1
Q
What is the foundation for behavior therapy?
A
learning theory
2
Q
Core characteristics of BT
A
- Most abnormal bx is acquired maintained according to the same principles of learning which govern normal bx.
- Tx is derived from theory and experimental findings of scientific psychology, specific and replicable, tailored to diff people and situations.
- focus of therapy is on changing bx.
- bxs are seen as functional.
- BT is active, time-limited and emphasizes variables that maintain bx.
3
Q
methodological focus
A
techniques cannot be assumed to be valid
4
Q
focus of BT on changing bx
A
Increasing frequency of adaptive bx, decreasing frequency of maladaptive bx, enhancing flexibility of bx repertoire
5
Q
bx are seen as functional
A
Problem bxs are associated with some type of desired consequence, or are a result of learned association based upon experiences, modeling, or instruction
6
Q
BT is active
A
involve having client perform some action, monitoring thoughts, engage in a new activity
7
Q
BT emphasizes variables that maintain bx
A
Acknowledgement of past events in development of problem, but past hx is assumed to have a smaller role in maintenance over time
8
Q
belief of BT
A
the symptom is the problem and is a target for therapy (rejects medical notion that trouble bx is a symptom for an underlying disorder)
9
Q
3 major emphases in BT
A
approach based on classical conditioning, approach based on operant conditioning, approach based on use of cognitive explanations
10
Q
classical conditioning approach
A
- Wolpe
- use as a model to explain anxiety-related bx problems
- techniques such as systematic desensitization and assertiveness training
- use the term behavior therapist
11
Q
operant conditioning approach
A
- AKA behavior modification
- change the contingencies that control bx
- Skinner
- often called applied behavioral analysis
12
Q
cognitive explanations approach
A
- techniques for producing bx change
- Beck and Ellis
- techniques include cognitive restructuring, downward arrow, daily thought record
- sometimes called cognitive therapy
13
Q
counterconditioning
A
-classical conditioning approach
-Wolpe conditioned cats to fear a buzzer
attempt to identify bx that could be used to inhibit and counter condition anxiety
relaxation to inhibit anxiety became the basis of systematic desensitization, assertive responses to inhibit social anxiety became basis for assertiveness training, sexual arousal to inhibit anxiety became basis for sex therapy
14
Q
theory of psychopathology
A
anxiety is an important factor in most bx do, a pattern of responses of the sympathetic nervous system when exposed to a threatening stimulus, can be learned (through conditioning), considered a primary problem in psychopathology, can impair other aspects of bx and lead to secondary sx if it becomes a habitual response, can produce avoidant responses
15
Q
2 critical tasks in counterconditioning
A
- identify a response that is incompatible with anxiety and can be paired with stimuli that evoke anxiety.
- In treatment, begin with stimuli that are low on the anxiety hierarchy (stimuli that elicit a mild amount of anxiety) – “baby steps”.
16
Q
systematic desensitization
A
- Use of deep muscle relaxation as an incompatible response with anxiety.
- Construction of an anxiety hierarchy
- Desensitization Session
17
Q
deep muscle relaxation
A
- Wolpe – teaches clients to discriminate between tense and relaxed muscle
- Client contracts muscle group, focuses on sensation, then actively lets muscles relax
- Each muscle group is tensed and relaxed, usually beginning with the hands, arms, shoulders, face, neck, etc.
18
Q
anxiety hierarchy
A
- Rank stimuli from most to least anxiety arousing
- Hierarchy often constructed around a time or space dimension
- Typical hierarchy will have 10-20 stimulus scenes
- Scenes are typically realistic, concrete situations related to the client’s problems
19
Q
desensitization session
A
- Used relaxation exercises to become deeply relaxed
- Imagine first scene in hierarchy
- If anxiety is experienced, signal the therapist
- Instructed to stop imagining the scene and return to relaxing scene or previous scene
- May have to add new scenes to the hierarchy
- Once relaxed again, go back to stimulus scene again
- If anxiety not elicited, asked to imagine scene for 10 seconds.
- Repeat the scene before moving on to next scene in hierarchy.
- End session with a successful scene
- Can last about 15-30 minutes; most clients have trouble sustaining concentration for more than 30 minutes.
- When desensitization is completed, move to in vivo (real life) desensitization – approach feared stimuli in real life. Again, develop a hierarchy.
