Transcript Behavior

Behavior and Cognitive
Behavior Therapy
Skinner: Radical Behaviorism
Bandura, Ellis, Beck
Meicheanbaum
1
Compare -- Contrast
Humanistic Theories
Person Centered-Existential-Gestalt

Common Themes


List ways in which the three approaches are
similar
Distinct aspects each approach emphasizes


Central focus of each approach
Unique ideas, constructs, and/or techniques each
brought to counseling practice
2
Areas of Major Emphasis

Psychoanalytic/Psychodynamic


Humanistic


Basic drives and the contribution of early
emotional experiences to the person’s
presenting concern
The therapeutic process -- the relationship-and emotional states in the here and now
Behavioral

observable behaviors & learning principles;
congnitions
3
Skinner:
Radical Behaviorism




Placed primary emphasis on the role of the
environment in producing behavior
Applied learning principles to psychology
Experimental psychologist: examined learning
principles with rats in the laboratory
Books



1948
1953
1971
Walden Two
Science and Human Behavior
Beyond Freedom and Dignity
4
Behavior/
Cognitive Behavior Theory
Classical Conditioning
 Operant Conditioning
 Social Learning Approach
 Cognitive Behavior Therapy

5
Classical Conditioning

If you pair a conditioned stimulus to a
natural stimulus, after time, the conditioned
stimulus produces the same response as the
natural one: Learning by association
Pavlov discovery (1900)
1. Meat (us) >>
Salivation (ur)
2. Bell (cs)>>Meat (us) >>Salivation (ur)
3. Bell (cs) >>
Salivation (cr)
4. Bell (cs) >>
Extinguished
response
6
Wolpe: 1950

Applied classical conditioning to treat anxiety by pairing
stimuli that cause anxiety (taking an exam) with a
state of relaxation, to break the connection between
the stimulus and the anxious response
Exam (us)>>>Anxiety (ur)
Relaxation> Images Exam>Anxiety>Relaxation
(cs)
(us)
(ur)
(cr)
Images Exam (us) >>> Relaxation (cr)
Exam (us)
>>> Relaxation (cr)
7
Behavior Therapy: Learning by
Association: Exposure Techniques
1.
Systematic Desensitization - anxiety
•
•
Relaxation training/ Anxiety hierarchy
Pairing (+) stimulus with (–) stimulus (shot-lollipop)
2.
Aversive Counter Conditioning
3.
Exposure Techniques
•
•
In vivo desensitization
Flooding (in vivo, imaginary)
8
Anxiety:
Facilitating and Debilitating
9
10
Aversive Counter-Conditioning
11
Exposure Techniques
12
Operant Conditioning

Behavior is controlled by its
consequences

Desired Consequences – Increase Behavior



Reinforcement
No consequences
Decrease Beh.
Not-desired consequences - Decrease Beh.

Punishment
13
Environmental Consequences

Reinforcement



Punishment



Positive R
Negative R
Positive P:
Negative P:
Increase a behavior
Adds a pleasant consequence
Takes away an aversive stimulus
Extinguish a behavior
Add an aversive consequence
Takes away a desired stimulus
Lack of consequence - Extinguish behavior
14
Applied Behavioral Analysis:
Functional Assessment Model

Examine the antecedents and consequences of
problem behaviors

Conduct a functional assessment using interviews and
direct observations (e.g. keeping a diary) to identify



Antecedents: conditions that contribute to the behavior
of interest
Consequences: what happens after specific behavior occurs
Behavioral treatments are devised to replace problem
behaviors with more adaptive behaviors using
reinforcement and extinction strategies
15
Behavior Modification Program

Reinforcement
Token economy

Extinction
Time out, loose privileges,
punishment

Stimulus control
Change environmental
antecedents of problem
behaviors
16
Cognitive Behavior Therapy

Emphasizes cognitive processes and selftalk as mediators of behavior change




Reciprocal Determinism
Bandura
Rational Emotive Therapy
Ellis
Cognitive Therapy
Beck
Cognitive Behavior Modification Meichenbaum
17
Bandura: Social Learning
Approach

Psychological functions involve a reciprocal
interaction between:
Environment
<><><>
Behavior
<>
<>
<>
<>
<> Cognitive Process <>
18
Modeling
Vicarious
Learning
19
Cognitive-Behavior Techniques
1.
Assertiveness Training
Provide Information
Examine beliefs and self-talk
Role play assertive behaviors
1.
2.
3.

