1. Outline

Cognitive Behavioral Therapy(CBT, 認知行動治療)

Cognitive behavioral therapy is a counseling theory that focuses on human cognition and corrects cognition to solve problems.

It is assumed that the approach to cognitive behavior therapy does not place a problem in the situation itself based on the cognitive model, but is influenced by how people interpret their emotions, behaviors, and events.

Beck & Ellis said that disorders occur in distorted cognitive processes and effectiveness is found in behavioral correction.

One of the notable features of cognitive behavioral therapy is the persistence of therapeutic effect, which maintains significant therapeutic effect during follow-up and in some cases shows more improvement even after treatment is over.

There are consistent reports that the combination of cognitive behavioral therapy and drug treatment maximizes the therapeutic effect.

In other words, cognitive behavioral therapy serves as a basic treatment platform for strengthening treatment maintenance and drug treatment compliance, enhancing the effectiveness of other treatments, and dealing with other problems.

In cognitive behavioral therapy, the therapist forms a case conceptualization for the patient, thereby providing a roadmap for the treatment plan to the patient.

From a cognitive behavioral point of view, thinking, emotion, behavior, and situation are closely connected and have an interactive effect.

Cognitive behavioral therapy informs patients in detail in connection with the advanced mechanism of intervention strategies used during treatment.

Explain that acquiring adaptive coping skills is an effective way to deal with maladaptive thinking, mood condition, and behavior.

New adaptive coping skills can be learned and practiced within treatment, which can increase self-efficacy (defined as a level of confidence in one’s ability to perform specific actions) to implement adaptive coping behaviors in the future.

For example, people who use alcohol in an attempt to deal with panic attacks will learn and practice alternative coping strategies such as abdominal breathing during treatment.

If you realize that abdominal breathing is as effective as or more effective as alcohol use, the use of an adaptive coping strategy called abdominal breathing will be strengthened.

In addition, the more successful abdominal breathing is performed, the higher the sense of self-efficacy that new coping strategies can be implemented when experiencing panic symptoms in the future.

2. The components and techniques of Cognitive Behavioral Therapy

(1) Cooperation

Collaborative imperialism, in which treatment goals are jointly established and therapists and patients work together on a systematic treatment process, is a major variable in cognitive behavioral therapy.

The development of treatment relationships and cooperative experiences, along with factors that drive treatment success, are important parts of treating associated emotional and behavioral disorders and uncovering patients’ automatic thinking and core beliefs.

Working together in a collaborative manner creates a therapeutic relationship in which the therapist can understand the patient, and the patient and the therapist work together to discuss how the patient reveals their specific thoughts, emotions, and behaviors is a major therapeutic factor.

Cooperation helps explore and discover negative thinking, increases patient motivation for future changes, and becomes an important factor in inducing cognitive change and guiding case conceptualization.

(2) Case Conceptualization

Case conceptualization is the process of collecting and analyzing the information obtained by clinical interviews, medical records review, clinical evaluation, behavioral observation from family members or other providers of patients.

Case conceptualization is ① a mechanism that causes individual problems, ② the precipitant that triggers the mechanism, and ➂ the process of forming a hypothesis about the source of this mechanism.

This allows patients to share conceptualized information so that they can think and discuss together when deciding what strategies to focus on during the treatment process.

(3) Structuralization

Cognitive behavioral therapy proceeds according to standardized techniques and procedures, and has recently changed in the direction of applying a flexible and individual treatment structure.

Not all tasks (e.g., rapport formation, case conceptualization, motivation enhancement strategies) need to be performed sequentially or at once within the treatment stage.

The primary purpose of treatment is to engage in appropriate work according to the patient’s clinical symptoms.

(4) Cognition and motivation strategies

Motivation and cognitive intervention not only increases motivation for alternative activities, but can also provide work to reduce cognition that increases the likelihood of a particular behavior.

Drawing evidence from patients regarding the accuracy of cognitive distortion is more adaptive and helps patients make alternative evaluations that reflect their experiences in a better perspective.

Providing psychological education on the nature of thinking and its role in recovery helps patients become aware of how much this pattern of thinking affects the maintenance of disabilities.

(5) Management of contingency and exposure of clues

Contingency is a concept derived from the principle that the accompanying nature of prophetic relationships plays an important role in condition formation, in addition to the temporal and spatial association of operational condition formation between specific reactions and results. All actions occur in a specific context of how predictable the action is of contingency nature and are reinforced according to the outcome of the action.

In addition to considering traditional contingency management compensation such as monetary goods, gift certificates, and treatment “privileges” (e.g., taking methadone in patients with opium use disabilities), social contingency (i.e., social compensation) should also be considered.

If the goal is achieved, the patient clarifies the compensation (better occupation, relationship, social success, etc.) that occurs naturally due to the giving up the drinking in the treatment process.

