Cognitive Behavioral Therapy (CBT) | TEST SAUCE (2023)

Abstract

To overcome behavioral problems like anxiety, depression or anxiety, people often share their problems or fears with trusted friends or family members. For slightly more complicated problems, a consultant is consulted. These are relatively simple forms of psychotherapy that people have been practicing for centuries. However, with the development of modern science and advances in the field of psychology, theorists have identified some more effective approaches to psychoanalysis. One such approach is cognitive-behavioral treatment or therapy (CBT). CBT for depression is a psychotherapeutic treatment approach that involves the use of specific, empirically supported strategies designed to change negative thinking patterns and behaviors. Cognitive therapy teaches clients the connection between thought patterns, emotional state and behavior. This therapy encourages the client to change irrational and negative thinking patterns in order to alleviate the emotional symptoms caused by the thoughts. These approaches were developed as a result of modern psychological research and therefore based on scientific principles.

introduction

Cognitive behavioral therapy (CBT) represents a combination of behavioral and cognitive theories of human behavior, psychopathology, and a fusion of emotional, family, and peer influences. rational lifestyle and dialectical behavior therapy. CBT develops a series of skills that allow a person to be aware of their thoughts and emotions; recognize how situations, thoughts and behaviors affect emotions; and improve feelings by changing dysfunctional thoughts and behaviors (Cully, J., Teten, A., 2008). This theme/theory was chosen because it targets multiple areas of potential vulnerability (eg cognitive, behavioral, affective) with developmental strategies and cuts across multiple intervention pathways. The target groups, or population groups, that this research will target include mental disorders in adolescents and adolescents. This article discusses the framework and explains why this practice is the cornerstone of therapeutic practice. The application of CBT in the field of mental health is reviewed and the reasons why this specific theory is chosen for future practice are presented.

History of TCC

True to its name, cognitive behavioral therapy (CBT) emerged as a rational fusion of behavioral and cognitive theories of human behavior, causal and maintenance forces in psychopathology, and intervention goals (Kendall & Hollon, 1979). CBT was originally developed to treat depression and has since been adapted to treat anxiety disorders, substance use disorders, personality disorders, eating disorders, bipolar disorder, and schizophrenia (Wenzel, A., Brown, G.K. & Karlin, B.E. (2011) CBT was developed by Aaron Beck in the 1960s, starting with a development that combined elements of behavior therapy with cognitive therapy.Milkman H Wanberg K (2007) Derives from the original Rational-Emotive Behavioral Therapy (RET) approach. Cognitive Therapy (CT) by Donald Meichenbaum using Cognitive Behavior Modification (CBM) (Spicer, A.2005) REBT is a form of directive, persuasive, and confrontational therapy in which the therapist plays the role of teacher. negative "irrational" thoughts when confronted with a triggering event. When or if clients confront these thoughts and change them, the theory goes, changes will occur. behaviors/responses. Cognitive therapy involves open-ended questions to allow a person to reflect, address and solve problems.
The various strategies that make up TCC reflect its complex and inclusive history. Borrowing from theories of early response conditioning (Bandura, 1977), CBT includes concepts such as extinction and habituation. CBT began to integrate modeling strategies and cognitive restructuring of social learning and cognitive theories. Additionally, the focus on self-talk and problem solving is evident in CBT's overall approach to encouraging the development of personal coping skills and mastery of emotional and cognitive processes. Consistent with a tripartite (cognition, behavior, emotion) view of psychopathology (Barlow, 2000), CBT focuses on these multiple areas of vulnerability and potential for intervention.
The research provides a history of CBT applied to juvenile psychopathology. This history dates back to the 1960s, when the value and effectiveness of the prevailing psychodynamic perspective (Levitt, 1963) was questioned and found inadequate. As a result, behavioral therapy grew in importance, but by the 1960s these therapies were initially controversial and were relegated primarily to treating behavioral disorders in severely disturbed children. It was not until the mid-1970s that the continued expansion of behavioral therapies reached higher functioning patients, integrated the role of cognitive processing, and integrated a focus on emotions. The transition did not happen all at once. Eventually, sociocognitive processing, self-management psychology, and emotion regulation were combined into behavioral interventions and emerged as the CBT of today.
Before CBT, there was behavior therapy, which was initially controversial and underappreciated, but eventually paved the way for empirical treatments for adolescent mental disorders. For example, Mowrers' "bell and pad" approach to treating enuresis is a commonly cited example of early behavioral intervention. Although the clinical application of behavioral strategies did not begin in earnest until the 1960s, early work laid the groundwork by targeting and addressing observable behavior and measuring the outcomes of subsequent cognitive-behavioral interventions in the child.

