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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.
A phobia is an anxiety disorder, defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the object or situation cannot be avoided, they experience significant distress. Other symptoms can include fainting, which may occur in blood or injury phobia, and panic attacks, often found in agoraphobia and emetophobia. Around 75% of those with phobias have multiple phobias.
Operant conditioning, also called instrumental conditioning, is a learning process where voluntary behaviors are modified by association with the addition of reward or aversive stimuli. The frequency or duration of the behavior may increase through reinforcement or decrease through punishment or extinction.
In behavioral psychology, reinforcement is any consequence that increases the likelihood of an organism's future behavior whenever that behavior is preceded by a particular antecedent stimulus. For example, a rat can be trained to push a lever to receive food whenever a light is turned on. In this example, the light is the antecedent stimulus, the lever pushing is the behavior, and the food is the reinforcement. Likewise, a student that receives attention and praise when answering a teacher's question will be more likely to answer future questions in class. The teacher's question is the antecedent, the student's response is the behavior, and the praise and attention are the reinforcements.
Behaviorism is a systematic approach to understand the behavior of humans and other animals. It assumes that behavior is either a reflex evoked by the pairing of certain antecedent stimuli in the environment, or a consequence of that individual's history, including especially reinforcement and punishment contingencies, together with the individual's current motivational state and controlling stimuli. Although behaviorists generally accept the important role of heredity in determining behavior, they focus primarily on environmental events. The cognitive revolution of the late 20th century largely replaced behaviorism as an explanatory theory with cognitive psychology, which unlike behaviorism examines internal mental states.
Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD).
Impulse-control disorder (ICD) is a class of psychiatric disorders characterized by impulsivity – failure to resist a temptation, an urge, or an impulse; or having the inability to not speak on a thought. Many psychiatric disorders feature impulsivity, including substance-related disorders, behavioral addictions, attention deficit hyperactivity disorder, autism spectrum disorder, fetal alcohol spectrum disorders, antisocial personality disorder, borderline personality disorder, conduct disorder and some mood disorders.
Applied behavior analysis (ABA), also called behavioral engineering, is a psychological intervention that applies approaches based upon the principles of respondent and operant conditioning to change behavior of social significance. It is the applied form of behavior analysis; the other two forms are radical behaviorism and the experimental analysis of behavior.
Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people's mental states, influences those behaviours, and consists of techniques based on behaviorism's theory of learning: respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method, but it has a wide range of techniques that can be used to treat a person's psychological problems.
Andrew Salter was an American clinical psychologist who introduced behavior therapy, developed many of its conceptual foundations, and created numerous techniques still used today across its varied descendants, including cognitive behavioral therapy. His work in the early 1940s demystified hypnosis, interpreting it as a form of conditioning, now the widely accepted view. He was one of the founders of the Association for the Advancement of Behavioral Therapies, now the Association for Behavioral and Cognitive Therapies. He maintained an active clinical practice in Manhattan until shortly before his death. His key ideas are documented in his book, Conditioned Reflex Therapy,, originally published in 1949 and reprinted many times, with a new edition published by Watkins Press in 2019. All citations from CRT refer to this edition.
Systematic desensitization, or graduated exposure therapy, is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioral therapy and applied behavior analysis. When used in applied behavior analysis, it is based on radical behaviorism as it incorporates counterconditioning principles. These include meditation and breathing. From the cognitive psychology perspective, cognitions and feelings precede behavior, so it initially uses cognitive restructuring.
Behavior modification is a treatment approach that uses respondent and operant conditioning to change behavior. Based on methodological behaviorism, overt behavior is modified with (antecedent) stimulus control and consequences, including positive and negative reinforcement contingencies to increase desirable behavior, or administering positive and negative punishment and/or extinction to reduce problematic behavior. It also uses systematic desensitization and flooding to combat phobias.
Contingency management (CM) is the application of the three-term contingency, which uses stimulus control and consequences to change behavior. CM originally derived from the science of applied behavior analysis (ABA), but it is sometimes implemented from a cognitive-behavior therapy (CBT) framework as well.
In operant conditioning, punishment is any change in a human or animal's surroundings which, occurring after a given behavior or response, reduces the likelihood of that behavior occurring again in the future. As with reinforcement, it is the behavior, not the human/animal, that is punished. Whether a change is or is not punishing is determined by its effect on the rate that the behavior occurs. This is called motivating operations (MO), because they alter the effectiveness of a stimulus. MO can be categorized in abolishing operations, decrease the effectiveness of the stimuli and establishing, increase the effectiveness of the stimuli. For example, a painful stimulus which would act as a punisher for most people may actually reinforce some behaviors of masochistic individuals.
In psychology, desensitization is a treatment or process that diminishes emotional responsiveness to a negative, aversive, or positive stimulus after repeated exposure. Desensitization can also occur when an emotional response is repeatedly evoked when the action tendency associated with the emotion proves irrelevant or unnecessary. The process of desensitization was developed by psychologist Mary Cover Jones and is primarily used to assist individuals in unlearning phobias and anxieties. Desensitization is a psychological process where a response is repeatedly elicited in circumstances where the emotion's propensity for action is irrelevant. Joseph Wolpe (1958) developed a method of a hierarchal list of anxiety-evoking stimuli in order of intensity, which allows individuals to undergo adaptation. Although medication is available for individuals with anxiety, fear, or phobias, empirical evidence supports desensitization with high rates of cure, particularly in clients with depression or schizophrenia. Wolpe's "reciprocal inhibition" desensitization process is based on well-known psychology theories such as Hull's "drive-reduction" theory and Sherrington's concept of "reciprocal inhibition." Individuals are gradually exposed to anxiety triggers while using relaxation techniques to reduce anxiety. It is an effective treatment for anxiety disorders.
Exposure therapy is a technique in behavior therapy to treat anxiety disorders.
The professional practice of behavior analysis is a domain of behavior analysis, the others being radical behaviorism, experimental analysis of behavior and applied behavior analysis. The practice of behavior analysis is the delivery of interventions to consumers that are guided by the principles of radical behaviorism and the research of both experimental and applied behavior analysis. Professional practice seeks to change specific behavior through the implementation of these principles. In many states, practicing behavior analysts hold a license, certificate, or registration. In other states, there are no laws governing their practice and, as such, the practice may be prohibited as falling under the practice definition of other mental health professionals. This is rapidly changing as behavior analysts are becoming more and more common.
Behavioral activation (BA) is a third-generation behavior therapy for treating mood disorders. Behavioral activation primarily emphasizes engaging in positive and enjoyable activities to enhance one's mood.
Cognitive behavioral therapy for insomnia (CBT-I) is a technique for treating insomnia without medications. Insomnia is a common problem involving trouble falling asleep, staying asleep, or getting quality sleep. CBT-I aims to improve sleep habits and behaviors by identifying and changing the thoughts and the behaviors that affect the ability of a person to sleep or sleep well.
Imagery Rescripting is an experiential therapeutic technique that uses imagery and imagination to intervene in traumatic memories. The process is guided by a therapist who works with the client to define ways to work with particular traumatic memories, images, or nightmares.
References
- Cautela, Joseph R and Kearney, Albert J. (1990) "Behavior analysis, cognitive therapy, and covert conditioning", Journal of behavior therapy and experimental psychiatry, 21 (2), pp. 83–90.