•
Modeling – therapist demonstrates
behavior
Behavioral rehearsal – client demonstrates
behavior
20
Cognitive-Behavior Techniques
2. Steps: Self-Management Program
1. Identify goal in behavioral terms
2. Behavioral assessment
environmental and cognitive contingencies
3. Plan for change
4. Self-Monitoring and Self-Reinforcement
Behaviors, thoughts, self-talk
5.
Evaluation of action plan - results
21
Cognitive Behavior

Mental disorder- problem with thinking in which
a client distorts reality, including:




Specific misconceptions
Unrealistic expectations
Maladaptive attributions
Therapy’ aim is to identify and change



Theory
Faulty patterns of thinking
Faulty premises and attitudes
Distressing emotions result from
maladaptive thinking
22
Rational Emotive Behavior Therapy:
(REBT) Albert Ellis

Stresses thinking, judging, deciding, analyzing, and
doing

Assumes that cognitions, emotions, and behaviors
affect ach other

Is highly didactic, directive,

Emotions stem mainly from our beliefs, evaluations
and interpretations
23
RET: The
ABC Theory
24
RET: Therapy Process


Therapy is seen as an educational process
Clients learn:



To identify and dispute irrational beliefs
To replace ineffective ways of thinking with
effective and rational cognitions
To stop absolutistic thinking, blaming, and
repeating false beliefs
25
RET: Therapy Process

Rational Emotive Imagery


Homework



Imagine being in the worst situation- train to
change irrational thoughts/feelings for retional
ones
REBT Self-Help Form
Act as if… to challenge self-limiting
Biblio-therapy – Psycho-education
26
Aaron Beck’s CT: Human Nature

Cognitive structures or schemas


Confirmatory bias


We all have implicit assumptions or premises that
influence what we attend to and how we interpret
events
We tend to electively attend to events that confirm our
beliefs
Schemas and Disorders


Anxiety
Depression
Threat and Danger
Social rejection and failure
27
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 taught by the therapist
28
CT’s Cognitive Distortions
1.
2.
3.
4.
5.
6.
7.
Arbitrary inferences
Selective abstraction
Overgeneralization
Magnification and minimization
Personalization
Labeling and mislabeling
Polarized thinking
29
CT’s Cognitive Distortions
Arbitrary inferences
• Gloria: relationships with the eligible men
do not work out because she feels anxious
and acts flippantly
Selective abstraction • Focuses on only on one aspect of a
situation: typically a negative aspect-
Overgeneralization
• This relationship did not work, no
relationship will ever work
Magnification and
minimization
• Emphasize negatives and minimize
positives
30
CT’s Cognitive Distortions
Presonalization
• A mother blames herself for child’s
problems
• A man blames himself for partner's lack of
interest in the relationship
Labeling and
mislabeling
Type of generalization:
• I made a mistake vs. I am a looser
Polarized thinking
• Either co-workers praise me or they hate
me
• Gloria: Men are either eligible or “icky”
31
Therapy Process




Teach clients to recognize, observe and
monitor negative "automatic" thoughts &
Subject their automatic thoughts to reality
testing: examine evidence for and against
them
Clients learn to substitute realistic and
accurate interpretations for biased cognitions
Process is collaborative an interactive:
Socratic dialogue
32
Beck’s Approach to
Depression: Cognitive Triad
1.
2.
Have a negative view of themselves; attribute
setbacks to themselves w/o looking at the
environment
Tend to interpret experiences in a negative
manner.
•
3.
Screen out positive experiences not consistent with
negative view of themselves (selective abstraction)
Gloomy vision and projections about the future
33
Ellis Vs. Beck


Ellis is more directional and confrontational in
pointing out and refuting irrational thoughts
Beck helps clients discover their distorted patterns
of thinking


