THE HISTORY OF CBT

CBT’s reputation as an efficient form of psychological treatment is growing. ‘Cognitive’

refers to mental processes i.e. thinking. The word ‘cognitive’ relates to everything that goes
on in an individual’s mind: thoughts, dreams, images, memories, and attention. ‘Behaviour’
refers to everything that an individual does. This includes what they say, how they try
to solve problems, how they act, and avoidance. ‘Behaviour’ refers to both action and
inaction, for example biting your tongue instead of speaking your mind is still a behaviour
even though they’re trying not to do something. ‘Therapy’ is a word used to describe a
systematic approach to tackling a problem, illness, or irregular condition.

Several studies conducted through the King’s College of London have revealed that CBT
is far more effective than treating those who suffer from anxiety and depression with only
medication. As a result of this research, briefer and more intense treatment methods have
been developed for specific anxiety disorders such as panic, social anxiety and even post-
traumatic stress.

The Greek philosopher Epictetus claimed that people are disturbed not by the things that
happen, but by their opinion of the things that happen. This ancient Greek concept became
part of the foundational theories of CBT, which was founded in the 1960s by Aaron T. Beck
who practised psychiatry at the University of Pennsylvania. Having lost faith in psychoanalysis
early in his profession, Beck’s main field of interest was exploring the use of cognitive therapy
for depression and anxiety. Since Freud’s arrival in the US, psychoanalysis had swept the field
of psychiatry to the point that within only a few years, over 95% of American psychiatrists had
committed to taking some expression of psychoanalytical training.

The “cognitive revolution” in psychology took place during the 1960s, and by the 1970s many
behaviour therapists who had been positively influenced by it began to call their therapy
‘CBT’. Part of this movement argued that the need for continued research was still crucial,
but the research that influenced second-generation Behavioural Therapy concentrated on
the cognitive mediators of learning. The argument was that conditioning in individuals is not
direct and automatic, but rather mediated by the person’s verbal and non-verbal cognitive
abilities. Awareness, attention, expectancy, attribution and linguistic representation were
constructs that were deemed necessary to account for learning.

The advent of cognitivism in the 1960s introduced a major paradigm shift within experimental
psychology. While the behavioural model had considered cognitive processes as an
epiphenomenon, a new approach appeared that considered cognitive knowledge as being
of central importance in psychological investigation whilst maintaining a verifiable first-hand
view. This led Cognitive therapy to be born (thanks to its founding fathers Beck, Shaw, Rush
& Emery) and with it also came the third generation of behaviour therapy. The concept of
associative learning was abandoned, leaving room for some slightly more flexible principles
which acknowledged the role that internal human experience (thoughts and feelings) played
in influencing human behaviour.

Based on the ancient philosophical argument, the CBT cognitive model assumes that
people’s emotions and behaviours are influenced by their perceptions of events rather than
the events themselves. What Aaron went onto argue was that cognition was split into three
levels: Dysfunctional Assumptions, Core Beliefs and Negative Automatic Thoughts (NATs).
Our dysfunctional assumptions can contort themselves into negative core beliefs if they
are maintained and ‘validated’ throughout our lives; for example, receiving a job rejection
may create a dysfunctional assumption that you are not good enough for that job, but the
assumption is fleeting. Years of job rejections, however, can manifest as a core belief
 THE HISTORY OF CBT
that you are not good enough. NATs aren’t always triggered by such obvious events: they
tend to exist in the background of our minds without us drawing too much attention to them.
An example would be rejecting a cookie at work because your NAT told you that cookie will
make you gain more weight and you already believe yourself to be someone who can’t risk
gaining any more weight.

‘Formulation’ is the process by which an individual’s experiences are placed within a CBT
framework known as the ABC model [for more information, see later section]. An example of
effective use of formulation is when a client (or someone you know) claims ‘X made me feel X’.
This process helps us dissect and break down people’s actual experience to help them make
better sense of themselves and understand how they are responsible for their own feelings
rather than other things and people.

CBT is a time-limit, solution-orientated and collaborative method which involves cognitive

and behavioural techniques such as Socratic questioning and activity schedulings. Many
forms of therapy tend to be open-ended and can continue for years on end. Whilst regular
access to therapy and revisiting it can be beneficial, CBT is more progress and goal focussed;
the sessions should be planned and scheduled with a specific goal in mind so that a
result can be monitored and seen by the end. This relies on clients taking responsibility for
themselves and their recovery and taking an active role in the implementation of techniques.

Scientific research of CBT is advancing. As a result, more is being learned about which
aspects of the treatment are most beneficial for different kinds of people and which
therapeutic interventions work best with different types of problems. CBT is a powerful
treatment as it combines scientific, philosophical and behavioural aspects into one combined
and comprehensive approach to understanding and overcoming common psychological
problems.

QUESTIONS FOR SELF-REFLECTION:

1. What is your main reason for wanting to study cognitive behaviour therapy?

2. How willing are you to apply any of the main ideas in this course to yourself?