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Cognitive-Behavioral Therapies: An Overview (Chapter 13) PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph

Cognitive-Behavioral Therapies: An Overview (Chapter 13) PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph.D. November 12, 2009. Announcements. Next response paper due December 1 Final exam: Tuesday, December 8 at 10:15. Announcements. Remaining schedule: Today: CBT overview

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Cognitive-Behavioral Therapies: An Overview (Chapter 13) PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph

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  1. Cognitive-Behavioral Therapies: An Overview(Chapter 13)PSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.November 12, 2009

  2. Announcements • Next response paper due December 1 • Final exam: Tuesday, December 8 at 10:15

  3. Announcements • Remaining schedule: • Today: CBT overview • 11/17: CBT for anxiety • 11/19: NO CLASS (Dr. Deacon at conference) • 11/24: CBT for depression • 11/26: NO CLASS (Thanksgiving) • 12/1: Eye Movement Desensitization and Reprocessing (EMDR) critique • 12/3: Prescription privileges for psychologists

  4. In the News • Fort Hood mass murderer NidalMalikHasan was a psychiatrist who counseled veterans with PTSD • The concept of “vicarious PTSD”

  5. From Last Class • Client-centered therapy: philosophy and practice • Carl Rogers psychotherapy video clips and discussion

  6. Cognitive-Behavioral Therapy • Encompasses variety of therapies • Behavior modification techniques • Cognitive modification techniques • Combinations of these • Gradual evolution toward emphasis on cognitive factors (AABT  ABCT)

  7. Characteristics of CBT • Brief and time-limited (M = 16 sessions) • A good therapeutic relationship is important, but not the focus (i.e., necessary but not sufficient) • Rooted in science and philosophy • Direct relationship between psychopathological processes and treatment strategies • Emphasis on outcome research

  8. Characteristics of CBT • From ABCT website: http://www.abct.org/dPublic/?m=mPublic&fa=WhatIsCBTpublic • The therapist and client work together with a mutual understanding that the therapist has theoretical and technical expertise, but the client is the expert on him- or herself. • The therapist seeks to help the client discover that he/she is powerful and capable of choosing positive thoughts and behaviors. • Treatment is often short-term. Clients actively participate in treatment in and out of session. Homework assignments often are included in therapy. The skills that are taught in these therapies require practice. • Treatment is goal-oriented to resolve present-day problems. Therapy involves working step-by-step to achieve goals. • The therapist and client develop goals for therapy together, and track progress toward goals throughout the course of treatment.

  9. Behavior Therapy • Based on behavioral principles of learning and behavior change • Classical conditioning • Operant conditioning • Vicarious conditioning • Direct relationship between learning principles that caused the problem and those used to treat it

  10. Basic Operant Techniques • Reinforcement – strengthening desirable behavior • Positive reinforcement – rewarding positive behavior with a desirable stimulus • Negative reinforcement – removing undesirable stimulus (e.g., nagging, seat belt buzzer)

  11. Basic Operant Techniques • Punishment – decreasing undesirable behavior • Positive punishment (aka “response-contingent aversive stimulation”) • Response cost • Ignoring

  12. Operant Techniques: Examples • Everyday examples • Potty training • Learning to tie shoes • Teaching pets how to do tricks

  13. Conditioning and Behavior Problems • Little Johnny refuses to eat his dinner at the table, hits his little brother during playtime, screams at his mother when he does not get his way, gets out of bed dozens of times during the night, and generally just does whatever he wants regardless of his parents’ wishes. Unable to tolerate Johnny’s escalating behavior when he becomes upset, his parents seldom deliver any actual discipline, instead letting him have his way if it means a little peace and quiet.

  14. Conditioning and Behavior Problems • How might you use behavioral methods to improve Johnny’s behavior?

  15. Conditioning and Behavior Problems • Ed is severely depressed. He is on disability leave from work and spends most of the day either lying in bed or sitting on the sofa watching TV. His mood has not improved for months and he worries that he will never feel better again.

  16. Conditioning and Behavior Problems • How might you use behavioral methods to extinguish Ed’s depression?

  17. Applying the Behavioral Model • Token economy • Social skills training • Shaping/successive approximations • Time out • Modeling for phobias • Aversion therapy (alcohol, nail biting, self-injurious behavior) • A Clockwork Orange

  18. Cognitive Modification Procedures • Rational Emotive Behavior Therapy (REBT) • Developed by Albert Ellis in 1950s • Basic idea: we are not disturbed by events, but by how we view them

  19. REBT • The REBT philosophy: • Preference vs. demand is the dividing line between emotional health and disturbance • Dissatisfaction is different from and does not lead to disturbance • Feelings are not externally caused • Irrational beliefs cause unhealthy emotions

  20. REBT • Healthy vs. unhealthy emotions • Sadness vs. depression • Annoyance vs. anger • Apprehension vs. fear • Regret vs. shame

  21. Typical Way of Thinking A → C Activating Consequence Event (Emotion)

  22. REBT Model A → B → C Activating Belief Consequence Event (Emotion)

  23. REBT Model A → B → C Fail an exam “I am stupid. I’ll never graduate. Despair I should just drop out.” Fail an exam “This stinks, but it’s not the end of the Disappointment world. I’ll study harder next time.”

  24. REBT • Clients usually present with problems with C • They usually blame A for their problems • REBT focuses on B • Dispute irrational Bs and replace with rational Bs

  25. Cognitive Therapy • Developed by Aaron Beck in 1950s • Similarities with REBT • Cognitive schemas – global, absolute beliefs • Cognitive distortions – in-situation errors in thinking • All or nothing thinking • Mind reading

  26. Cognitive Therapy • Disputing inaccurate thoughts • 1. Identify the specific, inaccurate thought • 2. Examine the evidence for alternative possibilities • 3. Replace it with a more realistic thought

  27. Integrating Cognitive and Behavioral Strategies • How can we combine cognitive and behavioral strategies so we can best modify a problem? • Behavioral experiments – testing the accuracy of negative beliefs in the real-world

  28. Behavioral Experiments • Devise an experiment to test the following beliefs: • The embarrassment of appearing foolish will be intolerable: http://www.youtube.com/watch?v=oFdkjj8oR6Q • I won’t have anything to say if I talk to other people • I will run out of air if I stay in an enclosed space for too long • If I don’t check the stove the house will burn down • Nobody is interested in talking to me • I can’t do anything right • I am crazy for having these weird obsessions • I will pass out if I hyperventilate for too long

  29. REBT • Video of Albert Ellis with Gloria • Pay attention to A-B-C model, identifying, and disputing beliefs • What’s it like to be a patient in REBT? • What’s it like to be a therapist in REBT?

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