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Overview
• CBT began in the 1970’s
• used to treat various psychological disorders
• umbrella term for various therapeutic approaches that emphasise cognitive, behavioural and environmental factors in relation to psychological disorders
• At least 10 different schools- differ with degree to which they view environment as a determinant of thinking, action and emotion
- Goal = realistic and accurate thinking
- Modification of these schemas can bring lasting therapeutic change
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Behavioral view on Abnormality
- Individuals showing problematic behaviours = deviant or abnormal
- maladaptive schemas- leads to behavioural and emotional disorders
- Neurochemical imbalances
- within behavioural therapy internal causes are largely avoided
- context where the behaviour occurs is still important
- Cultural norms say what is abnormal
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Behavioural Interventions Within CBT: Description and Application
• Psychological problems from a behavioural perspective are defined by behaviour, occurring both within the individual (covert- eg thoughts)
- And as actions that can be observed by others (overt)
• Functional relationships between the behaviour of the person and the environment that establishes the context of such behaviour plays a role
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Skinner´s three-term contingency
Basic unit of analysis within some forms of behavioural therapy
- The occasion within which the behaviour occurs (antecedent) eg person or event whether a person will engage in a behaviour also depends on learning the history for the behaviour under similar conditions and reinforcement
- The behaviour
- The consequences that follow behaviour: the effect that produces, reinforces behaviour
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A focus on why people act as they do
Functionalism:
Darwinian term where the physical structure of a species is determined by associated function
Environmental determinism: Behaviour produced by an individual varies and some units of behaviour are selected because they showed to be more successful that other units
Contextualism:
how events and behaviours are organised and linked together in meaningful ways
- also called contextual flow
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Following features are assessed and evaluated
- The antecedents of behaviour
- The consequences of behavior
- The client’s learning history as it relates to the current problematic behavior
- The client’s current behavioral repertoire
- Overt behaviors
- Thoughts
- Emotions
- Physiological sensations or responses
- The client’s motivation for change
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General characteristics of behavioural interventions
- An empirical orientation
- Therapist client collab
- An active orientation
- A flexible approach
- An emphasis on environmental-behaviour relations
- Time-limited and present focus
- A problem and learning focus
- An emphasis on both change and acceptance processes
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Do behavioural interventions within CBT work?
- Anxiety and depressive disorders: cognitive and beh elements within CBT are equally effective
- cognitive interventions do not necessarily add to the effectiveness of behavioural interventions
- Exposure techniques the best
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Basic Theories of Learning
• Pavlov or Bechterev studied classical or respondent conditioning during the late 1800’s
- Basic idea is to yield a reflexive, innate response
UCS: unconditioned stimulus
CS: Conditioned stimulus
UCR: Unconditioned Response
UR: unconditioned response
CR: conditioned response
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Basic Theories of Learning
• Generalisation
• Extinction
• trauma- conditioned response can be acquired to a neutral stimulus
• Edward Thorndike’s law of effect = learning process and associated behaviours are influenced by the consequences that follow behaviour
• B.F. Skinner = Theory of Instrumental Behaviour, operant theory of behaviour
- Operant = unit of behaviour that operates on the environment by producing consequences
- Behaviour is shaped by consequences over the course of a lifetime
- Behaviours forms of ontogenetic and phylogenetic selection
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Overview
- Behavioural assessment: approach for assessing persons, what they do, and the circumstances under which they are most likely to engage in behaviour of interest
- Assessment approach: guided by theoretical principle
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Goals of Behavioural Treatment
Primary emphasis = whole person + behaviour
- Clarification of the client’s problem
- Evaluation of impairment of clients functioning
- Identification of factors that support/maintain beh
- Development of formulation of client’s problems
- Evaluation of effectiveness of treatment strategy
Level of analysis in behavioural assessment = context of person, each person has unique environment and unique genetic endowment
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Initial Assessment
-Presenting problem of complaint
-Assessment of Responses Classes on the Basis of correlated or descriptive feature
• Topographical classifications of these are primarily concerned with how people behave and classified according to forms of behaviour they exhibit
Diagnostic assessment
• Questionnaire assessment
• Checking and rating scales
Identification of behavioural repertoire and skills deficit
• Categorise problematic behavioiurs with one or two braod categories
1. Behavioural excess: when a person displays particular forms of behavior that are excessive in terms of frequency, intensity or duration
2. Behavioral deficits: are apparent when persons do not demonstrate an adequate range of behavior in a variety contexts
Evaluating coping behaviour
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Evaluating Impairments in functioning
- Degree and pervasiveness of impairment -> severity
- Risk and safety- potential harm?
