Cognitive psychology is a research paradigm within empirical psychology. Emerging in the sixties, the cognitive paradigm recognizes that human psychology cannot be reduced to the stimulus-response mechanisms of behaviorism, which had previously dominated American academic psychology. Even though it’s impossible for one person to gain direct access to the inner workings of the human mind, it is possible to infer them; e.g., by looking at intermediate steps in solving a complex problem, by identifying and interpreting the types of errors people tend to make, by analyzing how people use language to understand and to communicate, by the systematic analysis of self-report data, by exploring motivations and emotional responses to performance, even by looking at MRI images of brain function while individuals are performing mental tasks. In historical continuity with psychological empiricism, cognitive researchers rely on the usual techniques: defining tasks and variables as precisely as possible, systematically collecting data from individual subjects, analyzing the aggregate via inferential statistics, comparing observed versus hypothesized results. Cognitivists, many of whom draw explicit analogies between human and machine information processing, also like to construct computer simulations of their models of human cognition.
CBT as a therapeutic paradigm also grew out of behaviorism. Like its research counterpart, therapeutic cognitivism acknowledges that humans have internal states and processes which intervene between stimulus and response. In CBT, emotional disorders like depression and anxiety both cause and result from the individual’s inability to do what she really wants to do. Instead of merely trying to change the client’s behaviors, though, the cognitive-behavioral therapist tries to change the attitudes and beliefs that drive behavior. In particular, CBT tries to identify “irrational” cognitions that get in the way of the client doing what she wants to do. CBT the relationship between therapist and client is meant to emulate that between psychological researcher and research subject. The therapist collects data about the client’s symptoms, using the data to assign the client to one or more diagnostic categories. Throughout the course of treatment the therapist and client together identify mismatches between what the client wants to do and what she actually does, between consciously espoused attitudes/beliefs that align with what the client wants and those maladaptive or irrational attitudes/beliefs that keep the client from doing what she wants. Systematic attempts are made to strengthen those cognitions that are most likely to lead to the desired behaviors. Direct attempts to modify behavior are also part of treatment, but always in conjunction with “attitude adjustment.” Success in therapy is evaluated by improvement in psychological disorder (as measured by pre-post changes in symptom checklists) and by client self-reported changes in cognitions and behaviors.
While CBT takes on the language and trappings of cognitive psychological research, it’s not really based on research findings. While it’s possible to identify statistical relationships between attitudes and behaviors, and while it’s possible to build hypothetical causal models linking particular attitudes to particular behaviors, these findings and models apply to very tightly constrained experimental tasks rather than to real-world complexities. Further, there’s precious little compelling research evidence to support CBT’s core contention that systematically tinkering with subjects’ attitudes will result in their becoming more successful in behaving the way they’d like to or in improving their emotional state. In my view, with its performance measurements and goal-setting activities and best practices for achieving goals, CBT has more in common with corporate managerial techniques than with cognitive psychological research.
For most psychological disorders, empirical studies of therapeutic outcomes detect no significant differences between CBT and pretty much any other therapeutic praxis in reducing clients’ symptoms. Even untrained non-professionals who enter into an ongoing supportive relationship with the client get results comparable to the pros. It should be noted, though, any sort of “therapeutic alliance,” whether professional or amateur, CBT or alternative, achieves much better symptom reduction than does “watchful waiting.”