Chapter 13: Cognitive-Behavioral Interventions March 6, 2006

Cognitive-Behavioral Therapy (CBT) Can be used to treat specific disorders or more broad issues e.g., bulimia, anxiety, poor study habits

Anxiety-Reduction Methods “Perhaps your performance anxiety wouldn’t be so bad if you performed better”

Systematic Desensitization Wolpe relaxation training hierarchy of fears step by step progression up hierarchy of fears

Graduated Real-Life Practice Meyer a.k.a. successive approximation, graded practice step by step progression along hierarchy, facing stimuli without relaxation

Both systematic desensitization and graduated real-life practice are based on the principle of...

Stimulus Generalization If you extinguish anxiety by exposing the client to a stimulus that resembles the phobic stimulus, but is less intense, then eventually anxiety will extinguish when the phobic stimulus is present

Imaginal Flooding Formerly implosive therapy (but now doesn’t include psychodynamic material) Imagine the most feared stimulus to invoke intense anxiety and continue until anxiety decreases

Exposure in Vivo Marks Real-life exposure to the feared stimulus Evoking stimulus (ES) = the feared situation Evoked response (ER) = the behaviour that the ES initiates

Operant Learning Techniques “I think I should warn you that the flip side of our generous bonus-incentive program is capital punishment.”

Reinforcement Strengthen or maintain a behaviour Positive –delivery of something –immediate small more effective than delayed large Negative –removal of something aversive

Shaping A.k.a. successive approximation Break learning into small steps Reinforce small steps that get closer and closer to the desired behaviour

Punishment decrease or stop behaviours response-contingent aversive stimulation (RCAS) –responseaversive stimulus

Punishment Response cost –responseremoval of appetitive stimulus

Effect on Behaviour Stimulus is Presented Stimulus is Withdrawn Behaviour Increases Behaviour Decreases Positive Reinforcement Negative Reinforcement Punishment RCAS Punishment Response Cost Scheduled Consequence of the Response

Extinction Disconnecting a reinforcement contingency

Schedules of Reinforcement Continuous –every response is reinforced –rapid extinction Variable Ratio –some responses reinforced in an unpredictable pattern –delayed extinction

Rule-governed behaviour –rules, laws –affect how a behaviour is performed Contingency- shaped behaviour –response rates, likelihood behavior will be performed What Controls Behaviour?

The application of operant learning principles to treat problem behaviors Used to help many types of problems with good success rate Applied Behaviour Analysis

The ABCs Must identify the contingency that is operating and maintaining the problem behaviour A: antecedent events B: behaviour C: consequences

Class Activity Quickly try to think of a behaviour in your life that you would like to change. Discuss the ABCs with someone near you.

Other Applications toilet training outbursts somatoform disorders schizophrenia –stimulus satiation= responses typically weaken when the reinforcing stimulus is made too abundant

Token Economies Used with groups (e.g., psychiatric or rehab facilities) give out tokens that can later be exchanged for tangible rewards or privileges A form of secondary reinforcement

Types of Reinforcers Secondary reinforcers: are not inherently reinforcing, but through association,one learns that they are reinforcing –e.g., money, grades, smiling Primary reinforcers: are inherently reinforcing –e.g., food, sex

Social Skills Training instruction modeling behaviour rehearsal praise prompts coaching feedback reinforcement homework assignments

Social Skills Training Generally, best for those who are in the community or are likely to be discharged key is a combination of modeling with role-playing aimed at specific skills (e.g., expressing feelings, starting a conversation)

Rehearsal Desensitization used when social anxiety is also present incorporates systematic desensitization elements move through hierarchy from low anxiety to high anxiety items

Problem-Solving Therapy Siegel & Spivack Training exercises dealing with problem identification, goal definition, solution evaluation, evaluation of alternatives, and selection of the best solution e.g., identifying emotions in others, perspective taking

Cognitive Modification Procedures “ My back is fine. My mind went out”

Self-Instructional Training Meichenbaum Teaching patients to use self-guiding speech

Stress-Inoculation Training Educational phase: learn that unhelpful thinking patterns produce and maintain unpleasant emotions and dysfunctional behviours Rehearsal phase: patient makes coping self- statements to help deal with stressful events Application phase: practice using coping skills while confronting actual stressors

Constructive Narrative clients viewed as “storytellers and makers of meaning” clients can reframe stressful events, “normalize” their experience, develop a “healing theory” of what happened, and build new “assumptive worlds” and ways to view themselves

Rational-Emotive Behavior Therapy Ellis “enable people to observe, understand, and persistently dispute irrational, grandiose, perfectionist shoulds, oughts and musts”

ABCs A: activating event B: beliefs C: consequence (emotional) most believe A causes C goal is to accept that B is very important in causing C rational vs irrational beliefs

ABC and D D: disrupting irrational beliefs challenge unrealistic and damaging beliefs e.g., “Why is it terrible if things do not go your way?”

Cognitive Therapy Beck challenge irrational beliefs and encourage client to attempt real life experiments to challenge faulty assumptions 3 fundamental concepts

1. The Cognitive Triad Depressed people have pessimistic thoughts about their: –self –world –future

2. Cognitive Schemas Global, absolute beliefs are activated during depressive episodes, and lie dormant between episodes established early in life

3. Cognitive Distortions Specific exaggerations of the negative aspects of a situation

Do certain thinking patterns correlate with certain mood states?

The Situational Self-Statement and Affective State Inventory “Imagine that you had studied really hard for your midterm and expected to get an A. However, when the marks came back, your mark was a C”

What feelings would you likely experience? A) Depression B) Disappointment C) Anger What thoughts would likely cross your mind? A) “I should drop out of school” B) “It was an unfair exam” C) “I wish I had done better”

Cognitive Restructuring Lazarus multimodal therapy model –BASIC ID behavior affect sensation imagery cognition interpersonal relations drugs/diet

Cognitive Restructuring Corrective self-talk point out errors in form and content thinking ignorance/misinformation

Coping and Problem Solving Goldfried general problem solving strategies and coping skills 4 areas of focus –problem solving –relaxation –cognitive restructuring –communication skills

Key Names Beck Lazarus Meichebaum Ellis Goldfried Wolpe Meyer

Summary- Key Concepts Anxiety Reduction Methods –systematic desensitization, graduated real-life practice, imaginal flooding, exposure in vivo Operant Learning Techniques –reinforcement, punishment,applied behavior analysis, token economies, social skills training, problem solving Cognitive Modification Procedures – self-instructional training, stress-inoculation training, rational-emotive behavior therapy, cognitive therapy, coping and problem solving

Thanks!!