Structured cognitive behavioral training

Structured Cognitive Behavioral Training (SCBT) is a regimented cognitive-behavioral process that uses a systematic, highly structured workshop-style approach to break down and replace dysfunctional emotionally dependent behaviors. The roots of SCBT lie in Cognitive Behavioral Therapy (CBT), and like CBT the basic premise of SCBT is that behavior is inextricably related to beliefs, thoughts and emotions. However, SCBT is delivered in a highly structured, regimented format and combines several other behavioral change theories and methodologies in addition to CBT. Structured Cognitive Behavioral Training is currently used primarily in the behavioral health industry and in criminal psychology.

SCBT and CBT – The difference

Although SCBTraining employs some similar foundational concepts that define Cognitive Behavioral Therapy, there are some fundamental differences between SCBTraining and CBTherapy, both in philosophy and in application. SCBT is training, not therapy. This is a critical distinction: unlike typical forms and applications of CBT, SCBT is a process that is absolutely finite. That is to say, when a person begins taking a Structured Cognitive Behavioral Training course or program, there is already in place a set schedule - and therefore a predetermined end date - to training. Among one other main difference is the goal for a change in In CBTherapy, as with most therapy, the patient plays a large role in determining the direction of the therapy, including the intensity and duration. An SCBTraining course, or program, is usually broken up into a series of progressive, strategically ordered sessions – each one with a particular focus. SCBTraining unfolds step by step, guiding the participant through the process of retraining the brain and dissolving the emotionally dependent thinking. Participants of SCBT take “classes,” are quizzed, and are given “homework.” SCBTraining is not tailored to the individual, it is tailored to the specific dependency it addresses. Cognitive behavioral training aims to create rapid change in the "students," is given in some sort of group or class form, and is governed by a prearranged pathway to change. Cognitive Behavioral Skills Training has been used to teach and firmly implant social behavioral modification in children. Here is a concise explanation of a main difference between cognitive behavioral therapy and cognitive behavioral skills training: "...cognitive behavioral therapy focuses on how beliefs affect mood...skills training focuses on practicing pragmatic skills of living..." ^[1] SBCTraining aims for swift and permanent implantation of new skills in living.

Description

Structured Cognitive Behavioral Training (SCBT) 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. Like Cognitive Behavioral Therapy (CBT), the philosophy of SCBT is rooted to one essential notion: feeling and thought are inextricably linked.

SCBT contends that in any emotionally dependent relationship, people make emotional decisions rather than rational choices. When an emotionally dependent relationship occurs, it creates a belief-induced emotional state. When someone is in this state, they are incapable of making rational choices for more than a short period of time due to an emotion-driven subconscious process that overrides their conscious mind. This phenomenon explains why an overeater cannot resist having another bite... and another... and another, despite the fact that they are not physically hungry and they know that overeating is unhealthy.

SCBT was born out of Cognitive Behavioral Therapy (CBT) and utilizes well established theories of psychology and treatment, including: bibliotherapy, acceptance and commitment therapy, behavioral self-control theory, behavioral economic theory, self-determination theory, and motivational interviewing. Each of these methods plays a role in SCBT, at varying stages of completion, in the common endeavor to bring a new sense of cognizant awareness in the participant.

Cognitive Behavioral Training, applied in a structured way (SCBT), has also been used to deal effectively with women dealing with the stressors of having breast cancer (e.g., changing thoughts about stressors ) in studies done at the University of Miami ^[2]

SCBT and willpower

In addressing addictive behavior and other potentially destructive behavior compelling to the participant, SCBT uses an approach of urge conditioning/desensitization. This approach stands in stark contrast to what is commonly most instinctive to people (urge avoidance), 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.^[3] 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. SCBT contends that, in fact, this white-knuckled method of willpower only lends the urge more power. With urge conditioning/desensitization, the participant is asked to actually create urges in order to become comfortable with having them. As the strategic format of SCBT unfolds through the training, the urges are methodically stripped of their power. In acknowledging "urge", says SCBT, you are actually acknowledging your power to choose.

Further distinguishing SCBT from its closely related psychological predecessors is the inclusion of the concept of "Training" in place of "Therapy". SCBT is a planned, intricately designed and systematically applied regimen that is purposely finite. SCBT begins with a specific goal, and is constructed as a time-specific road map to achieving the goal. As a person undergoes the training, SCBT aims to change not only this person’s self-talk but his/her self-image at a subconscious level, so that the change in behavior is intrinsically motivated and willpower never really plays a part in it.

