Psychological Reports, 1970,27, 175-178.

@ Psychological Reports 1970

LIMITATIONS I N THE CONCEPTUALIZATIONS OF BEHAVIOR

THERAPISTS: T O W A R D A COGNITIVE-BEHAVIORAL
MODEL OF BEHAVIOR THERAPY1

PHILIP H. FRIEDMAN
Eastern Pennsylvania Psychiatric Institute

Summary.-This paper proposes a cognitive-behavioral approach to be-

havior therapy as an alternative to che counterconditioning model presently in
vogue. The key terms i n this model are cognirive appraisal, threat, counterharm
resources, behavioral coping action tendencies, situational constraints, internalized
values and affects. The approach based o n R. Lazarus' theorizing is briefly de-
scribed, personalistic broad-spectrum behavior therapy techniques are classified
according to this model and an outline is presented to demonstrate the value of
the cognitive-behavioral approach in conceptualizing the development and change
of maladaptive behavior.

This paper briefly outlines a social psychological approach to the develop-

ment and treatment of behavior problems. Recent research and theory in the
field of social psychology indicate a strong attempt at the incegration of be-
havioral, cognitive, affective, and physiological systems of the human organism
interacting with environmental factors (Schachter & Singer, 1962; Walters &
Parke, 1964). Ullmann and Krasner (1969) have shifted from their strictly
operant-conditioning approach (Ullmann & Krasner, 1965) to a social psycho-
logical approach buc have not included the concepts of cognitive processes and
anxiety within their cheorecical frame of reference. Bandura (1969) has in-
cluded these concepts in his approach to behavioral learning and modification
but he does so from a social-learning perspective. For example, Bandura (1969)
has pointed out that desensitization and implosion techniques are primarily ef-
fective through symbolic and therefore cognitive processes. The theoretical mod-
el from which this social-psychological approach to behavior therapy is extrapo-
lated was presented in a book by Richard Lazarus ( 1966). Because of the heavy
emphasis his model places upon cognitive and behavioral faccors, it was labeled
a cognitive-behavioral approach to behavior therapy. Six of the main features of
this theoretical model are:
1. Primary appraisal, char is, h e appraisal of threat, which is a cognitive process.
2. The location of the harmful agent.
'This paper was supported i n part by the Public Health Service on a NIMH postdoctoral
research fellowship (No. 1 FO2 MH24138-01) at the Deparunent of Behavioral Science,
Temple University Medical School. An earlier draft of the paper which included a case
history was presented at the Pennsylvania Psychological Assocjarion convention in June,
1969, at a symposium o n the "Limitations in Behavior Therapy." The author wishes to
thank Arnold Lazarus, Aaron Beck, and Richard Lazarus for their suggestions and criticisms
of a prior version of this paper. The present address of the author is Family Psychiatry
Division, Eastern Pennsylvania Psychiatric Instirute, Henry Avenue, Philadelphia, Pennsyl-
vania 19129.
176 P. H. FRIEDMAN

3. Secondary appraisal, a cognitive process, determining how harmful the agent is and
evaluating whether an individual h a the resources to counter the harmful agent; and the
important coping process, a behavioral action tendency.
4. Situational constraints to the behavioral action tendency.
5. Internalized values fostering or inhibiting the behavioral action tendency from
overt expression.
6. The physiological and motoric consequences to the individual of the first five
factors.

In this orientation affects such as anxiety, anger, depression, fear, shame,

and guilt are consequences of the primary and secondary cognicive appraisal pro-
cesses and the effect of the coping process on situational constraints and internal-
ized values.
Threat is cognitively appraised if a stimulus configuration produces cues
that indicate to an individual a harmful condition is anticipated, i.e., one that will
rhwart an important motive. N o threat exists if the cues are cognitively appraised
as potentially benign or beneficial. Primary cognicive appraisal of threat is based
on factors in the stimulus configuration and factors within the individual. These
factors include (1) the comparative power of the harm-producing condition and
the individual's counterharm resources, ( 2 ) the imminence of the harmful con-
frontation, ( 3 ) the individual's motive strengths and patterns, such as approval
motives, and ( 4 ) the individual's beliefs about transactions with the environ-
ment.
If threat is cognitively appraised, the secondary appraisal process is set in
motion. The three sets of factors involved in the secondary appraisal process are
degree of threat, factors in the stimulus configuration and factors within the indi-
vidual. If the individual is not able cognitively to locate the agent of harm within
the stimulus configuration, he experiences anxiety. Some of the important ele-
ments appraised by the individual during secondary appraisal include the viability
of alternative available actions to prevent the harm, the pattern of motivation
which determines the "cost" of certain coping alternatives and the individual's
resources for dealing with the threat. Three broad sets of coping action ten-
dencies are conceprualized, ( 1) attack, ( 2 ) avoidance, and ( 3 ) inaction, with
their accompanying affects of anger, fear, and hopelessness or depression. De-
pending on the strength of situational constraints and internalized values, these
coping action tendencies may or may not be expressed in overt behavior. If not,
a new set of affects, guilt and shame, may result.
In Table 1 the intervention techniques used in personalistic broad-spectrum
behavior therapy (A. Lazarus, 1970) are classified according to this cognitive-
behavioral approach to human functioning. The table suggests that the cogni-
tive-behavioral approach is an alternative way to organize and conceptualize be-
havior therapy techniques. N o attempt is made in this paper to show why this
 BEHAVIOR THEMPISTS : LIMITS IN CONCEPTUALIZATION 177

