Theories - Exam 2

Define Behavior Therapy

• here and now

• directive - teaching/modeling/homework

• brief - 1-16 sessions

• empirical and strongly rooted in research

1950s - behaviorism

learning research grows, Eysenck questions psychoanalysis

1953 - behaviorism

term first used - operant methods with psychotic patients (Lindsley, Skinner, Soloman)

1958 - behaviorism

reciprocal inhibition - Lazarus applies the term to Wolpes procedures

1960 - behaviorism

behavior modification - operant programs such as token economies

today - behaviorism

blurred boarders - cognitive component added

behaviorists weight …

the situation

trait theorist weight…

the stable characteristics

four routes of learning

• classical conditioning - learn by association

• operant conditioning - learn by consequences

• modeling - lean by observing others

• stimulus generalization - spread conditioned association to similar situations

classical conditioning

learning by association - a neutral stimulus paired with one that naturally triggers a response comes to trigger a similar response on its own

key features of classical conditioning

• unconditioned stimulus and response

• conditioned stimulus and response

• extinction

how does classical conditioning work in therapy

explains automatic emotional reactions such as fear and panic. exposure and relaxation create new learning that competes with the old association

operant conditioning - positive + reinforcement

positive reinforcement - desirable stimulus added after the behavior and behavior increases

operant conditioning - negative + reinforcement

negative reinforcement -an adversive stimulus is removed after the behavior so the behavior increases

operant conditioning - positive + punishment

positive punishment - adversive stimulus is added after the behavior so the behavior decreases

operant conditioning - negative + punishment

negative punishment - desirable stimulus is removed after behavior so behavior decreases

modeling

learn by watching - people acquire behaviors by observing others and the consequences those others recieve

modeling key features

• four processes

• vicarious consequences

• who the model is

modeling - 4 processes

attention, retention, reproduction and motivation

vicarious consequences - modeling

model reward = more likely to copy; model punished = less likely to copy

how is modeling used in therapy

explains how fears and coping styles can be learned without any direct experience. used deliberately in participant modeling and social skills training

stimulus generalization

learned response spreads to new stimuli that resemble the original one. the more similar the stimulus, the stronger the response

stimulus generalization key features

• generalization gradient

• stimulus discrimination

• applies to all learning

generalization gradient - stimulus generalization

response strength falls off as stimulus look, sound, or feel less like original

stimulus discrimination - stimulus generalization

learning to respond only to the cues that actually predict outcome

stimulus generalization in therapy

explains how one problem grows into broad avoidance and guides exposure heirarchies. new learning from therapy must also generalize so practice is varied across stimuli and settings

how problems develop - classical conditioning

cues paired with danger trigger automatic fear

classical conditioning therapy tools

exposure, introceptive exposure, relaxation

operant conditioning - how problems develop

relief and rewards keep avoidance and habits going

operant conditioning - therapy tools

contingency management, shaping, behavioral activation

modeling - how problems develop

fears and coping styles copied from others

modeling - therapy tools

participant modeling, social skills training

stimulus generalization - how problems develop

one fear spreads to similar situations

stimulus generalization - therapy tools

heirarchies, discrimination training, varied practice

functional analysis - SORC

• stimulus - trigger of behavior

• organism - biology, temperment, history, culture, expectancies

• response - detailed analysis

• consequence - reinforcement and punishment

  • identify target behaviors and alternate behaviors to replace them

two traditions in assessment - behavioral therapy

functional analysis and symptom focused - ideally use both them measure across whole course

measuring…is one of the clearest ways behavior therapy differs from most therapies

outcome

assessment strategies - behavioral

direct observation, diaries and monitoring, clinical interviews, self report scales, psychophysiology, multiple informants

protocol for practice - bahvioral

idiographic (plan built for client) → disorder specific protocol → transdiagnostic manuals

why are manuals helpful

set evidence based care apart, made training and dissemination easier, fit managed cares demand for brief care

what are in the behavior therapist’s toolkit

goal setting, psychoeducation, exposure, response prevention, operant strategies, behavioral activation, social skills training, modeling, problem solving, relaxation, emotional regulation

goals should be….

safe, specific, measurable, attainable

psychoeducation is a …. conversation

two way

four ways to face a fear - behavioral

• in vivo (real life)

• imaginal

• introceptive (feared body sensations)

• virtual reality

seven principles of exposure

• client in control

• long enough

• intense enough

• close together - daily if possible

• vary stimulus

• many contexts

• drop safety behaviors - focus on fear, no distraction

the exposure heirarchy is a…

laddder of feared situations through subjective units of distress (SUDS)

three ways to climb the exposure ladder

• bottom up - move up one fear at a time

• start moderate - where client is willing to try

• random order - mix difficulty levels

  • rerate each item every session

Exposure + response prevention (ERP) process

block the ritual, delay the ritual (progressively longer waits if stopping feels impossible), best supported OCD treatment

how is operant conditioning a coercive cycle

each persons behavior rewards the others so the pattern escalates over time (Patterson)

