CLASSIC

ARTICLE

Aaron
therapy.

Becks

classic

In particular,

article

Beck defines

classic behavior
therapy.
procedural
(or technical)
those

ofbehavior
mainly

behavioral

approach.

ences

such

and to standard

In 1970,

the notion

beliefs,
behavior

article
efforts

therapy-an

in Becks work.
Beck identifies

therapy

therapy

and

which

of the contrasts

of dealing

with

or visual

fantasies

therapists.

This

a number

emphasis

that

of dimensions

them

to

psychotherapy.

therapists,

most

to
and

contrasts

with

subjective

experi-

was unacceptable
is no longer

the

to
case

in

of a heavier
the efficacy

evolved

eventually

shared

in 1970

are

the reader can see the beginnings

to define the theory and to determine

empirical

cognitive

conceptual,

psychoanalytic

Therefore,

the 1990s. In Becks

reliance
on empirical

of

of cognitive

ofbehavior

psychologists.

stimulus-response

of cognitive

of cognitive

for an audience

as loss, cognitions,

the classic

expositions

the relationship

aspects

iswritten

comprised

of the first

Beck also lays out the philosophical,

therapy

The article

is one

by behavior

more

fully

therapy

and

cognitive
therapy.
For example,
in both
modes the therapeutic
interview
is
rather structured
and the therapist
is more active than in standard
psychodynamic psychotherapy.
In both behavior
and cognitive
therapy,
the therapist
coaches

the patient

how

responses

or behaviors.

are circumscribed;

remediation.

both

Neither

The

aim at overt

relies

heavily

goals

of

symptom

on

childhood

primary foci of treatment.

Recent
by cognitive
therapists
(in the late 1980s and early 1990s) suggests
that
cognitive
therapy takes as one of its objectives
the further
explication
of
dysfunctional
attitudes
develop,
the process
often uncovers,
albeit secondsources
in early experiences
that provide the basis for these tightly held

recollections

arily,

to useful

regard

approaches

or behavioral

remission

work
when

with

therapeutic

both

or early

family

relationships

as

beliefs or schemata.
In addition,
both behavior
and cognitive
therapy,
compared with psychoanalytic
therapy,
are more likely to take patient
self-report
at face value.

Neither

aim at unlearning
origin

of these
Beck

tive)

thinking

the

or logic,

in the treatment

this

well-explicated
is the
and

notion

anxiety

fantasies

that

does

notes.

as Beck

not necessarily

of a cognitive

cognitions,

3) correcting

require

therapist

distortions

Finally,

both

insight

into

the

arbitrary

inference,

large

steps:

1)

Beck

cognitive

lays out
model

that

different

differ

from

For

think about the notion

of
a high frequency
of thinking
of deprivation
or self-blame.
The article ends with
therapeutic

change

hyperactive

cognitive

basis

steps

for

has

danger,

personal

whereas

a brief

overview

is accomplished.

The

organization.

Because

2 #{149}
NUMBER

issues

of the
basic

of this

4 #{149}
FALL

such

and

1993

pictorial
frequently

patients

that form

is the

hyperactivity,

as depression

most

assumptions

change

become

in this model

depressed

about

example

since

patients

in

magnifi-

cognitions

anxious

objec-

errors

by case

Important
disorders

and daydreaming

VOLUME

what

in the verbal

example,

(key

the three

of psychiatric

another

predominate.

deficiencies

of psychopathology.

forms
one

the

more

overgeneralization,

He illustrates
with anxiety.

of a patient

three

(or becoming

and

deficiency).

article,

into

2) distancing

cognitive

including

and cognitive
In

efforts

idiosyncratic

and

cation,

which

attitudes.

breaks

recognizing

abstractions,

high-level

makes

attitudes,

have

a theme

about

how

quieting
of a
psychiatric

343

BECK

patients

inappropriately

apply

everyday stimuli, thereby

are not viewed as stressful
specific

result

empathy

sessions

are viewed

and

and

reality-test

ongoing

desensitization,
kinds

general

therapeutic

of the
that

mood.

are

This

subsequently

effect

patient.

The

process

may be a
result

more

of

experience,

connected

to the

automatically

become

that

therapeutic

to identify,

causally

of

stresses

be an important

for the patient

or cognitions

to a variety

recurrent
quieting

or it may

as an opportunity

and patients

involves

objective

about

these

or fantasies.

of thoughts

Thus,

The

acceptance

or anxious

schemata

into ongoing,

instructions,

thoughts

depressed

hypervalent

them

by others.

of particular

therapist

irrational,

converting

construing

Beck is applying
the
it as being
effective

behavioral
derstanding

mechanism.
The
of the ideational

behavioral
through

concept
of desensitization
a cognitive
rather
than

but is
simply a

patients
transfer
of this new, differentiated
system to everyday
life is thought
to result

uneither

from simple
encountered,

rehearsal
or desensitization.
When previously
upsetting
events are
the patient,
now desensitized
and more objective,
can logically
the real, inherent
dangers
and difficulties
in these day-to-day previously

assess

frightening

or depressing

Beck

concludes

tive therapy
behavior

is sufficiently
therapy

limited

circumstances.

with

range

observable
treatment
of psychiatric

to encompass

Since

and

conditions

with

the theoretical

beyond

article

what

those

been

a cognitive

in

approach.

cognitive

particular

therapeutic

conditioning

model

a rather
that

are

a plethora

addressing

Beck

approach

of classic

time
events

1970,

published

of cogni-

notions

was at that

appeared

have

the

behavioral

framework

the basic

phenomena-namely,

techniques

era by indicating
that
for identifying
and developing
defined

them
this

to this
narrowly

both

clinical

others.

manuals

that

broad
to expand

and

of critical
by

the notion

provides

of

variety

a prelude

provides

the framework

strategies

that the rather

of the

time

did not

easily

It denotes

the

support.
In so doing,

differentiation
behavioral

model

substantial
and

this paper
of Becks
of

only

behaviors

the

period;

the

Beck

it also

therapists

foreshadows

issue

stimulus-response

what

and therapeutic
Of interest,
were

psychotherapy

by Beck

as well,

is a brief

at this early

particularly

on

become

has

techniques

of efficacy-even

themselves

of

value.

the classic

decades.

the

effectiveness

historic

from

theory

subsequent

discusses

the behavior

measuring

model

of cognitive

over

in which

when

the

elaboration

his followers

section

is of substantial

cognitive

date,

interested

symptoms

in

or particular

to be treated.

Itis also notable

theoretical

that this article

abstractions-a

theorists

and

therapists

quence

of such

efforts

trend

over
is that

is relatively
that

the

23 years

many

cognitive

and complex

free fromjargon

has continued
since

in the work
its

therapists

publication.

of cognitive
The

use brief

conse-

explanations

to patients of the anticipated

therapeutic
process,
as well as of the key concepts
in the understanding
of their psychiatric
symptomatology.
In noting
that
cognitive

therapy

understood
lution

has

by most
launched

and accessible

it with
to patients.

