Cognitive Therapy, Behavioral Therapy, Both, or Neither - Assignment Example

Cognitive Therapy, Behavioral Therapy, Both, or Neither? It is not likely that Sigmund Freud (1856-1939), considered the father of psychoanalysis, would appear in many papers as a major figure in the development and evolution of cognitive or behavioral therapies. He did play a significant role, though, in that the researchers who developed theories in these fields did so in a number of cases specifically to oppose the psychoanalytic and related theories proposed by Freud. For example, one description of John Watson (1878-1958), considered the father of behaviorism, stated, “…Watson disparaged psychology’s previous focus on mental states and argued that the true object of study for psychology must be that which can be observed: behavior. He showed particular scorn for Freud’s thesis that unconscious sexual impulses are the basis for conscious anxiety and pathological behavior.” (Demorest, 2005). As another example, Albert Ellis (1913 - ), a pioneer in rational emotive behavior therapy (REBT), which some consider a precursor to cognitive therapy, was described as “…originally a psychoanalyst but ultimately rejected the psychodynamic approach.” (Eisner, 2000). Aaron Beck (1921 - ) arguably the true founder of cognitive therapy, “…initially conducted research into psychoanalytic theories of depression, but when these hypotheses were disconfirmed, he developed a different theoretical-clinical approach that he labeled cognitive therapy.” (University of Pennsylvania Health System, A Biography of Aaron T. Beck, MD, n.d., para. 2). Clearly a number of researchers believed the Freudian/analytic model had lost its value, but the theories they developed had distinct differences. Cognitive therapy is most commonly associated with Aaron Beck, though of some similarity, pre-dating Beck, is the work of Albert Ellis. Behavioral therapy is most commonly associated with B.F. Skinner (1904-1990), though the original work should certainly be credited to John Watson. Although these four researchers may be recognized for their contributions to psychology by name, they too credit the many other researchers, philosophers and physicians who contributed to their knowledge base and the work they did. Behaviorism John Watson, known as the founder of behaviorism, started his graduate studies at the University of Chicago in philosophy but switched to psychology, and received his degree in that field. However, soon he joined the faculty at Johns Hopkins University in Maryland and became one of the few psychologists to establish and do research in an animal psychology laboratory. As he became more and more put off by how many psychologists still seemed to use a philosophical approach, he realized he “wanted to teach a psychology dealing with visible, concrete facts.” (Woodworth, 2000). Watson continued to be frustrated with the lesser status of animal psychology, but an excerpt from his book Behavior, published in 1914, showed a definite movement toward behaviorism (as quoted by Woodworth, 2000), “It is possible to write a psychology, to define it…as the ‘science of behavior,’ and never go back on the definition: never to use the terms consciousness, mental states, mind, content, will, imagery, and the like…It can be done in terms of stimulus and response, in terms of habit formation, habit integration, and the like…” Watson’s book Behaviorism, published in 1924, received much attention as did the idea of behaviorism. In it, he discussed his now-famous experiment with a 9-month old infant dubbed “Albert.” As described in Demorest (2005), Watson exposed Albert to varying stimuli (i.e. cotton balls, rabbit), with or without an unpleasant and/or unexpected loud sound to see how Albert responded to the stimuli. Watson was looking at Albert’s responses to the stimuli, specifically, whether Albert’s responses (curiosity or fear) to the stimuli (rabbit or cotton ball) were a function of how Watson had modified the environment (namely the presence or absence of a loud and unpleasant sound when paired with the stimuli). Albert’s responses to the stimuli did change as a function of the environment; as a result of his studies with Albert he proposed that human behavior is a function of environmental conditioning. Therefore, he stated that human behavior was a function of unconditioned stimuli, conditioned stimuli, or stimulus generation. Although Watson’s theories were not necessarily considered “mainstream” at the time, Behaviorism also contained a claim that further tarnished Watson’s reputation in the eyes of many: Give me a dozen healthy infants, well-formed, and my own specified world to bring them up in and I’ll guarantee to take any one at random and train him to become any type of specialist I might select – doctor, lawyer, artist, merchant-chief and, yes, beggar-man and thief, regardless of his talents, penchants, tendencies, abilities, vocations, and race of his ancestors. (Watson, 1924 and revised 1930, as cited in Demorest, 2005) There is a last sentence, often left off, which slightly softens Watson’s statement, “I am going beyond my facts and I admit it, but so have the advocates of the contrary and they have been doing it for many thousands of years.” Watson’s contributions to behaviorism were undeniably important, but his rather unconventional research methods and grandiose statements probably have overshadowed the legitimate value of his contributions to psychology. It was the work of B.F. Skinner, though, that truly developed behavioral theory. Having survived some difficult years where he lacked direction and purpose, he became interested in the work of Watson and in psychology, “a psychology that bypassed the inner world of thoughts and feelings and desires and saw human behavior as being controlled entirely by environmental forces.” (Demorest, 2005). Demorest (2005) provides a concise overview of Skinner’s approach to behaviorism. Skinner saw behavior divided into two categories, respondent and operant. Respondent behaviors are those that happen in response, reflexively, to some sort of