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Journal of Basic and Applied Psychology Research
ISSN: 2683-2267
Biannual Publication, Vol. 1, No. 2 (2020) 20-24

Cognitive-behavioral Therapy: a theoretical review of its bases

Terapia cognitivo-conductual: una revisión teórica de sus bases
Julio A. Hernández-Pineda a, Edén A. Medina-Guerrero b& José A. Castillo-Martínez c

Abstract:

This article is a theoretical review essay, which aims to present the events that are considered most relevant in the development and
consolidation of Cognitive-Behavioral Therapy (CBT) and which in turn have positioned it as a therapy of choice for Different
psychological problems. A review was carried out with two of the most accessible digital search engines for undergraduate students,
using search keywords according to the objective of this article. Identifying that cognitive-behavioral therapy is understood as the
application of scientific psychology to clinical practice in a systematic and structured way. This model based on behaviour
modification because of its solid theoretical and experimental basis, which emphasizes the empirical verification of the techniques
during its application. What makes CBT an effective, efficient, and timely clinical practice, improving the quality of life of users
and positioning themselves in front of other psychological models in terms of efficacy.
Keywords:
Behavior modification, Psychotherapy, Evidence-based psychology, Effectiveness, Efficacy

Resumen:

Este artículo es un ensayo de revisión teórica, cuyo objetivo es presentar los eventos que se consideran más relevantes en el
desarrollo y la consolidación de la terapia cognitiva conductual (TCC) y que a su vez la han posicionado como una terapia de
elección para diferentes problemas psicológicos. Se realizó una revision con dos de los motores de búsqueda digital más accesibles
para estudiantes universitarios, utilizando palabras clave de búsqueda de acuerdo con el objetivo de este artículo. Identificar que la
terapia cognitivo-conductual se entiende como la aplicación de la psicología científica a la práctica clínica de manera sistemática y
estructurada. Este modelo se basa en la modificación del comportamiento debido a su sólida base teórica y experimental, que
enfatiza la verificación empírica de las técnicas durante su aplicación. Lo que hace que la TCC sea una práctica clínica efectiva,
eficiente y oportuna, que mejora la calidad de vida de los usuarios y se posiciona frente a otros modelos psicológicos en términos de
eficacia.
Palabras Clave:
Modificación de conducta, Psicoterapia, Psicología basada en evidencia, Efectividad, Eficacia

evidence and basic research, what they had called the first
INTRODUCTION
generation of cognitive-behavioral therapies: Behavior
Cognitive-behavioral therapy (CBT) is a model of Therapy (CT).
psychological intervention, structured and grounded on This therapeutic approach has become the psychotherapeutic
scientific and empirical bases that have set the pattern for the approach with more significant evidence for a large number of
praxis of clinical, educational, and organizational psychological problems. The term psychological problem is
psychologists, among others. It is within the treatments of used (Pérez & Fernández, 2008) because it is understood as
choice and the most used therapies today, not only for its something that is within reach of the user to be able to solve,
development and proliferation but for its effectiveness and such as the daily circumstances of life, and not only as a
efficiency, which places it within the short and therefore pathogen that is causing a particular behavior.
economically accessible therapies (Hernández, 2017). Also, in
a short time is achieved the objective that has been established Nowadays, other authors affirm that:
at the beginning of the treatment. Under the heading of cognitive-behavioral, a set of schools,
Ruiz, Díaz, and Villalobos (2013) define CBT as the theories, and techniques are defined. They give way to a
systematic application of psychological science in the clinical therapeutic system based on a theory of psychopathology and
context. These procedures were derived from the learning a body of techniques derived from Experimental Psychology,
principles and theories, which are well-grounded by empirical Social Learning, Cognitive Sciences, Information Processing,
and Systems theory (Hernández & Sánchez, 2007, p. 9).CBT
________________________________________________________________________________________________________________________________________________________________________

a Autor de correspondencia, Universidad Autónoma de Guerreo, Instituto de Terapias Cognitivo Conductuales, https://orcid.org/0000-0002-

9871-7258, Email: [email protected]

b Universidad Autónoma del Estado de Hidalgo, Instituto de Ciencias de la Salud, https://orcid.org/0000-0003-0162-4483, Email:

