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Review of Philosophy and Psychology

, Volume 8, Issue 2, pp 391–410 | Cite as

Know Thyself? Questioning the Theoretical Foundations of Cognitive Behavioral Therapy

  • Garson LederEmail author
Article

Abstract

Cognitive Behavioral Therapy (CBT) has become the dominant form of psychotherapy in North America. The CBT model is theoretically based on the idea that all external and internal stimuli are filtered through meaning-making, consciously accessible cognitive schemas. The goal of CBT is to identify dysfunctional or maladaptive thoughts and beliefs, and replace them with more adaptive cognitive interpretations. While CBT is clearly effective as a treatment, there is good reason to be skeptical that its efficacy is due to the causal mechanisms posited by the CBT model. This paper will argue that the specific cognitive schemas posited by the CBT model likely do not play a direct role in the development or treatment of psychological illness. Cognitive schemas, as identified in CBT interventions, are likely to be the result of patient confabulation and epistemically under-supported practitioner-based identification. CBT interventions appear to impose coherence on patients’ psychological states, rather than identifying and modifying preexistent causally efficacious core beliefs.

Keywords

Cognitive Behavioral Therapy Cognitive Model Dialectical Behavioral Therapy Automatic Thought Core Belief 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Alford, B.A., and A.T. Beck. 1998. The integrative power of cognitive therapy. New York: Guilford Press.Google Scholar
  2. Anderson, T., K.M. Lunnen, and M. Ogles. 2010. Putting models and techniques in context. In The heart and should of change: Delivering what worlds in therapy, 2nd edn, eds. B.L. Duncan, S.D. Miller, B.E. Wampold, and M.A. Hubble, 143–166. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  3. Asay, T.P., and M.J. Lambert. 1999. The empirical case for the common factors in therapy: quantitative findings. In The heart and soul of change: What works in therapy, eds. M.A. Hubble, B.L. Duncan, and S.D. Miller, 23–55. Washington, DC, US: American Psychological Association.CrossRefGoogle Scholar
  4. Bargh, J.A., M. Chen, and L. Burrows. 1996. Automaticity of social behavior: direct effects of trait construct and stereotype activation on action. Journal of Personality and Social Psychology 71(2): 230–244.CrossRefGoogle Scholar
  5. Beck, A.T. 1967. Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.Google Scholar
  6. Beck, A.T., A.J., Rush, B.F., Shaw, and Emery, G. 1976. Cognitive therapy and the emotional disorders. New York: International Universities Press.Google Scholar
  7. Beck, A.T. 1996. Beyond belief: A theory of modes, personality, and psychopathology. In P.M. Salkovskis eds. Frontiers of cognitive therapy, 1–25. New York: Guilford Press.Google Scholar
  8. Beck, A.T. 1979. Cognitive therapy of depression. New York: Guilford Press.Google Scholar
  9. Beck, A.T. 2004. A cognitive continuum. In Cognition and psychotherapy, eds. A. Freeman, M. Mahoney, P. Devito, and D. Martin, 107–220. New York, NY, US: Springer.Google Scholar
  10. Beck, A.T. 2005. The current state of cognitive therapy: a 40-year retrospective. Archives of General Psychiatry 62(9): 953–959.CrossRefGoogle Scholar
  11. Beck, J.S. 2011. Cognitive behavior therapy, second edition: basics and beyond. New York: Guilford Press.Google Scholar
  12. Beck, A.T., and B.A. Alford. 2009. Depression: Causes and Treatment (2nd ed). Philadelphia: University of Pennsylvania Press.Google Scholar
  13. Beck, A.T., and D.J. Dozois. 2011. Cognitive therapy: current status and future directions. Annual Review of Medicine 62: 397–409.CrossRefGoogle Scholar
  14. Beck, A.T., and R.A. Steer. 1987. BDI, Beck depression inventory: manual. TX: Psychological Corporation San Antonio.Google Scholar
