Cognitive emotional behavioral therapy

Last updated March 09, 2023

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 (e.g., eating behaviors including binging, purging, restriction of food intake, and substance misuse). 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.

CEBT has been used primarily for individuals with eating disorders, as it offers an alternative when standard CBT is unsuccessful in relieving symptoms.^[1] Research indicates that CEBT may help reduce emotional eating, depression, and anxiety and also improve self-esteem.^[2] CEBT was developed in 2006 by British psychologist Emma Gray (née Corstorphine).^[3] Its key components include psychological education; techniques to enhance awareness of emotions and motivation to change; and strategies to restructure beliefs about the experience and expression of emotions. Although (CEBT) was initially developed to help individuals with eating disorders, its effectiveness in helping people to better understand and manage their emotions has meant that it is increasingly being used by psychologists as a 'pretreatment'^[4] to prepare patients for the process of therapy for a range of problems including anxiety, depression, obsessive compulsive disorder (OCD), and post traumatic stress disorder (PTSD), which can often be emotionally challenging.

Techniques

Dialectical behavior therapy (DBT) - DBT is a type of psychotherapy used to treat various disorders. The purpose of this therapy is to help create positive changes in a person's behavior.^[5] DBT focuses mainly on treating individuals who have bulimia, drug-dependence, borderline personality disorder, depression, or other psychological disorders.^[5]

Mindfulness meditation - Mindfulness meditation is a technique that increases and improves awareness. This technique aims to lower stress and improve our attention.^[6] It is a form of focusing on what is presently happening. Mindfulness meditation aims at improving mental health through helping those with disorders be able to manage their emotions.^[6]

Acceptance and commitment therapy (ACT) - Acceptance and commitment therapy is a treatment aimed at helping people to accept the feelings and experiences they go through.^[7] Oftentimes people must deal with unpleasant feelings, thoughts or experiences and in response they avoid those emotions as a way of coping. In regards to the way we react, ACT helps with acceptance, making a decision to make changes, and going through with that commitment.^[7]

Experiential exercises - Experiential exercises play an important part in CEBT because it allows individuals to become actively involved in the learning process. Experiencing what is being taught can have a positive impact on those individuals who experience emotional and behavioral difficulties.^[8] These exercises are often used in different types of therapy in order to help individuals learn about diversity, acceptance, injustice, and so forth.^[9] Experiential exercises can be incorporated in the treatment of individuals dealing with disorders. These exercises help people to know how to react or cope in certain situations.^[8]

Background

In 2006, Dr. Emma Gray (née Corstorphine) started the idea of Cognitive emotional behavioral therapy (CEBT). CEBT uses techniques from other types of treatment such as Cognitive behavior therapy and Dialectical behavioral therapy. The main goal of CEBT is to help individuals learn to cope with their emotions, reduce stress and anxiety, and make changes to their behavior.^[10] Gray noted that emotion plays a crucial part in disorders, therefore it needs to be further addressed in terms of treatment.^[10] Cognitive behavioral therapy aims to treat where a patient needs the most help, whether that is emotional, behavioral, cognitive, etc.^[11] CBT has been practiced since the 1960s. There is a greater focus on cognitive psychology and its impact on behavior.^[11] In 2003 there began to be suggestions that CBT needed to be expanded to meet the needs of even more specific vulnerabilities such as emotion, social environments, relationships, etc.^[11] Gray saw the need for an approach that has a greater focus on the emotional components.^[10]

Gray's research specifically analyzes cognitive emotional behavioral therapy (CBT) for eating disorders. She found that CBT and related techniques for bulimia were not effective.^[10] CBT mainly uses treatments aimed at discovering cognitive or behavioral issues to be the source.^[11] Gray's findings show that therapy focused on emotion helped individuals manage their emotions and difficulties.^[10] Research has shown that emotional distress is a major cause of bulimia.^[12] Additional studies show that what triggers bulimia is oftentimes one's emotional state and their relationships.^[13] CEBT helps these individuals with disorders to cope with their emotions and develop the skills necessary to positively handle their situation.^[10]

Case

Gray (née Corstorphine) analyzes a case to determine whether cognitive emotional behavior therapy for eating disorders (CEBT-ED) is effective. In this case, a 22-year-old woman named Anna, who has bulimia and anorexia, goes through CBT and is able to regulate some of her eating patterns and lower the number of times she purges.^[10] It was acknowledged that Anna had emotional trauma due to the environment she grew up in. Her self esteem and expression of emotion were repressed because of her family.^[10] CEBT-ED allowed her to feel encouraged to show her emotions and discover the source of her difficulties.^[10] CEBT is an effective way of easing the symptoms of cognitive and emotional disorders when the typical CBT does not provide sufficient exercises and training.^[14]^[15] Emotion is the primary issue of eating disorders.^[16] In Anna's case CBT would have been helpful but would have focused mainly on changing negative or unreasonable thoughts.^[15] At the center of Anna's problem was her emotional trauma as a child and her difficulty in expressing how she felt.^[10] To address Anna's specific needs, CBT was not enough, but CEBT allowed room for self-reflection to find the root of her issues. CEBT helped her to identify and understand her emotions, allowing her to learn skills that would help her cope with these emotions and relieve the symptoms of her issues.^[15]

Related Research Articles

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety 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 the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. Binge eating disorder is also linked with being overweight and obesity.

