Transcript cognitive-behavioral therapy

Behavioral
and
Cognitive-Behavioral
Psychotherapies
BEHAVIOR THERAPY
 It is not a single method but rather a large collection
of techniques designed to address people’s
psychological problems.
 Included are systematic desensitization, exposure
therapies, relaxation training, biofeedback,
assertiveness training, operant conditioning and
other reinforcement-based treatments, sensate
focus for sexual dysfunction, “bell-and-pad
conditioning” to prevent bed-wetting, and many
others.
Theoretical Foundations
 Classical Conditioning occurs when a neutral
stimulus comes just before another stimulus that
automatically triggers a reflexive response.
 Operant Conditioning occurs when certain behaviors
are strengthened or weakened by the rewards or
punishments that follow those behaviors.
Assessment in Behavioral Therapy
 Behavioral therapy assessment is intended to
identify a client’s problematic behaviors, the
environmental circumstances under which those
behaviors occur, and reinforcers and other
consequences that maintain them. In behavioral
assessment process, behavior therapists perform a
functional analysis or functional assessment which
examines four key areas: stimulus, organism,
response and consequence. It also includes the
assessment of cognitions and emotions as well as of
observable behaviors.
Assessment in Behavioral Therapy
 Behavior therapists are especially likely to use
objectively scored quantitative assessment methods
such as structures interviews, objective psychological
tests, and a variety of behavioral rating forms. These
measures are used partly to establish the precise
nature of a client’s problem and also to establish
baseline level of maladaptive responding.
THE ROLE OF THE THERAPIST
 They are empathic and supportive in response to
client’s feelings of anxiety, shame, hopelessness,
distress or confusion. They also play an educational
role explaining the theory behind what they do in
ways the client can understand.
GOALS OF BEHAVIORAL THERAPY
 To help the client modify maladaptive overt
behaviors as well as the cognitions, physical changes,
and emotions that accompany those behaviors.
CLINICAL APPLICATIONS
 Broad Spectrum Behavior Therapy. Behavior
therapists employ a variety of specific techniques not
only for patients but for the same patient of different
points in the overall treatments.
 Relaxation Training
Progressive Relaxation Training (PRT),
one of the basic techniques behavior therapist used.
It is an abbreviated version of a method pioneered by
Edmund Jacobson in 1938 and popularized in the
1960s by Joseph Wolpe.
 PRT involves tensing and then releasing various
groups of muscles while focusing on the sensations
of relaxation that follow. Generally, about six
sessions are devoted to relaxation training, and the
instructions can easily be taped and played at home
for practice. In some instances, hypnosis may be
utilized to induce relaxation; in other instances, the
patient may be asked to imagine relaxing scenes or
sometimes breathing exercised are used.
 Systematic Desensitization (SD) also known as
antianxiety treatment was developed in 1958 by
Joseph Wolpe. This idea is to teach patients to relax
and then, while they are in the relaxed state, to
introduce a gradually increasing series of anxietyproducing stimuli. Eventually, the patient becomes
desensitized to the feared stimuli by virtue of having
experienced them in a relaxed state.
 TECHNIQUES AND PROCEDURES
SD begins with the collection of a history of the
patient’s problem including information about
specific precipitating conditions and developmental
factors which may require several interviews and
often include the administration of questionnaires.
The principle reason for all of this is to pinpoint the
locus of the patient’s anxiety as well as to determine
whether SD is the proper treatment.
 Virtual Reality Exposure is an alternative
treatment for those patients who suffered from
anxiety disorders.
 Exposure and Response Prevention
Techniques entail direct exposure to frightening
stimuli, but the idea is not to prevent anxiety.
Instead, exposure to feared stimuli-is arranged so
that anxiety occurs and continues until it eventually
disappears through the earning process known as
“extinction”.
