Cognitive behaves as a system of psychotherapy, emerged in the 60’s, XX century. Aaron Beck, driven by theoretical concerns, and lending of academic psychology the scientific methodology, empirical studies conducted with the intention of confirming psychoanalytical principles, in particular the motivational psychoanalytic model of depression as retroflex aggression of the individual against each other in an attempt to self- punishment. His studies with moderate and severe depressive generated negative results, and, contrary to his expectations, led to the disconfirmation of the psychoanalytic model of depression. Beck proposed a new model, the cognitive model of depression, which, evolving in its theoretical aspects and applied, resulted in the proposal of a new system of psychotherapy – cognitive therapy.
Despite its own independent historical paths, cognitive therapy has often been identified with behavioral therapy, and denominations Cognitive Therapy and Cognitive Behavioral Therapy, especially in Brazil, have been used interchangeably. From the perspective of Cognitive Therapy, this text will emphasize factors specific to each approach, and overlay factors, highlighting interesting historical aspects and converged on the emergence of each of these approaches in different periods and contexts.
historical basis of Cognitive Therapy
In the 50’s, the United States, due to the emergence of the cognitive sciences, the circumstances already signaled a widespread transition to the cognitive perspective of information processing with clinical advocating a more cognitive approach to emotional disorders. At that time, there was a convergence between psychoanalysts and behaviorists with respect to their dissatisfaction with their own models of depression, respectively, the psychoanalytic model of retroflex anger and the behaviorist model of operant conditioning. Clinical pointed to the questionable validity of these models as clinical depression models.
In the 60s and 70s, there was the removal of psychoanalysis and radical behaviorism by several of his supporters. In 1962, Ellis Rational Emotive Therapy proposed, the first contemporary psychotherapy with clear cognitive emphasis. Behaviorists as Bandura (Behavior Modification Principles, 1969; Social Learning Theory, 1971), Mahoney (Cognition and Behavior Modification, 1974) and Meichenbaum (Cognitive Behavior Modification, 1977) published important works that showed cognitive processes as crucial the acquisition and regulation of behavior as well as cognitive and behavioral strategies for intervention on cognitive variables. Martin Seligman, at the same time, proposed the theory of Helplessness Learned, an essentially cognitive theory, and its revisions, which resulted in the assignment Styles Theory, as relevant to psychological processes in depression.
In 1977, it launched the Journal of Cognitive Therapy and Research, the first journal to treat of Cognitive Therapy. In 1985, the word “cognition” is now accepted in Association publications for the Advancement of Behavior Therapy (AABT). In 1986 Beck is accepted as a member of the same entity. And in 1987, that is, only two years after the AABT accept the inclusion of the word “cognition” in their publications, in a survey conducted among members of AABT, 69% identified themselves as having a cognitive-behavioral orientation.
It was thus inaugurated the era cognitive psychotherapy, from facts that converged decisively to the emergence of a cognitive perspective, which was reflected in the Cognitive Therapy proposition as a system of psychotherapy, based on own models of human functioning and installation and maintenance of psychopathology.
Emergency Cognitive Therapy
Fundamentally, the most important influence, and that gave rise to cognitive therapy, were the experiments and clinical observations of Beck himself.
In the area of his experiments, Beck initially explored the psychoanalytic model of depression as retroflex aggression through content exploration studies of dreams and manipulation of mood and performance with depression. Contrary to the psychoanalytic model, Beck gathered data that pointed to depression as simply reflecting negative patterns of information processing. In the area of clinical observations, Beck noted that during free association, patients did not report a flow of automatic thoughts, preconscious, rapid and specific. Delving noted that such thoughts streams functioned as a mediational variable between the ideation of the patient and their emotional and behavioral response. In contrast to the motivational psychoanalytic model of depression, these thoughts expressed a negativity or pessimism, general individual against each other, the environment and the future.
Based on their clinical and experimental observations, Beck proposed the cognitive theory of depression. The general negativity expressed by patients, he said, was not a symptom, but played a central role in the installation and maintenance of depression. Depressive systematically distorted reality by applying a negative bias in processing information. Beck points cognition, not emotion, as the essential factor in depression, conceptualizing it, therefore, as a disorder of thought and not an emotional disorder. It proposes cognitive vulnerability hypothesis, as the cornerstone of the new model of depression, and the notion of cognitive schemata.
In 1967, Beck, published Depression: Causes and Treatment (1967), which was followed by a continuous series of significant publications such as cognitive therapy of emotional disorders (1976), in which cognitive therapy is already presented as a new system of psychotherapy, Therapy cognitive Depression (1979), the work most frequently cited in the literature, and other important works, some of them recent, that Beck and his collaborators develop and expand the limits of cognitive Therapy.
