The cognitive-behavioral approach

By: Marcia J. Wood

The behavioral psychologist is often thought to control and manipulate behavior by giving reinforcements (such as M&M candies) to people when they behave in a desired manner and punishments (such as electric shocks) when they behave in an undesirable manner.

Sometimes people assume that psychologists who are behavioral in orientation are not warm and caring and that they have little interest or tolerance for non-observable behavior such as feelings and fantasies. Popular films also help to perpetuate the image of a cold, aloof, mechanistic behaviorist concerned with specific behaviors rather than individuals.

Similar to the stereotype of the psychodynamic professional, the stereotype of the behaviorist is also outdated and inaccurate. Both behavioral and cognitive (thoughts and beliefs) focuses make up the broad behavioral/cognitive-behavioral perspective. Although some would argue that the behavioral and cognitive-behavioral viewpoints are separate, in this review, I combine these perspectives because they are generally more similar than divergent in their assumptions about human nature and behavioral change. Furthermore, the cognitive-behavioral approach generally draws on behaviorism rather than cognitive neuroscience or cognitive psychology.

However, many contemporary cognitive theorists use cognitive science and information processing methods to enhance their theories and applications. I refer to the cognitive-behavioral perspective as including both the strictly traditional behavioral perspective (the theories of B. F. Skinner) as well as the newer cognitive perspective. Like the psychodynamic approach, the cognitive-behavioral approach subsumes a wealth of sub-perspectives associated with specific leading authors who develop and advocate certain theories and techniques. These leaders in cognitive-behavioral psychology include Albert Ellis, Aaron Beck, Arnold Lazarus, Leonard Krasner, Joseph Wolpe, B. F. Skinner, Donald Meichenbaum, Marsha Linehan, among others.

The cognitive-behavioral approach ishistorically based on the principles of learning and has its roots in the academic experimental
psychology and conditioning research conducted by B. F. Skinner, John Watson, Clarke Hull, Edward Thorndike, William James, Ivan Pavlov, and others.

The cognitive-behavioral approach focuses on overt (i.e., observable behavior) and covert (non-observable behavior such as thinking) behaviors acquired through learning and conditioning in the social environment.

Basic assumptions that provide the foundation of the cognitive-behavioral approach include a focus on current rather than past experiences, the emphasis on measurable and observable behavior, the importance of environmental influences on the development of both normal and problematic behavior, and an emphasis on empirical research methods to develop assessment and treatment strategies and interventions.

Cognitive-behavioral perspectives include principles of operant conditioning, classical conditioning, social learning, and attribution theories to help assess and treat a wide variety of difficulties.

For example, operant conditioning may be used to help a child improve his or her behavior and performance in a classroom setting. A child might obtain reinforcements such as stickers or social praise from the teacher for improved classroom behavior that is defined, for example, as being more attentive, talking less with peers during classroom instruction, and improving test scores. Contingency management (changing behavior by altering the consequences that follow behavior) and behavioral rehearsal (practicing appropriate behavior) may also be used. Classical conditioning techniques might be used to help someone overcome various fears and anxieties. Someone who is fearful of dogs, for example, might learn to overcome this fear through the use of systematic desensitization (a technique developed by Wolpe, 1958), counter conditioning (developing a more adaptive response to dogs), or by exposure such as a gradual approach to being with dogs.

Social learning might be used to help a child undergoing a painful medical procedure (such as a bone marrow transplant) to cope with the anxiety and pain associated with the procedure. For example, the child might watch an educational video of other children who cope well with the medical procedure.

Furthermore, long-standing and maladaptive beliefs may contribute to many psychological problems such as depression and anxiety. Maladaptive irrational and automatic thoughts such as, “I’m a failure,” “No one will love me,” and “I can’t do anything right,” might be examined, challenged, and altered using cognitive-behavioral techniques such as thought stopping and rehearsal of positive self statements.

The Classical Conditioning Perspective:

The classical conditioning perspective originated with the work of Ivan Pavlov as well as the work of Joseph Wolpe and Hans Eysenck. This viewpoint maintains learning occurs and subsequently, behavior, through the association of conditioned and unconditioned stimuli. Thus, two or more random events (stimuli) that are paired together become associated over time.

For example, a psychologist using the classical conditioning perspective with Mary might examine the pairing of Mary’s panic and fear with going to church, the grocery store, and the bank. When Mary had her first panic attack at church, she associated the church with the uncomfortable and frightening feelings that accompany panic, thereby causing her to avoid the church in the future.

Panic attacks in other places such as the grocery store, on the bus, and in the bank all become associated through classical conditioning, resulting in more and more avoidance of various places. Furthermore, generalization occurs, for example, although Mary may have had a panic attack at one specific branch office of a bank, she feels fearful of entering any bank.

