Behavioral and Cognitive-Behavioral Therapies

1. Behavioral and Cognitive-Behavioral Therapies

2. The Behavioral Approaches • Behavior, Learning, Social Context • People’s unique learning histories • Commonalities in rules, values, and learning histories • Principles of learning • Behavioral consistency vs. behavioral specificity

3. Three Main Versions • 1). Classical Conditioning • (Respondent Learning) • Joseph Wolpe, • Hans Eysenck • emphasize the association of conditioned and unconditioned stimuli

4. 2). Operant Conditioning • B.F. Skinner • Functional Analysis : focus on describing and explaining functional relationships among stimuli, responses, and consequences • 3). Social-Cognitive (Cognitive-Behavioral) Theories • a). Albert Bandura • Observational Learning • Self-Efficacy

5. ABC Functional Analysis • Antecedent • Event Behavior Consequence • organismic variable

6. b). Walter Mischel • Cognitive Social Learning Person Variables(Table 2.2, p.49) • Competencies, Encoding Strategies and Personal Construct, Expectancies, Subjective Value, Self-Regulatory Systems and Plans • c). Aron Beck • Cognitive Theory of Depression

7. d). Seligman et al. • Attribution (Habitual explanations) • Internality, Stability, Globalness • e). Albert Ellis • Rational-Emotive Behavioral Therapy (REBT) • Irrational Beliefs : “should” statement, unrealistically high standards

8. Behavior Therapy • May be regarded as the attempt to apply data from behavioral science research to the process of behavior change for remediation and treatment for individuals experiencing difficulty in coping with problems of living (Walker et al., 1981) • Learning-theory approach to therapy

9. Assumptions of behavioral approach • 1). Any behaviors are developing through the same law of learning • 2). Therapy methods should be guided by the results of research on learning • 3). Aimed at modifying overt, maladaptive behaviors, as well as the cognitions, physical changes, & emotions that accompany overt behavior

10. 4). Treatment should address client’s current problems by dealing with the contemporary environmental forces, learned habits, and cognitive factors that maintain them • 5). Commitment to the experimental evaluation of treatment • Learning-oriented, empirical, here and now

11. The beginnings of behavior therapy • The term behavior therapy first appeared in a paper (Lindsley, Skinner, & Solomon, 1953) • Groundwork 1920s • studying the role of conditioning and learning in development of anxiety • Ivan Pavlov experimental neuroses • J.B. Watson & Rosalie Rayner(1920) little Albert • Mary Cover Jones(1924)

12. What is behavior? • 1). Respondents: antecedent-controlled • somatic reflexes, emotional reaction, sensations • 2). Operants: consequence-controlled • actions, instrumental responses, cognition • a). Behavioral excesses, b). Behavioral deficits, • c). Behavioral anomalies, d). Behavioral assets

13. Martin & Pear • Behavior therapy Behavior modification • 1). Pavlovian-Hullian Skinnerian tradition • -Wolpean tradition • 2). Clinical Nonclinical • 3). Therapeutic setting Natural setting • 4). Experimental foundation Experimental foundation • based on clinical setting based on animal or human • operant research • 5). European tradition American tradition

14. Systematic Desensitization • Joseph Wolpe (1958) • Rationale : Reciprocal Inhibition • responses incompatible with anxiety • 1). deep muscle relaxation, 2). interpersonal assertion, 3). sexual arousal • combination of 1). counter-conditioning & 2). extinction

15. Procedures of SD • 1). Diagnosis evaluation • History Taking, Behavioral Inventory… • 2). Hierarchy construction • Anxiety hierarchy (table 7.2, p.247) • 3). Teaching anxiety-inhibiting responses • Progressive relaxation training(Jacobson, 1938) • 4). Conducting the therapy session • Imagery (imagination training) • In vivo

16. Exposure Techniques • Exposed to the most anxiety-provoking stimulus for an extended period of time • Rationale : Extinction • Implosion Therapy : Thomas Stampfl(1957) • use of hypothetical construction • Flooding : (Polin, 1959) • use to objective anxiety-related stimuli • Combine with Response Prevention

17. Social Skills Training • Social skill deficits • Assertiveness Training • appropriate expression of feeling in ways that do not infringe upon the rights of others • 1). Teach clients how to express themselves appropriately • 2). Eliminate cognitive obstacles to clear self-expression

18. Modeling • Observational Learning (Bandura, 1969) • 1). Attention process • 2). Retention process • 3). Motor production process • 4). Incentive & motivation process • Model Characteristic : similarity, high status, be rewarded for their actions • Participant Modeling

19. Aversion Therapy • A set of techniques in which painful or unpleasant stimuli are used to decrease the probability of unwanted behaviors • Rationale : • 1). Punishment • 2). Escape and Avoidance Conditioning • 3). Classical Conditioning • Debate problems

20. Contingency Management • Behavior modification procedures • Rationale : Status of Stimulus • present(+) removed(-) • Nature positive positiveindirect • of (+) reinforcementpunishment • Stimulus negative directnegative • (-) punishmentreinforcement

21. Reinforcer • Reinforcer vs. Punisher • Primary vs. Secondary Reinforcer • Social Reinforcer • Choice rules • 1). Personal values & needs • 2). Premack Principle • 3). Trial & error

22. Schedules of Reinforcement • Continuous reinforcement(CRF) • Intermittent reinforcement (Partial) • 1). Ratio schedule • a). Fixed ratio schedule(FR) • b). Variable ratio schedule(VR) • 2). Interval schedule • a). Fixed interval schedule(FI) • b). Fixed variable schedule(VI) • Extinction

23. Shaping • successive approximation • Time Out • a special sample of extinction • Contingency Contract • five components: 1). Responsibilities, 2). Rewards, 3). Monitoring system, 4). Bonuses, 5). Penalties for failure • Response Cost

24. Token Economies • A system for implementing the principles of contingency management to alter a variety of behaviors • Four elements • 1). Target behaviors • 2). Token system • 3). Back-up reinforcers • 4). Rules of exchange governing

25. Biofeedback • Behavioral methods used to control heart rate, blood pressure, muscle tension, & physiological responses are known as biofeedback • Monitor & feedback apparatus • meter reading, graph, or auditory signal • Used to treat several clinical disorders

26. Cognitive-Behavioral Therapy(CBT) • Cognitive therapy : directed toward changing clients’ maladaptive cognition • The behavioral and cognitive approaches have tended to merge, called CBT • 1). Beck’s Cognitive Therapy • approach to treatment of depression

27. 2). Rational Emotive behavior Therapy(REBT) • Albert Ellis • ABC Model • A B C • (Activating event) (Belief) (emotional consequence) • D (Dispute) • E F • (Effect) (new Feeling)

28. 3). Dialectical Behavior Therapy (DBT) • Marsha Linehan • Borderline Personality Disorder • helps the client confront any traumatic experiences • 4). Relapse Prevention • Alan Marlatt & Judith Gordon • Alcoholism & Substance Use Disorder • teach the client to monitor risky cognition and to replace them with different thinking strategies

29. 5). Cognitive Behavior Modification(CBM) • Meichenbaum, D. • Self-talk or Self-instruction • Coping-Skills Programs • Stress Inoculation Training (SIT) • a). Conceptualization Phase • b). Skill Acquisition & Rehearsal Phase • c). Application Phase