JOURNAL

limited

educated

set of objectives
lay people,

certain

features

Demystifying

OF PSWHOTHERAPY

and in using

proponents
that

made

cognitive

it particularly

psychotherapy

PRACTICE

language

of the
and

revo-

acceptable

bringing

AND RESEARCH

that is

an em-

344

COGNITIVE

pirical

focus

to these

efforts

has sustained,

and

indeed

expanded,

the interests

of practitioners
from a variety of disciplines
in the development
these techniques,
as well as encouraging
patients
to pursue
treatment
than perhaps
was the case in the late 1960s and early

and
more
1970s.

A.Jomi

Rum,

Rush, M.D., is Betty Jo Hay Chair in Mental Health and

of Texas Southwestern
Medical Center, Dallas, Texas.
Cognitive
Therapy Nature and Relation to Behavior Therapy,

A.John

Director,

Mental

THERAPY

Health

use of
timely

M.D.

Clinical

Research

Center,

University

byAaron
Therapy (1970; 1:184-200).
Copyright
1970 by the Association
Reprinted
by permission
of the publisher and the author.
Introduction
copyright
1993 American
Psychiatric
Press, Inc.
in &havior

VOLUME

2 #{149}
NUMBER

4 #{149}
FALL

1993

T. Beck, M.D., was originally

Advancement
of Behavior

for

published
Therapy.

345

BECK

Cognitive
Nature

Therapy

and Relation
T.

AARON

Recent
have,

in behavior

for the most

of cognitive

and

alleviation

self-reports
able

part,

around

by other

a wealth

peated

correlations

the

these

of testable

are not verifiintrospective

data

hypotheses.

of measures

Re-

of inferred

con-

an individuals
belief systems, expectancies,
and
assumptions
exert a strong influence
on his
state of well-being,
as well as on his directly obbehavior.

Applying

a cognitive

model,

the clinician
may usefully
construe
neurotic
havior in terms of the patients
idiosyncratic
cepts

of himself

inanimate

of his animate

environment.

The

may be grossly

systems

may

and

simultaneously

same

event

individuals

credence

even

knowledge
Cognitive
theory,

he
real-

of the
in be-

therapy,

based

to modify

maladaptive

technique

individuals

he may concomitantly

consists

specific

The

of delineating

misconceptions,

basic

ences

more

is enabled
realistically.

to formulate
Clinical

JOURNAL

signs

behavior

idi-

the therapeutic
structured
and

cog-

of psychotherapy

have
been

recent
entry
and behavior
of becoming

atic

in both

and

into

therinstitu-

therapy

have
systems

interview
the therapist

in other
psychotherapies.
nary
diagnostic
interviews

the

in

has

been

in a large number
of articles
and
cognitive
therapy
has received
recognition.
Despite
the fact that

tems
mon.

distortions,

highly

detailed

on learntherapy
is
the two sys-

much

in com-

of psychotherapy
is more
overtly
more active than
After the preimiin which a systemdescription

of the

patients
problems
is obtained,
both the cognitive
and the behavior
therapists
formulate

his experiexperience,

show

ac-

First,

the individuals

substanappear

that
have

behavior
therapy
is based
primarily
ing theory
whereas
cognitive
rooted
more
in cognitive
theory,

and maladaptive
assumptions,
and of testing
their validity and reasonableness.
By loosening
the grip of his perseverative,
distorted
ideation,
the patient

publicized
monographs,
much
less

on cognitive

ideation.

already

tionalized.
Although

fear is unrealistic.

this

is designed

osyncratic,
nitive

though

that

that

symptom

the subject
of a rapidly
increasing
number
of
clinical
and experimental
studies.
Cognitive
therapy
[Ellis (1957)
used
the label
rational
therapy, which
he later
changed
to rational-

apy

liefs may explain,

for example,
why an individual may react with fear to an innocuous
situation

to

wo systems
of psychotherapy
recently
gained
prominence

con-

to both

This inconsistency

emotive
therapy], the more
the field of psychotherapy,

belief
i.e.,

conceptualizations

or object.

indicate

leads

[Editors
note: In thefollowingtext,
tive footnotes
to the original
article
square brackets.]

be-

and

contradictory:
attach

istic and unrealistic

studies,

restructuring

relief.

structs with observable

behaviors
have yielded
consistent
findings
in the predicted
direction.
Systematic
study of self-reports
suggests that

servable

experimental

cognitive

Although

experiences

observers,

provide

such

in the production

of symptomatology.
of private

well as some

modification

detoured

processes

Therapy

M.D.

BECK,

innovations

role

to Behavior

the
as

OF PSstHOThERAPY

tive

patients
or

PRACTICE

presenting

behavioral

AND RESEARCH

symptoms
terms,

respectively)

(in cogniand

346

COGNITIVE

design
ticular

specific

sets of operations

problem
areas.
After mapping
out

peutic

work,

the

patient

and

behaviors

the

the

therapist

regarding

areas

the

for

explicitly

the

that

for

kinds

are useful

par-

coaches
this

sensitization)
and recognition
therapy).

The

circumscribed,
therapies
(Frank,

to facilitate
his
of his cognitions

goals
in

of

these

contrast
goals

whose

therapists
the overt

both

awareness
(cognitive

therapies

are

to the evocative
are
open
ended

phobia,
However,

symptom.

what.

The
the

and

cognitive

focuses

on

avoidance

therapeutic
formation

responses.

systems
in terms

Both

conceptualize
of constructs

accessible
either
to introspection,

to behavioral
in contrast

sis, which
views
guised
derivatives

most
symptoms
of unconscious

Third,

in further

therapy,

behavior
ollections

in

the

neither

symptom
that
are
or

as the
conflicts.

dis-

therapy

substantially
of the

is accessible

tion.
lytic

Furthermore,
formulations,

nor

on recpatients

assumption
behavior

the
tion

patient
patterns

apy

One
has

designed

experiments

its basic

assumptions.

cent vintage,
porting
the
therapy
have
Travers,

two

systems

is

digms
exclude
lytic assumptions
fixations,
of defense.
apists

may

that

their

the unconscious,
The behavior
devise

theoretical

many
traditional
such as infantile

their

cogis that

Krippner,
Tuthill,

Schwab,

1968).

The

reac-

few controlled-outcome
(Ellis,
1957;

There
techniques

are

obvious

used

in behavior

therapy.

with

and

are the

tems

the

studies of
Trexier

of

FALL

periods
on

target

For

1993

example,

in

other

the
cog-

hand,

thoughts.
pictorial

between
are
the

and

spontaneously
verbal

work.
the

often

cognitive

These
or

for therapeutic

psychotherapy

of

of relaxation.
the

patients
in

and

evidence

therapist
induces
of pictorial
im-

reported

distinctions

however.

4.

on

1968;

desensitization,

behavior
sequence

whether

technical

of
re-

therapy

In systematic
the

cognitions,
form,

certain
of more

differences

therapist,

more

therwell-

Diggory,
and
1969; Velten,

Karst,
1969) provide
preliminary
the effectiveness
of this therapy.

nitive

in-

Jones,

therapy

experienced

2 #{149}
NUMBER

1969;

1964;
Loeb,
Beck,
1967; Rimm
and Litvak,

para-

strategies

support

Although

relies

psychoanasexuality,

VOLUME

of both
therapy

that

these

and mechanisms
and cognitive
thertherapeutic

tech-

several
systematic
studies
supunderpinnings
of cognitive
also been
reported
(Carlson,

and

alternating

between

research

of the major assets of behavior

been
the large
number
of

cognitive

in common

introspec-

has acquired
maladaptive
that can be unlearnedwithout

ages

point

available

and

The

in

psychotherapy.

