NATIONAL FORENSIC SCIENCES UNIVERSITY

(2019-2021)

INSTITUTE OF BEHAVIORAL SCIENCES

ASSIGNMENT

MILITARY PSYCHOLOGY

COGNITIVE BEHAVIORAL THERAPY

SUBMITTED TO: SUBMITTED BY:

DR. SONIA SHALI HIMANI BAIRWA (04)

MSCP (SEM-III)
BACKGROUND:

In an effort to prove Freudian's theory of depression as repressed retroflexed aggression, the

cognitive model was developed following research experiments performed by Aaron Beck to
describe the psychological mechanisms in depression. Beck suggested that the signs of
depression could be explained as biased perceptions of events due to the activation of
pessimistic images of the self, the personal world, and the future in cognitive terms. Beck
started to profoundly question the motivational paradigm and therapeutic approach of
psychoanalytic unconsciousness, especially the focus of psychoanalysis on motivational
affective conceptualizations of emotional problems, which generally overlooked cognitive
causes, as supported by his research findings on depression.

Instead of overt behavior, cognitive theory focuses on intrapsychic mechanisms, while

behavioral techniques are more similar to behavior therapy.

CBT has been researched and successfully extended to individuals with multiple and complex
needs that may receive alternative forms of therapy or have not been successful with other
types of therapy.

What is CBT (cognitive behavioral therapy)?

CBT is a psychological therapy that tackles the relationships between how we think, feel and
act. It is a form of talking therapy that in the context of particular circumstances and
symptoms, shows the connections between our emotions, thoughts and behaviors. Usually, it
is time-limited (about 10-20 sessions), focuses on current issues, and follows a structured
intervention style. CBT is a process where positive behaviors are taught, coached, and
strengthened. CBT helps individuals identify cognitive patterns or thoughts and emotions
associated with behaviors.

PRINCIPLES:

CBT can be regarded as having several primary principles. These concepts are:

• It is based on the emotional disorders cognitive-behavioral model (for instance,

thoughts affect feelings and behavior);
• Short and time-limited.
• A sound therapeutic relationship is required and is a collaborative effort between the
qualified CBT practitioner and the person seeking treatment.
 • Individuals are guided to discover new ways of thinking with specific questions for
themselves;
• Is structured, problem-oriented, and directed;
• Often based on a model of education (for example, explaining the effects of the
perceived threat on body reactions);
• Relies on the inductive method, using logic and reasoning as a scientific approach;
and
• Uses the practice of inter-session as a central feature (for people to put into practice
what they have learned). In safe situations for example, the practitioner's office), new
behaviors are initially tested.

OBJECTIVES:

1) Cognitive-behavioral therapy for the treatment of post-traumatic stress disorder.

2) Cognitive Behavioural Therapy for Insomnia in Veterans.

3) Using Cognitive Behavioral Interventions to Help Children Cope with Parental Military
Deployments.

4) Cognitive Behavioural Therapy for Mood Disorders: Efficacy, Moderators and Mediators

5) Cultural adaptations of CBT: a summary and discussion of the Special Issue on Cultural
Adaptation of CBT.

1) Cognitive-behavioral therapy for the treatment of post-traumatic stress disorder:

Nilamadhab Kar (2011) found that Post-traumatic stress disorder (PTSD) is a psychiatric
sequel to a stressful event or situation that is threatening or catastrophic in nature. For many
years, cognitive-behavioral therapy (CBT) has been used in the management of PTSD. The
efficacy of CBT in the treatment of PTSD following different types of trauma, its potential
for the prevention of PTSD, the methods used in CBT, and the mechanisms of action of CBT
in PTSD are reflected.

Following a range of traumatic experiences in adults, kids, and adolescents, CBT is a safe and
effective intervention for both acute and chronic PTSD. Non-response to CBT by PTSD,
however, can be as high as 50%, caused by various variables, including comorbidity and the
nature of the study population. CBT has been validated and used across many cultures and,
following brief training in individual and group settings, has been used successfully by
community therapists. The use of Internet-based CBT in PTSD has been effective. The effect
of CBT has been mediated mostly by the change in maladaptive cognitive distortions
associated with PTSD. Many studies also report physiological, functional neuroimaging, and
electroencephalographic changes correlating with response to CBT.

2) Cognitive Behavioural Therapy for Insomnia in Veterans:

Cognitive-Behavioural Therapy for Insomnia (CBT-I) is a multi-component therapy that

addresses the cognitions and behaviors that interfere with sleep in patients. Lack of awareness
of the biological and psychological underpinnings of the sleep process leads many patients to
maintain attitudes and participate in activities that have a detrimental effect on their sleep
despite their facial validity. Thus, education regarding the biological and psychological
processes that regulate sleep is an important component of CBT-I. Patients who understand
how sleep control applies to their particular experiences are more able to understand why
their therapist suggests such improvements to their regular habits and cognitions related to
sleep, and are more likely to stick to therapy and benefit from it.

