Behavior Therapy

Behavior Therapy A set of clinical procedures relying on experimental findings of psychological research Based on principles of learning that are systematically applied Treatment goals are specific and measurable Focusing on the client’s current problems To help people change maladaptive to adaptive behaviors The therapy is largely educational - teaching clients skills of self-management

Four Aspects of Behavior Therapy 1. Classical Conditioning In classical conditioning certain respondent behaviors, such as knee jerks and salivation, are elicited from a passive organism 2. Operant Conditioning Focuses on actions that operate on the environment to produce consequences If the environmental change brought about by the behavior is reinforcing, the chances are strengthened that the behavior will occur again. If the environmental changes produce no reinforcement, the chances are lessened that the behavior will recur

Four Aspects of Behavior Therapy 3. Social Learning Approach Gives prominence to the reciprocal interactions between an individual’s behavior and the environment 4. Cognitive Behavior Therapy Emphasizes cognitive processes and private events (such as client’s self-talk) as mediators of behavior change

Humans Learn Through Association Classical conditioning Behaviors learned through association with natural reflexes Temporal-spatial association of one stimulus with another A stimulus naturally capable of producing a certain response is associated in time or space with another Eventually second stimulus elicits virtually the same response Undesirable responses modified by breaking the association

Techniques Based on Classical Conditioning Principles Counterconditioning Systematic desensitization Imaginal flooding In vivo desensitization Biofeedback

Systematic desensitization: A close up Relaxation training Progressive muscle relaxation Awareness of tension in each muscle group Awareness of relaxation in each muscle group Pairing relaxation with Counting Relaxing voice tone Relaxing without tensing Focus on cognition, too

Systematic desensitization: A close up Construction of a stimulus hierarchy Temporal relationships Spatial relationships Use of SUDS Use of real and imagined scenarios Presentation of the hierarchy Beginning with least threatening Proceeds at client’s pace Number of trials In vivo trials Sound ethical judgment; agency policies Client must be ready; proceeds at client’s pace

Humans Learn Through Direct Experience Operant conditioning Behaviors are learned or maintained through experience with rewarding, punishing, relief-giving consequences of behavior Reinforcement Continuous Intermittent Extinction Punishment Avoidance learning Shaping Undesirable responses modified by changing consequences

Techniques Based on Operant Conditioning Principles Contingency Management Assessing antecedents, behaviors, and consequences of problem behaviors Behavior modification Shaping (for acquisition of new behaviors) Reinforcing (ensuring a stable response rate) Extinguishing (eliminating or reducing a problem behavior) Token economies

Humans Learn Through Other’s Experience Vicarious learning Behavior is learned or maintained by observing behavior of others and/or outcomes that the actions produce Undesirable responses modified by observing different others; different outcomes

Techniques Based on Vicarious Learning Principles Modeling, rehearsal, & psycho-educational instruction Modeling as a technique Live modeling Symbolic modeling Role-playing Participant modeling Covert modeling Assertiveness training Social skills training Stress inoculation Self-instructional training

Research Abundant outcome research Children and adults Testing Validation Experimental processes How, how often, and under what circumstances each technique works Children and adults Simple and complex behaviors Social behaviors Programs designed to help clients acquire, change, eliminate behaviors only limited by ethics and creativity

Critique PROS CONS Individualized treatment Proven efficacy in treating many problems Based on scientifically, treatments are data-driven CONS Minute behavioral focus may limit complexity Treating the problem behavior, rather than whole person Ethics and politics of who decides what behaviors are maladaptive Individual environments v social environments treated for dysfunction

Cognitive Behavior Therapy

“Big” Names associated with Cognitive Behavioral Therapy Epictetus, Greek philosopher. Observed that people are not disturbed by things that happen but by the view they take of things that happen. Albert Ellis, Ph.D. “grandfather of cognitive behavioral therapy.” Aaron Beck, MD, a psychiatrist (University of Pennsylvania)

Characteristics of Cognitive-Behavioral Therapies: Thoughts cause Feelings and Behaviors. Brief and Time-Limited. Average # of sessions = 16 VS psychoanalysis = several years 3. Emphasis placed on current behavior.

4. CBT is a collaborative effort between the therapist and the client. Client role - define goals, express concerns, learn & implement learning Therapist role - help client define goals, listen, teach, encourage. 5. Teaches the benefit of remaining calm or at least neutral when faced with difficult situations. (If you are upset by your problems, you now have 2 problems: 1) the problem, and 2) your upsetness.

