Modern talking therapy traces its roots to Stoic philosophers and Pavlov's dogs
Cognitive behavioural therapy works on a simple premise: distorted thinking and unhelpful habits keep many psychological problems going, so changing them can ease symptoms. It grew through three distinct waves in the twentieth century, drawing on laboratory conditioning, Aaron Beck's cognitive therapy and, later, Buddhist ideas of mindfulness and acceptance.
The first wave was behavioural. John B. Watson and Rosalie Rayner published conditioning studies in 1920, and by 1924 Mary Cover Jones was helping children unlearn their fears. Joseph Wolpe built on Pavlov's work in the 1950s with systematic desensitisation, a forerunner of today's fear-reduction methods, while Hans Eysenck promoted behaviour therapy in Britain. B. F. Skinner's operant conditioning, called radical behaviourism, deliberately ignored thought, but Julian Rotter in 1954 and Albert Bandura in 1969 showed through social learning theory that cognition shapes how people learn and change.
The second wave put thinking at the centre. Aaron Beck, trained as a psychoanalyst, developed cognitive therapy in the 1950s, and merging it with behavioural methods produced classical CBT. Beck's own depression manual traces the philosophy back to the Stoics, and Albert Ellis drew on Epictetus. John Stuart Mill's associationism, an ancestor of conditioning theory, is also counted among the influences. A third wave in the 1980s and 1990s brought in mindfulness and acceptance, spawning approaches such as dialectical behaviour therapy and acceptance and commitment therapy.
In practice CBT is problem-focused and action-oriented. Therapist and client identify obstacles and rehearse practical mental and behavioural strategies, aiming to improve emotional regulation and coping. Though designed for depression, it is now used for conditions including obsessive-compulsive disorder, generalised anxiety, eating disorders and substance use. Alongside interpersonal psychotherapy, it is named in treatment guidelines as a preferred psychological treatment, endorsed by the NHS in Britain and by both the American Psychological Association and the American Psychiatric Association, and is recommended first for most psychological disorders in children and adolescents.
It has critics. They point to a shortage of double-blind research, relatively high drop-out rates, and a tendency to address symptoms rather than whatever lies beneath them.
Source: Cognitive behavioral therapy
