Cognitive and Behavioral Treatments

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The histories of psychology and mental health treatment specifically have seen periods in which certain phenomena are treated as central to an understanding of human mental life and behavior, while others are neglected, ignored, or written off as unimportant. Psychoanalysis once dominated until the behaviorists came along and warned us to stay out of the black box of the mind. Biological models have come to prominence within the last 10 to 15 years or so. The mid-twentieth century ushered in an era in which the mind reemerged. This approach to mental life was a break from psychoanalysis and owed a great deal to developments in the field of cognitive science. This era is sometimes referred to as the cognitive revolution. The mind once again mattered, and there were fresh ways to approach it without reference to legions of Freud. The cognitive approach took root in both experimental psychology and eventually in the treatment of mental disorders and psychotherapy. With respect to psychotherapy, cognitive approaches were often combined with more behavioral approaches, yielding what is often referred to as cognitive-behavioral therapy (CBT). There are behavioral, cognitive, and cognitive-behavioral therapies for depression, Anxiety Disorders, phobias, and even psychosis. There are also a number of cognitive-behavioral approaches to the treatment of PTSD. Research and practice have shown that such treatments are effective. The National Center for Post-Traumatic Stress Disorder cites CBT for PTSD as a successful intervention in one of their public-information guides.

Before we go on, however, let's define some terms:

Behavior therapy. At its most basic level, behavior therapy consists of the application of learning theory, classical conditioning, operant conditioning, and social learning theory to the treatment of clinical disorders and abnormal behavior. Disorders are viewed as acquired or learned in the same way as nondisordered or normal behavior and, therefore, can be unacquired or unlearned in turn. The historical or developmental roots of disordered behavior are important only as histories of chains of operant behavior or associations. It does not matter, per se, why a disordered behavior exists or what caused it but, rather, what is maintaining it through positive reinforcement, negative reinforcement, or other learning principles.

Cognitive therapy. Aaron Beck and Marjorie E. Weishaar (1989) provide an excellent definition of cognitive therapy:

Cognitive therapy is based on a theory of personality which maintains that how one thinks largely determines how one feels and behaves. The therapy is a collaborative process of empirical investigation, reality testing, and problem solving between therapist and patient. The patient's maladaptive interpretations and conclusions are treated as testable hypotheses. Behavioral experiments and verbal procedures are used to examine alternative interpretations and to generate contradictory evidence that supports more adaptive beliefs and leads to therapeutic change. (Beck & Weishaar, 1989, p. 229)

Cognitive-behavioral therapy. For our purposes, CBT can be understood as any treatment that utilizes any combination of either behavior therapy or cognitive therapy. Most therapies from this perspective appear to be more CBT than either pure behavioral or cognitive.

Some pioneers and heavy hitters of behavior therapy include Joseph Wolpe, S. Rachman, E. Jacobson, Alan Kazdin, Ivar Lovaas, and Albert Bandura. From the cognitive therapy perspective, Albert Ellis, Aaron Beck, and Eric Byrne are important figures. Finally, big names in CBT include, again, Aaron Beck, but also Marsha Linehan, Christine Padesky, J. E. Young, and Arnold Lazarus. Two others require mentioning despite their eventual expansion and moving beyond CBT; they are Donald Meichenbaum and Mardi Horowitz.

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