Cognitive Behavior Modification

Cognitive behavior modification (CBM) is a blending of two conceptual models of management behavioral and cognitive theory, and as such is a powerful tool for changing trajectories of behavior in children and adults. One of the most widely researched and heavily evidenced types of therapy or intervention, CBM provides an evidence-based model for practice in public and private applications. Behavioral models of management originate with John Watson, Edward Thorn-dike, and B. F. Skinner and are based on learning theories of operant conditioning. Behavior is thought to be ‘learned’ and as such can be ‘unlearned.’ All behavior serves a function for the individual, such as escape and avoidance or access to a reinforcer or reinforcement of some kind. Those reinforcers could be tangible or intangible things or conditions. Cognitive theory involves thoughts and feelings, two things that a behaviorist could not identify or measure overtly. Cognitive theorists would discuss cognitive structures and internal dialogue as the reason for behavior. This internal dialogue is also called self-speech or self-talk and is believed to be modifiable through self-instruction training, whereas a purely behavioral model would seek to change the antecedents and consequences that maintain the behavior.

Definition and Description

Cognitive behavior modification is the theory and practice that people's thinking about events, rather than the events themselves, are responsible for their actions, and that thinking can be modified and lead to behavior change. CBM involves overt behavior but also considers the verbal and internal processes that monitor and guide the more observable behavior. Interventions that are grounded in CBM include self-dialogue and thinking as component antecedents and consequences in changing behavior.

Behavioral Model: Observable and Measurable Events

Jack has learned that hitting will result in escaping teasing and may be more likely to hit the next time there is an occurrence of something Jack wants to escape. A behavioral intervention would target teaching Jack to escape appropriately. This would reflect the function of the behavior (escape) while teaching a new skill to get the same need met.

Cognitive-Behavioral Model

The feelings and behavior in this model are the focus of the intervention rather than the behavior of hitting. A cognitive behavioral intervention would target the thinking and feeling or self-dialogue that occurred rather than attempt to control the consequences and antecedents.

Cognitive behavior modification is a form of intervention that emphasizes the important role of thinking in how people feel and what they do. Cognitive behavior modification involves the attribution of beliefs to people's thoughts that theoretically cause their feelings and behaviors. The benefit of this CBM model is that thinking and beliefs are conceptualized as learned. Thinking, feeling, believing (self-talk, self-narration, self-schema) as a learned behavior means people can change the way they think in order to feel or act, regardless of the situation. CBM can be thought of as a theory, a system of strategies, and a series of techniques. The theory is based on the idea that the processing of information is crucial for the survival of any person or individual.

Cognitive-behavioral therapists teach that when people's brains are healthy, it is their thinking that causes them to feel and act the way they do. Therefore, if a person is experiencing unwanted feelings and behaviors, it is important to identify the thinking that is causing the feelings or behaviors and learn how to replace this thinking with thoughts that lead to more desirable reactions.

Purpose

Theoretically, cognitive-behavioral therapy can be employed in any situation in which there is a pattern of unwanted behavior accompanied by distress and impairment. It is a recommended treatment option for a number of mental disorders, including affective (mood) disorders, personality disorders, social phobia, obsessive-compulsive disorder, eating disorders, substance abuse, anxiety or panic disorder, agoraphobia, posttraumatic stress disorder, and attention deficit/ hyperactivity disorder (ADHD). Patients with sleep disorders may also find cognitive-behavioral therapy a useful treatment for insomnia.

Cognitive-behavioral therapy combines the individual goals of cognitive therapy and behavioral therapy. Pioneered by psychologists Aaron Beck and Albert Ellis in the 1960s, cognitive therapy assumes that maladaptive behaviors and disturbed mood or emotions are the result of inappropriate or irrational thinking patterns, called automatic thoughts. Instead of reacting to the reality of a situation, an individual reacts to his or her own distorted viewpoint of the situation. For example, a person may conclude that he or she is ‘worthless’ simply because he or she failed an exam or didn't get a date. Cognitive therapists attempt to make their patients aware of these distorted thinking patterns, or cognitive distortions, and change them (a process termed cognitive restructuring).

Behavioral therapy, or behavior modification, trains individuals to replace undesirable behaviors with healthier behavioral patterns. Unlike psychodynamic therapies, it does not focus on uncovering or understanding the unconscious motivations that may be behind the maladaptive behavior. In other words, those who are strictly behavioral therapists don't try to find out why their patients behave the way they do, they just teach them to change the behavior.

