6 Ivan Pavlov’s influence on Modern Exposure Therapies and Eye Movement Desensitization and Reprocessing Therapy

1 Introduction

Ivan Pavlov’s contribution to psychology is undeniable, as his discoveries associated with classical conditioning formed a major part of behaviorism and furthermore, the school of
thought. In modern times, varying forms of therapy have become more popular in society as the stigma of mental illness has decreased over time. With that, individuals have sought out ways to improve themselves and achieve mental wellness, one of those ways being through behavioral therapy. Through Pavlov’s work, alongside other behaviouralists, behavorial therapy emerged as further research continues to be conducted to expand the ways in which psychologists approach various mental illnesses’ to achieve positive results for their patients. Due to the increasing prevalence of therapy, Pavlov’s research has a profound influence on how psychologists provide care in regard to his field of behaviorism. Thus, the question arises of what impact Pavlov has had on the modern methods of therapy relevant to his field, namely exposure therapy and eye movement desensitization and reprocessing therapy (EMDR).

1.1 Background
The careers of Ivan Pavlov’s father and paternal grandfather, both priests, influenced Pavlov as a young man growing up in the small town of Ryazan, Russia. Upon Pavlov’s discovery of Darwin’s work, however, he found that they had similarities as Darwin was also initially planning on pursuing being a priest in his early life which as we know took a drastic change.
After learning this new source of knowledge, his passion sparked to pursue education where he earned his medical degree from the St. Petersburg Military Academy in 1891, where he went on to found the Institue of Experimental Medicine followed by becoming a professor of physiology [reference not listed yet on elearn]. Where he went on to achieve the great accomplishment of a Nobel prize for his ‘Lectures on the Work of the Digestive Gland’.

1.2 Discovery of Classical Conditioning
Following this achievement, he went on to focus on what he coined psychical stimuli, where he went on to make observations on the dogs he was studying in regards to salivary reflexes, leading him to his most famous experiments in the discovery of classical conditioning. A variety of stimuli was used to train the dogs, including a bell sound, a ticking metronome, and electric shocks. At first, there was no noticeable response from the dogs to these neutral stimuli; however, subjects began salivating in response to stimuli when they coincided with feeding time (Waude, 2017). Pavlov’s experiments were profound because his theory of conditioning can be applied not only to learning in dogs but also to learning in humans (Waude, 2017). For instance, A child may associate the sound of a cupboard opening (a neutral stimulus) with getting snacks. This repeated association results in the child becoming excited whenever the cabinet opens, a conditioned response.

1.3 Psychological Application of Pavlov’s Theories
Within Pavlov’s studies, it brings to question when theories surrounding application to animals changed and began entering the psychological world, and inherently the application of his theories to humans. Hans J. Eysenck who is one of the founders of behavioural therapy is what Wolpe & Plaud would describe as a representative of Pavlov’s “tradition” in behavior therapy (Wolpe & Plaud, 1997). It is stated in the article “Pavlov’s Contributions to Behavior Therapy: the obvious and the not so obvious” that he paid particular attention to the study of factors related to anxiety, noting that the dogs in his and his students’ experiments displayed very different personalities with regard to friendliness, aggression, and timidity (Wolpe & Plaud, 1997). Furthermore, in regards to exposure therapy, Zuj & Norrholm state that the treatment for the technique in this therapy is greatly influenced by Pavlov’s classical conditioning theory of behavioral learning in regards to the mechanisms of fear conditioning (Zuj & Norrholm 2018). Pavlov and his students conducted conditioning experiments that provide a comprehensive database that is essential to modern scientific psychology, and through that, behavior therapy was been founded and advanced considerably. Whilst Eysenck and Wolpe, two of the creators of behavioral therapy, work in different directions of the Pavlovian paradigm, the systematic study of Pavlovian conditioning has profound implications for how psychopathology is conceptualized and treated, especially within the realm of anxiety responses (Wolpe & Plaud, 1997). The Evolution of Pavlov’s Theories into the Modern World Following Pavlov’s discovery of classical conditioning, the evolution of his theories throughout the decades into the present allows us to make further discoveries and analyze these theories further. In the article “From Pavlov to PTSD: The extinction of conditioned fear in rodents, humans, and in anxiety disorders”, they explore the relation of Pavlov’s works in classical conditioning in the context of post-traumatic stress disorder. Which states that as with sustenance, the danger is biologically relevant, and neutral cues can take on greater significance when they predict a threat to survival (VanElzakker et al., 2013). Through this, the connection can be made to behavioral therapies as exposure therapy and EMDR therapy are both deemed effective treatments for post-traumatic stress disorder.

