• For more details see the European Association of Behavioural and Cognitive Therapies (EABCT - http//www.eabct.com)
DEFINITION: Cognitive and behavioral psychotherapies (commonly referred to as cognitive behavior therapy - CBT) are psychological interventions focused on (1) human development/optimization; (2) mental health promotion and prevention of clinical psychological problems; and (3) treatment of life problems and subclinical and clinical conditions that involve psychological mechanisms/factors. In order to reach these goals, CBT uses cognitive and behavioral learning theories and principles, to help the clients change their irrational/distorted cognitions/beliefs, maladaptive behaviors, and dysfunctional feelings, in order to make them feel, get, and stay better.
BRIEF HISTORY: The fundamental and paradigmatic aspects of the modern CBT were set by Albert Ellis and Aaron T. Beck. Indeed, Ellis’ Rational Emotive Behavior Therapy (REBT) and Beck’s Cognitive Therapy (CT) (mentioned here in historical order) were the foundational forms (i.e., the original CBT strategies) of CBT that, although slightly different in the type of cognitions they emphasize, set the common fundamentals of theory, research, practice, and even training in the modern CBT field. In order to illustrate this historical aspect, sometimes the name used for this form of psychotherapy is not simply cognitive-behavior therapy (CBT), but rational-emotive & cognitive-behavior therapy (REBT/CBT). However, the simpler CBT name is now more and more common and widespread, while REBT and CT are typically considered as the two initial foundational CBT strategies that constitute the architecture of modern CBT.
THEORY: Arguably, the cognitive ABC model (i.e., A-Activating events prime B-explicit and implicit Beliefs/cognitions that contribute to C-emotional and behavioral Consequences) is the general framework of modern CBT. This general framework of modern CBT incorporated those previous rigorous developments of behavioral therapy (BT) strategies that were supported by experimental and clinical research [e.g., the behavioral ABC model (A-antecedents; B-behavior; and C: consequences in the form of reinforcements), conditioning theories etc.]. Moreover, the CBT framework was further (1) developed in new CBT strategies (e.g., including new concepts/techniques like mindfulness in Mindfulness-Based Cognitive Therapy, Dialectic Behavior Therapy, Metacognitive Therapy etc., acceptance in Acceptance and Commitment Therapy, Compassion-Focused Therapy etc.) and/or (2) adapted in various CBT strategies (e.g., Glasser’s Reality and Choice Therapy; Lazarus’ Multimodal Therapy; Maultsby’s Rational Behavior Therapy; Meichenbaum’s Cognitive-Behavioral Modifications etc.). For a comprehensive list of the most important CBT strategies see Dobson (2009) and Kuehlwein & Rosen (1993). Thus, various CBT strategies vary in the type of components of the cognitive and behavioral ABC models they emphasize and target. For example, in the cognitive ABC model some CBT strategies (mainly behaviorally oriented) emphasize and directly target A (e.g., by using problem solving techniques) and C (e.g., by behavioral modifications, relaxation) components, while others are more cognitively oriented (B), focusing and using cognitive restructuring techniques (and here the focus could be on various types of cognitions). Based on the new developments in psychology (i.e., cognitive sciences, behavioral genetics and cognitive neurosciences, behavioral learning theories etc.) and based on its own basic/fundamental research, CBT theory is updated continuously, thus being a progressive research program in science.
PRACTICE: The main components of the CBT practice are: (1) clinical diagnosis/evidence-based psychological assessment; (2) CBT conceptualization (the key distinctive aspect of CBT); (3) CBT strategies (including the above mentioned techniques); and (4) a sound therapeutical relationship (e.g., active collaboration, empathy, unconditional acceptance of the client, congruence). CBT can be practiced individually, in groups, and for couples/families, for a large range of clinical and non-clinical conditions and ages (e.g., children/adolescents, adults, aging population). The main CBT techniques - reunited in CBT strategies - include cognitive restructuring techniques (e.g., empirical, logical, pragmatical, metaphorical, cognitive hypnotherapy etc.), behavioral techniques (e.g., exposure, desensitization, social skill training/assertiveness training, relaxation, biofeedback, behavioral hypnosis etc.), coping strategies (e.g., self-instructional training, relaxation, breath control, socio-cognitive hypnotherapy etc.), problems solving techniques (e.g., problem solving, solution focus, decision making, negotiation and conflict resolution etc.), mindfulness/acceptance techniques etc. Some of these techniques can be used in the context of the new technologies (e.g., computer/online-based CBT, virtual reality-based CBT etc.). Based on theoretical developments in psychology and basic/fundamental, translational, and applied CBT research, new CBT strategies and techniques are developing continuously, thus making the field a very dynamic one.
