Cognitive-behavioral therapy ( CBT ) is a psycho-social intervention that is the most widely used evidence-based practice for improving mental health. Guided by empirical research, CBT focuses on the development of personal coping strategies that target current problem resolution and change unhelpful patterns in cognition (eg thinking, belief, and attitudes), behavior, and emotional regulation. It was originally designed to treat depression, and is now used for a number of mental health conditions, such as anxiety.
The CBT model is based on a combination of the basic principles of behavioral and cognitive psychology. This wave of therapy has been called the second wave. Behavioral therapy is thus now referred to as the first wave. The most recent wave is the third wave, which contains an awareness-based therapy. CBT sits firmly inside the second wave. This differs from the historical approach to psychotherapy, such as the psychoanalytic approach in which the therapist looks for the subconscious meaning behind the behavior and then formulates the diagnosis. In contrast, CBT is a form of "problem-oriented" and "action-oriented" therapy, which means it is used to treat specific problems associated with a diagnosed mental disorder. The role of the therapist is to assist the client in finding and practicing effective strategies to address identified goals and reduce the symptoms of the disorder. CBT is based on the belief that distortion thinking and maladaptive behavior play a role in the development and maintenance of psychological disorders, and that related symptoms and disorders can be reduced by teaching new information processing skills and coping mechanisms.
When compared with psychoactive drugs, the review study has found CBT alone to be effective for treating less severe forms of depression and anxiety, post-traumatic stress disorder (PTSD), tics, substance abuse (with the exception of opioid use disorders), eating disorders and borderline personality disorder. It is often recommended in combination with medications to treat other conditions, such as obsessive compulsive disorder (OCD) and major depressive disorders, opioid addiction, bipolar disorder and psychotic disorders. In addition, CBT is recommended as first-line treatment for most psychological disorders in children and adolescents, including aggression and behavioral disorders. Researchers have found that other therapeutic interventions are equally effective for treating certain conditions in adults. Together with interpersonal psychotherapy (IPT), CBT is recommended in treatment guidelines as a psychosocial treatment option, and CBT and IPT are the only psychosocial interventions that require psychiatric citizens to be trained.
Video Cognitive behavioral therapy
Description
Mainstream cognitive behavioral therapy assumes that changing maladaptive thinking leads to changes in behavior and affect, but the latest variants emphasize change in one's relationship with maladaptive thinking rather than change in thinking itself. The goal of cognitive behavioral therapy is not to diagnose a person with a particular disease, but to look at the person as a whole and decide what can be changed. The basic steps in cognitive-behavioral assessment include:
- Step 1: Identify critical behaviors
- Step 2: Determine whether critical behavior is excess or deficit
- Step 3: Evaluate critical behavior for frequency, duration, or intensity (get baseline)
- Step 4: If excess, try to reduce the frequency, duration, or intensity of the behavior; if deficit, try to improve the behavior.
These steps are based on systems created by Kanfer and Saslow. After identifying the behavior that needs to be changed, whether it is an advantage or a deficiency, and treatment has occurred, the psychologist must identify whether the intervention is successful or not. For example, "If the goal is to reduce behavior, then there must be a relative decline in the baseline If critical behavior remains at or above the baseline, then the intervention has failed."
Therapists or computer-based programs use CBT techniques to help individuals challenge their patterns and beliefs and replace "mistakes in thinking such as overgeneralization, negative magnification, minimizing positive and disastrous" with "more realistic and effective thinking, thereby reducing emotional and self- defeating behavior ". This error in thinking is known as cognitive distortion. Cognitive distortions can be pseudo-discriminatory beliefs or excessive generalizations of something. CBT techniques can also be used to help individuals take a more open, caring, and aware attitude toward cognitive distortions that can reduce their impact. CBT Mainstream helps individuals replace "adaptability, cognition, emotion and behavior with more adaptive", by challenging individual ways of thinking and the way they react to certain habits or behaviors, but there is still controversy about the extent to which cognitive elements traditionally explains the effects seen with CBT above and above previous behavioral elements such as exposure and skills training.
Modern CBT forms include a variety of diverse but related techniques such as exposure therapy, stress inoculation, cognitive processing therapy, cognitive therapy, relaxation training, dialectical behavior therapy, and acceptance and commitment therapy. Some practitioners promote a form of mindful cognitive therapy that includes a greater emphasis on self-awareness as part of the therapeutic process.
CBT has six phases:
- Psychological assessment or assessment;
- Reconceptualization;
- Skill skills;
- Consolidate skills and application training;
- Generalization and maintenance;
- Post-treatment follow-up checks.
The reconceptualization phase makes the most of the "cognitive" part of CBT. A summary of the modern CBT approach is given by Hofmann.