Behavioral and Cognitive-Behavioral Therapies
In the first half of the twentieth century, psychoanalysis in its various guidelines, dominated the field of psychotherapy. However, around the ’50s, scientists began to question the theoretical underpinnings and the effectiveness of psychoanalysis, while at the same time, the theory of learning and conditioning processes, and behavioral approach derived from them, began to influence research and psychological clinic.
Pavlov, the scientist who first described and analyzed the conditioning process, expressed interest in its possible clinical applications. In the postwar years, the theory of learning proposed by Clark Hull, proved to be the dominant orientation in most psychology departments, especially in the United States. Then, however, finding theoretical obstacles that led to its weakening and discrediting gave way to proposals for B.F.Skinner.
The theoretical-clinical former, in this early stage, firmly believed that behavioral therapy should continue closely associated with behaviorism of 50 and 60. The basic principles of behaviorism, which challenged the orthodox psychoanalysis, could be summarized as follows: the mind has not represented a legitimate object of scientific study; the patient of the problem was limited to its observable behavior against the need to rely on non-observable processes, and non-testable as unconscious processes; the focus evaluation and treatment should be directed to what could be observed, measured and operated; in behavior modification, important factors were the ones who competed for the maintenance of the patient’s problem, rather than its supposed origin; and finally, the scientific method provided a legitimate fit for the development of a theory and clinical practice in the understanding and application of theoretical principles and therapeutic would move better through systematic empirical observation.
However, the development of behavioral therapy in England and the United States followed parallel and separate paths until, with time, these distinctions abated.
In England, in the 50s, Hans Eysenck, which ranks among the major contributors to the development of British behavioral therapy, and a group of outstanding members of the Institute of Psychiatry at Maudsley Hospital, under the direction of Aubrey Lewis, discussing the feasibility of a new form of psychotherapy based on the conditioning theory.
After a visit to the United States, and unimpressed with academic psychology and American clinic, Eysenck developed parameters for psychology in England: the laws established by academic psychology should be applied in the clinic; clinical psychology should be an independent profession; such as psychotherapy and projective tests did not originate from theories or knowledge of academic psychology, they should not be used in clinical psychology; clinical psychology or psychotherapy should be based on knowledge, methods and developments generated by academic psychology, outlined in his popular book Uses and Abuses of Psychology (1953) and concluded that conditioning process offered the best foundation for the new approach.
After the war, Eysenck, encouraged by Lewis, founded an academic program for clinical psychologists, and Monte Shapiro as the first director of clinical training section, giving rise to the Department of Psychology of the Institute of Psychiatry at Maudsley, affiliated with the University of London. The conducted and case studies were mostly anxiety disorders, especially agoraphobia, resulting in the publication of case studies. However, this time, these initial efforts at all still looked like a new form of psychotherapy.
At the same time, 1954 in Johannesburg, Joseph Wolpe published its first results with a new anxiety reduction technique, systematic desensitization, a conditioning technique, but that clearly involved cognitive variables, the use envisioned gradual trials. Wolpe and Eysenck shared some important insights: both used the Pavlovian principles, both considered psychological problems as a result of aversive conditioning experiences or poor conditioning, and both believed the applicability of conditioning procedures for therapeutic for patients of so called neurotic disorders . The work of Wolpe represented the clinical application of theoretical setting that Eysenck, who had never been involved with clinical practice, was developing. In addition to these common factors, they shared yet serious resistance to inclusion, around 1980, concepts and cognitive techniques in behavioral therapy, despite interestingly, the clear presence of cognitive variables in the systematic desensitization technique developed by Wolpe.
The rationale of the program developed by Eysenck and colleagues was later explained in a book, coauthored with Rachman entitled “The Causes and Cures of Neuroses: Introduction to Modern Behavior Therapy Based on the Theory of Learning and Conditioning Principles” (1965 ). Eysenck was succeeded in the direction of the department by Jeffrey Gray, former Dean at the Experimental Psychology Department of the University of Oxford. Jeffrey, was in turn replaced by the duo David Clark and Paul Salkovskis, which are among the brightest researchers in cognitive therapy on the world stage, and which occupy the Institute of Psychiatry at Maudsley Hospital, previously occupied by the legendary figures posts who preceded them, definitely imposing the Institute cognitive therapy, replacing predecessor behavioral therapy. At the same time, in 2000, an important milestone in the development of British behavioral therapy ended at the same Institute, with the retirement of Isaac Marks.
In the United States
After the visit of Eysenck to the United States, and as he tried to found an academic department of clinical psychology in England, the United States the most prominent model in academic psychology was the model of Boulder, Colorado, who insisted that the training of clinical psychologists it should build on the academic psychology departments, with strong background in undergraduate level in psychology and a significant component in research at the doctoral level. However, in contrast, it was observed in the clinic a tendency to uncritical acceptance of a variety of forms of psychotherapy practiced at the time, and the indiscriminate use of psychometric instruments, particularly projective tests like the Rorschach.
