Cognitive-Behavioral Interventions

Question 1

Cognitive-Behavioral Interventions

Answer 1

C-B Interventions:

1. assumes that cognition mediates emotional and behavioral dysfunction
2. some types of cognitions may be monitored and altered
3. dysfunctional emotions are behaviors change when relevant cognitions are modified
4. C-B Intervention for anxiety
   
   1. self-monitoring, self-control desensitization, anxiety management training, and cognitive restructuring.
5. C-B Intervention for childhood anxiety/fears
   
   1. coping self-statements, positive visual imagery, relaxation techniques, modeling, and positive reinforcement.

Question 2

Rational-Emotive Behavioral Therapy

REBT

Ellis

Answer 2

REBT Albert Ellis!

1. conceptualizes emotions and behaviors in terms of a chain of events A-B-C
2. A: external Activating event to which the individual is exposed
3. B: is the Belief that individual has about A (event).
4. C: emotion or behavior that results from B (belief) (consequence).
5. an emotional or behavioral response to an external event is due to beliefs about that event RATHER than to the event itself!
6. cause of Neurosis: continual repetition of certain common irrational beliefs such as the belief that it’s necessary to be loved by everyone or the belief that one should be thoroughly competent, intelligent, and achieveing in all aspects of life.
7. Irrational Beliefs: dogmatic demands (must’s/should’s), awfulizing, low frustration tolerance and negative evaluations of oneself and others.
8. irrational beliefs: result of of certain biological tendencies that include negativism, moodiness, and excitement-seeking and that interfere with the ability to think productively and rationally.
9. D: therapist’s attempt to Dispute and alter the irrational beliefs
10. E: alternative thoughts and beliefs that result from D (disputing). Evolving…
11. Therapists adopt an educational, confrontive, and persuasive approach and use teachniques such as modeling, behavior rehearsal, problem-solving, in vivo desensitization, rational-emotive imagery, and cognitive homework assignments.

Question 3

BECK

Cognitive Therapy (CT)

Answer 3

Cognitive Therapy (Beck): CBT: initially for depression, extended to anxiety, anorexia/bulimia, sx ds, substance abuse.

GOAL: help clients identify and alter dysfunctional and distorted assumptions.

1. Cognitive Schemas: underlying cognitive structures and rules that consist of core beliefs and that codify, categorize and interpret experiences.
   
   1. automatic thoughts and supported by cognitive distrotions.
   2. develop early in life as a result of biological, developmental and environmental factors.
   3. functional or dysfunctional, may be dormant until their activiated by internal or external stress (especially in situations similar to original stress).
   4. once activated, impair the ability to think ratuionally and predispose to depression and other dx.
2. Automatic Thoughts: surface level cognitions that intercede between an event or stimulus and the indivduals emotional and behavioral reactions.
   
   1. Not necessarily dysfunctional but can contribute to dysfunction when they’re the result of maladaptive schemas and frequent, persistent and not critically examined.
3. Cognitive Distortions: systematic errors or biases in information processing and are the link between maladaptive cognitive schemas and negative automatic thoughts. Problematic when they are pervasive and are not critically examined.
   
   1. arbitrary inference: drawing conclusions w/o corroborative evidence.
   2. overgeneralization: drawing general conclusions on the basis of a single event.
   3. selective abstraction: attending to detail while ignoring the total context.
   4. personalization: erroneously atrributing external events to oneself.
   5. dichotomous thinking: polarized either/or way of thinking
   6. emotional reasoning: believing things are a certain way because one feels they are that way.
4. Cognitive Profile: each psychological disorder is characterized by a different cognitive profile.
   
   1. Depression: cognitive triad of negative view of oneself, the world, and the future.
   2. Anxiety: reflects an excessive form of normal survival mechanisms and consists of unrealistic fears about physical and psychological threats.

