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Last updated: Thu, Feb 6, 2025
CBT, or cognitive behavioral therapy, is an approach to therapy that is centered around two basic propositions: 1) Peoples' behavior is guided by their conscious beliefs; 2) Peoples' behavior is guided by their implicit learning. These two ideas are the basis for a therapeutic technique that is used clinically to address a range of life problems, ranging from phobias to social awkwardness. The objectives of this therapy are changes in behavior. The format of the therapy includes two distinct roles. The therapist, who is trained in the principles of psychology, diagnoses the problems of the client, who participates in explicit learning exercises prescribed and often adminiltered by the therapis. The client also performs exercises intended to change behavior from "maladaptive" to "adaptive," as suggested by the therapist.
The central propositions behind CBT, that an individual's behaviors are guided by explicit and implicit learning, are of course very consistent with behavioral psychology, and seem almost self-evident to many psychologists. CBT has found favor among practicing psychologists as well as with health-care financing organizations, and it has proven fairly effective in helping clients with certain types of problems, particularly with problem situations in which its basic foundations are most true--those situations in which the "problem" is caused by erroneous explicit beliefs and maladaptive implicit learning, which can also be described as maladaptive behavioral habits. An important plus of CBT is that programs to address common problems can be routinized and executed in a limited number of sessions.
Cognitive behavioral therapy is also found under other names: cognitive therapy, problem-solving therapy, rational-emotive therapy, interpersonal cognitive therapy, and schema therapy. It is intended for clients who are aware that they have a problem, have a preference to change, but don't know what changes to make or how to make them.
Therapy begins with a process wherein the therapist develops a sense both of what situations the patient is troubled by, and the beliefs and learnings which seem to lead to unsatisfactory outcomes for the client. This becomes the basis for a plan of explicit learning (or relearning) and behavioral exercises intended to guide the client to more-successful outcomes. In the language of CBT, "beliefs are 'cognitive configurations,' pre-existing notions about the nature of reality. Attitudes are feelings about events. Expectancies are beliefs about the future. Self-efficacy expectancies are about one's capacity to execute a required behavior. Outcome expectancies are about outcomes."1
"Motivational" techniques are used with clients in these initial interviews and in general for all interactions. Motivational interviewing intends to influence the client's attitudes about his own behaviors and the situations he has troubles with in a direction that favors acceptance of the changes which the therapist favors.
CBT techniques are based on additional principles ostensibly garnered from psychological science.2
The "access hypothesis" asserts that the content and process of thinking (that is, the thinking behind the problem behaviors) can be known to the client, with appropriate practice and coaching. This technique has been rejected as "mentalism" in the development of psychological knowledge, but is adjudged to be adequate in a clinical situation.
The "mediation hypothesis" is that our thoughts shape our emotional responses to problematic situations. This seems to be held as universally true, in other words, it applies as much when we suddenly stub a toe, as it does in out relationships with our partners or our habitual response to walking into a noisy room.
The "change hypothesis" is that, since we have access to our thoughts and since these thoughts determine our response, we are able, with application, to change our responses to troublesome situations.
The "realist assumption" is that there is a reality in the world, even in the social world, and that mental ease or discomfort result from acknowledging and responding effectively to reality.
Each of these assumptions and hypotheses is realistic in certain circumstances. We clearly have conscious awareness of some of our thoughts, although neuroscience is clearly finding that much of our cognition is subconscious. We all know of situations in which our thought-guided emotions have been wrong, yet none of us knows all the subconscious thoughts we have. All grown-ups know how to use our rational brains to make personal changes. And we all know, or can imagine, circumstances in which someone (usually someone else) might be better off living outside of reality.