chosen theory

Respondents' explanations of conditioning behaviors influenced early behavior therapy, particularly for the treatment of anxiety. In respondent conditioning, a conditioned stimulus (CS) closely follows an unconditional stimulus (UCS) that elicits an unconditional fear response (UCR). After repeated matings, only the CS will elicit the fear-related response (CR). Response conditioning was historically important in giving rise to notions of exposure tasks to treat anxiety that are now an established example, if not a hallmark, of modern CBT for childhood anxiety (Barrios, O'Dell, 1998). Children often experience a variety of behaviors and then learn from the consequences. An example of this is smoking. If they try to smoke and are accepted into the crowd of peers, this is positive reinforcement and the child is likely to repeat the behavior. If the same child is picked up and disciplined, the likelihood that he will continue the behavior is minimized and he is less likely to repeat it (McLeod, p. 2007). These opportunities play an important role in shaping behavior over time. Environments with unpredictable and preferred contingencies can lead to decreased self-efficacy and maladjustment.
Many behavioral processes continue to be used in CBT. Over time, behavioral therapy began to address the thought processes and cognitive skills thought to be involved in implementing and receiving emergency management and has become more widely used in less severe populations. This shift towards more functional youth and greater awareness of the role of cognition was an important part of the shift to CBT. Many behavioral and cognitive behavioral interventions were initiated and studied with children in mind. They were not adult treatments, nor were they downward extensions of adult treatments used in children. To their credit, cognitive-behavioral therapies with adolescents were intentionally developmentally sensitive and research-based interventions.
In CBT, the approach is based on the rationale that a person's cognitions play an important role in developing and maintaining emotional and behavioral responses to life situations. Post Traumatic Stress Disorder (PTSD) Case Study. PTSD is a type of anxiety disorder that can occur after extreme emotional trauma with a perceived threat of death or serious injury. The CBT treatment approach typically involves two theoretical orientations about why anxiety develops. The first of these is learning theory. Learning theory focuses on how fear and trauma avoidance mechanisms are conditioned, activated, and reinforced. The second is the Emotional Processing Theory. It is this meaning attributed to the memory that prevents the individual from engaging with the traumatic memory and then processing the information. The purpose of CBT for patients with PTSD is to teach cognitive reframing techniques. This may include some form of confrontation with the traumatic memory, such as B. repeated exposure to images or a written description of the trauma. This allows the patient to construct a detailed description of the event and discuss feelings and cognitions associated with it. The thought process strategy allows patients to understand how switching from memory to mind actually increases the impact of memory. Memory, on the other hand, is treated and accepted as memory. In a study of 92 victims of aggression, trauma-focused cognitive-behavioral therapy/treatment, use of virtual reality, imagery, or written representations were effective treatments for PTSD (Prendes, A., & Resko, S.). Exposure to violence and traumatic experiences of children and young people is extremely high. In a nationally representative sample of children and adolescents in the United States, 60.4% reported exposure in the past year, with lifetime rates increasing from nearly one-half to one-third depending on the type of exposure (Finkelhor, Turner, Omrod, and Hamby, 2009). With these statistics, CBT will clearly be beneficial in the treatment of children and adolescents. Cognitive-behavioral therapy is also frequently used in the treatment of borderline personalities in adolescence. CBT with borderline patients due to its explicit focus on self-regulation and use of the Meichenbaum approach to teach impulse control to impulsive children. Focus on progressively internalizing and reusing the self-instructions to stop, watch, listen, postpone, plan, and execute an appropriate strategy. Cognitive techniques directed against catastrophizing, black-and-white thinking, or either thinking are appropriate for treating borderline patients. The therapist points out how these cognitive patterns are activated in specific circumstances and helps the patient test for them as they arise. Borderline patients are not easily "discussed" about their distortions and are rarely able to engage in the reality-oriented "collaborative empiricism" of cognitive therapy when their emotions are aroused (Westen, D. 1991).