A therapist using a classical conditioning approach may choose to treat Mary’s anxiety with systematic desensitization (SD; Wolpe, 1958). The therapist would ask Mary to create a hierarchy of anxiety-provoking situations from less anxiety-provoking situations such as walking on the sidewalk outside of her home to extremely anxiety-provoking situations such as flying in an airplane. The therapist would train Mary in a relaxation procedure and then pair relaxation with each of the anxiety-provoking situations that she would imagine. Thus, each step of the hierarchy would be paired with relaxation using classical conditioning strategies.

The Operant Perspective:

The operant perspective of the behavioral approach originated with the work of B. F. Skinner. This viewpoint maintains that all behavior can be understood through a functional analysis of antecedents (the conditions present just before a target behavior occurs) and consequences (what occurs following the target behavior) of behavior. This is often referred to as Functional Behavioral Analysis or the A-B-Cs of behaviorism: Antecedents, Behavior, Consequences.

Thus, behavior is learned and developed through interaction with the environment. If behavior is reinforced in some way, it will continue, while behavior that is punished or not reinforced will be diminished. The gradual shaping of desired behavior is achieved by reinforcing small increments toward the target behavior. Problematic behavior, such as aggressiveness in children, fears and phobias, and overeating can be altered by changing the reinforcements associated with the target behavior (Plaud & Gaither, 1996).

For example, a psychologist using the operant perspective might be concerned that Mary, the patient with panic disorder, might receive reinforcement for her panic behavior (e.g., not having to work, attention from her husband and other family members). Intervention might include an analysis of the antecedents (the conditions present just before her panic symptoms) and consequences of her panic behavior followed by reinforcement of desired behavior (e.g., praise when Mary has no panic symptoms while taking a bus).

The reinforcement would likely include shaping the successive approximations of targeted behavior toward the goal of engaging in specific activities outside of the home such as food shopping and
other errands.

The Social Learning Perspective:

The social learning perspective originated with the work of Albert Bandura. This viewpoint maintains that learning occurs through observational or vicarious methods. Thus, behaviors can be learned and developed by watching others perform various behaviors rather than by practicing a behavior or being personally reinforced for a given behavior.

For example, someone might learn to avoid walking through a surprisingly deep puddle by watching someone else get uncomfortably wet when they walk through it. The psychologist working with Mary might use the social learning perspective in understanding how Mary learned panic behaviors from her mother who also had panic attacks. Mary’s mother might have been reinforced for her panic behavior through attention, distracting family members from other problems or conflicts, and avoiding work or household chores. Thus, by observing her mother Mary may have learned that panic behaviors result in a variety of secondary gains such as avoiding things you do not want to do.

The social learning perspective also incorporates the role of expectations in behavior development. For example, Julian Rotter (1954) proposed that behavior develops as a by-product of what someone expects to happen after they make a given response. The importance of the desired outcome also impacts the likelihood of that behavior.

For example, someone will pay a large sum of money and dedicate several years of his life to obtain a college degree because he expects that a college degree will result in a satisfying career and life. Thus, Mary avoids the grocery store, the bank, and her church because she expects that she will experience a panic attack at these locations. The fear of having a panic attack is so great that she makes a great effort to avoid these places.

An important variation concerning the role that expectations play in behavior involves the concept of self-efficacy (Bandura, 1986). Self-efficacy refers to the belief that one can successfully perform a particular behavior. For example, someone is more likely to kick a field goal in football or make a free throw in basketball if he or she believe that they can accomplish these athletic tasks.

Thus, confidence in one’s ability to successfully accomplish a task results in greater likelihood of success in the given task. Mary is more likely to take the bus to the grocery store if she believes that she will be able to adequately cope with her anxiety by practicing positive self statements such as “I can handle this,” employing breathing techniques, and feeling confident that she can shop with minimal stress.

The Cognitive Perspective: Beliefs, Appraisals, and Attributions:

The cognitive perspective originated with the work and writings of several professionals notably including Aaron Beck and Albert Ellis. The cognitive perspective suggests that our beliefs, appraisals, and attributions play a significant role in behavior and behavioral problems.

Appraisals include the manner in which we examine or evaluate our behavior. For example, if a soccer player thinks her athletic abilities are mediocre, she will evaluate all of her successes and failures in this light. If the soccer player has an exceptionally great game, she may attribute her good fortune to luck or poor performance on the part of the opposing team. If Mary feels that her attempts to develop more independence are hampered by marginal skills and motivation, she will more likely fail.

