What is Cognitive Behavioral Intervention in the Context of Applied Behavior Analysis?

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Cognitive behavioral intervention (CBI) is a process by which patients learn to become experts of their own behavior. Through CBI, patients learn to examine their thoughts, recognize when negative thoughts are increasing, and then apply a number of strategies to alter those negative thoughts and emotions.

The theory behind CBI is that if people can learn to better understand their thoughts and emotions, then they can also alter them through a host of strategies or exercises. The ultimate goal of CBI is to teach patients how to change undesirable emotions, such as anxiety and anger, that result in maladaptive or destructive behaviors.

CBI strategies, all of which are focused on increasing positive behaviors, reducing undesirable or inappropriate behaviors, and promoting self-control, include actionable goals that promote problem-solving, communication, relaxation, and self-awareness.

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What Does CBI Look Like?

The strategies of CBI are designed to be simple, straightforward, and actionable. Through CBI, patients are taught to break down their feelings and emotions into easily identifiable parts. Doing so enables them to better understand when they need to begin applying CBI strategies.

Some of the exercises/techniques used in CBI include:

  • Cognitive restructuring: Involves helping patients better understand and track their negative thinking patterns that lead to negative responses and then devise alternative responses.
  • Activity scheduling: Involves encouraging patients to gradually engage in behaviors they would normally avoid due to anxiety, fear, etc. The behavior analyst would help the patient schedule these behaviors throughout the week, slowly at first and then increasing in frequency.
  • Mindful meditation: Involves helping patients eliminate negative thoughts by connecting in the moment through meditation.
  • Problem solving: Involves helping patients become active participants in finding solutions to their problems; focuses on implementing problem-solving strategies to regain control of their lives.
  • Graded Exposure: Involves repeatedly introducing something that is feared to gradually reduce anxiety and fear.
  • Successive Approximation: Involves helping patients break down overwhelming or daunting goals into easily manageable steps.

How is CBI Used?

CBI is always actionable, goal-oriented, and engaging. The patient and behavior therapist work together to:

  • Identify the problem
  • Define the specifics of the problem (how it occurs, when it occurs, etc.)
  • Develop a plan for solving the problem
  • Evaluate different strategies for implementing the plan
  • Discuss the consequences of implementing the plan and discussing alternative plans
  • Agree on a course of action

For example, a behavior therapist may use CBI on a patient who is plagued with excessive worry. Using cognitive restructuring, the behavior analyst would help the patient identify the thoughts that lead to worry and then help her replace those thoughts with more grounded, positive thoughts, which in turn would lessen her anxiety.

Or, the behavior analyst may implement the graded exposure strategy to help the patient achieve the goal of grocery shopping, which she always avoided out of fear. Through graded exposure, the patient would accomplish smaller goals that would eventually lead to completing a shopping trip:

  • Day 1: Drive to the shopping center.
  • Day 2: Drive to the shopping center and park.
  • Day 3: Drive to the shopping center, park, and walk to the store entrance.
  • Day 4: Drive to the shopping center, park, and walk into the store.
  • Day 5: Drive to the shopping center, park, walk into the store, and walk through the store.
  • Day 6: Drive to the shopping center, park, walk into the store, and walk through the store with a shopping cart.
  • Day 7: Drive to the shopping center, park, walk into the store, and put one item into the shopping cart.
  • Day 8: Drive to the shopping center, park, walk into the store, put one item into the shopping cart, and purchase that item.

When is CBI Used?

CBI has been used for decades on children, adolescents, and adults. Just some of the conditions CBI is used to treat include depression, anxiety, post-traumatic stress disorder, obsessive-compulsive disorders, eating disorders, and substance abuse disorders.