Cognitive-behavioral therapy is used to mitigate maladaptive behaviors through the use of covert self-statements with the behavioral modification techniques of behavioral therapy. The therapist works with the patient to identify both the thoughts and the behaviors that are causing distress, and to change those thoughts in order to readjust the behavior. In some cases, the patient may have certain fundamental core beliefs, called schemas, that are flawed and require modification. For example, a patient suffering from depression may avoid social contact with others and suffer considerable emotional distress because of this isolation. When questioned, the patient reveals to his therapist that he is afraid of rejection, of what others may do or say to him. Upon further exploration with his therapist, they discover that his real fear is not rejection, but the belief that he is uninteresting and unlovable. His therapist then tests the reality of that assertion by having the patient name friends and family who love him and enjoy his company. By showing the patient that others value him, the therapist both exposes the irrationality of the patient's belief and provides him with a new model of thought to change his old behavior pattern. In this case, the person learns to think, ‘I am an interesting and lovable person; therefore, I should not have difficulty making new friends in social situations.’ If enough irrational cognitions are changed, this patient may experience considerable relief from his depression.

Interventions

Intervention in CBM works on the identification of one of two types of beliefs: rational and irrational. Several types of interventions work from this basic principle.

Cognitive restructuring is the process of replacing maladaptive thought patterns with more constructive thoughts and beliefs. Maladaptive thoughts are those considered unsuitable or counterproductive; for example, maladaptive behavior is behavior that is inappropriate to a given situation.

Verbal mediation is the process of identifying the self-talk or inner speech that will lead to goal fulfillment or task achievement. A script of self-talk that corresponds to the targeted or desired behavior is used in mental rehearsal to shape behavior.

Problem solving involves deconstructing problem scenarios and developing alternative causal explanations and inferences along with alternative solutions or behaviors. These alternatives are then mapped todetermine best choices or best options for subsequent conditions of the same problem.

Self-instruction is the process of teaching steps toward task completion. There are specific steps in self-instruction as follows:

1. Demonstration by Model. The teacher/therapist models behavior and says out loud what he or she is doing.
2. Modeling With Overt Adult Guidance. The student/ client performs the task while talking to him- or herself out loud. The teacher/therapist corrects the student/client, helps with difficulties, and gives positive feedback.
3. Modeling With Overt Self-Guidance. The student/ client performs the task while orally talking himor herself through without guidance from the teacher/therapist.
4. Modeling With Faded Self-Guidance. The student/ client whispers the self-guidance while performing the task.
5. Self-Guidance. The student/client speaks silently while performing the actions.

Tips for Implementation. Frequent practice is needed for fluency and mastery. Participants all need verbal rehearsal and opportunities for application. Start small before tackling large issues. Use visual prompts.

Benefits

CBM has been reported to have a host of benefits. Individuals report having more self-control, and some research reports its use for increasing time on task in classrooms, improved performance on intellectual tasks, decreases in impulsivity, and increases in attention. Other positive effects include an increased awareness of feelings and maladaptive belief systems, as well as an increase in self-evaluation of how behaviors related to personal behaviors.

CBM has demonstrated effectiveness for many children who benefit from modeling and rehearsing. CBM increases the attention of children after limited treatment exposures. CBM improves the processing abilities of aggressive students and increases problem-solving abilities. For students with ADHD, CBM has demonstrated effects for reducing the impulsiveness of many students by having them implement problem solving, and for students with learning disabilities, anxiety disorders, depression, anger, and impulsivity, improved performance is expected from CBM.

Cognitive behavior modification is different from psychodynamic therapy, and they should not be confused one for the other. Psychodynamic therapy is a therapeutic approach that assumes that dysfunctional or unwanted behavior is caused by unconscious, internal conflicts and focuses on gaining insight into these motivations. CBM is a focus on the verbal behavior of an individual. It is covert but not unconscious. This verbal behavior is also conceptualized as automatic thoughts, which automatically come to mind when a particular situation occurs. Cognitive-behavioral therapy seeks to challenge automatic thoughts for their rational or irrational basis. Schemas are the fundamental core beliefs or assumptions that are part of the perceptual filter that people use to view the world. Cognitive-behavioral therapy seeks to change mal-adaptive schemas. Relaxation techniques are sometimes used to relieve stress. Exercise, biofeedback, hypnosis, and meditation are all effective relaxation tools. Relaxation techniques are used in cognitive-behavioral therapy to teach patients new ways of coping with stressful situations but are not a direct component of CBM.

Future research on CBM includes a need for data on the long-term effectiveness of using the procedures and the applicability for individuals with specific disabilities, such as attention deficits and emotional and behavioral disabilities across ages.

Entry Citation:

"Cognitive Behavior Modification." Encyclopedia of Educational Psychology. 2008. SAGE Publications. 22 Sep. 2009. .