There are various protocols for providing cognitive behavioral therapy, with important similarities between them. The use of the term CBT may refer to different interventions, including "self-instruction (eg disturbances, imagery, motivational self-talk), relaxation and/or biofeedback, development of adaptive mitigation strategies (eg minimizing negatives or thoughts who mislead themselves), change maladaptive beliefs about pain, and goal setting ". Treatment is sometimes done manually, with short, direct, and time-limited treatments for specific individual-driven psychological disorders. CBT is used both in individual and group settings, and techniques are often customized for self-help applications. Some physicians and researchers are cognitively oriented (eg cognitive restructuring), while others are more behavior-oriented (eg, in vivo exposure therapy ). Interventions such as imaginal exposure therapy combine both approaches.
Maps Cognitive behavioral therapy
Medical use
In adults, CBT has been shown to have an effectiveness and role in treatment plans for anxiety disorders, body dysmorphic disorders, depression, eating disorders, chronic back pain, personality disorders, psychosis, schizophrenia, substance use disorders, adjustment, depression, and anxiety. associated with fibromyalgia, and with post-spinal nerve injury.
In children or adolescents, CBT is an effective part of the treatment plan for anxiety disorder, body dysmorphic disorder, depression and suicide, eating disorders and obesity, obsessive-compulsive disorder (OCD), and post traumatic stress disorder and tic disorders , trichotillomania and other repetitive behavior disorders. CBT-SP, an adaptation of CBT for Suicide Prevention (SP), is specifically designed to treat a very depressed young man and who recently attempted suicide in the past 90 days, and found to be effective, feasible, and acceptable. Sparx is a video games to help young people, using CBT to teach them how to solve their own problems. CBT has also been proven effective for posttraumatic stress disorder in children are very young (3 to 6 years). CBT has also been applied to a variety of childhood disorders, including depression and various anxiety disorders.
CBT is combined with hypnosis and self-reported pain relief in children.
Cochrane's review found no evidence that CBT is effective for tinnitus, although there appears to be an effect on the management of related depression and quality of life under these conditions. The other recent Cochrane reviews found no convincing evidence that CBT training helps foster providers manage behavior that is difficult for youth under their care, nor does it help in treating people who abuse their intimate partners.
According to a 2004 review by INSERM of the three methods, cognitive behavioral therapy is "proven" or "suspected" to be an effective therapy in some specific mental disorders. According to the study, CBT is effective for treating schizophrenia, depression, bipolar disorder, panic disorder, post-traumatic stress, anxiety disorders, bulimia, anorexia, personality disorders and alcohol dependence.
Some meta-analyzes found CBT to be more effective than psychodynamic therapy and similar to other treatments for anxiety and depression.
Computerized CBT (CCBT) has been shown to be effective with randomized and other controlled trials in treating depression and anxiety disorders, including children, as well as insomnia. Several studies have found similar effectiveness to information website intervention and weekly phone calls. CCBT is found to be as effective as CBT face-to-face in teenage anxiety and insomnia.
Critics of CBT sometimes focus on implementation (such as UK IAPT) which can result in low quality therapy offered by poorly trained practitioners. However, evidence supports the effectiveness of CBT for anxiety and depression. Acceptance and commitment therapy (ACT) is a specialist branch of CBT (sometimes referred to as contextual CBT). ACT uses awareness and acceptance intervention and has been found to have greater longevity in therapeutic outcomes. In an anxious study, CBT and ACT increased similarly in all outcomes from pre-post-treatment. However, during 12 months of follow-up, ACT was shown to be more effective, suggesting that it was a long-lasting treatment model for anxiety disorders.
The evidence suggests that the addition of hypnotherapy in addition to CBT increases the efficacy of treatment for a variety of clinical problems.
CBT has been applied in both clinical and non-clinical environments to treat disorders such as personality conditions and behavioral problems. A systematic review of CBT in depression and anxiety disorders concluded that "CBT delivered in primary care, especially including computer-based or Internet-based self-help programs, is potentially more effective than ordinary treatments and can be delivered effectively by primary care therapists."
Emerging evidence suggests a possible role for CBT in the treatment of attention deficit hyperactivity disorder (ADHD); hypochondriasis; overcoming the effects of multiple sclerosis; sleep disorders associated with aging; dysmenorrhea; and bipolar disorder, but further studies are needed and the results should be interpreted with caution. CBT can have a therapeutic effect to reduce symptoms of anxiety and depression in people with Alzheimer's disease. CBT has been studied as an aid in the treatment of anxiety associated with stuttering. Initial studies have shown CBT to be effective in reducing social anxiety in stuttering adults, but not in reducing the frequency of stuttering.
