1. Introduction to Behaviorism & Cognitive Behavior Therapies Anne Farrell, Ph.D. New York Medical College

2. Introduction and goals  Background  Knowledge and experience  Goals –Familiarize participants with tenets of behaviorism and basis for cognitive behavior therapies –Background and interrelationships –Common adult and pediatric applications –References and resources

3. Behavior Therapy  Commonly used to treat –anxiety, mood, eating disorders, parasuicidality –impulse, anger control disorders, disruptive behavior –sexual dysfunction, substance abuse –behavioral medicine and compliance  Two models of conditioning –Classical (Pavlovian) conditioning model –Operant (Skinnerian) conditioning model

4. Classical conditioning  “Pavlovian” conditioning model –unconditioned reflexes (UCR) salivation, eye blink –Contingency: pair with neutral stimulus (UCS) bell, tone, bang, ash –Conditioning (CS) Previously neutral stimulus becomes conditioned stimulus –Conditioned response (CR) Reflex now occurs in response to CS  Common examples?

8. Classical conditioning  Relation to specific disorders –Post-traumatic stress –Specific phobias (Little Albert) Panic disorder with agoraphobia  Related principles –Contingency, extinction, generalization, discrimination –Schedules of reinforcement and resistance  Background –First applied as BT by Wolpe, Lazarus

9.  Skinnerian conditioning (“B-mod”)  consequences of a behavior change future probability of occurrence  key influence –association between response and consequences  Thorndike’s Law of Effect –positive outcomes strengthen behaviors –negative outcomes weaken them Operant Conditioning

10. Positive reinforcement  Probability of response  when it is followed by a rewarding stimulus  examples Negative reinforcement  Probability of response  when it is followed by removal of an unpleasant stimulus  examples Punishment  frequency of response  due to consequence Operant Conditioning (Skinner)

11. Operant Conditioning Principles  timing –learning is more efficient under immediate rather than delayed circumstances  shaping –reward successive approximations of desired behavior  primary reinforcement –reinforcer is innately satisfying  secondary reinforcement –reinforcer acquires its value through experience

12. Schedules of Reinforcement  Continuous reinforcement –response is reinforced every time it occurs.  Partial reinforcement –a response is reinforced only part of the time.  Schedules: rules for partial reinforcement –fixed ratio: after set # target responses –variable ratio * : after average (unpredictable) # of responses –fixed interval: after a fixed amount of time –variable interval: after an unpredictable amount of time

13. Resistance to extinction

14. Operant Conditioning extinction  a response is not reinforced and it decreases spontaneous recovery  occurs in operant conditioning (and CC) discrimination  learning to repeat only reinforced responses generalization  giving the learned response to similar stimuli Applied behavioral analysis (ABA):  operant conditioning principles to change behavior

15. BT and disorders  Assumptions about etiology?  Anxiety disorders –Acquired – classical conditioning –Maintained – operant conditioning  Role of avoidance –Highly reinforcing  Manualized treatments –Barlow: panic disorder, GAD Stress innoculation, panic induction, biological challenge –Foa: OCD, PTSD Exposure with response prevention Relaxation strategies and retelling –Frequently combined with meds, cog therapies

16. Basics of CBTs  Assessment and intervention  Empirical support for practice  Characteristics of treatment –Active, structured, focused –Past v. present v. future –Brief therapies –Change is achieved by Altering connections between troublesome situations and habitual reactions to them Challenging and changing distorted beliefs and thoughts that relate to dysfunction

17. Applications  Operant conditioning –Applied behavior analysis (ABA) Single case designs Children with autism, challenging behavior –Educational interventions Functional behavioral assessment (FBA) and behavior intervention plans (BIP) –Mandated under IDEA –Generic parenting strategies Reinforcement and punishment  ABCs –Antecedent – behavior - consequence

18. Single case design (ABA)

19. Cognitive therapies  Emerge from behavioral models –Use BT techniques –Assume interrelationship among cognition, affect, behavior  Beck, Ellis, Young  Situation, thoughts, feelings, behavior  Common elements: –Ellis (RET): core irrational ideas –Beck (CT): maladaptive beliefs –Young: Early maladaptive schemas

20. CBT techniques  Relaxation and imagery  Self monitoring (mood monitoring, impulse control, self-mutilation)  Exposure  Response prevention  Flooding  Behavioral rehearsal  Thought stopping  Coping statements  Cognitive disputation

21. Outcomes  Empirical support evidenced via –Single case design (A-B-A-B) –Controlled studies Comparison to no treatment, wait-list, placebo- controls; comparison to other therapies and combinations of therapies –Meta-analyses Group differences expressed in sds

22. Resources  Association for the Advancement of Behavior Therapy (AABT.org)  American Institute for Cognitive Therapy (AICT.com)  Ellis Institute, Beck Institute  National Institutes of Mental Health – –Web site – Facts about…