{"id":117,"date":"2021-02-04T16:10:42","date_gmt":"2021-02-04T16:10:42","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/?post_type=chapter&p=117"},"modified":"2021-06-01T20:03:01","modified_gmt":"2021-06-01T20:03:01","slug":"cognitive-behavioral-approaches-to-health-behavior-change","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/chapter\/cognitive-behavioral-approaches-to-health-behavior-change\/","title":{"raw":"Cognitive-behavioral approaches to health behavior change","rendered":"Cognitive-behavioral approaches to health behavior change"},"content":{"raw":"

Implementation intentions<\/h1>\r\n
\r\n
Implementation intentions\u00a0\u00a0are a strategy for\u00a0self-regulation\u00a0.\u00a0The function of this concept is to specify the conditions through which long-term goals (e.g. a healthier diet or more sport) can be realized through certain actions.\u00a0The term \"Implementation Intentions\" was introduced in 1993 by the psychologist\u00a0Peter M. Gollwitzer<\/a>\u00a0.<\/div>\r\n
\r\n\r\nWhile a\u00a0goal intention\u00a0only to designate which goal you want to achieve (intent), one describes\u00a0implementation intention\u00a0on the work of the precise ways and means to overcome the discrepancy between the current and desired behavior (eg. As an extra serving of fruit in the Eat coffee break).\u00a0\u00a0The\u00a0implementation intentions\u00a0therefore describe an exact when, where and how and are described as in the form of if-then plans (\"If situation X occurs, I will show behavior Y\").\u00a0We distinguish therefore two types of intentions: the goal intention (\u00a0Engl.\u00a0Goal intention\u00a0) or intent and the implementation intention (Engl.\u00a0Implementation intention) or the intent.\r\n\r\nThe\u00a0implementation intentions\u00a0are just a concept to explain the tension between\u00a0intention<\/a>\u00a0and\u00a0action<\/a>\u00a0.\u00a0Many people decide to change their health behavior, but fail to do so.\u00a0The relationship between goal intention and actual behavior is low.\u00a0Goal intention explains only 20% to 30% of the variance in goal achievement.\u00a0Past behavior is a more appropriate\u00a0predictor<\/a>\u00a0of people's future behavior than their goal intentions.\u00a0A similar approach, which deals with intention and behavior, while still taking social norms, attitudes and behavior control into account, is the\u00a0theory of planned behavior<\/a>\u00a0(Icek Ajzen).\r\n\r\nVarious variables determine the success of target achievement.\u00a0For example, when working out target agreements, it depends on whether the goal has been formulated in a demanding, special way and will therefore be more successful or whether it is a demanding but vaguely formulated goal which will be less successful.\r\n\r\nStudies have shown that if-then plans help people address their goals and help the process automate over time.\u00a0For example in health behavior (consumption of fruit and vegetables).\u00a0So far, research on implementation intentions has mainly focused on the initiation of goal striving,\u00a0while the problem of shielding this\u00a0goal striving\u00a0and possible applications in the context of emotion regulation have been largely neglected..\r\n

Cognitive behavioral therapy<\/h1>\r\n
\r\n
\r\n \t
\"Depicting<\/dt>\r\n \t
The diagram depicts how feelings, thoughts, and behaviors all influence each other. The triangle in the middle represents CBT's tenet that all humans' core beliefs can be summed up in three categories: self, others, future.<\/dd>\r\n<\/dl>\r\n<\/div>\r\nCognitive behavioral therapy\u00a0(CBT) is a\u00a0psycho-social intervention<\/a>[1]<\/a>[2]<\/a>\u00a0that aims to improve\u00a0mental health<\/a>.[3]<\/a>\u00a0CBT focuses on challenging and changing unhelpful\u00a0cognitive distortions<\/a>\u00a0(e.g. thoughts, beliefs, and attitudes) and behaviors, improving\u00a0emotional regulation<\/a>,[2]<\/a>[4]<\/a>\u00a0and the development of personal\u00a0coping strategies<\/a>\u00a0that target solving current problems. Originally, it was designed to treat\u00a0depression<\/a>, but its uses have been expanded to include treatment of a number of mental health conditions, including\u00a0anxiety<\/a>.[5]<\/a>[6]<\/a>\u00a0CBT includes a number of cognitive or behavior psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.[7]<\/a>[8]<\/a>[9]<\/a>\r\n\r\nCBT is based on the combination of the basic principles from\u00a0behavioral<\/a>\u00a0and\u00a0cognitive psychology<\/a>.[2]<\/a>\u00a0It is different from historical approaches to\u00a0psychotherapy<\/a>, such as the\u00a0psychoanalytic<\/a>\u00a0approach where the therapist looks for the unconscious meaning behind the behaviors and then formulates a diagnosis. Instead, CBT is a \"problem-focused\" and \"action-oriented\" form of therapy, meaning it is used to treat specific problems related to a diagnosed mental disorder. The therapist's role is to assist the client in finding and practicing effective strategies to address the identified goals and decrease symptoms of the disorder.[10]<\/a>\u00a0CBT is based on the belief that\u00a0thought distortions<\/a>\u00a0and\u00a0maladaptive<\/a>\u00a0behaviors play a role in the development and maintenance of\u00a0psychological disorders<\/a>,[3]<\/a>\u00a0and that symptoms and associated distress can be reduced by teaching new information-processing skills and coping mechanisms.[1]<\/a>[10]<\/a>[11]<\/a>\r\n

Description<\/span><\/h2>\r\nMainstream cognitive behavioral therapy assumes that changing\u00a0maladaptive<\/a>\u00a0thinking leads to change in\u00a0behavior<\/a>\u00a0and\u00a0affect<\/a>,[39]<\/a>\u00a0but recent variants emphasize changes in one's relationship to maladaptive thinking rather than changes in thinking itself.[40]<\/a>\u00a0The goal of cognitive behavioral therapy is not to diagnose a person with a particular disease, but to look at the person as a whole and decide what can be altered.\r\n