History of development

Along with CBT, SCBT also owes some debt to Albert Ellis's Rational Emotive Behavior Therapy (REBT), formerly known as Rational Emotive Therapy. REBT is classified as a form of CBT,^[4] and is anchored by the belief that a person is "affected emotionally by his/her perspective and attitude about outside things." As with SCBT, REBT incorporates Positive Self-Image Psychology. Lou Ryan, a pioneer in the creation, development, and practical application of SCBT, 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 SCBT programs, and played a peripheral part in some of the development. According to Ryan when asked about the evolutional process of his particular philosophy: "I had collected a potpourri of different types of approaches, programs, and philosophies that I had come across through the years. To me, what seemed to be missing was vision. Vision for what people want from life is motivating but can often be lost in the daily trudge of life." About his time with Ellis, Ryan said: “I had met him at a conference in Hawaii. We met afterwards, and I told him what I was doing, that there were similarities between what we were doing. I asked him if he would review what I had put together, and for his input... he coached me on a few things. It occurred to me to add a structure to all of these philosophies."^[5] Also involved in some of the early development of SCBT were Dr. John E. Martin^[6] and Dr. Scott T. Waters.^[7] In a written critical evaluation of SCBT, Dr. Martin and Dr. Waters stated that, "The greatest strength [of SCBT] is the strategic and effective use of techniques that exclusively target people who are ready to change now." They went on to say, in the same report, "...the rigidity of language and pacing might result in negative feelings towards a Training that gives so little choice itself." ^[8]

Specific applications

SCBT has been used most notably in two different spectrums: health and wellness, and criminal psychology (with the intention to minimize recidivism).

Health and wellness

SCBT has been established to some degree in changing emotionally addictive behaviors related to tobacco.^[9][10] There is evidence that cognitive group behavioral training may be beneficial for patients with type 1 diabetes in their self-care ^[11] 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. San Diego based SelfHelpWorks Inc.^[12] has incorporated SCBT as a core component of its behavioral training courses for smoking cessation, alcohol management, weight management, diabetes management, and stress management. Case studies^[13] within the American workplace indicate the efficacy of SCBT, however as of yet academic studies in this promising area are still relatively sparse. Cognitive Behavioral Training has been used, combined with diet and exercise to reduce body weight and raise physical capacity in health care workers ^[14]

Addiction

SCBT has been perhaps most documented in its efficacy with addiction-related issues that involve substances such as food, alcohol and tobacco. Since the philosophy of SCBT is that feeling is related to thought, and thought can lead to belief, it assumes that addiction in itself is at least partially dependent on the continued dysfunctional and oft-practiced thoughts and beliefs of the addict. Much of SCBT is the encouragement to expand your "comfort zone" until the discomfort of physical withdrawal is no longer bothersome. For instance, when seasoned smokers decide to quit on their own, they typically consider it a matter of willpower, following the natural instinct to avoid cigarettes and "white knuckle" it. By contrast, SCBT focuses on the cognitive aspects. It systematically applies a combination of techniques that makes the smoker consciously aware of the urge to smoke, explains the emotionally charged thought process that is really causing the urges, and brings the smoker to the point of purposefully creating urges while choosing the benefits of not smoking over the consequences of smoking in a way that no longer causes discomfort.

Stress and anxiety

SCBT contends that high levels of stress and anxiety are the practiced, subconscious choice of the mind. If stress is a feeling related to thought, and if thinking thoughts that produce stress is an unconscious habit, then this unconscious habit must first be made conscious to the patient. Once this is accomplished, the power to change thought, and hence feeling, is feasible. In a nine week "Brief Structured Cognitive Behavioral Intervention" designed for family caregivers for persons diagnosed with Alzheimer's Disease, there was a reduction in stress and Anxiety - "Moreover, these reductions in anxiety were maintained through a six-week follow-up period..."^[15]

Disease management

SCBT has been used in helping diabetics manage their disease. Since diabetes is a disease that needs to be managed to a large degree by the patient himself/herself, much is dependent on the patient's lifestyle. In addition to producing a shift in mindset from living like a victim to living normally, SCBT has been used to help change pre-existing aversions to healthy living that are known to exacerbate the diabetic condition or, in the case of type 2 diabetes, may even have brought it on in the first place.

In all areas SCBT is applied to, there is maintained a key concept that when one is constantly aware of the power to choose, one will not be vulnerable to feelings of deprivation.

In Adolescents with behavior disorders

A training program was developed and applied with the specific aim to increase self-control and reduce aggression in young people ^[16] Students were divided into six classes, with five students comprising each class.

