: Use of experimentally-established principles of learning for the purpose of changing maladaptive behavior
Models of Behavior Therapy
:
Classical conditioning
(Pavlov) - The concept of learning through pairing of stimuli with reflexive responses (Stimulus association; Single-trial association) that give rise to systematic desensitization (expose patient to the feared situation) as an anxiety treatment paradigm.
Operant conditioning
(Skinner) - Skinner’s theory that behavior is a function of its consequences which forms the basis for environmental manipulation (i.e. the use of punishments/rewards) to produce behavioral change, or behavior modification (Extinction - "Time-out" when misbehaving; Intermittent schedule of reinforcement - random pattern of rewarding (giving candy bar at grocery store at random times results in child crying for the reward every visit))
Social Learning theory
(Bandura) - emphasizes role of modeling and cognitive process in behavior change (vicarious learning - learning from watching someone; i.e. one child watched a video of another kid punching "Bo-Bo the clown" and being rewarded for it, the observing child was later seen punching "Bo-Bo the clown")
Cognitive-Behavior therapy
(most current) - integration of behavior and thinking; posits that clinical disorders are the result of maladaptive, faulty thought patterns
Integration movement
- efforts to integrate the best aspects of behavioral and dynamic psychotherapeutic approaches
Insight/Psychodynamic vs Behavioral theory
-divergent at level of theory/technique; convergent at level of strategy
Maladaptive behavior is learned through same principles governing normal behavior
Commitment to applied science approach
Emphasis on role of maintaining variables
Behavior assessment
- emphasizing direct sampling of an individual’s response to various life situations
Empirical validation
- subjecting intervention strategies to scientific evaluation
Emphasis on ongoing re-assessment - the concept of intervention strategies as "data driven"
Use of single case experimental design - the experimental analysis of behavior at the individual level
Behavioral Strategies
Stimulus management
(derives from classical conditioning): principle of Reciprocal Inhibition (anxiety and relaxation cannot co-exist); Systematic Desensitization (no hierarchy used); Exposure Treatment (no hierarchy used); Modeling; Aversion (i.e. whenever Tim bites someone, he gets a squirt of lemon juice in his mouth; no longer used); Covert Sensitization (creating a covert stimulus within yourself)
Response management
(self regulation): Relaxation training (used to treat job related stress); Social skills training (used to treat schizophrenics); Assertiveness training (anxiety is a product of not getting what we want because we don’t know how to ask for them); Cognitive self-management (the way we perceive things matter)
Contingency management
Cognitive Theory
(Aaron Beck)
Definitions
:
Cognitive Triad
- beliefs about oneself, the world, the future drive how we feel (i.e. depression, example about his briefcase on top of his car)
Schema
- way of organizing and interpreting experiences
Principles of Cognitive-Behavioral System
- perception of reality is what counts, not what reality actually is
Cognitive Distortions
Arbitrary inference
- drawing a specific conclusion without sufficient evidence
Specific abstraction
- focus on a single detail while ignoring aspects of experiences
Overgeneralization
- forming conclusions based on too little information
Magnification, minimization
- over- or undervaluing the significance of an event
Personalization
- tendency to self-reference
Absolutist, dichotomous thinking
- all-or-none thinking
Cognitive-Behavioral Approaches to Therapy
Basic Cognitive and Behavioral Concepts
:
Learning Theory -
Behavior is learned and is a function of its consequences. Behavior that is rewarded tends to increase and behavior that is punished tends to decrease
Cognitive Theory -
thoughts (or cognitions) can have an important influence on people’s emotions and behaviors
Automatic thoughts
- the idiosyncratic, discrete thoughts that just seem to pop into one’s head (e.g. "I’m a loser")
Underlying assumptions
- one’s basic beliefs developed over the course of life experience (e.g. "I have to be competent at everything in order to be worthwhile")
Depression
:
Cognitive-behavioral theoryof depression
The cognitive triad
- a negative view of the self, experience, and future; cognitive triad is characteristic of depression
Activity level
- depressed people tend not to engage in those activities that were formerly rewarding to them
Downward spiral of depression
- dysfunctional thoughts, reduced activity level, and depressive affect tend to work together to accelerate a downward spiral
Cognitive-behavioral therapyof depression
Activity scheduling
- helping the patient to increase number of rewarding activities
Cognitive restructuring
- challenging dysfunctional automatic thoughts and underlying assumptions through verbal disputation and behavioral experiments
Anxiety Disorders
:
Cognitive-behavioral theoryof anxiety
Anxiety is related to one’s perception of risk or threat as compared to one’s perceived self-efficacy (belief in one’s ability to cope with the situation)
Avoidance can reduce anxiety at the moment but serves to maintain the perception of threat and the belief that one is incapable of handling the situation
Cognitive-behavioral therapyfor anxiety
Systematic desensitization
- gradual step-by-step exposure through imagery
Flooding and implosion
- exposure to the most anxiety-provoking situation
In vivo exposure
- exposure to the actual anxiety-provoking situation
Interoceptive exposure
- exposure to the internal sensations of anxiety and panic
Cognitive interventions
- challenging the belief in the level of threat and/or belief that one is unable to cope
Response prevention
- with obsessive-compulsive disorder, preventing the anxiety-reducing ritual