Individual and group approaches to treatment Individual Approaches: Cognitive Therapy Behavior Therapy Group Approaches:

Basic Assumptions Faulty or Irrational thinking causes abnormal behaviour. Human behaviour is heavily influenced by schemata  Many of these schemata relate to how we see ourselves (I am confident and self-assertive, I am good at relationships) Schemata develop as a result of early experience  Traumatic or unhappy experiences early in life may lead to faulty assumptions about the self. Negative schemata, or core beliefs, when activated can lead to negative automatic thoughts (or NATs). These are considered to be maladaptive and dysfunctional. An organized pattern of thought or behaviour Schemata

Cognitive Triad (Beck 1967) Negative view of the self I am incompetent and undeserving Negative view of the future Negative view of the world it is a hostile place problems will not disappear, there will always be emotional pain

Cognitive Triad (Beck 1967) Aaron Beck’s (1979) model of depression involved three negative schemata: Negative view of the self ( I am incompetent and undeserving) Negative view of the world ( it is a hostile place) Negative view of the future (problems will not disappear. I will always be useless.) These negative schemata can be seen in the attributions depressed people make i.e. their explanations of why things happen. Attributions can be internal or external. ( ‘It’s all my fault’ or ‘the whole world is against me’) Attributions can be specific or global (to one particular event or to all events) Attributions can be stable or unstable (may change depending on the situation or stay the same in all situations)

Irrational thinking (Ellis 1962) Stimulu s ThinkingFeelingsBehaviourOutcome ThinkingFeelingsBehaviourOutcome Maladaptive response Adaptive response ‘I can’t sit exams’Fear of failureLeave college Psychological problems, e.g. depression ‘I must try harder’Determination Work harder Success Fail mock exam According to Ellis when we think rationally, we behave rationally = happy, competent and effective Irrational thinking often leads people to be comfortable with disturbing thoughts

Irrational ways of thinking  Polarized thinking – seeing everything in black and white  Overgeneralization – generalizing the outcome of a single event to all future events  Tyranny of ‘should’, ‘ought’ and ‘must’  I ought to be good for my parents  David should be nice to me  I must be loved by everyone  Catastrophizing – making a mountain out of a molehill

CBT – Cognitive Behavioural Therapy  Aim : encouraging people to analyse their thought patterns and replace irrational thinking with a more positive/adaptive thought pattern  Procedures : o Cognitive – Leading the client to become aware of beliefs that contribute to anxiety or depression (ABC model) o Behavioural – client and therapist decide together on a belief to be reality-tested (through role-play or homework assignment) A: Activating event B: Beliefs (about A) C: Consequences (of B)

Evaluation  Use Crane to take a minute and evaluate the approach (make notes) using the ideas below to guide you. This should act as a supplement to what you’ve read in Pearson. Approach/Understanding (p ) Treatments: - Depression (p176) - PTSD (p178,179) - Bulimia (p )

The Behavioural Model  Main assumptions:  Abnormal behavior is the consequence of abnormal learning from the environment  There is no qualitative difference between normal and abnormal behavior – they are learned in the same ways: A.Classical conditioning: Learning through association B.Operant conditioning: Learning through consequences C.Social learning: Learning through observation

Classical Conditioning  Learning by association :  When two environmental changes (stimuli) occur together, we learn to associate them  The response to one may transfer to the other  E.g. Pavlov (1901) taught dogs to salivate when they heard a bell Click for an example Author: Pavlov

Operant Conditioning  Learning by consequences  Organisms operate on their environments  The likelihood of them repeating any given behaviour depends on its consequences  Reinforcement – more likely to repeat  Punishment – less likely to repeat Click for an example Author: Skinner

Social Learning  Learning by observation  People observe the behaviour of other people (models)  They may imitate the behaviour they observe  Whether or not they do so depends on the observed consequences:  Vicarious reinforcement  Vicarious punishment Author: Bandura

Behaviour Therapy  Systematic desensitisation  Flooding  Aversion Therapy

Aim of therapies  Behaviour therapy seeks to remove the conditioned association between fear and the situation/object. Therapies based on CC: Systematic desensitization Aversion Flooding Therapies based on OC: Token economy

Systematic desensitization  Aims to replace the fear response of a phobia for a relaxation response  This is done by having the patient form a hierarchy of fear (from least fearful to most fearful) – fear ladder  The patient works his way down each step and practicing his/her relaxation techniques  Eventually this removes the fear response and replaces it with a relaxation response

Systematic desensitization  For example: phobia of dogs – fear ladder  Step 1: Look at pictures of dogs.  Step 2: Watch a video with dogs in it.  Step 3: Look at a dog through a window.  Step 4: Stand across the street from a dog on a leash.  Step 5: Stand 10 feet away from a dog on a leash.  Step 6: Stand 5 feet away from a dog on a leash.  Step 7: Stand beside a dog on a leash.  Step 8: Pet a small dog that someone is holding.  Step 9: Pet a larger dog on a leash.  Step 10: Pet a larger dog off leash

Systematic desensitization Imagines anxiety situation starting with small anxiety Two incompatible emotional states cannot exist at the same time. Client systematically works through levels When client is desensitized- able to work through anxiety In vivo = imagined, in vitro = real life. Between therapy sessions clients advised to place themselves in progressively more anxiety provoking situations in vitro. Start with muscle relaxation techniques RELAXATION HIERARCHY OF ANXIETY PROKOVKING SITUATIONS (FEAR LADDER) RECIPROCAL INHIBITION COMPLETE TREATMENT IN VIVO AND IN VITRO Key Concepts

Aversion Therapy The patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. Used with smoking an alcoholism.  E.g. An alcoholic drink may be given which is laced with an emetic (which will make you sick). After a few pairings the person will wish to avoid the taste!

Flooding  Aim is to remove the association between stimulus and response.  Assumes high levels of anxiety cannot be maintained.  A person who is scared of spiders may be locked in a room with spiders.

Token economy (behaviour modification)  Tokens are given when a desired behaviour is performed  Tokens can later be exchanged for good privileges This is often used with autistic children or other people with learning disabilities.

Summary/Application  Use the two approaches (biological and individual) to explain & treat this abnormal behaviour: Shenesse is suffering from bipolarism, she has extreme mood swings that are unexpected and irregular. Biological Individual

Group Therapy  A group of clients meeting with one or more therapists.  It is intended to give a platform for those who struggle to begin the healing process. Allowing access to others makes the abnormality seem normal (as in many cases it actually is…remember our definition?)  Advantages :  cheaper  allows the client/patient relationship to become less over-reliant  allows opportunities to develop skills in a safe context (Role-play scenarios for example)

More on group therapy  Disadvantages:  Lacks confidentiality  Each group/group dynamics are different  Research is very vague and inconclusive in this area  Group treatments tend to work in scenarios where there are two admitted parties at play (i.e. depression in conjunction with divorce counseling)  Group treatments tend to be more effective in relation to eating disorders than in the other two categories discussed. This could be due to the above relationship with defining abnormality and the action based relationship to the disorder category.