Transcript Areas of Clinical Behavior Therapy

Areas of Clinical
Behavior Therapy
Chapter 28
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ESTs
• Empirically-Supported Treatments
– Therapies that have been shown to be
effective through scientific clinical trials
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Treatments for Phobias
• Systematic Desensitization –
Counterconditioning
• Based on Wolpe’s belief that phobias are
developed through respondent conditioning
– To change a response to a feared stimulus, one must
establish a fear-antagonistic response to that
stimulus
– Fear-antagonistic response: Relaxation
– Uses three steps:
• Progressive relaxation
• Development of anxiety hierarchy and control scene
• Combination of progressive relaxation with anxiety
hierarchy
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Treatments for Phobias
• Flooding – Exposure
– If client faces the feared stimulus, can’t escape,
and no aversive stimulus follows, the fear
response will become extinguished
– In vivo – in person
• Preferred – maximizes generalization
– Can elicit fear at or near full intensity, or may
use graded levels of exposure
• Participant Modeling
– Both client and therapist are participating
together in feared situation
– Therapist models approaches to feared stimuli
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Treatments for Other
Anxiety Disorders
• Panic Disorder and Agoraphobia
– In vivo exposure
– Cognitive Behavioral Treatment
• Behavioral component – exposure
• Cognitive component – changing client’s
misconception about panic attacks
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Treatments for Other
Anxiety Disorders
• Generalized Anxiety Disorder
– Most effective treatments combine cognitive
and behavioral strategies
– Exposure is an efficient form of behavioral
treatment:
• Teach client relaxation techniques
• Client uses the start of worrying as signal to relax
– Cognitive techniques can be used to
challenge and change client’s beliefs and
thoughts
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Treatments for Other
Anxiety Disorders
• Obsessive-Compulsive Disorder
– In vivo exposure and response prevention
• Client is encouraged to engage in a behavior
leading to the obsession while being prevented
from performing the compulsive behavior
• Prevention of compulsive response extinguishes
anxiety that follows the obsession
• Exposure may be graded
– Cognitive Therapy
• Used to change the self-statements clients make
that help them maintain the obsession
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Treatments for Other
Anxiety Disorders
• Posttraumatic Stress Disorder
– Exposure treatment
• Imagination
• Talking about event
• Writing about event
– Combination of cognitive restructuring and
exposure
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Treatment of Depression
• Depression
– Behavioral interventions:
• Increasing contingency reinforcers in individuals’ lives
• Encourage clients to seek out reinforcers through hobbies
and various social activities
• Involve significant others in reinforcement
– Cognitive Interventions – Beck’s Cognitive Therapy
• Negative cognitive schemas lead to negative interpretation
of life events, which lead to depressed behavior
• Cognitive restructuring a key component
• Homework includes behavioral activities
• Behavioral activation – behavioral homework assignments
that are aimed at increasing contingency reinforcers
– Research suggests these can be used alone as treatment for
depression
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Treatment of Alcohol Problems
• Alcoholics Anonymous (AA) – abstinence based
program
– Research shows that behavior therapy can be as or
more effective than AA (Emmelkamp, 2004)
• Behavioral approaches
– Moderation drinking programs teach drinkers to:
•
•
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Use goal setting to drink in moderation
Control “triggers” (SD’s) for drinking
Learn problem-solving skills to avoid high-risk situations
Engage in self-monitoring to detect controlling cues and
maintaining consequences of drinking behaviors
• Practice these techniques with various homework
assignments
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Treatment of Alcohol Problems
(continued)
• Behavioral programs have utilized:
– Motivational interview
• Therapist asks client questions, the answers for
which act as motivational establishing operations
for change
– Coping-skills training
• Teach clients to deal with stressors that may lead
to excessive alcohol consumption
– Relapse prevention strategies
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Treatments for Eating Disorders
• Eating Disorders
– Bulimia
– Anorexia
– Obesity
• Behavioral and Cognitive Interventions
– Reinforcements for going for a particular time without binges
(time increases gradually)
– Counteract client’s unrealistic beliefs about food, weight, and
appearance
– Focus on helping individuals adopt long-term lifestyle changes in
eating habits, exercise, and their attitudes toward both
• Self-monitoring – food intake, body weight
• Stimulus control – restricting eating to a specific location
• Changing rate of eating – laying down utensils between bites; taking
breaks between courses
• Behavioral contracting – agree to lose a certain amount of weight in a
certain time period to get a reinforcer
• Relapse prevention strategies
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Treatments for Couple Distress
• Behavioral couple therapy includes:
– Instigation of positive exchanges – increasing
behaviors that are pleasant to each partner
– Communication training – teaching how to
express thoughts and feelings; teaching to be an
effective listener
– Problem-solving training – learning to use
communication skills to identify and solve
problems
– Program generality – looking for signs of relapse
and use skills learned
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Treatment of Sexual Dysfunction
• Hypothesis that anxiety is a factor in
sexual dysfunction
– Exposure programs appear most effective
• Masters and Johnson (1970)
– Couple engages in pleasurable stimulation
– Relaxation, no pressure for orgasm
– Goal is pleasure, not performance
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Treatments for Habit Disorders
• Habits – repetitive behaviors that are inconvenient
and annoying
– EX: nail biting, lip biting, etc.
• Habit reversal – three-step program:
1. Client learns to describe and identify problem behavior
2. Client learns and practices a behavior that is incompatible
with or competes with problem behavior
•
Client practices competing behavior daily in front of mirror
and engages in it immediately after the occurrence of the
problem behavior
3. For motivation, the client reviews the inconvenience
caused by the disorder, records and graphs the behavior,
and has a family member provide reinforcement for
engaging in treatment
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