A fourth

patients

unlike
many psychoanathe inferences
can be

therapy

furthermore,
psychoanalytic

than

to the

nitive

for example,
a predetermined

less prominent

by

of his maladaptive
this concept
is not
psychoanalytic
sense

tested
by currently
niques.]
Finally,
a major

childhood
experiences
and early family
relationships.
The emphasis
on correlating
present problems
with
developmental
events,
is much

provided

formulations.
[Alnot be immediately

content
patterns,
in the

and

cognitive

to psychoana-

cognitive

therapy
draws
or reconstructions

psycho-

observation
to psychoanaly-

contrast

data

of psychoanalytic
the patient
may

aware
of the
attitudes
and
unconscious

more

involved

of introspective

the absolute
requirement
that he obtain
sight into the origin
of the symptom.

or hysterical
differs
some-

therapist
content

at
such

viz., the irrational

inferences
and
The
behavior
therapist
focuses
the overt
behavior,
e.g., the mal-

premises.

adaptive

behavior

techniques
problem,

obsession,
the target

ideational

symptom,
more

the cognitive

aim their therapeutic

symptom
or behavior

as a particular

lytic

to
de-

1961).

Second,

on

or

acteristic
though

partic-

ular form
of therapy.
Detailed
instructions
are presented
to the patient,
for example,
stimulate
pictorial
fantasies
(systematic

basis

the patient;
however,
they generally
take the
patients
self-reports
at face value and do not
make the kind of high-level
abstractions
char-

thera-

of responses

with

on the

THERAPY

The

two
blurred,
therapist

sys-

347

BECK

uses

induced

(Beck,
pist uses
stoppage
The

and

cognitive

the

to

1970),

clarify
the

problems

behavior

verbal
techniques
such
(Wolpe
and Lazarus,
most striking
theoretical

between
in

images

1967;

and

concepts

tion

of maladaptive

apy.

Wolpe,

for

example,

the

tion

of conceptual
or

systems,
of

i.e.,

thinking.

discussed
later, many behavior
plicitly
or explicitly
recognize
of cognitive

factors

do not expand
1968; Lazarus,

modifica-

TECHNIQUES

COGNITIVE

therapy
sense,

you

mode

of action

patterns
nitive

of thinking
therapy.
This

therapeutic
the cognitive
directly
individuals
world,

These

cognitions

cause

they
a mild

tern

In the

ents

that
indirectly affect
as well as those
that

affect
them
(Frank,
1961).
An
distorted
views of himself
and his
example,

insight

may

into

the

be

the

patients

the

patient

of his misinterpretations

psychotherapy),

through

However,

cognitive

fined
more
focused
on
pictorial)

narrowly
a patients
and

and

attitudes

This

section

niques

on

therapy

premises,

underlying
will

of cognitive

assumptions,

these

describe

the

cognitions.
specific

may

tech-

OF PSHOTHERAPY

much

aware

and

can

In such

cases,

of these

idio-

easily

paranoid

patients

describe

patient,

with

for

thoughts
abused,

reporting

a sequence
(external
affect.

outline

the

and

then

friend

in-

relevant
or discrimi-

unpleasant
consisting

stimulus)
For

af

of a spe-

leading

instance,

sequence

of (a)

(b) experiencing

sadness.
Oftentimes,
ble to the patient.

the
seeing

to an
patient
an old

a feeling

of

the sadness
is inexplicaAnother
person
(a) hears

about
somebody
having
been
automobile
accident
and
(b)
tion
there

therapy.

JOURNAL

to attend

However,

or

of

field.

in ignoring
them.]
It is therefore
to motivate
and to train
the patient
to these thoughts.

necessary

event

as a set of operations
cognitions
(verbal

the

difficulty

unpleasant

de-

dis-

generally
at the periphery
of awareness.
[In
obsessional
neurosis,
of course,
the idiosyncratic
ideas
are central
and the patient
has

cific

be

the
center

persecuted,

(as in dynamic

may

patient,

nated
against
by other
people.
In the mild or
moderate
neurotic,
the distorted
ideas
are

describe

tion).

or

state.
in the

acutely

Many

ence between
the concept
of the self and the
ideal
(as in Rogerian
therapy),
and through
increasingly
sharp
recognition
of the unreality of fears
(as in systematic
desensitiza-

a pat-

individual

disturbed

is bombarded

fects

congru-

misin-

fall into

is frequently
is very

The

be-

ranging

a complete
they

to a given

thoughts

anteced-

greater

to

phenomenal

to his being

corrected

historical

acutely

to the

idiosyncratic

psychopathological

ideation

to

yourself.

appraisal,

because

is peculiar

to a particular
torted

of faulty

distortion

them
tell

termed

a faulty

and

syncratic

modification

are

reflect

that

they

can be regarded
as cogdefinition
embraces
all

operations
patterns,

for

through

is the

things

refers

statements

explains

terpretation,

in twoways:
whose
major

(1962)

that

them.

maybe
defined
any technique

Ellis

and

as

stance,
Cognitive
In a broad

1963).

as internalized

patient

from

THERAPY

techniques
to recognize
or automatic

or self-statements,

in

OF

cognitive

the patient
cognitions

(Beck,

be

(Davison,

main

cognitions

As will

although

in detail

these

changes

therapists
imthe importance

in therapy,

on these
1968).

such as
inhibi-

the

of the

consists
of training
his idiosyncratic
thoughts

ther-

behavioral

postulate

modes

lies

through

utilizes

One

dissolu-

explanations
or reciprocal

cognitivists

attitudes

the

responses

or neurophysiological
counterconditioning
tion;

therapy

to explain

Idiosyncratic
Cognitions

as thought1966).
difference

behavior

used

Recognizing

thera-

he

between

cannot

these

is a missing
link
In these
instances

leading
to an unpleasant
to discern
an intervening

PRACTICE

AND RESEARCH

make

two

killed
in an
feels
anxiety.
a direct
connec-

phenomena;

in the sequence.
of a particular

i.e.,
event

it is possible
variable,
namely,

affect,

348

COGNITIVE

cognition,

which

the

external

ing.

Seeing

tions

such

He

wont

forms

stimulus
an

old

accept
then

stimulates

is the

victim

image

as he

used

to.

the

leads

fact

that

when

the

was

obviously

your

the

[Ellis
was

next

time

by

or else

patient

thoughts

you

was

go
see

in-

re-

he had reche had not no-

ticed
previously;
namely,
that each time he
saw the dog he had a thought
such as Its
going
to bite me.
By being
able to detect
the intervening
cognitions,
stand
why

the
he

indiscriminately
gerous.
when

patient
was
felt anxious,
regarded

He stated,
I saw a small

able

to undernamely,
he

every

I even
poodle.

dog

as dan-

how ridiculous
it was to think
that a poodle
could
hurt
me.
He also recognized
that
he saw a big dog on a leash,

of the

most

deleterious

he thought

consequences:

The

dog will jump

up and bite out one of my
eyes, or It will jump
up and bite myjugular vein and kill me. Within
2 or 3 weeks,
the
patient
was able
pletely
his long-standing
by

recognizing

posed

to a dog.
Another
example

lege
anxiety
trained

student
in

his

who
a social

to examine

to

overcome
dog phobia

cognitions

were

comsimply
when

ex-

anxiety

experienced
situation.
and write

by a col-

attack

his

anxiety

2 #{149}
NUMBER

re-

training

he

reported

pushing

me

a pushover,
of me.

