Donald Meichenbaum is considered one of the most influential psychotherapists of the 20th century. He developed cognitive behavioral modification (CBM), which focuses on modifying maladaptive thoughts and inner dialogue. Two techniques of CBM are self-instructional training, where clients learn self-talk strategies, and stress inoculation training, which equips clients to better cope with stressors. CBM aims to help clients develop awareness and control of their thoughts, feelings, and behaviors.

1. Donald Meichenbaum
By Andy Crosier, Jenny Underwood & Julia Chapman

2. Donald Meichenbaum
• Distinguished Professor at
the University of Waterloo,
Ontario, Canada for 33yrs.
• Voted one of the 10 most influential
psychotherapists of the Century by
North American clinicians.
• Part of the „Cognitive Revolution‟

3. Donald Meichenbaum
• Founder of Cognitive-Behavioral Modification
• In 1977 he published Cognitive-behavior
Modification: An Integrative Approach.
• As an expert in the treatment of PTSD, as a
clinician and researcher, he has treated all
age groups for traumas suffered from
violence, abuse, accidents, and illness

4. Cognitive Behavioral Modification
A technique which puts patients in
charge of their own psychotherapy by
modifying what they say to themselves -
their so-called 'inner dialogue'

5. Cognitive Behavioral Modification
According to Meichenbaum (1980),
the premise of CBM is that individuals
must develop the ability to notice (a)
how they feel, think, and behave and
(b) the impact their behavior has on
others as a prerequisite to behavior
change.

6. Cognitive Behavioral Modification
• In Cognitive Therapy a therapist teaches a
client to question his or her inferences but
in CBM the therapist teaches a client to
change them.
• CBM is less direct then REBT and utilises „self
instructional training‟ to help the client
become more self aware of their self talk.

7. Self-Instructional Training
• Meichenbaum believed that
learning to control behavior begins
in childhood, based on parental
instruction
• This helped him create the idea of
„Self-Instructional Training‟(SIT), which
remains today as a major part of self-
control strategies.

8. Self-Instructional Training
Meichenbaum 's SIT was originally developed to help impulsive
children:
1. Adult performs the task while speaking to the child (cognitive
modelling)
2. Child performs the task with adult supervision (external guidance)
3. Child performs on his/her own while verbalizing the directions out
load
4. Child performs on his/her own while whispering to his/her self (self-
guidance)
5. Child uses inside voice while performing the task (self-instruction)

9. Self-Instructional Training
In a therapy setting Self-instructional training is
a cognitive technique which aims to give
clients control over their behavior through
guided self talk that gradually becomes
covert and self generated.

10. Self-Instructional Training
3 phases of behavior change:
• self-observation
• starting a new internal dialogue
• learning new skills

11. SIT in therapy
• The client identifies the internal feelings and the
negative self-statements that are produced by a
stressful situation.
• The client uses this a cue to initiate self-instruction
• A therapist rehearses with the client self-talk to
counteract the negative self statements.
• The client is then taught to self-instruct a range of
coping skills that help to alleviate the stress-
(breathing, relaxation techniques, imagery etc)
• Finally the client is instructed to make self
reinforcing statements- (“I‟m doing it”)

12. Cognitive Behavioral Modification
• CBM emphasises modifying thinking as a
means of changing feelings and behavior
• Combines cognitive and behavioral
learning principles to shape and
encourage desired behaviors
• CBM in essence: You are what you think!

13. Cognitive Behavioral Modification
According to Kaplan and Carter (1995), five characteristics distinguish
cognitive behavior modification from other types of behavior
management systems:
• Participants themselves rather than external agents are the primary
change agents.
• Verbalization is on an overt level, then a self-monitor level, and
then a covert level.
• Participants are taught to identify and use a series of problem-
solving steps.
• Modelling is used for instructional purposes.
• Cognitive behavior modification facilitates self-control.

