Concept and scope
Cognitive-behavioral theory is not one person's theory but a label covering several approaches. The shared premise is that how a person interprets an event, more than the event itself, affects emotions and behavior, and that these interpretations and behaviors are learned and can be relearned. Therapy focuses on current problems and proceeds through short-term, structured sessions with goals and homework. The cognitive foundations are covered in cognitive theory.
The first wave: behavior therapy
This strand applied behaviorist learning principles, classical conditioning and operant conditioning, to clinical problems. Wolpe (1958) introduced systematic desensitization, pairing relaxation with an anxiety hierarchy. Techniques such as exposure and response prevention, token economies and reinforcement schedules, behavioral rehearsal, modeling and relaxation training remain core tools of CBT.
The second wave: bringing in cognition
In the 1960s and 1970s, there was growing recognition that observable behavior alone could not fully explain depression and anxiety. Ellis (1962) systematized rational-emotive therapy, which disputes irrational beliefs, and Beck (1976) systematized cognitive therapy, which tests automatic thoughts and cognitive distortions. As these merged with behavioral techniques, the name cognitive-behavioral therapy took hold.
Meichenbaum's cognitive-behavior modification
Meichenbaum (1977) developed self-instructional training, which changes what people say to themselves (self-statements). Impulsive children are taught first to repeat the therapist's instructions aloud and then gradually to say them silently to regulate their behavior. His stress inoculation training (1985) builds coping skills in advance through three phases: conceptualization, skill acquisition and rehearsal, and application and follow-through.
The third wave
Hayes (2004) called the third wave the strand that changes a person's relationship to thoughts rather than their content. Acceptance and commitment therapy (ACT) stresses acceptance and values-based action; Linehan's (1993) dialectical behavior therapy (DBT) stresses a balance of acceptance and change and emotion regulation skills; and the mindfulness-based cognitive therapy (MBCT) of Segal, Williams and Teasdale (2002) uses mindfulness to prevent depressive relapse.
Evidence and criticism
Reviewing meta-analyses, Hofmann et al. (2012) concluded that the evidence for CBT is strong for anxiety disorders, somatoform disorders, anger control and general stress, among others. Critics, however, argue that it gives less attention to past experience and the therapeutic relationship and that its manual-based format can miss individual context.
References
- Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press.
- Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.
- Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.
- Meichenbaum, D. (1977). Cognitive-behavior modification: An integrative approach. New York: Plenum.
- Meichenbaum, D. (1985). Stress inoculation training. New York: Pergamon.
- Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford.
- Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression. New York: Guilford.
- Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), 639-665.
- Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.