On the 18th of June in 2021, the global mental health community celebrated the 100th birthday of the father of cognitive-behavioral therapy – Dr. Aaron T. Beck. However, a few months later on the 1st of November, 2021 he died peacefully in his sleep. While Dr. Beck may no longer be here, his research, contributions, and impact on the way we perceive disorders and treat clients will continue to live on, eternally.
This article explores the history of cognitive-behavioral therapy and the various theories proposed by Dr. Beck, Dr. Albert Ellis, and other key figures who propelled this type of therapy into what it is today.
However, to better understand the origins of CBT, it is essential to know what CBT really is.
Let’s get started!
How Psychotherapy Impacts the History of Cognitive Behavioral Therapy
Psychotherapy establishes a way to help people experiencing emotional or mental distress and disorders. It is a general term and is synonymous with talk therapy given its emphasis on verbal techniques. Psychotherapy has been practiced throughout the ages and taken various forms as physicians began to understand the potential impact they could have on both their mental as well as physical ailments.
By the 1980s there were almost 250 types of psychotherapies. This number continued to increase until now, where in the 21st century we have over a thousand named psychotherapies. Some of the most popular ones include humanistic, insight-oriented, systemic, expressive, postmodernist, and of course, cognitive behavior therapy.
Cognitive behavior therapy or CBT emphasizes the importance of perception and its impact on the individual in question. This includes identifying various thoughts in response to a situation, reflecting on how accurate these thoughts are, and further changing those thoughts that are maladaptive or inaccurate.
Now, let’s take a look at how this type of therapy came into existence.
Tracing the Origins of CBT
While CBT is most commonly associated with the cognitive revolution of the 1950s, the keen learner will find traces of it in earlier centuries. One only has to look at the evolution of philosophy.
Philosophy and CBT
Both, Dr. Albert Ellis as well as Dr. Aaron Beck reference stoicism as the precursor to cognitive behavioral therapy as we know it today. In particular, the Greek stoic philosopher Epictetus emphasized the use of logic in identifying and discarding false or irrational beliefs. In the third century B.C, philosophers were often referenced as philosophers for the soul.
The teachings of stoicism were used for self-improvement and self-healing.
When examined, stoicism and CBT share a few key principles. These include:
- Logic to differentiate between realistic and unrealistic beliefs
- Acceptance of what cannot be changed
- Control over our thoughts and beliefs
While philosophy has a more metaphysical component that is aimed at accepting fate, CBT is a more psychological one.
Cognitive Behavioral Therapy: The First Wave
Cognitive therapy is the amalgamation of behavior therapy and cognitive therapy. While the former dates back to the early years of the 20th century, the latter began its development in the 1960s.
Behavior therapy studies the correlation between environmental factors and other people, on one’s behavior. The focus was solely on learning. It was more symptom-based, offering little insight or emphasis on the conscious or subconscious beliefs or motivations that led to these behavioral patterns.
In the 1920s, studies and research began exploring concepts like classical conditioning, operant conditioning, radical behaviorism, social learning, and more. Psychologists of the time like Ivan Pavlov, J.B Watson, and more studied the relationship between stimulus and response.
B.F Skinner would go on to popularize behavioral therapy and work closely with patients using these principles. Through animal learning, he would develop the concept of a schedule of reinforcement and shaping.
This constituted the first wave of cognitive behavior therapy.
The Second Wave
While the first wave focused primarily on the behavioral aspect, the second wave witnessed the growing emphasis on cognition. This time frame, that began the interdisciplinary study of the mind in the 1950s is now regarded as the cognitive revolution.
It was Dr. Alfred Adler, the founder of individual psychology who explored feelings and the idea of “basic mistakes” and their impact on one’s behavior. His work would eventually go on to inspire Dr. Albert Ellis who would further develop rational emotive therapy (now known as rational emotive behavioral therapy), the very first cognitive-based psychotherapy.
Simultaneously, Dr. Aaron Beck, at the time a practitioner of psychoanalysis proposed a hypothesis. According to Dr. Beck’s observations, there were certain patterns or types of thinking, and these can have an impact on one’s levels of distress. Dr. Beck made these observations during his practice, noting that not all feelings owed their roots to unconscious thought.
Rather, Dr. Beck proposed the idea of automatic thought. He hypothesized that those living with depression develop cognitive distortions, a type of cognitive bias. Although they are sometimes conscious thoughts, these could also exist at the subconscious level and were hence, automatic.
The second wave of CBT is defined by the creation of rational emotive therapy and Dr. Beck’s cognitive therapy is what would precede the big merge we witness in the subsequent wave.
The Third Wave
Behavior therapy began to lose its popularity upon the growing cognitive revolution. Although behavior therapy was helpful in treating more neurotic disorders, it was observed that that behaviorism proved fairly ineffective in treating depression and other mood disorders. Instead, the more cognitive-based approaches of Dr. Albert Ellis and Dr. Aaron Beck began to find increasing approval.
Finally, in the 1980s and the 1990s, both behavior therapy and cognitive therapy witnessed a merge to create cognitive behavior therapy. Once treatments from both therapies became more established, it was simpler to develop procedures that incorporated strategies from both therapies.
