CBT: Not a Single Therapy, but a Framework of Many Therapies

From CBT in Action: A Practitioners Toolkit by Dr Monica O’Kelly

When people hear the term "CBT," they often think of it as a single, unified therapy. In reality, this is a misunderstanding shared by both clients and, sometimes, even therapists. Cognitive Behavioral Therapy (CBT) is not a singular therapeutic technique or intervention; rather, it is a broad theoretical framework that encompasses numerous therapies sharing its core principles. Understanding this distinction can enhance how we approach mental health treatment and highlight the flexibility of CBT as a guiding structure.

The Core Concept of CBT

At its foundation, CBT is a theoretical model built on the idea that our thoughts, emotions, and behaviors are interconnected. The underlying premise is that maladaptive patterns of thinking lead to emotional distress and dysfunctional behaviors. By identifying, challenging, and modifying these unhelpful thought patterns, individuals can develop healthier emotional responses and behavioral habits.

However, the way this theory is applied varies significantly depending on the specific therapy being used. Different approaches within the CBT family emphasize different aspects of this framework, from challenging cognitive distortions to altering behavior through exposure techniques.

"CBT’s": A Family of Approaches

Rather than a singular therapy, CBT is more accurately described as an umbrella term for a range of therapies that adhere to its conceptual framework. These therapies all share the belief that cognition (thought processes) plays a critical role in shaping emotions and behaviors, but they employ diverse methods to bring about change.

Some prominent therapies within the CBT family include:

• Cognitive Therapy (CT): Developed by Aaron Beck, this approach focuses primarily on identifying and restructuring distorted thinking patterns to alleviate emotional distress.

• Rational Emotive Behavior Therapy (REBT): Pioneered by Albert Ellis, REBT targets irrational beliefs, encouraging individuals to adopt more rational, constructive ways of thinking.

• Dialectical Behavior Therapy (DBT): A variation of CBT developed by Marsha Linehan for individuals with intense emotional dysregulation, DBT incorporates mindfulness, emotion regulation, and interpersonal effectiveness skills.

• Acceptance and Commitment Therapy (ACT): While still aligned with CBT principles, ACT emphasizes accepting thoughts rather than challenging them, focusing on values-driven action.

• Behavioral Activation (BA): A focused, behavioral intervention primarily used in treating depression, BA encourages engagement in rewarding and meaningful activities to shift mood and behavior.

• Exposure and Response Prevention (ERP): Commonly used for anxiety and OCD, ERP emphasizes confronting feared situations and resisting compulsive behaviors.

Each of these therapies operates under the larger CBT paradigm but applies the theory in different ways to address specific client needs and conditions.

Why Does This Matter?

Recognizing that CBT is not a singular therapy but rather a flexible framework can improve both the delivery and understanding of treatment. Here’s why this matters:

1. Tailored Treatment: Because there are multiple therapies within the CBT framework, clinicians can adapt their approach to suit the individual needs of each client. For instance, a client struggling with depression may benefit from Behavioral Activation, while someone with intense emotional dysregulation may find Dialectical Behavior Therapy more effective.

2. Dispelling Myths: Many people assume CBT is a rigid, one-size-fits-all method. In truth, its versatility is one of its greatest strengths. Therapists can draw on various CBT-based interventions, integrating strategies that align with the client’s goals and therapeutic context.

3. A Broader Perspective: Therapists and clients alike benefit from understanding that CBT is an evolving field with contributions from numerous experts over decades. It is not a static "recipe" but a growing collection of tools grounded in a shared conceptual model.

4. Improved Outcomes: When clients recognize the diversity within CBT, they may feel more hopeful about finding an approach that resonates with them. Therapists, in turn, are empowered to deliver more flexible and creative care.

Moving Beyond "One True CBT"

The idea that there is a single, definitive CBT can limit both therapists and clients. It overlooks the richness and diversity of therapies that fall under its umbrella. Therapists who understand the many “CBT’s” can integrate techniques from various approaches to address the complexities of their clients' experiences. This adaptability is what makes CBT so widely used and effective across a broad range of mental health challenges.

In essence, CBT is not a singular therapy; it is a conceptual framework that has inspired an array of evidence-based approaches. By embracing this diversity, we can harness the full potential of CBT to help individuals lead healthier, more fulfilling lives.

Further reading:

1. https://www.sagepub.com/sites/default/files/upm-binaries/40689_2.pdf

2. Collard, James. (2019). Conceptual Confusion in Psychological Therapy: Towards a Taxonomy of Therapies, 10.1007/s10942-019-00313-7, Journal of Rational-Emotive & Cognitive-Behavior Therapy

3. O’Kelly, Monica (2003). CBT, REBT, and CT: Do Psychologists really know what they are doing? Dept Psychology, Psychiatry and Psychological Medicine Monash University, Clayton, VIC, 3168, Aus, paper presented at the Conference for the Australian Psychological Society, Perth.

4. https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00004/full