Chapter 13: Cognitive-Behavioral Interventions

1. Chapter 13: Cognitive-Behavioral Interventions March 6, 2006

2. Cognitive-Behavioral Therapy (CBT) • Can be used to treat specific disorders or more broad issues • e.g., bulimia, anxiety, poor study habits

3. Anxiety-Reduction Methods “Perhaps your performance anxiety wouldn’t be so bad if you performed better”

4. Systematic Desensitization • Wolpe • relaxation training • hierarchy of fears • step by step progression up hierarchy of fears

5. Graduated Real-Life Practice • Meyer • a.k.a. successive approximation, graded practice • step by step progression along hierarchy, facing stimuli without relaxation

6. Both systematic desensitization and graduated real-life practice are based on the principle of...

7. Stimulus Generalization • If you extinguish anxiety by exposing the client to a stimulus that resembles the phobic stimulus, but is less intense, then eventually anxiety will extinguish when the phobic stimulus is present

8. Imaginal Flooding • Formerly implosive therapy (but now doesn’t include psychodynamic material) • Imagine the most feared stimulus to invoke intense anxiety and continue until anxiety decreases

9. Exposure in Vivo • Marks • Real-life exposure to the feared stimulus • Evoking stimulus (ES) = the feared situation • Evoked response (ER) = the behaviour that the ES initiates

10. Operant Learning Techniques “I think I should warn you that the flip side of our generous bonus-incentive program is capital punishment.”

11. Reinforcement • Strengthen or maintain a behaviour • Positive • delivery of something • immediate small more effective than delayed large • Negative • removal of something aversive

12. Shaping • A.k.a. successive approximation • Break learning into small steps • Reinforce small steps that get closer and closer to the desired behaviour

13. Punishment • decrease or stop behaviours • response-contingent aversive stimulation (RCAS) • response aversive stimulus

14. Punishment • Response cost • response removal of appetitive stimulus

15. Effect on Behaviour Behaviour Increases Behaviour Decreases Stimulus is Presented Positive Reinforcement Punishment RCAS Scheduled Consequence of the Response Punishment Response Cost Negative Reinforcement Stimulus isWithdrawn

16. Extinction • Disconnecting a reinforcement contingency

17. Schedules of Reinforcement • Continuous • every response is reinforced • rapid extinction • Variable Ratio • some responses reinforced in an unpredictable pattern • delayed extinction

18. Rule-governed behaviour rules, laws affect how a behaviour is performed Contingency-shaped behaviour response rates, likelihood behavior will be performed What Controls Behaviour?

19. Applied Behaviour Analysis • The application of operant learning principles to treat problem behaviors • Used to help many types of problems with good success rate

20. The ABCs • Must identify the contingency that is operating and maintaining the problem behaviour • A: antecedent events • B: behaviour • C: consequences

21. Class Activity Quickly try to think of a behaviour in your life that you would like to change. Discuss the ABCs with someone near you.

22. Other Applications • toilet training • outbursts • somatoform disorders • schizophrenia • stimulus satiation= responses typically weaken when the reinforcing stimulus is made too abundant

23. Token Economies • Used with groups (e.g., psychiatric or rehab facilities) • give out tokens that can later be exchanged for tangible rewards or privileges • A form of secondary reinforcement

24. Types of Reinforcers • Secondary reinforcers: are not inherently reinforcing, but through association,one learns that they are reinforcing • e.g., money, grades, smiling • Primary reinforcers: are inherently reinforcing • e.g., food, sex

25. Social Skills Training • instruction • modeling • behaviour rehearsal • praise • prompts • coaching • feedback • reinforcement • homework assignments

26. Social Skills Training • Generally, best for those who are in the community or are likely to be discharged • key is a combination of modeling with role-playing aimed at specific skills (e.g., expressing feelings, starting a conversation)

27. Rehearsal Desensitization • used when social anxiety is also present • incorporates systematic desensitization elements • move through hierarchy from low anxiety to high anxiety items

28. Problem-Solving Therapy • Siegel & Spivack • Training exercises dealing with problem identification, goal definition, solution evaluation, evaluation of alternatives, and selection of the best solution • e.g., identifying emotions in others, perspective taking

29. Cognitive Modification Procedures “My back is fine. My mind went out”

30. Self-Instructional Training • Meichenbaum • Teaching patients to use self-guiding speech

31. Stress-Inoculation Training • Educational phase: learn that unhelpful thinking patterns produce and maintain unpleasant emotions and dysfunctional behviours • Rehearsal phase: patient makes coping self-statements to help deal with stressful events • Application phase: practice using coping skills while confronting actual stressors

32. Constructive Narrative • clients viewed as “storytellers and makers of meaning” • clients can reframe stressful events, “normalize” their experience, develop a “healing theory” of what happened, and build new “assumptive worlds” and ways to view themselves

33. Rational-Emotive Behavior Therapy • Ellis • “enable people to observe, understand, and persistently dispute irrational, grandiose, perfectionist shoulds, oughts and musts”

34. ABCs • A: activating event • B: beliefs • C: consequence (emotional) • most believe A causes C • goal is to accept that B is very important in causing C • rational vs irrational beliefs

35. ABC and D • D: disrupting irrational beliefs • challenge unrealistic and damaging beliefs • e.g., “Why is it terrible if things do not go your way?”

36. Cognitive Therapy • Beck • challenge irrational beliefs • and encourage client to attempt real life experiments to challenge faulty assumptions • 3 fundamental concepts

37. 1. The Cognitive Triad • Depressed people have pessimistic thoughts about their: • self • world • future

38. 2. Cognitive Schemas • Global, absolute beliefs • are activated during depressive episodes, and lie dormant between episodes • established early in life

39. 3. Cognitive Distortions • Specific exaggerations of the negative aspects of a situation

40. Do certain thinking patterns correlate with certain mood states?

41. The Situational Self-Statement and Affective State Inventory • “Imagine that you had studied really hard for your midterm and expected to get an A. However, when the marks came back, your mark was a C”

42. What feelings would you likely experience? A) Depression B) Disappointment C) Anger What thoughts would likely cross your mind? A) “I should drop out of school” B) “It was an unfair exam” C) “I wish I had done better”

43. Cognitive Restructuring • Lazarus • multimodal therapy model • BASIC ID • behavior • affect • sensation • imagery • cognition • interpersonal relations • drugs/diet

44. Cognitive Restructuring • Corrective self-talk • point out errors in form and content thinking • ignorance/misinformation

45. Coping and Problem Solving • Goldfried • general problem solving strategies and coping skills • 4 areas of focus • problem solving • relaxation • cognitive restructuring • communication skills

46. Key Names • Beck • Lazarus • Meichebaum • Ellis • Goldfried • Wolpe • Meyer

47. Summary- Key Concepts • Anxiety Reduction Methods • systematic desensitization, graduated real-life practice, imaginal flooding, exposure in vivo • Operant Learning Techniques • reinforcement, punishment,applied behavior analysis, token economies, social skills training, problem solving • Cognitive Modification Procedures • self-instructional training, stress-inoculation training, rational-emotive behavior therapy, cognitive therapy, coping and problem solving

48. Thanks!!