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Extending the Goals of Behavior Therapy and of Cognitive Behavior Therapy

Albert Ellis, Albert Ellis Institute for Rational Emotive Behavior Therapy

For the past half century, traditional behavior therapy has done a credible job of helping clients to alleviate their dysfunctional feelings and behaviors and to maintain this improvement. Rational Emotive Behavior Therapy (REBT), and some other forms of cognitive behavior therapy (CBT), have added to behavior therapy's record of success by including cognitive and philosophic restructuring techniques that aim to help some clients not only to feel better, but to become less disturbed and less disturbable. Unlike more traditional forms of behavior therapy, REBT and CBT often lead to profound and more lasting attitudinal change in clients that include anti-musturbation, unconditional self-acceptance, unconditional other-acceptance, high frustration tolerance, anti-awfulizing, and minimal overgeneralizing. Such lasting attitudinal changes, and understanding the processes and mechanisms by which they are achieved, may enhance and extend the goals of behavior therapy into the next millennium.

The Relation Between Cognitive and Behavioral Therapies (Commentary on "Extending the Goals of Behavior Therapy and of Cognitive Behavior Therapy")

David Reitman, Louisiana State University

Ellis (1997) describes how Rational Emotive Behavior Therapy (REBT) can be distinguished from Behavior Therapy (BT) and, perhaps more significantly, "adds" to BT. Among the issues raised by Ellis is the suggestion that traditional BT may lead only to temporary or superficial behavior changes, and that the goals of BT should be extended to include more comprehensive and enduring "personality change." In this commentary, I discuss the underlying medical model adopted by cognitive therapists, the empirical data that bear on the issue of "adding" to BT, and an alternative framework to evaluate clinical practice. It is suggested that there are more similarities among therapists, and their therapies, than differences. Thus, as Charles Ferster (1972) suggested more than 25 years ago, more effort should be devoted to studying what successful therapists do, and less to arguing the merits of therapists' theoretically informed explanations for success.

Behavior Therapy and a Culturally Diverse Society: Forging an Alliance

Gayle Y. Iwamasa, Oklahoma State University

As society continues to become increasingly culturally diverse, behavior therapy will need to adapt and develop in order to meet society's changing needs. I discuss behavior therapy's historical lack of attention to issues of diversity, why cultural diversity is important to behavior therapy, and recent developments on diversity in behavior therapy. Some positive implications of behavior therapists' establishing a commitment to issues of diversity in behavioral research are reviewed and recommendations regarding future research directions are offered.

Commentary on "Behavior Therapy and a Culturally Diverse Society: Forging an Alliance"

Rosemery Nelson-Gray, Scott T. Gaynor, William J. Korotitsch, University of North Carolina at Greensboro

We agree with Iwamasa (1997) that it is important to study and to consider issues of cultural diversity within behavior therapy. The timing to do so seems ripe, now that there are effective behavioral assessment and treatment strategies in place. Furthermore, issues of cultural diversity, and particularly Iwamasa's paper, provide behavior therapists with an opportunity to revisit some important issues within behavior therapy: topographic descriptions of cultures vs. functional descriptions of clients, group-based cultural descriptions versus individual-based clinical practice, and general principles versus idiographic applications.

Disenchantment and Hope: Will We Ever Occupy Center Stage? A Personal Odyssey

Arnold A. Lazarus, Rutgers University

I discuss why I gravitated to behavioral approaches and grew disenchanted with psychoanalytic concepts, the thrill of being part of Wolpe's coterie of "conditioning therapists" in South Africa (circa 1956), the Philadelphia fiasco (circa 1968), and how the high hopes that objective behavioral approaches would displace subjective psychodynamic theorizing were not realized. The popularity of behavior therapy, having almost attained "front page glamour" in the 1970s, began to decline in the 1980s. The 1990s have witnessed not only the proliferation of psychodynamic speculations, but a slew of so-called New Age and other forces that place no value on empirical testing. Instead, we need to generate more data-based on established treatments, coupled with clearly articulated practice standards

Psychoanalysis Ruled (Much of) The 20th Century — Behavior Therapy The 21st Century? (Commentary on "Disenchantment and Hope: Will We Ever Occupy Center Stage"

Georg H. Eifert, West Virginia University

This article comments on the conceptual, professional, and geographical odyssey of one of the pioneers of behavior therapy, Arnold Lazarus (1997). His odyssey is a fascinating reminder of the extraordinary professional battles our forebears had to fight. Lazarus also describes how these battles have not only been restricted to psychoanalysis and psychiatry but at times scarred relationships between pioneers themselves. From the perspective of a second-generation behavior therapist, I comment on some of the personal exceptional qualities of first-generation behavior therapists and highlight the international roots and proliferation of behavior therapy. I conclude that the decline of the Freudian empire may extend well into the next century, but behavior therapy has a good chance of becoming the dominant player in the psychotherapy arena in the new century.