[email protected]
c Universidad Autónoma de Guerreo, Instituto de Terapias Cognitivo Conductuales, https://orcid.org/0000-0002-0943-9074, Email:
[email protected]
 Biannual Publication, Journal of Basic and Applied Psychology Research, Vol. 1, No. 2 (2020) 20-24

groups a wide range of intervention techniques and procedures in the face of stimuli or situations that previously seemed
specific to each disorder or problem that can be cognitive, harmless and give clear explanations of how a problem can be
behavioral, and emotional, in which the person may be acquired as a specific Phobia.
presenting difficulties, and they affected their performance in In America, the one considers as primarily responsible for
some vital areas. Also, to develop in people some skills to had psychology focusing on behavior is John B. Watson, who,
better social adaptation and increase their quality of life- with his student Rayner and using the procedures of classical
related to their satisfaction and perception. conditioning, managed to induce an experimental phobia. He
also encouraged one of his disciples, Mary Cover Jones, to
METHOD follow his line of research and a few years later he was able to
This text is a theoretical revision essay. In this review, digital treat a phobia (Pérez, Gutiérrez, García, & Gómez, 2010).
search engines were used to analyze journal articles with
scientific content and publications of empirical research in the This event, it could be said that, starts the BT, inspiring other
field of Psychology. In a second stage, books, manuals, and researchers to transfer the experimental findings to the clinical
protocols of cognitive-behavioral therapy were also reviewed field of psychology.
in which precise descriptions are made of the scientific and Another of the most important contributions is Skinner's
empirical foundations and bases that support the effectiveness operant conditioning, in which it is postulated that the
of the techniques used within this model to solve the problems behavior will be more likely to occur or not due to the
of psychological nature. The search was conducted consequences that it has. Positive reinforcement, negative
considering the essential databases to which undergraduate reinforcement, positive punishment, negative punishment, and
students have easy access as the first resource in the search for extinction are some of the fundamental premises (principles)
articles on this topic (Dialnet and Google Scholar). Logical that were derived from the Behavioral Experimental Analysis
operators and search keywords were used, such as: “bases of (see Holland & Skinner, 1990, for the revision of these
CBT, fundamentals of CBT, scientific bases of CBT, concepts). If we systematically applied these principles, we
fundamentals of Cognitive Behavioral Therapy.” Once the can modify "maladaptive" and "adapted" behaviors that are
articles were collected, the most appropriate ones were acquired under the same learning principles. In this sense, in
reviewed to integrate the information as a theoretical essay the field of Behavioral Modification, instead of referring to
review. normal or abnormal pathological or healthy behaviors, it is
preferred to use the terms of excesses or deficits.
RESULTS The investigations named early and others such as Wolpe
(1958) with systematic desensitization, Meichenbaum (1974)
Basis and foundations of CBT with training in self-instruction, Mahoney (1974) with the
Under the title CBT, different interventions are grouped that mediation model, among others, have made possible the
can be organized according to their level of response and evolution and consolidation of CBT as therapy of choice for
objectives, varying from behavioral, cognitive, and currently different psychological problems.
contextual ones.
About empirical evidence
Basic and Behavioral Research
A relevant period for BT began in 1970, including cognitive
Its genesis, development, and consolidation is related mainly and social aspects. The cognitive variable was included
to Behavior Therapy (BT) or Behavior Modification (BM). because the Stimulus-Response (E-R) model was insufficient
Since its beginnings in the '50s, as an alternative intervention to give a complete explanation of human behavior. That was
to psychoanalysis, it was born with a solid theoretical basis an advance for this psychological therapy proposal because it
and experimental foundation due to its interest in basic showed that it did not neglect the relevant aspects of
research (Froján & Calero, 2011). Considered a powerful psychological science (emotion, cognition, memory, etc.).
technology (Bornas & Noguera, 2002) and the strongest pillar During this critical period (70’s), one of the most
on which cognitive-behavioral therapies are supported. representative theories was the Social Learning Theory that
From the investigations of the Russian physiologist Pavlov weighted the social influence and the ability of a persona to
who, in the early twentieth century, showed that a neutral self-regulate his behavior. The works of Bandura and the
stimulus (sound of a bell), which caused no response in the appearance of the relevance of cognitive aspects in the BT
organism and has no formal properties in common with gave way to the so-called cognitive revolution, where the
another stimulus, he called unconditional stimulus (food). For highest value was attributed to thoughts and mental structures .
its part, food does cause natural reactions in the body. By The incorporation of cognitive variables changed the
presenting them almost simultaneously, the neutral stimulus conceptualization and treatments of psychological problems
begins to elicit responses of the organism similar to those and their implications in clinical practice (Ruiz, Díaz &
caused by the unconditional or unconditioned (in this case, Villalobos, 2013). A crucial moment was the publication of
salivation). Once the stimulus (before neutral) acquires the the work Cognition and behavior modification by Mahoney
ability to elicit the salivation response, it changes its name to a (1974). By the early '80s, CBT was already well positioned as
conditioned stimulus, and the response, in the same way, an effective and efficient therapy that could be compared, in
changes to a conditioned response in a procedure called terms of efficacy, with pharmacological treatments.
responsive, classical or Pavlovian conditioning. The discovery
of classical conditioning allowed us to understand how an
unconditioned response (e.g., fear or anxiety) could be evoked Clinical application

