Book contents
- Frontmatter
- Dedication
- Contents
- List of tables, boxes, figures and case examples
- Foreword
- Preface
- Structure of the book
- List of abbreviations
- 1 Introduction
- 2 Assessment
- 3 Rules of reinforcement and practical examples
- 4 Social skills training
- 5 Relationship, communication and sexual skills training
- 6 Phobic and social anxiety
- 7 Treatment of obsessive–compulsive disorders
- 8 Depression
- 9 Generalised anxiety disorder and panic
- 10 Body dysmorphic disorder and the somatic symptom and related disorders
- 11 Eating disorders
- 12 Addictive behaviour
- 13 Schizophrenia and the psychoses
- 14 Personality disorder
- 15 CBT in combination with other therapy
- Glossary
- Index
- Frontmatter
- Dedication
- Contents
- List of tables, boxes, figures and case examples
- Foreword
- Preface
- Structure of the book
- List of abbreviations
- 1 Introduction
- 2 Assessment
- 3 Rules of reinforcement and practical examples
- 4 Social skills training
- 5 Relationship, communication and sexual skills training
- 6 Phobic and social anxiety
- 7 Treatment of obsessive–compulsive disorders
- 8 Depression
- 9 Generalised anxiety disorder and panic
- 10 Body dysmorphic disorder and the somatic symptom and related disorders
- 11 Eating disorders
- 12 Addictive behaviour
- 13 Schizophrenia and the psychoses
- 14 Personality disorder
- 15 CBT in combination with other therapy
- Glossary
- Index
Summary
Overview
This chapter will examine the development and future of cognitive–behavioural therapy (CBT). Starting with the ideas of behaviourism and the development of conditioning theory, it moves to examine the exposure theory and its application in clinical practice. This sets the groundwork for the concept of pragmatic treatments based on direct clinical observations rather than being guided purely by theoretical models. Mention will be made of other third wave treatments such as mindfulness, behavioural activation, dialectical behaviour therapy (DBT), acceptance and commitment therapy and integrative couple therapy, the cognitive–behavioural analysis system of psychotherapy and functional analytic psychotherapy. Finally, there is a summary concerning research and CBT and a look towards possible future developments.
The development of CBT: history, theory and practice
First generation therapies
Behaviourism arose at the beginning of the 20th century. Its central tenet is that all organisms react to the external environment with a variety of behaviours. These behaviours are learnt and are in response to reinforcement, and so it follows that psychological and psychiatric conditions are seen largely as being due to maladaptive learnt behaviour in response to the environment.
Key people who developed the theories of behaviourism were:
• Ivan Pavlov (classical conditioning; Pavlov, 1927)
• Edward Lee Thorndike (pioneer of using animals in psychological experiments; Thorndike, 1933)
• John Broadus Watson (animal studies and also genesis of phobias in humans – the ‘Little Albert’ experiment; Watson, 1925)
• Burrhus Frederic Skinner (operant conditioning; Skinner 1950).
It was not until mid-20th century that the potential for using behavioural methods to treat patients with psychological conditions was realised. Joseph Wolpe developed a technique called systematic desensitisation for the treatment of phobic anxiety (Wolpe, 1958). In this technique, the patient is taught deep muscle relaxation and a very detailed hierarchy of fears is produced. The patient is very gradually exposed to the fear while inducing relaxation. This treatment worked at reducing anxiety but was painstakingly slow and any therapeutic gains tended to be lost if the patient subsequently became anxious. Thus the treatment was rendered virtually obsolete in the 1970s with the development of graded in vivo exposure.
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- CBT for AdultsA Practical Guide for Clinicians, pp. 1 - 7Publisher: Royal College of PsychiatristsPrint publication year: 2014