Cognitive Behavioral Therapy Essay
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In the early 1960’s there was a drift towards Cognitive Behavior Therapy as people turned away out of disappointment in the psychodynamic theory for psychotherapy. Also at this time social learning theory was the new and upcoming study. This is when Cognitive theory emerged with Alfred Adler. He was the first Cognitive therapist who came up with the idea that an individuals beliefs and ideas is what makes up their behavior (Lantz, 1996). He believed that this type of psychotherapy would allow the clients to make changes in the way they think to change their behavior and solve their problems.
Alfred Adler was not the only contributor to Cognitive theory. Between the late 1950’s and early 1960’s Albert Ellis came up with dysfunctional thinking or emotions that come from irrational beliefs.
He sought out to change these unclear emotions with psychotherapy and by challenging these beliefs. His books are very well known and used a lot of by different therapist. He is basically considered the grandfather of Cognitive Behavior Therapy and his ABC model is used widely.
Albert came up with Rational-emotive therapy, which was later on changed to Rational-emotive behavior therapy because Ellis wanted his clients to act upon their new beliefs by putting them into practice (Wilde, 1996, p. 9). Others who have contributed to Cognitive theory have been William Glasser, Arnold Lazarus, Don Tosi, Victor Ramy, Maxie Maultsby, Aron Beck and many more. William Glasser used effective psychotherapy to help his clients find courage to change their life style and become more responsible of their goals.
He did this by pointing out the worth of self and the basic human need to be loved. His ‘reality therapy’ consisted of his clients focusing on personal responsibility to understand their own reality (Lantz, 1996). Arnold Lazarus came up with the seven modes of the client that help assess their functioning. These seven modes are sensation, imagery, cognition, behavior affect, interpersonal living and drugs (Lantz, 1996). These modes, according to Lazarus, would help come up with a treatment plan that would help the client in all areas of their function lives. Don Tosi contributed to Cognitive theory by intergrading hypnosis with the therapy.
Hypnosis is used to help the clients picture their thoughts in a healthy way through exploration and redirection (Lantz, 1996). Victor Ramy focused his work on helping clients change their self-concept. His books show how to help a client work with and change the cognitive misunderstanding of themselves. Maxie Maultsby used the ABC model as used by Albert Ellis but he also contributed by using rational behavior therapy with youngsters, for self-help groups, and group therapy. Aron Beck was a psychiatrist who used cognitive treatment to help his clients who had anxiety and personality disorders. He did extensive research on effective Cognitive therapy and how it helps clients with a range of individual problems from suicidal patients to those who have borderline personality disorders.
Many of those who contributed to Cognitive therapy were not social workers. The first social worker that used Cognitive therapy was Harold Werner. Werner struggled early on when he tried to bring Cognitive therapy to social work as those who had a psychoanalytical point of view attacked him. His efforts allowed the theory to be accepted in the social work arena. Howard Goldstein also helped bring Cognitive therapy into the social work profession.
Behavior theory is a mixture of different theories combined and it first came about in the first quarter of this century. The work of Ivan Pavlov and his classical conditioning theory, the work of B.F. Skinner and J.B. Watson and their operant condition theory and the work of Bandura on the social learning theory is all combined in the behavior theory. The classical conditioning theory states that a conditioned stimulus can cause a conditioned response with the famous example of Pavlov and the salivating dog.
This is a behavior that is learned and that can be used to help clients during therapy especially those who have anxiety disorders. The operant conditioning uses human behavior and examines it. Skinner believed that behavior was measurable and that certain situations cause human to react is certain ways. Once these behaviors are learned through the scientific method we can predetermine a clients actions and help them with either negative or positive reinforcements. This will either increase or decrease the client’s behavior depending on if the behavior is punished or positively reinforced.
In the late 60’s is when behavior theory became a front-runner with clinical social work. At this time the psychodynamic theories were under attack and a new theories were sought out. Social learning theory focuses on using the ABC model that Albert Ellis used to help clients. This involves finding the antecedents, target behaviors, and consequence in ones problematic behavior.
Antecedents is what the client was doing before the situation occurred, target behavior is the behavior that needs to be changed or focused on and the consequence is the result because of their target behavior (Thomlison & Thomlison, 1996). These three are analyzed to figure out what needs to change in the behavior to get an alternate positive consequence or to see how the situation can be avoided. Principles and Concepts:
There are four basic concepts to Cognitive theory. The first uses Albert Ellis’s ABC model to deal with the emotions we feel and the way we think about our situations and ourselves. The ABC model helps us identify our thoughts and then helps us control our emotions (Lantz, 1996). If what we are thinking during a situation is irrational then our emotions are going to be uncontrollable and irrational also. If we have rational thoughts then our emotions will be functional. If our trigger behavior causes irrational emotions then we need to find rational emotions to replace the irrational belief (Wilde, 1996, p. 33).
The second basic concept to Cognitive theory is that these irrational beliefs are in our unconscious and we are not aware of them. This may make it difficult to find out what the thoughts are and why we have dysfunctional emotions. To help our clients notice their irrational beliefs we have to allow them to learn misconceptions about themselves so they are more aware of their thoughts. Irrational believes lead to illogical emotions, which causes the client to react in an unreasonable way, but there are exactions to these types of situation, which is basic concept three (Lantz, 1996). Sometimes the way we feel has nothing to do with our irrational beliefs. What we are feeling is really true or there could be a neurological or other health problem, which can make an individual feel down or angry or upset. A disparity in the brain chemistry can cause dysfunctional emotions.
