Psychotherapy Final

What variables explain behavior according to the theory of personality for Behavior Therapy?

Behavior is explained in terms of variables in the environment ⇒ learning, situational cues, and temperament

Operant conditioning

assumes behavior is controlled by the environment and includes reinforcement (which increases behavior) and punishment (which decreases behavior)

Classical conditioning

a neutral stimulus comes to elicit a response through repeated pairing with another stimulus

Importance of temperament in relation to behavior therapy

stable temperamental characteristics affecting behavior and the assumption that these patterns are influenced by both the individual’s learning history and biological makeup

Positive In Relation to Operant Conditioning

the introduction of a stimulus

Negative In Relation to Operant Conditioning

the removal of a stimulus

Reinforcement

a consequence that causes a behavior to increase in frequency or intensity

positive reinforcement

behavior is followed by a stimulus that is rewarding ex) doing chores ⇒ get money

Negative reinforcement

behavior is followed by a the removal of an aversive (bad) stimulus  ex) taking medicine to remove a headache (the bad stopped)

Punishment

any consequence that causes a behavior to decrease in frequency or intensity

Positive punishment

behavior is followed by an aversive consequence ex) getting pulled over for speeding and you receive a ticket

Negative punishment

behavior is followed by the removal of a desired stimulus

Discrimination learning

when a response is reinforced or punished in one situation but not in another (discrimination = different)

ex) a person with OCD may engage in excessive handwashing at home, but may resist urges in public

Generalization

the occurrence of a learned behavior in situations other than those where the behavior was acquired (generalization = global/similar)

ex) little albert

Vicarious learning

learning about environmental contingencies by watching the behavior of others (observational learning)

ex) seeing others enjoy themselves while using cocaine can lead to someone trying it for the 1st time

Rule-governed behavior/instructional learning

learning about contingencies indirectly through information that they hear or read without ever experiencing the contingencies first-hand

ex) looking both ways when crossing the road as a result of parents explaining the dangers

Goal of Behavior Therapy

For the client to no longer be in therapy ⇒ clients are taught strategies not only to change problem behaviors but also to maintain their improvements once treatment has ended

ABC model in Behavior Therapy

A ⇒ antecedents of the target behavior 

B ⇒ behavior 

C ⇒ consequences of the behavior (includes reinforcement/punishment from client’s environment)

• Most behavior therapists attend to somewhat internal variables that may contribute to client’s behavior such as biological factors (e.g. head injury, fatigue from lack of sleep) and personality styles

If given the option to use reinforcement or punishment, which should we use?

Reinforcement ⇒ more effective long term

Aversive conditioning

exposing individuals to an unwanted consequence with the goal of decreasing an undesirable behavior (punishment)

Is Aversive conditioning considered to be effective long term?

No ⇒ relapse is common after the negative consequences are removed and some may find ways to avoid negative consequences

T/F: exposure therapy is the “gold standard” for phobias and anxiety

True

What is Behavior Therapy helpful for?

Effective for: Anxiety disorders, depression, substance-use disorders, schizophrenia

What did Aaron Beck observe with people’s cognitive processing?

• Trained in psychoanalysis

• Observed consistent negative biases in cognitive processing

• Develops theory of emotional disorder and cognitive model of depression

Temperament

an individual’s biologically based behavioral and emotional tendencies

• Influences how they perceive and react to their environment

Cognitive schemas

structures that contain the individual’s fundamental beliefs and assumptions

• Develop early in life by personal experiences

Psychopathology is on the same continuum with normal behavior but is …

manifested in exaggerated and persistent ways (ex. Depression ⇒ loss of interest and sadness are prolonged and intensified; mania ⇒  heightened investment in self)

Distress results from

1. Perceived threat

2. Maladaptive interpretations

3. Reduced cognitive and reasoning abilities

Catastrophizing

tendency to blow circumstances out of proportion by making problems larger than life

Personalization

the tendency to take the blame for absolutely everything that goes wrong in your life

Emotional Reasoning

the tendency to interpret your experience based upon how you are feeling in the moment

Overgeneralizing

the tendency to make broad generalizations based upon a single event and minimal evidence