1.4 Influential Figures in Behaviourism
Whilst Ivan Pavlov made great strides in laying a foundation in behaviorism, there are a number of significant figures who had impacts on the development of theories to allow for exposure therapy, EMDR therapy, and behavioural therapies as a whole to expand. Namely, John B. Watson, Joseph Wolpe, and Mary Cover Jones. American psychologist John B. Watson built on Pavlov’s work in classical conditioning and made a name for himself in behaviorism. Whilst he initially focused on learning and sensory input in animals, he would go on to make influential findings in his pursuit to further understand child development and early learning. Most notably, Watson’s Little Albert experiment using a 9-month-old baby boy explored Pavlov’s theories of classical conditioning. Noting that in modern-day this experiment is highly unethical, Watson used a neutral stimulus was used to condition Little Albert to fear the object even though there was no initial fear associated with it, combining it with loud noises to elicit more fear (Good Therapy, 2015). Watson’s behaviorism has impacted the nature versus nurture debate for decades, and his work shed light on the importance of early experiences in shaping the person we become. Psychology professionals may use behaviorist techniques to condition away fears and phobias; meanwhile, advertisers frequently use behaviorist approaches to motivate consumers to buy products (Good Therapy, 2015). Joseph Wolpe was a South African psychiatrist whose theories were initiated through treating PTSD as a medical officer, through which his systematic desensitization technique was based on
the notion that a lot of human behaviour is learned and, therefore, can be unlearned (New World Encyclopedia, 2018). Using Pavlovian classical conditioning, Wolpe began experimentation on cats where he paired shocks with sounds to prompt fear. Through furthering research and theories Wolpe became an instigator for cognitive behavioral therapy, his systematic desensitization technique was furthered to cure phobias and anxiety, and his Units of Disturbance Scale is used to this day in EMDR. In addition, his assertiveness training provided a framework for modern behavior therapy and prompted the behavioral therapy movement in the 1950s (Kaczkurkin & Foa, 2015). Wolpe, a close friend of Mary Cover Jones deemed her “the mother of behaviour therapy”, as Cover Jones’s work made her well-known for developmental psychology specializing in child and adolescent development. Her work included testing techniques to reduce and eliminate phobias in children, drawing inspiration from Watson’s “Little Albert”, her most well-known experiment was on three-year-old Peter. She used “direct conditioning” to reduce Peter’s fear of rabbits, a method similar to behavior therapy known today as “systematic desensitization” (National Women’s History Museum, 2010). The Oakland Growth Study (OGS), a series of studies on the long-term psychological and behavioral effects of early and late physical maturation in adolescence was among the over 100 articles Jones published using data from the study on the 212 OGS adolescents. (Rutherford, 2001). Jones also developed the Subjective Units Disturbance Scale, Subjective Anxiety Scale, and Fear Survey, which had a significant impact on behavior therapy.

