Cognitive behavioral training

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Cognitive behavioral training (CBTraining), sometimes referred to as structured cognitive behavioral training, (SCBT) is an organized process that uses systematic, highly-structured tasks designed to improve cognitive functions. Functions such as working memory, decision making, and attention are thought to inform whether a person defaults to an impulsive behavior or a premeditated behavior. [1] The aim of CBTraining is to affect a person's decision-making process and cause them to choose the premeditated behavior over the impulsive behavior in their everyday life. [2] Through scheduled trainings that may be up to a few hours long and may be weekly or daily over a specific set of time, the goal of CBTraining is to show that focusing on repetitive, increasingly difficult cognitive tasks can transfer those skills to other cognitive processes in your brain, leading to behavioral change. [3] There has been a recent resurgence of interest in this field with the invention of new technologies and a greater understanding of cognition in general. [3]

Contents

The roots of CBTraining lie in a combination of cognitive behavioral therapy (CBT) and general cognitive training. Cognitive training seeks to improve cognitive functions for the sake of improved brain processing ability. [4] The basic premise of CBT is that behavior is inextricably related to beliefs, thoughts and emotions. [5] Between those two mentalities lies the idea that in changing the way a person responds to stimulus through training, it is possible to change a person's actions.

However, the positive effects of CBTraining have been difficult to prove throughout the field of research. [6] Lack of randomized controlled trials (RCTs) in many studies and a lack of a standardization of training methods and definitions of success make it difficult to compare studies with each other and find trends. [7] Overall, many clinical reviews conclude that initial results expressing the benefits of CBTraining may have been overestimated, but the data shows positive enough results that continued research is encouraged. [2] [3] [8] [9]

Description

Methods

Cognitive behavioral training (CBTraining) is a cognitive-based process designed with the aim to systematically break down emotionally driven dependencies and behaviors, replacing them with behaviors that are based on rational choice. [4] Testing can be computerized or gamified. Bickel et al. describe this method of training as such, "adaptive-training programs rely on computerized algorithms that adjust intervention content to a patient's skill level in realtime in order to tax participants at the limit of their capacity and maintain engagement during training." [10] Nixon and Lewis note that programs which adjust to participants' skill levels are more successful at encouraging participants to complete trainings since the testing itself can be repetitive and uninteresting. [3]

Inhibitory control training (ICT) is a method of CBTraining, which uses cues paired with promoting or inhibiting stimulus to change behavior. [11] These cues can be general or specific to an undesirable behavior and use Go/no go or Stop-Signal tests. [11] An example of a cue-specific ICT test was used in Stice et al.'s study designed to limit unhealthy food consumption by combining inhibitory signals with images of unhealthy food more often than non-food-related images. [12]

Working memory training (WMT) is a method that targets working memory enhancements as a vehicle for changing behavior. [13] Working memory is "the ability to retain some information active for further use, and to do so in a flexible way allowing information to be prioritized, added, or removed." [1] Self-regulatory and goal-maintaining behavior has been tied to working memory [1] so WMT has emerged as a way to alter behavior through improving cognition. For example, Snider et al. sought to extend the time-related reward window in patients with alcohol dependency by improving working memory so they created twelve training exercises including one that had participants move objects on a digital desk while following auditory instructions in a particular order. [13]

Attentional bias modification (ABM) seeks to change an individual's behavior by directing their attention away from undesired cues and sometimes includes neutral cues that attention is directed towards. [8] This is commonly carried out by a visual probe test like the one used by Kerst et al. on a handheld mobile device given to habitual cigarette smokers. [14] Participants were asked to engage in three trainings and one assessment per day over a one week period and self report cravings and alterations, if any, in smoking habits. [14]

Difference from CBT

Although CBTraining employs some similar concepts that define Cognitive Behavioral Therapy, there are some fundamental differences between CBTraining and CBT, both in philosophy and in application. CBTraining is training, not therapy. This is a critical distinction: unlike typical forms and applications of CBT, CBTraining is a process that is finite. In CBT, as with most therapy, the patient plays a large role in determining the direction of the therapy, including the intensity and duration. [5] A CBTraining course, or program, is often broken up into a series of progressive, strategically ordered sessions designed to guide the participant through the process of training the brain away from impulsive thinking. [15] The goal is to adjust the automatic processes that lead to undesired behaviors through repetitious training sessions designed to promote a desired behavior. [8] CBTraining aims to change participants' behaviors through seemingly unrelated tasks by demonstrating near transfer (application of improved skills to circumstances that are very similar to those of the trained task) and far transfer (application of improved skills to circumstances that are very different from those of the trained task). [3]