In the case of people with metastatic breast cancer, data is limited but CBT and other psychosocial interventions may help with psychological outcome and pain management.
There is some evidence that CBT is superior in the long term for benzodiazepines and nonbenzodiazepines in the care and management of insomnia. CBT has been shown to be effective enough to treat chronic fatigue syndrome.
In the UK, the National Institute for Health and Nursing Excellence (NICE) recommends CBT in treatment plans for a number of mental health problems, including post-traumatic stress disorder, obsessive-compulsive disorder (OCD), bulimia nervosa, and clinical depression.
Anxiety disorder
CBT has been shown to be effective in treating adults with anxiety disorders.
The basic concept in some CBT treatments used in anxiety disorders is exposure in vivo . This term refers to a direct confrontation of the object, activity, or situation feared by the patient. For example, a woman with PTSD who is worried about the location where she is attacked may be assisted by her therapist to go to that location and face the fear immediately. Likewise, a person with a social anxiety disorder who is afraid to speak in public can be instructed to directly confront the fear by giving a speech. This "two-factor" model is often credited to O. Hobart Mowrer. Through stimulus exposure, this dangerous conditioning can be "not learned" (referred to as extinction and habituation). Studies have provided evidence that when examining animals and humans that glucocorticoids can lead to more successful extinction learning during exposure therapy. For example, glucocorticoids can prevent disturbing learning episodes from taking and increasing memory traction strengthening that creates a fearless reaction in a dreaded situation. The combination of glucocorticoids and exposure therapy may be a better treatment for treating patients with anxiety disorders.
The 2015 Cochrane review also found that CBT may be useful for patients with non-cardiac chest pain, and may reduce the frequency of episodes of chest pain.
Schizophrenia, psychosis, and mood disorders
Cognitive behavioral therapy has been shown to be an effective treatment for clinical depression. The American Psychiatric Association's Practice Guidelines (April 2000) show that, among psychotherapy approaches, cognitive behavioral therapy and interpersonal psychotherapy have the best documented efficacy for the treatment of major depressive disorders. One theory of depression aetiology is the cognitive theory of depression Aaron T. Beck. His theory states that depressed people think like that because their thinking is biased against negative interpretation. According to this theory, depressed people acquire the negative schemes of the world in childhood and adolescence as the effect of stressful life events, and negative schemes are activated in the future when the person faces the same situation.
Beck also describes negative cognitive triads. The cognitive triad consists of individual negative evaluations of self, world, and future. Beck suggests that this negative evaluation comes from the negative scheme and the cognitive biases of that person. According to this theory, depressed people have views such as "I never do a good job", "It is impossible to have a good day", and "things will never get better". Negative schemes help to cause cognitive bias, and cognitive biases help trigger negative schemes. Beck further proposes that depressed people often have the following cognitive biases: arbitrary inference, selective abstraction, over-generalization, enlargement, and minimization. This cognitive bias quickly makes negative, general, and personal conclusions about oneself, thereby triggering negative schemes.
In long-term psychosis, CBT is used to complement drugs and is tailored to meet individual needs. Interventions primarily associated with these conditions include exploring reality testing, altering delusions and hallucinations, checking for recurring factors, and managing relapse. Several meta-analyzes show that CBT is effective in schizophrenia, and the American Psychiatric Association incorporates CBT in its schizophrenical guidelines as evidence-based treatment. There is also limited evidence of effectiveness for CBT in bipolar disorder and severe depression.
A 2010 meta-analysis found that no trial using both blinding and psychological placebo has shown CBT to be effective in either schizophrenia or bipolar disorder, and that the size of the CBT effect is small in major depressive disorders. They also found a lack of evidence to conclude that CBT is effective in preventing recurrence of bipolar disorder. Evidence that severe depression is calmed by CBT is also lacking, with anti-depressant drugs still seen as much more effective than CBT, although success with CBT for depression was observed beginning in the 1990s.
According to Cox, Lyn Yvonne Abramson, Patricia Devine, and Hollon (2012), cognitive behavioral therapy can also be used to reduce prejudice against others. These other directed prejudices can cause depression in "others," or in the person when a person belongs to a group that has previously been prejudiced (ie deprejudice). "Devine and colleagues (2012) developed successful Prejudice Perpetrator interventions with many conceptual parallels for CBT, such as CBT, their intervention taught Sources to realize their automated thinking and deliberately disseminate various cognitive techniques to automated stereotypes." A systematic review of 2012 investigates the effects of CBT compared to other psychosocial therapies for people with schizophrenia:
With an older adult
CBT is used to help people of all ages, but therapy should be tailored based on the age of the patient with whom the therapist handles. Older individuals in particular have certain characteristics that need to be acknowledged and therapy is changed to account for these differences thanks to age.
