The rise and evolution of cognitive behaviour therapy 

Pavlov’s dogs salivating at the sound of the dinner bell; Skinner and his rats in boxes learning to bring food down the chute by knocking a lever; Watson’s ‘little Albert’, the baby who learned to develop a fear of rats after being frightened by a loud noise – all these behavioural experiments from the start of the 20th century have passed into our cultural history.

This early experimentation went on to inspire a form of therapeutic technique called ‘behaviour modification’ which was applied—more often than not, unsuccessfully—across a range of conditions, including addictions, serious mental disturbance, and even autism.

New ways of thinking

Cognitive therapy emerged after the middle of the last century, partly as a result of advances in understanding of the way the brain and the mind function neurologically and biochemically.

This understanding was perceived at the time as a counter to the work of Sigmund Freud and his followers, who saw human responses and behaviours as an expression of deep-seated neuroses, linked to unconscious memories and emotions. Instead, the cognitive therapists were more interested in the conscious mind. They got their clients talking about their conscious beliefs and habitual ways of thinking, and helped them challenge fixed ideas by looking at themselves and their situation in new ways.

Aaron Beck, founder of cognitive therapy, famously told the New York Times about his falling-out-of-love with the psychoanalysis he trained in: “[Beck] found work with patients exhausting, because the goals seemed so unclear. ‘The idea was that if you sat back and listened and said 'Ah-hah,' somehow secrets would come out,’ Dr. Beck remembers. ‘And you would get exhausted just from the helplessness of it.’”

Dealing with the here and now

Cognitive behaviour therapy is an amalgamation of cognitive therapy and techniques to address changes in behaviour. Although each stems from a different tradition, they both concern themselves primarily with what’s happening now to this client, and what this client experiences, and believes, and feels, at this present time.

This is very different to the psychodynamic / psychoanalytic approach inspired by Freud, where traditionally, you might see your analyst, Woody Allen style, a few times a week over a period of years. There the focus is on analysing the past in order to discover clues about past experiences are affecting the client now.

The evidence for CBT

CBT had become widespread by the mid-90s, and today in the UK it is promoted by the NHS, and often in the media, as the most effective and efficient form of therapy available. This attention is due in most part to CBT psychologists having made it their business to prove the effectiveness of CBT. And so many more clinical trials have been conducted around CBT than for any form of therapy, and it boasts a strong evidence base across a whole range of emotional issues.

Unfortunately this has lead to something of a schism within the therapy profession, with an opposing school of thought arguing that human emotional experience cannot be subject to purely scientific enquiry. Despite this, other therapy methods are now striving to catch up with CBT’s dominant evidence base. However as the results come in, it would now appear, somewhat ironically, that all mainstream forms of therapy are more or less equally effective.

This in turn has accelerated research aimed at discovering the ‘common factors’ that are general to all forms of therapy. The strength of the relationship between client and therapist is clearly very important here, but so too is a belief shared by client and therapist that this style of therapy, as opposed to that, is the one best suited to this situation and to this client.

‘Third wave’ cognitive behaviour therapy 

If strict behaviourism was the first wave, and cognitive therapy the second, what’s now referred to  the ‘Third Wave’ of CBT is relatively new, though it has developed more strands and refinements over just the past five to ten years.

The emphasis now is not so much on rationally contesting negative thinking patterns, but on developing a posture of mindfulness in relation to ones thoughts and emotions – seeing them as transient events that are happening to us, rather than as absolute fixed truths in their own right: noticing ones emotions rather than fighting them; observing ones thoughts rather than getting caught up them.

Branches of this third wave include Mindfulness Based Cognitive Therapy (MBCT) and Acceptance & Commitment Therapy (ACT) both of which are covered elsewhere on this website.