Cognitive-behavioral therapy (CBT) is a brief and time-limited approach that recognizes the importance of a sound and collaborative therapeutic alliance. Meichenbaum created a self-instructional training program (SIT) for impulsive children. It combines strategies designed to modify maladaptive self-talk with knowledge of the development manner in which children learn by modeling behavior. SIT is a self-management tool that provides a way for people to overcome negative self-talk encourage themselves with more positive words, and teach themselves how to effectively cope in situations that had previously been difficult for them (Seligman & Reichenberg, 2014). The therapist models behavior and the client practices the behavior by repeating it back. SIT can be used with all ages, and for many behaviors.
Cognitive-Behavior Modification
Meichenbaum developed cognitive behavior modification in an effort to integrate psychodynamic and cognitive treatment systems with the "technology of behavior therapists" (Seligman & Reichenberg, 2014). Three assumptions made in CBM:
The role of the counselor is to help people alter their stories and cognitions so they can build "new assumptive worlds". To do this, CBM uses cognitive interventions, like Socratic dialogues and reframing (Seligman & Reichenberg, 2014)
- Constructive narrative - people actively construct their own reality
- Information processing - an activating event taps into a person's core cognitions, leading to an unhelpful, inaccurate, and distorted thought
- Conditioning - cognitions are viewed as covert behaviors that have been conditioned
The role of the counselor is to help people alter their stories and cognitions so they can build "new assumptive worlds". To do this, CBM uses cognitive interventions, like Socratic dialogues and reframing (Seligman & Reichenberg, 2014)
Strategies and Interventions
Stress Innoculation Training - this is an approach to reduce stress and assumes that if people can successfully cope with relatively mild stressors, they will be able to tolerate and successfully cope with more severe ones. It seeks to immunize people against the adverse impact of stress by helping them successfully handle increasing levels of stress (Seligman & Reichenberg, 2014). People typically experience stress because of a perception that their life circumstances exceed their capacity to cope (Seligman & Reichenberg, 2014).
Three phases of stress inoculation:
Treatment includes continuous reinforcement and assessment of people's efforts and accomplishments. Taking one step at a time and building on successes can make challenging situations manageable and foster self-esteem and more desirable cognitions and behaviors (Seligman & Reichenberg, 2014).
Behavioral Activation Therapy - this therapy involves increasing activity on a daily basis to help motivate people with depression who may experience low energy and may have withdrawn from life to such an extent that they are not capable of participating in cognitive therapy. This therapy is also used when individuals do not have enough energy to recognize or discuss cognitive distortions or cannot seem to overcome what may be keeping them stuck in their depression (Seligman & Reichenberg, 2014). Behavioral activation therapy is usually started at the beginning of treatment for depression and helps people increase their activity levels, improve their mood, and provide a source of pleasure on which they can build. The most frequently used strategies used include establishing a list of pleasant activities, scheduling, monitoring, and charting activities, relaxation and skills training, recognizing aversive and avoidant behaviors, and confronting cognitive distortions (Seligman & Reichenberg, 2014).
Habit Reversal Training - uses reinforcement and other behavior techniques to help people recognize tics before they happen, monitor their own behavior during stressful situations, use relaxation techniques, and perform alternative behaviors that are incompatible with the behavior they are trying to extinguish (Seligman & Reichenberg, 2014). This technique has been shown to be effective in reducing tics and sometimes results in a reduction in the need for medication as well.
Exposure - through the use of exposure, the person learns to identify his or her fear responses, to recognize maladaptive cognitions, to confront or "sit with" the uncomfortable feelings without avoiding, running away, or otherwise modifying the experience, and achieve a certain amount of self-efficacy or control over the feelings of distress. As a result the person learns new methods of coping and handling emotions, rather than giving in to the fear (Seligman & Reichenberg, 2014).
Flooding - usually provides intensive exposure over 30 minutes to 8 hours. Flooding can be overwhelming and is not appropriate for use in the treatment of phobias in which it might be dangerous.
Graduated exposure - involves having the person confront the fear for a short period of time and then gradually increasing the length of exposure which each session.
Systematic desensitization - designed to reduce fears, phobias, obsessions, compulsions, and anxiety (Seligman & Reichenberg, 2014).
Eye Movement Desensitization and Reprocessing - a form of exposure therapy that combines bilateral stimulation, behavioral desensitization, and cognitive restructuring in a structured eight-phase process. This therapy originally focused on people who had had traumatic experiences by helping them to reduce negative images and emotions related to those images and modify self-destructive cognitions.
