The term cognitive behavior therapy refers to a diverse assemblage of theoretical and applied orientations that share three underlying assumptions. First, a person’s behavior is mediated by cognitive events (i.e., thoughts, images, expectancies, and beliefs). Second is a corollary to the first; it states that a change in mediating events results in a change in behavior. Third, a person is an active participant in his or her own learning. The third assumption recognizes the reciprocal relationships among a person’s thoughts, behavior, and environment and runs counter to the behaviorist’s unidirectional view of the individual as a passive recipient of environmental influences.
During the reign of behaviorism in American psychology, cognitions were banned from investigation because the earlier methods used in their investigation were methodologically unsound and because cognitions, which are not directly observable, were considered inappropriate subject matter for the scientific study of psychology. During the 1960s, an explosion of research into such cognitive processes as attention, memory, problem solving, imagery, self-referent speech, beliefs, attributions, and motivation heralded a cognitive revolution in American psychology. Behaviorists impressed with the rigor of experimental cognitive psychologists and alert to the limitations of traditional behaviorism increasingly considered the role of cognitive variables in the development of behavior and in the treatment of maladaptive behavior. Because Bandura’s research in observational learning was couched in a learning theory framework, it provided a timely bridge between the cognitivists and behaviorists. Bandura’s explanations for modeling became more cognitive as he introduced such cognitive constructs as attention, retention, and expectancies to explain observational learning. Bandura’s view of the reciprocal relationships among cognitions, behavior, and environment remains a basic tenet of cognitive behavior therapy. The widely discussed controversy between the cognitivists and the behaviorists that was prevalent in the 1960s and early 1970s quieted. The compatibility of the two perspectives has been recognized and the advantages of the joint consideration of cognitions and behaviors in modifying behaviors has been demonstrated.
Overview
A variety of therapies derived from research in cognitive psychology and taking advantage of the broadened behavioral perspective were developed and subjected to empirical test. These therapies attempt to modify thinking processes as a mechanism for effecting cognitive and behavioral changes. Particular therapeutic approaches that are closely identified with cognitive behavior therapy include modeling, self-instructional training, problem-solving training, rational emotive therapy, cognitive therapy, self-control training, and cognitive skills training. Because self-instructional training and problem-solving training illustrate the dual focus on cognitions and behavior, have been researched in schools, and are particularly well suited to classroom application, they will be briefly described in this entry.
In self-instructional training, the child is taught to regulate his or her behavior through self-talk. The child is taught to ask and to answer covertly questions that guide his or her own performance. The questions are of four types:
- Questions about the nature of the problem. (“OK. Now what is it I have to do? I have to find the two cars that are twins.”)
- Plans, or self-instructions for solving the task (“How can I do it? I could look at each car carefully, looking at the hood first, and then the front wheels, until I get to the end.”)
- Self-monitoring (“Am I using my plan?”)
- Self-evaluation. (“How did I do? I did fine because I looked at each car carefully and I found the twins.”)
The particular self-statements vary according to the type of task.
The steps in teaching children to use self-speech to guide problem-solving behavior are derived from research in the developmental sequence by which language regulates one’s behavior. First, an adult talks out loud while solving a task, and the child observes (modeling). Next, the child performs the same task while the adult verbally instructs the child. Next, the child performs the task while instructing himself or herself out loud. Then the child performs the task while whispering. Finally, the child performs the task while talking silently to himself or herself, with no lip movements.
Research in self-instructional talk has demonstrated that it helps impulsive children to think before acting (Meichenbaum & Goodman, 1971). While treated children have improved on novel problem-solving tasks and academic performance (Camp, Blom, Hebert, & Van Doorninck, 1977; Douglas, Parry, Marton, & Garson, 1976; Meichenbaum & Goodman, 1971), results of treatment on classroom behavior have been inconclusive (Camp, 1980; Camp et al., 1977).
Problem-solving training is similar to self-instructional training in that the child is taught to think through problems following a systematic problem-solving process. In a series of studies, Spivack and Shure (1974; Spivack, Platt, & Shure, 1976) taught preschool children the following interpersonal cognitive problem-solving skills: problem identification, means-end thinking, alternative thinking, and consequential thinking. Means-end thinking includes the ability to plan, step-by-step, ways to reach an interpersonal goal. Alternative thinking includes the ability to generate different plans for solving a given interpersonal problem. Consequential thinking is the ability to anticipate and evaluate consequences of a given interpersonal solution. These skills are taught in game-type interactions involving pictures, puppets, and stories depicting interpersonal problem situations. Research on problem-solving training has demonstrated improvement on teacher ratings, academic performance, and behavior observations (Shure, 1981).
In terms of psychotherapeutic intervention, cognitive behavior therapy has been shown to be very helpful with pain control (Tan & Leucht, 1997), depression (Murphy, Carney, Kreserich, & Wetzel, 1995), body dysmorphic disorder (Neziroglu, McKay, Todaro, & Yaryura-Tobias, 1996), and eating disorders (Eldredge et al., 1997). However, there are two caveats for using cognitive behavior therapy with school-aged populations. The first is including both the assessment of logical/analytical thought structures and social perspective-taking abilities of the child when planning a course of cognitive behavior therapy (Kinney, 1991). The second, which pertains to any age of client/subject, is that multicultural influences and diversity must be taken into account and formally addressed if the course of treatment is to be successful (Hays, 1995).
Definition: A therapeutic practice that helps patients recognize and remedy dysfunctional thought patterns. One characteristic technique is exposure and response prevention, in which a patient with a phobia deliberately exposes himself or herself to the feared situation, gradually decreasing the panic response. Cognitive behavior therapy is used to treat obsessive compulsive disorder, panic disorder, and other biologically based psychiatric illnesses, often in combination with medication. Evidence gathered from brain scans indicates that over time this therapy can sometimes create actual changes in brain and neurotransmitter function. Abbreviated CBT.