History of CBT


I: Behavior Therapy (BT): Cognitive-behavior therapies are actually a group of modern related therapies that are the first truly “empirical” psychotherapies. “Empirical” means the psychological theories on which these therapies are based on pure scientific research and furthermore the resulting therapeutic strategies are scientifically proven effective. Beginning in the 1940’s, the need for an effective short term therapy for anxiety and depression had became an absolute necessity because of returning WWII vets and the major emotional adjustments they were faced with. This practical need for effective short-term therapy coincided with a build up of behavioral research which psychologists had been building for a few decades regarding how we “learn” to behave and react emotionally (behavioral learning theory). This combination of events gave birth to the “first wave” of behavior therapy. This therapy, called “behavior therapy” or “behavioral therapy”, was a revolutionary challenge to the traditional therapy of that day which was psychoanalytic (Freudian) therapy (today modern Freudian based therapies are sometimes referred to as psychodynamic or therapy). Behavior therapy is still a very important part of all therapies now called cognitive-behavior therapy or cognitive therapy.


II: Cognitive-Behavior Therapy (CBT): A second revolution in behavior therapy occurred in the late 1960’s. Psychologists and psychiatrists began the empirical study of how thinking (cognitions) affected emotions and behavior. This was a revolutionary challenge to traditional behavior therapy is sometimes referred to as a “second wave” or the “cognitive revolution”. Paying more attention to the role of conscious thinking in psychotherapy made common sense to patients and slowly to most mental health professionals. The history of the cognitive revolution in psychotherapy was also helped along by two other developing “cognitive” sciences. The first was social psychology which was beginning to understand the complex ways in which individuals interact and think about each other. “Attribution theory” was the main reason why social psychology gave a boost to the development of cognitive therapy. Social attribution research was the exploration our minds tendency to think about or “attribute” causes to the actions of others. The second boost to the cognitive revolution was the development of computer science and computer programming. It seemed that computer software and software programs were a perfect analogy for understanding the “programming rules” for human brains and behavior. These two areas of research and gave added momentum and scientific legitimacy to the cognitive revolution. Behavior therapists could now further understand a patient’s difficulties by assessing the role of conscious thoughts and not just study visible behavior. This combination of scientific disciplines and theories gave us the first true “Cognitive-Behavior Therapy” (CBT).


III: Third Wave or Third Generation CBT: Now in 2006 with cognitive behavioral therapy being nearly 50 years old, there is talk of new changes in traditional CBT, a so called “third wave” of cognitive-behavior therapies. While trying to describe all the newer therapies loosely known as third generation CBT’s is impossible to do here, let me briefly review some of the main similarities and differences. There are many similarities, third wave CBT therapists base themselves in empirical research, they acknowledge the important role of behavior just as much if not more so than traditional CBT, most also continue to acknowledge the important role of cognitions (thinking). So what is so revolutionary? Some of the main theoretical difference seems to be about control and emotional avoidance. Third wave therapists have sparked a re-examination of whether trying to control our thoughts and emotions is part of the solution or the problem. They believe that there may be other non-traditional ways to address the way we deal to our thinking. This theoretical question has stimulated renewed efforts for cognitive-behavioral therapists to improve their ability to not just work with the content of our thoughts but the process of thinking itself. Another way of saying this is trying not to just change what we think but how we think. Now traditional CT has also tried to do this in its own way, but when it comes to our thoughts, third wave CBT is putting much more emphasis reacting to our thoughts in a new ways, placing them in context, rather than getting caught in arguing with the content our negative thoughts. (For a more technical definition of “3rd generation CBT” see footnote quote 1 below).

Philosophically third wave therapies have a decreased emphasis on controlling our internal experience; they offer a more eastern approach to our psychological lives. Many of these therapies are incorporating the role of acceptance and mindfulness into traditional CBT (see description above for more on acceptance and commitment therapy). However we relate to our thoughts, the third wave therapist wants thoughts to help our behavior to be adaptive. Are our reactions to our thoughts flexible enough to lead us into consistent with leading valuable, productive lives, or are our efforts at controlling our thoughts and emotions taking up all of our attention and energy? These are some of the main problems confronted by third wave CBT’s. For a further brief history of some of the most influential therapists for each of the above types of therapy see the above section on “types of CBT”.

So called “third wave” CBT is a loose affiliation of various modern therapies with no specific criteria about who is or isn’t third wave. At the risk of sounding like alphabet soup here are some of the major third wave CBT therapies; Acceptance and Commitment Therapy (ACT), Mindfulness Based Cognitive Therapy (MBCT), Dialectical Behavior Therapy (DBT), Behavioral Activation (BA), Functional Analytic Psychotherapy (FAP), Cognitive Behavioral Analysis System of Psychotherapy (CBASP), Integrative Couple Therapy (ICT).


1. Third Generation or Third Wave CBT (Hayes, S. C., 2004): “Grounded in an empirical, principle-focused approach, the third wave of behavioral and cognitive therapy is particularly sensitive to the context and functions of psychological phenomena, not just their form, and thus tends to emphasize contextual and experiential change strategies in addition to more direct and didactic ones. These treatments tend to seek the construction of broad, flexible and effective repertoires over an eliminative approach to narrowly defined problems, and to emphasize the relevance of the issues they examine for clinicians as well as clients. The third wave reformulates and synthesizes previous generations of behavioral and cognitive therapy and carries them forward into questions, issues, and domains previously addressed primarily by other traditions, in hopes of improving both understanding and outcomes”.


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