Transcript SOME DISTINGUISHING CHARACTERISTICS OF COGNITIVE

Behavior Theory and Therapy
• SOW 6425 Assessment and Planning
• Professor Nan Van Den Bergh
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:
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Learning via watching others
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Environmental feedback
 Intervention must focus on influencing reinforcement or punishments
Consistent and immediate reinforcement produces change most frequently
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
Change Through a Behavioral Perspective (cont.)
• Goal of behavioral intervention: to change behavior
• Two primary methods of changing behavior:
– Altering reinforcements
– Modeling new behaviors
• Altering reinforcement patterns: manipulating the
environment: Clients helped to seek out new behaviors that
offer alternative reinforcements
– Ex: rather than drinking/drugging use exercise, yoga, mindfulness,
singing, acting, drawing, etc.
– Ex.: parents taught to reinforce pro-social behaviors and extinguish
negative behaviors via ignoring or punishments
Change Through a Behavioral Perspective
(cont.)
• Modeling: watching others engage in behaviors and
observe their outcomes (being rewarded or punished)
• Challenge in behavior therapy is to identify the specific
antecedent conditions and responses that are reinforcing to
the client
BEHAVIOR THEORY
Stimulus
Behavior
Consequence
(Antecedent,
(Response)
Positive Reinforcement
Cue)
Negative Reinforcement
Positive Punishment
Negative Punishment
Behavior Theory Concepts:
Consequences
• Positive reinforcement: encourages the continuation of a behavior
preceding it.
– Alcohol use is positively reinforced by feelings of well–being and pleasant social
interaction with others, when drinking
• Negative reinforcement: process by which an aversive event is
terminated by the individual’s behavior; therefore the behavior is
reinforced
– Alcohol is negatively reinforcing when it leads to escape from feelings of boredom
or sadness
• Positive punishment: adding a consequence that eliminates a behavior
(time out)
• Negative punishment: eliminating a reinforcer that extinguishes the
behavior (removing a privilege)
Classical Conditioning: paired associations with certain
aspects of a setting
•
Conditioning: Developing patterns of behavior through responses to
environmental stimuli or specific behavioral consequences
– A “neutral stimulus” produces a response after being repeatedly paired with a
conditioned stimulus.
– Pavlov: food = salivation; food plus bell = salivation; bell = salivation
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Behavioral intervention through principles of classical conditioning
– Individual is “exposed” to stimulus but provided with alternatives to usual response
– Examples:
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Attending 12 Step meetings when wanting to drink/drug,
Practicing deep breathing when experiencing public speaking anxiety
Practicing progressive muscle relaxation prior to stressful event
Systematic desensitization for alternative to phobia or obsession/compulsions (elevators,
hand washing….)
**New reinforcements must be consistently supported over time by all
significant persons in client’s life to maintain long term effect
Operant Conditioning
• Major premise: future behavior is determined by consequences of
present behavior
– Practitioner also pays attention to the antecedent, or prior, conditions that
may trigger the behavior
• Two types of reinforcement: positive and negative
– Both encourage the continuation of behavior
• Positive reinforcement: encourages the continuation of the behavior
preceding it
– Alcohol is positively reinforcing if it aids engaging socially with others
• Negative reinforcement: an aversive event is terminated by an
individual’s behavior; as a result the behavior is reinforced
– Alcohol is negatively reinforcing if it is an escape from sadness
• Operant conditioning focus: clients are encouraged to engage in
behaviors that offer alternative reinforcements so they will not be as
prone to indulge in problem behaviors
– Exercising rather than drinking to reduce stress
– Meditating rather than taking drugs to feel calmer
Operant Conditioning: Punishments
(cont.)
• Punishment’s purpose is to decrease behavior
• Positive punishment: adding a consequence that
eliminates a behavior
– Verbal reprimand
– Corporeal punishment
• Negative punishment: eliminating a reinforcer that
eliminates a behavior
– Loss of privileges
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 (visualizataion)
• Rehearsal of new skills in session with the client is important for
building confidence
Functional Behavioral Assessment
• Step One: Client's problem behavior is specified as clearly and
concretely as possible
• Step Two: Environmental cues 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
Functional Behavioral Analysis
• Queries about Environmental Cues in Five Areas:
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Social cues
Environmental cues
Emotional cues
Cognitive cues
Physical cues
• Cues lead to behaviors which lead to consequences
• From behavior analysis practitioner determines the
reinforcers and triggers that maintain the behavior
• Assessment leads to planning for construction of concrete
target behaviors (goals), and their antecedent conditions
Functional Behavioral Analysis: Questions
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When do you experience the behavior?
Where do you experience the behavior?
Who are you with when the behavior occurs?
How long does the behavior typically last?
What happens immediately after the behavior?
What do you do or what does someone else do to or with you?
What bodily reactions do you experience with the behavior?
How long do these reaction last?
How often does the behavior typically happen?(hourly, daily, weekly)
What is the typical timing of the behavior
What do people around you do when the behavior is happening
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)
Behavioral Therapy Process (con.t)
• Practitioner, client or other persons collect data about the
client's activities
– Client's behavior changes are documented regularly
• Client and practitioner evaluate the intervention process
regularly, comparing baseline conditions to current
“counts” of desired behaviors
• Intervention ends after the client achieves his or her goals
and demonstrates the likelihood of goal maintenance
• Ending intervention is a process of “fading.”
– After an intervention has been underway and the client has
acquired new behaviors, meetings with worker and reinforcement
schedule are gradually eliminated
BEHAVIORISM AND THE SOCIAL
WORKER/CLIENT RELATIONSHIP
•Social worker must be perceived as competent, caring and
trustworthy as s/he will be asking client to undertake behaviors that
will feel uncomfortable and threatening
•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)
 “ tell me more….”
 “help me to understand what you mean by…”
 Paraphrasing a client’s comments to add clarity (reflecting
feeling and meaning)
 “you felt both angry and shamed when you parent called you a
“wench……”
 Seeking connections among the client’s topic areas
 Exploring themes related to behaviors
 “ How did feeling rejected affect your binge behavior?”
 Providing and maintaining a focus on topic/s
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 how s/he experiences stress:
–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 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