Question 4

Cognitive Therapy

Charactistics and Strategy

Answer 4

CT is distringuished from other CBT by:

1. Collaborative Empiricism: developing a collaboration between therapist-client and gathering evidence to test hypotheses about the client’s beliefs and assumptions.
2. Time-Limited treatment with ave length of therapy being 15 sessions, each one structured and goal-oriented.
3. Goals:
   
   1. est. rapport/trust
   2. socializing client to CT
   3. educating the client about their disorder, cognitive model, and therapy process
   4. normalizing the client’s expectations about therapy
   5. collecting info about clients problems.
   6. developing goal list.
4. Historical material may be addressed to clarify core beliefs, but emphasis is on current experiences
5. Assumes relevant cognitions become accessible and modifiable only with affect arousal.
   
   1. use of imagery and other techniques to elicit affect.
6. Socratic Dialogue: questioning is primary therapeutic tool.
   
   1. Guided Discovery: asking questions that are designed to help the client reach logical conclusions about a problem and its consequences.
7. Relapse Prevention: focus throughout treatment.

Strategies:

• Behavioral Strategies: activity scheduling, behavior rehearsal, social skills training and relaxation.
• Cognitive Strategies: downward arrow (if so, then what), questioing the evidence, decatastrophizing, mental imagery, and cognitive rehearsal.
• HW, daily record of dysfunctional thoughts journal,

Question 5

Other Cognitive Restructuring Techniques

–Self-Instructional Training

–Thought Stopping

—Attribution Retraining

Answer 5

Self-Instructional Training:

1. Meichenbaum and Goodman: (SIT): developed to help impulsive and hyperactive children perform academic and other tasks by teaching them to interpolate adaptive, self-controlling thoughts between a stimulus situation and their response to that situation.
2. True Voluntary behavior does not occur until there is a shift from external to internal language control (vygotsky/luria) and Bandura’s observational learning
   
   1. Cognitive Modeling: the client observes a model perform the task while the model makes self-statements aloud. Questions about the task, answers to the questions, specific instructions on how to do the task, and self-reinforcement.
   2. Cognitive Participant Modeling: client performs that task as the model verbalizes the instructions.
   3. Overt Self-Instruction: The client performs the talsk while instructing himself aloud.
   4. Fading Overt Self-Instruction: client whispers the instructions while carrying out the task.
   5. Covert Self-Instruction: Client performs the task while saying the instructions covertly.

Question 6

—Thought Stopping

—Attribution Retraining

Answer 6

Thought Stopping

• eliminating obsessive ruminations, self-criticism, depressive or anxiety-arousing ideas, and other unwanted or unproductive thoughts by using such as covertly yelling ‘stop, stop, stop’ or snapping a rubber band placed around the wrist to snap.
• combined with ‘covert assertion’: involves making alternative assertive self-statements following thought stopping.

Attribution Retraining

• altering the individual’s perceptions of the causes of his problematic behavior.
• used to treat depression/anxiety/alcoholism/improve academic performance.
• is consistent with the assumptions of the reformulated learned helplessness model and with the optimistic explanatory style (learned optimism).
• GOAL: help clients attribute their failures to external, unstable, and specific factors and successes to internal, stable and global factors (usually this is reversed = depression)

Question 7

Coping and Problem-Solving Techniques

—stress inoculation

–problem-solving therapy

Answer 7

Stress Inoculation (Meichenbaum/Jaremko)

to help people deal with stress by increasing their coping skills.

three phases to treatment

1. Cognitive Preparation Phase/Conceptualization Phase: is primarily educational and helps cluent understand his behavior and cognitive processes to stressful situations.
2. Skill Acquisition and Rehearsal Phase: learn and rehearse a variety of coping skills.
   
   1. direct-action techniques (relaxation, pleasant imagery, arranging escape routes)
   2. cognitive techniques: replacing negative self-statements with coping self-statements
3. Final Application and Follow-through Phase: client applies the coping skills he has acquired to imagined, filmed, and in vivo stress-producing situations.

Question 8

Problem Solving Therapy

(coping/problem solving techniques)

Answer 8

Problem Solving Therapy (PST)

D’Zurilla and Goldfried:

• Problem solving outcomes are determined primarily by
  
  • Problem Orientation: relatively stable cognitive schemas that can be either positive or negative and that represent the person’s views about problems and his ability to successfully solve them.
  • Problem-Solving Style: activities that individual engages in when solving problems
• Distinguishes between rational, impulsive/careless, and avoidance styles.
  
