Transcript Chapter 14

Behavior Therapy
Behavior Therapy
• A set of clinical procedures relying on experimental
findings of psychological research
– Based on principles of learning that are
systematically applied
• Treatment goals are specific and measurable
– Focusing on the client’s current problems
• To help people change maladaptive to adaptive
behaviors
– The therapy is largely educational - teaching
clients skills of self-management
Four Aspects of Behavior
Therapy
• 1. Classical Conditioning
– In classical conditioning certain respondent behaviors, such
as knee jerks and salivation, are elicited from a passive
organism
• 2. Operant Conditioning
– Focuses on actions that operate on the environment to
produce consequences
• If the environmental change brought about by the
behavior is reinforcing, the chances are strengthened
that the behavior will occur again.
• If the environmental changes produce no reinforcement,
the chances are lessened that the behavior will recur
Four Aspects of Behavior
Therapy
• 3. Social Learning Approach
– Gives prominence to the reciprocal interactions
between an individual’s behavior and the
environment
• 4. Cognitive Behavior Therapy
– Emphasizes cognitive processes and private
events (such as client’s self-talk) as mediators
of behavior change
Humans Learn Through
Association
• Classical conditioning
– Behaviors learned through association with natural
reflexes
– Temporal-spatial association of one stimulus with
another
– A stimulus naturally capable of producing a certain
response is associated in time or space with another
– Eventually second stimulus elicits virtually the same
response
– Undesirable responses modified by breaking the
association
Techniques Based on
Classical Conditioning Principles
• Counterconditioning
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Systematic desensitization
Imaginal flooding
In vivo desensitization
Biofeedback
Systematic desensitization:
A close up
• Relaxation training
– Progressive muscle relaxation
• Awareness of tension in each muscle group
• Awareness of relaxation in each muscle group
• Pairing relaxation with
– Counting
– Relaxing voice tone
• Relaxing without tensing
• Focus on cognition, too
Systematic desensitization:
A close up
• Construction of a stimulus hierarchy
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Temporal relationships
Spatial relationships
Use of SUDS
Use of real and imagined scenarios
• Presentation of the hierarchy
– Beginning with least threatening
– Proceeds at client’s pace
– Number of trials
• In vivo trials
– Sound ethical judgment; agency policies
– Client must be ready; proceeds at client’s pace
Humans Learn Through
Direct Experience
• Operant conditioning
– Behaviors are learned or maintained through experience with
rewarding, punishing, relief-giving consequences of behavior
• Reinforcement
– Continuous
– Intermittent
– Extinction
• Punishment
• Avoidance learning
• Shaping
– Undesirable responses modified by changing consequences
Techniques Based on Operant
Conditioning Principles
• Contingency Management
– Assessing antecedents, behaviors, and
consequences of problem behaviors
– Behavior modification
• Shaping (for acquisition of new behaviors)
• Reinforcing (ensuring a stable response rate)
• Extinguishing (eliminating or reducing a problem
behavior)
• Token economies
Humans Learn Through
Other’s Experience
• Vicarious learning
– Behavior is learned or maintained by observing
behavior of others and/or outcomes that the
actions produce
– Undesirable responses modified by observing
different others; different outcomes
Techniques Based on Vicarious
Learning Principles
• Modeling, rehearsal, & psycho-educational
instruction
– Modeling as a technique
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Live modeling
Symbolic modeling
Role-playing
Participant modeling
Covert modeling
Assertiveness training
Social skills training
Stress inoculation
Self-instructional training
Research
• Abundant outcome research
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Testing
Validation
Experimental processes
How, how often, and under what circumstances each technique
works
Children and adults
Simple and complex behaviors
Social behaviors
Programs designed to help clients acquire, change,
eliminate behaviors only limited by ethics and creativity
Critique
• PROS
– Individualized
treatment
– Proven efficacy in
treating many
problems
– Based on scientifically,
treatments are datadriven
• CONS
– Minute behavioral focus
may limit complexity
– Treating the problem
behavior, rather than whole
person
– Ethics and politics of who
decides what behaviors are
maladaptive
– Individual environments v
social environments treated
for dysfunction
Cognitive Behavior Therapy
“Big” Names associated with Cognitive
Behavioral Therapy
1. Epictetus, Greek philosopher. Observed
that people are not disturbed by things that
happen but by the view they take of things
that happen.
2. Albert Ellis, Ph.D. “grandfather of cognitive
behavioral therapy.”
3. Aaron Beck, MD, a psychiatrist (University
of Pennsylvania)
Characteristics of
Cognitive-Behavioral Therapies:
1. Thoughts cause Feelings and
Behaviors.
2. Brief and Time-Limited.
Average # of sessions = 16 VS
psychoanalysis = several years
3. Emphasis placed on current behavior.
4. CBT is a collaborative effort between the
therapist and the client.
Client role - define goals, express concerns,
learn & implement learning
Therapist role - help client define goals, listen,
teach, encourage.
