A Critical Comparison of Behavior Therapy and Rational-Emotive Therapy
In this paper, I consider the benefits and drawbacks of behavior therapy and the cognitive therapy. These are talking therapies that now have over a half-century of application in clinical settings and are still used today in conjunction with, or as an alternative to, drug treatments of psychological disorders. I conclude that these therapies are still useful, though each has its limitations.
Behavior therapy (BT) and rational-emotive therapy (RET) were developed in the mid 20th century as alternative psychotherapies to Freudian psychoanalysis. A key foundational text for BT is Joseph Wolpe's (1958) Psychotherapy by Reciprocal Inhibition. Rational-emotive therapy (originally called simply "rational therapy") was founded in 1955 by Albert Ellis (Ellis & Dryden 1987, p. 1). Ellis' RET incorporates aspects of learning theory, which is central to BT, but goes beyond BT to utilize the central concept of "cognition," which includes subjective beliefs, narratives, language, and the attendant feelings these internal thoughts invoke. Rational-emotive therapy is thus seen as an early form of "cognitive-behavioral therapy" (National Association of Cognitive-Behavioral Therapists [NABCT] 2010).
Wolpe's (1958) Psychotherapy by Reciprocal Inhibition grew out of findings from his laboratory experiments on cats. Wolpe was able to demonstrate that he could inhibit the animals' fear responses by feeding them while gradually introducing and intensifying stimuli that would previously have frightened them. Wolpe extended this technique to humans, treating phobias and inhibitions through gradual desensitization by getting the patients to physically relax while gradually introducing increasingly intense exposure to things that produced anxiety, within the safe, controlled context of a therapy session.
Wolpe based his BT on the experimental psychology of behaviorists. Behaviorism was pioneered in the early 20th century by the Russian physiologist Ivan Petrovich Pavlov in his studies of the digestive system. Pavlov was interested in reflexive and involuntary reactions to anticipatory rewards. His experiments with dogs demonstrated the phenomenon of the "conditioned reflex."[footnoteRef:1] Pavlov demonstrated that an involuntary, instinctual behavior (such as salivating) could be activated by an artificial, environmental cue (such as the ringing a dinner bell). [1: In Russian, also translated as "conditional reflex."]
The idea of conditioning as a fundamental learning process was further developed in the United States by behaviorists, notably John B. Watson and B.F. Skinner, who argued that the investigation into overt, observable behavior constituted a more scientific basis for psychology than investigation into the subjective phenomena mental states or feelings.
Skinner's studies of lab rats went beyond Pavlovian classical conditioning (eliciting an involuntary reflex by paring the behavior with an environmental stimulus) by experimenting in operant conditioning (increasing/decreasing voluntary behaviors using reward/punishment). Skinner (1953) distinguished four types of operant conditioning:
1. Positive reinforcement occurs when a behavior increases in frequency as it is rewarded by a desirable stimulus. A child cleans her plate at dinner and her mother rewards her with desert.
2. Negative reinforcement occurs when a behavior increases in frequency as it is rewarded by the removal of a negative stimulus. A child cleans her plate so her mother will stop nagging at her.
3. Positive punishment occurs when a behavior decreases in response to an unpleasant stimulus. The child stops running around the house so her mother will not yell at her.
4. Negative punishment occurs when a behavior decreases as a result of a desired stimulus being removed. A child stops talking back so her toy will not be taken away.
The assumption of the behavioral psychologists is that most (or possibly all) behavioral maladjustments must have been acquired through learning. People come to suffer later in life from being rewarded early on for self-defeating behaviors, or punished for self-enhancing behaviors. Since our negative behaviors were acquired by conditioning in the first place, they could be undone and replaced by better behaviors by a deliberate course of beneficial conditioning.
Albert Ellis, a contemporary of Wolpe, developed a competing model of psychopathology, which incorporated some elements of BT, but also was more in line with the cognitive revolution. Over the course of his work in the 1940s as a clinical psychologist in New York City specializing in marital and sexual problems, Ellis grew dissatisfied with psychoanalysis as a means of problem solving (Ellis & Dryden 1987, p. 1). The psychoanalytic model Ellis was working from framed all relationship problems as the product of internal disturbances and conflicts within a person (Ellis 1962, p.3). Ellis based his alternative RET on ideas from Greek and Roman Stoic philosophers, such as Epictetus and Marcus Aurelius. Rather than internal psychodynamic conflicts, disturbances on this view were caused by irrational beliefs.