14. Stress Inoculation Training
Stress Inoculation Training is a form of CBM.
It is based on the assumption that knowledge alone is often not
sufficient in helping people to deal with stressful situations. Stress
inoculation training can be used to teach a variety of physical
and cognitive coping skills that will increase an individual‟s ability
to function under pressure, and „inoculate‟ them against future
stressors.

15. Stress Inoculation Training
• Helpful for a wide range of issues –
Managing anxiety reactions
Coping with physiological pain
Phobias
Anger management
• Used as a treatment to help people deal with the
aftermath of traumatic events
• Used as a preventative measure, to equip people
for the future

16. Stress inoculation – 3 phases
1. The conceptual stage
2. The skills acquisition and rehearsal phase
3. Application and follow through

17. Stress inoculation training
Phase 1 - Conceptualisation
• Collaborative therapeutic relationship is established in which the
client and therapist get an overview of the client‟s issues
• Client is taught the nature and impact of stress, e.g. the fight or
flight response, and the vicious circle that they may have
unknowingly entered in to
• Client learns to identify their helpful/unhelpful responses to stressors.
These could be any self-defeating behaviours or internal dialogue

18. Stress inoculation training
Phase 2 - Acquisition of skills and rehearsal
• Skills are tailored to specific stressors, e.g. work pressure,
physical pain, relationship problems, military combat,
surgery etc
• Practical coping skills are taught in the clinic or training
setting at first, and are then rehearsed gradually using
role-play and modelling with support and guidance from
the therapist

19. Coping skills include:
• Self-instructional training
• Self-soothing and relaxation techniques
• Cognitive restructuring
• Problem-solving
• Emotional self-regulation
• Attention diversion procedures
• Training in interpersonal communication skills
• Using support systems
• Doing activities that are meaningful to the
individual

20. Stress inoculation training
Phase 3 - Application and follow through
• Client practises using their new coping skills in increasingly
stressful situations
• Clients do experiments in the form of graded exposure,
which reinforce their ability to cope
• Client implements relapse prevention measures, e.g.
identifying warning signs and ways to cope with lapses
• Booster sessions

21. Disorders Treated by CBM
• Aggression • Bipolar depression
• Anxiety • Borderline personality
• Panic disorders • Depression
• Substance abuse • Limited self-control
• Schizophrenia • Eating Disorders

22. Treatment of Eating Disorders
• CBM is at the root of treatment for anorexia and other eating
disorders.
• These behaviour modification techniques were first developed by
Donald Meichenbaum.
• Through behaviour modification techniques, therapists are able to
help change attitudes about ideal body shape and weight,
replace unhealthy eating habits with normalized eating patterns,
and teach patients how they can resist the urge to binge and
purge.
• Many eating disorder patients also experience anxiety and
depression and a combination of behaviour therapy and cognitive
therapy is also commonly used in the treatment of anxiety disorders
so treatment by way of these techniques becomes even more
powerful.

23. Advantages of CBM
• Cognitive behavior modification can be performed
individually or in group therapy sessions.
• High success rate of therapy.
• In many instances, the complete elimination of the
undesirable behavior is achieved.
• Even when a complete cure is not achieved, in the
majority of cases, dramatic improvements can be
seen.

24. Advantages of CBM (cont)
• The results often last longer than therapy or medication
alone.
• Deeply ingrained behaviors may require a longer
course of treatment, along with medication. However,
most CBM programs can be completed in several
weeks or months, where conventional talk therapy can
require several years.
• Because the course of treatment is shorter than that of
conventional talk therapy, CBM can be a less expensive
means of obtaining mental health treatment.
• The self-help element also means that patients can
work to maintain their own treatment even after formal
therapy has ended.

25. Disadvantages of CBM
• Extensive training required.
• Can be exhausting for some people because they
have to constantly verbalize instead of just thinking.
• Therapist may misuse power by imposing their ideas of
"rational" thinking on a client.
• Therapists must take special care to encourage clients
to act rationally within the framework of their own value
system and cultural context.
• Minimal attention to client's past experiences.

26. Questions?