Collaborative empiricism
Guided discovery

client and therapist examine and evaluate beliefs and
modify and correct client’s misconceptions
34
Contributions Beh- Cog Beh

Focus on short-term behavioral goals

Emphasis on evaluation of therapy
outcome

Empirical evidence of positive results
35
Limitations

May lead to symptom substitution

Too much therapist power and control

Lack of attention to relationship issues

No processing of emotions and feelings

Focus only on cognitive issues
36
Meichenbaum: Cognitive
Behavior Modification
Is primarily a self-instructional therapy that



Focuses on helping clients become aware of their selftalk, - cognitive restructuring - and
acquire practical coping skills to deal with problems
and behaviors
Process of Change

1.
2.
3.
Self observation
Start a new internal dialogue
Learn new behaviors
37
Phase 1: Self-Observation



Observe thoughts, feelings, actions,
Realize how client contributes to own
problems
Leads to new cognitive structures – see
problems in a new light
Phase 2: Start New Internal
Dialogue




Identify maladaptive behaviors
Recognize more adaptive options
Develop adaptive internal dialogue to
guide behaviors
New behaviors impact cognitive
structures
Phase 3: New Skills





Teaches more effective coping skills
Practice in real- life situations
Continue monitoring/changing internal
dialogue
Observe behaviors
Assess outcomes
Coping Skills Program:
Stress Inoculation

Stress management techniques for present and
future problems

Three phases:
1.
2.
3.
Conceptual phase
Skills acquisition and rehearsal
Application and follow-through
41
Conceptual Phase





Collaborative relationship (Rogers)
Didactic presentation of the role cognitions and
emotions play in stress (Ellis)
Guided discovery to identify own self-talk and
how it creates stress (Beck)
Systematic observation and monitoring of
maladaptive behaviors and their related selftalk (Behavioral)
New cognitive structures = see problems in a new
light (Beck)
42
Skills Acquisition and Rehearsal

Give clients behavioral and cognitive coping
techniques to apply to stressful situations





Rehearse new self-statements
Relaxation training
Social skills training
Time management instruction
Making changes in everyday life
43
Application and Follow-Through

Arrange for transfer and maintenance of
change from therapy to the real world



Homework assignments of increasing complexity
Results of assignments are carefully evaluated
Follow-up and booster sessions are scheduled
in 3-, 6-, and 12 months intervals
44
Contributions

Focus on short-term behavioral goals

Emphasis on evaluation of therapy
outcome

Empirical evidence of positive results
45
Limitations

May lead to symptom substitution

Too much therapist power and control

Lack of attention to relationship issues

No processing of emotions and feelings

Focus only on cognitive issues
46
Multimodal Therapy: Lazarus
Holistic approach to behavior modification
 Technical eclecticism
 Human experience



interplay of genetics, environment and social
learning
can be accounted by examining the BASIC ID
BASIC ID

Framework for assessment and therapy







B–
A–
S–
I –
C–
I –
D–
behavior
affective processes
sensation- five senses
imagery
cognition
interpersonal relations
physiological aspects - health
Therapy Process





Therapy is guided by what is best for the client
Starts with a thorough assessment of the BASIC
ID profile
BASIC ID determines the tone or quality of the
person’s functioning
Therapist functions as trainer, educators,
consultant, role model
Emphasize skill learning
New Applications and Integrations
(end of Behavior Chapter #9)

Mindfulness and Acceptance- Based Cognitive
Therapies: Emotional Regulation

Dialectical – Behavior Therapy (DBT)






Combines CBT and Psychodynamic
Highly structured- requires training - Borderline PD
Minimum 1-year of frequent outpatient treatment
Mindfulness-Based Stress Reduction (MBSR)
Mindfulness-Based Cognitive Therapy (MBCT)
Acceptance and Commitment Therapy (ACT)
50
Mindfulness and Acceptance

Mindfulness




How to live more fully in the present (Ext)
Interventions: yoga, meditation
Experiential learning and self-discovery (Ext- Gestalt Rogers)
Practice – In session and home-work


Acceptance


(rather than challenge cognitions)
change awareness of and relation to negative
thoughts (Ext)
acceptance (nonjudgmental awareness) of
cognitions (Rogers)
51