Criticism Of The Mechanisms Of Change (CBT)

Mechanisms of Change
CBT aims to promote more adaptive behavioral, affective, and cognitive responding (Craske, 2017). It does this by helping clients gain new learning experiences and new ways of responding to stimuli, either cognitively or behaviorally. For example, the mechanisms of change using classical conditioning theory, aim to disrupt the associations between a cue or conditional stimulus and the unconditioned stimulus, like exposure interventions. Thus, if the conditioned stimulus is presented frequently enough without the unconditioned stimulus, the conditioned response will diminish or extinguish (Craske, 2017). Other behavioral interventions strive to reduce maladaptive behaviors and increase adaptive ones by changing antecedents

136). For clients who have Western values and assumptions, traditional CBT may be a good fit. However, for clients that align themselves with a different worldview, CBT may need be modified. The highly active role of the client in CBT may be helpful in achieving this (Craske, 2017). CBT’s ongoing evaluation and modification of strategies, as appropriate, is also helpful for achieving this. For example, because assertiveness may conflict with collectivist values, assertiveness training can be adapted (Craske, 2017). One culturally responsive manner of adapting it may include preceding assertive communication with customary traditions of deference and respect, and replacing assertiveness with other strategies like problem-solving. Another example of a cultural modification is the addition of mindfulness and defusion approaches to CBT. These approaches aim to change the function of the thought rather than its content, and thus, can be helpful when working with culturally diverse clients (Craske, 2017). Additionally, Hodge (2008) suggests a different way to modify CBT using a three-step process. First, the European Enlightenment values need to be unpacked from the underlying therapeutic concepts. The second step is to evaluate the underlying concepts to ensure their congruence with the client’s spiritual narrative. Finally, the therapist repacks the key concepts in values drawn from the client’s value system. Hodge (2008) notes that that key to this process is to work with the client in a dialectical process to find appropriate statements. Finally, while in its early stages, research on the effectiveness with diverse clientele is showing some promising results. For example,