Chapter 14: Behavioral and Cognitive-Behavioral Perspectives :Chapter 14: Behavioral and Cognitive-Behavioral Perspectives


Origins of Behavioral Approach :Origins of Behavioral Approach Behavioral approach allies itself with: (a) a scientific emphasis and (b) a deemphasis of the role of inferred variables.


Brief History of Behavioral Approach :Brief History of Behavioral Approach Ivan Pavlov Little Albert - Watson Mary Cover Jones (1924) demonstrated how such fears could be removed. Wolpe – systematic desensitization Skinner


Traditional Techniques of Behavior Therapy :Traditional Techniques of Behavior Therapy The Relationship Broad Spectrum of Specific Treatment Techniques Systematic Desensitization Exposure Therapy Behavioral Rehearsal Contingency Management – time out, shaping, behavioral contracting Aversion Therapy – overcorrection, aversive meds, response cost.


Systematic Desensitization :Systematic Desensitization Developed by Salter(1949) and Wolpe (1958) Based on reciprocal inhibition – Goals – Teach relaxation skills, including PMR, Develop anxiety hierarchy, While relaxed, introduce a gradually increasing series of anxiety-producing stimuli. Moves up the hierarchy. If anxiety level increases the patient signals and the therapist helps the patient relax once more.


Slide 6:Example of Behavior Therapy for Obesity Therapy http://www.youtube.com/watch?v=x7-VxSSEzso&feature=fvw


Exposure Therapy :Exposure Therapy Exposure therapy describes a behavior therapy technique that is a refinement of a set of procedures originally known as flooding or implosion. Roots can be traced to Masserman Patients expose themselves to stimuli or situations that were previously feared or avoided.


Slide 8:Dr. Linda Papadopoulos discussing Graded Exposure http://www.youtube.com/watch?v=LcojyGx8q9U


Exposure Therapy – Features that must be present for maximum benefit :Exposure Therapy – Features that must be present for maximum benefit Exposure should be of long rather than short duration. Exposure should be repeated until all fear/anxiety is eliminated. Exposure should be graduated, starting with low-anxiety stimuli/situations and progressing to high-anxiety stimuli/situations. Patients must attend to the feared stimulus and interact with it as much as possible. Exposure must provoke anxiety.


Slide 10:Example of Graded Exposure for a Snake Phobia http://www.youtube.com/watch?v=J7A1xN6Qkpw&feature=related


Slide 11:Example of Virtual Reality Exposure Therapy http://www.youtube.com/watch?v=CQgKEp_NhHk&feature=related


Behavioral Rehearsal :Behavioral Rehearsal A variety of techniques whose aim is to enlarge the patient’s repertoire of coping behaviors. Involves four stages: - First – to prepare the patient by explaining the necessity for acquiring new behaviors, getting the client to accept behavior rehearsal as a useful device, and reducing any initial anxiety over the prospect of target situations. - Second – involves the selection of target situations - Third – Actual behavior rehearsal - Final – actual utilization of newly acquired skills in real-life situations


Behavioral Rehearsal :Behavioral Rehearsal One application is assertiveness training. Originally designed as a treatment for persons whose anxiety seemed to stem from their timid mode of coping with situations. A variety of assertiveness training programs have been developed specifically for individuals seeking to overcome destructive passivity. Also been used in treating sexual problems, depression, and marital conflicts.


Slide 14:Example of Behavioral Rehearsal http://www.youtube.com/watch?v=bkCbxXg9ORs&feature=related


Contingency Management :Contingency Management Goal of controlling behavior by manipulating its consequences. Examples: - Shaping - Time-out - Contingency contracting - “Grandma’s rule” Token Economies


Aversion Therapy :Aversion Therapy Based on the apparently simple principle that when a response is followed by an unpleasant consequence. The presentation of the aversive agent is done systematically. The punishment is consistently applied. Used to help patients develop increased self-control, cope with problems of obesity, smoking, alcoholism, and sexual deviations.


Aversion Therapy :Aversion Therapy Among the aversive agents that have been used most frequently are electrical stimulation and drugs. Cautela developed a set of procedures, known as covert sensitization, that rely on imagery rather than the actual use of punishment, drugs, or stimulation. Other techniques: response cost, overcorrection


Slide 18:Dr. Judith Beck on Cognitive-Behavioral Therapy http://www.youtube.com/watch?v=45U1F7cDH5k&feature=related


Cognitive-Behavior Therapy :Cognitive-Behavior Therapy Cognitive Therapy - emphasizes the role of maladaptive beliefs, and distorted thinking in the etiology and maintenance of problems. Cognitive-behavioral therapy (CBT) – seeks to modify or change patterns of maladaptive thinking and problematic behaviors that are believed to contribute to a client’s problems.