Willpower

In addressing addictive behavior and other potentially destructive behavior compelling to the participant, CBTraining uses an approach of urge conditioning/desensitization. This approach stands in contrast to what is commonly most instinctive to people (urge avoidance), and seems counter-intuitive at first. The approach of urge desensitization has been applied to patients with gambling addictions, and research has shown it to be effective. [16] When a person is trying to quit smoking, for instance, the instinct is to remove all smoking paraphernalia from his presence. While this "out of sight, out of mind" approach seems to make sense, it does nothing to actually deal with the emotionally driven urge to smoke. A measure of success that is vital for positive results, but not often recorded in studies, is the determination to complete the program and adjust behaviors. [3]

Further distinguishing CBTraining from its closely related psychological predecessors is the inclusion of the concept of "Training" in place of "Therapy". CBTraining is a planned, intricately designed and systematically applied regimen that is purposely finite. CBTraining begins with a specific goal, and is constructed as a time-specific road map to achieving the goal. [17]

History of development

Along with CBT, CBTraining also owes some debt to Albert Ellis's rational emotive behavior therapy (REBT), formerly known as Rational Emotive Therapy. REBT is classified as a form of CBT, [18] and is anchored by the belief that a person is "affected emotionally by his/her perspective and attitude about outside things." As with CBTraining, REBT incorporates Positive Self-Image Psychology. Lou Ryan, a pioneer in the creation, development, and practical application of CBTraining, worked for some time under the guidance of Albert Ellis. In the early 1980s, Ryan, who was well-versed in Ellis's theories and philosophies, met Ellis in Hawaii after a series of seminars. Ellis recognized his own impact in Ryan's CBTraining programs, and played a peripheral part in some of the development.

Specific applications

Health and wellness

CBTraining has been established to some degree in changing emotionally addictive behaviors related to tobacco. [19] [20] There is evidence that cognitive group behavioral training may be beneficial for patients with type 1 diabetes in their self-care. [21] SCBT has been used to help people with diabetes manage their disease, with the primary goal being maintained lifestyle changes to slow or halt the progression of the disease. It has also shown some promise in reducing pain receptor reactions in the brain after a painful stimulus. [22]

In studies of overeating and obesity, researchers note that high impulsivity is correlated with overweight and obese individuals. [2] CBTraining in the form of response inhibition training has shown positive results affecting amount and type of food eaten in a sitting and weight reduction, though the longevity of results requires more study. [2] [8]

Addiction

Alcohol Use Disorder (AUD) and Substance Use Disorder (SUD) have been correlated to cognitive impairments, though it is not known if one is cause for the other. [3] [9] [10] Verdejo-Garcia et al. specifically indicate AUD and SUD patients display "deficits in reward and salience valuation, executive functions, and decision-making." [9] Continued engagement in treatment programs for these diseases has also been related to cognitive levels leading researchers to aim to promote program engagement through improving cognitive skills in AUD and SUD patients. [3] [10] One study showed improvements in self-control and delayed reward valuation in participants who completed several working memory training sessions, but those gains did not transfer to other inhibition skills. [10] The field of studying CBTraining in AUD and SUD patients suffers from lack of randomized controlled trials making it difficult to quantify results. [3] [10] Nixon and Lewis argue that with studies in this field, it is not sufficient to only show improvements in memory recall and decision-making, but those improvements must be applicable to participants’ lives outside of the study, their continued sobriety and engagement in society. [3]

PTSD

CBTraining has been applied to symptoms of post-traumatic stress disorder in one study by showing participants traumatizing video clips and then having them play a game of Tetris for a specific amount of time. [23] The study was designed to replace the act of recalling a traumatic memory, which is a visuospatial memory process, with another visuospatial activity within the desired time window in order to disrupt the brain's ability to solidify the original memory. [23] Minimal results were reported. [23]

Disease management

Cognitive Behavioral Training, applied in a structured way, has been used to deal effectively with women dealing with the stressors of having breast cancer (e.g., changing thoughts about stressors) in studies done at the University of Miami. [24]

In adolescents with behavior disorders

Two studies examining CBTraining gamification applied to autism spectrum disorder used three levels of the game Junior Detective Training Program and 20 hours of the game Let's Face It! respectively to teach children to recognize facial cues, physical positions and other forms of emotional communication with moderately positive results. [23]

Efficacy

Overall criticisms

Although studies have been limited, initial data indicates that success with CBTraining is largely dependent on the active, cooperative participation of the patient. This essentially means that CBTraining, as it is presented in internet form, is geared towards participants who, in relation to the stages-of-change theory, are in the preparation and action stages. [25] In other words, CBTraining is most effective when applied to people with a high motivation and capacity to change. [3]

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.

