Running head: COGNITIVE BEHAVIOR THERAPY 1

Cognitive Behavior Therapy

Kasey A. Johnson
Dallas Baptist University
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Brief history of the theory and theorist

Aaron Beck developed Cognitive Behavior Therapy (CBT). According to Tan (2011),

Beck was born in Providence, Rhode Island on July 18, 1921 to Jewish immigrant parents from

Russia. When he was a child, he broke his arm which led to a bone and blood infection, requiring

major surgery. His mother suffered from depression, and his first grade teacher was very

abusive. As a result of his poor physical health and depression, he developed several fears and

phobias, including a public speaking anxiety. These experiences caused him to have a special

sensitivity toward others and ultimately were the reasons he became interested in psychiatry

(Tan, 2011, p.249). Beck graduated from Brown and started at Yale University School of

Medicine in 1942. “In 1946 he received his MD degree, and eventually earned his residency

training in psychiatry” (Tan, 2011, p.249). CBT is one of the most widely supported therapies

still in use today. Beck began to develop his CBT into a logical system of treatment for

depression and anxiety. “His work has been a major force in shaping a new direction in

psychology and psychiatry, which has been described as the cognitive revolution” (Childress &

Burns, 1981).

David Burns was Aaron Beck’s partner in his research. “Dr. Burns graduated magna cum

laude from Amherst College, received his MD from Stanford University School of Medicine and

completed his psychiatry residency at the University of Pennsylvania School of Medicine”

(Burns, n.d., para. 1). After contributing to the creation of CBT, over time he has seen a number

of inadequacies. He has since developed an additional model for therapy called T.E.A.M. T is for

Testing, E is for Empathy, A is for Agenda Setting, and M is for Methods. The goal of T.E.A.M.

is to produce powerful and intense changes all within one session (Burns, n.d., para. 17).
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View of human nature and unconscious

CBT focuses on how a person’s thoughts influence and affect behavior and feelings.

People have some degree of free will and choice which increases their ability for self-regulation

(Tan, 2011, p.252). Therefore, Tan (2011) states “Cognitive Behavior Therapy still views human

beings as basically neutral, neither inherently good nor inherently evil” (p. 253). Based on social

learning, CBT mainly focuses on the present rather than the past and “tends to ignore

unconscious processes, including transference and dreams that can provide helpful insights to

clients and facilitate further therapeutic improvements” (Tan, 2011, p. 273). Clients have the

ability to alter their thought processes from irrational to more rational thinking. Clients are then

able to realize how their ideas, attitudes, or beliefs profoundly influence their feelings and

experiences (Tan, 2011, p. 253).

The role of the therapist and the client

Cognitive Behavior therapists believe the way a person perceives certain events

determines how they will feel and act. Clients learn how to restructure their brains and focus on

the positive and not the negative events around them. Therapists help train their clients to

identify negative automatic thoughts and replace them with more objective and positive

thoughts, in order to help relieve painful feelings. “The aim of therapy is to restructure the

depressed patient’s negative view of the self, the world, and the future” (Childress & Burns,

1981). The therapist functions as an educator and technical consultant who helps the client

identify maladaptive cognitions and the behavior associated with the cognitions (Tan, 2011, p.

257). The therapist helps clients identify the main complaints or issues they would like to work

through, and clients set their own goals along with the therapist (Tan, 2011, p. 257). Each week

the therapist begins by setting an agenda, and reviews any previous homework from the week
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before (Tan, 2011, p. 257). As clients continue to make progress on their goals, therapy sessions

become less frequent and are eventually phased out (Tan, 2011, p.257). “A therapist who

embodies Self and feels unconditional positive regard in the face of whatever the person in

treatment may be experiencing nurtures the therapeutic relationship. Without a therapeutic

relationship, there is no therapy” (“Elements”, 2015).

Unique techniques utilized in therapy

CBT maintains that interventions are more important and have a longer lasting effect than

the positive therapeutic relationship. “Cognitive behavioral therapy emphasizes the role our

thoughts play in how we feel. Even if stressful external situations don’t change, changing how

we think about them can prevent a negative emotional response such as depression”

(Aboujaoude, 2009, para. 2). CBT challenges clients to change their distorted thinking, and their

destructive behavior patterns. The goal of CBT is to help clients understand how to interpret and

take control of their surroundings. According to the article “What is Cognitive behavior

therapy?” (2015), to help a client resist destructive thoughts and behaviors, the therapist will start

by working with the client to identify problematic beliefs. “It’s important for clients to learn how

thoughts, feelings, and situations can contribute to maladaptive behaviors” (“Cognitive behavior

therapy”, 2015, para. 9). After the therapist has helped the client identify their destructive

behaviors, the client can then learn and practice new skills to combat the maladaptive behaviors.

