Sunday, November 17, 2013

Cognitive Behavioral Training

Cognitive behavioral training (CBT) targets maladaptive behaviors and thought processes. It is based on the idea that people's thoughts influence their behavior and their overall mood and life experience. This type of training assumes individuals can alter irrational thinking through practicing techniques that help the individual identify negative and distorted ways of thinking, change inaccurate beliefs, and modify unhealthy and counterproductive behaviors. These skills can help people appraise their circumstances as less threatening, and provokes more effective responses to stress. According to Lazarus (1991) the initial subjective interpretation of circumstances (the cognitive appraisal), and the level of threat they present, ultimately determines the coping strategies implemented and the self-perceived ability to cope. Since cognitive appraisals are pivotal in the ability to manage stress, changing the cognitive appraisal may be effective in the development of adaptive coping strategies in some populations (Singer et al., 2007). CBT provides tools to reframe circumstances and support healthy reappraisal processes.

Evaluating Effectiveness
One measure that effectively measures changes in daily stressor exposure is the Daily Inventory of Stressful Events (DISE). Self-reports can be provide valuable assessments, although several limitations and shortcoming exist in this type of instrument. Responses can be influenced by the environment in which the assessment is given, and responses may fluctuate because of time of day and mood of the individual (Bowling, 2005). Furthermore, responses may be fabricated or exaggerated (Almeida, Stawski, & Cichy, 2011). The DISE, implemented pre-and post CBT may be valuable to determine the effectiveness of the training. It is comprehensive and evaluates the respondents' subjective appraisals (Almeida, Stawski, & Cichy, 2011), which seems salient when evaluating the effectiveness of stress management techniques.

Although this assessment is time consuming, it provides valuable information regarding whether and to what extent CBT is effective. It is valuable in identifying daily stressor exposure in an individual over time (Almeida, Stawski, & Cichy, 2011). In addition, I appreciate its adaptability to use over the phone. This makes it practical for the consumer as well as the practitioner and could be implemented in a variety of environments (possibly for research). Finally, the DISE approach assesses within-person processes, and this seems a valuable component in measuring the effectiveness of a stress management technique.

Benefits of Multi-Faceted Interventions

Singer, Ethridge, and Aldana (2007) found implementing multi-faceted interventions over longer time periods was significantly more effective than single stress management techniques. Utilizing a combination of techniques is in agreement with Lazarus (1991), which posited the nature of stress is complex with a variety of components. Effective stress management must affect the confluent forces of cognitive appraisal, perception of resources available, moderating variables such as personality and temperament, and mediating variables that occur within the circumstances (Lazarus, 1991). Utilizing a more complex combination of stress management strategies may be consistent with Lazarus' findings.

Two Barriers to Effective Stress Management
Two barriers to effective stress management are failure to adhere to prescribed stress management strategies, (Bailey et al., 1990) and in the case of CBT, not having the techniques presented over a long enough period (Singer et al., 2007). In addition, and according to the Health Belief Model, self-efficacy is an integral component of health behavior change (Clemow, 2004). If an individual does not believe they are capable of making a change, or adhering to stress management techniques, they are more likely to fail. It is important for the treatment plan to consider the unique context of the individual. If it is not a practical or practicable there may be far less chance of success.


Almeida, D. M., Stawski, R. S., & Cichy, K. E. (2011). Combining checklist and interview approaches for assessing daily stressors: The daily inventory of stressful events. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 583–595). New York, NY: Springer Publishing Company.

Bailey, W., Richards, J., Brooks, C., Soong, S., Windsor, R., & Manzella, B. (1990). A randomized trial to improve self-management practices of adults with asthma. Archives Of Internal Medicine, 150(8), 1664-1668.

Bowling, A. (2005). Mode of questionnaire administration can have serious effects on data quality. Journal of Public Health, 27(3), 281-291. doi: 10.1093/pubmed/fdi031

Butler, A., Chapman, J., Forman, E., & Beck, A. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31. doi: 10.1016/j.cpr.2005.07.003

Clemow, L. (2004). Health belief model. In N. Anderson (Ed.), Encyclopedia of health and behavior. (pp. 390-393). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412952576.n113

Lazarus, R. S. (1991). Progress on a cognitive-motivational-relational theory of emotion. American Psychologist, 46(8), 819-834. doi:10.1037/0003-066X.46.8.819

Singer, G. H., Ethridge, B. L., & Aldana, S. I. (2007). Primary and secondary effects of parenting and stress management interventions for parents of children with developmental disabilities: A meta-analysis. Mental Retardation and Developmental Disabilities Research Reviews, 13(4), 357-369. doi: 10.1002/mrdd.20175

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