TRAINING: While all CBT psychotherapists share the fundamentals of the CBT (i.e., cognitive and/or behavioral learning theories) they
“…may call themselves Cognitive Psychotherapists, Behavioural Psychotherapists, Cognitive Behavioural Psychotherapists or Rational Emotive Behaviour Therapists. These different titles often reflect the preference and training of individual therapists for specific techniques which address problematic thoughts, assumptions and beliefs directly (Cognitive Psychotherapists), address behaviour directly (Behavioural Psychotherapists) or a combination of techniques aimed at addressing thoughts and behaviour (Cognitive Behavioural Psychotherapists, Rational Emotive Behaviour Therapists). Whatever title they use, the approach is commonly referred to as CBT. Most importantly, all therapists aim to help clients achieve desired change in the way they think, feel and behave…” (EABCT: http://www.eabct.com, retrieved 18 July, 2013).
The CBT training components typically include (for details please see the EABCT standards): (1) personal therapy/development (especially when it is regulated in the country of interest); (2) CBT theoretical training (focused on the general architecture and fundamentals of CBT – including various cognitive and behavioral models and strategies –, rather than focused only on a specific CBT strategy); (3) CBT clinical practice (it can be more focused on preferred CBT strategies/psychological treatments); and (4) CBT clinical supervision. The minimal training is 5 years, including professional (i.e., in a mental health profession) and post-professional (i.e., CBT) training. Due to the continuing theoretical and practical developments in the CBT field, the training programs are dynamically evolving and thus, the continuing education is a fundamental aspect for any already trained CBT psychotherapist.
RESEARCH AND CLINICAL EVIDENCE: Starting from the fundamentals of the CBT paradigm, various specific CBT psychological treatments (often flexibly manualized and including particular CBT strategies) are continuously elaborated and tested in clinical trials for a large spectrum of clinical (e.g., CBT for major psychiatric/psychological and medical disorders that involve psychological mechanisms/factors) and non-clinical (e.g., rational-emotive education) conditions (for details see the NICE Guidelines and the APA’s Research Supported Psychological Treatments). Thus, CBT is the spearhead of psychotherapy in the evidence-based movement in the health field. Hundreds of studies supporting the efficacy and/or (cost)effectiveness of various CBT psychological treatments also tentatively support CBT’s overall efficacy and/or (cost)effectiveness and clearly argue for its evidence-based oriented profile and its evidence-based status (e.g., one of the golden standard psychotherapy treatments for a large variety of clinical conditions). For more details and for specific evidence-based CBT psychological treatments refer to the Key Resources in CBT section.
• Dobson, K. (2009, ed.). Handbook of cognitive-behavioral therapies (third edition). The Guilford Press: New York.
• EABCT (2013). What is CBT? (http://www.eabct.com; retrieved 18 July, 2013)
• Kuehlwein, K.T., & Rosen, H. (1993, eds). Cognitive Therapies in action. Evolving innovative practice. Jossey-Bass Publishers: San Francisco.
KEY RESOURCES IN CBT:
• European Association for Behavioural and Cognitive Therapies (http://www.eabct.com)
• Association for Behavioral and Cognitive Therapies (http://www.abct.org)
• Beck Institute for Cognitive Behavior Therapy (http://www.beckinstitute.org)
• Academy of Cognitive Therapy (http://www.academyofct.org)
• International Association of Cognitive Psychotherapy (www.the-iacp.com/)
• Albert Ellis Institute (http://www.albertellis.org)
• Association for Rational Emotive Behaviour Therapy (http://www.arebt.net)
• APA’s Research Supported Psychological Treatments (http://www.div12.org/PsychologicalTreatments/index.html) – American Psychological Association (APA - http://www.apa.org)
• NICE Guidelines - National Institute for Health and Clinical Excellence (NICE - http://nice.org.uk)
• International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health (http://www.psychotherapy.ro)
European Association for Psychotherapy - Mariahilfer Straße 1d/3. Stock/Tür 13, A-1060 Vienna, Austria - www.europsyche.org