1. Behavior and Cognitive Behavior Therapy
Chapter 14
Behavior and Cognitive Behavior Therapy

2. Origins of the Behavioral Approach
Definition
Clinical work that aligns itself with the study of human behavior
Highly diversified field
Scientific emphasis
De-emphasis of inferred variables

3. Origins of the Behavioral Approach
Classical conditioning
Learning theory
Systemic desensitization
Operant tradition

4. Origins of the Behavioral Approach

5. Treatments Based on Counterconditioning
Behavioral techniques utilizing counterconditioning pair a maladaptive behavior with an incompatible behavior in order to eliminate the former.
reciprocal inhibition - if a response antagonistic to anxiety can be made to occur in the presence of anxiety-evoking stimuli so that it is accompanied by a complete or partial suppression of the anxiety responses, the bond between these stimuli and the anxiety response will be weakened.

6. Joseph Wolpe

7. Treatments Based on Counterconditioning
Systematic Desensitization: involves pairing relaxation with hierarchically-arranged anxiety-evoking events

8. Systematic Desensitization: -
There are four stages to the systematic desensitization process:
Relaxation Training
Constructing the Anxiety Hierarchy: consists of events related to the target behavior that are ordered on the basis of the amount of anxiety they evoke.
Subjective Units of Distress Scale (SUDS)
Desensitization in Imagination:
In Vivo Desensitization

9. Systematic Desensitization
Rationale
Counterconditioning: the substitution of relaxation for anxiety
Extinction of behaviors: when the patient repeatedly visualizes anxiety-generating situations but without ensuing bad experiences, the anxiety responses are eventually extinguished
Habituation
Positive reinforcement

10. Assertiveness Training:
Assertiveness training is based on the assumption that assertive behaviors are incompatible with anxiety and, therefore, can be used to eliminate maladaptive anxiety reactions.
behavior rehearsal entails constructing a hierarchy of items that each describe an anxiety -arousing social interaction

11. Aversion Therapy -
procedures applied to behaviors regarded as undesirable
Aversive counterconditioning - pairs the target behavior or a stimulus associated with it (CS) with a stimulus (US) that naturally evokes an unpleasant response.

12. Aversion Therapy -
In Vivo Aversion Therapy: involves pairing the target behavior with an aversive stimulus such as electric shock, noxious odor, or emetic (nausea-inducing) drug.
Covert Sensitization: client imagines (rather than actually confronts) an aversive condition while simultaneously imagining that he or she is engaging in the maladaptive behavior

13. Treatments Based on Classical Extinction/ Exposure Therapies
Flooding/ Exposure - the client is exposed to a high anxiety-arousing stimulus for a prolonged period of time (usually 30 to 60 minutes).
exposure with response prevention - patient is exposed to the anxiety provoking stimuli and is prevented from engaging in the behavior/ compulsion that relieves the anxiety
Interoceptive exposure - patient exposes themselves to interoceptive cues - internal physiological stimuli

14. Exposure Therapy Requirements Long durations Repetition to extinction
Graduated process
Interaction with stimuli
Exposure must provoke anxiety

15. Rules of Behavior Therapy using Operant Conditioning
Punishment does not work well
Temporarily suppresses behavior
Reinforcement does not have to be pleasant or pleasurable
Short term consequences trump long term
Reinforcement can use a variable schedule, punishment cannot
Have to do an assessment, everyone has to be onboard, communicate the rules

16. Contingency Management -
control behavior by manipulating the consequences
Shaping involves reinforcing successive approximations to the desired behavior
Premack Principle: a high probability behavior is used to reinforce a low probability behavior in order to increase the frequency of the low probability behavior.

17. Contingency Management -
Differential Reinforcement for Alternative Behaviors (DRA): all behaviors except the target behavior are positively reinforced
Time-Out From Reinforcement: - undesirable behavior is extinguished by removing a person temporarily from a situation in which the behavior is reinforced

18. Contingency Management -
Contingency Contracts:- is a formal written agreement that clearly defines the behaviors that are to be modified and the consequences (rewards and punishments) that will follow performance of those behaviors.
The Token Economy: desirable behaviors increased by reinforcing them with tokens that can be exchanged for desired items, activities, and other back-up reinforcers, and undesirable behaviors are decreased by withholding or removing tokens following those behaviors.

19. Punishment Overcorrection - 2 procedures
restitution - overcorrect any negative effects of behavior
positive practice - practice more appropriate behaviors usually in an exaggerated fashion
Response Cost: - a specific positive reinforcer is removed each time the behavior is performed

20. Punishment Immediacy Consistency
Reinforcement for alternative behaviors

21. Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy (CBT)
Modify thought patterns
Empirically supported
Social learning theory
Sense of self efficacy
Active process

22. Cognitive-Behavioral Therapy
Modeling
Best and most efficient when
Subject attends to model
Patient retains the information provided by model
Patient performs modeled behavior
Motivation to use behavior

23. Cognitive-Behavioral Therapy
Rational restructuring
Relabeling of situations, more realistically
Modification of the internal “self-talk”
Rational Emotive Therapy (RET)
Beliefs (B)
Activating events (A)
Consequences (C)
Therapist as a teacher; correct “illogical” thinking

24. Rational-Emotive Therapy - Albert Ellis
In rational-emotive therapy, two more events -- D and E -- are added to the ABC chain:
D is the therapist*s attempt to alter the individuals irrational beliefs,
E is the alternative thoughts and beliefs that result from D.

25. Beck*s Cognitive Therapy -
Schemas are underlying cognitive structures, or patterns of assumptions, thoughts, and beliefs that determine how individuals codify, categorize. and interpret their experiences

26. Beck*s Cognitive Therapy -
Common cognitive distortions (errors in logic) include the following:
Overgeneralization: Drawing general conclusions on the basis of one event.
Selective Abstraction: Attending to detail while ignoring the total context.
Personalization: Erroneously attributing external events to oneself.
Polarized Thinking: Thinking in a black-or-white fashion.

27. Beck*s Cognitive Therapy -
cognitive profile.
collaborative empiricism:- approach founded on a collaborative relationship between the therapist and client and involves gathering evidence and testing hypotheses about the client*s beliefs and assumptions.

28. Beck*s Cognitive Therapy -
Cognitive strategies include
“Daily Record of Dysfunctional Thoughts,” which helps the client and therapist identify the irrational automatic thoughts that underlie the client*s undesirable emotions and behaviors.
when identify irrational automatic thoughts and cognitive distortions help patient change
guided discovery - using Socratic method to help challenge

29. Cognitive-Behavioral Therapy
Dialectical Behavior Therapy (DBT)
Used primarily with Borderline Personality Disorder (BPD)
Four skills training modules
Mindfulness – to be aware of the moment, focused, nonjudgmental
Emotional regulation – identifying and dealing with emotions
Distress tolerance – learning to cope with stress
Interpersonal effectiveness – how to deal with conflict, get needs met, say no to unwanted demands