Helping People Improve Their Lives With Behavior Therapy

W. Stewart Agras, Stanford University School of Medicine

If the aim of behavior therapy is to help individuals with clinical problems improve their lives, then the field has been, and will continue to be, an outstanding success. However, the same problems that were present for therapy researchers in the beginning days of the field remain, namely, how to improve the results of treatment, and what mechanisms underlie the effectiveness of treatment. Some current approaches to these problems are outlined largely in reference to the eating disorders. The advent of managed care will, in my opinion, be advantageous for the further development of behavior therapy, which is likely to remain a strong field, ultimately linking therapeutic behavior change with neurochemical changes in the central nervous system.

Looking Up, Forward, and Back —Commentary on "Helping People Improve Their Lives With Behavior Therapy"

Jacqueline B. Persons, Center for Cognitive Therapy

This article comments on Agras' (1997) review of the past and future of behavior therapy in the context of its mission to help people improve their lives. It includes discussions of the success of behavior therapy in accomplishing the goal of helping people improve their lives, the cognitive behavioral split, the effect of managed care on behavior therapy, and the process and outcome of treatment for bulimia nervosa.

It Was The Best of Times, It Was The Worst of Times

Cyril M. Franks, Rutgers University

A brief history of the origins of the Association for Advancement of Behavior Therapy (AABT) is followed by a discussion of the best and worst in contemporary behavior therapy as filtered through the admittedly biased perceptions of the present writer. Next comes a presentation of several issues whose resolutions are unpredictable at this time, with possible solutions being good or bad, depending on one's point of view. The paper concludes with a discussion of the present status of behavior therapy and some speculations about future trends and long-term prognoses.

It Was The Age of Wisdom, It Is The Age of Hope — Commentary on "It Was the Best of TImes, It Was the Worst of Times"

John P. Forsyth, University at Albany, State University of New York

In a spirit of intellectual honestly, Franks (1997) provides an evaluation of the best and worst of behavior therapy from the eyes of a founding member. In so doing, he notes that conceptual and theoretical advancement of behavior therapy as a science has given way to professional advancement. In this commentary, it is agreed that behavior therapy, in its present form, is less descriptive of the actual practices of a unique group of scientists and practitioners who call themselves behavior therapists because of what they do. It is suggested that the hope of behavior therapy rests in our ability to reestablish our identity and integrity with basic behavioral principles and functional, process-oriented thinking.

Back to The Future: The Continued Relevance of Behavior Theory to Modern Behavior Therapy

Joseph J. Plaud, and Nancy D. Vogeltanz, University of North Dakota

Although modern behavior therapy has become increasingly cognitive, empirically validated behavior and cognitive behavior therapies continue to be firmly based on modern learning theory. The relation between behavior theory and behavior therapy is critical to the continued advancement of behavior therapy in the modern era of radical changes within the mental health care system. Of particular relevance to the continued success of behavior therapy is behavior analysis. Not only is behavior analysis a direct, applied extension of behavior theory, but it is also a highly practical and effective approach for understanding, explaining, and modifying verbal behavior, behavioral trajectories, and the contextual factors that contribute to, and maintain, maladaptive behaviors.

Adventures in Flatland — Commentary on "Back to the Future: The Continued Relevance of Behavior Therapy to Modern Behavior Therapy"

Cyril M. Franks, Rutgers University

Plaud and Vogeltanz (1997) present applied behavior analysis as a valuable extension of behavior therapy to resolve clinical concerns. In so doing, they overlook the undeniable fact that, as yet, no one model has proven itself to be superior either theoretically or clinically. In this commentary, I take serious issue with their unidimensional view of behavior theory. As far as their evaluation of cognitive behavior therapy is concerned, I am in total agreement. Finally, the point is made in this commentary that, for the most part, the ultimate value of any behavior theory or model should be judged in terms of its contributions to society at large and to individual well-being.

The Value of Recognizing Our Differences and Promoting Healthy Competition: The Cognitive Behavioral Debate

David Reitman, Louisiana State University, and Ronald S. Drabman, University of Mississippi Medical Center

Few issues within behavior therapy have aroused as much debate as the causal status of cognitions. We briefly trace the history of the debate, provide recent exemplars of misunderstanding, and seek to clarify important epistemological distinctions between radical and cognitive behaviorism. It is suggested that cognitive and radical behavioral therapists share a pragmatic interest in effecting and demonstrating behavior change, but differ significantly with respect to how change is explained. Less certain is the extent to which the practices of radical behavioral and cognitive therapists differ. It is concluded that radical (contextual) and cognitive (mechanistic) views, though distinct, are both scientifically respected approaches to studying human behavior with important roles to play in the future of behavior therapy. The multigenerational enterprise called behavior therapy stands to be enriched by promoting shared values, acceptance of our differences, and encouraging healthy competition.

