Cognitive Behavior Therapy or CBT is a popular and practical modern approach to counseling and psychotherapy that focuses on changing self-defeating ways of thinking and behaving. The basic assumption of the Cognitive Model is that underlying every feeling is a thought. Therefore, to change the way you feel, you need to pinpoint the associated thought or thoughts and change them.
CBT is generally a time-limited or short-term structured form of psychotherapy that emphasizes a collaborative partnership between the client and the therapist. In more traditional forms of psychotherapy based on the Freudian psychoanalytic approach, the therapist mostly listens and takes notes. In CBT, the therapist is more active and engaged and when appropriate, gives advice. The CBT therapist is a teacher and instructs the client in new more effective coping skills. CBT is considered a psycho-educational approach. Therefore, the client is also expected to be active and engaged for CBT to be effective. CBT therapists encourage and expect the client to do homework and keep written records.
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Thoughts and feelings are “covert behaviors” (meaning unseen or internal) as opposed to “overt behaviors” which are visible to others. But CBT also addresses overt behaviors and incorporates different behavior modification techniques for changing self-defeating behavioral habits.
Originally, CBT emerged from the pioneering work of several innovators:
- Dr. Albert Ellis was a clinical psychologist who was the founder of Rational Emotive Therapy (RET) which he later changed to Rational Emotive Behavior Therapy (REBT).
- Dr. Aaron Beck is a psychiatrist who founded Cognitive Therapy.
- Dr. Donald Meichenbaum is a psychologist who founded Cognitive Behavior Modification.
- Dr. Arnold Lazarus was a psychologist who founded Multimodal Behavior Therapy.
- There were other innovators but these are the most famous and had the largest influence.
In the past two decades, various offshoots of CBT have emerged as a “second wave” and “third wave” of what has been called the “cognitive revolution” in the field of psychotherapy. These include:
- Dr. Marsha Linehan’s Dialectical Behavior Therapy (DBT) and
- Dr. Steven Hayes’s Acceptance and Commitment Therapy, also known as ACT.
In recent years, Mindfulness based on the work of Dr. Jon Kabat Zinn of the University of Massachusetts has greatly influenced the practice of Cognitive Therapy and Cognitive Behavior Therapy. The study and practice of mindfulness has roots in Zen Buddhist philosophy. Both DBT and ACT also draw from Zen in their emphasis on acceptance of what is, commitment to change and balancing the dialectical tension between the two.
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Cognitive Therapy is considered an Evidence Based Treatment or EBT for clinical depression, other mood disorders and various anxiety disorders. DBT is considered an EBT for Borderline Personality Disorder. ACT and Mindfulness Based Stress Reduction and Mindfulness Based Cognitive Therapy have been shown to be effective in treating chronic pain and addictions.
I have personally trained with Aaron Beck the founder of Cognitive Therapy at the University of Pennsylvania, Albert Ellis the founder of Rational Emotive Therapy in NYC, and Arnold Lazarus the founder of Multimodal Behavior Therapy at Rutgers University in New Jersey.
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