  15. Beevers, C.G., D.R. Strong, B. Meyer, P.A. Pilkonis, and I.W. Miller. 2007. Efficiently assessing negative cognition in depression: An item response theory analysis of the dysfunctional attitude scale. Psychological Assessment 19(2): 199–209.CrossRefGoogle Scholar
  16. Bertrand, M., & Mullainathan, S. (2003). Are Emily and Greg more employable than Lakisha and Jamal? A field experiment on labor market discrimination. National Bureau of Economic Research (Working Paper 9873).Google Scholar
  17. Brewin, C.R. 1996. Theoretical foundations of cognitive-behavior therapy for anxiety and depression. Annual Review of Psychology 47(1): 33–57.CrossRefGoogle Scholar
  18. Butler, A.C., J.E. Chapman, E.M. Forman, and A.T. Beck. 2006. The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review 26(1): 17–31.CrossRefGoogle Scholar
  19. Clark, D.A. 2004. Cognitive-behavioral therapy for OCD. New York, New York: Guilford Press.Google Scholar
  20. Clark, D.A., and A.T. Beck. 1999. Scientific foundations of cognitive theory and therapy of depression. New York: Wiley & Sons.Google Scholar
  21. Clark, D.A., 2011. Cognitive therapy of anxiety disorders: science and practice. New York, USA: New York: Guilford Press.Google Scholar
  22. Coyne, J.C., and I.H. Gotlib. 1983. The role of cognition in depression: A critical appraisal. Psychological Bulletin 94(3): 472.CrossRefGoogle Scholar
  23. Crits-Christoph, P. 1997. Limitations of the dodo bird verdict and the role of clinical trials in psychotherapy research: Comments on Wampold et al. (1997). Psychological Bulletin 122(3): 216–220.CrossRefGoogle Scholar
  24. Cuijpers, P., F. Smit, E. Bohlmeijer, S.D. Hollon, and G. Andersson. 2010. Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. The British Journal of Psychiatry: the Journal of Mental Science 196(3): 173–178.CrossRefGoogle Scholar
  25. Eagle, M.N., and D.L. Wolitzky. 1992. Psychoanalytic theories of psychotherapy. In History of psychotherapy: A century of change, eds. D.K. Freedheim, H.J. Freudenberger, J.W. Kessler, S.B. Messer, D.R. Peterson, H.H. Strupp, and P.L. Wachtel, 109–158. Washington, DC, US: American Psychological Association.CrossRefGoogle Scholar
  26. Ellis, A. 1962. Reason and emotion in psychotherapy. Secaucus, NJ: Lyle Stuart.Google Scholar
  27. Ellis, A. (1994). Reason and emotion in psychotherapy, Revised and Updated. New York: Carol Publishing.Google Scholar
  28. Frank, J.D., and J.B. Frank. 1991. Persuasion and healing: A comparative study of psychotherapy, 3rd edn. Baltimore, MD, US: Johns Hopkins University Press.Google Scholar
  29. Freud, S. 2000. Three essays on the theory of sexuality (J. Strachey, Trans.). New York: Basic Books. (Original work published in 1905).Google Scholar
  30. Gabbard, G.O. 2000. Psychodynamic psychotherapy in clinical practice, 3rd. edn. Washington, DC: American Psychological Association.Google Scholar
  31. Gipps, R.G.T. 2013. Cognitive behavior therapy: a philosophical appraisal. In The Oxford handbook of philosophy and psychiatry, eds. K. Fulford, M. Davies, R. Gipps, G. Graham, J. Sadler, G. Stanghellini, and T. Thorton. Oxford: Oxford University Press.Google Scholar
  32. Grissom, R.J. 1996. The magic number .7 + −.2: Meta-meta-analysis of the probability of superior outcome in comparisons involving therapy, placebo, and control. Journal of Consulting and Clinical Psychology 64: 973–982.CrossRefGoogle Scholar
  33. Haidt, J. 2006. The happiness hypothesis. Cambridge, MA: Basic Books.Google Scholar
  34. Harden, C.D., and M.R. Banaji. 2013. The nature of implicit prejudice: implications for personal and public policy. In The behavioral foundations of public policy, ed. E. Shafir, 13–31. New Jersey: Princeton University Press.Google Scholar