3) Using Cognitive Behavioral Interventions to Help Children Cope with Parental

Military Deployments:

Wars in Afghanistan and Iraq are associated with more deployments. Recent estimates show
that 1.2 million schoolchildren have a parent that is serving in the active military. Family
stress increases proportionately to the length of deployment and the perception of danger. In a
recent study, twenty percent of children whose parent was being deployed were identified as
"high risk" for psychosocial disturbances. A deployed parent represents a stressor reflecting
ambiguous loss which prompts emotional distress. Cognitive behaviourally based prevention
and intervention efforts have shown considerable promise with children experiencing a
variety of disorders who do not necessarily have a deployed parent.

(Cozza et al. 2005; Ryan-Wenger 2001) found that there are many emotional challenges
that children may face when coping with a parent deployed in military combat. It is important
to note that many studies assessing children from military families point to the resilient nature
of these children.

Thus, children whose parents are currently involved in the active-duty military or reservist
may be at greater risk for emotional and behavioral difficulties particularly if there is a pre-
existing mental health condition (e.g., depression, anxiety, or behavioral difficulties)
(Johnson et al. 2007), pre-existing familial stressors (e.g., maternal depression or family
aggression) or poor family relationships (Hagan et al. 1996).

Problems faced by children of deployed parents:

• Separation Anxiety

• Grief and Ambiguous Loss

• Secondary Traumatic Stress

• Sleep Issues

• Depression and Anxiety

• Attention Difficulties/School Difficulties

Overall, the emotional and behavioral difficulties displayed by children may vary in severity
based on several factors including child-centered factors (e.g., developmental age,
temperament, and coping skills) and family-centered factors (e.g., family relationships,
mental health issues, and support from the remaining parent). However, programs focused on
assisting families with deployment through psychoeducational programs and therapeutic
services will enhance their ability to face adversities related to deployment.

Interventions:

1) Project FOCUS

The primary program aimed at assisting family members deal with deployment is called
Project FOCUS (Families Overcoming and Coping Under Stress). This program focuses on
enhancing resiliency in children during the deployment cycle (Cohen et al. 2009). The main
modules of Project FOCUS are centered on emotional regulation, communication, problem-
solving, goal-setting, and managing deployment reminders.

2) School-Based Programs
There is also a dearth of school-based programs to assist children with parental deployment.
This program focuses on teaching children resiliency skills in a group setting by enhancing
their ability to express their feelings related to a family member's deployment and develop
appropriate coping skills to deal with these feelings.

CBT approach

CBT approaches hold promise for helping children cope with a variety of stressors and
negative emotional experiences. cognitive behavioral modules to help children manage
negative affectivity, deal with inaccurate appraisals, as well as cope with uncertainty and
uncontrollability.

4) Cognitive Behavioural Therapy for Mood Disorders: Efficacy, Moderators, and

Mediators:

Cognitive behavior therapy (CBT) is efficacious in the acute treatment of depression and may
provide a viable alternative to antidepressant medications (ADM) for even more severely
depressed unipolar patients when implemented skilfully. CBT is also used as medication
treatment for bipolar patients. CBT does appear to have an enduring effect that protects
against subsequent relapse and recurrence following the end of active treatment, something
that cannot be said for medications. Single studies that require replication suggest that
patients who are married or unemployed or who have more antecedent life events may do
better in CBT than in ADM, as might patients who are free from comorbid Axis II disorders,
whereas patients with comorbid Axis II disorders appear to do better in ADM than in CBT.
There also are indications that CBT may work through processes specified by theory to
produce a change in cognition that in turn mediate subsequent change in depression and
freedom from relapse following treatment termination, although evidence in that regard is not
yet conclusive.

Among patients who respond to acute treatment, relapse rates are lower following treatment
termination after acute CBT than after acute ADM and also lower for patients treated with
combined treatment than for patients treated with ADM alone. This suggests that it is not so
much the withdrawal of medication that provokes relapse in remitted patients as that prior
exposure to CBT prevents it.
Cognitive theory shows that negative automatic thoughts and maladaptive information
processing proclivities play a causal role in the etiology and maintenance of depression. CBT
works by implementing efforts (process) to correct these errors in thinking (a mechanism). To
the extent that this is true then efforts to help patients learn how to examine the accuracy of
their own beliefs should help ameliorate the level of existing distress and reduce the risk for
future episodes. Other factors that also are believed to mediate the efficacy of psychotherapy
are the quality of the therapeutic relationship and facilitative conditions, such as therapist
warmth and empathy. If the cognitive theory is correct, then adherence to the specific
components of CBT should drive symptom change and subsequent freedom from relapse
over and above whatever contribution is made by nonspecific factors common to other
therapies.

