Transcript SOME DISTINGUISHING CHARACTERISTICS OF COGNITIVE

Change Through a Behavioral Perspective
• All behavior is influenced by learning principles of classical
conditioning, operant condition and modeling
• No behavior is inherently healthy or unhealthy, normal or abnormal
• Behavior is developed and maintained because of an individual’s
unique reinforcement schedules
• Reinforcement: environmental feedback that encourages
continuation of a behavior
• Punishment: environmental feedback that discourages continuation
of a behavior
• Behavioral change occurs when reinforcements change and are
consistently applied
• Clinical intervention involves the rearrangement of a client’s
reinforcements so that more functional behaviors will result
Basic Assumptions of Behavior Theory
 Behavior is defined as what a person does, thinks or feels that can be
observed
Assessment should focus on observable events with a minimum of
interpretation
 Behavior is amenable to change
Behavior of concern must be defined in measurable terms
 People behave based on their learning, by watching others and by
environmental feedback
 Intervention must focus on influencing reinforcement or punishments
Consistent and immediate reinforcement produces change most frequently
 Thoughts and feelings are behaviors subject to reinforcement
principles
Change Through a Behavioral Perspective (cont.)
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Social worker helps client achieve new behaviors by:
– manipulating environment to alter reinforcement patterns
– Providing new opportunities for positive modeling
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Challenge in behavior therapy is to identify the specific antecedent conditions
and responses that are reinforcing to the client
Classical Conditioning
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Conditioning: Developing patterns of behavior through responses to environmental
stimuli or specific behavioral consequences
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A “neutral stimulus” produces a response after being repeatedly PAIRED with a certain
stimulus. Pavlov: bell, food, dog salivates
Previously neutral cues (places, people, feelings) become associated with problem behaviors
During behavioral intervention the principles of classical conditioning are reversed
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Individual is “exposed” to stimulus but provided with alternatives to usual response
Attending 12 Step meetings when wanting to drink/drug, relaxation when experiencing public
speaking anxiety, systematic desensitization to a stimulus (i.e.. elevators)
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**New reinforcement must be consistently supported over time by all significant
persons in client’s life to maintain long term effect
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Classical conditioning: paired associations with certain aspects of a setting
Systematic desensitization is an example
Operant Conditioning
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Major premise: future behavior is determined by consequences of present behavior
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Two types of reinforcement: positive and negative
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Earning tokens within a token economy program
Negative reinforcement: an aversive event is terminated by an individual’s behavior; as
a result the behavior is reinforced
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Both encourage the continuation of behavior
Positive means: adding a stimulus
Negative means: removing or preventing a stimulus from occurring
Positive reinforcement: encourages the continuation of the behavior preceding it
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Practitioner also pays attention to the antecedent, or prior, conditions that may trigger the
behavior
Alcohol is negatively reinforcing if it leads to escape from sadness
Punishments decrease behavior, reinforcements increase behavior
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Positive punishment: verbal reprimand, corporeal punishment
Negative punishment: fines, loss of privileges
Operant Conditioning Theory
Stimulus
Behavior
Consequence
(Antecedent,
(Response)
Positive Reinforcement
Cue)
Negative Reinforcement
Positive Punishment
Negative Punishment
Extinction
Modeling
• Modeling: watching others engaging in behavior and observing
reinforcement or punishment for the behavior
• In modeling the practitioner shows the client how to enact a new
behavior
– Behavioral rehearsal: client practices the new behavior
• Modeling is a significant way by which all people learn; particularly
for youth
• Covert modeling: worker guides the client through a process of
imagining the successful completion of an outcome
• Rehearsal of new skills in session with the client is important for
building confidence
• Modeling: watching others behave and receiving feedback
Behavioral Assessment
• Step One: Client's problem behavior is specified as clearly and
concretely as possible
• Step Two: Environmental cures that enhance or maintain the behavior
are identified
• Step Three: Consequences of the behavior are considered
• Assessment interviewing: questions are focused on environmental cues
in each of five “domains” that may be related to the problem situation
FIVE “ DOMAINS” OF BEHAVIORAL ASSESSMENT
Life Domain
Antecedents (Triggers, Cues)
Consequences (Reinforcers)
Social
With whom does the client
spend most of his time?
Does he have relationships with
people who do not have the
problem?
Does he live with someone who
is involved in the problem?
Has his social network changed
since the problem began or
escalated?
How have his relationships been
affected?
Environmental
What are the particular
environmental cues for the
problem?
What people, places, and things
have been affected by the
problem?
What is the level of her day-today exposure to these cues?
Has her environment changed as
a result of the problem?
Can some of these cues be
avoided?
FIVE “DOMAINS” OF BEHAVIORAL ASSESSMENT
Life
Domain
Antecedents (Triggers,
Cues)
Emotional
What feeling states
How does he feel afterward?
precede the occurrence of
How does he feel about himself?
the problem?
Cognitive
What thoughts run
through her mind, or
what beliefs does she
have about the problem?
What is she thinking afterward?
What uncomfortable
physical states precede
the problem occurrence?
How does he feel physically
afterward?
Physical
Consequences (Reinforcers)
What does she say to herself?
How is his physical health as a
result?
