Cognitive Behavior Therapy

Cognitive behavior therapy (CBT) theorists propose that disturbances in cognition underlie and maintain much emotional disturbance. Accordingly the cognitive addition to behavioral therapy typically consists in collaboratively noticing, restructuring, de-fusing from, and challenging these cognitions by the therapist and the patient. With the right group of problems, patients, and therapists, the practice of CBT is well known to possess therapeutic efficacy. This chapter, however, primarily considers the theory rather than the therapy of CBT; in particular it looks at the central significance it gives tocognitionin healthy and disturbed emotional function. It suggests that if "cognition" is used to mean merely ourbelief and thought, then CBT theory provides an implausible model of much emotional distress. If, on the other hand, "cognition" refers to the processing ofmeaning, then CBT risks losing its distinctiveness from all therapies other than the most blandly behavioral. The chapter also suggests: (a) that the appearance, in CBT's causal models of psychopathology, of what seem to be distinct causal processes and multiple discrete intervention sites may owe more to the formalism of the theory than to the structure of the well or troubled mind; (b) that CBT theorists sometimes unhelpfully assimilate the having of thoughts to episodes of thinking; (c) that CBT models may sometimes overemphasize the significance of belief and thought in psychopathology because they have unhelpfully theorized meaning as belonging more properly to these, rather than to emotional, functions; (d) that CBT approaches can also misconstrue the nature and value of acknowledgement and self-knowledge-thereby underplaying the value of some of the CBT therapist's own interventions. The theoretical and clinical implications of these critiques is discussed-such as that there are reasons to doubt that CBT always works, when it does, in the manner it tends to describe for itself.