Problem-Solving Therapy - provides a positive intervention that focuses on the acquisition of constructive problem-solving skills to address increased stress, relationship conflict, anxiety, mood disorders, and a variety of other issues. Problem-solving therapy consists of a four-step process 1) identifying the problem, 2) brainstorming alternatives, 3) conducting a cost/benefit analysis of possible solutions and 4) monitoring and evaluating outcomes (Seligman & Reichenberg, 2014). Clients reduce impulsive decisions, minimize conflict, and decrease the use of maladaptive coping skills. Problem-solving therapy has been used successfully for relational problem solving, compliance with behavior change, with physical illness, and with increased stress due to caregiving (Seligman & Reichenberg, 2014).
Three phases of stress inoculation:
- Conceptualization - in this phase, the client and clinician develop a collaborative relationship. Clients are taught about stress, the relationship between stress and coping, and the roles that thoughts, actions, and emotions play in engendering and maintaining stress. Initial goals of treatment include translating stress into specific fears and problems that are amenable to solution and helping people achieve some control over their lives (Seligman & Reichenberg, 2014).
- Skills Acquistion and Rehearsal Phase - this phase teaches people to cope effectively with mild stressors by gathering information, using coping self-statements, learning relaxation strategies, changing their behaviors, or using other strategies to reduce those fears. People also learn to apply problem solving to their fears according to the following five steps: problem identification, goal selection, development of alternatives, evaluation of each possible solution and its probable consequences, and decision making and rehearsal of coping strategies (Seligman & Reichenberg, 2014).
- Application and Follow-Through - in the last phase, people implement their plans to solve problems and reduce stress. Distressing stressors are tackled as people become able to modify their dysfunctional thoughts, effectively using coping skills, and applying what they learned in phase 2. (Seligman & Reichenberg, 2014).
Treatment includes continuous reinforcement and assessment of people's efforts and accomplishments. Taking one step at a time and building on successes can make challenging situations manageable and foster self-esteem and more desirable cognitions and behaviors (Seligman & Reichenberg, 2014).
Behavioral Activation Therapy - this therapy involves increasing activity on a daily basis to help motivate people with depression who may experience low energy and may have withdrawn from life to such an extent that they are not capable of participating in cognitive therapy. This therapy is also used when individuals do not have enough energy to recognize or discuss cognitive distortions or cannot seem to overcome what may be keeping them stuck in their depression (Seligman & Reichenberg, 2014). Behavioral activation therapy is usually started at the beginning of treatment for depression and helps people increase their activity levels, improve their mood, and provide a source of pleasure on which they can build. The most frequently used strategies used include establishing a list of pleasant activities, scheduling, monitoring, and charting activities, relaxation and skills training, recognizing aversive and avoidant behaviors, and confronting cognitive distortions (Seligman & Reichenberg, 2014).
Habit Reversal Training - uses reinforcement and other behavior techniques to help people recognize tics before they happen, monitor their own behavior during stressful situations, use relaxation techniques, and perform alternative behaviors that are incompatible with the behavior they are trying to extinguish (Seligman & Reichenberg, 2014). This technique has been shown to be effective in reducing tics and sometimes results in a reduction in the need for medication as well.
Exposure - through the use of exposure, the person learns to identify his or her fear responses, to recognize maladaptive cognitions, to confront or "sit with" the uncomfortable feelings without avoiding, running away, or otherwise modifying the experience, and achieve a certain amount of self-efficacy or control over the feelings of distress. As a result the person learns new methods of coping and handling emotions, rather than giving in to the fear (Seligman & Reichenberg, 2014).
Flooding - usually provides intensive exposure over 30 minutes to 8 hours. Flooding can be overwhelming and is not appropriate for use in the treatment of phobias in which it might be dangerous.
Graduated exposure - involves having the person confront the fear for a short period of time and then gradually increasing the length of exposure which each session.
Systematic desensitization - designed to reduce fears, phobias, obsessions, compulsions, and anxiety (Seligman & Reichenberg, 2014).
Eye Movement Desensitization and Reprocessing - a form of exposure therapy that combines bilateral stimulation, behavioral desensitization, and cognitive restructuring in a structured eight-phase process. This therapy originally focused on people who had had traumatic experiences by helping them to reduce negative images and emotions related to those images and modify self-destructive cognitions.
Problem-Solving Therapy - provides a positive intervention that focuses on the acquisition of constructive problem-solving skills to address increased stress, relationship conflict, anxiety, mood disorders, and a variety of other issues. Problem-solving therapy consists of a four-step process 1) identifying the problem, 2) brainstorming alternatives, 3) conducting a cost/benefit analysis of possible solutions and 4) monitoring and evaluating outcomes (Seligman & Reichenberg, 2014). Clients reduce impulsive decisions, minimize conflict, and decrease the use of maladaptive coping skills. Problem-solving therapy has been used successfully for relational problem solving, compliance with behavior change, with physical illness, and with increased stress due to caregiving (Seligman & Reichenberg, 2014).