operant strategies - parent training

1. set up cur

2. ignore tantrum

3. reward compliance

4. follow through

extinction - operant conditioning

withdraw reinforcer

shaping - operant conditioning

reinforce steps toward desired behavior

stimulus control - operant conditioning

change cues - discriminative stimulus

natural reinforcers - operant conditioning

use reinforcers that occur in the environment - leads to maintenance and generalization

self management - operant conditioning

provide contingencies or rewards for good behavior

punishment - operant conditioning

response cost - removing availiable rewards use sparingly

activity scheduling - behavioral

1. monitor

2. choose

3. schedule

4. start small - easy 10 minute steps

5. review

communication skills definition

teaches individuals or groups to communicate more effectively, from basic skills like eye contact to complex skills like assertiveness

how are communication skills taught

psychoeducation, modeling, role play, feedback - refine and try again

social skills training features

• builds from simple to complex

• video feedback

• practice in real life

what are social skills training used for

schizophrenia, social anxiety and children with emotional and behavioral issues

definition of demonstrating behavior

therapist/ model demonstrates behavior before client tries it and the client attempt is then reinforced

sequence of demonstrating behavior you want to see

1. model demonstrates the behavior

2. client performs behavior

3. therapist reinforces attempt

live modeling - behavioral

models can be live in session to guide client step by step

coping vs mastery models - behavioral

model who shows some difficulty and then succeeds is ofted more helpful than one who seems effortless

shows what is safe and how - behavioral modeling

watching someone else approach a feared situation reduces fear and teaches the exact same steps

what is modeling used for

common in treating feat based problems and a core part of social skills training and parent training

problem solving definition

teaches clients to handle everyday problems effectively with the goal of reducing distress and improving functioning

problem solving skill steps - behavioral

1. define and formulate problem

2. generate possible solutions

3. choose best solution

4. implement it and evaluate outcome

problem solving key features - behavioral

• problem orientation

• stop and think

• brainstorm before judging

problem orientation

seeing problems as challenges, believing you can solve them and noticing how emotions affect you

how problem solving is used

depression, stress, social anxiety, schizophrenia, physical health complaints, either on its own or within a larger treatment package

relaxation training - behavioral

teaches clients to reduce physical tension and arousal, progressive muscle relaxation (PMR), taught within applied relaxation, is the most studied form

applied relaxation training

1. learn to detect early anxiety cues

2. master progressive muscle relaxation

3. apply relaxation at the first cue

relaxation training key features

• tense then release - build awareness of tension and deepen release

• shortened over time - as skill grows, fewer muscle groups needed, untill recalling the feeling is enough

• daily practice

relaxation training useage

mainly generalized anxiety disorder, applied through applied relaxation. it can stand alone or be a part of a larger treatment package

emotion regulation - behavioral

helps clients recognize, understand and respond adaptively to their own emotions especially when emotions are intense

core skills of emotional regulation

1. notice and label the emotion as it happens

2. distinguish primary from secondary emotions

3. choose an adaptive response

key features of emotional regulation

• primary emotions - direct responses to event

• secondary emotions - reaction to first emotion

• respond, dont eliminate emotion

emotional regulation uses in therapy

supported in RCT for for deliberate self harm, effects of childhood sexual abuse, and anxiety and depressive disorders

therapist role if self help works

self help improves symptoms but therapist is a reinforcer

when clients are ambivalent…

lead less. reflect, dont advocate and return to motivational interviewing whenever ambivalence shows up

common causes of ruptures in alliance

disagreement about goals and tasks, feeling misunderstood, schedule conflicts

5 proposed mechanisms of change

1. environmental contingencies - new behaviors and natural reinforcement

2. inhibitory learning - non threat associations compete with old fears

3. cognitive change - experience disconfirms previous belief

4. inner experience - decentering, more tolerance and less reactivity

5. biological change - brain metabolism shifts after OCD treatment

fear is never….only…

erased…outcompeted

keep going until expectation drops, not necessarily fear

how to not make behavior therapy coercive

• agree on goals together

• reassess goals and progress often

• attend to the power differential

where behavioral methods help

anxiety, OCD, trauma, depression, substance use, eating, personality, ODD, serious mental illness

best with focal problems and gains spread

behavioral therapy is the…

best studied psychological treatments

where behavioral therapy is going

• combined treatment - therapy - medication beats either for depression, panic, OCD not GAD or PTSD

• access - internet CBT, apps and brief CBT primary care

• enhancing exposure

• effectiveness research - real world CBT effets comparable to lab trials

• integration - mindfullness, acceptance, interpersonal elements

• systems and culture - adapting to discrimination/contexts

CBT is …

a combination of cognitive and behavioral interventions

CBT characteristics

problem focused, present focused, time limited, manualized (summarized in manuals)

behavior therapy targer

learned behavior in response to the environment

behavior therapy how

change antecedents and consequences through guide practice

bahvior therapy goal

fewer maladaptive behaviors and more adaptive ones

cognitive therapy target

thoughts about self, the world and the future

cognitive therapy how

examine and modify beliefs and expectations

cognitive therapy goal

new ways of thinking about a situation

1950-60s

behavior therapy - reduce maladaptive behaviors and increase adaptive ones

late 1950s

cognitive therapy - target thoughts and how thoughts are associated with responses

1980s

combining behavior and cognitive therapy - how thinking shapes both emotion and behavior