Cognitive Behavioural Therapy: The Origins and History

CBT is a modern talk-based therapy that has grown in popularity in recent years, largely because there is a large evidence base from research and clinical practice to prove it is an effective therapy for a large range of mental health issues including, but not restricted to, depression, anxiety, and obsessive compulsive behaviour. This report seeks to outline the origins and history of CBT before considering and analysis the main tools and techniques in use in CBT. There is continual development and this therapy is continually evolving to ensure methods remain effective as society changes.

It can be argued that the origins of CBT are rooted in ancient Greek times. Socrates began asking questions to support and encourage people to think through of problems to work toward a rational solution, very similar to CBT today, indeed he gives his name to a CBT tool that will be discussed in a later section. Indeed, the pioneers of the development of CBT, Aaron Beck and Albert Ellis have highlighted their approached are rooted in Stoic philosophy from ancient Greek times. The 17th century philosopher, René Descartes, was the first to accentuate the relationship between the mind and body. He considered the two to be separate entities and the mind to be the source of the soul. He wrote about their interaction and realised the mind could control the body although he thought it was due to animal spirits moving through the body and controlling the nerves and musclesю

Before the 18th century, mental health issues were thought of as ‘madness’ and theories beliefs about possible treatments came from alchemy, astrology and belief systems of spirits or gods. From origins in philosophy and biology, psychology emerged in the late 19th century as a unique discipline to examine the human mind and behaviour patterns. The first psychological laboratory was opened by William Wundt at the University of Leipzig in Germany in 1879. This enables experimentation to measurably prove hypotheses rather than base theories on beliefs establish psychology as a science. The emergence and development of the behaviourism strand of psychology happened in the late 19th and early 20th century. In 1890, Pavlov conducted experiments with dogs. He noted the dogs would salivate when he and his assistants entered the room, even when they did not have food. Pavlov measured the amount of saliva produced by the dogs when they were presented with food. He used a bell as a neutral stimulus and rang the bell whenever food was given to the dogs. After this was repeated a number of times, Pavlov discovered that the bell alone would trigger similar levels of salivation as when the dogs were presented with the food. The dogs had learned o associate the bell with food. This conditioned response is known as the Pavlovian response and the linking of a conditioned response (in this case the bell) to an unconditioned stimulus, such as food, is known as Pavlovian Conditioning (1902). As the name suggests, behaviourism concentrated on observing the behavioural response to external stimuli. At this stage it was thought it was impossible to scientifically examine the mind so the focus was on the measurable behavioural responses, indeed Watson stated the stimuli only shaped behaviour, in other words only environmental factors caused resulting behaviour, genetic or instinctive factors were irrelevant to behaviourists. Skinner viewed classical conditioning as too simplistic too explain human behaviour. He believed to understand behaviour, it was necessary to examine the causes to actions and consequences through rewards and punishments. He called this operant conditioning. He devised a series of experiments on rats to determine the effects of positive reinforcement and punishment. He examined the response rate and the extinction rate, how fast the behaviour is unlearned after the reward or punishment is withdrawn.

Based on the principles of classical conditioning, Joseph Wolpe developed his systemic desensitisation for the treatment of phobias, such as arachnophobia. The treatment has three phases. Firstly, the patient is taught a relaxation technique then the patient creates a hierarchy of fear starting at the lowest level of anxiety and increasing to the highest level of fear. In the third phase the patient works up the hierarchy while practicing the relaxation technique. The therapy is deemed successful when the situation does not provoke anxiety. This technique only deals with the symptoms of anxiety, not the underlying causes.

Cognitive psychology started to gain popularity in the 1960s. Albert Bandura described himself as a social cognitivist rather than a behaviourist. His social learning theory stressed the importance of observed learning, cognitions and the environment. Whilst he emphasised the importance of social influences on behaviour, he also believed in personal control.

George Kelly developed his personal constructs theory that purported that people develop personal constructs about the world they interact with and use these constructs to view their experiences. If the constructs seem to be true, their belief is strengthened but if the constructs fail, new constructs are developed.

Albert Ellis helped found and shape CBT with the development of Rational Emotive Behaviour Therapy (REBT). This is a more direct and active approach than previous talking therapies where the therapist helps the client understand core irrational beliefs that are causing them emotional and psychological distress and leading to undesired behaviour. REBT then uses a technique called “disputing” to help clients reformulate their dysfunctional beliefs to be more realistic and functional.

One of the key figures in the development of CBT is Aaron Beck. He became interested in the cognitive approach when he discovered that depressed patients often expressed negative automatic thoughts about themselves, others or the environment around them. He began to help clients to identify these thoughts replace them with more correct thoughts. Although he initially focussed on clients suffering from depression, he discovered that successful treatment of any disorder involved making patient aware of their negative thought patterns. Once these thought patterns are change dysfunctional behaviour patterns, such as staying in bed, are also replaced by more constructive behaviour.