- Personal functioning: compare currently functioning with the past functioning
- Family and social relations
- Occupational and school functioning
- Legal and difficulties or proceeding: more likely with person history of substance abuse, bipolar disorder, and antisocial behaviors
- Current life situation and QoL
- Suicidal risk and other risk areas
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Antecedents of behaviour
- Discriminative Stimuli: events that provide information about the likelihood that reinforcement or punishment will follow the engagement in some types of behavior
- Establishing operations: are sometimes referred as motivational operations that set the occasion for certain behaviors
- influence of the environmental events or conditions have on behavior by changing the reinforcing or punishing properties of environmental events, internal events such as thoughts, emotional states are common Eos for some behaviors
- EOs are rules that influence behavior
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The consequences of behaviour
Factors that increase or maintain behaviors
• Positive reinforcement = behavior results in the application of a reinforcing event which increases the probability of the behavior in the future similar situations
• Negative reinforcement = behavior results in the removal or termination of an aversive event or condition which increases the probability of the behavior in the future similar situations - both maintain behavior excesses
Factors that decrease or extinguish behavior
x Positive punishment = behavior results in the application of an aversive event or condition which decreases the probability of the behavior in future similar situations.
x Negative punishment = heavier results in the removal or termination of reinforcing event or condition which decreases the probability of the behavior in future similar situations
Extinction =
behavior is reliably performed without being followed by reinforcing consequences.
If a behavior does not produce intended effects or reinforcing consequences then it will simply “drop out” and no longer be displayed over time
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Person Variables (organismic variables)
and learning history
- Biological characteristics: genetic predisposition, temperament
- Learning history: influence that a lifetime of environmental learning has on one’s behaviour
Ch2 Functional response class assessment
• These are groups of behaviours that produce the same or similar outcomes even through different forms
- Eg = phobic behavior, dissociation, self-harm and substance abuse are different forms of behavior but have similar underlying function = avoidance
• powerful ST negative reinforcing properties, but v harmful LT associated outcomes
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Examples of other behavioural assessment methods
Self-monitoring
Direct Observations
• Person other than client monitor the frequency of the target behaviours, contextual features associated with target behaviour
• Therapist can also do this by entering clients natural environment (ABC recordings)
• Also, role playing
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Functional analysis:
Clarifying the context and purpose of behaviour
A functional understanding of behavior =
isolate the conditions under which the behavior is most likely to occur and identify the consequences that function to maintain over time
- Antecedents of beh
- Consequences of beh
- Person Var and Learning history
- Functional response class assessment
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Case formulation
- identification of problem areas
- generation of hypotheses about factors that develop and maintain them
- Ability to account for areas on the problem list
- Abilityto predict relevant behaviour
- Clients reaction to formulation
- Effectiveness of the intervention
Behavioral case formulations = emphasize operant and classical conditioning and social learning principles
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Narrowing down the client’s problem areas
- Broadly surveying possible problem areas
- Transition from broad survey to focal assessment
- Useful to consider nomothetic principles (Kant described as tendency to use general principles) as a guideline for formulationclient problems
- Finally, the assessment is performed post-treatment to evaluate the effects of therapy.
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Assumptions associated with behavioral formulations
- In behavioral assessment the primary level of analysis is the whole person in interaction with his or her environment
- Behavior (overt and covert) and context are analyzed as a unit - The focus of behavioral interventions = current situational determinants of behavior.
- Difference between etiology and the maintenance of a disorder -> Factors responsible for the development must not be relevant in maintenance
- Problematic behavior = indicates the absence of alternative and more effective behaviors in the patient´s behavioral repertoire
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A model case formulation by Pearson
- The problem lists
- Situational determinants of behavior (antecedent, consequences)
- Questionnaires, clinical interviews, and on-going self-monitoring
- Verbal rules(If, then)
- Self-efficacy expectations
- Outcome expectations: persons estimate of a given result - Hypothesised origins
- Working hypothesis
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1 Intro33
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2 Exposure42
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Cl Conditioning and Exposure16
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4 Parent training35
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5 PTSD and EMDR28
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6 Cog Interventions21
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7 Psychosis24
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8 Beh interventions and Eating dis27
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9 Beh activation/actvity scheduling27
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10 Cog interventions: beh exp21
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11 Schema focused therapies37
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12 3.Wave (Mindfulness, MBCT, ACT)0
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13 Critical CBT0
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14 3.Wave Pt.20
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Slimstampen0
