Development of CBT
Cognitive behavior therapy (CBT) is a combination of principles of cognition and behavior. As a therapy, it takes a short-term approach to treatment. According to Corey (2009), CBT “has generated more empirical research than any other psychotherapy model” (p. 274). Aaron Beck is known as this form of therapy’s most famous progenitor. Judith Beck (2011) explains that her father “drew on a number of different sources when he developed this form of psychotherapy, including early philosophers, such as Epictetus, and theorists, such as Karen Horney, Alfred Adler, George Kelly, Albert Ellis, Richard Lazarus, and Albert Bandura” (p. 2). The birth of cognitive psychology upon which CBT is based was the 1960’s when influences from Gestalt and social psychology, as well as advances in physiology displaced radical behaviorism (Hergenhahn & Henley, 2014, p. 585). Certain pivotal advances of CBT run contrary to the prevalent behaviorism that it would replace. The patient is considered an active participant in the process (Beck, 2011, p. 8). This is in stark contrast to the passive behavior modification of behaviorism. In addition, CBT is an educative process that “aims to teach the patient to be her own therapist” (Beck, 2011, p. 8).
In “Using CBT during a return to work,” Brady and Harriss (2015) explain CBT through a case study of an employee who, after being diagnosed with depression, frequent absences, and then a bereavement leave, experienced debilitating anxiety at the thought of returning to work. She was referred to occupational health for resolution. The specialist took a CBT approach. Brady and Harriss (2015) explain:
The OH assessment for Sarah identified behaviours, cognitions and emotions with related biological symptoms. Emotionally, she felt overwhelmed and anxious that she might be unable to cope on returning to work. Her reluctance came from concerns regarding facing colleagues with dominant personalities within her team. Behaviourally, she was disengaged from work and had lost social contact.
Within this diagnosis, cognitive and behavioral factors are clearly stated. After discussions with the employee, it was ascertained that the origin of her anxiety with regard to dominant personalities stemmed from incidents of bullying in her childhood. These incidents led to negative feelings. Interactions with dominant personalities was associated in Sarah’s mind with the incidents of bullying. When Sarah did not come to work, she was not exposed to those negative feelings. This in essence provided positive reinforcement for the anxiety. “Work avoidance reduced Sarah's anxiety as she did not have to face her colleagues. The positive reinforcement associated with this avoidance continued that behaviour, thus maintaining her anxiety” (Brady & Harriss, 2015).
Through their discussions, the specialist was able to help Sarah become aware of her belief and develop a therapeutic approach to overcoming her anxiety. Brady and Harriss (2015) explain “There are two components to CBT as an approach: the first is a cognitive approach considering thoughts and mental processes; and the second considers behavior.” The approach began with addressing the anxiety through exploring her underlying beliefs and then by setting SMART goals for her eventual returns to the workplace. Brady and Harriss report that after three weeks she was able to return to work with self-reported minimal anxiety. This is a prime example of how CBT can be effectively utilized within the workplace. However, it is unlikely that many occupational health specialists have this type of interventional training.
Beck, J. (2011). Cognitive behavior therapy: basics and beyond, (2nd ed.). New York: The Guilford Press
Hergenhahn, B. & Henley, T. (2014). An introduction to the history of psychology, (7th ed.). Belmont, CA: Wadsworth.
Brady, H., & Harriss, A. (2015). Using CBT during a return to work. Occupational Health, 67(9), 27-29.