The first wave of CBT is Behavioural therapy, which provides new learning experiences to clients to increase adaptive behaviour and decrease problematic ones. They use behaviour activation to decrease avoidance and increase their experience of mastery and pleasure. The second wave, Cognitive Therapy, came from Aaron Beck.

Aaron Beck was a young psychiatrist in the 1950s, trained using the modality of psychoanalysis. His earliest research refuted the principles of psychoanalysis. Rather than clients with depression feeling an innate need to suffer, his studies pointed to clients’ underlying negative beliefs associated with failure and loss.  Beck found that three thinking patterns of how they view themselves, the world, and the future were overly distorted and negative. They may judge their self overly harshly, not based on reality. They view their society and environment as excessively negative. They may catastrophize what is likely to come.

Beck suggested that the negative schemas or core beliefs focus primarily on feelings of failure, loss, worthlessness, and inadequacy. Beck used behavioural techniques to activate clients’ lives, prevent avoidance, and combat hopelessness. The maladaptive cognition includes general beliefs or schemas that give rise to automatic thoughts triggered by a particular situation. The automatic thoughts are always short, direct, and temporary.

Radical behavioralism states that the environment determines people’s behavior. Second wave CBT sees cognition and behaviour as a two-way relationship that mutually affect each other. CBT is based on two principles. i) Cognition has a controlling influence on our emotions and behaviour. ii) Behaviour can powerfully affect our cognition and emotions. CBT asserts that the appraisal of the situation, rather than the situation itself, directs the client’s emotion and behaviour. Negative life events could trigger the cognitive vulnerability, and their maladaptive schemas are further reinforced.

The goal of CBT is to reduce symptoms, improve functioning, and remission of the disorder through changing maladaptive cognition, processing strategies, and structure. Clients are assisted in testing and challenging the validity of their maladaptive cognition and modifying their maladaptive behaviour.

CBT uses active techniques such as exposure, cognitive restructuring, and role play. The beginning stage of CBT is working on the automatic thought, aiming to make the hidden thoughts obvious. Then evaluate and refute the distorted core belief. The CBT approach is more directive through providing psychoeducation and homework assignments between sessions. The length of therapy is shorter compared with others, like psychodynamic therapy.

CBT treatments are reflective: psychoeducation (ABC model), homework, Socratic questioning, thought log, unhelpful thinking habit, cost and benefit analysis, cognitive continuum, reframe of competence belief chart, behavioural experiment, put on/put off chart, pie technique. (Beck, 2021)

The third wave of CBT (DBT, ACT, and Schema Therapy) shifts focus to the experience of troubling thoughts and emotions instead of simply changing the thoughts.

Reference:
Beck, J. S. (2021). Cognitive Behavior Therapy : Basics and Beyond (Third edition. ed.). The Guilford Press.