The origin of Cognitive-Behavioural Therapy (CBT) is grounded in the cognitive revolution that started in the 1950s. Nonetheless, its influences can be tracked as early as the 1900s, when behaviourism emerged as a reaction to previous forms of Psychology that struggled to test psychological constructs experimentally. CBT’s development progressed over time, but its onset can be traced to the 1060s, with Aaron Beck as his founder (Rafael, Vera, Bardinet and Molina, 2012).
With influences from a variety of Psychology branches, such as Behaviourism (from the 1920s to the 1050s), Systematic Desensitisation (1950s), Social Learning Theory (1977), Personal Construct Psychology (1955) and Rational Emotive Behavioural Therapy (1957), CBT is the most effective type of therapy for multiple conditions, including depression, anxiety, eating disorders, etc. It is essential to know its origins and development to understand CBT. Hence, in the present essay, we explore CBT’s principles and the main theories that shaped them and helped CBT become the type of therapy that has already helped thousands of people (Rafael, Vera, Bardinet and Molina, 2012).
The first Psychology current that needs to be analysed is Behaviourism. Behavioural theory is essential in CBT, and it is undeniable the influence of this trend forged in the 1900s. It was John Watson who claimed in 1913 that anything intrapsychic should be disregard and that Psychology should focus on behaviour, as only what is observable can be tested experimentally. This was considered the starting point of this Psychology current (Torres, 2021).
Pavlov and Skinner markedly influenced Behaviourism. Pavlov was a Russian physiologist born in 1849. He studied the dog’s saliva secretion when he discovered that only with the presence of food would the animals salivate. Later he proved that dogs would also salivate with the sound of a bell, after a few trials where he gave food to the dogs while playing the bell (Ardila, 2013).
These findings allowed him to develop his Classical Conditioning. The basic idea behind his theory is that an unconditional stimulus (food) can trigger an unconditional response (salivate). If a neutral stimulus (bell) is paired with the unconditional stimulus, after a few repetitions, the animal will perform a conditional response (salivate) (Yela, 2012). From Watson, the famous Albert experiment is another example of Classical Conditioning (Torres, 2021).
The second most relevant behaviourist was Skinner, an American Psychologist born in 1905, who discovered another type of conditioning: Operant Conditioning. He believed that all behaviour resulted from learnt associations between stimulus and responses and introduced the concepts of reinforcement and punishment (Ardila, 2013).
Skinner experimented with pigeons, and he demonstrated that by rewarding behaviours, he could reinforce them or, otherwise, could extinguish behaviours by punishing actions (Ardila, 2013).
The influence of both authors is such that their concepts impacted many researchers afterwards, and their ideas are still used in multiple contexts, like learning disabilities or addiction treatment.
A few years after, Joseph Wolpe, another behaviourist, became famous thanks to his Systematic Desensitisation.
Wolpe was born in Johannesburg, South Africa, in 1915 but later obtained American citizenship. He gained fame thanks to the development of Systematic Desensitisation therapy in the 1950s, a type of behavioural therapy founded on classical conditioning ideas and designed to treat anxiety disorders and phobias (McLeod, 2021; Ankrom, 2021). The technique is based on the idea that anything learned, such as fear, can be unlearned (Ankrom, 2021).
In Systematic Desensitisation therapy, the patient faces their fears of worry by exposing himself to the feared situation while using relaxation techniques that calm the anxiety (Ankrom, 2021). Relaxation is a fundamental part of this method, as it is seen as incompatible with anxiety. Consequently, relaxing is essential before exposure (McLeod, 2021).
The exposure to the feared situation should be gradual, and the client creates a hierarchical list of events that trigger his anxiety, sorted by the intensity of the emotion prompted. By exposure to these situations, the patient gets habituated to the feared stimulus, and he can face the next more feared event, proving to his brain that the expected negative outcome is not as bad as forecasted (McLeod, 2021).
This method has proven its efficacy for phobias (Mealiea and Nawas, 1971), speaking anxiety(Woy and Efran, 1972), and reducing nightmares (Cellucci and Lawrence, 1978) among others.
Currently, it is widely used within CBT therapy as a method called Exposure Therapy. Although it can’t be applied for many psychological disorders, such as eating disorders, or depression, CBT with Exposure Therapy is the main line of treatment for conditions such as Obsessive-Compulsive disorders or social anxiety.