20
Q
exposure based strategies
A
repeated and systematic confrontation of feared stimuli; essential component for most anxiety disorders
21
Q
4 types of exposure
A
- in vivo
- imaginal
- interoceptive
- virtual reality exposure
22
Q
in vivo exposure
A
exposure to external situations and objects in real life; entering social situations to reduce anxiety of people
23
Q
imaginal exposure
A
- exposure in imagination to thoughts, memories, and other cognitive stimuli; -exposure to obsessional thoughts; exposure to feared traumatic memory
- useful for clients who are afraid of their own thoughts, images, or memories or clients who are unwilling/unable to do in vivo
24
Q
interoceptive exposure
A
- experiencing feared physical sensations; ex: breathe through a straw to induce breathlessness
- uses process of extinction
25
exposure based therapy guidelines
• Exposure seems to work best when:
• It’s predictable & under client's control (client knows what’s going to happen and can control intensity and duration)
• Sessions are prolonged
• Practices are not too spread out (sessions are close together)
-vary the stimulus across exposure practices (fear of bridge should be exposed to many bridges)
-conduct practices in multiple contexts (fear of spiders should be exposed in home, garden, office)
26
assertiveness training
Employed for anxiety related to interpersonal interactions
• Theoretically, assertive bx can inhibit anxiety about rejection/failure
• Counter condition anxiety by substituting assertive bx
• Improvement leads to reinforcement via reduction of anxiety and enhanced to social abilities
27
candidates for assertiveness training
* Passive or aggressive in interpersonal situations
| * Afraid to complain about poor service, to leave situations, to express differences of opinion, and inappropriate anger
28
assertiveness training techniques
* Covertly -- distinguish passive, assertive, and aggressive responses and imagine being more assertive in situations
* Overtly -- rehearse assertion through role-playing activities with therapist or group
29
operant conditioning model
aka contingency management, bx modification
Bx is largely controlled by its consequences
Abnormal bx can be explained by the same operant principles that account for other bx
Maladaptive bx is likely to increase if it’s followed by reinforcements; likely to decrease if followed by punishment or if unrewarded (extinction).
Some environmental stimuli set the occasion for the bx
Behavior modification attempts to systematically control contingencies to shape and maintain adaptive bx and to extinguish maladaptive bx; change the contingencies and the bx will change
30
discriminative stimuli (cues)
bx is determined by environmental cues that indicate whether a bx is likely to be rewarded or punished
31
behavioral/functional analysis
-behavioral activation
-Specify the stimulus situation that set the occasion for maladaptive bx (antecedents); i.e. What is the situation before/when the tantrums occur?
-Operationalizing the behavior itself
-Detailing the reinforcement contingencies that follow (consequences)
A-B-C sequence
32
reinforcement based strategies
Techniques to reinforce desired bx, thereby increasing their frequency
33
Differential reinforcement
reinforcing the absence of an unwanted bx (e.g. Tantrums) or reinforcing the occurrence of a desired alternative bx (e.g. Appropriate eye contact)
34
contingency management
type of differential reinforcement
1. Operationalize the target bx -- state the general problem in behavioral terms, including behaviors and situations in which they occur
2. Identify behavioral objectives -- in terms of target behaviors -- should they be increased, decreased, or reinforced only when emitted in more appropriate situation?
3. Develop behavioral measures and assess baseline activity -- used to determine if tx is effective
4. Modifying existing contingencies -- specify the conditions under which reinforcement will be give, what rewards will be, and who will administer them
5. Monitor results -- chart frequency of responses and compare to baseline, make changes as necessary, terminate treatment when objectives are met (ex. Token economies, level system at residential facilities)
35
psychoeducation
- discussion of bx model for problem being treated
- description of tx process
- not lecturing
- 2 way discussion btw therapist and client
- correcting misinformation the client has picked up
- suggest recommended readings
36
virtual reality exposure
- using 3D computer generated images projected on the inside of a head-mounted display worn in front of the eyes
- as effective as in vivo for certain phobias
37
response prevention
involves preventing bx that are designed to decrease anxiety, fear, or tension (compulsive hand washing) until the urge to perform these bx subsides
38
operant strategies
- discriminative stimuli
- contingency management
- positive/negative reinforcement
- positive/negative punishment
- extinction
39
positive reinforcement
giving a reward to increase a behavior
40
negative reinforcement
removing an aversive consequence (reduction in distress after escaping a feared situation)
41
positive punishment
receiving an aversive consequence (electric shock) following a bx
42
negative punishment
taking away something desirable following a bx (permission to use family car)
43
behavioral activation
- aimed at helping depressed clients increase their contact with positive reinforcers and decrease patterns of avoidance and inactivity
- focus on changing bx rather than altering mood
- targets avoidance bx and inactivity
- TRAP & TRAC (identify Triggers, Responses, and Avoidance Patterns then help generate Alternative Coping responses to the same triggers and responses)
44
social and communication skills training
- teaching individuals or groups to communicate more effectively
- learning basic skills
- learning complex skills
45
modeling
-demonstrating a particular bx in the presence of a client, usually before asking the client to perform the same bx
46
problem solving training
- aims to teach clients to solve problems effectively
- involves: 1. problem orientation (individual's appraisal of his awareness of problems that arise, as well as ability to solve problems)
2. problem solving skills (specific steps needed to solve problems) problem definition and formulation, generate possible solutions, select best solutions, implement solution and evaluate outcome
47
relaxation based strategies -- 3 components of applied relaxation for anxiety
1. early cue detection -- identify early environmental, cognitive, physiological and emotional cue for anxiety
2. intensive relaxation practice -- develop clients ability to relax through PMR
3. combo of first 2 skills so client can apply relaxation to his life
48
mindfulness and acceptance based strategies
- acceptance: tolerating, embracing, experiencing instead of avoiding, trying to escape or becoming aggressive towards stimulations
- mindfulness: nonjudgemental awareness, bringing one's attention to the present moment while distractions continue to arise and taking self out of the present moment
49
emotion regulation skills training
- help clients to develop skills to more effectively recognize, understand, and respond to their own emotions
- distinguish between primary and secondary emotional responses
Psychotherapy
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