Cognitive Behavioral Theory Versus Rational Emotive Behavioral Theory

Since the introduction of Beck’s cognitive theory of emotional disorders, and their treatment with psychotherapy, cognitive- behavioral approaches have become the most extensively researched psychological treatment for a wide variety of disorders.Despite this, the relative contributionof cognitive to behavioral approaches to treatment are poorly understood and the mechanistic role of cognitive change in therapy is widely debated. We critically review this literature, focusing on the mechanistic role of cognitive change across cognitive and behavioral therapies for depressive and anxiety disorders.

Keywords: cognitive-behavioral therapy; cognitive theory; psychotherapy processes; depression; anxiety

THE ORIGIN OF COGNITIVE-BEHAVIORAL THERAPIES (CBTs) as a family of interventions can be traced to the advent of behavioral treatments for psychopa- thology in the 1950s and, later, the so-called “cognitive revolution” of the 1950–1960s (Dobson, 2009). Consequently, CBTs blend techniques that are emphasized in behavioral therapies (BTs) and cogni- tive therapies (CTs). However, there remains skepti- cism regarding the relative contributions of CT strategies to BT strategies in promoting symptom change within the CBTs (Longmore & Worrell, 2007). Additionally, critics have asserted that changes in thinking are not mechanisms of change in CBTs (e.g., Kazdin, 2007), calling into question whether

Correspondence regarding this article should be addressed to Lorenzo Lorenzo-Luaces, University of Pennsylvania, Department of Psychology, 3720 Walnut Street D20, Philadelphia PA 19104; e-mail: lorenzl@sas.upenn.edu.

there is any kind of contribution of the “cognitive” in cognitive-behavioral therapy. Despite debate regarding their active treatment

components as well as working mechanisms, CBTs continue to be the most widely studied forms of therapy (Hofmann, Asmundson, & Beck, 2013). A uniquely appealing aspect of CBTs is that their theo- ries of therapeutic change comport well with most modern conceptualizations of psychopathology. In this review, we attempt to reconcile skepticism regarding the relative contribution of CT strategies to BT, aswell as themechanisms that account for their efficacy. First, we provide a very brief historical over- view of the origins of CBT and discuss the support for the cognitive vulnerability models to depression and anxiety disorders. We discuss methodological chal- lenges in psychotherapy research that have impeded a more thorough understanding of the relative con- tributions of cognitive to behavioral techniques. We then focus most of our discussion on research on the cognitive mechanisms of change in CT, BT, and CBTs for depression and anxiety disorders. We use the terms cognitive therapy (CT) and

cognitive techniques to refer to behaviors therapists engage in that are targeted towards changing the content or process of thoughts, inferences, inter- pretations, cognitive biases, and cognitive schemas.1

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Cognitive Behavioral Theory Versus Rational Emotive Behavioral Theory