 Exposure treatments are especially popular in cases
of Obsessive-Compulsive Disorder. It is also used
extensively with agoraphobia and panic attacks that
often precede the development of agoraphobia, for
binge craving in Bulimia, and for other problems.
 Social Skills Training often include in the
treatment of adult disorders such as schizophrenia,
depression, anxiety, and a variety of childhood
disorder including delinquency, attention deficit
hyperactivity disorder, autistic spectrum disorders,
and even behavior problems resulting from fatal
alcohol syndrome.
 Social Skills Training encompasses many techniques,
one of the most popular techniques is the
Assertiveness Training, which is designed to (a)
teach clients how to express themselves
appropriately if they do not already have the skills to
do so, and/or (b)eliminate cognitive obstacles to
clear self expression.
 Modeling or Observational Learning an
important mechanism in the development of human
behavior. It has been used to treat many clinical
problems including social withdrawal among adults
and children, Obsessive-compulsive behaviors,
unassertiveness, antisocial conduct, physical
aggressiveness and early infantile autism.
The simplest modeling approach involves having a
client observe live or videotaped models fearlessly
and successfully perform behaviors that the client
avoids.
 Behavioral Rehearsal and Homework
Behavior therapists establish practice sessions
and situations whose demands are minimal, thus
maximizing the client’s chances of early success.
 Aversion Therapy and Punishment
Aversion Therapy is a set of learning-based
techniques in which painful or unpleasant stimuli
are used to decrease the probability of unwanted
behaviors such as drug abuse, alcoholism,
overeating, smoking, and disturbing sexual practices.
COGNITIVE THERAPY
 All therapeutic interventions involve thought
processes, but cognitive therapies are specifically
directed toward identifying and changing clients’
maladaptive cognitions. These cognitions may
include a client’s belief, causal explanations,
schemas, self-statements and problem solving
strategies.
THEORETICAL FOUNDATIONS
 Cognitive Mediation
Perhaps the most basic notion in cognitive
therapy is that normal and abnormal behavior is
triggered by our cognitive interpretations of events,
not by the events themselves. A cognitive model
would suggest that our thoughts about events will
shape our emotional and our behaviors.
 Schemas also called as schematas, the organized
knowledge structures that influence how we
perceive, interpret, and recall information.
 Schemas can be built around actions objects,
persons, and situations; they can be helpful guides in
everyday life. They can also create problems, as when
schemas lead o inaccurate stereotypes about
particular categories of people or things. They also
serve as filters that influence how persons perceive
themselves and their relations to the world.
 The Role of Automatic Thoughts.
The cognitive approach strongly emphasizes the
habitual nature of some thoughts, including many
maladaptive thoughts. Negative schema-driven
thoughts can occur so quickly that we are not
consciously aware of having them, let alone of being
influenced by them.
 Cognitive therapists view our maladaptive cognitions
as learned habits that are near the surface and
accessible by simple questioning and conversation.
Accordingly, they use the term automatic rather
than unconscious to describe client’s maladaptive
and self-defeating cognitions.
 As cognitively oriented clinicians worked on
identifying clients’ automatic thoughts, they noted
that persons with certain disorders were inclined to
employ some cognitive distortions more than others;
this is called a negative attributional style.
 Beck’s Cognitive Therapy
Aaron Beck’s approach to the treatment of
depression is based on the assumption that
depression and other emotions are determined
largely by the way people think about their
experiences. Beck says that depressive symptoms
result from logical errors and distortions that clients
make about the events in their lives.
 Beck proposed that depressed individuals show a
characteristic pattern of negative perceptions and
conclusions about (a) themselves, (b) their world,
and (c) their future.
 Rational Emotive Behavior Therapy
Albert Ellis proposed that psychological
problems result not from external stress but from the
irrational ideas people hold, which lead them to
insist that their wishes must be met in order for
them to be happy.
The therapist’s task in REBT is to attack these
irrational, unrealistic, self-defeating beliefs and to
instruct clients in more rational or logical thinking
patterns that will not upset them.
