Cultural-Historical Approach as a Methodological Basis for Cognitive Behavioural Psychotherapy

Author: Dzyakau D. R., PhD in Psychology, Associate Professor, Institute of Psychology of Maxim Tank Belarusian State Pedagogical University, Minsk, Belarus

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Recently, the work on cognitive behavioural therapy has begun to discuss the methodological foundations of this effective approach recommended by the World Health Organization (Kholomogorova, 1996; Alford, Beck, 1998). The researchers conclude that, despite the similarity of the name, neither cognitive psychology, nor behaviorism can create a comprehensive methodological platform for cognitive behavioral therapy (Kholomogorova, 2011; Westbrook, Kennerley & Kirk, 2007). Moreover, psychoanalysis also cannot be considered as such platform because it sees driving sources of human behavior in the unconscious.

On the other hand, representatives of cultural-historical psychology make numerous, but not always successful attempts to find a practical application of this theory, trying to find its practical usage (Zejgarnik, 2002; Slobodchikov & Isaev, 1995).


Review of recent studies and publications. Recently, assumptions appear more and more often in the specialized literature that the cultural- historical approach in psychology is the methodological basis of cognitive behavioral therapy (CBT). Thus, even D. Maihenbuam, one of the leading cognitive psychotherapists of the 20th century, noted that CBT development, especially CBT for children, was influenced to some extent by the works of the Soviet psychologists Lev Vygotsky and his student A. Luria. Their models of socialization and interiorization became the theoretical basis for children’s behavioral changes and cognitive control (Meichenbaum, 1977: 18). J. Wertsch, a well-known follower of «Mozart in psychology», also finds important concepts for cognitive behavioral psychotherapy in the works of L.S. Vygotsky: the emergence of self- regulating capacities in ontogenesis is the central theme of the works of L. S. Vygotsky and his followers. Their ideas about self-regulation can be properly understood only if we conduct a genetic analysis that goes back to the origins of self-regulation (Wertsch, 2008: 66).

A. B. Kholmogorova pays also attention to the general methodological positions of cultural-historical psychology and the cognitive behavioral approach (Kholomogorova, 1996, 2011, 2016).
Our study aim was to verify the assumption that cognitive behavioral therapy implements, on the whole, the theoretical and methodological foundations of the cultural-historical approach.

Methodology and results

First of all, we should say about the unified methodological context of these approaches – the non-classical type of rationality. Both cultural- historical psychology and the modern Oxford version of cognitive behavioral psychotherapy implement the non-classical type of rationality in psychology (Kravtsova, 2008; Puzyrej, 1986; Wertsch, 2008; Westbrook, Kennerley & Kirk, 2007). Cultural-historical psychology, as well as cognitive behavioral approach, recognizes the holistic nature of the human psyche, and rejects the atomistic view of its structure. From the point of view of L.S. Vygotsky, it is incorrect and not productive to divide the psyche into separate parts at its exploration, as it is incorrect to study the properties of water, by dividing it into oxygen and hydrogen (Vygotsky, 1982). Namely this methodological position let L. S. Vygotsky to substantiate a meaning as a unit of verbal thinking, and a meaningful experience as a unit of the psyche (in the «late» L. S. Vygotsky) (Vygotsky, 1983). Thus, the «non-classicality» of rationality, which is the base of both cultural-historical and cognitive behavioral approaches, determines the uniformity of understanding of a study object and a change in psychology. A study object in both approaches is understood not as an atomistic structure, but holistically. L. S. Vygotsky understood the normative psyche structure as a dynamically changing unity of affect and intellect. Similarly, the psyche in cognitive behavioral therapy is considered interactively, in the unity of emotions, thoughts, physiological reactions, behavior (Bek, Rash, Sho & Jemeri, 2003; Bek, 2006; Dyakov, 2019; Kravtsova, 2008; Alford & Beck, 1998; Beck, 1976). Moreover, the critic of attempts to define mental phenomena with linear determinism characteristic for the non-classical type of rationality and the methodology of the both approaches is worth noting. So, in the case of cultural-historical psychology, the so-called teleological determinism prevails, the essence of which was described by L.S. Vygotsky as importance to look not so much for the reasons determining a child’s psyche development, but for those social- cultural tasks that should be solved to achieve goals of this development (Vygotsky, 1982). In case of the cognitive behavioral approach, we see a ring-type nonlinear determinism, which is expressed in the fact that the modern CBT, in its Oxford version, involves an idea of supporting cycles in which an individual independently, but, of course, not always consciously, supports an existing problem through his/her own ways of thinking and behavior. Such a support cycle includes, as a rule, cognitive, affective, and behavioral aspects of the problem and leads to cognitive distortions or counterproductive behavioral patterns (Perris, Blackburn & Perris, 1988; Westbrook, Kennerley & Kirk, 2007).