Cognitive-Behavior Therapies :Cognitive-Behavior Therapies Albert Bandura – Observational Learning Theory – use of Models and Modeling; Albert Ellis – Rational Restructuring; RET Donald Michenbaum – Stress Innoculation Training Aaron Beck – Cognitive Therapy and CBT – beliefs, distorted thinking, automatic thoughts Marsha Linehan – Dialectical Behavior Therapy


Slide 22:Introduction to Rational Emotive Therapy http://www.youtube.com/watch?v=u9tTrN4mjeQ&feature=related


Slide 23:Dr. Albert Ellis conducting Rational Emotive Therapy with Gloria http://www.youtube.com/watch?v=e6oZGjVLC34&feature=related


Cognitive-Behavior Therapy :Cognitive-Behavior Therapy Cognitive Therapy - emphasizes the role of maladaptive beliefs, and distorted thinking in the etiology and maintenance of problems. Cognitive-behavioral therapy (CBT) – seeks to modify or change patterns of maladaptive thinking and problematic behaviors that are believed to contribute to a client’s problems.


Slide 25:Example of Cognitive-Behavioral Therapy http://www.youtube.com/watch?v=GqW8p9WPweQ&feature=related


Cognitive-Behavior Therapy – Rational Restructuring :Cognitive-Behavior Therapy – Rational Restructuring Much maladaptive behavior is determined by the ways in which people construe their world or by the assumptions they make about it. If this is true, it follows that the behavior therapist must help the patients learn to label situations more realistically so they can ultimately attain greater satisfactions. Example: thought record


Example of a Thought Record :Example of a Thought Record Much maladaptive behavior is determined by the ways in which people construe their world or by the assumptions they make about it. If this is true, it follows that the behavior therapist must help the patients learn to label situations more realistically so they can ultimately attain greater satisfactions. Example: thought record


Cognitive-Behavior Therapy – Stress Inoculation Training :Cognitive-Behavior Therapy – Stress Inoculation Training Patients could use self-talk or self-instruction to modify their behavior and that therapists could in effect train patients to change their self-talk SIT aims to prevent problems from developing by “inoculating” individuals to ongoing and future stressors.


Cognitive-Behavior Therapy – Phases of Stress Inoculation Training :Cognitive-Behavior Therapy – Phases of Stress Inoculation Training Conceptualization phase – client is educated with regard to how certain thinking or appraisal patterns lead to stress, other negative emotions, and dysfunctional behavior. Skill acquisition and rehearsal phase – client practices coping skill in the clinic and then gradually out in the real world as he/she is confronted with stressors. Application phase – additional opportunities arise for the client to apply a wide variety of coping skills across a range of stressful conditions.


Slide 30:Dr. Meichenbaum Conducting Stress Innoculation Training http://www.youtube.com/watch?v=8cK4xdZvHUM&feature=related


Cognitive-Behavior Therapy – Beck’s Cognitive Therapy :Cognitive-Behavior Therapy – Beck’s Cognitive Therapy Aaron Beck has been a pioneer in the development of cognitive-behavioral treatments for a variety of clinical problems. This model of intervention entails the use of both cognitive and behavioral techniques to modify dysfunctional thinking patterns that characterize the problem or disorder in question.


Slide 32:Dr. Aaron Beck discussing Assessing of Depression http://www.youtube.com/watch?v=23GdhVpOHCw&feature=PlayList&p=01E2E47421CEA841&index=0&playnext=1


Cognitive-Behavior Therapy – Dialectical Behavior Therapy :Cognitive-Behavior Therapy – Dialectical Behavior Therapy Relatively new cognitive-behavioral treatment for borderline personality disorder and related conditions involving emotional deregulation and impulsivity. Involves skills training in problem-solving techniques, emotional regulation, and interpersonal skills.


Slide 34:Dr. Jeffrey Wood discussing Dialectical Behavior Therapy http://www.youtube.com/watch?v=dFI4673AeGo&feature=PlayList&p=9965EC9C1C1A9B77&playnext=1&playnext_from=PL&index=6


Slide 35:Dr. Marsha Linehan discussing Dialectical Behavior Therapy http://www.youtube.com/watch?v=q7VFgEwnmdk&feature=PlayList&p=31ADA0833DBBE7C8&playnext=1&playnext_from=PL&index=2


Cognitive-Behavior Therapy – Dialectical Behavior Therapy :Cognitive-Behavior Therapy – Dialectical Behavior Therapy Clients cycle twice through four skills training modules: (a) mindfulness (the ability to be aware of the moment, not to be distracted, and to be nonjudgmental); (b) emotional regulation (identifying emotions, appreciating the effects of emotions on oneself and others, learning to counteract negative emotional states and to engage in behavior that will increase positive emotions); (c) distress tolerance (learning to cope with stressful situations and to self-soothe); and (d) interpersonal effectiveness (learning to deal effectively with interpersonal conflict, to appropriately get one’s desires and needs met, and to appropriately say no to unwanted demands from others)


Strengths and Weaknesses :Strengths and Weaknesses Efficacy Efficiency Array of Empirically Supported Techniques Symptom Substitution Breadth of Application Scientist-Practitioner and Clinical Scientist Linking Practice to Science Dehumanizing? Inner Growth Nonspecific Problems Mental Processes Manipulation and Control Generalization Lack of Unifying Theory