Immediately

thoughts,

individual

He

Hes
he

would

towards
also realized

whom

that

instead

of, or in addition

to, the

(Beck,
spurts

1970).
A woman
of anxiety
when

who exriding

alone,
found
that her
images
of her having

being

his

by visual

idiosyncratic
or verbal)

may

contain

into

a very

an

as though

seem

to

through

as

reasoning

to

may

ble to the

4 #{149}
FALL

are

automatic;
reflex

them

patient.

1993

off.
to appear

into
experi-

though

Furthermore,
completely

they

i.e.,

experience
even

even
are
rather

quality.

continually

tend

compressed

or paranoid

cognitions,

ward

idea

by

at-

(whether
and often

or deliberation.

or depressed

iosyncratic

at night

of time,

an involuntary

to have

anxious

if

on
that

of being

cognitions

they

arise

dying

dormitory

cognitions
very rapid

period

These

enced

and

fantasies

are

spells of
a heart

discovered

elaborate

short

second.

seem

helpless
student

at leaving

tacked.
The
pictorial

split

left

A college

triggered

cognitions

VOLUME

the

he

angry

some

Hes

Im

directed.

and
street.

try

his cogni-

as

whom

a bridge
was able to recognize
that the
was preceded
by a pictorial
image
of
breaking
through
the guard
rail and
off the bridge.
Another
woman,
with a

the

inexplicable
down

at

his

cognitions,

these

of walldng
followed

After

being

After

thoughts

form

across
anxiety
her car
falling
fear

for

people.
his

he was chron-

was no realistic
basis for his appraising
in this negative
way.
Sometimes,
the cognition
may take a pic-

example,

was provided

these

verbal
form
perienced

was

got that thought

Then
I realized

when

they
there
people

that

account

experiencing
angry

he

thoughts

everybody

He thinks
to take advantage

torial

a dog-any

not

such

feel

These

complained

recognizing

through

next interview,
the patient
during
numerous
encounters

with dogs between

appointments,
ognized
a phenomenon
that

to

after

even

or caged
The

what

puzzled

a misfit.

at practically

could

sponse

situations

as, They
think I
will want to talk to

by anxiety.

angry

trying

(1962)

just

A patient

around,

treated

anxiety

chained

harmless.

At the
that

He

followed

but

in social
such

or Nobody

Im

having

he experienced

experienced

was

Notice

mind

dog.
ported

he

dog

structed:

case.]

were

at
illustrated

he saw a dog.

a similar

described

that

or

saw,

The

A patient

complained

whenever

the

accident.

that

thoughts

me,

ically

himself

can be further

have

The

stimulates

the patient

of examples.

writer

anxiety

The

anxiety.

to the

paradigm

by a number
by the

in which

he reported

would

look pathetic,

or

sadness.

accident

of an automobile

then
This

cognitimes,

generates

image

feel-

old

me

tions,

between

be like

of an automobile

a pictorial

bridge

the subjective

friend

as It wont

cognition
report

the

and

THERAPY

than

They

also

A severely

person,

for
the

he

idmay

these

plausi-

349

BECK

Distancing

of fallacious

thinking

involved

in his

cogni-

tive responses.
Even

after

a patient

tify his idiosyncratic

culty
in examining
The thought
often
hence

as the

ulus.

Distancing

the

thoughts
of critical

learned

have

refers

to

the

stim-

process

towards
these
cognitions.
with a neurosis
tends

validity

of

his

a distinction
reality,

and

external

fact.
that

Patients
are often
surprised
they have been
equating

with

reality

and

between

that

of truth

they

value

have

to their

therapeutic

dictum

regularity

benefited

from

who

had

thought,

I probably

of personalization

depressed

thoughts
reality.

are

not

the

patient

thoughts,
he
reality
testing:
logic

had

woman,

few

minutes

has

deliberately

by the

and

is ready
applying

equivalent

to

The

writer

has

therapist,

thought,

left in order

to avoid

tients
certain

show faulty
circumscribed

these
ability

particular
to make

his

Overgeneralization

to make

global,

of a single incident.
that was described

man

with

the

exaggerate
particular
dying,

for

dog

this
that

pain
In

a reduced
and tend
judgments.

JOURNAL

the

kind

OF PSWHOTHERAPY

refers

instance,

the

generalized

might
attack
is a patient

to the

him
who

when

he

propensity

interpreted
or pain
disease

kind

to

every

un-

in his body as a
such
as cancer,
hemorrhage.
castrophizing

Ellis
to

of reaction.

As noted
above,
patient
to label the

it is often
particular

helpful
for the
aberration
in-

volved
in his maladaptive
cognition.
the patient
has firmly established
that

Once
a par-

ticular

dog

type

of cognition,

going
to bite
me,
equipped
to correct

less poodle

to specify

who

attack,
or cerebral
applied
the label

very

patient

of

on

This may take the

in the case of the

phobia,

sensation
some
fatal

quent

for the

process

the meaning
or significance
of a
event.
A person
with
a fear
of

Part of the task of cognitive

therapy
is to help
the patient
to recognize
faulty
thinking
and
to make
appropriate
corrections.
It is often
useful

to the

generalization

basis
form

heart
(1962)

or disordered
thinking
areas of experience.

undifferentiated

refers

an unjustified

pleasant
sign of

Cognitive
and Deficiencies

sectors,
they have
fine discriminations

He
seeing

external

explana-

indicated

for a

waiting

thinks,
I never succeed
at anything
has a single isolated
failure.

that

for the later stages

of
rules of evidence
and

already

was kept

have

tions.
Correcting
Distortions

got the

disease.

from a particular
dog that
to all dogs. Another
example

to objectify

alternative

attack,

heart

seem
with

patients
reminder

considering

me.

con-

may
found

repeated

is able

a heart
have

who

Magnzflcation

Once

(or self-reference).

a high

communicated

that

the

of

is lack-

a woman

to the patient
is as follows:
Simply
because
he
thinks something
does not necessarily
mean

surprising

process

to

and

distorted

that it is true. While

such a dictum
to be a platitude,
the writer
has

evidence

ing or is actually
contrary
to the conclusion.
This type of deviant
thinking
usually
takes the

making
The

to the

when

who saw a frown

on the
thought,
He is disgusted
girl of 21, reading
about

to discover
an inference
attached

refers

depressed
patient,
face of a passerby,
with me. A phobic

thought

hypothesis

inference

a conclusion

form

idiosyncratic

between

drawing

of

without
subjecting
them to any kind
evaluation,
it is essential
to train

to make

Arbitrary

diffi-

objectively.
kind of sa-

of an external

him

degree
cepts.

to iden-

he may

these
ideas
has the same

perception

gaining
objectivity
Since the individual
accept

has

ideas,

rational
poodle

PRAC11CE

occasions.