ASSESSMENT
 Assessment in cognitive therapy is interested in
developing a detailed understanding of the
chronicity, intensity, and extent of the client’s
automatic cognitive distortions. They usually used
rating scales, self-report, and standardized
instruments. They also pay particular attention to
assessing factors that will support or limit the client’s
to engage in the tasks required in cognitive therapy.
These tasks include adopting a “thinking” attitude
toward symptoms and emotional experiences, and
tolerating the sometimes challenging and even
confrontational approach adopted by therapists.
ROLE OF THERAPISTS
 They are also empathic and supportive in
recognizing the distress associated with the client’s
emotional experiences, but they also make it clear
that the client has an important role to play in
treatment.
 They also built on education about how maladaptive
schemas, self-defeating beliefs, negative attributional
styles, and other cognitive factors create and
maintain psychological disorders.
GOALS OF COGNITIVE THERAPY
 To educate the client about the role of maladaptive
thoughts in behavior and experience’
 To help clients learn to recognize when they engage
in those thoughts, and
 To arm them with skills for challenging maladaptive
thoughts and for replacing them with more accurate
and adaptive ones.
Clinical Applications
 Psycho education - It involves mini lectures on
symptoms, realistic goal setting, and behavioral
activation, how thoughts affect feelings, the
automatic nature of thoughts, strategies for
challenging thoughts and the like.
 Socratic Questioning
Named after the philosopher Socrates, it is a
style of discourse in which the therapist pursues a
line of questioning until the client’s fundamental
beliefs and assumptions are laid bare and open to
analysis.
 Refuting and Replacing Maladaptive
thoughts
- Clients are often quite tenacious in holding
onto their self-defeating beliefs and attributions.
Confirmation bias- clients are like everyone
else in seeking to preserve their core beliefs even
including beliefs about themselves that make them
anxious, insecure, and unhappy.
 Reattribution Training
To help clients overcome those tendencies,
cognitive therapists ask them to repeatedly practice
challenging maladaptive beliefs.
They encouraged clients to consider the internal
versus external dimension of attributions.
Decatastrophizing- helping clients evaluate
their catastrophic predictions. Used particularly with
anxious and socially phobic clients, is designed to
help them see that there are graduations in
discomfort and their most feared scenarios may in
fact be tolerable.
 Thought Recording and Multicolumn
Records
Keeping written records of events that have
emotional significance with clients often begin with
two-column thought record. This procedure is
designed to provide practice in recognizing
automatic and often maladaptive cognitions.
COGNITIVE-BEHAVIORAL THERAPY
 An approach to psychotherapy based originally on
Behavioral Therapy, it involves the extension of the
modification and relearning procedures to cognitive
processes.
 THEORETICAL FOUNDATIONS
The addition of cognitive principles and
practices to the behaviorist theoretical framework
leads to a clear, persuasive, and evidence-based
description of how normal and abnormal behavior
develops and can be changed.

CLINICAL APPLICATIONS
 RELAPSE PREVENTION is designed to help
clients who are trying to overcome alcoholism or
other substance use disorders.

Once a relapse episode occurs, guilt and shame tend to
generate a cascade of negative self-evaluations which
increases the probability of continued drinking is called
Abstinence Violation Effect.
 DIALECTICAL BEHAVIOR THERAPY-
pioneered by Marsha Linehan is often used to help
clients who display the impulsive behavior, mood
swings, fragile self-image and stormy interpersonal
relationships associated with borderline personality
disorder. DBT helps these clients develop skill at
containing their erratic behaviors, but after these
“containment” goals have been reached, the therapist
helps the client to confront any traumatic
experiences- such as physical or sexual abuse in
childhood- that might have contributed to their
current emotional difficulties.
Group 5
 Cuadra, Karla Kamille
 Pili, Ara Belle
 Oller, Diesebel
 Sancho, Selah Marie