TABLE 1
APPROACH TO BEHAVIORTHERAPY
A COGNITIVE-BEHAVIORAL

Aspects of a Cognitive- Active Intervention Techniques

Behavioral Model of
Human Functioning

I. Primary cognitive appraisal of 1. Therapist uses a variety of cognitive restruc-

threat-interference with im-
portant motives perceived.
11. Location of harmful agent. If
not located, anxiety is
experienced.
111. a. Secondary cognitive
appraisal process.
b. Behavioral coping action
tendencies : anack,
avoidance, inaction.
c. Affects of anger, fear,
depression experienced.
IV. Situational constraints agninst
behavioral coping action
tendencies.
V. Internalized values-if in
conflict with behavioral
coping action tendencies,
may lead to affects of
shame, guilt.
VI. Physiological and motor
responses.
turing procedures to reduce client's appraisal
of threat, such as: use of fantasy methods, emo-
tive imagery, metaphors, humorous stories; self-
disclosure, implosion, rational emotive discus-
sions, relabeling. T o increase primary appraisal
of threat, therapist uses aversive techniques,
such as electric shock or covert sensitization.
2. Therapist makes discriminations for client, la-
beling the harmful agent, reducing or elimi-
nating anxiety through verbal methods, im-
plosion, imagery, psychomotor techniques.
3. Therapist reevaluates with client his counter-
harm resources: uses self-assertion training,
modeling (visual, auditory, verbal), role-play-
ing, behavior rehearsal, affective imagery; as-
signs readings; gives verbal examples from lives
of self, other patients; helps client to reorient
his secondary appraisal process, develop adap-
tive coping mechanisms and reduce negative
affects.
4. Therapist encourages client to bring in sources
of situational constraint, e.g., family, spouse;
to seek out environments with fewer situational
constraints; or cope adaptively with the sima-
tional constraints. Procedures used by the ther-
apist include encouraging self-assertion with
family, employers, etc., and the discussion of
behavioral alternatives with the client.
5. Therapist engages in self-disclosure, frank dis-
cussion of values and consequences to individual
and society. He may encourage the adoption of
certain humanistic values by the client, such as
authenticity, compassion, etc. Therapist re-
labels thoughts, feelings, behavior; discusses des-
ert island fantasy techniques and inner circle
model of personality functioning with client to
reduce the client's shame and guilt and reorient
the client's values.
6. Therapist uses relaxation and desensitization,
hypnosis, psychomotor methods, sensory stimu-
lation techniques, and possibly drugs, such as
Brevitol, Valium, Lithium, Elavil, etc.
- -

In general, the therapist openly and directly intervenes to change maladaptive cognitions,
behavioral action tendencies, affects, and physiological and motoric responses of the indi-
vidual. The change in any one of these systems has feedback, positive or negative, upon
one or more of the other systems and usually has direct consequences for an individual's
interpersonal relationships.
178 P. H. FRIEDMAN

approach is more adequate than the counterconditioning model for organizing

behavior therapy techniques. Moreover, no attempt is made to indicate when,
where and how a technique should be employed using the cognitive-behavioral
model. These questions will be dealt with later.
REFERENCES
BANDURA,A. Principles of behavior modification. New York: Holr, Rineharr & Win-
ston, 1969.
LAZARUS, A. A. Behavior therapy and beyond. New York: McGraw-Hill, 1970.
LAZARUS, R. P~ychological stress and the coping process. New York: McGraw-Hill,
1966.
SCHACHTER,S., & SINGER,J. H. Cognitive, social and physiological determinants of emo-
tional srate. Psychological Review, 1962, 69, 379-399.
ULLMANN, L., & KRASNER, L. (Eds.) Clrre ~tudiesin behavior modification. New York:
Holr, Rinehart & Winston, 1965.
ULLMANN, L., & KRASNER, L. A psychological approach to ablzormal behavior. Engle-
wood Cliffs: Prenrice-Hall, 1969.
WALTERS, R. H., & PARKE,R. D. Social motivation, dependency and susceptibility to
social influence. I n L. Berkowirz (Ed.), Advances in experimental social psychol-
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Accepted June 4, 1970.