Prevention of mental illness
For anxiety disorders, the use of CBT with at-risk people has significantly reduced the number of episodes of general anxiety disorder and other anxiety symptoms, and also provides significant improvements in explanatory style, despair, and dysfunctional attitudes. In another study, 3% of the group receiving CBT intervention developed generalized anxiety disorder with 12 months postintervention compared with 14% in the control group. Panic disorder Subthreshold patients were found to benefit significantly from the use of CBT. The use of CBT was found to significantly reduce the prevalence of social anxiety.
For depressive disorders, treatment intervention interventions (waiting with caution, CBT and treatment where appropriate) achieved a 50% lower incidence rate in the 75 or older age group. Other depression studies found a neutral effect compared to personal, social, and health education, and the provision of regular schools, and included comments on the potential increase in depression scores from those who had received CBT due to greater self-confidence and recognition of the symptoms of depression present. and negative thinking styles. Further studies also see neutral results. A meta-study of the Coping with Depression course, cognitive behavioral interventions delivered by psychoeducation methods, saw a 38% reduction in the risk of major depression.
For people at risk of psychosis, by 2014 the UK National Institute for Health and Nursing Excellence (NICE) recommends preventive CBT.
Gambling addiction
CBT is also used for gambling addiction. The percentage of people who bet the problem is 1-3% worldwide. Cognitive behavioral therapy develops skills for relapse prevention and one can learn to control their thoughts and manage high-risk cases.
Smoking cess
CBT sees smoking habits as a learned behavior, which then evolves into a coping strategy to deal with day to day stress. Because smoking is often easily accessible, and quickly enables users to feel good, it can take precedence over other coping strategies, and end up working in everyday life during non-stressful events as well. CBT aims to target behavioral function, as it may vary among individuals, and work to inject other coping mechanisms in place of smoking. CBT also aims to support individuals suffering from strong cravings, which is the main reason for relapse during treatment.
In a controlled study in 2008 from Stanford University Medical School, CBT proved to be an effective tool for most participants. Results from 304 random adult participants were tracked for one year. During this program, some participants are given medication, CBT, 24 hour telephone support, or a combination of three methods. At 20 weeks, participants receiving CBT had a 45% abstinence rate, compared to non-CBT participants, who had a 29% abstinence rate. Overall, the study concluded that emphasizing cognitive and behavioral strategies to support quitting smoking can help individuals build tools for long-term smoking cessation.
A mental health history may affect treatment outcomes. It should be noted that individuals with a history of depressive disorder have a lower success rate when using CBT alone to combat smoking addiction.
Feeding disorders
Although many forms of treatment may support individuals with eating disorders, CBT has been shown to be a more effective treatment than interpersonal drugs and psychotherapy alone. CBT aims to combat the main causes of adversity such as negative cognition around weight, shape and size. CBT therapists also work with individuals to organize strong emotions and thoughts that lead to dangerous compensatory behaviors. CBT is the first-line treatment for Bulimia Nervosa, and Non-Specific Eating Disorders.
History
Philosophical roots
Precursors of certain fundamental aspects of CBT have been identified in various traditions of ancient philosophy, especially Stoicism. Stoic philosophers, in particular Epictetus, believe that logic can be used to identify and dispel the false beliefs that lead to destructive emotions, which have influenced the way modern cognitive-behavioral therapists identify cognitive distortions that contribute to depression and anxiety. For example, the original treatment guide Aaron T. Beck for expressing depression, "The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers". Another example of Stoic's influence on cognitive theorists is Epictetus on Albert Ellis. The key philosophical figure that also influenced the development of CBT was John Stuart Mill.
Root behavior therapy
The modern roots of CBT can be traced to the development of behavioral therapy in the early 20th century, the development of cognitive therapy in the 1960s, and the subsequent merging of the two. Innovative work of behaviorism began with the study of John B. Watson and Rosalie Rayner about conditioning in 1920. The behavior-centered approach to therapy emerged in early 1924 with the work of Mary Cover Jones dedicated to the fear of children. This was the antecedent of the development of Joseph Wolpe's behavioral therapy in the 1950s. It is the work of Wolpe and Watson, based on Ivan Pavlov's work on learning and conditioning, which influenced Hans Eysenck and Arnold Lazarus to develop new behavioral therapy techniques based on classical conditioning. One of Eysenck's colleagues, Glenn Wilson points out that the conditioning of classic fear in humans can be controlled by verbal cognitive expectations, thereby opening up areas of research that support the thinking of cognitive behavioral therapy.
