Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and cognitive-emotional integration: Application to Experiential Education
Rachel Dolowich, Kathleen Larsen, Jim Stellar
This blog continues the topic of our last blog. There we brought thinking from clinical psychology to experiential education, focusing on the integration of cognitive and emotional brain circuits in the area of fear and anxiety. This blog is followed by a companion blog which extends this thinking to both negative and positive cognitive-emotional integration.
In this current blog, we look specifically and more deeply at two types of psychological treatments in helping a patient achieve therapeutic insight primarily from fear or anxiety concerns. Then we compare that to the insight an undergraduate gets from reflection on an experience (e.g. internship, study abroad), again focusing on integrating the emotional impact of the experience with the cognitive structure from the study of a college major. Experiential educators believe that it is in this integration that the student develops a sophistication and maturity that makes them more successful while in college as well as in gaining employment or further education after graduation.
Cognitive Behavioral Therapy (CBT) has become an important option in the treatment of some psychiatric disorders. That is due to the ability of CBT to take negative emotions paired with negative thoughts, and then replace these emotions with positive, less intrusive thoughts. CBT has allowed for significant treatment progress in a patient who, for example, is first experiencing high levels of anxiety but then sees the world differently, feels their emotions, and learns to cope with them. According to the American Psychological Association (APA), CBT aims to use the present moment to narrow a patient’s anxiety and change the way in which they mental, emotionally, and physically respond to a situation. Specifically, looking at the use of CBT for anxiety and Post-Traumatic Stress Disorder, which go hand in hand, patients have been seen to replace intrusive thinking patterns with coping responses that are functional for daily living. This is not to say CBT works for all; however, CBT has proven itself to be useful among a large span of diagnosed disorders.
Dialectical Behavior Therapy (DBT) is a form of CBT that focuses on the use of behavioral practices to acknowledge and shift negative thinking patterns. DBT establishes a dialectic between what is happening in patient’s lives and their behaviors and changing those behaviors for the better. Thus, it uses behavior and cognitive control of behavior to alter emotional processing, hence the interest for this blog. These behavioral skills can be used with patients who suffer from depression, anxiety, and self-injurious behavior by teaching patients to cope with and change their unhealthy/unsafe habits. DBT is particularly useful for borderline personality disorders and hard-to-treat syndromes.
Comparing DBT to CBT, the primary difference is the way in which patients are taught to identify the emotions that need work and how they are able to cope with them. While also similar, each form of treatment benefits certain disorders more or less than others.
Looking at treatment options, the APA notes that CBT is a mix between the patient’s own preference of treatment as well as the therapist. Coming up with a treatment plan that works for both parties gives the patient a sense of control over their situation and allows for more success. Structurally, these ideas of rebuilding thinking patterns might be tied to neuroplasticity (e.g. in the amygdala for fear and anxiety). Future research could suggest where there might be a connection between replacing these thoughts and structurally healing the brain. A structural approach could change the way psychologists treat mental disorders by adding a long-term physical aspect to treatment plans.
While both treatments were created to help those who battle with their mental health there are differences between the two, specific to the type of person. For example, CBT has been proven to help in the treatment of depression and anxiety, whereas DBT has been proven to help more to those with bipolar disorder. Although both do focus on how your thoughts, feelings, and behavior influence each other, DBT emphasizes the importance of regulating your emotions, being mindful, and coming to terms when dealing with pain. Which in turn teaches said patient to accept themselves while feeling safe and manage their emotions to prevent dangerous behavior. It is also known to increase amygdala emotional regulation and higher-order functions. CBT provides patients with the steps to acknowledge harmful/negative thoughts and redirect/change them.
Experiential education, A previous blog examines the role of reflection to an experience with emotional impact. But it is also the case that in most of our previous writing, we emphasize the integration of neocortical or cognitive brain processing with limbic brain or emotional processing in determining the impact of a internships, etc. We saw them, as Kahneman wrote, divided into two processes. One is behaviorally always on, immediate, and intuitive. This is the “Thinking Fast” in component as compared to the more deliberative “Thinking Slow” processing in making a decision. In our minds, making a good decision means integrating these two forms of decision making.
However, what if the thinking fast, or what we would say is more limbic processing, comes itself in two forms? One of those limbic forms could be the result of anatomical integration of the prefrontal cortex with the amygdala and manages what is negative and should be avoided or even feared for the health of the person. The other form could come from integration of the prefrontal cortex with the accumbens and manages what is positive or rewarding and should be approached for the health of the person. According to this thinking, as stated, the direct experience is not only a source of cognitive information, but it is the source of emotional information such as the student’s reaction to the workplace. In addition to a general reaction to the workplace, there are the much more specific reactions to individual interactions with a workplace professional and it feels right or wrong. That emotional reaction occurs simultaneously with the cognitive understanding of the moment and the question now is how are these “pros” and “cons” weighed in the brain so the student can make a decision about whether to continue with that college major and enter the field or not.