The forward shift

CBT is defined as an intentional combination of demonstrated efficiency and methodological rigor of behavioral procedures with cognitive-mediative processes that affect adaptation (Kendall, Hollon, 1979). In the 1970s, internal thought processes (eg, self-talk) began to be seen as targets and mechanisms of change, important for cognitive improvement rather than behavior change. modeling and a reaction cost contingency. As has shown promise in efforts to incorporate children's developing cognitive abilities into behavior modification to effect therapeutic change, cognition processes have been integrated into behavioral interventions. By integrating cognition, the behavioral model took on a broader approach and was effectively a behavior change strategy.
Meyers and Craighead (1984) identified several forces driving the shift to cognitive-behavioral interventions. One strength, cognitive psychology, has been a factor in influencing behavior therapy with children through (a) modeling, (b) self-instruction training, and (c) problem solving. The cognitive information processing explanation for modeling or observational learning states that a person can learn, even without responsive or operant contingencies, by observing another person's behavior. Although modeling has historically been identified with behavior therapy, Bandura's explanation of the effects of modeling highlighted attention and retention, which are cognitive processes derived from a cognitive-psychological model of information processing, as one of the main factors that affect observational learning. Bandura's model report, which marked the beginning of a cognitive report for part of behavior therapy, and his discussion of the role of symbolic cognitive processes in behavior change were springboards for later theoretical development of CBT (Meyers, Craighead, 1984 ). Indeed, many behavioral interventions have been understood from both an information processing and a more general cognitive perspective (Mahoney, 1974).
Self-instruction training was another way in which cognitive psychology influenced behavior therapy. Self-instruction emerged to teach impulsive children to control their behavior. The program drew on the language development sector of cognitive developmental psychology, specifically on the work of Luria and Vygotsky, who proposed that children learn to control their own behavior through overt and eventually covert language. Researchers and clinicians continue to draw on the cognitive development literature to incorporate cognitive strategies and improve behavior therapy procedures. For example, the literature on social cognition has contributed to ideas about self-talk and social skills training and to our understanding of behavior change mechanisms.
Problem solving, although once associated with behavioral learning, has a cognitive, information-processing twist. Problem solving within CBT for youth focuses on internal thought processes as a mechanism for change. Some of the early youth programs used problem solving. As evidence of their lasting impact, many evidence-based youth programs today have a problem-solving approach. The emphasis on modifying thought processes as a means of producing cognitive and behavioral change illustrates the integration of CBT and developmental cognitive psychology.
Self-management interventions have been described as the third force behind CBT for adolescents. Explanations for self-control procedures have increasingly been cognitive in nature, with influential papers supporting the role of internal factors in self-control. In work with children, core self-control beliefs were applied in the mid-1970s as theoretical advances (eg, Bandura's self-efficacy reinforced the relationship between overt and covert events. Studies of self-control and self-efficacy came to the fore). of private cognitive experiences in a way that can be integrated into behavioral paradigms.
Anxiety disorders in children are often linked to causal factors such as school, family relationships, and social functioning. Childhood anxiety disorders are not sufficiently recognized and treated. It has been speculated that up to 12-20% of children in mental health settings experience extreme manifestations of anxiety and nervousness (Knell & Dasari, 2006, Schafer, 2009). Behavioral problems that result from fearful responses to their world disrupt the child, families, and community. Parents often misinterpret the root of the problem as anxiety and instead describe it as attitude, indulgence, or attention-seeking behavior. A study of children aged 7 to 17 years with separation anxiety or generalized anxiety disorder were treated with CBT over a period of years. CBT was a 60-minute session that included several tools to assess children's anxiety for data collection. The drug was introduced for part of the group and a combination was used for the remaining group members. The final results show that CBT is an effective treatment. This is good news and will increase parents' focus on treatment and open the door to more diagnoses and treatments for children (Walkup, J., Albano, A., Piacentini, J. & Birmaher, B. (2008).