6. Based on "rational thought." - Fact not assumptions. 7. CBT is structured and directive. Based on notion that maladaptive behaviors are the result of skill deficits. 8. Based on assumption that most emotional and behavioral reactions are learned.  Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting. 9. Homework is a central feature of CBT.

Rational Emotive Behavioral Therapy (REBT) Stresses thinking, judging, deciding, analyzing, and doing Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship Is highly didactic, very directive, and concerned as much with thinking as with feeling Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations

The Therapeutic Process Therapy is seen as an educational process Clients learn: To identify and dispute irrational beliefs that are maintained by self-indoctrination To replace ineffective ways of thinking with effective and rational cognitions To stop absolutistic thinking, blaming, and repeating false beliefs

View of Human Nature We are born with a potential for both rational and irrational thinking We have the biological and cultural tendency to think crookedly and to needlessly disturb ourselves We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk We have the capacity to change our cognitive, emotive, and behavioral processes

A →B → C ABC’s of REBT A = Activating Event B = Beliefs, Thoughts, Attitudes, Assumptions C = Consequences, Feelings, Emotions, Behaviors, Actions

The Self-Defeating Rules (Irrational Beliefs) Ellis suggested that a small number of core beliefs underlie most unhelpful emotions and behaviours. Core beliefs are underlying rules that guide how people react to the events and circumstances in their lives. Here is a sample list of such of these: 1. I need love and approval from those around to me. 2. I must avoid disapproval from any source. 3. To be worthwhile as a person I must achieve success at whatever I do. 4. I can not allow myself to make mistakes. 5. People should always do the right thing. When they behave obnoxiously, unfairlyor selfishly, they must be blamed and punished. 6. Things must be the way I want them to be. 7. My unhappiness is caused by things that are outside my control – so there is nothing I can do to feel any better. 8. I must worry about things that could be dangerous, unpleasant or frightening – otherwise they might happen. 9. I must avoid life’s difficulties, unpleasantness, and responsibilities. 10. Everyone needs to depend on someone stronger than themselves. 11. Events in my past are the cause of my problems – and they continue to influence my feelings and behaviours now. 12. I should become upset when other people have problems, and feel unhappy when they’re sad. 13, I shouldn’t have to feel discomfort and pain. 14, Every problem should have an ideal solution. The Self-Defeating Rules (Irrational Beliefs)

Aaron Beck’s Cognitive Therapy (CT) Insight-focused therapy Emphasizes changing negative thoughts and maladaptive beliefs Theoretical Assumptions People’s internal communication is accessible to introspection Clients’ beliefs have highly personal meanings These meanings can be discovered by the client rather than being taught or interpreted by the therapist

Theory, Goals & Principles of CT Basic theory: To understand the nature of an emotional episode or disturbance it is essential to focus on the cognitive content of an individual’s reaction to the upsetting event or stream of thoughts Goals: To change the way clients think by using their automatic thoughts to reach the core schemata and begin to introduce the idea of schema restructuring Principles: Automatic thoughts: personalized notions that are triggered by particular stimuli that lead to emotional responses

Depression and Negative Schemas Always present Unconscious Become activated with stressful events

Example Person with negative schema involving rejection will become depressed when a partner leaves him or her

Beck’s Cognitive Therapy: First Sessions Identify and changing maladaptive thoughts First sessions: therapist explains cognitive theory of emotional disorders (negative cognitions contribute to distress) Middle Sessions: Client is taught to identify, evaluate and replace negative automatic thoughts were more positive cognitions Therapist is a collaborator (fellow scientists in therapy) Final Sessions: solidify gains, focus on prevention of recurrence

CT’s Cognitive Distortions Arbitrary inferences Selective abstraction Overgeneralization Magnification and minimization Personalization Labeling and mislabeling Polarized thinking

CT’s Cognitive Triad Pattern that triggers depression: 1. Client holds negative view of themselves 2. Selective abstraction: Client has tendency to interpret experiences in a negative manner 3. Client has a gloomy vision and projections about the future

Constructivist Narrative Perspective (CNP) Focuses on the stories people tell about themselves and others about significant events in their lives Therapeutic task: Help clients appreciate how they construct their realities and how they author their own stories