Behavioral Therapy Process
• State problems in behavioral terms
• Establish clear, measurable goals and objectives
• Gather baseline data
• Specify action steps toward problem resolution
• Specify personal and environmental resources
• Identify relevant "significant others" for participation
• Identify possible obstacles in advance
• Undertake behavioral intervention (emphasize positive
consequences of behavior change)
BEHAVIORISM AND THE SOCIAL
WORKER/CLIENT RELATIONSHIP
•The behavior of both the social worker and client is subject to
operant conditioning principles
•The client will be attracted to the social worker if:
–interactions result in less anxiety
–the practitioner is perceived as having the ability to secure rewards
for the client
•The practitioner’s empathic understanding will facilitate these
conditions
•The social worker must be careful not to use punishing behaviors
with the client
Behaviorism and the Social Worker/Client
Relationship (cont.)
•The social worker must be collaborative with the client
–client must be behaviorally invested in change strategies
•Client will evaluate therapeutic relationship based on
its rewards and costs relative to alternative behaviors
•Regular discussions about how the client is reacting to
the intervention help to sustain his or her sense of
reward for participation
Interviewing Skills Within Behavioral Therapy:
Verbal Following and Focusing
 Furthering a client’s verbal presentations (with prompts)
 Paraphrasing a client’s comments to add clarity
 Seeking connections among the client’s topic areas
 Providing and maintaining a focus on:
Selecting topics
Exploring topics
Staying on topic
Interviewing Skills Within Behavioral Therapy:
Summarizing
 Highlighting key aspects of a discussion before changing
topics
 Making connections between different threads of a client’s
communication
 Reviewing major themes of a session
 Planning for next session
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SYSTEMATIC DESENSITIZATION
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Goal
To reduce the client’s experience of anxiety by guiding his or her exposure
to, and mastery of, situations that evoke the anxiety
Prerequisites for Using the Technique
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Essence of the presenting problem is anxiety
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Anxiety-provoking stimuli can be identified and recreated
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The client is motivated to confront mildly anxiety-provoking situations
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The social worker and client can jointly plan a program of exposure
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Exposure to problem situations does not involve realistic danger
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The client is not under the influence of non-prescription drugs
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The client does not have a medical condition that makes the experience of
moderate anxiety dangerous
Systematic Desensitization Intervention Steps
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Instruct the client in the technique
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Isolate the anxiety-evoking stimulus
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Construct a “hierarchy” of graduated tasks
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Teach and rehearse relaxation techniques
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Begin work on a task that the client selects
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Reassure the client (ongoing support)
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Give the client control of the process (the power to redirect or terminate)
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Initiate the exposure tasks
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Greatest gains occur early
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Visualization may be used if “in vivo” experiences are not possible
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Review and evaluate
STRESS MANAGEMENT /
RELAXATION SKILLS DEVELOPMENT
Assessment: Taking a Stress and Coping Inventory
•Ask the client to describe situations that cause stress
•Ask the client to define what stress means to him or her.
–Clarify that there are four aspects of stress: cognitive, emotional, behavioral and
physiological
•Help the client be specific in identifying situations that create stress
–Clarify incident-specific effects of the stress (in cognitive, emotional, behavioral and
physiological terms)
•Ask the client what he or she already does to cope with stress, including actions and
thoughts
•Provide positive feedback to the client about stress coping efforts
–Point out situations where she or he dealt well with stress
STRESS MANAGEMENT /
RELAXATION SKILLS DEVELOPMENT
INTERVENTION
 Teach new skills (via education and modeling)
 Breathing (diaphramatic and belly breathing)
 Progressive muscle relaxation
 Meditation
 Rehearse the skills with the client “in vivo” or in session
 Arrange for real-life applications
PARENTING SKILLS DEVELOPMENT
•An operant behavioral intervention that teaches parents to apply principles of
reinforcement to change their children’s behavior.
•Parents learn to reinforce desirable behavior and ignore or punish negative
behavior.
Steps:
•Parents select a priority goal related to the child’s behavior
•Goals are broken down into smaller, observable components
•Tasks are specified to encourage the presence of positive behavior rather than
the absence of negative behavior
•A baseline is determined
•A target goal is established
•The intervention is initiated
•Preferred reinforcement systems include high-probability behaviors, social
reinforcement, and token economies
Parenting Skills Development: Shaping
•Shaping - reinforcing successive approximations of a desired behavior to
eventually meet a goal that is initially out-of-reach for the child.
•Command-giving should feature the following elements:
–Use only commands that are necessary; too many may be counterproductive
–Issue only one command at a time
–Issue specific commands rather than vague warnings
–Issue statements rather than questions
–Phrase commands clearly as what the child should do or should not do
–Keep commands brief
–Praise compliance to a command
Parenting Skills Development:
The Do’s and Don’ts of Praise
“Do’s”:
•Label praise (describe specifically what a child does to deserve it)
•Couple verbal praise with eye contact, a smile, or physical affection
•Praise effort rather than just achievement
•Praise positive behavior immediately after it is performed
“Don’ts”:
•Unlabeled praise (global statements such as “What a good boy!”)
•Coupling praise and criticism (“You did a good job washing the dishes,
but why can’t you dry them right?”)
•Waiting too long after the behavior
•Taking any feelings of awkwardness as a sign to stop praising
Parenting Skills Development: Punishment and Time Out
•Punishment involves presenting negative events (discipline, criticism) or
removing positive events (privileges) that decrease the occurrence of a
response
•Positive reinforcements should be provided at three times the ratio of
punishments
•Time Out is punishment that involves removing the child from a source of
reinforcement for a brief period (one minute per year of the child’s age). Its
purposes are:
•To extinguish the negative behavior
•Help the child calm down
•Help the child understand why the behavior is unacceptable
The location for time out should be free from reinforcement