There are many different techniques that therapists can use with clients to help them combat

distorted cognitions. One of the most powerful techniques used is “Rational Responding.” Tan

(2011) reports four steps to rational responding: exploring the evidence for the belief, creating a

more adaptable plan, changing the belief to be less catastrophic, and creating steps to cope more

effectively with the problem (p. 259). This technique helps clients identify and analyze
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maladaptive thoughts and replace them with more positive thoughts. Another technique used is

“Examining Options and Alternatives,” where the therapist helps the client brainstorm alternative

options or solutions to a problem, so that the client can see past a limited list of solutions (Tan,

2011, p.259). According to Tan (2011), a third technique is “Decatastrophizing,” where the

therapist uses the Socratic Questioning Method “to help the client see if he or she is blowing

things out of proportion, or making extreme conclusions about a situation or outcome” (p. 259).

The therapist helps the client put things in a realistic perspective. A fourth technique is

“Scaling,” where the clients rates themselves on a scale of 0-100 in an area they are having

difficulties. Tan (2011) reports “The client then rates herself on this 0-to-100 competency scale

and will often achieve a less extreme view of herself in terms of competence, with some

strengths and weaknesses (and not all weaknesses and no competence)” (p. 260). This helps

clients realize they are not as hopeless as they believed. Last of all, there is “Bibliotherapy.”

Some therapists will assign a book to read as homework for continued progress. Clients may be

asked to keep a record of dysfunctional thoughts, to include a description of the situation,

emotions, automatic thoughts, rational responses, and outcomes. “The therapist reviews the

written homework at each session. Initially, patients may be able to identify and write down their

negative thoughts but find it difficult to generate meaningful rational responses” (Childress &

Burns, 1981). Over time, however, the more the client uses this technique at home and with the

therapist, the easier this becomes.

Target clientele for the theory

Due to the numerous therapeutic techniques employed by CBT, practitioners are able to

treat clients with a broad scope of emotional disorders. Conditions treated with CBT include

depression, anxiety disorders and phobias, bipolar disorder, suicidality, eating disorders,
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alcoholism and substance abuse, marital problems and relationship difficulties, personality

disorders, schizophrenia and psychotic disorders, pain and anger, hostility and violence problems

(Tan, 2011, p. 249). CBT focuses on changing the maladaptive cognitive distortions a person

develops over time, often from childhood, which eventually develop into the above listed

disorders. In a relatively short period of time therapists are able to help clients change their

thought process and patterns. Some clients may need more specialized and individualized

treatment depending on the disorder, but many will go on to lead happy, healthy, and productive

lives. Clients are usually able to contact the therapist for a follow up appointment if needed. The

therapies and techniques clients learn from their therapist often stay with them for years,

enhancing clients’ self-efficacy.

Analysis of how change takes place

Cognitive Behavior Therapy helps clients change cognitive distortions. Tan (2011) states

“Clients have the capacity to change their maladaptive thinking and hence change problem

feelings and behaviors” (p. 248). CBT consists of cognitive learning therapies that have three

major categories. One therapy is “cognitive restructuring,” where clients learn to change their

maladaptive thoughts. Another therapy is “coping skills therapy,” where clients learn to use

cognitive and behavioral skills in stressful situations. The third therapy is “problem-solving

therapy,” where clients explore other options and implement solutions to particular problems that

arise. Cameron (2015) explains that Cognitive Theory was created on the belief that our

emotions and the problems we face are a result of the way we think (p. 25). “By changing their

thought processes, individuals can change the way they respond to situations” (Cameron, 2015,

p. 25). Once clients learn strategies and therapies to help change their thinking, their outlook on

life becomes a lot better and they will notice a significant change in daily life.
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Strengths and weaknesses

Cognitive Behavior Therapy has several strengths and weaknesses. According to Tan

(2011), “CBT is a comprehensive and versatile approach to therapy that has been used with

diverse populations to address a wide range of psychological disorders and clinical problems, in

a variety of practice settings” (p. 271). As such, CBT is accessible to most clients: young

children, adolescent, middle aged and older aged clients, as well as those of different ethnicities.

CBT empowers clients across many cultures to identify problems and choose the most

appropriate goals. Therapists support clients and monitor their progress, allowing clients to

choose the type of treatment options they prefer (Tan, 2011, p. 271). One final strength of CBT

is the wide range of therapeutic techniques that can be used to treat specific psychological

disorders such as alcoholism and substance abuse, depression, anxiety disorders and phobias

mentioned above. Therapists are also open to using medication “in the treatment of severe

psychological disorders such as major depressive disorder, bipolar disorder, OCD, and

schizophrenia” (Tan, 2011, p. 271).

One weakness of CBT is that it tends to focus on and treat the existing issue or symptom.