During the 1950s and 1960s, behavioral therapy was widely used by researchers in the United States, Britain and South Africa, inspired by the behaviorist learning theories of Ivan Pavlov, John B. Watson, and Clark L. Hull. In the UK, Joseph Wolpe, who applied experimental findings on animals to his systematic desensitization method, applied behavioral research to the treatment of neurotic disorders. Wolpe's therapeutic efforts are precursors to current fear-reduction techniques. British psychologist Hans Eysenck presented behavioral therapy as a constructive alternative.
At the same time as Eysenck's work, B. F. Skinner and his colleagues began to impact with their work on operant conditioning. Skinner's work is called radical behaviorism and avoids anything related to cognition. However, Julian Rotter, in 1954, and Albert Bandura, in 1969, contributed behavioral therapy with their respective works on social learning theory, demonstrating the effects of cognition on learning modification and behavior.
The emphasis on behavioral factors is the "first wave" of CBT.
Root cognitive therapy
One of the first therapists to discuss cognition in psychotherapy is Alfred Adler with the idea of ​​basic error and how they contribute to the creation of unhealthy or useless behavioral and life goals. Adler's work affects the work of Albert Ellis, who developed the earliest cognitive-based psychotherapy, known today as a rational emotive behavior therapy, or REBT.
Around the same time that rational emotional therapy, as it was known, was being developed, Aaron T. Beck was conducting free association sessions in his psychoanalytic practice. During these sessions, Beck notes that the mind is not at least as Freud had once thought, and that certain types of thinking can be the culprit of emotional stress. It was from this hypothesis that Beck developed cognitive therapy, and called these thoughts "automatic thinking".
These two therapies, rational emotional therapy and cognitive therapy, initiate the "second wave" of CBT, which is an emphasis on cognitive factors.
Cognitive behavior and therapy combine
Although initial behavioral approaches are successful in many neurotic disorders, they have little success in treating depression. Behaviorism is also losing popularity due to the so-called "cognitive revolution". Therapeutic approaches Albert Ellis and Aaron T. Beck are gaining popularity among behavioral therapists, although previously there were behaviorist rejection of "mentalistic" concepts like mind and cognition. Both of these systems include elements and behavioral interventions and are mainly concentrated on problems in the present.
In the initial study, cognitive therapy often contrasted with behavioral care to see which was most effective. During the 1980s and 1990s, cognitive and behavioral techniques were incorporated into cognitive behavioral therapy. Important for this incorporation is the successful development of care for panic disorder by David M. Clark in the UK and David H. Barlow in the US.
Over time, cognitive behavioral therapy becomes known not only as a therapy, but as a general term for all cognitive-based psychotherapy. This therapy includes, but is not limited to, emotional rational therapy, cognitive therapy, acceptance and commitment therapy, dialectical behavior therapy, reality therapy/choice theory, cognitive processing therapy, EMDR, and multimodal therapy. All these therapies are a blend of cognitive and behavioral based elements.
The mixing of theoretical and technical foundations of both behavior and cognitive therapy is the "third wave" of CBT, which is the current wave. The most prominent therapy of this third wave is dialectical behavior therapy and acceptance and commitment therapy.
Access method
Therapist
A typical CBT program will consist of a face-to-face session between the patient and the therapist, which consists of 6-18 sessions about an hour each with a gap between 1-3 weeks between sessions. This initial program may be followed by several booster sessions, for example after one month and three months. CBT has also been found to be effective if the patient and the type of therapist are in real time to each other through a computer connection.
Cognitive behavioral therapy is closest to scientist-practitioner models in which clinical practice and research are informed by a scientific perspective, a clear operationalization of the problem, and emphasis on measurement, including measuring changes in cognition and behavior and in achieving goals. These are often encountered through "homework" assignments in which patients and therapists work together to arrange tasks to complete before the next session. The completion of these tasks - which can be as simple as a person suffering from depression attending some kind of social event - shows dedication to medication compliance and the desire to change. The therapist can then logically measure the next treatment step based on how thoroughly the patient completes the task. Effective cognitive behavioral therapy depends on therapeutic alliances between health care practitioners and people seeking help. Unlike many other forms of psychotherapy, patients are heavily involved in CBT. For example, an anxious patient may be asked to speak with a stranger as a homework assignment, but if it is too difficult, he can do an easier task first. The therapist must be flexible and willing to listen to the patient rather than acting as an authority figure.
Computerize or Internet delivery
Computerized cognitive behavioral therapy (CCBT) has been described by NICE as "a general term for delivering CBT through interactive computer interfaces delivered by personal computers, the Internet, or an interactive voice response system," rather than face-to human therapists. It is also known as cognitive behavioral therapy delivered via the internet or ICBT. CCBT has the potential to improve access to evidence-based therapy, and to address the costly and inadequate availability that is sometimes associated with maintaining human therapists. In this context, it is important not to disrupt CBT with 'computer-based training', which is now more commonly referred to as e-Learning.