Unlike the British behaviorism, which was largely based on the concepts of Pavlov, Watson and Hull, and worked in clinical settings with neurotic patients, the American behaviorism was based primarily on Skinner’s ideas and his followers, who were trying to replicate in psychiatric patients conditioning effects obtained with laboratory animals, i.e. modeling behavior through the use of operant conditioning techniques. This view strongly influenced the concepts of psychiatric disorder and abnormal behavior, leading the medical model of psychological problems. Psychiatric problems, severe and chronic patients were redefined as behavioral problems, whose solution depended on a correction program through operant conditioning.
The research conducted were of great value, but did not produce the expected results. In addition to this, two other important factors brought as serious obstacles: first, the success of behavioral therapy in the treatment of anxiety disorders was not replicated in the treatment of depressive disorders; and second, while the theory of Hull learning was discredited, the theory of fear conditioning, which represented a fundamental role in the initial proposition of behavioral therapy, gave clear signs of the need for revision. However, behavioral therapy contributed decisively to the development of Clinical Psychology and resulted in a major change in how they are evaluated psychotherapeutic approaches, especially the widespread expectation of psychotherapies based on evidence through controlled efficacy studies.
Cognitive behavioral therapy
Behavioral therapy showed promise, particularly in the treatment of phobias and obsessive-compulsive disorders. However, their very early theoretical limitations and applied became clear, especially with regard to the limited range of disorders for which showed effective. In the 60s, the dominant theories in psychology have changed their environment can focus on the individual to the rational processes as a source of direction of human actions, reflected in expectations, decisions, choices and individual control, foreshadowing the effects of cognitive revolution on clinical from the emergence of the cognitive orientations.
In view of the limited success in treating depression behavioral therapists and in spite of behavioral therapy resistance concepts and cognitive techniques, when Beck (1970) stated that: “Although private experiences self-reports are not verifiable by other observers, these introspective data comes a wealth of testable hypotheses, “he found an interested audience. In addition, there was the fact that he was articulating concerns of a growing number of practitioners, who advocated the attention of behaviorists to a valuable source of data and clinical understanding: cognition. Re-assured by characteristics of the cognitive model proposed by Beck, which included behavioral tasks, structured sessions, limited-term treatment, scientific evidence, and daily record of maladaptativas experiences, etc., the writings of Beck found surprising interest from behavioral. Overcoming their resistance, behavioral now include cognitive techniques in their treatment programs at the same time recognized behaviorists started taking cognition as a mediational construct between environment and behavior.
However, another source of distrust behaviorists, including the Eysenck himself, referred especially to the fact that cognitive therapy developed independent or parallel to, cognitive psychology as a basic science, violating the maximum behaviorist that psychological science should support the Clinical Psychology. But the success of cognitive therapy in the treatment of depression contributed to counteract this resistance.
Interestingly, as cognitive concepts were incorporated into behavioral practice, giving thus rise to cognitive behavioral therapies, it was noted that in addition to superiority in efficacy in treating depression, cognitive techniques possibly also demonstrated its superiority in the treatment of disorders anxiety, the field where behavioral therapy had achieved undeniable success.
The introduction of concepts and cognitive behavioral therapy techniques in coincided with the fall of the theory of learning Hull, which provided the theoretical foundation of behavioral therapy. On the other hand, the absorption of cognitive concepts made possible, among other advantages, higher explanatory value greater coverage in the application of behavioral therapy, more accurate specificity and the ability to focus the psychological content, for example, to specify the cognitive content of the disorders panic. These advantages ultimately ensure the incorporation of techniques and concepts cognitive behavioral therapy, resulting in the consecration of the new orientation, cognitive behavioral therapy, among behaviorists. Authors (eg. Rachman, 1997) refer to cognitive behavioral therapy as an enriched and expanded behavioral therapy form.
The question concerning the historical legacies shared between the three approaches was discussed above. It remains only to examine the existence of commonalities between the three approaches from the perspective of their theoretical and applied propositions. From an ontological perspective, cognitive and behavioral therapies differ radically in their vision of man. From a philosophical point of view, the cognitive model, based on schemes as a human functioning model recognizes the influence of the observer, and its assumptions and expectations on the observation process. The behavioral model, on the other hand, in their eagerness to methodological rigor, or proposes to reduce the observed object observable object, or proposes naively that pure observation, in which the observer is free from assumptions, it is possible, when, according to Popper, it only sets a philosophical myth. The renowned philosopher Karl Popper, defender of critical rationalism, influenced behaviorists in the 50s, claiming to be psychoanalysis out of science not be subject to forgery. The epistemological perspective, cognitive therapy suggests that, being refutable hypotheses are candidates to the status of scientific, adopting a similar approach to critical rationalism. On the other hand, behaviorism always declared as fan of logical positivism, with its emphasis on the need for direct verification, to a relative loosening, to admit the action, on the dependent variable, the intervening variables, which coincided with the popularization, in scientific circles, the hypothetical-deductive method. This adopted by Cognitivism allowed the investigation of unobservable cognition, based on the proposition, the basic model of cognitive processes such as Mediational between the environment variables and the emotional and behavioral responses of the individual, these constituting the observable consequences.
