1. Behavior Therapy

2. 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

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Cognitive Behavior Therapy

16. “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)

17. 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.

18. 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.

19. 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.

20. 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

21. 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

22. 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

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

24. 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)

25. 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

26. 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

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

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

29. 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

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

31. 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

32. 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