In addition to the uniform understanding of a study object, cultural- historical psychology and cognitive behavioural approach are similar in understanding the methods of the psyche studying. Moreover, this understanding is fairly uniform, although this does not look entirely true at the first glance. Indeed, the method of cognition and personality development in cultural-historical psychology is a genetic-modelling, formative experiment (Vygotsky, 1982). A psychologist models the psyche, throwing a «grain into the future»; new psychological formations grow from this «grain». A similar situation is observed in the cognitive behavioral approach. In both cases, a psychologist creates an experimental situation realigning the psyche, developing new ways of reality understanding, accordingly, and new tools mediating emotional attitude to this reality. Like in a formative experiment proposed by L. S. Vygotsky, the conditions to form new methods of cognitive interpretation of reality and its content are created in the interpersonal space at the first step. Then people obtain opportunities to implement these new methods by their own. In other words, we carry out the same genetic-modelling experiment aimed at the formation of new ways of thinking, behavior in cognitive behavioral therapy, as we do it in cultural-historical psychology (Bek, Rash, Sho & Jemeri, 2003; Vygotsky, 1982; Lubovskij, 2008; Westbrook, Kennerley & Kirk, 2007).
Now let us talk about the psyche units of analysis, another cornerstone of any theory embodied in practice. The problem of the psyche units for analysis is always one of the most acute in psychology. «The psyche units for analysis» is a concept that was interpreted differently in the history of psychological science. In the «pre- Vygotsky» era, a unit of analysis was considered as the simplest part into which a psychological phenomenon can be decomposed. So, elementary mental phenomena were, as a rule, the psyche units of analysis in classical theories: «the simplest sensations in associationism, reactions in reactology, reflexes in reflexology, behavioral acts in behaviorism, intellectual operations in J. Piaget’s theory» (Dyakov, 2019: 107).
In the non-classical era, ideas about the psyche units of analysis changed radically together with changes of the ways rationalizing the reality. Non-classical psychology, based on the principle that a whole cannot be reduced to the totality of its parts, turned to such psyche units of analysis that contain the systemic features of a studied subject as a whole (Dyakov, 2019). The structural relations formed between a figure and its background, considered as the psyche units of analysis in gestalt psychology, are an example of such approach to the examined problem (Dyakov, 2019: 107–108).
It seems to us that L. S. Vygotsky’ approach is the most constructive solution to the problem of the psyche units of analysis. He proposed to change the interpretation of this concept by delimiting analysis by elements and units (Dyakov, 2019). Analysis by units, in contrast to analysis by elements, from his point of view, means separation of some substantial units in a studied object that include significant properties of the object as a whole. According to L. S. Vygotsky, the analysis by elements does not allow obtaining of full-fledged ideas about an object as a psychological integrity. On the contrary, the analysis by units, according to the founder of the cultural-historical theory of the psyche development, is focused on psychological structures that give us information about the system as a whole. L. S. Vygotsky understood under the psychic unit of analysis, as already noted above, firstly a meaning, and later, an individual’s meaningful experience. A meaningful experience was considered by L. S. Vygotsky as a dynamic unity of intellect and affect (Vygotsky, 1983). In the cognitive behavioral approach, the psyche unit for analysis is the same as it in the theory of L.S. Vygotsky, namely, a unity of cognitive and emotional (Kholomogorova, 2011). An individual’s thoughts and beliefs are not considered in the CBT as a self-sufficient phenomenon. Their significance is determined solely in the context of their influence on an individual’s emotional states, physiological sensations and behavior (Bek, Rash, Sho & Jemeri, 2003; Bek, 2006; Kholomogorova, 1996; Perris, Blackburn & Perris, 1988).
