There is no “one” CBT but many.
Cognitive Behaviour Therapy or “CBT” is best thought of in three distinct but related categories:
Theory
Therapy Packages
Intervention techniques
Let’s go through these one by one.
Cognitive Behaviour “Therapy” is more of a theory than it is a stand alone “therapy”. It is an umbrella term that references a school of cognitive behaviour therapies that all share the general notion that thoughts, feelings, and behaviours interact as various aspects of psychological functioning - so there is no one “true CBT”. CBT is based on learning theory, which acknowledges people are biologically predisposed towards emotional disturbance, but also acquire it through observation and association. Because of this position on emotional disturbance, CBT attempts to help individuals un- or re-learn from their previous experiences in order to improve their functioning for the present and future by examining and changing any one aspect of psychological functioning:
For example, changing a thought, leads to a change in feeling, and the change in feeling leads to change in behaviour
Conversely, a change in behaviour, leads to a change in thought, which leads to a change in feeling
And changes in feelings, lead to change in behaviour, and change in thoughts
Because each of these domains is interrelated with the other, affecting one domain affects another and so on. All of the CBT’s target thoughts, emotions, and behaviours no matter the emphasis it places on particular domains. For example, it is well known that Rational Emotive Behavior Therapy and Cognitive Therapy as second wave CBT’s tend to focus more on challenging thoughts whereas so-called third wave CBT’s like Eye Movement Desensitisation and Reprocessing Therapy (EMDR) and Acceptance and Commitment Therapy (ACT) may prefer to emphasise focus on emotions through experiential exercises - whilst this differs on the practical level, these are merely different techniques that go toward achieving the same goal (keep reading to understand the difference between theory and techniques).
2. Specific “Therapy Packages” or “Specific Models" of the Cognitive Behaviour tradition are often confused with being different therapies from CBT. However, they share the same theoretical underpinnings (explained in section 1), though they place different (and in some, exclusive) emphasis on certain aspects of psychological functioning (e.g. thoughts, feelings or behaviours), propose particular protocols to treat maladaptive functioning, and often use their own idiosyncratic terminology to describe the same concepts. Some (of the most well-known) examples, but certainly not an exhaustive list, of the cognitive behaviour therapies and their respective authors include:
Rational Emotive Behaviour Therapy (REBT) - Albert Ellis, PhD (1953)
Cognitive Therapy (CT) - Aaron Beck (1967)
Dialectical Behaviour Therapy (DBT) - Marsha Linehan (1993)
Acceptance and Commitment Therapy (ACT) - Hayes (1982)
Schema Therapy - Jeffrey Young (1990)
Narrative Therapy - Michael White (1990)
Trauma-Focussed Cognitive Behaviour Therapy (TF-CBT) - Cohen, Mannarino, and Deblinger (2006)
Mindfulness-Based Cognitive Behaviour Therapy (MBCBT) - Segal, Williams, Teasdale (2000)
Eye Movement Desensitisation and Reprocessing (EMDR) therapy - Shapiro (1989)
From CBT in Action: A Practitioners Toolkit by Dr Monica O’Kelly
3. Intervention techniques are the “tools” or “strategies” that a client would experience being given from their practitioner in the therapy room. Though these techniques/strategies/tools may differ in their “appearance” (e.g. how they may be idiosyncratically described) or presented with their respective therapy packages, they are all informed by the same concept of cognitive behaviour theory.
For example, all CBT’s tend to focus on helping individuals to break out of problematic “rigidly held beliefs and expectations" about their circumstances:
In CT, these are referred to as “conditional assumptions”
In ACT, these are referred to as “rule governance”
In REBT, these are referred to as “irrational demands”
Here are some, but not an exhaustive list, of individual techniques that are utilised across specific therapy packages, though they are non-specifically included in most of these cognitive behaviour therapies, often receive different emphasis in their use depending on the individual authors consideration of their importance in how to resolve emotional disturbance and improve an individuals adaptive functioning:
Psychoeducation (e.g. providing clients with education on certain disorders/treatments available, the role of cognitions in emotional functioning, emotion labelling, etc)
Bibliotherapy (self-help reading)
Goal setting
Cognitive restructuring
Exposure/imagery (imaginal/in-vivo/interoceptive)
Skills training (mindfulness/relaxation/breathing/assertiveness/parenting, etc)
Behavioural activation
Activity scheduling
Relapse prevention
Summary:
A psychologist who practices CBT considers that emotional disturbance can be resolved and adaptive functioning can be increased by changing either thoughts, feelings, and/or behaviour in an individual as although they are technically seperate constructs of psychological functioning they are inextricably interrelated and cannot be for all intensive purposes experienced in isolation.
This psychologist may be trained in a variety of cognitive behaviour therapies, (e.g. ACT, DBT, CT, REBT, EMDR) and utilise specific protocols based on a clients presenting problem or use a combination of these skills - which has been referred to as “theoretically consistent eclecticism” by Windy Dryden.
It is also possible that a psychologist who says they practice “CBT” exclusively or predominantly does so from one specific therapy package (e.g. REBT or CT or ACT or DBT)
References/links/further reading:
All of the above information is not original thought, but has been derived from the following sources (which may also be helpful further reading on the summarised outline of “CBT” above):
https://www.sagepub.com/sites/default/files/upm-binaries/40689_2.pdf
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
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.
https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00004/full
