Chapter 1 - CBT Past and Present

Lesson 4 – The history of CBT: Adapting and Refining CBT

 This lesson began with a brief mindfulness practice. In it we brought our attention to our

breath, body sensations, feelings and thoughts in a way that allowed them to just be

there, without trying to control or change them.

 Beck’s CBT focuses primarily on the content of negative thoughts and how distorted

thinking creates distress. Third wave CBT adopts a different approach: thoughts are

observed and allowed to follow their own course rather than challenged.

 The idea behind this is that when we try to control or change thoughts we can often get

into a battle. We try to ‘fix’ our emotions using the sort of problem-solving we would use

to manage difficulties in the outside world, such as dealing with a leak in the plumbing.

But emotions can’t be fixed in the same way.

 Therapies such as Mindfulness Based Cognitive Therapy (Segal et al 2002) and Acceptance

and Commitment Therapy (Hayes et al 1999) help patients to step back from their

thoughts and disengage from them without focusing on their content.

 Standard CBT has always recognized the value of distancing or decentring from our

thoughts (Beck 1976 p. *), and in fact some of the standard CBT therapies for anxiety

disorders such as obsessive compulsive disorder and generalised anxiety disorder focus

more on how we relate to worries rather then the content of these worries.

 Adrian Wells has taken this further and developed Metacognitive Therapy (Wells 2000)

which works entirely with our beliefs about our thoughts (e.g. ‘I must control my

thinking’, ‘If I don't worry, something bad will happen.’) while Ed Watkins has formulated

an approach to ruminations (Watkins 2014).

 These therapies which focus on thought process rather than thought content are still in

their infancy and further research is needed before they fully become mainstream

treatments. Results so far indicate that MBCT, for instance, is an effective treatment for

recurrent depression (Teasdale et al 2000).

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 Developments in CBT have not exclusively focused on process, however. Young’s Schema

Therapy takes on core negative beliefs head to head. It is an integrative approach that

brings together humanistic and object relations concepts within a cognitive framework.

Unmet childhood needs lead to Early Maladaptive Schemas (e.g. criticism and rejection

leads to a belief that ‘I am unlovable and defective’). Schema Therapy seeks to change

this schema through cognitive and behavioural techniques combined with experiential

techniques like rescripting of early childhood memories. Encouraging results are emerging

from trial of schema therapy with borderline personality disorder (Young et al 2003).

 In the rest of the course we will be talking about the second wave of CBT that integrates

cognitive and behavioural methods.

REFERENCES

 Hayes, S.C., Strosahl, K.D. & Wilson, K.G. (1999) Acceptance and Commitment Therapy:
An Experiential Approach to Behavior Change. New York: Guilford Press.
 Segal, Z. V., Williams, J. M. G., Teasdale, J. D. (2002) Mindfulness-Based Cognitive
Therapy for Depression: A New Approach to Preventing Relapse. New York: Guilford
Press.
 Teasdale JD, Segal ZV, Williams JMG, Ridgeway V, Soulsby J & Lau M (2000) Prevention of
relapse/recurrence in major depression by midfulness-based cognitive therapy. Journal of
Consulting and Clinical Psychology, 68, 615-623.
 Watkins, E. (2014) Rumination-Focused Cognitive-Behavioral Therapy for Depression New
York: Guilford Press.
 Wells, A. (2000). Emotional Disorders and Metacognition: innovative cognitive therapy.
Chichester: Wiley.
 Young, J.E., Klosko, J.S. & Weishaar, M.E. (2003) Schema Therapy: A Practitioner’s Guide.
New York: Guilford Press.

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