Without regard to the past and any unresolved painful experiences (Tan, 2011, p. 272). Some

critics may say that treatment is difficult unless underlying issues are resolved. Another

weakness is that CBT often focuses too much on technique instead of the overall therapeutic

relationship. In order to encourage the client to talk freely and make the most of the client’s

overall experience, the therapist should cultivate a warm, empathetic, and collective relationship

(Tan, 2011, p. 272). Beck (2011) states the therapist will show understanding of clients by using

certain empathetic statements, choosing correct words, using a calm tone of voice, and positive

body language (p.18). One final weakness of CBT is that it is a “directive, structured, and
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systematic approach in which the therapist functions as a teacher, coach, consultant, and role

model” (Tan, 2011, p. 273). As a result, if the therapist is not adequately trained, there is a

danger that they may impose their own values on clients, possibly impeding their progress

instead of allowing them to work hard through their own cognitive processes (Tan, 2011, p. 273).

Analysis of the theory from a Christian perspective

From a Christian perspective, CBT is thought-provoking. One tenet of CBT is that clients

choose their own goals to work on, and the therapist is there to coach them through. As believers

we seek to align our values and goals with scripture, as 2 Timothy 3:16 states “All scripture is

God breathed and is useful for teaching, rebuking, correcting, and training in righteousness, so

that the man of God may be thoroughly equipped for every good work” (New International

Version). It’s most beneficial when clients look to their creator who knows them more fully than

they know themselves instead of putting their trust in others.

A biblical perspective will help the client work more adequately through past issues and

not only current problems and symptoms. As stated earlier, one of the weaknesses of CBT is that

it does not address the past and unresolved issues. It seems the best case scenario would be a

marriage of CBT with Christianity, knowing that Jesus heals our past sin and sets us free from

the chains that bind us. To bring lasting behavioral change in addition to certain techniques a

therapist teaches, Philippians 4:13 states “I can do everything through Him who gives me

strength” (New International Version). Those that choose to fix their mind, heart, eyes, and

strength on Him will find that God alone is fully capable of healing our hurts.

The client needs to be confronted with the truth no matter how hard it may be in order to

be set free. John 8:31-32 states “To the Jews who had believed him, Jesus said, “If you hold to

my teaching, you are really my disciples. Then you will know the truth and the truth will set you
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free” (New International Version). Once the hard topics are discussed the client may experience

a peace that has not been experienced before.

A biblical perspective also teaches and helps the client understand that everyone has a

darker, evil side because sin resides in us. We are all capable of evil and unconscious conflicts,

but the ultimate goal of Christian counseling and believers is to become more Christ-like.

Romans 8:29 states “For those God fore-knew He also predestined to be conformed to the

likeness of His Son, that he might be the firstborn among many brothers” (New International

Version). Acknowledging the sin inside allows clients to realize and accept their past issues, and

furthers their treatment.

In conclusion, CBT has become one of the most widely researched and practiced forms

of psychotherapy used around the world. CBT treats the client’s maladaptive thought process

which causes the unwanted behavior. The therapist helps the client realize the cognitive thoughts

that are causing the negative behavior they do not want. The therapist allows the client to choose

their own goals and different techniques to use by creating a warm and encouraging environment

for the client. This positive and supportive atmosphere allows the client a more successful

therapeutic experience.
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References

Aboujaoude, Elias. (2009, July 10). The biology of psychotherapy. Psychology today. Retrieved from

https://www.psychologytoday.com/blog/compulsive-acts/200907/the-biology-psychotherapy

Beck, J. S. (2011). Cognitive behavior therapy basics and beyond. Retrieved from

https://books.google.com/books?hl=en&lr=&id=J_iAUcHc60cC&oi=fnd&pg=PR1&dq=Cogniti

ve+Behavior&ots=0C3_Q4WPvE&sig=zR1B_EeSRfEF9YveNV8uncXsPDE#v=onepage&q=C

ognitive%20Behavior&f=false

Burns, D. (n.d.). From CBT to T.E.A.M. Feeling good. Retrieved from http://feelinggood.com/team-vs-

cbt/

Cameron, E., & Green, M. (2015). Making sense of change management: a complete guide to the

models, tools and techniques of organizational change. Kogan Page Publishers. Retrieved from

https://books.google.com/books?hl=en&lr=&id=tVXHBgAAQBAJ&oi=fnd&pg=PR9&dq=Anal

ysis+of+how+change+takes+place+in+cognitive+therapy&ots=1vr6FlS3q5&sig=feaN40C-

dk8R5WPNBSVhE3P8r68#v=onepage&q&f=false

Childress, A.R., & Burns, D. D. (1981, December). The basics of cognitive therapy. Psychosomatics.

22(12).

The elements of good therapy. (2015, July 16). Good therapy. Retrieved from

http://www.goodtherapy.org/what-is-good-therapy.html

What is cognitive behavior therapy? (2015, December 8). About health. Retrieved from

http://psychology.about.com/od/psychotherapy/a/cbt.htm
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Tan, S. (2011) Counseling and psychotherapy: A Christian perspective. Grand Rapids,

Michigan.