  • Rational style: only one that likely to result in adaptive problem solutions.
  • relies on 5 skills:
    
    • recognizing the problem (problem orientation),
    • defining the problem,
    • generating alternative solutions,
    • choosing the best solution, and
    • implementing and evaluating the chosen solution.
  • Psychoeducation, guided discussion, role-playing, and HW help clients adopt a positive problem-solving orientation and rational problem-solving style.

Question 9

Rehm’s Self-Control Therapy

Answer 9

Rehm’s Self-Control Therapy

• brief therapy, usually group
• assumes that deficits in three aspects of self-control increase a person’s vulnerability to depression and make it difficult to deal with depressive symptoms.
  
  • Self-Monitoring: Depressed people selectively attend to negative events and to the immediate (not delayed) consequences of their behavior.
  • Self-Evaluation: Depressed people make inaccurate internal attributions and compare their bx to standards that are excessively rigid and perfectionistic.
  • Self-Reinforcement: Depressed individual engage in low rates of self-reward and high rates of self-punishment.
• monitor negative self-statements and positive outcomes, set realistic goals, make appropriate attributions for behavior, reinforce self with positive self-statements and activities for working towards and achieving goals.

Question 10

Lewinsohn’s Behavioral Model

Answer 10

Lewinsohn’s Behavioral Model

• attributes depression to a low rate of response-contingent reinforcement due to inadequate reinforcing stimuli in the environment,
• and/or the individual’s lack of skill in obtaining reinforcement
• I.E…i try to interact with a family member or co-worker are not reinforced, those behaviors extinguish.
• A low rate of response-contingent reinforcement eliminates/reduces certain behaviors AND
  
  • elicits pessimism, low self-esteem, and other features that are associated with depression.

Treatment:

• initially Lewinsohn emphasized reactivating depressed patients by increasing their activity levels and access to reinforcing events but subsequently….
• incorporated cognitive techniques similar to those developed by Beck.
• renewed interest in recent years in behavioral activation approaches for depression that utilize behavioral strategies only!

Question 11

Self-Managment Procedures

1. self-monitoring
2. stimulus control
3. biofeedback

Answer 11

Self-Managment Procedures

emphasize the client’s responsibility for modifying his own behavior

1. Self-Monitoring: Client records information about the frequency and conditions surrounding the target behavior.
   
   1. provides info/data on magniture and nature of the bx so an appropriate treatment strategy can be developed and effects of the treatment can be evaluated.
   2. very powerful assessment tool to promote bx change.
2. Stimulus Control: when the performance of the behavior is contingent on the presence of certain stimuli.
   
   1. Smoking: controlled by coffee, friends, alone, etc…
   2. alter the associations between stimuli and the behavior and/or its consequences
      
      1. Narrowing: restricting the target behavior to a limited set of stimuli (eating only at mealtime)
      2. Cue Strengthening: link behavior to specific environmental conditions (studying only in den w/no TV)
      3. Fading: changing the stimulus conditions associated with the behavior (replacing fetish object with more appropriate sex stimuli).
3. Biofeedback: involves having client learn to modify behavior and is based on operant conditioning.
   
   1. targets physiological response that is considered involuntary such as heart rate, skin temp, brain wave activity, or blood glucose level.
   2. connected to EMG or EEG or anything that can immediately and continuously provide performance feedback about the target behavior…visual or auditory signal.
   3. EMG for tension headaches: training the person to relax the frontalis muscle in the forehead…which shows up in the EMG!

Question 12

biofeedback cont…

Answer 12

Evaluation of Biofeedback:

• relaxation training was found to be as effective as biofeedback for tension headaches, hypertension, GAD, insomnia, and lower back pain
• Biofeedback treatment of choice for: Raynaud’s disease (thermal skin-temp biofeedback) or decreased blood supply in the fingers and toes.
• pelvic muscle EMG biofeedback is used to treat certain types of urinary and fecal incontinence
• Migrain Headaches: thermal biofeedback and autogenic training (relaxation tech) has been found to be the best approach.