1.5 Exposure Therapy
The origins of exposure therapy can be located in Pavlov and Watson’s work on classical conditioning, which led to Cover Jone’s study of counter conditioning, Joseph Wolpe’s systematic desensitization, and Stanley Rachman’s exposure and response prevention. Exposure therapy is a type of behavioral therapy used which used is to help people confront their fears, to which the exposure to fears in a safe environment created by the healthcare professional can aid in decreasing the avoidance of fear. This form of therapy has the potential to aid patients in several ways, those being habituation where the client finds that their reactions to fears decrease, extinction which is the weakening of previously learned patterns of thought in regard to fear, self-efficacy, and emotional processing (American Psychological Association, 2017).

1.6 Eye Movement Desensitization and Reprocessing Therapy
Developed by Dr. Francine Shapiro, she went on to discover EMDR therapy as her initial inspirations were drawn from her own experiences of disturbing thoughts while on a walk and
noticed relief in moving her eyes in a back and forth motion. EMDR therapy is mostly used to treat post-traumatic stress disorder, which entails the patient thinking about a trauma memory while simultaneously receiving bilateral stimulation, typically through eye movements (American Psychological Association, 2017). This form of therapy is conducted in phases, those being history-taking, preparing the client, assessing the target memory, processing the memory to an adaptive resolution, and evaluating treatment results. Through doing so, when recounting the trauma memory after EMDR the patient will no longer experience the fight or flight response or be triggered by the event, henceforth reducing the anxiety surrounding objects, people, or situations.

1.7 Conclusion
Behaviorism has had a profound impact on psychology, beginning with its works on classical conditioning and reaching into current treatment practices. At present-day we are constantly seeking new ways to achieve mental well-being, and with that, it is important to look at the very foundations that allowed us to arrive at this point of progression in psychology. Moving forward, it brings to question how the impact of Pavlov, Watson, Wolpe, Cover Jones, and other impactful figures in behaviorism will induce further thought into modes of therapy in relation to exposure to stimuli and confronting issues in a manner that induces physical response.

2 Dialectical Behavioural Therapy (DBT)

Dialectical behavioural therapy (DBT) is a thorough cognitive-behavioural treatment intended for mental disorders which are seen to be complicated and hard to treat (Dimeff & Linehan, 2001). It was founded by Dr. Linehan in the 1970’s (Lynch et al., 2006). Dr. Linehan’s main area of study surrounded behavioural psychology and models to suicidal tendencies, drug abuse and personality disorder (Dimeff & Linehan, 2008). Dr. Linehan originally developed DBT for the purpose of treating suicidal behaviours by means of change (Dimeff & Linehan, 2008). The term “dialect” in dialectical behavioural therapy (DBT) resembles the connectivity of two opposite beings- these opposites for patients are change and acceptance (Dimeff & Linehan, 2008). Change included mindfulness which used methods of chain analysis and dialectics (Lynch et al., 2006). Dr. Linehan worked under Gerald May and Tilden Edwards- her concept of dialectical behavioural therapy (DBT) was further researched and developed improvements by adapting from Eastern Zen and Western contemplative practices (Dimeff & Linehan, 2001). The development of cognitive behavioural therapy (CBT) lead Dr. Linehan to further expand her ideologies and beliefs which created dialectical behavioural therapy (DBT) for patients who struggle with complex mental disorders-in order for them to better control their emotions.