For

response
would
be,
and

such

example,

to the
Actually,

there

AND RESEARCH

as That

is invalid,
this cognition

is only

he
his

stimulus
it isjust
a remote

is

will be
on subseplanned,
of a toy
a harmchance

350

COGNITIVE

that

it would

could

not

bite

really

me.

And

injure

even

if it did,

it

me.

ing-he

imaged

driver

car

consisted

Cognitive
for an
Patients

deficiency

important
with this

grate,

or do

from

experience.

refers

aspect
defect

not

of a life situation.
ignore,
fail to inte-

utilize

information

Such

tients

in

chopaths,

as

those

who

well

as

behavior
sabotages
These
individuals
faction

or expose

he
This

those

and
The

two

whose
personal
long-range

themselves

to later

psyovert
goals.
satis-

pain

or

satisfactions.
such as alcosexual deviapatients

characteristics:

First,

about

trating
fortify
rate

only

the

consequences

this

on the present
modus operandi

system

of self-deceptions,

do any harm
to cut loose,
irrespective
of how often

they

by concen-

activity.
through

They may
an elabo-

such

as It cant

now. Secondly,
the individual
is

burned
as a result
of his maladaptive
actions,
he does not seem
to integrate
knowledge
of the cause-and-effect
relationships
into

his behavior.
Therapy
of such

cases

the

patient

of the

soon

as his

eration

into

to think
self-defeating

of the

loss

between

A patient,
for instance,
ated his car beyond

consists

of training

consequences

wish

long-range

the interval

arises.
must

impulse

as
Consid-

be forced

and

action.

who continually
operthe speed
limit or drove

through
stoplights
was surprised
each
time
he was stopped
by a traffic
officer.
On interview, it was discovered
that the patient
was
generally

absorbed

engaged

in a race.
to get

in

a fantasy

Therapy
him

odometer-but
without
success.
proach
consisted
of inducing
speeding,

getting

ishment.

At first,

caught,
the

culty
in visualizing
though,
in general,

racing-

and

patient

the

The next
fantasies

apof

receiving
had

getting
he could

at first

to watch

pun-

great

caught
fantasize

diffieven
almost

everything.
However,
after several
sessions
induced
fantasies,
he was able to incorporate
a negative

outcome

into

his

fantasy.

quently,
he stopped
daydreaming
ing
and
was
able
to observe

of

Subse-

while

drivtraffic

report,
several
at modifying

coganxi-

regulations.
nitive

In the following
case
techniques
directed

ety proneness

are

illustrated.

Case

Report

show

when

yield to their wishes

to engage
in self-defeating, dangerous,
or antisocial
activities,
they
are oblivious
of the probable
consequences
of their
actions.
At these
times,
they avoid
thinking

as a famous

of trying

gambling.

deficient-anticipation

major

e.g.,

important
sacrifice

compulsion

in

realizes,
in
class of pa-

act out,

danger
in favor
of immediate
This category
includes
problems
holism,
obesity,
drug addiction,
tion,

conse-

he has a defect
he consistently

behavior
which
is self-defeating.

includes

derived

a patient,

quently,
behaves
as though
his system
of expectations:
engages
retrospect,

to the disregard

himself

THERAPY

while

VOLUME

driv-

2 #{149}
NUMBER

[This patient was treated

in collaboration
with
Dr. William Dyson.]
Mrs. G. was an attractive
27-year-old
mother
of three children.
When first seen by
the writer, she complained
of periods
of anxiety
lasting
up to 6 or 7 hours a day and recurring
repeatedly
over a 4-year period.
She had consulted
her family physician,
who had prescribed
a variety of sedatives,
including
Thorazine,
without
any apparent
improvement.
In an analysis of the cause-and-effect
sequence
of her anxiety,
the following
facts were
elicited. The first anxiety episode
occurred
about
2 weeks after she had had a miscarriage.
At that time she was bending
over to bathe her
1-year-old son, and she suddenly
began to feel
faint. Following this episode, she had her first
anxiety attack which lasted several hours. The
patient could not find any explanation
for her
anxiety. However,
when the writer asked
whether
she had had any thought
at the time
she felt dizzy, she recalled
having had the
thought,
Suppose
I should pass out and injure
the baby. It seemed
plausible
that her dizziness,
which was probably
the result of a postpartum
anemia,
led to the fear she might faint and drop
the baby. This fear then produced
anxiety,
which she interpreted
as a sign that she was
going to pieces.

4 #{149}
FALL

1993

351

BECK

Until the time of her miscarriage,

the patient had been reasonably
carefree
and had not
experienced
any episodes
of anxiety.
However,
after her miscarriage,
she periodically
had the
thought,
Bad things can happen
to me. Subsequently,
when she heard of somebodys
becoming sick, she often would have the thought,
This
can happen
to me, and she would begin
to feel anxious.
The patient
was instructed
to try to pinpoint any thoughts
that preceded
further
episodes of anxiety.
At the next interview,
she
reported
the following
events:
1. One evening,
she heard that the husband of one of her friends was sick with a severe
pulmonary
infection.
She then had an anxiety attack lasting several
hours. In accordance
with
the instructions,
she tried to recall the preceding cognition,
which was, Tom could get sick
like that and maybe die.
2. She had considerable
anxiety just before starting
a trip to her sisters house. She focused on her thoughts
and realized
she had the
repetitive
thought
that she might get sick on the
trip. She had had a serious episode
of gastroenteritis during a previous
trip to her sisters
house. She evidently
believed
that such a sickness could happen
to her again.
3. On another
occasion,
she was feeling
uneasy
and objects seemed
somewhat
unreal to
her. She then had the thought
that she might
be losing
her mind
and
enced
an anxiety
attack.

immediately

experi-

4. One of her friends was committed

to a
state hospital
because
of a psychiatric
illness.
The patient
had the thought,
This could happen to me. I could lose my mind. When questioned about why she was afraid of losing her
mind, she stated that she was afraid that if she
went crazy, she would do something
that would
harm
either her children
or herself.
It was evident
that the patients
crucial fear
was the anticipation
of loss of control,
whether
by fainting
or by becoming
psychotic.
The patient was reassured
that there were no signs that
she was going psychotic.
She was also provided
with an explanation
of the arousal of her anxiety and of her secondary
elaboration
of the
meaning
of these attacks.
The major therapeutic
thrust in this case
was coaching
the patient
to recall and reflect on
the thoughts
that preceded
her anxiety attacks.
The realization
that these attacks were initiated

JOURNAL

OF PSLtHOTHERAPY

by a cognition
rather than by some vague mysterious force convinced
her she was neither
totally
vulnerable
nor unable to control
her reactions.
Furthermore,
by learning
to pinpoint
the anxiety-reducing
thoughts,
she was able to gain
some detachment
and to subject them to reality
testing. Consequently,
she was able to nullify the
effects of those thoughts.
During
the next few
weeks, her anxiety attacks became
less frequent
and less intense and, by the end of 4 weeks, they
disappeared
completely.
DIFFERENCES

IN

CONCEPTUAL

FRAMEWORK

BETWEEN

BEHAVIOR

THERAPY

AND

COGNITIVE

THERAPY

Behavior

therapists

conceptualize

of behavior
and procedures
ration
within
a theoretical
rowed
from
the
field
learning

theory

concepts

of classical

ing.