CBT put the focus back on the client’s core beliefs, their experiences, and how they were feeling in a given moment.
Eventually, CBT would evolve to include all types of cognition-based psychotherapies. Some of these are:
- Rational emotive behavior therapy
- Cognitive therapy
- Dialectical behavior therapy
- Metacognitive therapy
- Eye movement desensitization and reprocessing therapy
Each of these combines various elements of behavior and cognitive therapy. This period is regarded as the third wave of cognitive behavior therapy.
So where does that leave us today?
Cognitive Behavioral Therapy Today
While cognition refers to the thoughts and contents of our minds, behavior refers to the actions we perform in a given moment. CBT today, focuses on the various types of maladaptive thinking and how it impacts our actions. However, there is also additional research being done on our relationship with maladaptive thinking patterns.
In a nutshell, CBT assumes that thoughts impact emotions which in turn impact our actions.
With that in mind, let’s take a look at some important strategies employed in CBT.
One of the most effective CBT techniques involves taking a good hard look at negative thoughts and identifying the cognitive distortions at play. Even the wisest of us are not immune to fallacious thinking.
Cognitive restructuring and reframing encourage clients to explore the validity of their thoughts. Some examples of common cognitive distortions include:
- Filtering: putting the focus on the negative aspects of something while fully ignoring the positive
- Catastrophizing: expecting the worst out of a situation
- Polarized thinking: ignoring grey areas and taking an all or nothing approach
- The fallacy of control: assuming only you or only someone else is to blame
- Personalization: assuming that one is always at fault
- Overgeneralization: making broad assumptions based on one or two experiences
- Emotional reasoning: making assumptions based on feeling rather than fact
Once the client is able to identify the thought and the errors of reasoning that led to that thought, they are encouraged to correct the reasoning and reframe it. Once a maladaptive thought is reframed it may be significantly less distressing to the client.
Exposure Response Prevention
Exposure response prevention therapy or ERP encourages clients to face their fears. This method has been proven particularly effective for clients living with Obsessive compulsive disorder or OCD.
At first, patients are asked to confront their fears on a smaller, more tolerable scale. As their tolerance increases, these exercises get progressively more intense until ultimately, the client is able to face their fears far more comfortably than before.
In the context of OCD, this might include exposing oneself to something that induces a compulsive behavior. Here, the client must delay and ultimately refrain from carrying out their compulsions in response to the event/ object in question.
Journaling or maintaining thought records allows clients more insight into their moods and thinking patterns. CBT journaling requires clients to identify the thought, the time it occurred, the event that preceded it, and the emotions that followed.
Additionally, it is also a great way to document progress between therapy sessions and measure the efficacy of some CBT techniques versus others. It allows therapists and clients to identify what works for them on an individual level.
Behavior activation allows clients to use actions or certain behaviors to alter their emotional state. This involves the study of how certain behavioral patterns affect our thoughts and feelings.
It is designed to increase the client’s contact with activities they find pleasurable and improve their overall quality of life. Through this technique clients are asked to:
- Identify activities they want to do, as opposed to what they think they should do
- The activities must be specific and allow for measurable progress
- These activities must be placed in a sequence based on the level of difficulty
- Activities must be diverse
Clients are encouraged to seek out the support of loved ones and reward their progress along the way.
During guided discovery, the therapist walks the client through various questions, encouraging them to reflect on their own thoughts and challenge previously held beliefs. You may be asked to provide evidence to support your claims and also reflect on other perspectives.
Through roleplaying clients are asked to play out various scenarios. This allows them to explore different behaviors and ways of thinking when confronted with distressing or difficult situations.
During role play, the therapist may assume the role of someone the client is afraid of, dislikes, or finds triggering. The therapist then examines the interactions with the client and helps them identify better ways of managing these confrontations.
CBT as a Treatment: Who Can it Help?
CBT has been designed to address a wide range of psychological issues. There is solid, evidence-based research to back up its efficacy in treating mood disorders, phobias, various types of addiction, and more. Some areas where CBT is particularly helpful, include:
- Anxiety disorders
- Major depressive disorder
- Obsessive compulsive disorder
- Anorexia nervosa and other eating disorders
- Panic disorders
- Bipolar disorder
- Substance abuse disorders
Additionally, CBT is often used effectively in conjunction with other therapies or medication-assisted treatment while treating disorders as complex as schizophrenia.
CBT: The Therapy That Stood the Test of Time
From the philosophies of stoicism to behavior therapy, Dr. Beck’s cognitive therapy to the amalgamation of the two, we’ve come a long way. The history of cognitive behavioral therapy has played an enormous role in our understanding of psychology and disorders today.
If you or someone you know is living with an addiction or any other type of mental illness, know that help is available to you. Don’t be afraid to reach out and get the support you need.
At Beat Addiction Recovery, we provide comprehensive programs designed to incorporate the most effective techniques personalized to the individual’s own unique needs and psychology. Take the first step and learn more about what our team of mental health professionals can do for you, today!