environmental stimulus, perhaps shivering when cold. They are also referred to as involuntary behaviors. Operant behaviors, those Skinner considered the most important, are those that occur more “as a function of feedback” with something in the environment. For example, if a worker stays late and gets praise from their manager the next day for doing so, it is more likely they will stay late in the future. The increased frequency in staying late is the respondent behavior. If the worker gets lectured, however, they probably will not stay late again in the future. Operant behavior is considered voluntary. Operant behaviors, according to Skinner, are environmentally controlled in three manners: reinforcement, extinction, and punishment. With reinforcement, the behavior in question is likely to increase, such as the worker choosing to stay late more often. Reinforcement can also be the removal of something undesirable – perhaps the worker is relieved of producing a tedious report when staying late. With extinction, the behavior stops when the desired response is no longer given, for example the worker resumes leaving on time if the positive feedback from the manager has stopped. Lastly, with punishment, the behavior decreases because of the presence of something unfavorable. Using the example of the worker, if the worker had simultaneously been coming in late, and was advised that continuing such behavior would result in a pay cut, it is likely the worker would make a better effort to come in on time for fear of the punishment of the pay cut. Skinner did not go to the extremes that Watson did in saying that environmental factors were the sole forces over behavior. He focused more on identifying what the basic principles were by which the environment influences human behavior. From there, he developed a theory of behaviorism to use to help people understand and gain a sense of control over the world around them. That is not to say Skinner did not leave behind a legacy, as did Watson with the “Dozen Healthy Infants” comment. Skinner is known worldwide for his research with rats that led him toward his conclusions about behavior. As the rats were placed in a black box for the study, with a lever either producing a shock or food, at Skinner’s control, Skinner’s name and “Black Box” now go together. Behaviorism has not had extensive “staying power,” though. This is likely because, starting from Watson’s notions of pure environmentalism to Skinner’s modified environmentalism, neither theory is appealing. Each deny that a person themselves, whether their thoughts or past experience, has any impact on what happens in their life. They seem to ignore that people truly do have thoughts and feelings, families and friends, pasts and futures, and that these are important to consider when understanding human behavior. I can see why behaviorism may look good as a theory, but in practice, it may not be my first choice if I were a practicing psychologist. Cognitive Therapy The literature is abundant with references to cognitive therapy, sometimes in conjunction with behavioral therapy, as in the practice of cognitive-behavioral therapy (CBT), other times on its own, as in Beck’s Cognitive Therapy of Depression. However, “cognitive therapy” has its beginnings before it was known as “cognitive therapy” with the work of Albert Ellis and REBT. Ellis was one of the therapists in the 20th century who believed psychoanalytic theory was not the most effective way to treat patients. As Eisner (2000) wrote, Ellis did not attempt to analyze patients’ interactions with the therapist or dwell on the past. According to Eisner, Ellis’ motto for REBT was: So as a person thinks, that is how he or she feels. In essence, how a person interprets an event (their cognitive interpretation) will determine their attitudes and emotions associated with it. If they have a positive interpretation, they will not be as distraught as if they interpret the event in a negative way. As Eisner (2000) summarized, REBT is known for its ABC theory of practice: Activating event (A) Belief about the event (B) Emotional consequences that follow (C) Ellis and REBT hypothesize that it is not the event itself that causes emotional distress, but the person’s beliefs about it. He states that when people have irrational beliefs, such as, “Everyone must like me,” or “Everyone must think I am beautiful” that when a seemingly harmless but undesirable event arises, the person’s irrational belief will lead to their own unhappiness. For example, a worker overhears a co-worker comment about going out after work but no one has told the worker of this (activating event - A). If the event becomes a catastrophe in the person’s mind due to their irrational beliefs (belief about the event – B, that “No one likes me because I wasn’t invited out”) as opposed to just a disappointment or frustration (“Maybe they will ask me later”) this can lead to depression and other undesirable emotional states (C). As in the previous example, REBT can help people see their situations more realistically. It also helps people understand that the causes of their negative feelings come from inside themselves. In this way, they can see that their feelings are controllable and something they can change, as opposed to being “outside of them” and beyond their capacity to change. Following the initial works of Ellis, in the 1960s, Albert Beck also turned away from the psychoanalytic approach to helping patients, but his approach focused on identifying, examining, and modifying patients’ distorted and maladaptive thinking that was underlying their unhappiness. (Dryden & Neenan, 2004), thus developing what is now known as cognitive therapy. In cognitive therapy people learn how to identify negative thoughts and replace them with positive thoughts, which lets people realize they do have control over their feelings. However, as Evans (2003) notes, “Cognitive therapy…teaches specific techniques for identifying and eliminating negative thoughts.” Apparently cognitive therapy has proven to be very successful. In a press release by the National Academies (Institute of