CCBT has been found in meta-studies to be cost-effective and often less expensive than usual treatments, including for anxiety. Studies have shown that individuals with social anxiety and depression have improved with online CBT-based methods. A review of current CCBT research in OCD treatment in children found this interface to have great potential for future OCD treatment in adolescents and adolescent populations. In addition, most of the internet interventions for post-traumatic stress disorder use CCBT. CCBT also tends to treat mood disorders among non-heterosexual populations, which may avoid face-to-face therapy for fear of stigma. But currently the CCBT program rarely serves this population.
The main problem in using CCBT is low absorption and settlement rates, even when it is clearly available and explained. The CCBT completion rate and efficacy of treatment have been found in some studies to be higher when the use of CCBT is supported personally, with support not only limited to therapists, compared to use only in the form of self-help. Another approach to improving the rate of absorption and completion, as well as the results of treatments, is to design software that supports the formation of strong therapeutic alliances between users and technology.
In February 2006 NICE recommended that CCBT be available for use in the NHS throughout England and Wales for patients with mild to moderate depression, rather than directly selecting antidepressant medications, and CCBT provided by some health systems. The NICE 2009 guidelines recognize that there is the possibility of a number of computerized CBT products that benefit the patients, but eliminates support for specific products.
The relatively new research path is a combination of artificial intelligence and CCBT. It has been proposed to use modern technology to create CCBTs that simulate face-to-face therapy. This may be achieved in cognitive behavioral therapy for certain disorders using CBT's comprehensive domain knowledge. One area where this has been tried is the specific domain area of ​​social anxiety in those who stutter.
Reading the self-help materials
Enabling patients to read CBT self-help guidelines has proven effective by several studies. However one study found negative effects on patients who tended to chew the breed, and other meta-analyzes found that benefits were only significant when self-help was guided (eg by a medical professional).
Group education course
Patient participation in group courses has proven to be effective. In a meta-analysis that reviewed evidence-based OCD treatment in children, individual CBTs were found to be more effective than CBT groups.
Type
BCBT
Short cognitive behavioral therapy (BCBT) is a form of CBT that has been developed for situations where there are time constraints on therapy sessions. BCBT lasts for several sessions that can last up to 12 hours of accumulation by design. This technique was first applied and developed to soldiers abroad in active duty by David M. Rudd to prevent suicide.
Treatment details
- Orientation
- Commitment to care
- Crisis response and safety planning
- Means restrictions
- Survival tools
- Reason for live card
- Model suicide
- Journal of care
- Lessons learned
- Focus on skills
- Skill development worksheet
- Overcome card
- Demonstration
- Practicing
- Skill enhancement
- Relapse prevention
- Generalize expertise
- Skill enhancement
Cognitive emotional behavioral therapy
Cognitive emotional behavioral therapy (CEBT) is a form of CBT developed initially for individuals with eating disorders but is now used with a variety of problems including anxiety, depression, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and anger problems. It combines aspects of CBT and dialectical behavioral therapy and aims to enhance understanding and emotional tolerance to facilitate therapeutic processes. It is often used as a "pretreatment" to prepare and better equip individuals for long-term therapy.
Structured cognitive behavior training
Structured cognitive behavior training (SCBT) is a cognitive-based process with a very interesting core philosophy of CBT. Like CBT, SCBT insists that behavior is closely related to beliefs, thoughts, and emotions. SCBT is also built on the core CBT philosophy by combining other well-known modalities in the field of behavioral health and psychology: in particular, Albert Ellis's rational emotional behavior therapy. SCBT differs from CBT in two different ways. First, SCBT is delivered in a very strict format. Secondly, SCBT is a pre-determined and limited training process that becomes personalized by input from participants. SCBT is designed to bring participants to specific results within a certain time frame. SCBT has been used to challenge addictive behaviors, especially with substances such as tobacco, alcohol and food, and to manage diabetes and deal with stress and anxiety. SCBT has also been used in the field of criminal psychology in an effort to reduce recidivism.
Moral reconstruction therapy
Moral reconstruction therapy, a type of CBT used to help felons overcome antisocial personality disorder (ASPD), slightly reduces the risk of further abuses. This is generally implemented in group format because the risk of offenders with ASPD is given one-on-one therapy reinforces narcissistic behavioral characteristics, and can be used in correctional or outpatient settings. Groups usually meet every week for two to six months.