Mental constructs such as "beliefs" played no part in behaviorist psychology. The radical behaviorist view reduced all of human psychology to objectively observable behavior. Proponents of behaviorism saw their subject matter as more scientific than psychological theories that probed into unobservable constructs such as the unconscious mind or the superego. The positivist goal of reducing all of human experience to observable behavior came under challenge in the 1950s from advocates of cognitive science. Cognitive scientists, including linguists, psychologists, philosophers of mind, and computer programmers, proposed that internal mental activities that underlay action could be equally subject to scientific research, using introspection, as were overt behaviors.
Early investigations into cognition in experimental psychology predated the "cognitive revolution" of the 1950s, dating back to the works of William James and Wilhelm Wundt. These psychologists defined psychology as the science of mental life, and examined their own subjective experience using introspection.
Influential theoretical critiques of behaviorism came from linguists, such as Noam Chomsky (1959) and Lev Vygotsky (1962). These linguists argued that the syntax of a human language was so subtle and complex that reward and punishment for correct usage by adult speakers was insufficient to account for the acquisition of language. In light of its complex syntax, critics of behaviorism argued that language is impossible to analyze in behavioral terms alone. Instead, scientists should posit complex mental structures as the source of analysis.
This critique marked the beginnings of the cognitive revolution in psychology. Jean Piaget (1954) was a significant contributor to the field of cognitive psychology. Piaget studied the ways in which children build mental models of the world through observation and experimentation, not simple reward and punishment. Albert Ellis (1962) and Aaron Beck (1967) were early clinicians who applied cognitive ideas to promote mental health.
Models of Psychopathology
A key assumption of BT is that maladaptive behaviors are acquired through learning and they can be modified through additional learning; basically unlearning what is causing distress and relearning new habits (Wolpe, 1958). Following the arguments of the radical behaviorists, the maladaptive behavior is itself the disorder that the therapy addresses, not merely the symptom of some underlying mental problem. So effective BT should focus on changing the behavior itself, not taking a detour to explain in detail its underlying cause as a complex of developmental traumas. The basic premise of BT is: (a) emotional pathologies can be reduced to patterns of behavior, and (b) behaviors that have been learned can later be unlearned.
Cognitive therapists such as Ellis, in contrast, emphasize maladaptive thoughts as the underlying cause of psychopathology. Rather than focusing on changing overt behavior through reward and punishment, RET is designed to help the patient reorganize his or her self-defeating habits of thought that manifest externally as maladaptive behaviors.
Behavior therapy focuses narrowly on changing behavior, using reward and punishment to reshape the patient's overt behavior in a desired direction. Cognitive therapy conceives of overt behavior as the external expression of patterns of thought, feelings, and beliefs. In order to produce positive change, the therapist should help the client restructure their thought processes.
Ellis (1962) claimed that irrational beliefs are pervasive in human life and are easy to acquire without much thought or effort. For example, it is easier for many people to fall into a pattern of self-defeating behavior such as overeating than to deliberately craft a self-enhancing behavior such as following a sensible diet. Ellis also took a dim view of religion as a source of dogmatic, inflexible strictures that block people from achieving their desires and generate negative, inhibiting feelings such as guilt, self-condemnation and judgment of others. Ellis thought of religiosity as a central feature of human emotional and behavioral disturbance, since religious belief systems are absolutist, dogmatic, and include evaluative demands in the form of "ought," "must," and "have to."
In order to assess clients' psychological problems, Ellis developed an ABC framework, in which A stands for Activating event, B for a person's Belief about that event, and C. For the Consequences that will follow in light of that belief (Ellis 1962).
RET does not advance an elaborate theory of how people come to acquire psychological disturbances. Ellis saw people's tendency to arrive at irrational beliefs as part of our biological nature. Furthermore, simply knowing how a person developed an irrational belief does not suggest a therapeutic intervention, and RET is designed to provide practical solutions rather than…
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