Chapter 2 and 4 - introduction and cognitive-behavioral approach

The Individual

Ivan Pavlov

Founding father of behaviour therapy. Classical conditioning.

Cognitive-behavioral therapy

Randomized clinical/controlled trials (RCT)

Classical conditioning

Pavlov. Dogs start to salivate when hearing the bell, as they think food is coming. The dog learns that every time the bell rings, food is coming.

Contingency

Predictability and strength of the association (classical conditioning). How likely is the dog to start salivating when hearing the bell?

Little Albert

Watson. Little Albert was conditioned to fear a white rat by pairing it with loud noises.

Operant (instrumental) conditioning

Skinner.

Skinner box

Rat in box (handle/light) + push handle → food

Schedules of reinforcement

When and how often reinforcement is delivered after the behavior. The types are fixed ratio, variable ratio, fixed interval, and variable interval schedules.

Shaping

Reinforce successive approximations of the target behavior until it is achieved.

Extinction

The reinforcing stimulus does not appear after a response; therefore, the response decreases over time.

Spontaneous recovery

Discriminative stimulus

Respondent behaviors

Involuntary and reflexive nature

Behaviorism

Interested in why people behave in certain ways. Stimulus → black box → response.

John Watson

Founding father of behaviour therapy.

Burrhus Skinner

Founding father of behaviour therapy. Operant conditioning.

Model learning

Bandura

Reinforcement

(+) Adding something positive, or (-) removing something negative

Punishment

(-) Removing something positive, or (+) adding something negative

Social learning theory

Modeling or observational learning. The role of observation and imitation in learning.

Social learning theory: attention

The behavior must be captivating and worth imitating.

Social learning theory: retention

Observers must store the behavior in their mind, just noticing is not enough, it must be remembered.

Social learning theory: motor reproduction

Ability to perform the behavior that we observe.

Social learning theory: incentives/motivation

Observers analyze the rewards and punishments of the behavior.

Reciprocal determinism

Cognitive therapy

Aaron Beck

Cognitive distortion

Over-generalization

Dichotomous thinking

Personalisation

Albert Ellis

Rational emotive therapy

Irrational beliefs

Metacognition

Thinking about your own thinking.

Behavioural modification

Dysfunctional thoughts

Scientist practitioner

3 theoretical principles of CBT

• Cognitive activity affects behaviour

• Cognitive activity may be monitored and altered

• Desired behaviour change may be affected through cognitive change

Effectiveness studies

Investigations that document the outcomes of therapy in routine situations.

Efficacy studies

How does the treatment perform in ideal circumstances?

Client satisfaction studies

Assess he client’s satisfaction about therapy, by using a questionnaire, for example.

++ Give clients a voice, flexible and cheap, easy to analyze.

— Depends on client’s willingness to complete it, is affected by the halo effect, 95% of completed forms show positive rates.

Outcome research

Research into the effectiveness of therapy and its benefits to clients and society.

Process research

Identifying the ingredients of therapy that contribute to outcome and developing models of how change occurs and how it can be facilitated.

Therapist effects

Studies of the qualities and attributes of therapists, and ways of enhancing therapist competence such as training and supervision.

Professional knowledge

Documenting and disseminating what therapists have learned about how to work most effectively with different client groups and using different therapy approaches.

Methodological pluralism

Because therapy is complex and hard to understand, researchers need to make use of all the methodological strategies that are available: measures, controlled comparative studies, qualitative interviews, etc.

Practice-based research

Data are gathered in routine everyday therapy practice rather than through specially designed research projects such as RCTs. For example, clients complete brief symptom measures at each therapy session.

CORE outcome measure

Clinical Outcomes Routine Evaluation. A 34-item self-report questionnaire that measures client distress in terms of four dimensions: well-being, symptoms, functioning, and risk.

Therapy drop-out rates

The percentage of clients who drop out of therapy early, or who have unplanned endings, can be used as an indicator of the effectiveness of therapy.