  35. Harwood, T.M., Beutler, L.E., and M. Charvat. (2009). Cognitive-behavioral therapy and psychotherapy integration. In Dobson K, eds. Handbook of cognitive-behavioral therapies, 94–130. New York: Guilford Press.Google Scholar
  36. Hurlburt, R.T. 2011. Investigating pristine inner experience: Moments of truth. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  37. Isen, A.M., and P.F. Levin. 1972. Effect of feeling good on helping: cookies and kindness. Journal of Personality and Social Psychology 21(3): 384–388.CrossRefGoogle Scholar
  38. Johansson, P., L. Hall, S. Sikström, and A. Olsson. 2005. Failure to detect mismatches between intention and outcome in a simple decision task. Science 310(5745): 116–119.CrossRefGoogle Scholar
  39. Kahneman, D. 2011. Thinking, Fast and Slow. New York: Farrar, Straus and Giroux.Google Scholar
  40. Knowles, E.D., B.S. Lowery, and R.L. Schaumberg. 2010. Racial prejudice predicts opposition to Obama and his health care reform plan. Journal of Experimental Social Psychology 46(2): 420–423.CrossRefGoogle Scholar
  41. Krantz, S., and C.L. Hammen. 1979. Assessment of cognitive bias in depression. Journal of Abnormal Psychology 88(6): 611.CrossRefGoogle Scholar
  42. Leahy, R.L. 1996. Cognitive Therapy: Basic Principles and Applications. New Jersey: Jason Aronson, Incorporated.Google Scholar
  43. Lebowitz, M.S. 2014. Biological conceptualizations of mental disorders among affected individuals: A review of correlates and consequences. Clinical Psychology: Science and Practice 21(1): 67–83.Google Scholar
  44. Leichsenring, F., W. Hiller, M. Weissberg, and E. Leibing. 2006. Cognitive-behavioral therapy and psychodynamic psychotherapy: techniques, efficacy, and indications. American Journal of Psychotherapy 60(3): 233–259.Google Scholar
  45. Liu, J., D. Smeesters, and K. Vohs. 2012. Reminders of money elicit feelings of threat and reactance in response to social influence. Journal of Consumer Research 38(6): 1030–1046.CrossRefGoogle Scholar
  46. Luborsky, L., R. Rosenthal, L. Diguer, T.P. Andrusyna, J.S. Berman, J.T. Levitt, and E.D. Krause. 2002. The dodo bird verdict Is alive and well—mostly. Clinical Psychology: Science and Practice 9(1): 2–12.Google Scholar
  47. McEachrane, M. 2009. Capturing emotional thoughts: the philosophy of cognitive-behavioral therapy. In Emotions and Understanding: Wittgensteinian perspectives, eds. Y. Gustafsson, C. Kronqvist, and M. McEachrane. New York: Palgrave Macmillan.Google Scholar
  48. Messer, S.B., and B.E. Wampold. 2002. Let’s face facts: common factors are more potent Than Specific Therapy ingredients. Clinical Psychology: Science and Practice 9(1): 21–25.Google Scholar
  49. Nasar, J.L., and A.S. Devlin. 2011. Impressions of psychotherapists’ offices. Journal of Counseling Psychology 58(3): 310–320.CrossRefGoogle Scholar
  50. Neenan, M., and W. Dryden. 2005. Cognitive therapy. London: SAGE Publications.Google Scholar
  51. Nisbett, R.E., and T.D. Wilson. 1977. Telling more than we can know: verbal reports on mental processes. Psychological Review 84(3): 231–259.CrossRefGoogle Scholar
  52. Norcross, J.C., and C.P. Karpiak. 2012. Clinical psychologists in the 2010s: 50 years of the APA division of clinical psychology. Clinical Psychology: Science and Practice 19(1): 1–12.Google Scholar
  53. Nosek, B.A., M. Banaji, and A.G. Greenwald. 2002. Harvesting implicit group attitudes and beleifs from a demonstration web site. Group Dynamics: Theory, Research, and Practice 6(1): 101.CrossRefGoogle Scholar
  54. Nosek, B.A., F.L. Smyth, J.J. Hansen, T. Devos, N.M. Lindner, K.A. Ranganath, C.T. Smith, K.R. Olson, D. Chugh, A.G. Greenwald, and M.R. Banaji. 2007. Pervasiveness and correlates of implicit attitudes and stereotypes. European Review of Social Psychology 18(1): 36–88.CrossRefGoogle Scholar