5. Teaches the benefit of remaining calm or
at least neutral when faced with difficult
situations. (If you are upset by your
problems, you now have 2 problems: 1) the
problem, and 2) your upsetness.
6. Based on "rational thought." - Fact not
assumptions.
7. CBT is structured and directive. Based on
notion that maladaptive behaviors are the
result of skill deficits.
8. Based on assumption that most emotional
and behavioral reactions are
learned. Therefore, the goal of therapy is to
help clients unlearn their unwanted reactions
and to learn a new way of reacting.
9. Homework is a central feature of CBT.
Rational Emotive Behavioral
Therapy (REBT)
• Stresses thinking, judging, deciding, analyzing,
and doing
• Assumes that cognitions, emotions, and behaviors
interact and have a reciprocal cause-and-effect
relationship
• Is highly didactic, very directive, and concerned as
much with thinking as with feeling
• Teaches that our emotions stem mainly from our
beliefs, evaluations, interpretations, and reactions
to life situations
The Therapeutic Process
• Therapy is seen as an educational process
• Clients learn:
– To identify and dispute irrational beliefs that
are maintained by self-indoctrination
– To replace ineffective ways of thinking with
effective and rational cognitions
– To stop absolutistic thinking, blaming, and
repeating false beliefs
View of Human Nature
• We are born with a potential for both rational and
irrational thinking
• We have the biological and cultural tendency to
think crookedly and to needlessly disturb
ourselves
• We learn and invent disturbing beliefs and keep
ourselves disturbed through our self-talk
• We have the capacity to change our cognitive,
emotive, and behavioral processes
ABC’s of REBT
A →B → C
A = Activating Event
B = Beliefs, Thoughts, Attitudes, Assumptions
C = Consequences, Feelings, Emotions,
Behaviors, Actions
The Self-Defeating Rules (Irrational Beliefs)
Ellis suggested that a small number of core beliefs underlie most unhelpful emotions
and behaviours. Core beliefs are underlying rules that guide how people react
to the events and circumstances in their lives. Here is a sample list of such of
these:
1. I need love and approval from those around to me.
2. I must avoid disapproval from any source.
3. To be worthwhile as a person I must achieve success at whatever I do.
4. I can not allow myself to make mistakes.
5. People should always do the right thing. When they behave obnoxiously,
unfairlyor selfishly, they must be blamed and punished.
6. Things must be the way I want them to be.
7. My unhappiness is caused by things that are outside my control – so there is
nothing I can do to feel any better.
8. I must worry about things that could be dangerous, unpleasant or frightening –
otherwise they might happen.
9. I must avoid life’s difficulties, unpleasantness, and responsibilities.
10. Everyone needs to depend on someone stronger than themselves.
11. Events in my past are the cause of my problems – and they continue to influence
my feelings and behaviours now.
12. I should become upset when other people have problems, and feel unhappy
when they’re sad.
13, I shouldn’t have to feel discomfort and pain.
14, Every problem should have an ideal solution.
Aaron Beck’s Cognitive Therapy
(CT)
• Insight-focused therapy
• Emphasizes changing negative thoughts and
maladaptive beliefs
• Theoretical Assumptions
– People’s internal communication is accessible to
introspection
– Clients’ beliefs have highly personal meanings
– These meanings can be discovered by the client
rather than being taught or interpreted by the
therapist
Theory, Goals & Principles of CT
• Basic theory:
– To understand the nature of an emotional episode or
disturbance it is essential to focus on the cognitive content
of an individual’s reaction to the upsetting event or stream
of thoughts
• Goals:
– To change the way clients think by using their automatic
thoughts to reach the core schemata and begin to introduce
the idea of schema restructuring
• Principles:
– Automatic thoughts: personalized notions that are triggered
by particular stimuli that lead to emotional responses
Depression and Negative
Schemas
Negative schemas:
• Always present
• Unconscious
• Become activated with stressful events
Example
• Person with negative schema involving
rejection will become depressed when a
partner leaves him or her
Beck’s Cognitive Therapy: First
Sessions
• Identify and changing maladaptive thoughts
• First sessions: therapist explains cognitive theory
of emotional disorders (negative cognitions
contribute to distress)
• Middle Sessions: Client is taught to identify,
evaluate and replace negative automatic thoughts
were more positive cognitions
• Therapist is a collaborator (fellow scientists in
therapy)
• Final Sessions: solidify gains, focus on prevention
CT’s Cognitive Distortions
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Arbitrary inferences
Selective abstraction
Overgeneralization
Magnification and minimization
Personalization
Labeling and mislabeling
Polarized thinking
CT’s Cognitive Triad
• Pattern that triggers depression:
– 1. Client holds negative view of themselves
– 2. Selective abstraction: Client has tendency to
interpret experiences in a negative manner
– 3. Client has a gloomy vision and projections
about the future
Constructivist Narrative Perspective
(CNP)
• Focuses on the stories people tell about
themselves and others about significant
events in their lives
• Therapeutic task:
– Help clients appreciate how they construct their
realities and how they author their own stories