Important factors contributing to the initiation and maintenance of behavioral changes are provided by individual external and internal clues.

(6) Psychological education

Psychological education is to provide information on psychological principles and knowledge related to patients receiving services.

This includes information on appropriate diagnosis, other types of evidence-based treatment, coping strategies, findings, or resources.

In cognitive behavioral therapy, psychological education is commonly used as a contextual component of the entire framework and is available throughout the treatment process, but is generally more useful in the early stages of treatment, where more information on diagnostic problems, treatment models, and intervention plans is required.

(7) Skill training

Skill training is a common factor in cognitive behavioral therapy in addiction disorders.

The use of skill straining strategies should be based on case conceptualization and should be made through patient reporting and behavioral observation.

Interpersonal skills training activities aim to increase the ability to use social support and communicate effectively to increase interpersonal skills.

Emotional control skills include patience and response skills. Strategies to deal with negative emotions, such as using social support, engaging in enjoyable activities, and exercising, are introduced as a list and then practiced.

Finally, leading patients to set treatment goals is also the first and final practice of technical training. Helping patients set specific practicable goals is also an important activity.

The Third Trend

There are at least two major trends in the development of cognitive behavioral therapy (Goldfried & Davidson, 1994; Hayes, Masuda & De May, Infree; Moon Hyun-mi 2005 re-quote)

One is behavioral therapy featuring techniques related to classical and operational conditioning principles, and the other is cognitive therapy that has emerged since the early 1970s based on the constituent concept of cognitive mediation.

In early behavioral approach therapy, it is difficult to explain human language and cognition only with stimulation-response behavioral analysis, and the third trend of cognitive behavioral therapy emerges as it feels the need to deal with cognition and emotions more corely.

This served as an opportunity to switch to a first-generation behavioral approach and a second-generation cognitive approach, and to eliminate distorted beliefs and behaviors caused by cognitive errors through various techniques applying cognitive models for conversion of cognitive and dysfunctional beliefs.

Modern cognitive behavioral therapy tends to view experience as an essential element rather than negative emotional control.

This trend makes acceptance useful in situations of approach-avoidance conflict, and strengthening empirical contact rather than avoidance can increase the ability to deal with problems in new and constructive ways.

When comparing traditional CBT and the third trends, the performance immediately after counseling is similar, but in the prevention of recurrence and future performance, the CBT of the third trend was improved more than the existing treatment technique (Hyun-mi Moon, 2005).

n addition to the dialectical approach (MBCT, Mindful Cognitive Therapy) (Teasdale, Segal, & Williams, 1999), various treatment methods such as recognition and acceptance techniques (Marlatt, 1994) are emerging as addiction treatments.

Compared to traditional cognitive behavior therapy, the third trend behavior therapy which is based on relational frame theory that is about the relationship between human high cognition and language skill considers the function of behavior and the context in which behavior occurs(functional contextualism) and it is characterized by taking the position that the observer’s intention and value have a significant influence on the composition of the outcome of the action(constructivism)

In other words, traditional cognitive behavior therapy approaches clinical(problem) behavior as ‘precedent event(A), thinking/belief(B)-result(C)’, while the tird trend behavior therapy focuses on ’precedent event(A), behavior(B), outcome(C)’ and use mindfulness, acceptance, value as the core elements of treatment.

A number of treatment techniques such as Dialectic Behavioral Therapy (Linehan, 1993), Functional Analysis Psychotherapy (Kohlenberg & Tsai, 1991), Integratie Behavior Couple Therapy (Jacobson & Christense, 1996), Mindfulness-Based Cognitive Therapy(Segal Williams & Teasdale, 2002), Acceptance & Commitment Therapy(Hayes, Strosahl & Wilson, 1991), Using Mindfulness addiction treatment(Marlatt, 1994; Marlatt et al., 2004), Pan-anxiety Disorder Treatment using Acceptance and Mindfulness(Roemer & Orsillo, 2002) are emerging.

These treatment techniques mainly emphasize problems such as acceptance, mindfulness, cognitive defusion, dialectic of acceptance and change, value, spirituality, and relationship.

The third trend has something in common that promotes a change in the context of accepting private experiences rather than direct changes in emotion or cognition, so it is sometimes referred to as an acceptance-based treatment (Zettle, Rains, & Hayes, 2011; Roemer & Orsillo, 2002).

These treatment techniques mainly emphasize problems such as acceptance, mindfulness, cognitive defusion, dialectic of acceptance and change, value, spirituality, and relationship.

The third trend has something in common that promotes a change in the context of accepting private experiences rather than direct changes in emotion or cognition, so it is sometimes referred to as an acceptance-based treatment (Zettle, Rains, & Hayes, 2011; Roemer & Orsillo, 2002).