  55. Pescosolido, B.A., J.K. Martin, J.S. Long, T.R. Medina, J.C. Phelan, and B.G. Link. 2010. “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry 167: 1321–1330.CrossRefGoogle Scholar
  56. Robinson, M.D., and G.L. Clore. 2002. Beliefs, situations, and their interactions: towards a model of emotion reporting. Psychological Bulletin 128: 934–960.CrossRefGoogle Scholar
  57. Schnall, S., J. Benton, and S. Harvey. 2008. With a clean conscience: cleanliness reduces the severity of moral judgments. Psychological Science 19(12): 1219–1222.CrossRefGoogle Scholar
  58. Schwitzgebel, E. 2008. The unreliability of naive introspection. Philosophical Review 117(2): 245–273.CrossRefGoogle Scholar
  59. Segal, Z.V., J.D. Teasdale, and J. Mark. 2004. Mindfulness-based cognitive therapy: theoretical rationale and empirical status. In Mindfulness and acceptance: Expanding the cognitive-behavioral tradition, eds. S.C. Hayes, V.M. Follette, and M.M. Linehan, 45–65. New York: Guilford Press.Google Scholar
  60. Segal, Z.V., J.M.G. Williams, and J.D. Teasdale. 2012. Mindfulness-based cognitive therapy for depression. New York: Guilford Press.Google Scholar
  61. Skinner, B.F. 1977. Why I am not a cognitive psychologist. Behaviorism 5(2): 1–10.Google Scholar
  62. Solomon, A., and D.A. Haaga. 2004. Cognitive theory and therapy in depression. In Cognitive therapy across the lifespan, eds. M.A. Reinecke, and D.A. Clark, 12–40. Cambridge, UK: Cambridge University Press.Google Scholar
  63. Steinpreis, R.E., K.A. Anders, and D. Ritzke. 1999. The impact of gender on the review of the curricula vitae of job applicants and tenure candidates: A national empirical study. Sex Roles 41: 509–528.CrossRefGoogle Scholar
  64. Teasdale, J.D. 1997. The relationship between cognition and emotion: the mind-in-place in mood disorders. In Science and practice of cognitive behaviour therapy, eds. D.M. Clark, and C.G. Fairburn, 67–93. New York, US: Oxford University Press.Google Scholar
  65. Teasdale, J.D., and P.J. Barnard. 1993. Affect, cognition, and change: Re-modelling depressive thought (vol. xv). Hillsdale, NJ, England: Lawrence Erlbaum Associates, Inc.Google Scholar
  66. Thomas, D.L., and E. Diener. 1990. Memory accuracy in the recall of emotions. Journal of Personality and Social Psychology 59(2): 291–297.CrossRefGoogle Scholar
  67. Wampold, B.E., and Imel, Z.E. 2015. The Great Psychotherapy Debate: The Evidence For What Makes Psychotherapy Work. New York: Routledge.Google Scholar
  68. Wampold, B.E., G.W. Mondin, M. Moody, F. Stich, K. Benson, and H. Ahn. 1997. A meta-analysis of outcome studies comparing bona fide psychotherapies. Psychological Bulletin 122(3): 203.CrossRefGoogle Scholar
  69. Wampold, B.E., T. Minami, T.W. Baskin, and S. Callen Tierney. 2002. A meta-(re) analysis of the effects of cognitive therapy versus “other therapies” for depression. Journal of Affective Disorders 68(2): 159–165.CrossRefGoogle Scholar
  70. Wells, A. 2009. Metacognitive therapy for anxiety and depression (vol. xvii). New York: Guilford Press.Google Scholar
  71. Westbrook, D., H. Kennerley, and J. Kirk. 2011. An introduction to Cognitive Behaviour Therapy: Skills and Applications. London: SAGE Publications.Google Scholar
  72. Wilson, T.D. 2002. Strangers to Ourselves: Discovering the Adaptive Unconscious, New Ed edn. Cambridge: Mass.: Belknap Press.Google Scholar
  73. Young, J.E., J.S. Klosko, and M.E. Weishaar. 2003. Schema Therapy: A Practitioner’s Guide. New York: Guilford Press.Google Scholar
  74. Young, J.E., and G. Brown. (1994). Young Schema Questionnaire, 2nd edition. In Young, J.E., Cognitive Therapy for Personality Disorders: A Schema-Focused Approach (rev. edition). Sarasota, FL: Professional Resource Press.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.Department of PhilosophyUniversity of British ColumbiaVancouverCanada

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