<span class="mw-page-title-main">Anger management</span> Therapy for anger prevention and control

Anger management is a psycho-therapeutic program for anger prevention and control. It has been described as deploying anger successfully. Anger is frequently a result of frustration, or of feeling blocked or thwarted from something the subject feels is important. Anger can also be a defensive response to underlying fear or feelings of vulnerability or powerlessness. Anger management programs consider anger to be a motivation caused by an identifiable reason which can be logically analyzed and addressed.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Mindfulness-based cognitive therapy (MBCT) is an approach to psychotherapy that uses cognitive behavioral therapy (CBT) methods in conjunction with mindfulness meditative practices and similar psychological strategies. The origins to its conception and creation can be traced back to the traditional approaches from East Asian formative and functional medicine, philosophy and spirituality, birthed from the basic underlying tenets from classical Taoist, Buddhist and Traditional Chinese medical texts, doctrine and teachings.

<span class="mw-page-title-main">Psychological intervention</span>

In applied psychology, interventions are actions performed to bring about change in people. A wide range of intervention strategies exist and they are directed towards various types of issues. Most generally, it means any activities used to modify behavior, emotional state, or feelings. Psychological interventions have many different applications and the most common use is for the treatment of mental disorders, most commonly using psychotherapy. The ultimate goal behind these interventions is not only to alleviate symptoms but also to target the root cause of mental disorders.

Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one therapeutic approach within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cognitive therapy is based on the cognitive model, which states that thoughts, feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses. This involves the individual working with the therapist to develop skills for testing and changing beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors. A cognitive case conceptualization is developed by the cognitive therapist as a guide to understand the individual's internal reality, select appropriate interventions and identify areas of distress.

SMART Recovery is an international community of peer support groups that help people recover from addictive and problematic behaviors, using a self-empowering and evidence-informed program. SMART stands for Self-Management and Recovery Training. The SMART approach is secular and research-based. SMART has a global reach, with a presence established in more than 30 countries. SMART Recovery is effective with a range of addictive and problematic behaviors

<span class="mw-page-title-main">Polysubstance dependence</span> Medical condition

Polysubstance dependence refers to a type of substance use disorder in which an individual uses at least three different classes of substances indiscriminately and does not have a favorite substance that qualifies for dependence on its own. Although any combination of three substances can be used, studies have shown that alcohol is commonly used with another substance. This is supported by one study on polysubstance use that separated participants who used multiple substances into groups based on their preferred substance. The results of a longitudinal study on substance use led the researchers to observe that excessively using or relying on one substance increased the probability of excessively using or relying on another substance.

In psychology and neuroscience, executive dysfunction, or executive function deficit, is a disruption to the efficacy of the executive functions, which is a group of cognitive processes that regulate, control, and manage other cognitive processes. Executive dysfunction can refer to both neurocognitive deficits and behavioural symptoms. It is implicated in numerous psychopathologies and mental disorders, as well as short-term and long-term changes in non-clinical executive control. Executive dysfunction is the mechanism underlying ADHD Paralysis, and in a broader context, it can encompass other cognitive difficulties like planning, organizing, initiating tasks and regulating emotions. It is a core characteristic of ADHD and can elucidate numerous other recognized symptoms.

Cognitive remediation is designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved psychosocial functioning.

Attentional retraining is the retraining of automatic attentional processes. The method of retraining varies but has typically employed computerized training programs. The term originally indicated retraining of attention to rehabilitate individuals after a brain injury who had neurological disorders of attention including hemineglect, perseveration, limited attention span, and even ADHD. However, in more recent research and clinical applications attentional retraining has also been applied as a type of cognitive bias modification. In this application, attentional retraining refers to the retraining of automatic attentional biases that have been observed in high levels of anxiety.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

About 1 in 7 Americans suffer from active addiction to a particular substance. Addiction can cause physical, psychological, and emotional harm to those who are affected by it. The American Society of Addiction Medicine defines addiction as "a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences." In the world of psychology and medicine, there are two models that are commonly used in understanding the psychology behind addiction itself. One model is referred to as the disease model of addiction. The disease model suggests that addiction is a diagnosable disease similar to cancer or diabetes. This model attributes addiction to a chemical imbalance in an individual's brain that could be caused by genetics or environmental factors. The second model is the choice model of addiction, which holds that addiction is a result of voluntary actions rather than some dysfunction of the brain. Through this model, addiction is viewed as a choice and is studied through components of the brain such as reward, stress, and memory. Substance addictions relate to drugs, alcohol, and smoking. Process addictions relate to non-substance-related behaviors such as gambling, spending money, sexual activity, gaming, spending time on the internet, and eating.