Another difference, incidentally referred to as best philosophical incompatibility refers to the concept of cognition, which is a behavioral for covert behavior and for cognitive constitutes a mental event. For this is explicitly the notion of subordination of emotions and behaviors to cognitions, reflecting a realistic constructivist posture, cognitive vision frontally collides with the behaviorist model of human behavior. To illustrate this fundamental difference, let us take the example of the behavioral experiments, technique widely used in both approaches, but for purposes that clearly express their differences; as Beck (1979) states: “for the behavioral therapist, behavior modification is an end in itself, for the cognitive therapist is a means to an end – that is, the cognitive change.”
What both approaches have in common? Due to the historical sequence, only cognitive therapy, in its proposal, there could be “borrowed” some of his predecessor, behavioral therapy. Despite the discussed differences, besides the influences that cognitive therapy suffered from previous psychoanalytic experience Beck, phenomenology, theory of personal constructs and rational-emotive therapy, behavioral therapy also provided important contributions, especially in the following aspects: emphasis on the use of the scientific method; importance to the maintenance factors of disorders rather than the origin of factors; emphasis on therapeutic elements such as structure of the sessions and the clinical process, definition of therapeutic goals, short-term treatment, and consideration of behavioral changes as an important means to achieve cognitive changes.
As for cognitive-behavioral therapy, it is situated in a comfortable middle ground between the two approaches, but with a degree of freedom given to its practitioners. occur-two groups. First, those previously trained as behavior therapists who tend to remain bound to the behavioral model, only adding to this principles and cognitive techniques, but with the primary objective to achieve behavioral changes. For these, cognition is still seen as a covert behavior. Second, those trained as cognitive therapists, and, adopting a cognitive model, they use behavioral techniques, but with the explicit purpose of getting cognitive changes.
The first group shows more numerous in Brazil, mainly due to the recent nature of cognitive therapy between us and the shortage of authorized training centers in this approach. The second group, composed of professionals trained as cognitive therapists, is the most self-called cognitive-behavioral therapists abroad, especially in the United States, Britain and other European countries. Outside, the group cognitive-behavioral therapists, previously trained as behavioral and remain linked to the behavioral model are far less numerous.
The main reason for this distribution of cognitive-behavioral therapists with clear cognitive or behavioral emphasis undoubtedly refers to the fact that Beck’s cognitive therapy today is the best validated approach of all available forms of psychological therapy, thanks to its emphasis on empirical research, the strength of its theoretical basis, and coherence between, on one hand, the model of installation and maintenance of psychopathology and on the other, its model applied.
It should be clear that the belief, common especially in Brazil, that cognitive therapy originated from behavioral therapy, constituting a form of neo-behaviorism, has no basis in historical sequence of events which would lead to the independent development of both. In 1994, Hans Eysenck, whose room was next to mine in the Department of Psychology Institute of Psychiatry, expressed as follows your opinion about the possible behavioral origin of cognitive therapy, “cognitive therapy has little in common with behavioral therapy . Beck was actually a redeemed psychoanalyst who was wise to leave the paraphernalia of psychoanalytic thinking and adopt a scientific methodology “(personal communication, 1994). And in the words of David Goldberg:. “Beck has the same relationship with psychoanalysis that Gorbachev has with communism Just as Gorbachev ended with communism without blood (…), promising that everything I was trying to do was rebuilt he, so Tim Beck dealt a deep blow to the subversive psychoanalysis, while assuring us that all he was trying to do was to expand the boundaries of psychotherapy “(personal communication P. Salkovskis, 1995).
Prepare this article, recalling facts and legends inevitably leads us to note that the sequence of historical events of great significance explain the current context of psychotherapies and inspire us to revere the great masters, some of which are gone and others still they are producing. These figures, through their ingenuity and remarkable energy, bequeathed us a sound foundation and an inexhaustible source of directions, in which emerged after psychotherapies are supported. Their examples serve as a source of inspiration in the setting and new ideas, especially with regard to study the association between cognitions and emotions, with emphasis on the possible creation of a cognitive-emotional processing theory as well as with regard to the strengthening of cooperation between and clinical research, a two-way showing signs of consolidação.tamental and Behavioral Therapy