Attributions refer to theories regarding the causes of behavior. We generally make attributions about behavior based on several factors. These factors include the concepts of the internal versus external locus of control as well as situational versus dispositional characteristics.

Internal locus of control refers to feeling that we have control and influence over much of our life experiences while external locus of control refers to feeling that we have very little control or influence over what happens to us. For example, success in life due to hard work and being smart reflects an internal locus of control while luck or fate reflects an external locus of control.

Situational factors refer to external influences impacting behavior, and dispositional factors refer to enduring characteristics of the person impacting behavior. For example, driving through a red light without stopping due to distraction from a heated conversation with a passenger would reflect a situational attribution while driving through the red light because the person is a careless and reckless driver would reflect a dispositional attribution.

Thus, a professional football player might attribute missing an easy field goal to distraction from a loud audience or from the sun in his eyes (external locus of control), low self-esteem or anxiety during the game (internal locus of control), having a bad day (situational), or being a bad player in general (dispositional).

Depression and learned helplessness can develop, for example, in people who make frequent dispositional and internal locus of control attributions about their perceived problematic feelings and behavior (Rosenhan & Seligman, 1989; Seligman, Peterson, Kaslow, Tanenbaum, Alloy, & Abramson, 1984). For example, Mary feels depressed and hopeless believing that she will never get over her panic attacks because she experiences her fears as being due to her long-term “character flaws” and “weaknesses.”

Albert Ellis (1962, 1977, 1980) and other professionals have focused on irrational beliefs and self-talk that lead to problematic feelings and behavior. For example, common beliefs such as “everyone should agree with me,” “everyone should appreciate me and my talents,” “no one could love someone as unattractive as me,” and “I should always be patient with my children and spouse” result in inevitable failure and disappointment.

Ellis and others use techniques such as rationalemotive therapy (RET) to help individuals think and process beliefs in a more rational manner. These techniques involve using logic and reason to challenge irrational and maladaptive thoughts and beliefs (e.g., “So do you really think that everyone you meet must like you in order to be a worthy human being?”). This approach relies on persuasion and reason to alter beliefs about self and others. For example, Ellis’s focus on irrational beliefs is related to Mary’s beliefs about her panic. Mary feels that if she experiences even a little anxiety while taking a bus or sitting in church, she is a failure and a weak person.

The therapist helps Mary to see that her beliefs are irrational and unrealistic and encourages her to develop more adaptive self-talk regarding her anxiety (e.g., “Even if I’m anxious, I can still overcome my fear and take the bus. I don’t need to have my anxiety control me; I can control it”).

Aaron Beck (1963, 1976) developed cognitive therapy (CT) to treat depression and other disorders. Beck posits that as people develop, they formulate rules about how the world works that tend to be simplistic, rigid, and often based on erroneous assumptions.

A schema or template develops to the extent that all new incoming data is filtered through these rules and distortions. Thus, overgeneralization (e.g., “everyone at work hates me”), all-or-none thinking (e.g., “If I don’t get this job my career will be ruined”), or exaggeration or downplaying the meaning or significance of events (e.g., “my divorce was no big deal and didn’t affect me or my children at all”) are typical ways of interpreting our world and experiences. Problematic behavior and attitudes are associated with these unrealistic and erroneous rules and interpretation of events.

Like Ellis, Beck evaluates and challenges these beliefs and assumptions and trains people to monitor and alter their automatic thoughts. However, Beck focuses on the treatment of beliefs as hypotheses that must be tested and evaluated to best determine whether the beliefs are useful and realistic.

A variety of variations on cognitivebehavioral psychotherapy has emerged over the years. For example, Marsha Linehan developed dialectical behavior therapy (DBT) to treat people experiencing borderline personality disorders (Linehan, 1993). DBT uses cognitive-behavioral strategies along with psychodynamic, client-centered, family systems, and crisis intervention perspectives. DBT focuses on acceptance of self and experiences along with efforts toward behavioral change.

These changes are sought through a threestage process that includes a pretreatment commitment phase, an exposure and emotional processing phase of past events, and a synthesis phase integrating progress from the first two stages to achieve treatment goals.

Another example includes David Barlow’s panic control treatments (PCT) developed to help those experiencing panic attacks (Barlow & Craske, 2000). In PCT, patients are exposed to the sensations that remind them of their panic attacks. For example, patients would participate in exercise to elevate their heart rates or shake their heads to create dizziness. Attitudes and fears about these induced panic-like symptoms are explored and demonstrated as harmless to the patient’s health. Furthermore, patients are taught breathing and relaxation exercises to help reduce anxiety.

References    

Contemporary clinical psychology / Thomas G. Plante — 2nd ed. Copyright © 2005 by John Wiley & Sons, Inc.

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