Introduction to CBT - Generations of CBTs

Behavior Therapy History

• Early 20th Century Era of Psychotherapy and Learning:: 1900-1950(ish)

• First generation behavior therapy: 1950s-1960s

• Second generation behavior therapy: 1970s-1990s

• Third generation behavior therapy: mid 1990s-present

• Research and Integration next wave?

Typical Themes in Non-CBT Treatments

• Non-directive

• Insight oriented

• Support oriented- e.g. expectation that an individual therapy session will make you feel better

• May focus on: early learning history, family relationships, unconscious processes

• Clear differential between therapist and patient

• Expectation that therapy is a long-term process

Cognitive-Behavioral Therapy (CBT)

Classification of therapies with similarities (Rational Emotive Behavior Therapy, Beckian Cognitive Therapy, Dialectic Behavior Therapy, Acceptance and Commitment Therapy, etc.)

• Does not exist as a distinct therapeutic technique. 

Early 20th Century

• Application of learning principles to human problems

• Commitment to empiricism as a core value

• Strong ties with theory and basic lab work

• Examples: exposure, contingency management, skills training

• Important figures Edward Thorndike, John Watson, B.F. Skinner, Joseph Wolpe

Edward Thorndike

• Law of Effect: behaviors followed by satisfying consequences are more likely to be repeated, while behaviors followed by uncomfortable consequences are less likely to recur. 

• Cat box experiment

John Watson

• Behaviorism

• Classical conditioning

• Little Albert experiment

B.F. Skinner

• Father of operant conditioning

• First to use term “behavior therapy”

• Skinner box with rats and pigeons

Joseph Wolpe

• Represent the really beginnings of modern behavior therapy

• Early research in the 1940s/1950s:

  -Attempts to replace anxiety/fear response with relaxation response through classical conditioning

  -Client associates being relaxed with anxiety/ fear-arousing stimulus by series of graded steps

First-Generation Behavioral Therapy Researchers - Similarities

• Basic learning research backgrounds

• Applied current (at least in their time!) learning research to clinical problems

• Results were positive (methods had problems by modern standards)

• Believed this was a small part of a larger program

• Committed to science and research

First-Generation Behavioral Therapy Researchers - Differences

• Different definitions of behavior therapy

• Heterogeneity in their research

• Didn’t use same learning principles

• Didn’t believe even in the same theory of learning

Limitations in Adoption of Behavior Therapy

Impact of BT initially limited because:

• Psychoanalysis dominated clinical practice 1900-1950s

• Clinical work dominated by psychoanalysis (and psychiatrists!)

• Academics primarily interested in basic issues

• Zealous/dogmatic way Watson publicized his work

Reactions of the Clinical Establishments to Behavior Therapy

This presented a serious challenge to the prevailing psychoanalytic model of psychopathology, assessment, and psychotherapy

• Ignoring

• Fierce resistance

• Co-opting (“I already do that”)

• Gradual incorporations/acceptance

Second Generation of Behavior Therapy (Late 70s - 90s)

• Emphasis on processes of language and cognition

• Expansion to problems beyond anxiety & depression

• Commitment to empiricism remained

• Born of clinician’s frustration of with limitations of behavioral approaches to complex clinical phenomena

• Innovations derived from therapy room, not lab

• Important figures: Aaron Beck, Albert Ellis

Second Generation - Growth into the Mainstream

• Widespread support and dissemination

• Very gradual (and ongoing) replacement of psychoanalysis as predominant model.

Third Generation of Behavioral Therapy (Mid 90s - Present)

• Accumulating questions about traditional BT/CBT emerged in 80s and 90s

• Efficacy seems to have stalled, even for core targets (e.g., depression, anxiety)

• Questions about mechanismsThird 

Third Generation - Incorporation of Acceptance and Mindfulness Approaches

Examples of approaches: 

• Kabat-Zinn’s MBSR

• Linehan’s Dialectical BT

• Kohlenberg’s Functional Analytic Psychotherapy

• Siegal and Teasdale’s MBCT

• Jacobson’s IBCT

• Hayes’ ACT

Also reflected in work of other leading CBT figures such as Barlow and Borkovec

Third Generation Themes

• Acceptance

• Mindfulness

• Cognitive defusion

• Values

• Experiential methods