Medicine), dated October 9, 2006, announcing that Aaron Beck had been awarded the Institute of Medicine’s 2006 Lienhard Award, it states, “In the United States, approximately 25 to 30 percent of clinical and counseling psychologists, and 20 percent to 25 percent of all mental health professionals now use cognitive therapy in their practices, reaching some 3 million to 5 million patients in the U.S. alone. Several million more patients worldwide benefit as well.” Aaron Beck’s name is synonymous with cognitive therapy, particularly with treating depression. In 2006, there is practically no emotional (and some physical) disorders for which cognitive therapy is not used (Dryden & Neenan, 2004). Eisner (2000) raises three interesting points that could explain cognitive therapy’s success over REBT: Cognitive therapy does not perceive a person’s distorted thoughts as irrational, as does REBT. Most people likely prefer to have their thoughts “respected” as opposed to being told they are irrational. In cognitive therapy, Beck proposes that various emotional problems do have their own typical cognitive “contents.” REBT focuses on essentially the same or similar sets of underlying irrational beliefs for almost all emotional problems. Last, and perhaps most important, Ellis and the REBT therapists have a “direct confrontational style” while Beck’s cognitive style is more interactive. As Eisner wrote of a previously presented case study, “As shown in the example above, Ellis directly attacks the alleged irrational or distorted cognition. Beck, on the other hand, helps the client discover the distorted cognition.” Some doubt the actual validity of cognitive therapy and say it is successful only for the “sympathy” (Evans, 2003) and interactive time it gives the person with the therapist. However, if the patient reaches their goal(s) and leaves the therapy happier than when they began, then perhaps the “sympathy” factor is not so bad. Further, cognitive therapy can be used in the truly catastrophic situations when REBT cannot. For example, in a truly catastrophic situation (rape, September 11, 2001) REBT’s underlying premise of focusing on irrational thoughts would not be appropriate. There would be no way to try to view such atrocities as merely “undesirable events.” Trying to say that viewing them as catastrophic events represents “irrational thoughts” is disrespectful to the person experiencing the event. Cognitive therapy, as it focuses more on exploring thoughts and making changes for the better, would seemingly be the more appropriate of the two. As previously discussed, cognitive therapy is almost automatically associated with the treatment of depression, with good reason, as it helps people view themselves differently, which may be the cause of their depression. Even though the press release about Aaron Beck stated that participants in a cognitive therapy group were 50 percent less likely to attempt suicide than the controls, I find it difficult to see how cognitive therapy alone could help a very despondent person who felt so much that life was not worth living that they wanted to kill themselves. Perhaps cognitive therapy in conjunction with medication could help the person, as a suicidal person likely could benefit from both kinds of treatment, but if I were a psychologist I would be concerned about treating someone suicidal using only cognitive therapy. Behavioral therapy seems completely unsuited to suicidal persons, as well as to persons who might not be able to recall or recount the details of the “activating event” that is leading to their problems. Without a clear picture of the activating event, the rest of the REBT therapy cannot occur. In my opinion, neither cognitive nor behavioral therapy alone would be a sufficient therapeutic foundation if I had a clinical practice. Therefore, I would opt for the two together, in CBT. Beck et al. (2000, as cited in Sudak, Beck, & Wright, 2003) provide a good reason in their description of CBT: Cognitive behavioral therapy (CBT) is a form of psychological treatment with a comprehensive theory of psychopathology and personality and specific models for various disorders. The therapy requires an empathic, active clinician, who collaborates with patients in order to define specific treatment goals. Sessions are structured with the purpose of reducing symptoms and learning disorder-specific cognitive and behavioral skills. Cognitive therapy has been found to be effective in working with individuals, groups, couples, and families. Although the ideas behind behaviorism had merit, both Watson and Skinner, in my opinion, failed to present their ideas in a fashion that was both understandable and respectful to those outside their narrow focus, thus limiting the acceptance of their ideas. Ellis and Beck, in particular, have enjoyed much more success, though changing thoughts alone does not always bring about desired change. Thus CBT, a combination of the two, can offer those seeking help “the best of both worlds.” References Demorest, A. (2005). Psychology’s grand theorists: How personal experiences shaped professional ideas. Mahwah, NJ: Lawrence Erlbaum Associates. Dryden, W. & Neenan, M. (2004). Cognitive Therapy: 100 Key Points. New York: Brunner- Routledge. Eisner, D.A. (2000). The death of psychotherapy: From Freud to alien abductions. Westport: Praeger. Evans, D. (2003). Emotion: A very short introduction. Oxford: Oxford University Press. Hardy, B. (2006). Aaron T. Beck, ‘father of cognitive therapy,’ wins Institute of Medicine’s 2006 Lienhard Award. Retrieved November 11, 2006, from The National Academies Web site: http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10092006b Sudak, D.M., Beck, J.S., & Wright, J. (2003). Cognitive behavioral therapy: A blueprint for attaining and assessing psychiatry resident competency. Academic Psychiatry, 27, 154-159. University of Pennsylvania Health System, A Biography of Aaron T. Beck MD. (n.d.). Retrieved November 11, 2006, from http://mail.med.upenn.edu/~abeck/biography.htm Woodworth, R.S. (1948). Contemporary schools of psychology. New York: Ronald Press. Read More