Cognitive distortions<\/span><\/h3>\r\nTherapists or computer-based programs use CBT techniques to help people challenge their patterns and beliefs and replace errors in thinking, known as\u00a0cognitive distortions<\/a>, such as \"overgeneralizing, magnifying negatives, minimizing positives and catastrophizing\" with \"more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior\".[39]<\/a>\u00a0Cognitive distortions can be either a pseudo-discrimination belief or an over-generalization of something.[41]<\/a>\u00a0CBT techniques may also be used to help individuals take a more open, mindful, and aware posture toward cognitive distortions so as to diminish their impact.[40]<\/a>\r\n

Skills<\/span><\/h3>\r\nMainstream CBT helps individuals replace \"maladaptive... coping skills, cognitions, emotions and behaviors with more adaptive ones\",[42]<\/a>\u00a0by challenging an individual's way of thinking and the way that they react to certain habits or behaviors,[43]<\/a>\u00a0but there is still controversy about the degree to which these traditional cognitive elements account for the effects seen with CBT over and above the earlier behavioral elements such as exposure and skills training.[44]<\/a>\r\n

Phases in therapy<\/span><\/h3>\r\nCBT can be seen as having six phases:[42]<\/a>\r\n
    \r\n \t
  1. Assessment or\u00a0psychological assessment<\/a>;<\/li>\r\n \t
  2. Reconceptualization;<\/li>\r\n \t
  3. Skills acquisition;<\/li>\r\n \t
  4. Skills consolidation and application training;<\/li>\r\n \t
  5. Generalization<\/a>\u00a0and maintenance;<\/li>\r\n \t
  6. Post-treatment assessment follow-up.<\/li>\r\n<\/ol>\r\nThese steps are based on a system created by Kanfer and Saslow.[45]<\/a>\u00a0After identifying the behaviors that need changing, whether they be in excess or deficit, and treatment has occurred, the psychologist must identify whether or not the intervention succeeded. For example, \"If the goal was to decrease the behavior, then there should be a decrease relative to the baseline. If the critical behavior remains at or above the baseline, then the intervention has failed.\"[45]<\/a>\r\n\r\nThe steps in the assessment phase include:\r\n
    \r\n \t
    Step 1: Identify critical behaviors<\/dd>\r\n \t
    Step 2: Determine whether critical behaviors are excesses or deficits<\/dd>\r\n \t
    Step 3: Evaluate critical behaviors for frequency, duration, or intensity (obtain a baseline)<\/dd>\r\n \t
    Step 4: If excess, attempt to decrease frequency, duration, or intensity of behaviors; if deficits, attempt to increase behaviors.[46]<\/a><\/dd>\r\n<\/dl>\r\nThe re-conceptualization phase makes up much of the \"cognitive\" portion of CBT.[42]<\/a>\u00a0A summary of modern CBT approaches is given by Hofmann.[47]<\/a>\r\n

    Delivery protocols<\/span><\/h3>\r\nThere are different protocols for delivering cognitive behavioral therapy, with important similarities among them.[48]<\/a>\u00a0Use of the term\u00a0CBT\u00a0may refer to different interventions, including \"self-instructions (e.g. distraction, imagery, motivational self-talk), relaxation and\/or\u00a0biofeedback<\/a>, development of adaptive coping strategies (e.g. minimizing negative or self-defeating thoughts), changing maladaptive beliefs about pain, and\u00a0goal setting<\/a>\".[42]<\/a>\u00a0Treatment is sometimes manualized, with brief, direct, and time-limited treatments for individual psychological disorders that are specific technique-driven.[49]<\/a>\u00a0CBT is used in both individual and group settings, and the techniques are often adapted for\u00a0self-help<\/a>\u00a0applications. Some clinicians and researchers are cognitively oriented (e.g.\u00a0cognitive restructuring<\/a>), while others are more behaviorally oriented (e.g.\u00a0in vivo<\/a>\u00a0exposure therapy<\/a>). Interventions such as imaginal exposure therapy combine both approaches.[50]<\/a>[51]<\/a>\r\n

    Related techniques<\/span><\/h3>\r\nCBT may be delivered in conjunction with a variety of diverse but related techniques such as\u00a0exposure therapy<\/a>,\u00a0stress inoculation<\/a>,\u00a0cognitive processing therapy<\/a>,\u00a0cognitive therapy<\/a>,\u00a0relaxation training<\/a>,\u00a0dialectical behavior therapy<\/a>, and\u00a0acceptance and commitment therapy<\/a>.[52]<\/a>[53]<\/a>\u00a0Some practitioners promote a form of mindful cognitive therapy which includes a greater emphasis on self-awareness as part of the therapeutic process.\r\n

    Self-monitoring<\/h3>\r\nSelf monitoring is a method used in behavioral management in which individuals keep a record of their behavior (e.g., time spent, form and place of occurrence, feelings during performance), especially in connection with efforts to change or control the self. For example, a therapist may assign a client self-monitoring as homework to encourage better\u00a0self-regulation<\/a>\u00a0by that person.\r\n\r\nSelf-regulation<\/a>\u00a0is reducing the intensity and or the frequency of those impulses by\u00a0self-managing stress<\/a>\u00a0and negative environmental impact. Self-control is possible because of practices in self-regulation.\r\n\r\nTheories of self-control can be described within the theory of self-regulation theory. The process of self-regulation creates various challenges for human beings. Self-control is one of these challenges.\r\n\r\nFor self-regulation to be successful, the following must occur:\r\n