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The interest of treatment is the modification of maladaptive Techniques and strategies applied
responses without neglecting internal or private processes
(emotion, cognition, physiology, etc.). Behavior is understood Some of the best-known techniques that were derived from the
as a learning process as a result of the events that have theoretical knowledge achieved by this model are cognitive
happened in the subject's environment without forgetting restructuring techniques. Which focuses on the identification
biological and cultural aspects. Although there are many of thoughts that are considered problematic and then correct or
misunderstandings, mostly by people unfamiliar with the replace them with more adaptive ones that allow the
theoretical foundations of the model, CBT not only focuses on achievement of the objectives. These techniques are very
behavior or thoughts but also takes into account other representative of Rational Emotive Behavioral Therapy
variables as emotion, physiology, and environment (Dattilio & (REBT) and Beck's Cognitive Therapy (CT).
Padesky, 1995). These five variables usually complemented by
the subject's clinical history and the functional analysis of the Other techniques have stood out for their effectiveness, their
behavior that is important to understand the problem and easy implementation and the possibility of providing the user
focusing on the present. Consequently, the goal of the with practical knowledge to improve their cognitions,
treatment is cognitive, emotional, and behavioral change, emotions and behaviors (See Figure 1).
which can be achieved by reducing the user's maladaptive
behavior.
CBT weighs the evaluation of the effectiveness of Problem-
interventions in treatments, which originates in an empirical solving
approach. A useful intervention can be qualified with all training
changes that indicate improvements in the target behavior.

The Cognitive Behavioral Therapist is essentially an active

Stress
manager in what refers to psychotherapy, actively involving Social skills
inoculation
the patient in his treatment. First showing him how he operates training
training
to modify the variables within the office and then asking for
specific tasks such as thought detection, questioning
techniques and behavioral experiments that serve to verify the
truthfulness or functionality of their assumptions that give Self-
meaning to their experiences (Bunge, Gomar, & Mandil, instruction
2011). As the treatment progresses, the patient becomes the training
specialist and can benefit from what he learned in sessions.
This way of working together with the patient (forming a Figure 1. Some of the best-known intervention strategies of the
collaborative team), Beck, Rush, Shaw, and Emery (1983) cognitive-behavioral model
called it collaborative empiricism.
The patient has active participation because people tend to These strategies focus on the relationship between what is
make errors in the processing of information (cognitive thought (cognition), is felt (emotion/affection), and is done
distortions) that they receive from outside, distorted by (behavior).
thought patterns that refer to a negative view of the world, Starting from the fact that CBT assumes that emotions and
themselves, and the future (cognitive triad). Perpetuating the behaviors are mostly a product of what we think (Kendall,
schemes, which are cognitive structures that will determine the 1991, cited in Stallard, 2007). Therefore, cognitive-behavioral
aspects that will be taken care of, resulting in psychological techniques are intended to help users of psychotherapy to
distress. That is why the active participation of the patient in change the problematic patterns of behavior, facilitating that
what he considers a problem is necessary because they are the they change the content of their thoughts for a more rational
only ones who can access the world inaccessible to the explanation of the events they live.
therapist. In 1955, Ellis proposed Rational Emotive Behavioral
Therapy (REBT) (Ellis & Dryden, 1989). Some distinctive features and their contributions to mental
Ellis, in the REBT, proposes his ABC model of emotion, health
which is a graphic representation of a constellation of
variables that make up the psychological event. ABC model What characterizes CBT is that it is based on a collaborative
allows conceptualizing the psychological problems of team between the therapist and the client. From the first
psychotherapy users in a simple way. Where A represents the sessions in the psychoeducation part, the therapist socializes
adversity or situation from which the inferences are derived. the possible genesis, development, and maintenance of the
And these are what activate the belief system B, which problem, which increases the knowledge of themselves and the
attributed the emotional, physiological, and behavioral variables related to their problem. This activity involves the
consequences C, which are the perceived problems for the client in his treatment, promoting in him the development of
patient. These proposals for intervention are based on the new skills that will help him to the solution of future
already well-known stoic premise that it is not the events that vicissitudes that are presented and promoting independence to
disturb or alter man, but the interpretation he makes of the develop new skills that facilitate the achievement of his
facts (Epictetus, 1st century AD, cited in Lega, Horse & Ellis, objectives. It is a model of brief therapy (in general with limited
1997). Which is also considered a cornerstone in CBT. time, between 15 or 20 sessions) with clear goals, operating in a
structured way.