2.1 Cognitive Behavioural Therapy Influence on DBT
Dialectical behavioural therapy (DBT) is a type of cognitive behavioural therapy (CBT) originated from the early works of behavioural psychology. Cognitive behavioural therapy
(CBT) involves a connection between behaviour and emotions- which is used to treat many mental health disorders (Fenn & Byrne, 2013). This therapy was developed by Aaron Beck in the 1960s and is used in many clinical settings today (Fenn & Byrne, 2013). CBT highlights the importance of how one reacts to their environment and how they transcribe certain situations (Fenn & Byrne, 2013). The cognitive model includes three main levels: core beliefs (the self), dysfunctional assumptions (the world/ others), and negative autonomic thoughts (the future) (Fenn & Byrne, 2013). It is used to understand a person’s own experience and how a mental issue is causing them suffering- in order to help them better manage distress and be able to adapt to their environment (Fenn & Byrne, 2013). The goal of cognitive behavioural therapy is to help patients work through their problems and be able to manage hardships on their own- without a negative emotional outburst (Fenn & Byrne, 2013). The works of cognitive behavioural therapy lead to Dr. Linehan’s development of dialectical behavioural therapy (DBT). Dialectical behavioural therapy (DBT) was developed initially to exclusively treat suicidal behaviours, but has since broadened to treating borderline personality disorder (BPD) and other disorders which are complex and include emotional dysregulation (Dimeff & Linehan, 2008). Dr. Linehan used a balance of cognitive behavioural therapy and humanism which were both influenced by her training in Zen practices (History of DBT, 2021). Dr. Linehan almost named dialectical behavioural therapy (DBT) Zen Therapy, due to the formal inclusion of mindfulness which was the first psychotherapy to include such beliefs (History of DBT, 2021). The development of cognitive behavioural therapy lead to Dr. Linehan’s ideologies of dialectical behavioural therapy (DBT) which are being used in practice today.

2.2 Reactions to DBT
Dialectical behavioural therapy (DBT) went through a number of hardships and changes in order to attempt adaptation of standard cognitive and behaviour therapy ideologies of the late 1970s for suicidal and other patients (Dimeff & Linehan, 2001). This therapy was quick to develop criticism due to patients negatively responding to the idea of change by shutting down or experiencing feelings of anger as they saw this method as belittling their experiences with pain and suffering (Dimeff & Linehan, 2008). This would cause certain patients to remove themselves from therapy or verbally attack the therapist out of feelings of neglect (Dimeff & Linehan, 2001). Adapting and learning new skills was another hardship of DBT for patients-this method of change would often surface overwhelming feelings for the patient if change was thought to be expected too drastically or too quickly (Dimeff & Linehan, 2001). For example, a patient who is experiencing thoughts of suicide or self- harm are not going to be able to change the next day if they are being told to. It is much more complex than that and is a process in which happens over a period of time. Additionally, the patient would sometimes act out if they didn’t get the answer they wanted from the therapist (Dimeff & Linehan, 2001). For example-the patient would attempt suicide if the therapist refused hospitalization) (Dimeff & Linehan, 2001). These reactions made it hard for the therapist to initiate any change without the fear of making the patients mental state worse, which limited the effectiveness of dialectical behavioural therapy (DBT). These hardships caused limitations of DBT which required further advancements in order for effective clinical use. In order to prove dialectical behavioural therapy (DBT) to be effective, the patient has to feel as though they were being heard and understood. Treatment is most successful when there is an equal amount of limitation of painful experiences and acceptance of certain other experiences which are uncomfortable for the patient (Dimeff & Linehan, 2008). Considering this, acceptance and validation behavioural functions and capabilities were implemented in treatment to avoid feelings of neglect (Dimeff & Linehan, 2001). When treating patients with depression or BPD, a requirement for a positive response is a balance between acceptance and change (Dimeff & Linehan, 2001). If there is too much change without acceptance, the patient will respond negatively to treatment. The strategies of change are based on the learning principles and the crises theory of acceptance adapted from Zen and Western practices- specifically Gerald May and Tilden Edwards (Dimeff & Linehan, 2001). This development has limited the negative patient response from this therapy because they feel as though they are being heard due to the addition of validation by acceptance (Dimeff & Linehan, 2001). Dialectical behavioural therapy (DBT) further advanced by dividing into many different areas of treatment- including capability enhancement, motivation and skill strengthening, and coping skills application (Dimeff & Linehan, 2001). In a randomized clinical trial conducted by Dimeff & Linehan, it was found that suicidal patients were less likely to commit suicide during the year of DBT treatment compared to treatment as usual (2001). The advancements implemented into the therapy created a shift to a more positive response from patients and improvements in their mental health. Four Stages of Treatment for DBT in Clinical Practice Further development of DBT has resulted in the therapy exhibiting specific categories in
which specialize in one area of treatment for maximum enhancement (Dimeff & Linehan, 2001). In clinical settings, DBT uses stages while undergoing treatment with the goal of improved functionality and mental state for the patient (Dimeff & Linehan, 2001). There are four primary stages of treatment (Dimeff & Linehan, 2001). The first stage highlights the importance of the patient developing behavioural control as well as emotional stabilization- this can include lessening life threatening behaviours and increasing tolerance to distress and emotional outputs (Dimeff & Linehan, 2001). Gaining control of emotional stability can lead to behavioural improvements. The second stage focuses on experiencing “normal” feelings of happiness and unhappiness and minimizing the irrational effects these emotions have on daily living (Dimeff & Linehan, 2001). Hardships are a part of life- it is a matter of being able to control and adapt to these hardships to avoid unwanted emotional outbursts or behaviours which can develop from these outbursts (Dimeff & Linehan, 2001). The goal is to make daily living as unproblematic as possible. The third step is to start to incorporate feelings of joy and minimize feelings of emptiness (Dimeff & Linehan, 2001). The patient should feel complete and more stable overall. The fourth step is for the patient to get to a point where they feel as though they can live their day-to-day lives in control without feeding into the impulses of irrational thoughts in terms of their emotions and tendencies- and even gain some self-contentment (Dimeff & Linehan, 2001).

