Marketing Scoops: How Video Games Enhance Cognitive and Physical Rehabilitation

Alyssa Stone/Northeastern University

People with ADHD, learning difficulties or brain injuries from strokes can experience huge focus, cognitive and rehabilitative benefits from a surprising activity: playing video games. For more than 30 years, Northeastern University cognitive neuroscientist Tony Simon has worked on the leading edge of developing digital therapies that can alter brain function…….Continue reading….

By Kate Rix

Source: Northeastern

Critics:

Precursors of certain fundamental aspects of Cognitive Behavioral Therapy (CBT) have been identified in various ancient philosophical traditions, particularly Stoicism. Stoic philosophers, particularly Epictetus, believed logic could be used to identify and discard false beliefs that lead to destructive emotions, which has influenced the way modern cognitive-behavioral therapists identify cognitive distortions that contribute to depression and anxiety.

Aaron T. Beck’s original treatment manual for depression states, “The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers”. Another example of Stoic influence on cognitive theorists is Epictetus on Albert Ellis. A key philosophical figure who influenced the development of CBT was John Stuart Mill through his creation of Associationism, a predecessor of classical conditioning and behavioral theory.

Principles originating from Buddhism have significantly impacted the evolution of various new forms of CBT, including dialectical behavior therapy, mindfulness-based cognitive therapy, spirituality-based CBT, and compassion-focused therapy. The modern roots of CBT can be traced to the development of behavior therapy in the early 20th century, the development of cognitive therapy in the 1960s, and the subsequent merging of the two.

Although the early behavioral approaches were successful in many so-called neurotic disorders, they had little success in treating depression. Behaviorism was also losing popularity due to the cognitive revolution. The therapeutic approaches of Albert Ellis and Aaron T. Beck gained popularity among behavior therapists, despite the earlier behaviorist rejection of mentalistic concepts like thoughts and cognitions. Both of these systems included behavioral elements and interventions, with the primary focus being on problems in the present.

In initial studies, cognitive therapy was often contrasted with behavioral treatments to see which was most effective. During the 1980s and 1990s, cognitive and behavioral techniques were merged into cognitive behavioral therapy. Pivotal to this merging was the successful development of treatments for panic disorder by David M. Clark in the UK and David H. Barlow in the US. Over time, cognitive behavior therapy came to be known not only as a therapy, but as an umbrella term for all cognitive-based psychotherapies.

These therapies include, but are not limited to, REBT, cognitive therapy, acceptance and commitment therapy, dialectical behavior therapy, metacognitive therapy, metacognitive training, reality therapy/choice theory, cognitive processing therapy, EMDR, and multimodal therapy. This blending of theoretical and technical foundations from both behavior and cognitive therapies constituted the “third wave” of CBT. The most prominent therapies of this third wave are dialectical behavior therapy and acceptance and commitment therapy.

Despite the increasing popularity of third-wave treatment approaches, reviews of studies reveal there may be no difference in the effectiveness compared with non-third wave CBT for the treatment of depression. In adults, CBT has been shown to be an effective part of treatment plans for anxiety disorders, body dysmorphic disorder, depression, eating disorders, chronic low back pain, personality disorders, psychosis, schizophrenia, substance use disorders, and bipolar disorder.

It is also effective as part of treatment plans in the adjustment, depression, and anxiety associated with fibromyalgia, and as part of the treatment after spinal cord injuries. In children or adolescents, CBT is an effective part of treatment plans for anxiety disorders, body dysmorphic disorder, depression and suicidality, eating disorders and obesity, obsessive–compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), tic disorders, trichotillomania, and other repetitive behavior disorders.

CBT has also been used to help improve a variety of childhood disorders, including depressive disorders and various anxiety disorders. CBT has shown to be the most effective intervention for people exposed to adverse childhood experiences in the form of abuse or neglect. Criticism of CBT sometimes focuses on implementations (such as the UK IAPT) which may result initially in low quality therapy being offered by poorly trained practitioners. However, evidence supports the effectiveness of CBT for anxiety and depression.

