Anyone seeking psychological therapy has come across the terms behavioral, cognitive, and cognitive-behavioral therapy. Unfortunately, these terms can be confusing and one does not presuppose the other. For instance, does a cognitive therapist practice behavior therapy? Is it appropriate for any licensed psychologist who states they "use cognitive-behavioral techniques" be considered equivalent to a cognitive-behavioral therapist?
Though these terms are often used interchangeably to distinguish them from traditional forms of therapy, there are important differences. Despite the fact that behavioral and cognitive techniques have existed for over eight decades, it is only relatively recent (three decades or so) that they have achieved distinction in the field and with the public.
In behavior therapy, the primary focus is the manipulation of the external environment and physiological internal environment to cause behavior change. This is accomplished by employing a number of methods including:
- Systematic desensitization
- Exposure and response prevention
- Behavior modification
- Operant conditioning
- Covert conditioning
- Observational learning
- Contingency management
- Habit reversal training
- Social Skills Training
Depending on the disorder and reason for referral, some methods are more appropriate to use than others.
Cognitive therapy, by contrast, considers thinking as the factor for change. In cognitive therapy, the primary causal attribution of most relevant behavior is cognition. Cognitive restructuring, therefore involves:
- Evaluating validity of client's thoughts and beliefs
- Assessing what the client expects and predicts
- Assessing client's attributions for causes of events
If one were to view both behavior and cognitive therapies as opposite ends of a spectrum, then cognitive-behavioral theory is somewhere in between. Cognitive-behavioral therapy employs a combination of the aforementioned techniques.
If the primary focus of behavior therapy is the manipulation of the external environment and physiological internal environment to cause behavior change, then cognitive therapy considers thinking as the factor for change. In cognitive therapy, the primary causal attribution of most relevant behavior is cognition. If one were to view both of these theories as opposite ends of a spectrum, then cognitive-behavioral theory is somewhere in between.
There is also a growing body of literature that supports the efficacy and effectiveness of what have been called the "third wave of behavior therapies. These include Acceptance and Commitment Therapy (Hayes, Strosahl, and Wilson 1999), Functional Analytic Psychotherapy, (Kohlenberg and Tsai, 1991), Dialectical Behavior Therapy, (Linehan, 1993), and Behavior Activation (Martell, Addis, & Jacobson, 2001). All these forms of therapy share a greater adherence to the radical behaviorist philosophy of psychological science as espoused by Skinner (1953) which incorporates not only traditional behavioral case conceptualization and techniques, but also a contemporary understanding of verbal and rule governed behavior. These therapies represent the cutting edge of psychological science and continue to grow in popularity.
Contributions from these theories shaped the concept of psychopathology from a cognitive-behavioral standpoint. Specifically, psychopathology is result of: functional relationships among the environment; an individual's thinking and overt behavior; and, consequences of action. A fundamental assumption is that maladaptive behavior can be changed along the same lines that it was learned: through experience; change in habit/thinking; and, enhancement of adaptive skills over time.
So, the differences between behavior, cognitive, and cognitive-behavioral therapies are not easily explained. Fortunately, they are more alike than dissimilar. How a psychologist identifies himself or herself is typically based upon their training and their emphasis in therapy.
Hayes, S.C., Strosahl, K., & Wilson, K.G. (1999). Acceptance and Commitment Therapy: An Experimental Approach to Behavior Change. New York: Guilford Press.
Kohlenberg, R. J. & Tsai, M. (1991). Functional Analytic Psychotherapy: A guide for creating intense and curative therapeutic relationships. New York: Plenum.
Martell, C.R., Addis, M. E., & Jacobson, N.S. (2001).Depression in Context: Strategies for Guided Action. New York: W. W. Norton & Company, Inc.
Linehan, M.M. (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder. The Guilford Press.
Persons, J. B. (1989). Cognitive therapy in practice: A case formulation approach. New York: Norton.
Roth, A. & Fonagy, P. (1996). What Works for Whom? A Critical Review of Psychotherapy Research. New York, Guilford Press.
Skinner, B.F. (1953). Science and behavior. New York: Macmillan.