be time limited.
· CBT sessions are structured.
· CBT teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs.
· CBT uses a variety of techniques to change thinking, mood, and behavior.
I’m able to link much of my blog content to the aforementioned source, because there’s substantial crossover between core CBT and REBT. Thus, I’ll now offer a brief explanation of REBT.
REBT
From the perspective of REBT, there are four major dysfunctional beliefs: demandingness, awfulizing, frustration intolerance, and global evaluations which manifest in negative ratings of self, others, and life in general. As well, there is a specific manner in which these factors of self-disturbance are addressed.
REBT theory uses the ABC model to illustrate how when Activating events (“Actions”) occur and people maintain irrational Beliefs about the events, these unhelpful assumptions – and not the actual occurrences – are what create unpleasant cognitive, emotive, bodily sensation, and behavioral Consequences.
Addressing the four major dysfunctional beliefs, the ABC model incorporates Disputation of unhelpful assumptions in order to explore Effective new beliefs. This process functions much in the same manner as CBT’s challenging of core beliefs, dysfunctional assumptions, and automatic negative thoughts.
From a psychological standpoint, people disturb themselves using a Belief-Consequence (B-C) connection. Of course, this isn’t to suggest that in the context of the naturalistic or physical world there is no Action-Consequence (A-C) connection.
If a bee stings you (Action), you may feel pain (Consequence). Still, if you live through the experience and unproductively Believe, “That shouldn’t have happened to me,” then you’ll likely disturb yourself into an unpleasant emotional or behavioral experience (Consequence).
Thus, REBT helps people to stop upsetting themselves from use of B-C connections. If there were a mathematical formula for the ABC model, it would be something like: Action + Belief = Consequence ÷ Disputation = Effective new belief.
Furthermore, REBT uses the technique of unconditional acceptance to relieve suffering. This is accomplished through use of unconditional self-acceptance, unconditional other-acceptance, and unconditional life-acceptance.
Additionally, a foundational component incorporated into REBT relates to Stoicism—a philosophical practice valuing four virtues (wisdom, courage, temperance or moderation, and justice) as a means of achieving eudemonia—a life well-lived. All of these techniques require frequent practice.
Conclusion
In one form or another, I’ve practiced CBT techniques since the ‘90s. Even though I wasn’t initially aware of how interrelated cognitive, emotional, and behavioral variables were, I advocated cognitive restructuring and behavioral techniques to achieve change.
It wasn’t until my first graduate school experience that I learned a form of CBT when focusing my studies on the psychotherapeutic modality of REBT. Although the origins of CBT remain heavily contested, Ellis claimed to have developed the model before Beck.
Irrespective of quibbles related to psychological theorists and practitioners, I value the tenets of CBT. Unsurprisingly, these principles significantly overlap with elements of REBT. Expanding on this matter, one source offers:
Both CT [cognitive therapy] and REBT have contributed enormously to the success of CBTs, in fact they have been its linchpins. Both have demonstrated efficacy across a wide range of settings.
Both address maladaptive thinking to improve psychological, emotional and behavioural outcomes among clients. They diverge in some of their methods, however. REBT is a more philosophical, humanistic, and largely transdiagnostic approach.
REBT focuses on disputing and weakening deeply held irrational beliefs which include demandingness, awfulizing, frustration intolerance and global rating. CT is in contrast rooted in empiricism and more closely aligned with psychiatric diagnoses.
It typically addresses higher-order thinking, such as automatic thoughts and inferences, and indeed intermediate beliefs, before core beliefs. It does not incorporate philosophy like REBT does but is not wholly unphilosophical. Indeed, it is moving in more philosophical directions.
Given this distinction, I value both CBT and REBT while preferring the latter to the former. Additionally, I offer mental, emotional, and behavioral health services strictly through the medium of teletherapy.
Some may question the efficacy of this delivery mechanism, given that much of the research in support of CBT and REBT has assessed effectiveness related to in-clinic or other in-person mediums. Regarding teletherapy, one 2019 source helpfully clarified:
[Pim] Cuijpers and colleagues looked at a total of 155 studies with more than 15,000 patients. The study focused on CBT with the core component of cognitive restructuring (aimed at evaluating, challenging and changing a person’s inaccurate negative beliefs). Most of the treatments also included other components, such as behavioral activation, problem-solving, mindfulness and social skills training.
They found that individual, group, guided self-help and phone CBT were ranked best for effectiveness with little differences between them. They were more effective than going without treatment and more effective than unguided self-help. Unguided self-help was significantly less effective than the other formats but more effective than no treatment.
Whether or not a client desires CBT or REBT, it appears as though teletherapy is a reasonable approach to helping people concerning these modalities. Given the information addressed herein, are you ready to take the next step to challenging your unhelpful beliefs so that you may practice rational living?
If you’re looking for a provider who works to help you understand how thinking impacts physical, mental, emotional, and behavioral elements of your life—helping you to sharpen your critical thinking skills, I invite you to reach out today by using the contact widget on my website.
As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.
At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!
Deric Hollings, LPC, LCSW
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