Criminal behavior

Cognitive-behavioral programs developed for criminal offenders tend to focus on either cognitive deficits or cognitive distortions. Numerous studies have been conducted in correctional settings testing the effectiveness of cognitive-behavioral techniques at reducing recidivism. Highly individualized one-on-one cognitive-behavioral therapy, provided by clinical psychologists or other mental health workers, is simply not practical on a large scale within our prison system. Therefore cognitive-behavioral therapies in correctional settings consist of highly structured treatments that are typically delivered to groups of 8 to 12 individuals in classroom-like settings.^[17]

Methods of access

In group/in person

In the use of structured cognitive programs for convicted criminals to reduce recidivism, the method was in person, and in group form.^[18] There is no evidence that, when targeting this particular issue, SCBT has been used in any other format to date.

Internet

SCBT does require an instructor, or "guide", however the training is universal in its template because it is only individualized when the participant begins adding his/her own specific input when prompted. Therefore the internet is the most cost-effective and practical means to present SCBT. Though the use of SCBT in behavioral health began with live seminar programs, the ubiquity and convenience of the internet – coupled with easy program scalability – have created a transition to the virtual medium. There have been studies done comparing efficacy of internet programs focused on smoking cessation.^[19]

Criticisms

Although studies have been limited, initial data indicates that success with SCBT is largely dependent on the active, cooperative participation of the patient. The number one factor in inefficacy is failure to complete the training. This essentially means that SCBT, as it is presented in internet form, is geared towards participants who, in relation to the stages-of-change theory, are in the preparation and action stages^[20] In other words, SCBT will be most effective when applied to people with a high motivation to change. This is not necessarily a bad thing, but it is an indicator of limitations. Simply put, SCBT is not likely to be effective treatment in someone who has no intention to change.

References

1. Granholm, Eric PhD. "Cognitive Behavioral Skills Training"
2. Science Daily: Gallagher, Annette "Cognitive behavioral or relaxation training helps women reduce distress during breast cancer treatment"
3. Department of Psychiatry: Myongji Hospital, Goyang, Gyeonggi South Korea; Han C. Kim D. "Desensitization of Triggers and Urge Reproducing for Pathological Gambling: A Case Series"
4. "Different Types Of Cognitive Behavioral Therapy". Retrieved 3 December 2003.
5. Live interview with Lou Ryan, San Diego CA, February 2014
6. Martin, Dr. John E
7. Walters, Dr. Scott T
8. Martin, John E. PhD; Walters, Scott T. PhD."Evaluation of SelfHelpWorks Lifestyle Intervention Site: A Three Tiered Critical Analysis" August, 2003
9. John Martin, Ph.D;David M. Young "Comparison of American Cancer Society versus Internet Based treatment for Smokers" February 2003 San Diego State University Graduate Research
10. Michael Wooley, M.D.;John Whitlock, Ph.D "Case Study #1 St. Lukes Hospital and Medical Center" San Antonio TX, February 2001
11. Diabetes Research Group "Cognitive Behavioral Group Training for Patients with Type 1 Diabetes" March 2005
12. "SelfHelpWorks"
13. "Case Study: 390 Corporate Employees""Health Risk Assessment (HRA) Comparison"
14. Christensen, J.R.; Faber, Anne; Ekner, Dorte; Overgaard, Kristian; Holtermann, Andreas; Sogaard, Karen "Diet, physical exercise and cognitive behavioral training as a combined workplace based intervention to reduce body weight and increase physical capacity in health care workers - a randomized controlled trial."
15. Rhonda L. Akkerman, Phd. "Brief Structured Cognitive Behavioral Therapy"
16. Etscheidt, S. "Reducing Aggressive Behavior and Improving Self-Control: A Cognitive-Behavioral Training Program for Behaviorally Disordered Adolescents."
17. Wilson, David B.; Bouffard, Leana Allen; Mackenzie, Doris L. "A Quantitative Review of Structured, Group-Oriented, Cognitive-Behavioral Programs for Offenders" Criminal Justice and Behavior April 2005 vol. 32 no. 2 172-204 http://cjb.sagepub.com/content/32/2/172.short)
18. Wilson, David B.; Bouffard, Leana Allen; Mackenzie, Doris L. "A Quantitative Review of Structured, Group-Oriented, Cognitive-Behavioral Programs for Offenders" Criminal Justice and Behavior April 2005 vol. 32 no. 2 172-204) http://cjb.sagepub.com/content/32/2/172.short)
19. Etter, Jean-Francois PHD MPH. "Comparing the Efficacy of two Internet Based, Computer Tailored Smoking Cessation Programs: A Randomized Trial March 8, 2005
20. Gold, Mark S. MD "Stages of Change" Psyche Central,