Cognitive Approaches in Behavior Therapy

In the early 1970s, behavior therapists began to explore the possibility of integrating cognition and self-guided behavior change (see Bandura, 1977; Beck; Lazarus; Mahoney). With the exception of those who espouse a radical perspective, most cognitive behavior therapists implicitly assume that human behavior is guided in part by an internal "self" that consists of cognitive structures called schemas. Schemas comprise learned patterns of information processing that guide both immediate behavior and general perceptions of the world. These perceptions, in turn, have a significant impact on affective states. Cognitively oriented behavior therapists believe that to change behavior one must change the schemas through which the environmental information is processed. By helping the client to alter maladaptive schemas, the therapist enables the client to engage in broader, more effective information processing, thereby producing changes in attributions that ultimately lead to changes in both behavior and affect.

Most cognitive approaches to behavior therapy still reflect a primarily linear, mechanistic view of behavior. For example, the rational emotive therapy (RET) of Albert Ellis (1962), one of the earliest attempts at integration of cognitive and behavioral approaches, affirms that emotional states occur as the result of an information-processing sequence in which an external event triggers a set of beliefs (a schema), which in turn triggers an emotional response. Thus, a rational emotive therapist would view the emotion of anger as being triggered by the patient's thoughts about the event to which the patient responded with anger, rather than by the event itself. In the view of RET, to paraphrase Shakespeare, nothing is good or bad but thinking makes it so.

Effective treatment enables the client to alter irrational beliefs that lead to negative emotional states or other mala-daptive behaviors. This is accomplished by directly challenging irrational beliefs in a Socratic fashion and by devising behavioral exercises to assist the client in learning that irrational beliefs are, in fact, incorrect. For example, in order to combat irrational feelings of shame and self-consciousness, which are presumably based on an irrational fear of sanction or ridicule for particular types of behavior, a rational emotive therapist might assign a client to perform the behavioral exercise of boarding a commuter train and loudly announcing each stop to the other passengers. The objective is to demonstrate that such behavior, absurd and inappropriate though it may seem to the client, does not necessarily evoke public sanction or ridicule, and that, even if it does, such responses from others are not catastrophic.

In one form or another, this combination of restructured irrational beliefs and behavioral exercises is the hallmark of most cognitive approaches to behavior therapy. Albert Bandura's social learning theory (1977), for example, aims at altering specific cognitive structures called "self-efficacy expectations" through teaching clients new behavioral skills and helping these clients practice them both in the therapist's office and in the daily world. Self-efficacy is assumed to determine, in part, whether or not a given set of environmental contingencies will be responded to with a particular behavior by the client. Therapy consists, in part, of designing graded behavioral exercises leading to both new behavior and a revision of self-efficacy expectations. Accomplishing these goals is presumed to facilitate a change in client behavior in previously problematic situations.

Research has consistently demonstrated that, in spite of the heavy emphasis by many theorists on the "cognitive" component of cognitive-behavior therapy, the most effective means of promoting both cognitive and behavioral changes is through performance-based treatments; that is, by actively engaging in new behaviors that are incompatible with older, problematic ones (see Rachman and Wilson). Engaging in new behavior, under the guidance of a therapist, seems to be an effective approach to the treatment of a variety of emotional and behavioral disorders. For example, a client who suffers from a fear of cats might be encouraged, with the therapist's assistance, to engage in closer and closer contacts with cats, moving from merely approaching a cat to actually holding one, until the fear subsides.

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