Transcript Introduction to Cognitive Behavior Therapies

Introduction to
Behaviorism & Cognitive
Behavior Therapies
Anne Farrell, Ph.D.
New York Medical College
Introduction and goals
 Background
 Knowledge and experience
 Goals
– Familiarize participants with tenets of
behaviorism and basis for cognitive
behavior therapies
– Background and interrelationships
– Common adult and pediatric applications
– References and resources
Behavior Therapy
 Commonly used to treat
– anxiety, mood, eating disorders,
parasuicidality
– impulse, anger control disorders, disruptive
behavior
– sexual dysfunction, substance abuse
– behavioral medicine and compliance
 Two models of conditioning
– Classical (Pavlovian) conditioning model
– Operant (Skinnerian) conditioning model
Classical conditioning
 “Pavlovian” conditioning model
– unconditioned reflexes (UCR)
• salivation, eye blink
– Contingency: pair with neutral stimulus
(UCS)
• bell, tone, bang, ash
– Conditioning (CS)
• Previously neutral stimulus becomes conditioned
stimulus
– Conditioned response (CR)
• Reflex now occurs in response to CS
 Common examples?
Classical conditioning
 Relation to specific disorders
– Post-traumatic stress
– Specific phobias (Little Albert)
• Panic disorder with agoraphobia
 Related principles
– Contingency, extinction, generalization,
discrimination
– Schedules of reinforcement and resistance
 Background
– First applied as BT by Wolpe, Lazarus
Operant Conditioning
 Skinnerian conditioning (“B-mod”)
 consequences of a behavior change
future probability of occurrence
 key influence
– association between response and
consequences
 Thorndike’s Law of Effect
– positive outcomes strengthen behaviors
– negative outcomes weaken them
Operant Conditioning (Skinner)
Positive reinforcement
 Probability of response  when it is followed
by a rewarding stimulus
 examples
Negative reinforcement
 Probability of response  when it is followed
by removal of an unpleasant stimulus
 examples
Punishment
 frequency of response  due to consequence
Operant Conditioning Principles
 timing
– learning is more efficient under immediate
rather than delayed circumstances
 shaping
– reward successive approximations of
desired behavior
 primary reinforcement
– reinforcer is innately satisfying
 secondary reinforcement
– reinforcer acquires its value through
experience
Schedules of Reinforcement
 Continuous reinforcement
– response is reinforced every time it occurs.
 Partial reinforcement
– a response is reinforced only part of the
time.
 Schedules: rules for partial reinforcement
– fixed ratio: after set # target responses
– variable ratio*: after average (unpredictable)
# of responses
– fixed interval: after a fixed amount of time
– variable interval: after an unpredictable
amount of time
Resistance to extinction
Operant Conditioning
extinction
 a response is not reinforced and it decreases
spontaneous recovery
 occurs in operant conditioning (and CC)
discrimination
 learning to repeat only reinforced responses
generalization
 giving the learned response to similar stimuli
Applied behavioral analysis (ABA):
 operant conditioning principles to change
behavior
BT and disorders
 Assumptions about etiology?
 Anxiety disorders
– Acquired – classical conditioning
– Maintained – operant conditioning
 Role of avoidance
– Highly reinforcing
 Manualized treatments
– Barlow: panic disorder, GAD
• Stress innoculation, panic induction, biological challenge
– Foa: OCD, PTSD
• Exposure with response prevention
• Relaxation strategies and retelling
– Frequently combined with meds, cog therapies
Basics of CBTs
 Assessment and intervention
 Empirical support for practice
 Characteristics of treatment
– Active, structured, focused
– Past v. present v. future
– Brief therapies
– Change is achieved by
• Altering connections between troublesome
situations and habitual reactions to them
• Challenging and changing distorted beliefs and
thoughts that relate to dysfunction
Applications
 Operant conditioning
– Applied behavior analysis (ABA)
• Single case designs
• Children with autism, challenging behavior
– Educational interventions
• Functional behavioral assessment (FBA) and
behavior intervention plans (BIP)
– Mandated under IDEA
– Generic parenting strategies
• Reinforcement and punishment
 ABCs
– Antecedent – behavior - consequence
Single case design (ABA)
Baseline 1
Alternate 1
Baseline 2
13
15
14
13
12
11
10
9
8
7
6
5
4
3
2
Session number 1
9
8
7
6
5
4
3
2
1
0
Alternate 2
Cognitive therapies
 Emerge from behavioral models
– Use BT techniques
– Assume interrelationship among cognition,
affect, behavior
 Beck, Ellis, Young
 Situation, thoughts, feelings, behavior
 Common elements:
– Ellis (RET): core irrational ideas
– Beck (CT): maladaptive beliefs
– Young: Early maladaptive schemas
CBT techniques
 Relaxation and imagery
 Self monitoring (mood monitoring,
impulse control, self-mutilation)
 Exposure
 Response prevention
 Flooding
 Behavioral rehearsal
 Thought stopping
 Coping statements
 Cognitive disputation
Outcomes
 Empirical support evidenced via
– Single case design (A-B-A-B)
– Controlled studies
• Comparison to no treatment, wait-list, placebocontrols; comparison to other therapies and
combinations of therapies
– Meta-analyses
• Group differences expressed in sds
Resources
 Association for the Advancement of
Behavior Therapy (AABT.org)
 American Institute for Cognitive
Therapy (AICT.com)
 Ellis Institute, Beck Institute
 National Institutes of Mental Health –
– Web site – Facts about…