2.3 Conclusion
There have been many clinical trials on dialectical behavioural therapy (DBT) which has helped to develop the practice of it in clinical settings today. Dr. Linehan had originally developed dialectical behavioural therapy (DBT) to treat suicidal patients, but it has since expanded to treat other emotional dysfunctional irregularities-including borderline personality disorder (Dimeff & Linehan, 2008). Since its development in the 1970s, it has proven to use change and acceptance techniques in order to improve patient’s quality of life and overall
satisfaction using methods of chain analysis and dialectics (Dimeff & Linehan, 2008). Dr. Linehan’s concept of dialectical behavioural therapy was adapted from a combination of
cognitive behavioural therapy, humanism, and the works of Eastern Zen and Western contemplative practices- specifically Gerald May and Tilden Edwards (Dimeff & Linehan,
2001). This adaptation and the clinical trials worked to improve the reactions of DBT and further explore methods for further development. The development of cognitive behavioural therapy influenced Dr. Linehan to further expand her ideologies and beliefs which created DBT for patients who struggle with complex mental disorders-in order for them to better control their emotions. Future aims for DBT is to expand on treating patients with other mental disorders.

3 The Effectiveness of Cognitive Behavioural Therapy in the Modern World

Therapeutic approaches to psychology can provide some insight in determining what causes disruption in our thought patterns. In psychotherapy, psychologists apply scientifically validated procedures to help people develop healthier, more effective habits. There are several approaches to psychotherapy including: cognitive behavioural, interpersonal, applied
behavioural analysis and other kinds of talk therapy that help individuals work through their problems. Compared to all of the therapeutic approaches that were developed; Cognitive
behavioural therapy appears to be the most effective method used in the modern world that identifies mental challenges and how to support them. Determining how effective this method is we need to understand; what is cognitive behavioural therapy, who developed it, why was it successful, what was before CBT, why weren’t they effective, has cognitive behavioural therapy been an effective approach for modern-day use, and what needs to be done in order for it to become an effective therapeutic approach for the modern world. Cognitive behavioural therapy is a therapeutic approach to psychology, which is also aform of psychological treatment that has been demonstrated to be effective for a range of problems. including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. It helps people to develop skills and strategies for becoming and staying healthy. They then learn how to identify, question and change the thoughts, attitudes and beliefs related to the emotional and behavioural reactions that cause them difficulty. “Nevertheless, we believe the current model presents remarkable clinical potential – possibly implemented as part of a digital triage tool – which would allow clinicians to identify patients in depressive states which are typically less responsive to therapy. This would then enable the development and deployment of pharmacological and psychotherapeutic interventions in a stratified manner, aimed at increasing engagement and addressing core symptoms of a patient’s condition, potentially improving their likelihood of
responding to treatment.” (Catarino, A., Fawcett et al., 2022, 339). The goal of CBT is to help individuals learn to be able to help themselves. Cognitive behavioural therapy was developed by an American psychologist by the name of Aaron Beck. He recognized that there were negative thoughts and errors in people’s thinking which inevitably causes depression. Beck discovered that successful interventions will help a person to understand and become aware of their warped thinking, and how to challenge its effects. “He realized that depression was related to feelings of loss and rejection rather than ‘‘inverted hostility,’’ as predicated by Freudian psychoanalytic theory. Eventually, he came to understand that these underlying beliefs were consistent with a person’s automatic thoughts and cognitive distortions and that these could be evoked and examined during therapy sessions. By helping patients identify and correct negative information processing biases, Beck found that they felt better and engaged in more adaptive behaviors. He named this radically new therapeutic approach ‘cognitive therapy.’ ” (Mendlowicz MV et al. 1921-2021, 221-222). His key principles were derived from personal clinical observations and interpretation. Aaron Beck’s CBT has been proven to improve people’s mental health as well as improve their life. Numerous research studies suggest that CBT leads to significant improvement in functioning and quality of life. An example of one of these studies is from a systematic review conducted by Lisa Weston, Joanne Hodgekins, and Peter E. Langdon to see the effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders. “Autism spectrum disorders (ASDs) are a range of neurodevelopmental disorders characterized by difficulties with social communication and interaction across contexts, as well as restricted and repetitive patterns of behaviour, interests and activities.” (Weston, L., Hodgekins, J., & Langdon, P. E., 2016, 42). They found that preceding studies concluded that CBT interventions for children with ASDs have promising results. Their goal from this study was to see how effective CBT would be with groups of people on different levels of the autism spectrum. However, after diagnosing the results throughout these different groups they found that it’s effective on only certain levels of people with ASDs. “Further, while CBT should be adapted to meet the needs of those with ASDs, we still know relatively little about the effectiveness of many of these adaptations, as they have not been investigated using experimental designs to determine whether they lead to substantial improvements in treatment engagement and outcome.” (Weston, L., Hodgekins, J., & Langdon, P. E., 2016, 52). Due to the nature of how the cognitive behavioural therapy models are structured they seem to be not effective towards people with more complex mental health needs or learning difficulties. This review determines that CBT is effective towards determining and supporting some levels of people with ASDs, applied
behavioural therapy is another therapeutic approach that can support them. Cognitive behavioural therapy was developed after the previous therapeutic approach which was known as applied behavioural analysis. This field of psychology focuses on applying learning theories that improve social behaviour which should achieve positive change in their demeanour. “Applied behavioral analysis is science on which ABA-based interventions have been developed. ABA is derived from tenants of behaviorism, experimental analysis of behavior,
and applied research, and its methods can be applied to a variety of intervention approaches for children with ASD (8).” (Monica L. Bellon-Harn, Ryan L. Boyd, & Vinaya Manchaiah, 2022, 2). The difference between these two methods is that behaviourism explains things through outward behaviour or something that can be observed. Cognitivism is based on cognitive processes like decision making and memory. The similarity between these two approaches is that they both use mechanism as a fundamental assumption. However, cognitivism goes beyond behaviourism to make mechanical assumptions with reference to the mind and not just behaviour. Referring back to the previous study of the test on groups of individuals on the autism spectrum using the CBT to see if it would benefit them. ABA therapy applies the general understanding of how behaviour works to real situations. The goal of applied behavioural analysis is to expand on positive behaviours that are more helpful and to reduce chances of negative behaviours that can impact learning or could possibly become harmful. Behaviourist have used these principles to determine how behaviour is constructed, behaviours are affected by their environment, behaviours can be strengthened or weakened by its consequences, and behaviour changes are more effective with positive consequences instead of negative ones. In terms of the case study, ABA would have been more appropriate and effective towards this study. This is because ABA improves functional skills, while decreasing negative behaviours and CBT provides some cognitive solutions for people to be able to support themselves with their mental challenges. How did CBT become more successful rather than applied behavioural analysis? The previous methods of applied behavioural therapy weren’t effective because they did not have developed models that dealt with new psychological developments that were considered cognitive. Due to this, behaviourism went into a decline while cognitive behavioural therapy became even more popular. “After the Second World War, the popularity of behaviorism gradually declined. The waning influence of logical positivism, the pioneering work of G. A. Miller, Allen Newell, and Herbert Simon, developments in artificial intelligence and linguistics, the invention of the computer (and thereby the growing popularity of a computational perspective on cognition), as well as doubts about the scope of the behaviorist approach (Breland & Breland, 1961; Chomsky, 1959; Lashley, 1951), contributed to what has been called the “cognitive turn” in psychology.” (Braat, M., Engelen, J., van Gemert, T., & Verhaegh, S., 2020, 255). The behaviourist movement focused on specific issues rather than the problem at hand. They believed that behaviour could be explained without any notion of cognitive or interpretational influence on actions. After the CBT uprising it has been proven to be used in present time therapy.

