Cognitive-behavioral therapy (CBT) is the most commonly used evidence-based practice in the treatment of mental disorders (Field, Farnsworth, & Nielsen, 2011; Society of Clinical Psychology, 2014). Despite its ubiquity, CBT is not without limitations. For instance, mental health counselors who practice conventional CBT may experience a state of befuddlement when clients report no noticeable environmental antecedents or triggering events related to their maladaptive emotional and behavioral reactions. Clients may report no insight into their emotional experiences (“I don’t know why I feel this way”), lack of knowledge of their thought patterns (“I don’t know what I was thinking”), or scant awareness of their behaviors (“I just blacked out”) until after they experience emotional and behavioral consequences. Clients may have told the counselor that they lacked awareness of their behavior until it was too late, after the response had occurred. Presuming no deceit, this absence of awareness may cast uncertainty on a counselor’s ability to effectively practice conventional CBT. The emerging field of neuroscience provides reassurance by supplying information that clinicians can use in addressing such dilemmas. Findings from neuroimaging studies suggest that CBT has the potential to promote changes in the structure and function of such brain areas as the prefrontal cortex and amygdala, among many others (e.g., Linden, 2006, 2008; Siegle, Ghinassi, & Thase, 2007). As a result, conventional CBT models have been adapted to incorporate findings about the processes that change the structure and function of the brain during CBT (e.g., Clark & Beck, 2010; David, Szentagotai, Eva, & Macavei, 2005). Given how frequently CBT is used in clinical practice, the increased focus on neuroscience in the counseling literature, and trends emerging in the CBT literature, it is important for mental health counselors to consider neuroscience-informed practices. The purpose of this article is to synthesize studies of neuroscience and conventional CBT models to propose a new model of neuroscience-informed cognitive-behavioral practice.
THE OLD ABCS: CONVENTIONAL CBT APPROACHES
Conventional CBT is best defined as a group of therapeutic approaches that share the common belief that thoughts, beliefs, and cognitions cause emotional and behavioral experiences rather than external events. Two seminal models emerged in the 1950s and 1960s: Rational Therapy, later renamed Rational-Emotive Behavior Therapy (REBT), developed by Albert Ellis (1957, 1962), and Cognitive Therapy, developed by Aaron Beck (1967). Both models proposed that dysfunctional emotional and behavioral responses were caused directly by dysfunctional thinking, known as cognitive distortions (Beck) or irrational beliefs (Ellis). Treatment therefore focused on confronting, disputing, and restructuring maladaptive thought patterns into more adaptive patterns that would lead to more adaptive emotional and behavioral responses. While more contemporary models of CBT place less emphasis on the centrality of thoughts, such as Marsha Linehan’s Dialectical Behavior Therapy (Linehan, 1993) and Steven Hays’s Acceptance and Commitment Therapy (Hays, Strosahl, & Wilson, 2003), thought continues to be a central focus of many traditional CBT models today. Beck and Haigh’s most recent update (2014) re-envisions all mental disorders as best defined and differentiated by their underlying cognitions and schemas.