Since

these

from experiments
the observable
fact,

and

most

especially
and

concepts
with
behavior

by means

operant
are

of

condition-

derived

animals,
of the

of the published

ior therapy
pothesized

disorders

for their amelioframework

borof psychological

mainly

they focus
organism.

writings

on behav-

tend
to eschew
inferred
psychological
states which

be directly
observed
and measured.
and principles
based on immediate
in the organisms
environment

on
In

or hycannot

Concepts
referents
have advan-

tages of parsimony,
testability,
quantiflability,
and reliability.
However,
this framework
does
not readily
accommodate
notions
of internal
psychological

states

such

as

thoughts,

attitudes,
and the like, which
we commonly
use to understand
ourselves
and other
people. Cognitive
therapists
are more
willing
to
use these
inferred
psychological
states,
collectively
called
cognitions,
as clinical
data.
Consequently,
large
and useful
sets
ables are directly
taken
into account.
In recent
of behavior
importance
cognitive
(Brady,

PRACTICE

years,

several

therapy
have
of mediational
processes
1967; Davison,

AND RESEARCH

in

writers

of vari-

in the

acknowledged
constructs

area
the
or

behavior
therapy
1968;
Folkins,
Law-

352

son,
Opton,
and
1968;
Leitenberg,
Oliveau,
Murray

Lazarus,
Agras,

1969; London,
and Jacobson,

1961).

1968;
Lazarus,
Barlow,
and

than

a simple

Valine and Ray, 1967; Weitzman,

cognitive
formulations,
however,
most part been
brief.
Substantial

1967). Their
have for the
amplifica-

OF

tion

processes
is
for clinical

of the

Mischel,
Sloane,

nature
of cognitive
to account
adequately

more

of internal

complete

ogy

and

change.
nitive

view

the

events

mechanisms

ideas,
These

of

vide
the
materials

attitudes,
ideational

cognitive
with which

models.

Such

lead

to a

and

dreams,

concepts

with
form
are

cepts
radic

capable

far from
being
response
chain,
in its own right.
ally interacts

the

introspective
organization,

environment

to Freuds

appears

notion

mature

elements

may

(correspondSome
of the

be predominantly

appear
effects

Under
ordinary
idiosyncratic
con-

to exert
only
on the integrated
Peculiar

minimal
thinking

or irrational

cognitions

system are genand rejected

by

the higher

when

centers.

However,

is dislocated,
or paranoid
concepts
are

the cogni-

as in depresstates,
these
hyperactive.
In

the more
to become

to reality

and judgment.

the grip

The form
of psychiatric
disorder
lated to the content
of the predominant,

as depres-

sion.
By getting

inside

the

psychological

ma-

trix, as it were,
the cognitive
theorist
gains
glimpse
of considerable
activity.
Introspective
data

indicate

the

existence

of complex

orga-

nizations
of cognitive
structures
involved
in
the processes
of screening
external
stimuli,
interpreting
tively
and

recalling
plans

experiences,

storing

memories,
(Harvey,

and
Hunt

and

and
setting

selecgoals

Schroder,

VOLUME

spoof the

emanating
from the primitive
emily tested,
authenticated,

tend to supersede
tualizations
and

such

or

such circumstances,
the conceptual
systems
grind
out a powerful
stream
of depressing,
frightening,
or paranoid
thoughts.
As these
idiosyncratic
ideas become
hyperactive,
they

to a large

state

Pro-

composed

extent,
it may at other
times
be relatively
independent
of the environment,
for example, when
the patient
is daydreaming
or in
of an abnormal

to

of Primary
systems

structures
Process).

and unrealistic.
conditions,
these

tive organization
sion,
anxiety,
idiosyncratic

a mere
link in the stimulus
is a quasi-autonomous
system
Although
this system
gener-

with

organization

of more

individual.

1967).
Study
and analysis
of the
suggest
that the cognitive

and

of primitive
systems
consisting
crude
cognitive
structures
(cor-

and

syncratic
waking

of generating
hypotheses
amenable
to controlled
experiments
on psychiatric
patients
(Loeb
et al., 1967).
Also, introspective
data,
such
as dreams
and cognitions,
have
been
adapted
to systematic
investigation
(Beck,

data

more

stimulus

MODEL

cognitive

conceptual

the raw
concepts

also

between

much

verbal, whereas
others
may be predominantly
pictorial.
Many of the primitive
concepts
are idio-

daypro-

productions

theorist
he can

total

cess),

organiza-

are

PSYCHOPATHOLOGY

of refined
and elastic
ing to the Secondary

the cogpatients

cognitive
and

COGNITIVE

responding

behavioral
data,
the

to

The

that

active
conduit

be composed
of relatively

psychopathol-

By using introspective
theorist
has access

thoughts,
dreams.

can

of human

highly

phenomena
and for the effects
of therapeutic
intervention
(see Weitzman,
1967).
A greater
emphasis
on the individuals
descriptions

suggest

are

response.

necessary

1964;
1969;

Data

tions

1968;
1969;

and

Tiww&py

COGNITIVE

2 #{149}
NUMBER

testing

severating
Depressed
high

verbal
patients,

frequency

realistic
concepmore
refractory

cognitions
or
for example,

of themes

is reperfantasies.
report

of deprivation

or

of self-debasement
in their waking
thoughts,
daydreams,
and dreams.
Anxious
patients
are
dominated

by the concept

eralized
personal
danger.
are controlled
by patterns
tilled

abuse

4 #{149}
FALL

1993

or persecution.

of specific
Paranoid
relevant
The

or genpatients
to unjus-

phobic

pa-

353

BECK

dent
notion

has a disproportionate
of personal
danger

avoidable
situations,

situations.
(When
he experiences

the

way

same

The

as does

compulsive

or unrealistic
in specific
and
forced
anxiety

the

into these
in much

anxiety

patient

neurotic.)

is dominated

by

situation.
Whether
he is actually
in the phobic situation
or is simply
fantasizing
himself
in that
that
the

situation,

anxiety.

At times

doubts
or by fears of some danger
to himself
or others
and he seeks to put an end to the

that
fact

doubts

situation,

or fears

through

rituals.

CHANGE

How does
the cognitive
model
provide
an
explanation
for the therapeutic
effects
of
cognitive
or behavior
therapy
in states such
as depressions,
anxiety
reactions, or phobias?
First,

the

therapeutic

a quieting
down
tion
(Rachman,
may

be

the

empathy
and
khuff,
1967),
tions
(Wolpe
explicitly
and
may
ation

the

of either

stated

verbal

the

therapists

approval

1968).
produced

instructions

phobia

produces

acceptance
(Truax
and Carhis specific
relaxation
instrucand
Lazarus,
1966),
or his

Cauthen,
also be

ment
of
introduced

situation

of the hyperactive
organiza1968).
The quieting
down

result

(Wagner

The quieting
by automated

(Lang,

1969).

effects
relax-

In the treat-

phobias,
the quieting
effect
is
after the schemas
relevant
to the
have

been

imagery

Mathews

artificially

instruction.