Modern day use of CBT proves that this approach can still be used to help determine and prevent depression and many attributes that are accommodated with it. Internet delivered
CBT is an example of this type of therapy used in the present time. In the article, “Internet-Delivered Behavioral Therapy for Insomnia Comorbid With Chronic Pain: Randomized
Controlled Trial”, written by Wiklund, T., Molander, P., Lindner, P., Andersson, G., Gerdle, B., & Dragioti, E. they try to diagnose the effectiveness with the use of internet-delivered cognitive behavioural therapy for patients with insomnia comorbid with chronic pain. “Typically, CBT-i consists of several components such as a sleep diary, stimulus control, sleep restriction, and advice regarding sleep hygiene.” (Wiklund, T. et al. 2022, 2). CBT-i is a limited but effective alternative to standard internet treatments. They found throughout their testing that CBT-i was an effective method for insomnia, but wasn’t effective towards chronic pain. “Our results suggest that ICBT-i decreases insomnia severity and related nighttime symptoms. In particular, we found that the ICBT-i group, compared with the applied relaxation group, had greater immediate improvements in insomnia symptoms as measured by ISI, WASO, sleep efficiency, and EMA.” (Wiklund, T. et al. 2022, 23). However they did find that there were limitations to this procedure; the lack of internet connection is a common issue for this variant of cognitive behavioural therapy. The results did contribute valuable information for therapists in controlling insomnia, but overall wasn’t effective towards physical trauma.

Cognitive behavioural therapy has been a huge improvement in transition moving away from applied behavioural therapy. The downfall of behaviourism contributed to the uprising of
CBT, with updated discoveries of what bestows upon. Over the course of its development, new cognitive models have been created to deal with new developments and challenges of mental conditioning. CBT has become an accessible type of talk therapy that has helped support different mental challenges and how important it is to identify what contributes to your thinking behaviour. However this therapeutic approach isn’t currently an effective method when dealing with more complex mental conditions. Some of these conditions may not be able to be fully determined with cognitive models. There are many other types of therapeutic approaches that can be considered instead of using CBT to help support other conditions. Although there are many challenges that even most types of therapies cannot support. In retrospect cognitive behavioural therapy would be more of a considerable and effective option when they adapt to newer models that help accommodate those with those conditions. After some reworks then it would be one of the most effective therapeutic approaches to support and handle any type of mental challenge that the modern world faces.