Here, I would like to turn to another important point postulated as the main methodological idea in L. S. Vygotsky’s theory and fully implemented in cognitive behavioral therapy: this is an idea about how relationships of affect and intelligence are organized. Unlike his predecessors, as well as many modern researchers and practitioners, who linearly understood this problem, L. S. Vygotsky considered these relationships as dynamically developing. Moreover, during human development, the share and role of intellect in these relationships is growing: «During development, not so much the properties and structure of intelligence and affect are changed, but rather the relationship between them ... Studies of a child’s life » from its most primitive to the most complex forms – show that the transition from lower to higher affective formations is directly related to changed relationships between affect and intellect» (Vygotsky, 1982: 255). According to L. S. Vygotsky, a mature personality is characterized by the ability to control passions: «Thinking can be a slave to passions, their servant, but it can also be their master» (Vygotsky, 1982: 255).
If we describe ideas about the ways of interaction of intellect and affect in different psychotherapeutic approaches, we can find that, for example, an affect is primary, and an attraction, to paraphrase Z. Freud, is a «horse» that carries a subject in psychoanalysis, despite its mainly vain attempts to cognitively organize this movement; behaviorism do not regard the relationships between intellect and affect as one of the central problems; but we can see a different situation in the cognitive behavioral approach. So, affect dominates at the initial stage, during the formation of deep emotional patterns determining how an individual understands a situation; but then, as a result of cognitive behavioral therapy, a certain organized development of an individual, intellect becomes the leading component of this unity and subjugates affect. Thus, both the cognitive behavioral approach and cultural-historical psychology understand the development as changes in ratio of intellect and affect, in the nature of this relationship from the prevailing and determining influence of affect on human behavior to the dominance of intellectual processes and their determining influence on affect.
Thus, the goal of cognitive behavioral psychotherapy is to improve mental processes for more effective regulation of the emotional sphere and behavior. Therefore, we can confidently argue that cognitive psychotherapy in practice embodies one of L. S. Vygotsky’s central theses about the dynamic structure of experiencing as a unity of intellect and affect and the need for specially organized educational efforts to bring intellect to the leading position in this unity.
Another important methodological point where cognitive behavioral therapy is seen as the practical implementation of the cultural-historical theory is the idea of mediation. So, in the cultural- historical psychology, mediation is expressed in the use of culturally- formed methods that change the psyche’s functioning structurally and meaningfully so it evolves from the natural to the social-cultural forms (Vygotsky, 1982). In the cognitive behavioral approach, an individual’s development, his/her psyche is also based on new cultural tools, as for their genesis, dealing with his/her thoughts, autobiographical experience, emotional self-regulation included in the structure of his/her mental processes, primarily thinking and memory (Beck, 2006). Interpretations of cultural-historical theory often reduce such cultural tools to signs, but L. S. Vygotsky clearly indicates that signs are only one option of them (Vygotsky, 1982). The core of L. S. Vygotsky’s idea, as it seems to us, consists precisely in the fact that an individual, because of mental processes transformation from natural to higher (or social-cultural), starts using cultural methods created by humankind over the millennia of its development. The ways to control thinking, its optimization, to test thoughts, beliefs, methods identifying cognitive distortions, planning and modelling behavioral changes, methods of emotional self-regulation can be considered as cultural tools optimizing human mental processes and behavior, creating awareness and arbitrariness of these processes (Vygotsky, 1982).
Another common idea is the idea of an individual’s mental activity internalization and its reorganization from inter-psychic to intra-psychic. L.S. Vygotsky expressed this idea of the internalization of processes that are interpersonal in their form and initial functions (Vygotsky, 1982). In the cognitive model of A. Beck, the idea of internalization means internalization of initially interpersonal methods of reflection, carried out using dialogues of a Socratic type, aimed at checking cognitions of various levels in order to create conditions for an individual to internalize this dialogue further (Bek, Rash, Sho & Jemeri, 2003; Bek, 2006).
Thus, the methodology of cognitive behavioral psychotherapy, as well as that of the cultural-historical psychology, understands an individual’s development as acquisition of cultural methods, tools for solving of substantive, communicative and intellectual tasks, mastery of one’s thinking and mental activity in general, and the internalization of these methods. This goal is realized in the course of a specially organized training according to both approaches.