(1968)

have

stimulated

As
pointed

by

Lader

out,

and

reducing

the level of arousal

below a certain
point
tends
to facilitate
habituation
sensitization).
Second,

the

an opportunity
and to reality

therapeutic

trated

systematic

mode

of

operation

by the treatment
desensitization.

affords

to experience
pictorial

dons
that are causally
connected
pressed
or anxious
affect.
This

critical
(or de-

session

for the patient

test verbal
or

cogni-

to his

de-

be

illus-

of a phobia
through
In this procedure,
the phobic
experiences

type

of anxiety

(but

in lesser

would

occur

if he actually

were

JOURNAL

same
sis

and

he may

patients

way that
relives

under

may

be so strong

even

scream

report

that

can experience
This process
the

situation
the same

degree)

that

in the phobic

OF PSICHOTHERAPY

a patient

with

(abreacts)

for help.

mount

event

reality-test
Since
the
up,

the

a combat

combat

is employed,

the patient

the

(via imagery)

his

is able

and,

patient

still

to regard

has

has been

reaction,

and

sec-

in status
allowed
to

Even when
flooding
(Stampfl
and Levis,

the fantasy

examine

neuro-

experience

his reactions
anxiety
is not

patient

event objectively.
plosive
technique
nity, when

fantasy

with the acpatient

may
in much
the

the problem
in graded
doses.
enables
him, first, to experience

unpleasant

ond,
to
nascendi

of the
phobic

their

hypnosis
or Amytal.
In systematic desensitization,

he

the
or im1968)

the opportucompleted,
to
soon

realizes

that he has been reacting

to a fantasy
and
to a real danger.
Another
way of viewing
the process
desensitization
to increase
between

not
of

is that the patient

is enabled
his objectivity,
i.e., to discriminate

a real

danger

as he proceeds

and

a fantasied

in a stepwise

danger

progression

up

the desensitization
hierarchy.
With
increasing objectivity,
he is less prone
to misread
the
situation
or to accept
his unrealistic conceptualization of a situation. His increased
objectivity is reflected
in a reduction
in his anxiety
arousal

may

the patient
reproduces
in his fantasies,
and

fantasy

degree

he believes
in
greater
is his

experiences
are almost
identical
tual situational
experiences.
The
live through the frightening
event

OF

THERAPEUTIC

the

to some

more
the

the patient
may lose cognizance
that
he is not actually
in the
Many

EXPLANATION

he believes

he is in danger.
The
reality
of the danger,

by the

(London,
nation

imaged

or

the

Patients
who are questioned
of an induced
fantasy

strue

the

threatening

and more
realistically
1970).
The operation
desensitization

PRACTICE

real

situation

1964).

AND

has

RESEARCH

situation

at the termigenerally
condifferently

than previously
(Beck,
of cognitive
factors
in
also

been

illustrated

in

354

COGNITIVE

case material
cited
by Brown
(1967)
Weitzman
(1967).
It could be argued
that the phobic
tient really knows
However,
his belief
exists

only

moved

when

from

the

a highly
probable
For example,
phobia
would
get

re-

tered

danger.
is irrational

fear

is safely

situation.

he believes

he is in danger.

pa-

is no

patient

the phobic

in the situation,
that

that there
that his

his life. His emotional

iety, is the same that

and

When

to some

he is
degree

Desensitization

is effec-

the

as inappropriate,
and gain some inner
conviction
that the phobic
reaction
is irrational.
The same mode
of operation
described

elevator.
content
tients

believe

in relation

break

during

be observed
in the
therapy.
In cognitive

techniques

tient

distorted

examines

trained

his

ideas,

internal

embroidery.

between

between

his reality testing

ment.
He is thus

the
ideas

objective
He

pa-

and

rational
reality

is enabled

is

and

the

patient

According
mechanism

to

this

analysis,

in danger

bia),
persecuted
superhuman
(mania)
the abnormal
MECHANiSM

clinical

the

a crucial
chain

or shift in the patients

As his irrational
concept
(hysteria),
helpless
and

less (depression),

(anxiety

(paranoid
becomes
picture
OF

is

idethat
hopeor pho-

state),
deactivated,

or

recedes.

of the desensitization

situation

can be explained
concepts.
When
the

people

to the

is placed
in the phobic
situation
ple, an elevator,
tunnel,
or bridge),
as if there were a clear and present

phobic

that

in the

the

elevator

ascent
they

however,

and

they will starve

When

the

therapy

agines

he

by other

away from

patient

session

will

or that

will be attacked

of suffocation

that

airy

cables

or descent,

elevator.)

that

was highly

un-

the

is in a phobic

the

believed

patient

im-

situation.

The

patient
with an elevator
phobia,
for instance,
started
to gasp for breath
when she was asked
to imagine
herself
in the elevator.
It appears,
both

from

the

patients

descriptions

from
external
observation,
fantasy
the patient
actually
tion

as though

it were

and

that during
the
relives
the situa-

actually

happening.

In

other
words,
the woman
with the elevator
phobia
who is simply imagining
herself
in the
elevator
to some degree
gets carried
away by
the fantasy
and
to some
degree
herself
as in the elevator
at that
the fear of being suffocated
though
she is in the safety
room.

time.

perceives
Hence

is stimulated
even
of the consultation

As the patient
experiences
reaction
during
the

her inapprodesensitization

procedure,

she is able to practice viewing

fears

objectively.

more

The
real-life

(for examhe reacts

danger
to

ways:
gains

(a) the
experience

ideas

and

2 #{149}
NUMBER

be enough

in a large,

will get stuck

or that

using cogpatient

VOLUME

passenger

the

expectation

priate

readily
untreated

wont

fear of elevators
has a different
patient
to patient.
Other
pa-

reasonable.
In the

TRANSFER

GENERALIZATION

Transfer
nitive

to view

in the psychotherapeutic

a modification
ational
system.
he is paralyzed

OR

is able

only

(The
from

elevator

her

of his mind and not as a

of a reality
situation.

the

to death,

and

to bear and to apply judgable to realize

with convic-

fantasy as a product
veridical
representation

was

elevator,

to bring

There

experience
a feeling
of shortness
of
This experience
occurred
even when

and

tion that his idiosyncratic

ideas are irrational.
Often the ideation
is in the form of pictorial
fantasy,

she

the

of cognitive

psychotherapy,

to discriminate

irrational

may

danger
actually
did exist.
a woman
with an elevator
the idea whenever
she en-

elevator,

would
breath.

desensitization

reaction,
namely
anxwould be aroused
if such

air in here and I will suffocate.

Sometimes
she would
have a visual image of herself
gasping for air and suffocating.
In addition,
she

tive because
it provides
a practice
session
in
which
the patient
is able to experience
his
reactions
to the feared
situation,
label them

to systematic

THERAPY

4 #{149}
FALL

transfer
situation

or the generalization
may be explained

to the
in two

rehearsal
effect:
the patient
in attacking
the frightening

therefore,

1993

her

as a result

of this

prac-

355

BECK

dcc,

is able

in the
tization

to counteract

the

irrational

phobic
situation;
and
procedure
produces

(b)

modification
in the patients
concept
phobic
situation
so that
the latent
being

suffocated,

etc.,

whether

could

of the
fear of

introducing

legitimately

another

is warranted.

chotherapy

twofold.

