Making Cognitive-Behavioral Therapy Work, Third...
Deborah Roth Ledley, PhD, is a psychologist in private practice at the Children's Center for OCD and Anxiety in Plymouth Meeting, Pennsylvania. From 2001 to 2005, she was Assistant Professor of Psychology in Psychiatry at the University of Pennsylvania School of Medicine, where she was also a faculty member at the Center for the Treatment and Study of Anxiety. Dr. Ledley has published articles, book chapters, and books on topics including the nature and treatment of social anxiety disorder, obsessive-compulsive disorder, and other anxiety disorders. Brian P. Marx, PhD, is a staff psychologist at the National Center for PTSD, VA Boston Healthcare System, and Associate Professor of Psychiatry at Boston University School of Medicine. Dr. Marx has published numerous articles and book chapters on behavior therapy and assessment. His research interests include the association between posttraumatic stress disorder and functional impairment, identifying risk factors for posttraumatic difficulties, and developing brief, efficacious treatments for posttraumatic stress disorder. Richard G. Heimberg, PhD, is Thaddeus L. Bolton Professor of Psychology and Director of the Adult Anxiety Clinic of Temple at Temple University. He is past president of the Association for Behavioral and Cognitive Therapies as well as former editor of the Association's journal Behavior Therapy. Dr. Heimberg is well known for his efforts to develop and evaluate cognitive-behavioral treatments for social anxiety and generalized anxiety disorder and has published several books and more than 300 articles and chapters on these and related topics.
Making Cognitive-Behavioral Therapy Work, Third...
Through therapy, exercises, and homework, a therapist encourages people to recognize and gain control over their automatic thoughts and to learn ways to change their behaviors. As a result, a person may feel better, leading to a more positive cycle between these three things.
Basic research clearly indicates that cognitive processes play an important role in maintaining excessive and dysregulated eating habits, making healthy eating difficult . Moreover, several clinical studies in real-world settings have found significant associations between specific cognitive factors and treatment attrition, as well as the amount of weight patients are able to lose and maintain (Table 1) . These findings have been the basis upon which CBT-OB has been designed, with a view to overcoming some of the shortcomings of traditional behavioural therapy for obesity (BT-OB) .
"Dialectic [behavioral] therapy (DBT) is rooted in cognitive-behavioral therapy and integrates mindfulness, communication, and interpersonal skills; distress tolerance; and regulating emotions," Garcia defines. The core concept of dialectical thinking is being comfortable with the notion that two simultaneous opposing ideas can co-exist and be truthful at the same time, thus validating the contrasting emotional thoughts.
"Exposure therapy is a type of treatment that is rooted in behavioral therapy to help people confront their fears and decrease post-traumatic symptoms," Garcia says. This type of therapy is about facing your fears and has roots in cognitive-behavioral therapy.
Mindfulness-based therapy (MBCT) intertwines cognitive-behavioral techniques together with mindfulness and breathwork to bring awareness to your present moment. The intervention focuses on observing distressing emotions nonjudgmentally and separating your sense of self from negative messages to stave off depression.
Art therapy8 uses the creative process of art-making as an avenue for self-expression to examine your emotions and inner experiences. Through the process, it aims to enhance mental well-being and gain greater insight into who you are as an individual.
1. Borkovec, T. D., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61(4), 611-619.
Using the Scientific Methods Scale, Lösel and Schmucker (2005) excluded any studies that did not employ a control/comparison group. Altogether, 69 independent studies and 22,181 subjects were included in the analysis, making it one of the largest meta-analyses of studies of the effectiveness of sex offender treatment ever undertaken. In 40 percent of the comparisons, equivalence between the group of study subjects who received treatment and the group of comparison subjects who did not receive treatment was either demonstrated or it could be assumed. Nearly one-half of the comparisons in the analysis addressed cognitive-behavioral programs. About one-half were based on programs operating in an institutional setting. Significant differences between the recidivism rates of treated and untreated offenders were found (see table 3).
Lösel and Schmucker (2005) also found that physical treatments had larger treatment effects. Among psychological treatments, however, cognitive-behavioral treatments and behavior therapy had significant treatment effects. Treatment effects also were greater for sex offenders who completed treatment, as dropping out of treatment doubled the odds of recidivating.
Several other finding from the moderator analysis are noteworthy. First, while cognitive-behavioral treatment modalities yielded a significant reduction in sexual recidivism, other psychotherapeutic approaches did not. Second, treatment was equally effective for those who entered treatment on a voluntary or mandatory basis. This finding means that treatment initiated as a result of the external pressures of the criminal justice system can indeed be successful, and it "points to the important role of change motivation as a process (e.g., Prochaska and Levesque, 2002) and techniques such as motivational interviewing" (Schmucker and Lösel, 2015, p. 21). 26 Third, there was a tendency for community-based treatment to demonstrate higher levels of effectiveness than prison-based treatment. And finally, although confounding variables may be at work, findings from the moderator analysis suggest that incorporating individual therapeutic sessions in the treatment format produces better recidivism reduction results.
Based on findings from a recent Safer Society survey (McGrath et al., 2010), sex offender treatment programs operating in the United States in 2008 most frequently identified cognitive-behavioral therapy as one of the top three theoretical models that best described their treatment approach (McGrath et al., 2010). Relapse prevention therapy was the second most frequently identified model, but the number of programs endorsing relapse prevention has fallen since 2002. McGrath and colleagues (2010, p. vii) speculated that the decrease in the use of the relapse prevention model likely reflects the "considerable criticism leveled by practitioners and researchers against relapse prevention in recent years," specifically the criticisms that relapse prevention describes only one pathway to offending and that it overemphasizes risk avoidance as opposed to individual strengths and goals. 041b061a72