Cognitive emotional behavioral therapy (CEBT) is an extended version of cognitive behavioral therapy (CBT) aimed at helping individuals to evaluate the basis of their emotional distress and thus reduce the need for associated dysfunctional coping behaviors. This psychotherapeutic intervention draws on a range of models and techniques including dialectical behavior therapy (DBT), mindfulness meditation, acceptance and commitment therapy (ACT), and experiential exercises.

Relapse prevention (RP) is a cognitive-behavioral approach to relapse with the goal of identifying and preventing high-risk situations such as unhealthy substance use, obsessive-compulsive behavior, sexual offending, obesity, and depression. It is an important component in the treatment process for alcohol use disorder, or alcohol dependence. This model founding is attributed to Terence Gorski's 1986 book "Staying Sober."

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war. More recently, TF-CBT has been applied to and found effective in treating complex posttraumatic stress disorder.

Compassion-focused therapy (CFT) is a system of psychotherapy developed by Paul Gilbert that integrates techniques from cognitive behavioral therapy with concepts from evolutionary psychology, social psychology, developmental psychology, Buddhist psychology, and neuroscience. According to Gilbert, "One of its key concerns is to use compassionate mind training to help people develop and work with experiences of inner warmth, safeness and soothing, via compassion and self-compassion."

Donald H. Meichenbaum is an American psychologist and Distinguished Professor Emeritus of Psychology at the University of Waterloo, Ontario. He is a research director of the Melissa Institute for Violence Prevention and Treatment at the University of Miami. Meichenbaum is known for his research and publications on psychotherapy, and contributed to the development of the technique of cognitive-behavioural therapy (CBT). In 1982, a survey of 800 members of the American Psychological Association voted Meichenbaum the tenth most influential psychotherapist of the 20th century. At the time of his retirement from the University of Waterloo in 1998, Meichenbaum was the most-cited psychology researcher at a Canadian university.

<span class="mw-page-title-main">Mindfulness-Oriented Recovery Enhancement</span> Mind-Body therapy program

Mindfulness-Oriented Recovery Enhancement (MORE) is an evidence-based mind-body therapy program developed by Eric Garland. It is a therapeutic approach grounded in affective neuroscience that combines mindfulness training with reappraisal and savoring skills. Garland developed this approach by combining the key features of mindfulness training, "Third Wave" cognitive-behavioral therapy, and principles from positive psychology.

