The History of Cognitive Behavioural Therapy (CBT)
Cognitive behavioural therapy (CBT) has been gaining in popularity in recent years, as more people become aware of its effectiveness in treating common disorders such as anxiety and depression.
CBT is not a new therapy by any means and it has a practical structure which makes it easily measurable. These factors have resulted in a large body of successful clinical trials which, more recently, have secured its position as a recommended treatment on the NHS.
What is CBT?
Cognitive behavioural therapy is a type of talking therapy which involves identifying and challenging unhelpful thoughts and helping people learn how to modify their thinking patterns and behaviours, to improve the way they feel. CBT explores the relationship between feelings, thoughts, and behaviours. As such, it arose from two very distinct schools of psychology: behaviourism and cognitive therapy. Its roots can be traced to these two models and their subsequent merging.
Behavioural Therapy Roots
Behavioural treatment for mental disorders has been around since the early 1900’s. Skinner, Pavlov, and Watson were all early proponents of behavioural treatments. Behaviourism is based on the idea that behaviours can be measured, trained, and even changed. It says that it is our responses to environmental stimuli that shape our behaviours.
The first wave of behavioural therapy came about in the 1940s in response to the emotional adjustments faced by the many WWII veterans returning from war. This need for effective short-term therapy for depression and anxiety coincided with a build up of behavioural research regarding how people learn to behave and react emotionally to life situations. This challenged the psychoanalytic therapy that was popular at the time and is considered as the “first wave” of CBT.
Cognitive Therapy Roots
In the early 1900s, Austrian psychotherapist Alfred Adler’s notion of basic mistakes and their role in unpleasant emotions made him one of the earliest therapists to address cognition in psychotherapy. His work inspired American psychologist Albert Ellis to develop rational emotive behaviour therapy (REBT) in the 1950s. This is now considered one of the earliest forms of cognitive psychotherapy. It is based on the idea that a person’s emotional distress arises from their thoughts about an event rather than the actual event itself.
In the 1950s and 1960s, American psychiatrist Aaron T. Beck noticed that his clients had internal dialogues going on in their minds during analytical sessions. He discovered that the clients appeared to almost be talking to themselves, but they only shared a small part of this kind of thinking with him. For example, a person might have thought to themselves, “The therapist is being very quiet today; I wonder if he’s mad at me?” and then began to feel anxious as a result.
Automatic Thoughts in Cognitive Therapy
Beck understood the importance of the link between thoughts and feelings, and he coined the term “automatic thoughts” to describe the emotional thoughts that pop up in people’s minds. He discovered that although people aren’t always aware of these thoughts, they can learn to identify and report them. He found that people who were upset had negative thoughts that tended to be unrealistic, and by uncovering and challenging these thoughts, long-lasting and positive change can result. In essence, CBT helps people step outside of these automatic thoughts and test them out.
In the 1960s, a number of empirical studies into how cognitions affect behaviours and emotions were carried out. This is known as the cognitive revolution. It emphasised the role that conscious thinking plays in psychotherapy and is known as the “second wave” of CBT.
Combining the Approaches
Behavioural therapies were successful in treating neurotic disorders but weren’t able to conquer depression. As the popularity of cognitive therapies began to soar, psychologists started to merge the two approaches to successfully treat issues such as panic disorder. Although each of these schools of thought has a different emphasis, both are concerned with what is happening to the individual in the here and now. CBT focuses on the client’s beliefs, experiences, and feelings at the present moment.
CBT can be Helpful in Treating a Range of Issues
CBT has been the subject of a number of scientific studies and been applied to a broad range of psychological issues. Its use became more widespread in the 1990s and is now promoted by the NHS. As its popularity grows, the number of clinical trials into CBT is increasing and the evidence base is strengthening. It has been shown as an effective form of therapy for treating a range of conditions, including:
- Panic Disorder
- OCD – Obsessive Compulsive Disorder
- Irritable Bowel Syndrome
- Chronic Fatigue
- Eating Disorders
CBT and Other Therapies
Today, a number of therapies blend cognitive and behavioural elements into their approach, including:
- Integrative Psychotherapy
- Reality therapy
- Multimodal therapy
- Eye movement desensitisation and reprocessing
- Cognitive processing therapy
- Acceptance and commitment therapy
- Dialectical behaviour therapy