Behavioral Interventions in Cognitive Behavior Therapy
Chapter 1: Overview
Cognitive Behavior Therapy (CBT) is a widely used treatment approach for
psychological conditions such as depression, anxiety disorders, personality disorders,
substance abuse disorders, eating disorders and couple’s distress. CBT is a broad
concept, which represents a variety of therapeutic approaches that highlight cognitive,
behavioural and environmental factors in relation to psychological disorders. The term
CBT contains points of views that can be contradictory or even incompatible.
There are at least 10 different schools. The cognitive perspectives differ in the degree to
which they view the environment as a determinant of action, thinking and emotion.
The influential cognitive approach assumes that mood and behaviour are influenced by
distorted and that dysfunctional thinking and inaccurate and biased forms of thinking are
common to all psychological disorders. For each disorder there is a unique set of thought
distortions and underlying beliefs (schemas). Therapeutic activities should promote
realistic, accurate and balanced thinking. The modification of thinking will produce
changes in mood and behaviour and establish lasting therapeutic change. Schemas are
cognitive structures that can predispose persons to emotional and behavioural disorders
and influence evaluation and interpretation of experiences.
Behavioral interventions in CBT: underlying assumptions and
common feature
Behavioral Views on Abnormality
Individuals who have psychological disorders or who display problematic behaviors are
often considered as deviant or abnormal because of the dominant role of ‘deviant’ or
‘defect’ models of abnormality. Psychological disorders are often regarded as having
maladaptive schemas and underlying diseases or biological processes are presumed to
underlie psychological syndromes. The internal defect that the person has must be
changed, removed or altered in some way to no longer be disordered.
Behavior theorists and therapists do not search for internal causes of behaviour.
Although it is acknowledged that genetics might predispose individuals to react in certain
ways, they are primarily concerned about what a person does and the context where
,the behavior occurs. Culture provides the context for referencing which behaviors are
(ab)normal. Cultural norms and values can change over time (homosexuality was seen
as a mental disorder until the 70s).
From a behavioral perspective normal and abnormal behaviour are shaped by the same
determinants. They assume that there is nothing inherently defective or deviant about
people who report emotional or behavioral problems.
Behavioral interventions within CBT: Description and Application
Some people have negative thoughts about terms as behavior therapy, behavior
modification or behaviorism. These reactions are the result of misunderstanding, such as
the belief that behavioral therapy is an attempt to control someone’s actions.
A focus on Behavior and Its Context
Psychological disorders from a behavioral perspective are defined by behaviour, occurring
both within the individual (covert behavior such as thoughts) and as actions that can be
observed by others (overt behavior). The environment establishes the context of such
behavior.
The three-term contingency concept of Skinner represents the basic unit of analysis
within some forms of behavioral therapy. It consists of 3 elements:
1. Antecedents of behavior: stimuli and conditions that set the occasion for
behavior to occur
2. Behavior: anything a person does
3. Consequences that follow behavior: the effect that behavior produces
This framework is often used to develop hypotheses about behavior.
A Focus on Why People Act the Way They Do
Engaging in certain behavior depends on the learning history of behavior under similar
conditions and reinforcement. When behavior was successful in the past, it is more likely
to occur in similar current and future environments.
Functionalism is a term based on the evolution theory of Darwin. The physical structure
of a species is determined by its associated function. Natural selection is selecting the
most adaptive physical structures with functional properties that are associated with the
enhancement of gene fitness. People are more likely to select functional behavior that
,produces reinforcing consequences.Behavior varies and some units of behavior are
selected because they are more successful than other units.
Environmental determinism is the process of selection of variations in an individual’s
behavior during his or her lifetime. Cultural norms are also selected. Norms that proved
to be most beneficial or enhance fitness tend to be retained over time.
Contextual approaches in behavioral theories focus on how events and behaviour are
organize and linked together in meaningful ways. Contextualism is about the context
within behavior takes place, also called the contextual flow in which behavior occurs.
Therapies differ in underlying theories and presumed mechanisms of behavior change.
Cognitive therapies, for example, focus on automatic thoughts, underlying assumptions
and schemas. Every therapy targets on the most central determinant or cause of
problematic behavior (understood by associated theory). Consequently the types of
interventions vary between the different therapies.
Common Features among behavioral assessments
In the assessment of clients, behavior therapies focus on the behavioral repertoire to see
if it is necessary to learn new alternatives and the context within which the problematic
behavior occurs. They are looking for internal and external factors that maintain
problematic behavior. The motivation to change is also important. Motivation is seen
as a condition resulting from environmental events and is changeable by manipulations
of the environment.
The following features are assessed and evaluated in the behavioral assessment:
The Antecedents of problematic behavior: internal or environmental cues,
verbal rules.
The consequences of problematic behavior: short-term, long-term, positive
or negative reinforcing.
The client’s learning history as it relates to current problematic
behaviors: factors in the past that shaped and established the behaviors
The client’s current behavioral repertoire: a comprehensive assessment of
the client’s behavioral repertoire would cover four response domains: overt motor
behaviors, thoughts and mental images, emotions and physiological sensations
Overt behaviors: skill deficits, coping and problem-solving skills.
, Thoughts: (confused) evaluations of self, world and future.
Emotions: appropriate responses, overly reactive.
Physiological sensations or responses: associations with catastrophic
outcomes.
The client’s motivation for change: behavior consistent with values and goals.
Even though some people have similar problems, the factors that influence behavior vary
across individuals.
Common Features Among Behavioral Interventions
General characteristics of behavioral interventions:
An empirical orientation, as reflected in its grounding in the basic behavioral
sciences
Therapist-client collaboration, work together to formulate problems and a plan
for therapy.
An active orientation, in which client is actively encouraged to work on his
problem areas.
A flexible approach with continuous evaluations and testing of the hypotheses.
An emphasis on environment-behavior relations: describing the actions of
clients, their thoughts, emotions and physical sensations within the context in which
they occur.
A time-limited and present focus, in which the time allotted for therapy varies
in accordance with the nature and severity of the problem areas addressed in
therapy, with emphasis placed on one’s current situation rather than the past
A problem and learning focus, in which solutions to problematic behaviors are
sought
An emphasis on both change and acceptance processes, in which
interventions that promote therapeutic change are undertaken in a context that
conveys valuation of the client and encourages the development of client self-
validation