5) Cultural adaptations of CBT: a summary and discussion of the Special Issue on

Cultural Adaptation of CBT.

Cognitive-behavioral therapy (CBT) in its current form might not be acceptable to service
users from a variety of backgrounds. Therefore, it makes sense to adapt CBT when working
with diverse populations. Contributors to this special issue of the Cognitive Behaviour
Therapist have tackled the issues around the cultural adaptation of CBT from various
perspectives, using a variety of methods, and have addressed topics ranging from cultural
adaptation to improving access to CBT.

CBT involves exploration and attempts to modify core beliefs. Core beliefs, underlying
assumptions, and even the content of automatic thoughts vary across cultures (Sahin and
Sahin, 1992; Tam et al., 2007). Cultural and sub-cultural backgrounds also influence beliefs
about wellbeing, causes of illness and its cure, help-seeking behaviors, healing systems, and
even the healers.

CBT research until recently has primarily focused on white, middle-class, well-educated
service users, who are of European-American identities (Suinn, 2003). It is not common
practice to report participant's cultural or religious backgrounds in CBT research. Even when
the participant's background is reported, a broader term such as White, Asian, or Black is
used, ignoring variations among these groups. Similarly, researchers do not record
information concerning participants' sexual orientation (Bowen and Boehmer, 2007).
Culturally adapting CBT is the only way access to this evidence-based therapy can be
improved for marginalized communities in Europe and North America and for the local
population outside of these regions where more than 80% of the world population lives. It is
heartening to see this field grow over the past decade to the extent that it found it place in a
special edition of a highly prestigious journal. This special edition, therefore, is a welcome
addition to a fast-growing area in CBT research and practice: 'the cultural adaptation of CBT'.

CONCLUSION:

CBT is an approach which is very necessary and versatile. It uses its values and skills to help
people with depression, anxiety, mood disorders, schizophrenia, addiction, eating disorders,
PTSD, OCD, etc. It is a long-term process and has been found to be quite effective. In the
military, CBT is very commonly used and focuses specifically on an individual's cognitive
and behavioral components so that they can turn maladaptive, irrational behavior into an
adaptive, rational one. For both acute and chronic PTSD, CBT is a safe and effective
intervention which follows a variety of traumatic experiences in adults, children and
adolescents. To strengthen the psychological health of children whose parents are deployed,
cognitive-behavioral therapies are used. Children of deployed military parents are an
increasingly under-served demographic and feel emotional and behavioral decline. CBT
approaches focuses on helping children to cope with a variety of stressors and negative
emotional experiences. Cognitive behavioral modules to help children manage negative
affectivity, deal with inaccurate appraisals, as well as cope with uncertainty and
uncontrollability. Cognitive behaviorally based services provide support to deal with stressors
for children of deployed parents. CBT is also used to treat veterans suffering from insomnia,
by addressing the cognitions and behaviors that interfere with sleep in patients.

Since human cultures develop at a very rapid pace, Globalization brings people together and
increases their comprehension and knowledge of the new healthcare developments.
Therefore, in order for CBT to continue in the system, other therapy programs need to
develop, adapt, and even integrate to meet the demands of individuals with a range of needs.
In order to aid service users with anxiety, PTSD, OCD, and psychosis, the original CBT
model has been modified over the years. Good examples of the incorporation of CBT with
another model of therapy are third wave therapies. CBT adaptation can be seen as an
expansion of this phase for service users from a number of cultures and sub-cultures. The
culture-free dimensions of CBT need to be checked, too. Most significantly, there is a need to
concentrate on the introduction of adapted CBT, the growth of facilities and the enhancement
of access to adapted CBT, which can only be accomplished through construction.
REFERENCES:

• Cohen, J. A., Goodman, R. F., Campbell, C., Carroll, B., & Campagna, H. (2009).
Military children: The sometimes orphans of war. In S. M. Freeman, B. A. Moore, &
A. Freeman (Eds.), Living and surviving in harm's way (pp. 395–416). New York:
Routledge.
• Cozza, S. J., Chun, R. S., & Polo, J. A. (2005). Military families and children during
Operation Iraqi Freedom. Psychiatric Quarterly, 76, 371–378.
• Driessen, E., & Hollon, S. D. (2010). Cognitive-behavioral therapy for mood
disorders: efficacy, moderators, and mediators. The Psychiatric clinics of North
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181.
• Naeem, F. (2019). Cultural adaptations of CBT: a summary and discussion of the
special issue on cultural adaptation of CBT. The Cognitive Behaviour Therapist, 12.