Social Learning Theory
Although behaviourism was popular in the 1900s, a cognitivist revolution was to come in the 1950s. Many authors can be highlighted as responsible for this change, and Albert Bandura is one of them.
Born in 1925 in Canada, Bandura obtained his PhD in Psychology in 1952 at the University of Iowa. He became one of the Psychologists of reference thanks to his work on social learning theory, observational learning, self-efficacy and studies on aggression (Boeree, 2021).
Although many texts have classified Bandura as a behaviourist, he has considered himself a social cognitivist. In reality, Bandura could be viewed as a bridge between behaviourism and cognitivism since his learning theory departs from the stimulus-response cycle and adds an element of cognitivism (Cherry, 2021).
Bandura realised that as behaviourists described it, reinforcement couldn’t explain all types of learning since individuals can learn by observing other people. He developed his Social Learning Theory (1977) based on this principle and postulated that learning is possible through observation, imitation, and modelling (Bandura, 1965).
One of Bandura’s most famous researches was the Bodo Doll experiment conducted in 1961. He recruited children and assigned them to experimental or control groups. The experimental group watched an adult hitting a Bodo Doll. The children witnessing the aggressive adult hitting the doll engaged in similar aggressive behaviour and hit the Bodo doll in the same way (Bandura, Ross and Ross, 1961). There was no reward to beat up the doll; hence, Bandura demonstrated learning acquired through imitation of others’ behaviour (Tadayon Nabavi, 2012).
Not only did he transform Psychology, turning it into a more cognitivist position, but Bandura was also a prolific author. He published the famous books Aggression: A Social Learning Analysis (1977), where he analyses the origins of aggression; Social Learning Theory (1977), a description of his theory; and Self-Efficacy: Toward a Unifying Theory of Behavioral Change (1977), and introduction to the notion of self-efficacy (Cherry, 2021).
His ideas have remarkably influenced personality psychology, cognitive psychology, education, and psychotherapy (Cherry, 2021). His work allowed the Psychology world to leave behind the Behaviourism of the time and better understand how cognition works. This was essential for CBT to be discovered in the following years.
Personal Construct Psychology
Another important figure in the cognitive revolution and an influence on CBT was George Kelly, an American Clinical Psychologist born in Kansas in 1905. He is well known for his Personal Construct Psychology (PCP), a model that suggests that individual differences arise from the diverse ways individuals predict and interpret situations (Scheer, 2021).
His theory has been referred to as person-centred, cognitive, humanistic, Buddhistic, Marxist, behaviouristic or even reflective (Kelly, 2005). Regardless of the categorisation, his work contributed to the starting point of the cognitive revolution, and Cherry (2021) referred to him as one of the first cognitive Psychologists.
Before developing his framework, Kelly studied Psychoanalysis and the ideas of Sigmund Freud but, although he valued his ideas, he was not convinced about this type of therapy. He eventually moved on, and in 1955 he developed his Personal Construct Psychology, described in his published books The Psychology of Personal Constructs, Volumes I and II (Cherry, 2021).
Kelly coined the concept of constructive alternativism, stating that each person forms a unique construction of reality. No construction is better or worse, all have value, and there is no utterly accurate interpretation (Cherry, 2021).
Founded in the concept of pragmatism developed by the psychologist John Dewey, Kelly denied the separation of an individual’s processes into emotion, cognition, and behaviour, to include them all in the notion of construing. He hypothesises that people’s processes are mediated by how they anticipate outcomes. The way individuals foresee results is through the act of construing. (Butt, 2021).
Therefore, at the root of PCP is the way people construe their world. This model sees individuals as scientists or adventurers, able to push their boundaries and conduct experiments to test different explanations for situations and events to enhance predictability (Walker and Winter, 2007). It doesn’t force concepts on the patients but focuses on clients’ theories of themselves and their ideas about life.
Although rooted in some complex philosophical ideas, PCP’s basic idea is not what happened to the person, but how the person interprets it, and the appreciation that these interpretations can change are elements that impacted CBT and its way of delivering therapy.
