Introduction to CBT - Commonalities Across CBTs

Commonalities Across CBTs

• Present-centeredness

• Empiricism

• Measurement

• Dimensionality

• Lawfulness

• Importance of functional analysis

• Way to learn/maintain behavior

• Contextually of behavior

• Importance of precision and clarity

• Individualized approach

• Chunking

• Treatment Packages

• CBT is often upheld as “the gold standard”

Present-Centeredness

Focus on what maintains the problem behavior NOW vs. what started it originally.

• Example: substance use

Empiricism

Focus on what works empirically (in real test of it) to modify behavior, regardless of what should work theoretically

• Example: EXRP for OCD rather than CT for OCD

Measurement

Strong focus on measurement of behavior before, during, and after treatment

• Examples: Self-monitoring of food intake, situations, urges, and emotions in the management of binge eating to identify triggers.

Dimensionality

Behaviors exist along different dimensions: intensity, frequency, duration

• Example: perfectionism

Lawfulness

Behavior doesn’t happen randomly, but can be predicted once you understand the cognitive, affective, and situational triggers.

Importance of Functional Analysis

To change a behavior you need to carefully analyze and change the context of a behavior (what happens/exists before and after a behavior)

• Example: tantrums in kids

One Way to Learn/Maintain Behaviors

All behavior is learned the same way whether helpful or unhelpful behavior.

• Example: negative reinforcement can maintain useful behaviors (e.g. eating healthy, being physically active, reaching out to friends during times of distress) , but also maintains most problematic behaviors (e.g. extreme dietary restriction, substance use, self-harm).

Contextually of Behavior

No behavior is bad or good per se, it depends on the context

• Example: Checking behavior

Importance of Precision and Clarity

• Labels (including traits) seen as imprecise and not very helpful

• Better: behavioral descriptions of presenting problems

Individualized Approach

Behavior is individually determined.

• What created, maintains a particular behavior in one person may not create or maintain the same behavior in another person.

• Example: two patients with a heroin addiction.

Chunking

Tendency to break problem down into subparts and then target areas for intervention

• Example: Goal of getting blood drawn for blood injury injection phobia pt.

Treatment Packages

Use of multiple behavior therapy techniques together to achieve treatment goals (e.g., operant conditioning, shaping, modeling all together).

• Example: CBT-I

Other Characteristics of CBTs

• Thoughts-Emotions-Behaviors are reciprocally linked.

• Brief and Time-Limited.

• Emphasis placed on current behavior.

• Didactic, but Socratic.

• CBT is a collaborative effort between the therapist and the client.

• Teaches the benefit of remaining calm or at least neutral when faced with difficult situations

• Based on "rational thought." - Fact not assumptions.

• CBT is structured and directive

• Based on assumption that most emotional and behavioral reactions are learned.

• Homework/between-session practice

Therapist’s Role

• Help client define goals

• Listen

• Teach

• Encourage

Client’s Role

• Define goals

• Express concerns

• Learn and implement learning

The Role of Technology in Therapy

• Integration of technology and digital mental health

• Neuroscience-informed therapy