Lastly all irrational emotions are not always dysfunctional which means a rational belief can be dysfunctional also. A client might get sort of ‘high’ or excited from something dangerous such as a gun. Playing with a gun might give a client a feeling of excitement and happiness but it is not safe to play with guns. Feeling happy or excited is not considered a dysfunctional emotion but in this case we would have to teach the client about the misconception in their mind that playing with guns is safe or fun. Cognitive theory allows a person to recognize their environment and their situation both physically and communally and it allows them to work through and change it (Lantz, 1996).
A basic concept to Behavior theory is that all behavior is learned and that individual have problematic behaviors. According to Skinner our social problems can be measured through our behavior. By changing the environment and reinforcing the client with either positive reinforcement or negative reinforcement we can get them to change their behavior. The stimuli from the reinforcement will allow the client to either change or remove the behavior (Thomlison & Thomlison, 1996). Social learning theory, which involves the ABC model, shows us how behavior can change for the better. Similarities and Differences:
The biggest similarity between Cognitive theory and Behavior theory is the intertwining of the Social Learning Theory. They both use the ABC model and look at the antecedents, behaviors, and consequences of each situation. With Cognitive theory, the trigger behavior comes with an irrational belief that needs to be changed. Clients often times have irrational beliefs during their behavior. After the consequence takes place the ABC model will help us show them their irrational beliefs and teach them that with a rational belief a different consequence could have taken place. With Behavior theory a similar pattern is used.
The problem is identified and the target behavior is observed by the social worker other wise known as ‘behavior analysis’ (Thomlison & Thomlison, 1996). The social worker then works with the clients on changing both the antecedents and the consequences to attain a different behavior. Changing the antecedent is known as manipulating the environment condition (Streff, Geller, 1986). The antecedent is changed to increase a positive behavior in the situation. The consequence is used as reinforcement either positive or negative. The reinforcement allows for a change in behavior.
The difference between the two theories is that one focuses on the beliefs and emotions that one has about themselves and the behavior that comes from these beliefs and the other focuses on problematic behavior and the reinforcements that change this type of behavior. Behavior therapy uses both positive and negative reinforcements and Cognitive therapy focuses on eliminating the negative behavior or emotion and replacing it with positive rational behavior.
A belief scale that serves as a measure from one to ten, is used to see how irrational the clients beliefs really are (Watson, Morris, Miller, 2001). With Behavior therapy reinforcements are used to encourage clients but with Cognitive therapy rational beliefs are used to encourage clients. The clients are questioned on their beliefs and often times humor is used to show the clients how irrational their beliefs can be (Wilde, 1996, p. 61).
A limitation of behavior therapy is that reinforcement don’t always work for everyone. A stimulus for reinforcing someone depends on that person’s perception of the stimulus (Wilde, 1996, p. 18). If an individual is having behavior problems and the negative reinforcement is to stay after school, the individual might not think of it as negative reinforcement if they don’t like going home. Their situation at home might be worse then staying after school for detention. Another issue is that behavior theory only deals with the exterior of the problem and does not investigate the deep down root of the problem. Because behavior therapy doesn’t focus on the internal process of the client, the reinforcements are only successful if they bring change in the client’s life for the better.
Although Cognitive theory may look at the root of the problem by focusing on automatic thoughts and core beliefs, it also has limitations. It is argued that Cognitive theory only looks at the problem for that one situation that occurs. One incident takes place where the client has inappropriate behavior with irrational beliefs (Atherton, 2007). Other aspects of the client’s life may or may not come up while discovering their irrational beliefs.
Another issue is that with Cognitive theory, treatment is not emphasized with family members, the environment, and other interventions (Lantz, 1996). Both theories are culturally sensitive and work with all different backgrounds. Because different races and cultures have different social misconceptions, irrational beliefs may vary from culture to culture; but all cultures have irrational beliefs (Lantz, 1996).
What is considered positive or negative reinforcements in one culture may not be considered so in another culture. These types of things vary but both types of therapy work with all different sorts of people. Both theories are compatible with the NASW code of ethics. Cognitive therapy and Behavior therapy both value the client and humanity. Cognitive therapists emphasize the use for rational thinking, which is not only for the client but also for society. The worth of the client is maintained and it is important to make sure that the client doesn’t feel threatened or ashamed by these techniques and it is up to the social worker to maintain these techniques. Blending The Two Theories:
Research shows that when blending Cognitive therapy with Behavior therapy there are no proven results that the outcome is better for the client right away. The research does show however that there are more long term results when combining the two theories as apposed to just using one therapy or the other (Thomlison & Thomlison, 1996). Behavior theorists such as Skinner argue that when combining Cognitive theory to Behavior theory, the focus on behavior gets diverted and so the therapy is not as effective.
Research is not conclusive on this matter but it shows that efficacy to the therapy depends on the problem that the client is having. As time goes on most social workers use Cognitive Behavior Therapy and not just one or the other. By blending the two theories we can focus on the client’s behavior, reinforce their positive behaviors and allow them to recognize their ideas and beliefs about their behavior to allow them to make rational choices and have rational emotions.