The emerging successes of cognitive therapy in adult disorders have influenced the psychological treatment of children. A central assumption of cognitive therapy is that maladaptive cognitive processes produce mental disorders that can be improved by modifying these cognitive processes. Ellis' irrational thinking and Beck's cognitive biases are examples of key concepts that have influenced CBT. In particular, Ellis and Harper suggested that people behave inappropriately and/or experience negative moods because they engage in irrational thought processes. Therefore, they argued that the focus of therapy is to change maladaptive thought patterns. Beck also believed that maladaptive cognition is associated with mental disorders. Many research reviews have supported cognitive therapy with adults, and clinical work with children has been influenced by and frequently referenced by the work of Beck and Ellis.
With the growing number of studies demonstrating the therapeutic benefits of cognitive therapy, the focus has shifted to the assessment and understanding of cognition, despite traditional difficulties in isolating and measuring such phenomena. Some of the earliest cognitive therapies in adults were based on belief and reason, although later efforts emphasize the usefulness of prospective hypothesis testing and behavioral tasks.
The integration of cognitive and behavioral strategies has thrived in achieving clinically meaningful results due to the convenience and feasibility of this combination. Indeed, without the positive research reviews, the approach would not have captured the interest of practitioners or among researchers. In summary, the use of contingencies to facilitate children's participation in exercises that produce cognitive changes was data-supported and clinically appealing.
While its initial impetus was the coming together and integration of cognitive (e.g., thoughts affect behavior and emotions) and behavioral (e.g., research assessment, contingency) traditions, CBT quickly evolved and evolved into an approach-based treatment. a broader set of models. CBT grew and materialized to address disorders arising in adolescence and developmental vulnerabilities to psychopathology. Just as the role of cognition in its pioneering form was incorporated into behavior therapy, so too were forces related to social environments, genetic vulnerabilities, therapeutic processes, and family and peer relationships.
To illustrate broad models, consider Clark and Watson's three-part model to explain the extensive overlap of disorders, anxiety and depression, that would otherwise be considered separate. The three-part model describes how anxiety and depression share a common component, negative affect, which explains the overlap in symptoms. Negative affect is the feeling of great objective suffering and includes a variety of affective states, such as: B. Feeling angry, afraid, sad, worried, and guilty. The model suggests that negative affect is a common dispositional susceptibility to emotional psychopathology, particularly anxiety and depression. On the other hand, low positive affect is a specific factor in depression and autonomic arousal is a specific factor in anxiety. CBT for treating emotional disorders also focuses on overlapping features, consistent with the tripartite model. However, Barlow suggested that anxiety is distinct from autonomic arousal. He proposed that negative affect is a pure manifestation of the emotion of fear, while autonomic arousal is a manifestation of the emotion of fear. Despite small differences, autonomic arousal, high levels of discomfort and negative affect, and low levels of positive affect are considered important predisposing features of emotional psychopathology. Targeting and addressing these prominent factors across all disorders is an accepted strategic approach in CBT.
Barlow described a triple vulnerability model of emotional disorders: (1) a general genetic vulnerability, (2) a general psychological vulnerability characterized by a diminished sense of control, and (3) a specific psychological vulnerability arising from early learned experiences. This stress-diathesis model is consistent with how children can develop a diminished sense of control through experiences of their own highly reactive arousal system and high negative affect and uncontrollable life events. Once a diminished sense of control develops, the child is more likely to perceive other events as uncontrollable, even those he could handle. For example, an overly controlling, insensitive and unpredictable family environment can promote a feeling of uncontrollability and an external locus of control, a great psychological vulnerability. A specific psychological vulnerability can arise from early experiences of socialization with family members or peers and contribute to the experience of psychopathology in specific areas. Consistent with this model of vulnerability, CBT approaches for adolescents involve training parents to focus more on contextual issues and developing children's mastery of their own environment.