Training of stress inoculation
This type of therapy uses a mixture of cognitive, behavioral, and some humanistic training techniques to target client stressors. This is usually used to help clients cope with their stress or anxiety better after a stressful event. This is a three-phase process that trains clients to use the skills they already have to better adapt to their current stress. The first phase is the interview phase that includes psychological testing, client self-monitoring, and various reading materials. This allows the therapist to individually tailor the training process with the client. Clients learn how to categorize problems into emotional focus or focus on issues, so they can better handle their negative situations. This phase ultimately prepares clients to finally confront and reflect on their current reaction to stressors, before finding ways to change their reactions and emotions in relation to their stressors. The focus is conceptualization.
The second stage emphasizes aspects of skill acquisition and continuing practice from the initial phase of conceptualization. Clients are taught skills that help them cope with their stressors. These skills are then practiced in the therapy room. These skills involve self-regulation, problem solving, interpersonal communication skills, etc.
The third and final phase is the application and follow the skills learned in the training process. This provides an opportunity for clients to apply the skills they learn to a variety of stressors. Activities include role playing, imaging, modeling, etc. Ultimately, clients will be trained in a preventative way to inject personal, chronic, and future stress by breaking their stress into problems they will deal with in the long term, short-term, and medium-term coping goals.
Hypnotherapy cognitive behavior based on consciousness
Mindfulness-based cognitive hypnotherapy (MCBH) is a form of CBT that focuses on awareness in a reflective approach by overcoming subconscious tendencies. This is more a process that essentially contains three phases that are used to achieve the desired goal.
Integrated Protocol
The Unified Protocol for the Treatment of Transdiagnostic of Emotional Disorders (UP) is a form of CBT, developed by David H. Barlow and a researcher at Boston University, which can be applied to a variety of depressive and anxiety disorders. The reason is that anxiety and depression disorders often occur together because of underlying common causes and can be efficiently treated together.
UP includes a common set of components:
- Psychic-education
- Cognitive review
- Emotional settings
- Changing the behavior
UP has been shown to produce results that are equivalent to a single diagnostic protocol for certain disorders, such as OCD and social anxiety disorders. UP is deployed by the Unified Protocol Institute.
Criticism
Relative effectiveness
Research conducted for CBT has become a topic of continuing controversy. While some researchers write that CBT is more effective than other treatments, many other researchers and practitioners have questioned the validity of the claim. For example, one study determined that CBT was superior to other treatments for treating anxiety and depression. However, researchers who responded directly to the study re-analyzed and found no evidence of CBT superior to other bonafide treatments, and analyzed thirteen other CBT clinical trials and determined that they failed to provide evidence of the superiority of CBT.
The main criticism is that clinical studies of the efficacy of CBT (or any psychotherapy) are not double blind (ie, subjects or therapists in psychotherapy studies are not blind to this type of treatment). They may be single blind, that the assessor may not know the treatment the patient is receiving, but the patient or therapist is unaware of the type of therapy (two of the three people involved in the trial, all of those involved in the treatment, are not blinded). The patient is an active participant in correcting the negative distorted mind, so as to be reasonably aware of the group of treatments they are entering.
The importance of double-blinding is demonstrated in a meta-analysis that examines the effectiveness of CBT when placebo and blindedness control are taken into account. Data were collected from experiments published by CBT in schizophrenia, major depressive disorder (MDD), and bipolar disorder control used for the non-specific effects of the intervention were analyzed. The study concluded that CBT was no better than non-specific control interventions in the treatment of schizophrenia and did not reduce recurrence rates; a small treatment effect in MDD treatment studies, and it is not an effective treatment strategy for the prevention of recurrence of bipolar disorder. For MDD, the authors note that the size of securities collected is very low. However, the methodological process used to select the study in the meta-analysis mentioned earlier and the value of its findings has been questioned.
Effectiveness decreases
In addition, the 2015 meta-analysis reveals that the positive effects of CBT on depression have declined since 1977. The overall results show two distinct decreases in effect size: 1) overall decline between 1977 and 2014, and 2) steeper decline between 1995 and 2014. Additional sub-analyzes revealed that a CBT study in which therapists in the test group were ordered to adhere to the Beck CBT manual had a steeper decrease in effect size since 1977 than studies in which the therapist in the test group was ordered to use CBT without a manual. The authors report that they are not sure why the effect is decreasing but the list of inadequate therapeutic training, failure to adhere to the manual, lack of therapist experience, and patient expectations and beliefs in its efficacy fade as a potential reason. The authors suggest that this study is limited to depression alone.
High drop-out rate
Furthermore, other researchers wrote that the CBT study had a high drop-out rate compared to other treatments. Sometimes, CBT drop-out rates can be more than five times higher than other treatment groups. For example, the researchers provided statistics from 28 participants in the group who received drop out of CBT therapy, compared with 5 participants in the group who received the dropout problem-solving therapy, or 11 participants in the group receiving psychodynamic therapy who dropped out. This high drop-out rate is also evident in the treatment of some disorders, especially eating disorders anorexia nervosa, which is generally treated with CBT. Those treated with CBT have a high chance of getting out of therapy before it is finished and returning to their anorexia behavior.