Radically Deep Thoughts — Commentary on : "The Value of Recognizing Our Differences and Promoting Healthy Competition: The Cognitive Behavioral Debate"

Ian M. Evans, University of Waikato

Reitman and Drabman (1997) encourage healthy competition among different theoretical frameworks that share common scientific values in behavior therapy. With a similar ecumenical spirit, this commentary compares radical behaviorism's emphasis on external causation with integrative explanatory models used clinically to effect change in clinical symptoms by changing other elements of the repertoire. Information processing constructs might be thought of as more causal fundamentally than environmental events, but cognitive theory's emphasis on meaning appears remarkably similar to psychotherapies consistent with radical behaviorism's contextual rationale.

Can Contextualism Help?

Neil S. Jacobson, University of Washington

The journal Behavior Therapy reflects the evolution of the field over the past 30 years, from an emphasis on analogue studies with college students and operant approaches with institutionalized subjects to increased use of clinical populations and the incorporation of cognitive therapy. Behavior therapy, as of 1997, has little to do with its philosophical roots in behaviorism, and we have paid a price for our departure from those roots. There is little left that is unique to behavior therapy, and certainly no unifying theory. We need go no further than the philosophical roots of behaviorism. It is suggested that contextualism provides a much needed overarching system that not only unites behavioral interventions, but has demonstrated some vitality in recent years for creating new interventions that do not emphasize cognitive therapy. The future of behavior therapy would be best served by revisiting our philosophical roots, returning to functional analytic thinking, and by attending to context.

It's Yet Another Empirical Question — Commentary on "Can Contextualism Help?"

David H. Barlow, Center for Anxiety and Related Disorders and Boston University

Neil Jacobson (1997) suggests that we should sharpen the theoretical roots of behavior therapy. In this commentary, some historical observations on the context of theory in behavior therapy are provided along with implications of narrowing the scope of behavior therapy.

Behavior Therapy At Century Close

G. Terence Wilson, Rutgers University

Although its impact has been less than originally hoped, behavior therapy has profoundly influenced psychotherapy over the second half of the 20th century. Behavior therapy has dominated controlled outcome research on psychological therapy, has led the field in the development of empirically validated treatments, and has become the treatment of choice for several adult and childhood clinical disorders. Behavior therapy has also responded to advances in psychological science and clinical practice by broadening its conceptual base to incorporate cognitive principles and procedures. Yet, important gaps between science and practice remain, and our high hopes at century close should not blind us to the need to fill such gaps with meaningful progress.

Behavior Therapy and the Philosophy of Science — Commentary on "Behavior Therapy at Century Close"

Joseph J. Plaud and Nancy D. Vogeltanz, University of North Dakota

G. T. Wilson (1997) describes how behavior therapy altered the field of psychotherapy by dominating controlled outcome research in Europe and in the United States, and by relating clinical science to clinical practice. Wilson maintains that behavior therapy has grown with continued scientific advances in experimental psychology, and concludes that the relation between behavior therapy and scientific formulations has, in fact, contributed to behavior therapy's record of success. In this commentary, we expand upon Wilson's points by relating the success of the behavior therapy movement with features of the evolutionary and problem-focused philosophy of science espoused by Laudan (1977). We conclude that behavior therapy's commitment to maximize problem-solving effectiveness accounts for its success in the domain of clinical science.

Dissemination of Effective Methods: Behavior Therapy's Next Challenge

Jacqueline B. Persons, Center for Cognitive Therapy, Oakland, CA

Dissemination of effective interventions developed by behavior therapists is one of behavior therapy's most important talks now and in the coming years. I argue that dissemination is timely when a treatment is supported by efficacy data from randomized controlled trials or from a large series of single case studies. I offer recommendations for improving dissemination of empirically supported behavioral interventions and methods.

Dissemination of Cognitive Behavioral Treatments (Commentary on "Dissemination of Effective Methods: Behavior Therapy's Next Challenge")

G. Terence Wilson, Rutgers University

Demonstrably effective cognitive behavioral treatments for a number of clinical disorders are underutilized in clinical practice. Improving dissemination presents a challenge as Persons (1997) argues. In this commentary, reasons for dissemination failures, and suggestions for promoting empirically supported treatments, are discussed.