Current and future directions

Disorder-specific CBT apps for children and teens are widely used. A search on the keywords "cognitive behavioral therapy" and "children" on PsycInfo, an online database of psychological literature, yielded 1,192 articles, of which 1,156 were published since 1990 in the field of Clinical and Adolescent Psychology and Psychiatry . The original book on CBT with children and adolescents is now in its fourth edition, with several chapters describing CBT procedures for specific disorders (Kendall, 1991).
True to its links to empirical methods of behavior therapy, cognitive-behavioral therapy with children and adolescents continues to be guided by empirical research. Studies of the nature of specific disorders inform treatment procedures, and evaluations of treatments applied to real cases inform distribution and practice. To date, an impressive body of empirical research supports the use of CBT for the treatment and prevention of various mental disorders in youth. The American Psychological Association Task Force for the Promotion and Dissemination of Psychological Procedures has established criteria for determining whether treatments can be considered empirically supported (see also Chambless & Hollon's criteria (Chambless, Hollon, 1998).
Based on the criteria, treatments can be classified as "well established", "probably effective", "possibly effective", or "experimental". CBT has become the most empirically supported treatment for various internalizing disorders in youth. Specific CBT modalities were categorized as “well-established” such as B. Children-only groups and children's groups plus a parent component for adolescents with depressive disorders. A specific CBT protocol for adolescents exposed to traumatic events, trauma-focused CBT, is also considered “well established”. Many other CBT protocols have been deemed "probably effective" in treating internalizing disorders, including the Coping Cat program for anxiety and phobic disorders, school group CBT for exposure to traumatic events, and individual exposure-based CBT for obsessive-compulsive disorders. disorder disorders. obsessive-compulsive disorder
Although less support has been found for the use of CBT for externalizing disorders in adolescents, group CBT is considered a "well-established" treatment for substance abuse in adolescents and some CBT protocols, such as programs, are considered "probably effective" for treating disruptive behavior in youth (Eyberg, Nelson, Boggs, 2008). In general, CBT is often considered the “first line of defense” in the treatment of adolescent mental disorders.
While additional work is needed to strengthen the effectiveness of CBT for adolescents, the researchers called for a change to examine mediators, moderators, and predictors of treatment outcome. This appeal urges researchers to go beyond assessing how well the treatment works and investigate why and for whom it works]. Future research has many candidates worth exploring. Potential mediating variables worth investigating include individual components of treatment protocols, therapeutic process variables such as therapeutic alliance and child involvement, and client change processes. Future work is also needed to delineate whether specific pretreatment characteristics, comorbidities, and treatment formats moderate or predict outcome. Given the increasing use of technology in society, a specific area ripe for research involves the use of computer technology in CBT protocols.
A pressing concern and an area that needs empirical support is how best to disseminate CBT in community practice (Beidas, Kendall, 2010). Growing empirical support for the effectiveness of CBT does not justify its use. “Bridging the gap” between research findings and clinical practice is an effort that requires efforts from all stakeholders, including mental health researchers, practitioners, policymakers, and consumers (Tansella, Thornicroft, 2009). Arguably, the pursuit of dissemination represents the next chapter in the history of CBT. Participation in these efforts is likely to lead to overall improvements in adolescent mental health care.

Diploma

CBT represents an integration of behavioral, cognitive, and other (eg, developmental, social) theories of human behavior and psychopathology. The many strategies that make up CBT reflect its complex and integrative history and include conditioning, modeling, cognitive restructuring, problem solving, and the development of personal coping skills, mastery, and a sense of self-control. CBT targets multiple areas of potential vulnerability (eg, cognitive, behavioral, or affective) and provides opportunities for intervention. CBT is often considered the treatment of choice for mental disorders in adolescence. More work is needed to understand the mediators, moderators, and predictors of treatment outcome and to seek dissemination of effective CBT approaches.

references

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