Other researchers performing care analysis for self-injured youth found similar rates of drop-out in CBT and DBT groups. In this study, the researchers analyzed several clinical trials that measured the effectiveness of CBT given to adolescents who injured themselves. The researchers concluded that none of them were found to be efficacious. This conclusion was made using the APA 12 Task Group on the Promotion and Dissemination of Psychological Procedures to determine the potential for intervention.
Philosophical concerns with CBT method
The method used in CBT research is not the only criticism; some people call the theory and the therapy as a question. For example, Fancher argues that CBT has failed to provide a clear and correct frame of mind. He stated that it was strange for CBT theorists to develop a framework for determining distorted thinking without ever developing a framework for "cognitive clarity" or what would be considered a "healthy and normal mind". In addition, he writes that irrational thinking can not be a source of mental and emotional stress when there is no evidence of rational thought leading to psychological well-being. Or, social psychology has proven the normal cognitive process of the average person becomes irrational, even those who are psychologically good. Fancher also said that CBT theory is inconsistent with basic principles and rationality research, and even ignores many rules of logic. He argues that CBT makes things far less appealing and true than thought possible. Among other arguments is maintaining the status quo promoted in CBT, self-deception is encouraged in clients and patients involved in CBT, how poorly the research is done, and some basic principles and norms: "The basic cognitive norm of therapy is this: except how patients think, Everything is alright ".
Meanwhile, Slife and Williams write that one of the hidden assumptions in CBT is determinism, or the absence of free will. They argue that CBT calls a type of causal relationship with cognition. They claim that CBT states that external stimuli from the environment enter the mind, causing thoughts that cause an emotional state. No place in CBT theory is an agent, or free will, that counts. On the most basic basic assumption, CBT argues that humans have no free will and are determined only by the cognitive processes generated by external stimuli.
Another criticism of the theory of CBT, especially applied to major depressive disorder (MDD), is that it confuses the symptoms of the disorder with its cause.
Side effects
CBT is generally seen to have very low if any side effects. Calls have been made for more assessment of CBT side effects.
Society and culture
The UK National Health Service announced in 2008 that more therapists will be trained to provide CBT at government costs as part of an initiative called Improving Access to Psychological Therapy (IAPT). NICE says that CBT will be the main treatment for non-severe depression, with drugs used only in cases where CBT has failed. The therapist complained that the data did not fully support the received attention and funding of CBT. Psychotherapist and professor Andrew Samuels stated that this was a "coup, a power game by a society that suddenly finds itself on the verge of huge sums of money... Everyone is tempted by the cheapness of CBT prices." The British Council for Psychotherapy issued a press release in 2012 saying that the IAPT policy undermined traditional psychotherapy and criticized a proposal that would limit some of the approved therapies for CBT, claiming that they restricted patients to "softened cognitive behavior therapy (CBT) delivered by highly trained staff ".
NICE also recommends offering CBT to people suffering from schizophrenia, as well as those at risk of suffering from psychotic episodes.
References
Further reading
- Aaron T. Beck (1979). Cognitive Therapy and Emotional Disorders . Plume. ISBN 978-0-45200-928-8
- Butler G, Fennell M, and Hackmann A. (2008). Cognitive-Behavioral Therapy for Anxiety Disorders . New York: The Guilford Press. ISBN 978-1-60623-869-1
- Dattilio FM, Freeman A. (Eds.) (2007). Cognitive Behavior Strategies in Crisis Interference (3rd ed.). New York: The Guilford Press. ISBN 978-1-60623-648-2
- Fancher, R. T. (1995). The Middlebrowland of Cognitive Therapy. In Healing Culture: Correcting the image of American mental health. p.Ã, 195-250.
- Keith S. Dobson (2009). Cognitive Behavior Therapy Handbook, Third Edition . Guilford Press. pp. 74-88. ISBN 978-1-60623-438-9.
- Hofmann, SG. (2011). Introduction to Modern CBT. Psychological Solutions for Mental Health Problems. Chichester, England: Wiley-Blackwell. ISBNÃ, 0-470-97175-4.
- Willson R, Branch R. (2006). Cognitive Behavior Therapy for Dummies . ISBN 978-0-470-01838-5
External links
- Association for Behavioral and Cognitive Therapy (ABCT)
- The British Association for Behavioral and Cognitive Psychotherapy
- National Association of Cognitive-Behavioral Therapists
- International Cognitive Psychotherapy Association
- Information on CBT Treatment Based on Research
Source of the article : Wikipedia
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