References

  1. 1 2 3 Bledowski C, Kaiser J, Rahm B (December 2010). "Basic operations in working memory: contributions from functional imaging studies". Behavioural Brain Research. 214 (2): 172–9. doi:10.1016/j.bbr.2010.05.041. PMID   20678984. S2CID   10918930.
  2. 1 2 3 4 Adams RC, Sedgmond J, Maizey L, Chambers CD, Lawrence NS (September 2019). "Food Addiction: Implications for the Diagnosis and Treatment of Overeating". Nutrients. 11 (9): 2086. doi: 10.3390/nu11092086 . PMC   6770567 . PMID   31487791.
  3. 1 2 3 4 5 6 7 8 9 10 11 Nixon SJ, Lewis B (September 2019). "Cognitive training as a component of treatment of alcohol use disorder: A review". Neuropsychology. 33 (6): 822–841. doi:10.1037/neu0000575. PMC   7429442 . PMID   31448949.
  4. 1 2 Lawrence BJ, Jayakody DM, Henshaw H, Ferguson MA, Eikelboom RH, Loftus AM, Friedland PL (2018-08-10). "Auditory and Cognitive Training for Cognition in Adults With Hearing Loss: A Systematic Review and Meta-Analysis". Trends in Hearing. 22: 2331216518792096. doi:10.1177/2331216518792096. PMC   6088475 . PMID   30092719.
  5. 1 2 "Cognitive Behavioral Therapy | Psychology Today". www.psychologytoday.com. Retrieved 2020-11-30.
  6. ↑ Simons DJ, Boot WR, Charness N, Gathercole SE, Chabris CF, Hambrick DZ, Stine-Morrow EA (October 2016). "Do "Brain-Training" Programs Work?". Psychological Science in the Public Interest. 17 (3): 103–186. doi:10.1177/1529100616661983. PMID   27697851. S2CID   13729927.
  7. ↑ Harvey PD, McGurk SR, Mahncke H, Wykes T (November 2018). "Controversies in Computerized Cognitive Training". Biological Psychiatry. Cognitive Neuroscience and Neuroimaging. 3 (11): 907–915. doi: 10.1016/j.bpsc.2018.06.008 . PMID   30197048.
  8. 1 2 3 4 Jones A, Hardman CA, Lawrence N, Field M (May 2018). "Cognitive training as a potential treatment for overweight and obesity: A critical review of the evidence". Appetite. 124: 50–67. doi: 10.1016/j.appet.2017.05.032 . hdl: 10871/27978 . PMID   28546010. S2CID   3844999.
  9. 1 2 3 Verdejo-Garcia A, Garcia-Fernandez G, Dom G (September 2019). "Cognition and addiction". Dialogues in Clinical Neuroscience. 21 (3): 281–290. doi:10.31887/DCNS.2019.21.3/gdom. PMC   6829168 . PMID   31749652.
  10. 1 2 3 4 5 Bickel WK, Moody L, Quisenberry A (2014). "Computerized Working-Memory Training as a Candidate Adjunctive Treatment for Addiction". Alcohol Research. 36 (1): 123–6. PMC   4432851 . PMID   26259006.
  11. 1 2 Anzman SL, Birch LL (November 2009). "Low inhibitory control and restrictive feeding practices predict weight outcomes". The Journal of Pediatrics. 155 (5): 651–6. doi:10.1016/j.jpeds.2009.04.052. PMC   2764786 . PMID   19595373.
  12. ↑ Stice E, Lawrence NS, Kemps E, Veling H (November 2016). "Training motor responses to food: A novel treatment for obesity targeting implicit processes". Clinical Psychology Review. 49: 16–27. doi:10.1016/j.cpr.2016.06.005. hdl: 10871/24679 . PMID   27498406.
  13. 1 2 Snider SE, Deshpande HU, Lisinski JM, Koffarnus MN, LaConte SM, Bickel WK (February 2018). "Working Memory Training Improves Alcohol Users' Episodic Future Thinking: A Rate-Dependent Analysis". Biological Psychiatry. Cognitive Neuroscience and Neuroimaging. 3 (2): 160–167. doi:10.1016/j.bpsc.2017.11.002. PMC   5851289 . PMID   29529411.
  14. 1 2 Kerst WF, Waters AJ (October 2014). "Attentional retraining administered in the field reduces smokers' attentional bias and craving". Health Psychology. 33 (10): 1232–40. doi:10.1037/a0035708. PMID   24818609.
  15. ↑ "Our Programs | LearningRx Brain Training Center". LearningRx. Retrieved 2020-11-30.
  16. ↑ Bae H, Han C, Kim D (March 2015). "Desensitization of triggers and urge reprocessing for pathological gambling: a case series". Journal of Gambling Studies. 31 (1): 331–42. doi:10.1007/s10899-013-9422-5. PMID   24293014. S2CID   12800888.
  17. ↑ Alavi, Seyyed Salman; Ferdosi, Masoud; Jannatifard, Fereshte; Eslami, Mehdi; Alaghemandan, Hamed; Setare, Mehrdad (April 2012). "Behavioral Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological Views". International Journal of Preventive Medicine. 3 (4): 290–294. ISSN   2008-7802. PMC   3354400 . PMID   22624087.
  18. ↑ "Rational Emotive Behavior Therapy | Psychology Today". www.psychologytoday.com. Retrieved 2020-11-25.
  19. ↑ Martin J, Young DM (February 2003). "Comparison of American Cancer Society versus Internet Based treatment for Smokers" (PDF). San Diego State University Graduate Research. Archived from the original (PDF) on 2013-07-01.
  20. ↑ Wooley M, Whitlock J (February 2001). "Case Study #1" (PDF). St. Lukes Hospital and Medical Center. San Antonio TX. Archived from the original (PDF) on 2013-07-01.
  21. ↑ Diabetes Research Group "Cognitive Behavioral Group Training for Patients with Type 1 Diabetes" March 2005
  22. ↑ Kucyi A, Salomons TV, Davis KD (September 2016). "Cognitive behavioral training reverses the effect of pain exposure on brain network activity" (PDF). Pain. 157 (9): 1895–1904. doi:10.1097/j.pain.0000000000000592. PMID   27101426. S2CID   34665112.
  23. 1 2 3 4 Lau HM, Smit JH, Fleming TM, Riper H (2017). "Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis". Frontiers in Psychiatry. 7: 209. doi: 10.3389/fpsyt.2016.00209 . PMC   5241302 . PMID   28149281.
  24. ↑ Gallagher A. "Cognitive behavioral or relaxation training helps women reduce distress during breast cancer treatment". Science Daily.
  25. ↑ Gold MS. "Stages of Change". Psyche Central.
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