Transcript Self Instructional: Cognitive Behavioral

Behavior
Therapy
The History
•Rooted in Experimental Psychology
•Based on Pavlovian concept of Classical
Conditioning & Skinnerian Operant
Conditioning
•Working only on observable events to work
with unobservable events
The Experiments
Classical Conditioning
•I.P.Pavlov – Experiments on a Dog
•John B. Watson – Albert & White Rat
•Mowrer & Mowrer –Treatment for Bedwetting
Operant Conditioning
•E.L.Thorndike – “law of effect” (consequences
that follow behavior help learning)
•B.F.Skinner – experiment on Pigeon
Social Cognitive Theory
•A. Bandura:
•- triadic reciprocal: the environment, the person, the behavioral
action
•Individual learns by observing others
•Self-efficacy
•Self-awareness, self-inducements, self-reinforcement
The Theory of Personality
•Positive Reinforcement: a positive event presented as a consequence of
a person’s performing a behavior
•Extinction: withdrawn reinforcer terminates behavior
•Generalization: the reinforced behavior is learned for other situations
•Discrimination: ability to respond differently depending upon the
stimulus condition
•Shaping: reinforcing behavior approximation from the original to the
desired behavior
The Theory of
Observational Learning
Attentional Processes – seeing is not enough; one must perceive accurately by
attending at varying degrees
Retention Processes – imaginal & verbal coding (self-talk) describe subvocal events for
remembering
Motor Reproduction Process – translating observed phenomena into action
Motivational Process – The modeled behavior that puts into action will continue if being
reinforced
Self-Efficacy – individual perception of self-ability to perform in different types of
situation; the major source of this includes:
•Performance accomplishment: successes are likely to create high expectations
•Vicarious Expectations: expecting able to do similar as the observed model
•Verbal Persuasion: impact of encouragement/ praise from others
•Emotional Arousal
The Goals of Behavior Therapy
Changing The Target Behavior
Perform Functional Analysis
•Define clearly & accurately the target behavior
•Identify possible actions
•Collaborate with clients on target behavior preference
Evaluate/ assess behavior, antecedents &consequence
•Identify causes & reasons
•Choose interventions
Select Appropriate Goals
•Identify specific goals
•Let clients explore the advantage/ disadvantage
•Measure achievement
The Assessment
Behavioral Interviews:
•What, When, Where, How, How Often
Behavioral Reports & Ratings:
•Rating scale on behavior inventory
Behavioral Observations:
•Frequency of performed target behavior
•Diaries indicating date, time place, & activity of the behavior
•Naturalistic Observation to eliminate Reactivity
Physiological Measurements:
•Blood pressure, Heart rate, Respiratory functioning, Skin electrical
conductivity
The Treatment
Systematic Desensitization (Joseph Wolpe)
Imaginal Flooding
•Contrast to Gradual Systematic Desensitization, this technique is conducted by exposing the client to a
frightening or anxiety provoking images
•The mental images are indicated in SUD (subjective unit of discomfort)
•Familiar condition conducted by imagining will reduce anxiety
•Relaxation procedure may includes prior, during & after therapy
•A specific form of this therapy: Implosive Therapy (by Thomas Stampfl)
In Vivo
•Procedure is conducted in actual environment
•2 types: one similar to SD, another similar to IF
•Relaxation is conducted whenever client is in a stressful / at tensed
Modeling (Bandura)
Self Instructional: Cognitive Behavioral (Meichenbaum)
Systematic Desensitization
Relaxation
•Twice a day 10-15 minutes Relaxation (by Jacobson, 1938)
•Clients learn to control muscles into relaxing condition
•Relaxed state is paired with imagined anxious situation
Anxiety Hierarchies
•Obtain information on specific situation producing anxiety
•List the situations in order on scale 0-100 (SUD = subj units of discomfort
•Determine the prioritized condition to treat
Desensitization
•Ask clients about the SUD level
•Presenting neutral scene
•Check how vivid the client can imagine/ visualize
•Rise the SUD level with more intense scene – recheck the response,
conduct relaxation
•continues
Modeling Technique
(Albert Bandura)
5 Basic Functions of Modeling:
TEACHING
through demonstration – sometimes therapist perform
the behavior repetitiously; the clients observe the model then perform
the behavior several times until achieving the expected stage
•PROMPT through imitation – the therapist prompt the client to
imitate the movement such as in sport intruction
•MOTIVATE by reinforcement – thus the client perceives the
enjoyment of behaving in a certain way
•REDUCE ANXIETY by reinforcement – such as instructing a child
to swim, when the model is in the pool, the child feel anxious knowing
all right being in the pool
•DISCOURAGING – watching a film on the impact of smoking onm
lung cancer discourage smokers to continue smoking
Modeling Technique
Live Modeling:
Watch live model (sometimes the Therapist) to perform the expected behavior
The model repeats the behavior several times
Symbolic Modeling:
When live model is not present
By film/ book including read story/ story telling
Indirect modeling
Role Playing:
Learn to interact in different situations/ posititions – sometimes the therapist
role play the client/ someone’s in client’s life
Participant Modeling:
Therapist model the client’s behavior
Therapist guide the client to behave as expected by participating – meanwhile
get ready to give help when needed such as in mountain climbing
Covert Modeling:
Visualizing the model, visualizing the consequences
The therapist describes the situation, and let the client consider the impact of
the behavior
Self Instructional Training
(Meichenbaum)
A way for people to teach themselves how to deal effectively with situations
that had previously caused difficulties – the therapist models the appropriate
behavior, the clients models the therapist’s behavior & repeats / practice
•A form of self-management
•A way people teach themselves to deal with previously
difficult situations
•First the client models the behavior
•Second the client practices the behavior
•Third the client repeats the instructions to self
•Sometimes use role play
•Sometimes use taped instructions
Stress Inoculation
(Meichenbaum)
The principle
Changing the beliefs and negative inner dialogue to positive & rehearsing the behavior
The conceptual phase
Gathering the information & see how client develop the inner dialogue
Educate the client by pointing out the cognitive & emotional responses
Skill Acquisition: Use cognitive behavioral skills:
relaxation
cognitive restructuring
“I’m afraid & can’t do anything” >> “When I am afraid I pause and feel can not do things”
problem solving skills
“I will change the situation”, “ I make the plan”, “I can walk with others”
self-reinforcement
“I do better”, “ I feel comfortable”
Application
Visualize
Mentally rehearse
Action