Although behavior therapists tend to focus attention on external stimuli and consequences as causes of maladaptive behavior, they also recognize that many disorders, including depression and anxiety, can be rooted in how clients perceive themselves and the world around them. As cognition (thinking) is a form of behavior, it should be possible to alter problematic thoughts just as it is possible to change other kinds of behavior by manipulating stimuli and consequences. Cognitive-behavior therapy (CBT) focuses on using learning principles to change the way clients think and, consequently, how they behave as a result of that thinking.
Aaron Beck, a hugely inﬂuential cognitive therapist, has had great success in the treatment of depression via cognitive restructuring. His approach assumes that mental disorders originate in false beliefs and errors of logic, called cognitive distortions (not to be confused with cognitive dissonance). Over time, these false beliefs (such things as “I can’t do anything right,” “I’m a total loser,” “If I say anything, they’ll all think I’m an idiot”) begin to occur automatically, so that the client never stops to consider whether they are even true. Therapy therefore consists of identifying the false beliefs and distortions, and then treating them as hypotheses to be tested. In addition to helping people examine their false beliefs through gentle questioning, therapy therefore often also involves designing empirical tests of these beliefs. As homework, a client who fears meeting new people may be required to introduce himself to a stranger. Success at this task without any negative consequences will help to reduce his anxiety in such situations, and further success may eventually eliminate the fear and anxiety entirely, or at least to a sufﬁcient extent that the anxiety is no longer a problem.
Another inﬂuential approach to cognitive-behavior therapy is Albert Ellis’s rational-emotive behavior therapy (REBT). In Ellis’s view, mental distress is produced not so much by upsetting events as it is caused by rigid and maladaptive ways in which we interpret those events. The person with depression, for example, may interpret a suggestion as criticism, friendliness as pity, or enter all situations with the belief that “I must be perfect at everything I do.” Like Beck’s approach, REBT consists of helping the client zero in on these irrational beliefs and then challenging them. Unlike Beck’s relatively gentle approach, however, REBT involves a rather blunt, confrontational approach. Beck has expressed his ultimate goal with a client as “making him work his ass off, cognitively, emotionally, and behaviorally, to profoundly change.” Like Beck’s therapy, this approach involves homework. A very shy client, for example, may be encouraged to sing loudly in a subway or ﬂirt with men she ﬁnds attractive, so that she may come to realize that her life does not fall apart as a result. Success in challenging false beliefs ultimately eliminates them, perhaps eliminating the resultant psychological disorder as well. Research on both Ellis’s and Beck’s therapy has generally shown positive results.
- Beck, J. S., and Beck, A. T. Cognitive Therapy: Basics and Beyond. New York: Guilford Press, 1995;
- Ellis, A. “Reﬂections on Rational-Emotive Therapy.” Journal of Consulting and Clinical Psychology, 61 (1993): 199–201.