Rational Emotive Behavioural Therapy
From the philosophical ideas of Kelly to the precursor of CBT. The following crucial figure was Albert Ellis, an essential Psychologist in the revolution of Cognitive Psychology, that developed Rational Emotive Behavioural Therapy (REBT) in 1950 (Cherry, 2021). Born in 1913 in Pittsburgh, Pennsylvania, he was awarded a PhD in Psychology in 1947 at Columbia University (The Albert Ellis Institute, 2021).
In his early days as a therapist, Ellis practised as a Psychoanalyst, but he soon became dissatisfied with a method that he saw as passive (Cherry, 2021). He then took a more active approach, delivering a more directive therapy, and discovered that his clients would improve quicker (The Albert Ellis Institute, 2021).
Inspired by the philosophies of Epictetus, Marcus Aurelius, and Spinoza, and influenced by Alfred Adler, Karen Horney, and Harry Stack Sullivan, he developed his approach to psychotherapy. Following this change in direction, in 1957, Ellis published his first book on Rational Emotive Behavioural Therapy (REBT; The Albert Ellis Institute, 2021).
REBT supports a cognitive-behavioural philosophy shared by many approaches, which sustains that events can’t directly cause emotions and behaviours. It is the thoughts about the events that generate feelings and behavioural reactivity (Turner, 2016). Rational and irrational beliefs are the constructs that build the person’s concepts of reality (David, Szentagotai, Eva and Macavei, 2005).
This notion is the keystone of the ABC framework that guides REBT and is currently used in CBT. When there is an activating event (A), beliefs about the event are activated (B), and those lead to the consequences (C; Turner, 2016; Raypole, 2021).
REBT focus on challenging the irrational beliefs (B) that cause emotional distress by using what Ellis coined as systematic disputation (D), where the client analyse the evidence and helpfulness of the beliefs and comes up with an alternative more effective (E; Turner, 2016).
The effectiveness of this type of therapy has been proven in multiple investigations (Ugwu et al., 2021). For instance, a quantitative review proved the efficacy compared to baseline and controls (Lyons and Woods, 1991). In another example, an 84 published articles review validated the REBT’s success for obsessive-compulsive disorder, social anxiety, depression, and disruptive behaviour (David et al., 2017).
CBT inherited ideas and tools from REBT that still today are practised in therapy. Both agree that emotions and behaviour result from thoughts and beliefs and, therefore, by modifying unhelpful thoughts, the client can improve the quality of his emotions and behaviours (Edelstein, 2021). In CBT, this concept is denominated the cognitive model, which purpose is to challenge unrealistic beliefs, thoughts or attitudes, and substitute them for others more helpful and valid (Fenn and Byrne, 2013).
Although CBT is a structured and directed type of therapy, it is collaborative, and the therapists aim to work as a team with the client to find solutions that best suit him. Each session starts with agenda-setting, the review of homework, discussion of topics included in the plan of the day, assigning more homework, and asking for feedback from the client.
In addition, in CBT, the educational part is essential, and as in most types of therapy, the therapeutic relationship is critical. This relationship is essential and allows an ever-evolving formulation of the client’s issues (Fenn and Byrne, 2013).
Unlike humanistic or existentialist psychotherapies, CBT is focused on the present and works with goals set up in collaboration with the client. Goals should be specific, measurable, achievable, realistic and time-limited. This gives a clear direction to where to go and allows to measure success (Fenn and Byrne, 2013).
Finally, CBT is limited in time, with a limited number of sessions (typically between 5 and 30 sessions). This helps achieve the goals, as having a deadline forces therapists and clients to focus on what is essential and prevents wandering around issues of less significance.
As analysed in the present essay, CBT is the most successful type of therapy, but the Psychology world had to go through a long way to find and develop it.
CBT inherits the main concepts and tools of multiple theories. From the behaviourists, CBT inherited the idea that what has been learned can be unlearned (e.g., unhelpful patterns of thoughts); Systematic Desensitisation is at the root of Exposure Therapy, crucial to treating conditions such as OCD; Social Learning Theory opened the door to researching cognition, the cornerstone of the cognitive model; Personal Construct Theory can be seen as the precursor of the motivational interview, transmitting the idea that we can improve and be better; and REBT designed the ABC model and other tools, still used in CBT.
In conclusion, knowing where CBT came from is essential to understanding its theory, tools and mechanisms.
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