The meta-cognitive idea of attitudes to one’s thoughts from a transcendental position, proposed by A. Beck, is consonant with the idea of reflexive thinking, developed by the cultural-historical psychology especially actively in the second half of the 20th century (Kholomogorova, 2016). CBT psychologists help to form the skill of meta-cognitive attitudes to cognitions at different levels with a Socratic dialogue; and the capability to reflect is realized in the course of activities carried out together with Other, according to the cultural-historical approach. In the categorical field of the cultural-historical psychology, this kind of work relies on a formed system of internal actions, which are components of a reflexive act and act as internal tools for managing cognitive processes, and through them, which is important, emotional states (Vygotsky, 1983; Galperin, 2017; Galperin & Danilova, 1980).

Let us now consider the concept of «internal speech», the most important for the cultural-historical theory. Internal speech, in contrast to external one, from L. S. Vygotsky’s point of view, has a predicative character and does not contain all the structural components necessary for external speech (Vygotsky, 1982). In the special theory of A. Beck, which formed the basis of cognitive behavioral therapy, the described concept can be put in line, with a certain degree of assumption, with the category of «automatic thoughts» (Bek, Rash, Sho & Jemeri, 2003; Bek, 2006; Westbrook, Kennerley & Kirk, 2007). So, in the course of his therapeutic practice, A. Beck discovered an essential role of non- apprehended cognitive processes, occurring in the form of curled inner speech, as well as uncontrolled visual images in the formation of depression. Such thoughts are characterized by speed, lack of control and a negative impact on an emotional state.
L. S. Vygotsky wrote on the role of negative automatic thoughts in the regulation of behavior and emotional states, as well as on the difficulties of their fixation in an experience: «... an individual always thinks inwardly: it always affects his/her behavior; a sudden change of thoughts during the experiment will always sharply demonstrated in the individual’s entire behavior... But we don’t know how to take this influence into account» (Vygotsky, 1982: 79). The development of a cognitive behavioral model allows us to take this influence into account and specially reorganize this influence for the benefit of an individual.


Thus, we can summarize that, from the standpoint of the cultural- historical psychology, psychological problems and disorders can rightfully be regarded as a lack of organizational tools for an individual’s mental activity and behavior, as well as for his/her self-regulation; and psychotherapy is a method to compensate the corresponding deficit. Namely such compensation occurs during cognitive behavioral therapy. The CBT strategic goal is to form an arsenal of psychological and behavioral tools to improve an individual’s self-regulation processes.

The methodologies of the cultural-historical approach and cognitive behavioral psychotherapy have a generally uniform idea on a study object, methods and the psychic units of analysis.
Cognitive behavioral therapy puts into practice the main provisions of L. S. Vygotsky’s cultural-historical approach: the idea of a dynamically developing unity of intellect and affect, the central role of cultural mediation of mental activities and its internalization in personal development.
**The prospects for further research are:** to examine cognitive behavioral therapy in the applied aspect.
**Declaration of Conflicting Interests.** The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

