Cognitive behavioral training
Cognitive behavioral training, sometimes referred to as structured cognitive behavioral training, is an organized process that uses systematic, highly-structured tasks designed to improve cognitive functions. Functions such as working memory, decision making, and attention are thought to inform whether a person defaults to an impulsive behavior or a premeditated behavior. The aim of CBTraining is to affect a person's decision-making process and cause them to choose the premeditated behavior over the impulsive behavior in their everyday life. Through scheduled trainings that may be up to a few hours long and may be weekly or daily over a specific set of time, the goal of CBTraining is to show that focusing on repetitive, increasingly difficult cognitive tasks can transfer those skills to other cognitive processes in your brain, leading to behavioral change. There has been a recent resurgence of interest in this field with the invention of new technologies and a greater understanding of cognition in general.
The roots of CBTraining lie in a combination of cognitive behavioral therapy and general cognitive training. Cognitive training seeks to improve cognitive functions for the sake of improved brain processing ability. The basic premise of CBT is that behavior is inextricably related to beliefs, thoughts and emotions. Between those two mentalities lies the idea that in changing the way a person responds to stimulus through training, it is possible to change a person's actions.
However, the positive effects of CBTraining have been difficult to prove throughout the field of research. Lack of randomized controlled trials in many studies and a lack of a standardization of training methods and definitions of success make it difficult to compare studies with each other and find trends. Overall, many clinical reviews conclude that initial results expressing the benefits of CBTraining may have been overestimated, but the data shows positive enough results that continued research is encouraged.
Description
Methods
Cognitive behavioral training is a cognitive-based process designed with the aim to systematically break down emotionally driven dependencies and behaviors, replacing them with behaviors that are based on rational choice. Testing can be computerized or gamified. Bickel et al. describe this method of training as such, "adaptive-training programs rely on computerized algorithms that adjust intervention content to a patient's skill level in realtime in order to tax participants at the limit of their capacity and maintain engagement during training." Nixon and Lewis note that programs which adjust to participants' skill levels are more successful at encouraging participants to complete trainings since the testing itself can be repetitive and uninteresting.Inhibitory control training is a method of CBTraining, which uses cues paired with promoting or inhibiting stimulus to change behavior. These cues can be general or specific to an undesirable behavior and use Go/no go or Stop-Signal tests. An example of a cue-specific ICT test was used in Stice et al.'s study designed to limit unhealthy food consumption by combining inhibitory signals with images of unhealthy food more often than non-food-related images.
Working memory training is a method that targets working memory enhancements as a vehicle for changing behavior. Working memory is "the ability to retain some information active for further use, and to do so in a flexible way allowing information to be prioritized, added, or removed." Self-regulatory and goal-maintaining behavior has been tied to working memory so WMT has emerged as a way to alter behavior through improving cognition. For example, Snider et al. sought to extend the time-related reward window in patients with alcohol dependency by improving working memory so they created twelve training exercises including one that had participants move objects on a digital desk while following auditory instructions in a particular order.
Attentional bias modification seeks to change an individual's behavior by directing their attention away from undesired cues and sometimes includes neutral cues that attention is directed towards. This is commonly carried out by a visual probe test like the one used by Kerst et al. on a handheld mobile device given to habitual cigarette smokers. Participants were asked to engage in three trainings and one assessment per day over a one week period and self report cravings and alterations, if any, in smoking habits.
Difference from CBT
Although CBTraining employs some similar concepts that define Cognitive Behavioral Therapy, there are some fundamental differences between CBTraining and CBT, both in philosophy and in application. CBTraining is training, not therapy. This is a critical distinction: unlike typical forms and applications of CBT, CBTraining is a process that is finite. In CBT, as with most therapy, the patient plays a large role in determining the direction of the therapy, including the intensity and duration. A CBTraining course, or program, is often broken up into a series of progressive, strategically ordered sessions designed to guide the participant through the process of training the brain away from impulsive thinking. The goal is to adjust the automatic processes that lead to undesired behaviors through repetitious training sessions designed to promote a desired behavior. CBTraining aims to change participants' behaviors through seemingly unrelated tasks by demonstrating near transfer and far transfer.Willpower
In addressing addictive behavior and other potentially destructive behavior compelling to the participant, CBTraining may incorporate an urge conditioning/desensitization approach that is a proactive form of Acceptance Commitment Therapy. This approach stands in contrast to what is commonly most instinctive to people, and seems counter-intuitive at first. The approach of urge desensitization has been applied to patients with gambling addictions, and research has shown it to be effective. When a person is trying to quit smoking, for instance, the instinct is to remove all smoking paraphernalia from his presence. While this "out of sight, out of mind" approach seems to make sense, it does nothing to actually deal with the emotionally driven urge to smoke. A measure of success that is vital for positive results, but not often recorded in studies, is the determination to complete the program and adjust behaviors.Further distinguishing CBTraining from its closely related psychological predecessors is the inclusion of the concept of "Training" in place of "Therapy". CBTraining is a planned, intricately designed and systematically applied regimen that is purposely finite. CBTraining begins with a specific goal, and is constructed as a time-specific road map to achieving the goal.
History of development
Along with CBT, CBTraining also owes some debt to Albert Ellis's rational emotive behavior therapy, formerly known as Rational Emotive Therapy. REBT is classified as a form of CBT, and is anchored by the belief that a person is "affected emotionally by his/her perspective and attitude about outside things." As with CBTraining, REBT incorporates Positive Self-Image Psychology. Lou Ryan, a pioneer in the creation, development, and practical application of CBTraining, worked for some time under the guidance of Albert Ellis. In the early 1980s, Ryan, who was well-versed in Ellis's theories and philosophies, met Ellis in Hawaii after a series of seminars. Ellis recognized his own impact in Ryan's CBTraining programs, and played a peripheral part in some of the development.Specific applications
Health and wellness
CBTraining has been established to some degree in changing emotionally addictive behaviors related to tobacco. There is evidence that cognitive group behavioral training may be beneficial for patients with type 1 diabetes in their self-care. SCBT has been used to help people with diabetes manage their disease, with the primary goal being maintained lifestyle changes to slow or halt the progression of the disease. It has also shown some promise in reducing pain receptor reactions in the brain after a painful stimulus.In studies of overeating and obesity, researchers note that high impulsivity is correlated with overweight and obese individuals. CBTraining in the form of response inhibition training has shown positive results affecting amount and type of food eaten in a sitting and weight reduction, though the longevity of results requires more study.