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The cognitive-behavioral therapist knows what he will do in

each meeting because the sessions have a structure that The techniques that makeup CBT are based on the scientific
consists of at least six components (See Figure 2) acording to principles of learning psychology, classical conditioning,
Friedberg and McClure (2005). These components somehow operant conditioning, social learning theory, and cognitive
guarantee to work for objectives within the session without learning.
forgetting that the therapist has the freedom to change it into Other techniques also had their basis in clinical experience to
the present contingencies of the session. what we have referred to as evidence-based therapies. This
body of knowledge, called Cognitive-behavioral Therapy, has
1) Assess the mood a history of birth, development, strengthening, and is
consolidated. This model tries to intervene promptly in the
2) Review of the tasks
discomfort of the subject showing deep respect for the
3) Setting an agenda emotional pain of people suffering from a disorder (Galasso,
2011). In this way, and with the evidence of the experiments
4) Session content and investigations, instead of investigating the possible
underlying conflicts or problems, behavioral therapists began
5) Eestablishment of tasks that work in a session
to focus on the manipulation of variables that were objective.
6) Feedback They set aside the subjective definitions to focus objectively
on the behavior.
CBT has demonstrated its effectiveness in a large number of
Figure 2. The General structure of a session in the cognitive- psychological disorders and problems in the daily life of the
behavioral model human being. Based on the behavior modification, because it
strictly adhered to the scientific method, establishing laws that
Cognitive-behavioral therapy also offers precise explanations explain the interaction of an organism, alive, with the variables
of the psychological problem that occupy the place of of the environment.
diagnosis. The case formulation and treatment plan (Nezu, The era of technology and the birth of artificial systems also
Nezu & Lombardo, 2006) would be the option to follow to supported these (cognitive) theories, serving as an analogy in
understand the current problem of the psychotherapy user. the processing of information in thinking subjects.
This formulation is a graphic representation for the therapist CBT is characterized by putting at the service of the client the
that allows him to see the predisposing events as well as the scientific principles of psychology for personal growth and
precipitants (distant variables and background) of the client's development.
complaints, which will enable the therapist to design a Arguing that behaviors are learned (both adaptive and
treatment program following the specific problem of the client. maladaptive) under the same conditions and based on this, the
learning process can be reversed or new behaviors; more
A large number of clinicians and researchers use evidence- adaptive or functional responses can be learned, according to
based therapies, which have given relief to a large number of the context. Dissatisfaction with the behavioral paradigm and
problems, thus contributing to the benefit of the society's its inability to explain the complexity of human behaviors
mental health from children to older adults in very diverse gave way to the integration of the cognitive variable and, with
circumstances and different backgrounds. it, the birth of CBT to provide a more structured and detailed
explanation of the variables that affect behavior. By the '80s,
Currently, cognitive-behavioral therapies are probably the CBT already circumscribed a great variety of these types of
most used due to a large amount of evidence they have in their techniques, which were positioned for their effectiveness in
interventions, to the degree that CBT and Evidence-Based clinical interventions.
Psychotherapy (PBE) has come to be understood as synonyms For CBT to maintain its scientific status, it should continue
(Pérez, 2019). They have reports of interventions for complex doing empirical studies with experimental and control groups,
problems such as trichotillomania (Morales, 2012), smoking comparative studies, meta-analysis, maintain methodological
(Froján & Becoña, 1999), communication disorders, learning skepticism, be self-critical, that is, that CBT is fallible and
(Caballo & Simón, 2002), to name a few. There are also perfectible.
complete intervention manuals for anxiety, sexual What psychologists need now is to focus on why it works,
dysfunctions, dissociative, somatoform, impulse control, mood highlighting the role of language and context as relevant tools
disorders, bipolar, schizophrenia, sleep disturbances, and in psychotherapy. To be aware of the process of cognitive-
partner problems (Barlow, 2018; Caballo, 1997). All this behavioral interventions would allow us for more precise and
evidence is contributing effectively and efficiently to the reliable indicators of the expected change in a
mental health of a large number of people who benefit from psychotherapeutic intervention.
these empirical treatments.

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CONCLUSION

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