#### References Alford, B., & Beck, А. (1998). The Integrative Power of Cognitive Therapy. New York : The Guilford Press. Beck, A. (1976). Cognitive therapy and the emotional disorders. New York : International Universities Press. Meichenbaum, D. H. (1977). Cognitive behavior modification: An integrative approach. New York : Plenum. Perris, C., Blackburn, I. M., & Perris, H. (1988). The foundations of cognitive psychotherapy and its standing in relations to other psychotherapies. In: Cognitive Psychotherapy (theory and practice). New York : Springer Verlag. Wertsch, J. (2008). From social interaction to higher psychological processes: a clarification and application of Vygotsky’s theory. Human Development, 51, 66–79. doi: Westbrook, D., Kennerley, Н., & Kirk, J. (2007). An introduction to cognitive behavior therapy: skills and application. – London : Sage Publications. Bek, A., Rash, A., Sho, B., & Jemeri, G. (2003). Kognitivnaja terapija depressii [Cognitive Therapy for Depression]. Sankt-Peterburg : Piter. [in Russian]. Bek, Dzh. (2006). Kognitivnaja terapija: polnoe rukovodstvo [Cognitive Therapy: A Complete Guide]. Moscow : OOO «I.D. Vil’jams». [in Russian]. Vygotsky, L. S. (1982). Istoricheskij smisl psihologicheskogo krizisna [The historical meaning of the psychological crisis] (Vols. 1–6). (Vol. 1, pp. 1–487). Moscow : Pedagogika. [in Russian]. Vygotsky, L. S. (1982). Sobranie cochinenij [Collected works] (Vols. 1–6). (Vol. 2, pp. 1–504). Moscow : Pedagogika. [in Russian]. Vygotsky, L. S. (1982). Sobranie sochinenij [Collected works] (Vols. 1–6). (Vol. 4, pp. 1–400). Moscow : Pedagogika. [in Russian]. Vygotsky, L. S. (1982). Soznanie kak problema psihologii povedenija [Consciousness as a Problem of Behavioral Psychology] (Vols. 1–6). (Vol. 1, pp. 79–98). Moscow: Pedagogika. [in Russian]. Vygotsky, L. S. (1983). Osnovy defektologii [Defectology Basics] (Vols. 1–6). (Vol. 5, pp. 1–368). Moscow : Pedagogika. [in Russian]. Galperin, P. Ya. (2017). Experience in studying the formation of mental actions. Moscow University Psychology Bulletin, 4, 3–20. [in Russian]. doi: 10.11621/ vsp.2017.04.03 Galperin, P. Ya., & Danilova, V. L. (1980). Vospitanie sistematicheskogo myshlenija v processe reshenija malyh tvorcheskih zadach [The education of systematic thinking in the process of solving small creative problems]. Voprosy psihologii, 1, 31–38. [in Russian]. Retrieved from Dzyakau, D. R. (2019). Metodologija, teorija i metody psihologicheskih issledovanij [Methodology, theory and methods of psychological research]. Minsk : BGPU. [in Russian]. Zejgarnik, B. V. (2002). Patopsihologija [Pathopsychology]. Moscow : Akademija. [in Russian]. Kravtsova, E. E. (2008). Psychotherapy from the Cultural-Historical Point of View. RGGU Bulletin. Series «Psychology», 3, 15–27. [in Russian]. Retrieved from Lubovskij, D. V. (2008). Metodologicheskie osnovy psihologii [Methodological foundations of psychology]. Moscow : Smysl. [in Russian]. Puzyrej, A. A. (1986). Kul’turno-istoricheskaja teorija L.S. Vygotskogo i sovremennaja psihologija [Cultural-historical theory L.S. Vygotsky and modern psychology]. Moscow : Izdatel’stvo Moskovskogo universiteta. [in Russian]. Slobodchikov, V. I., & Isaev, E. I. (1995). Psihologija cheloveka. Vvedenie v psihologiju sub”ektivnosti [Human’s psychology. Introduction to the Psychology of Subjectivity]. Moscow : Shkola-Press. [in Russian]. Kholomogorova, A. B. (2016). Znachenie kul’turno-istoricheskoj teorii razvitija psihiki L.S. Vygotskogo dlja razrabotki sovremennyh modelej social’nogo poznanija i metodov psihoterapii [The value of the cultural-historical theory of the development of the psyche L.S. Vygotsky for the development of modern models of social cognition and methods of psychotherapy]. Kul’turno-istoricheskaja psihologija, 12(3), 58–92. [in Russian]. Retrieved from kholmogorova.pdf Kholomogorova, A. B. (2011). Cognitive psychotherapy of A. Beck and cultural- historical psychology of L.Vygotsky. Counseling Psychology and Psychotherapy, 19(2), 20–33. [in Russian]. Retrieved from shtml Kholomogorova, A. B. (1996). Filosofsko-metodologicheskie aspekty kognitivnoj psihoterapii [Philosophical and methodological aspects of cognitive psychotherapy]. Moskovskij psihoterapevticheskij zhurnal, 3, 7–28. [in Russian]. Retrieved from aspektu.pdf