Cognitive and Behavior Therapy
As psychology gained the backing of science, the field of behavior and cognitive behavior therapy moved into the lime-light as useful, fast, and scientifically based models of change. Spotlighting the individual, and making the counselor more of a coach and teacher, rather than expert, moved the focus from one of sickness to one of problems that could be addressed. Counseling techniques from these perspectives leaked into education, and other aspects of mundane life. This technique addresses client behavior, but focuses on them as the cause of real change. Perhaps most importantly, these methods have been tested and found to be scientifically accurate and successful.
The Historical Context
Once the psychological community began to break away from Freud, they were able to re-examine human behavior in light of more humanistic truths, but with scientific backing. In the 1950’s, when behavior therapy was reintroduced as cognitive behavior therapy, it took into account changes of social mores in the community. Folks back from the war were settling in suburbs instead of urban or rural centers. The emerging middle class expected better for their children, and demanded social restructuring. The one room school house was changed in favor for large, regional schools as the population boomed. As population grew, problems in behavior developed or perhaps became more obvious. Society turned to science looking for answers, rather than psychoanalysts.
The Major Contributors
- Albert Ellis: “Ellis developed his approach in reaction to his disliking of the in-efficient and in-directive nature of Psychoanalysis. The philosophic origins of RET go back to the Stoic philosophers, including Epictetus and Marcus Aurelius. Epictetus wrote in The Enchiridion, ‘Men are disturbed not by things, but by the view which they take of them.’” (nabtc.org) Developed Rational Emotive Behavioral Therapy in 1955 and has been called the “grandfather of cognitive behavior therapy” (Corey).
- Albert Bandura: Pioneered social modeling and worked in developing theories of learning, particularly observational learning and social modeling. Founded social cognitive theory in 1986 (Corey). In particular, his work is important to educators and he is often taught in teacher training courses.
- Sees the individual as the producer and product of their own environment. Changes must be made by the client towards their behavior and themselves, not outward. Very action oriented, rather than reflective. Clients are responsible for their own behavior.
- Therapists concern themselves with how stimulus events act on the cognitive process. Focus is not on what exactly happened, but on how clients interpret what happened to them.
- Focus is on current influences and behavior, rather than historical ones.
- Emphasis is on overt behavior, the changes that need to happen, and evaluating if the interventions are working.
- Treatment goals are objective, specified and concrete, so that replication is possible outside of the therapists’ office.
- There is a strong reliance of research to demonstrate the validity of behavioral techniques. “The term “evidence-based” can be defined two ways:
“an approach to therapy emphasizes the pursuit of evidence on which to base its theory and techniques, as well as encourages its patients or clients to consider evidence before taking action; or an approach to therapy is supported by research findings, and those findings provide evidence that it is effective.” (Pucci)
- Using the scientific techniques, goals are set up so they can be measured and assessed along the way.
- Some argue that behavior therapists are treating symptom, not sources. You replace a negative behavior with a positive behavior, so change occurs. Knowing why a behavior occurs doesn’t necessarily change the fact that it does.
- The process is a collaboration between the therapist and the client. Client chooses what behavior to change: they establish goals. The therapist supports reaching the goal and makes sure goals are realistic. Together, they identify risks associated with achieving the goal. Goals are redefined and refined as treatment progresses as info from assessment comes in.
- Clients must be actively involved in the process, motivated, and persistent in the pursuit of change. They must identify their triggers, start a new internal dialogue, learn and practice new skills to make being different successful.
- Relaxation training is a technique often employed. Involves 4-6 hours of instruction about how to relax in this way. Involves deep breathing, tension and release of muscle groups, and mental focus on pleasant situations. This practiced daily for 20 minutes or so. In stressful situations, they can call back to this experiences of relaxation. Meditation and biofeedback are also used.
- Systematic desensitization is used for folks with anxiety, phobias and PTSD. Clients and therapists must thoroughly explore what stimulates this response, and rate them in the scale from least to most anxiety producing. Using relaxation techniques, the therapist guides the client through stimulus that causes anxiety and continues up the scale. In Vivo exposed (in real life)
- Implosive therapy: clients imagine highly fearful scenarios to produce high levels of anxiety and when they see the real thing, their anxiety is reduced because it is not as bad as they imagined it.
- Aversive techniques: (considered controversial because they cause the client pain and have some risk of further trauma). Used for alcoholics, smokers, over-eaters.
o Chemical aversion is when you give meds that cause sickness when it interacts with the stimulus, for example the pill causes the client to vomit when they drink alcohol. It makes consequences very clear.
o Electric shock might be used for children on the autism spectrum, and animals, but it is rarely used.
o Covert sensitization: a verbal aversion in which unpleasant scenes are paired with imagined scenes of deviant behavior. For example, addition to an inanimate object pairs the desire to being caught and humiliated and the negative consequences that might ensue. So a scene is played out until the very end, not just to the part that gives them pleasure.
o Time Out: a child acting out is removed from the situation so they do not get positive reinforcement for their behavior.
o Concerns: you MUST get informed consent. Therapists need to be confident in the technique, and know when to adjust it. Therapists must know how affective the technique is and measure improvement. Consider non-painful ones first, and then escalate to painful ones if necessary.
- Token economy: often used in a closed environment, like a mental hospital or prison. Allows one to earn privileges in exchange for good behavior. They are reminded daily what they need to do. It gives almost immediate rewards for good behavior, and delayed gratification. The therapist can adjust how many tokens are needed for individuals to get the privilege. Can teach long-term patterns for good behavior.
- Modeling therapy: looking at a model, and having emotions or behavior altered, based on what the model is doing. One can acquire new responses and new skills than can be performed well. It helps to inhibit fear to see the model be brave, especially if there are no negative consequences. It is used to increase behavior one is already aware of. The closer the model seems to you (such as race, socio-economic status, gender, etc) the more the model can affect you. Therapists often act as live role models. Multiple models can be good in group therapy. There may be some cognitive restructuring by creating their own world and making it better for them.
- Cognitive therapy addresses the thoughts and beliefs in a client’s thinking that create undesired behavior. It addresses not only the behavior, but how the client thinks.
Evaluation of the Theory from My Religious Perspective
I don’t think anyone from my religious background would balk at the approaches of cognitive and behavior therapy. We take a balanced approach to the world, and recognize that some techniques will work better than others for certain people. I know a lot of Pagans that are scientifically minded, and the idea of setting goals and creating change in oneself are tenants of magick and Esbat rituals. We would appreciate the evidence-based approach because that is how we tend to experience and create ritual. As a Wiccan practitioner and a professional counselor, I would not submit my practice only to this therapy, as it doesn’t address the past as a possible source for behavior, and sees client problems in an objective way. I would want to balance this approach with a warm client/therapist relationship, and acknowledge less rational approaches that may work for clients.
Corey, G; Theory and Practice of Counseling and Psychotherapy. 8th edition. Thompson Books. 2009.
Pucci, A.; “Evidence-Based Counseling and Psychotherapy”. 2005. From the National Association of Cognitive-Behavioral Therapists. < http://nacbt.org/evidenced-based-therapy.htm>. Accessed 1 August 2009.
NABTC: National Association of Cognitive-Behavioral Therapists. <nacbt.org> Accessed 1 August 2009.