First,

cognitive

the

therapy

havior

is broader

therapy

ditional
framework

and

than

of some

that

of the

psychotherapies.
is congruent

of psy-

justification
framework

theoretical

theories

development
strategies
that

from
the predominantly
of the conditioning

dence
further

raised

system

The

rivable
concepts

cognitive
the

is
of
of be-

more

tra-

This
theoretical
with many
of the

of their
exposition
Ultimately,

seems
the

cal modification

strategies

may

of psychologi-

be usefully

tive

techniques

would

include

tested

through

the

currently

available.

RE

RE

FE

AT: Thinking

Beck

tent

and

1963;

the

experimental

CE

and

cognitive

theoretical

yields
been)

hypothreadily

techniques

depression,

I: idiosyncratic

distortions.

Arch

Gen

of

Depression: Clinical,Experimental,
and TheoAspects
New York, Hoeber, 1967
BeckAT:
Role of fantasies
in psychotherapy
and psychopathology.J
Nerv Ment Dis 1970; 150:3-17
BradyJP:Psychotherapy,
learning
theory, and insight
Gen

apy.

Psychiatry

AmJ

Travers
to the

presented

A: Outcome
chotherapy.J

meeting

16:304-311
of Wolpes

process.J

Schwab
control

of employing
Clin

Psychol

ther-

EAJr.

A laboratory
of anxiety.
Paper

of the American

Las Vegas,

desensitization
Abnorm

behavior

124:162-167

Association,

Systematic

ditioning
Ellis

1967;
RMW,
cognitive

at the

Guidance

1969
Davison
GC:

aspects

Psychiatry

Carison
WA,
approach
and

1967;

Cognitive

imagery

operations
such

and

in

the

such
forms

direct

at-

cognitions.
would
include

of a nonintrospective

as in operant

sure
therapy,
graded
roleplaying,
and assertive

Psychol

Frank

1957;

March

as a counter-con-

Psychol
three

Personnel
NV,

1968;
techniques

73:91-99
of psy-

13:344-350

Reason
andEmotion
in Psychotherapy.
NewYork,
Lyle Stuart,
1962.
FolkinsCH, Lawson KD,OptonEM,etal:Desensitization
of the experimental
reduction
of threat.
J Abnorm
EllisA

JOURNAL

OF PSIHOTHERAPY

JD:

Hopkins
HarveyOJ,

retical

BM:

induced

ture,

con-

Psychiatry

9:324-333

Arch

methods

na-

conditioning,

expo-

task
assignments,
training.

BeckAT:

Brown

the

and
cogni-

making
direct
use of ideational
material
as systematic
desensitization
and other

those

Moreover,

regrouped

into the cognition-oriented

techniques
the behavior-oriented
techniques.
The

action

of cognitive
therapy
can be (and
have

practice,

warranted.

tempts
to modify
idiosyncratic
The behavioral
techniques

of therapy.

extrinsic
Since

model.

in clinical

efficacy

assumptions
of behavior
therapy,
but provides a greater
range
of concepts
for explaining psychopathology
as well as the mode
of
structure
eses that

provide
of a numare not de-

these cognitive
techniques,
as well as the behavior
techniques,
are easily
defined
and
have
demonstrated
some
preliminary
evi-

is obliterated.

be

the

a framework
for
ber of therapeutic

CONCLUSIONS

A question

Secondly,

ideas

the desensia significant

and
Jones

1968; 73:100.-uS

Persuasion
University

HuntDE,

and Healing.
1961

Press,
Schroder

personality

organization.
RG: A factored
measure

system
latet
lege,

with

personality

Baltimore,

Johns

HM: Conceptual
systems
New York, Wiley, 1961
of Ellis irrational
belief
and maladjustment
corre-

Doctoraldissertauon,TexasTechnologicalColLubbock,
TX, 1968

5: Relationship
between
reading
improvement
and ten selected variables.
Percept
Mot Skills 1964;
19:15-20
Lader MH, Mathews
AM: A physiological
model
of phobic anxietyand
desensitization.
BehavResTher
1968;
Krippner

6:411-421

Lang PJ: The mechanics

of desensitization
and the laboratory study of human
fear,
in Behavior
Therapy
Appraisal
and Status, edited byFranksCM.
NewYork,
McGraw-Hill,
1969,
pp 160-191
Lazarus
A: Variations
in desensitization
therapy. Psychotherapy
Theory, Research
and Practice
1968; 5:5052
Leitenberg
H, Agras WS, BarlowDH,
etal: Contribution
of selective

positive

reinforcement

PRACTICE AND RESEARCH

and

therapeutic

356

COGNITIVE

instructions
to systematic desensitization
therapy. J
Abnorm Psychol 1969; 74:113-118
Loeb A, Beck AT, DiggoryJC,
et al Expectancy, level of
aspiration,
performance,
and self-evaluation
in depression.
Proceedings
of the Annual
Convention,
American
PsychologicalAssociation,
1967,2:193-194
London
York,

P: The modesandmoralsof
Holt,

MischelW:

Rinehart

and

and assessment

Personality

New

psychotherapy.
Wmston,
1964

NewYork,

Wiley,

1968

EJ,Jacobson
LT: The nature of learning in traditional and behavioral
psychotherapy,
in Handbook
of Psychotherapy
and Behavior Change, edited by
Bergin AE, Garfield SL New York, Wiley, 1969

Murray

5: The role of muscular

Rachman
tization
DC,

Rimm

therapy.
Litvak

arousal.J

Sloane

RB:

Stampfl

TG,

Beh Res Ther

Abnorm

Psychol

in desensi-

6:159-166

1969; 74:181-187

Psychiatry

DJ: Implosive

therapy

and

1969; 125:877-885
therapy:

therapy? Behav Res Ther 1968; 6:31-36

TrexlerLD,
KarstTO: The use of fixed-role
and rationalemotive therapy in treating public-speaking
anxiety.
Paper presented
at the meeting of the Eastern Psychological
Association,
Philadelphia,
April 1969.
TruaxCB,CarkhuffRRiTowardeffectivecounselingand

psychotherapy:

2 #{149}
NUMBER

and practice.

Chicago,

Aid-

on

VeltenEkAlaboratorytaskforinductionofmoodstates.

Behav
Wagner

Res
ML

Ther 1968; 6:473-482

Cauthen

communications.

NR

Behav

Case
ResTher

histories

and

shorter

1968; 6:225-227

B: Behavior
therapy
and psychotherapy.
Psychol Rev 1967; 74:300-317
Wolpe J, Lazarus
AA: Behavior
therapy techniques:
a
guide
to the treatment
of neuroses. New York, Pergamon, 1966

a behavioral

VOLUME

training

me, 1967
Valins 5, Ray A: Effects of cognitive desensitization
avoidance
behavior.JournalofPersonalityandSodal
Psychology
1967; 7:345-350

Weitzman

and emotional

paths of behavior

AmJ
Levis

1968;

SB: Self-verbalization

Converging

psychotherapy.

relaxation

Tiww&py

4 #{149}
FALL

1993