Evidence suggests that the addition of hypnotherapy as an adjunct to CBT improves treatment efficacy for a variety of clinical issues. The United Kingdom’s National Institute for Health and Care Excellence (NICE) recommends CBT in the treatment plans for a number of mental health difficulties, including PTSD, OCD, bulimia nervosa, and clinical depression. Cognitive behavioral therapy has been shown as an effective treatment for clinical depression. Among psychotherapeutic approaches for

major depressive disorder, cognitive behavioral therapy and interpersonal psychotherapy are recommended by clinical practice guidelines including The American Psychiatric Association Practice (APA) Guidelines (April 2000),and the APA endorsed Veteran Affairs clinical practice guideline. CBT has been shown to be effective in the treatment of adults with anxiety disorders. There is also evidence that using CBT to treat children and adolescents with anxiety disorders was probably more effective (in the short term) than wait list or no treatment and more effective than attention control treatment approaches.

Some meta-analyses find CBT more effective than psychodynamic therapy and equal to other therapies in treating anxiety and depression. A 2013 meta-analysis suggested that CBT, interpersonal therapy, and problem-solving therapy outperformed psychodynamic psychotherapy and behavioral activation in the treatment of depression. According to a 2004 review by INSERM of three methods, cognitive behavioral therapy was either proven or presumed to be an effective therapy on several mental disorders. This included depression, panic disorder, post-traumatic stress, and other anxiety disorders.

A systematic review of CBT in depression and anxiety disorders concluded that “CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists.” A 2024 systematic review found that exposure and response prevention (ERP), a specific form of cognitive behavioral therapy, is considered a first-line treatment for pediatric obsessive–compulsive disorder (OCD).

Research indicates that ERP is effective in both in-person and remote settings, providing flexibility in treatment delivery without compromising efficacy. For anxiety disorders, use of CBT with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes. In another study, 3% of the group receiving the CBT intervention developed generalized anxiety disorder by 12 months postintervention compared with 14% in the control group.

Individuals with subthreshold levels of panic disorder significantly benefitted from use of CBT. Use of CBT was found to significantly reduce social anxiety prevalence. For depressive disorders, a stepped-care intervention (watchful waiting, CBT and medication if appropriate) achieved a 50% lower incidence rate in a patient group aged 75 or older. Another depression study found a neutral effect compared to personal, social, and health education, and usual school provision, and included a comment on potential for increased depression scores from people who have received CBT due to greater self recognition and acknowledgement of existing symptoms of depression and negative thinking styles.

A further study also saw a neutral result. A meta-study of the Coping with Depression course, a cognitive behavioral intervention delivered by a psychoeducational method, saw a 38% reduction in risk of major depression. Many studies show CBT, combined with pharmacotherapy, is effective in improving depressive symptoms, mania severity and psychosocial functioning with mild to moderate effects, and that it is better than medication alone. INSERM’s 2004 review found that CBT is an effective therapy for several mental disorders, including bipolar disorder.

This included schizophrenia, depression, bipolar disorder, panic disorder, post-traumatic stress, anxiety disorders, bulimia, anorexia, personality disorders and alcohol dependency. In long-term psychoses, CBT is used to complement medication and is adapted to meet individual needs. Interventions particularly related to these conditions include exploring reality testing, changing delusions and hallucinations, examining factors which precipitate relapse, and managing relapses.

Meta-analyses confirm the effectiveness of metacognitive training (MCT) for the improvement of positive symptoms (e.g., delusions). For people at risk of psychosis, in 2014 the UK National Institute for Health and Care Excellence (NICE) recommended preventive CBT. INSERM’s 2004 review found that CBT is an effective therapy for several mental disorders, including schizophrenia. A Cochrane review reported CBT had “no effect on long‐term risk of relapse” and no additional effect above standard care.

A 2015 systematic review investigated the effects of CBT compared with other psychosocial therapies for people with schizophrenia and determined that there is no clear advantage over other, often less expensive, interventions but acknowledged that better quality evidence is needed before firm conclusions can be drawn. CBT is also used for pathological and problem gambling. The percentage of people who problem gamble is 1–3% around the world.

Cognitive behavioral therapy develops skills for relapse prevention and someone can learn to control their mind and manage high-risk cases. There is evidence of efficacy of CBT for treating pathological and problem gambling at immediate follow up, however the longer term efficacy of CBT for it is currently unknown.

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The Philosophy of Cognitive-Behavioural Therapy: Stoicism as Rational and Cognitive Psychotherapy.

“A Pragmatic Man and His No-Nonsense Therapy”. The New York Times. Retrieved 2008-11-21.

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