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Anxiety Disorders

Cognitive Theory and Associated Therapies

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute

Although behavioral learning theory offered promising therapeutic techniques, there were some significant problems. Behaviorism sought to make psychology a respected science by studying observable (measurable) human behavior. To achieve this goal using systematic, scientific methods of research it was necessary to discount internal, mental events such as thoughts, beliefs, motivations, feelings, and perceptions. This is because these internal events, called cognitions, are not observable, nor readily measurable. Cognitive theorists have since recognized the importance of these internal events (collectively referred to as cognitions). They subsequently developed methods to study their effects.

brain imageCognitive therapy also rose in popularity due to the public's misinterpretation that behaviorism had the potential to control and manipulate people. People were philosophically opposed to the notion that human beings could be reduced to a collection of behaviors that could be easily manipulated through environmental rewards and punishments. Other factors also contributed to the decline of pure behaviorism, such as the increasing awareness of genetic influences on behavior.

Cognitive Theory:

In the 1950's, a psychologist named Albert Ellis, and a psychiatrist named Aaron Beck, independently developed two very similar theories. Both of these theories resulted in effective forms of cognitive therapy. These therapies continue to be widely practiced today. While behavioral learning theory emphasizes the role of the environment, cognitive theory emphasizes the key role of the mind's cognitions in determining behavior. These cognitions include a person's thoughts, feelings, beliefs, and perceptions.

According to cognitive theory, our dysfunctional thoughts lead to extreme emotions. These extreme emotions in turn, lead to maladaptive behaviors. To illustrate the powerful effect of these thoughts, consider the following example. Suppose I am preparing to take a difficult test. While doing so I think to myself "I can't do anything right, I'll probably fail this test." This thought will likely cause me to feel apprehensive. When I eventually take the test, this degree of anxiety will affect my ability to concentrate and earn a good grade. In addition, these negative thoughts will affect the amount of effort I put forth when studying for the test. When I incorrectly believe that I will certainly fail, it seems rather futile to invest a great deal of energy in attempting to succeed. As a result, I may indeed fail, simply because I didn't invest much time and energy in preparation for the exam. Ironically, this failure will serve to strengthen my faulty belief; i.e., my poor test score "proves" my belief is correct- I am a failure. However, the true reason for my failure was due to my lack of effort and preparation, and not because I am inherently a failure. Quite a different outcome would occur if I were to think to myself, "Yes, this test is going to be quite difficult but I have succeeded before. I will study hard and put forth my best effort. Besides, I am just as competent as any of the other students in the class." These thoughts would cause me to feel confident and ready to face the challenge. I would put forth the extra effort needed to succeed. Clearly, these two different ways to think about the same event result in very different behaviors and outcomes.

Albert Ellis's cognitive therapy is called Rational Emotive Behavior Therapy (REBT). He believed peoples' intense suffering from negative emotions was caused by their irrational core beliefs. Core beliefs refer to the basic beliefs people have about themselves and the world around them. For instance, in the previous example my thought "I'll probably fail this test" may stem from a core belief "I must always achieve complete success or else I am a complete failure." Irrational core beliefs cause the negative emotions that lead to dysfunctional behaviors.

Albert Ellis focused on irrational core beliefs by identifying beliefs for which there was no evidence. Thus, they are irrational. According to REBT, teaching therapy participants to think in a more rational, balanced manner eliminates the extreme emotions that result from these irrational beliefs. In so doing, this rational thinking eliminates dysfunctional behavior. Ellis identified common, irrational, core beliefs such as: 1) I must do well and win the approval of others or else I am no good. 2) Everybody should treat me kindly. (3) Life must be fair. Ellis noticed that irrational beliefs often contained words like "must," "should," and "can't." REBT has a systematic and direct way of teaching therapy participants to identify, challenge, and replace these irrational core beliefs with more rational and balanced ones.

Around this same (1950's), Aaron Beck was practicing as a psychoanalyst. He realized that people's internal thoughts and perceptions had a large influence on their emotions. He also believed that a more active and directive approach to modify thoughts would positively influence behavioral change. His theory takes a slightly different approach than REBT, and the terminology is somewhat different. Nonetheless, both Beck and Ellis sought to modify an individual's dysfunctional thoughts, in order to produce a change in emotions and behavior.

According to Beck, problems occur when distorted thinking patterns influence our interpretation of environmental events. In other words, our behavior is not really determined by what is actually happening in the environment. Instead, our behavior is determined by our thoughts about what is happening. Therefore, behavior is significantly influenced by our perceptions and interpretations of the environment. Let's illustrate this important distinction. Suppose someone walks past me and steps on my foot. I could interpret this as an accidental, clumsy act. Alternatively, I could interpret it as an intentional, hostile act. Each interpretation would likely elicit a very different emotional and behavioral response.

According to Beck, the way we interpret environmental events is a function of our core schema. A core schema is a central assumption about oneself, others, and the world. These assumptions influence our feelings and behavior. Examples of core schema include: 1) The world is a dangerous place. 2) I am unlovable. 3) I am inadequate. Notice how similar Ellis's concept of core beliefs is to Beck's concept of core schema. According to cognitive theory, when cognitive distortions and core beliefs are modified, behavioral change naturally follows. This principle forms the foundation for cognitive therapy techniques.

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