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.

<span class="mw-page-title-main">Cognitive restructuring</span> Type of psychological therapy

Cognitive restructuring (CR) is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortions, such as all-or-nothing thinking (splitting), magical thinking, overgeneralization, magnification, and emotional reasoning, which are commonly associated with many mental health disorders. CR employs many strategies, such as Socratic questioning, thought recording, and guided imagery, and is used in many types of therapies, including cognitive behavioral therapy (CBT) and rational emotive behaviour therapy (REBT). A number of studies demonstrate considerable efficacy in using CR-based therapies.

Mindfulness is the practice of purposely bringing one's attention to the present-moment experience without evaluation, a skill one develops through meditation or other training. Mindfulness derives from sati, a significant element of Hindu and Buddhist traditions, and is based on Zen, Vipassanā, and Tibetan meditation techniques. Though definitions and techniques of mindfulness are wide-ranging, Buddhist traditions explain what constitutes mindfulness such as how past, present and future moments arise and cease as momentary sense impressions and mental phenomena. Individuals who have contributed to the popularity of mindfulness in the modern Western context include Thích Nhất Hạnh, Herbert Benson, Jon Kabat-Zinn, Richard J. Davidson, and Sam Harris.

Acceptance and commitment therapy is a form of psychotherapy, as well as a branch of clinical behavior analysis. It is an empirically based psychological intervention that uses acceptance and mindfulness strategies along with commitment and behavior-change strategies to increase psychological flexibility.

Mindfulness-based cognitive therapy (MBCT) is an approach to psychotherapy that uses cognitive behavioral therapy (CBT) methods in collaboration 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.

Marsha M. Linehan is an American psychologist and author. She is the creator of dialectical behavior therapy (DBT), a type of psychotherapy that combines cognitive restructuring with acceptance, mindfulness, and shaping.

Self-compassion is extending compassion to one's self in instances of perceived inadequacy, failure, or general suffering. Kristin Neff has defined self-compassion as being composed of three main elements – self-kindness, common humanity, and mindfulness.

Eating recovery refers to the full spectrum of care that acknowledges and treats the multiple etiologies of anorexia nervosa and bulimia, including the biological, psychological, social and emotional causes of the disorder, through a comprehensive, integrated treatment regimen. When successful, this regimen restores the individual to a healthy weight and arms them with the skills and resources needed to maintain a sustainable recovery. Although there are a variety of treatment options available to the eating disorders patient, the intensive and multi-faceted program followed in eating recovery is the appropriate option for individuals who require intensive support and are able to commit to treatment in an inpatient, residential or full-day hospital setting.

The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.

Experiential avoidance (EA) has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences—even when doing so creates harm in the long run. The process of EA is thought to be maintained through negative reinforcement—that is, short-term relief of discomfort is achieved through avoidance, thereby increasing the likelihood that the avoidance behavior will persist. Importantly, the current conceptualization of EA suggests that it is not negative thoughts, emotions, and sensations that are problematic, but how one responds to them that can cause difficulties. In particular, a habitual and persistent unwillingness to experience uncomfortable thoughts and feelings is thought to be linked to a wide range of problems.

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.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Mode deactivation therapy (MDT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to the process of mode deactivation that is based on the concept of cognitive modes as introduced by Aaron T. Beck. The MDT methodology was developed by Jack A. Apsche by combining the unique validation–clarification–redirection (VCR) process step with elements from acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness to bring about durable behavior change.

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."

Distress tolerance is an emerging construct in psychology that has been conceptualized in several different ways. Broadly, however, it refers to an individual's "perceived capacity to withstand negative emotional and/or other aversive states, and the behavioral act of withstanding distressing internal states elicited by some type of stressor." Some definitions of distress tolerance have also specified that the endurance of these negative events occur in contexts in which methods to escape the distressor exist.

Self-as-context, one of the core principles in acceptance and commitment therapy (ACT), is the concept that people are not the content of their thoughts or feelings, but rather are the consciousness experiencing or observing the thoughts and feelings. Self-as-context is distinguished from self-as-content, defined in ACT as the social scripts people maintain about who they are and how they operate in the world.

References

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↑ Campbell, Holly (2012). "Managing emotional eating". Mental Health Practice. 8 (15). Retrieved 22 February 2013.
↑ Corstorphine, Emma (2006). "Cognitive Emotional Behavioural Therapy for the eating disorders; working with beliefs about emotions". European Eating Disorders Review. 14 (6): 448–461. doi:10.1002/erv.747.
↑ The British CBT & Counselling Service (2016). "The British CBT & Counselling Service - Cognitive Emotional Behavioural Therapy".
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↑ Lyubomirsky, Sonja; Casper, Regina C.; Sousa, Lorie (September 2001). "What Triggers Abnormal Eating in Bulimic and Nonbulimic Women?;The Role of Dissociative Experiences, Negative Affect, and Psychopathology". Psychology of Women Quarterly. 25 (3): 223–232. doi:10.1111/1471-6402.00023. ISSN 0361-6843. S2CID 2336497.
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