Shoulding & Musting

the tendency to make unrealistic and unreasonable demands on yourself or others

Magnification & Minimization

the tendency to magnify the positive attributes of another, while minimizing your own

cognitive triad of depression

1. Self ⇒ worthless

2. Future ⇒ hopeless and negative 

3. World ⇒ unsupportive

three components of anxiety

1. Exaggerated perception of danger

2. Difficulty recognizing cues of safety

3. Minimize ability to cope

Obsessions

doubting whether they have performed an act necessary for safety and causes distress

• ex) turning off a gas oven or locking the door at night

Compulsions

attempts to reduce excessive doubts by performing rituals designed to neutralize the anticipated disaster

• ex) handwashing ⇒ compulsion based on patient’s belief that they do not remove all the dirt or contaminants from parts of the body

Theory of Personality - Pyramid of Cognitive Therapy

Voluntary Thoughts

Automatic thoughts

Underlying assumptions

Core beliefs

Voluntary thoughts

most accessible and stable thoughts

Automatic thoughts

spontaneous and triggered by circumstances 

• Stimulus ⇒ automatic thought ⇒ emotion and behavior 

ex) socially awkward person before going to a party: “ everyone will see im nervous”

Underlying assumptions

gives rise to automatic thoughts; shapes perceptions, provides interpretation and meaning

Core Beliefs

foundations of maladaptive schemas

Goal of Cognitive Therapy

Correct faulty information processing

• Not simply substitution of positive beliefs for negative ones

• Treat thoughts as testable hypothesis

Therapeutic Relationship for Cognitive Therapy

• Collaborative

• Therapist as a guide and catalyst for change

• Warmth, empathy, genuineness, curiosity

• Emphasizes patient responsibility

When treating dysfunctional ideas, do we start top-down or bottom-up (in reference to the pyramid of personality)?

Top-down ==> start with the voluntary thoughts to get to the core beliefs

Where does most of the change happen in Cognitive Therapy?

Negative beliefs/thoughts

Structure of Treatment in Cognitive Therapy

Initial phase: assessment and contract: skills educations

• Building relationship with client; problems definition and symptoms relief; therapist has a more active role ⇒ gathers info, conceptualizes patient’s problem, gives homework

Middle and later sessions: identify themes in automatic thoughts; challenge core beliefs

• Emphasis shifts from patient’s symptoms to patient's pattern of thinking; patient has more responsibility for identifying problems and solutions; therapist more of an advisor rather than teacher 

Ending treatment: relapse prevention

• As patient develops self-reliance, therapy sessions becomes less frequent

Why do therapists often assign homework to their clients in Cognitive Therapy?

Homework gives patients the opportunity to apply cognitive principles between sessions; focuses on self-observation and self-monitoring, structuring time effectively and implementing procedure for dealing with concrete situations

What 3 components of the model of psychoeducation do Cognitive Therapists target?

thoughts

behaviors

feelings

What are the mechanisms of Cognitive Therapy?

• Modification of dysfunctional assumptions leads to effective change 

• Core beliefs must be made accessible to be modified

• Therapy allows patients to experience emotion and reality testing simultaneously

What are the cultural considerations for Cognitive Therapy?

Therapists:

• Must understand patient's beliefs, values and attitudes 

• When patient’s own beliefs do not match culture:

  • Develop flexibility

  • Reconcile beliefs with environmental constraints

Deficits-based approach in Positive Psych

negatives ⇒ one way to minimize negative emotions is to express them

Strengths-based approach in Positive Psych

positives ⇒ seeks to balance the attention given to negative and positive life events 

• Is more effective than deficits-based approach

Formula for Happiness in Positive Psych

Personal set range

Circumstances

Factors under volitional control

Character Strengths: Wisdom

strengths that involves acquiring and using knowledge

1. Creativity

2. Curiosity

3. Openmindedness

4. Love of learning

5. perspective

Character Strengths: Courage

emotional strengths that involve exercise of will to accomplish goals in the face of external or internal opposition

1. Bravery

2. Persistence

3. Integrity

4. Vitality/zest

Character Strengths: Humanity

interpersonal strengths that involve tending and befriending others

1. Love 

2. Kindness

3. Social intelligence

Character Strengths: Justice

strengths that underlie healthy community life

1. Citizenship

2. Fairness

3. Leadership

Character Strengths:Temperance

strengths that protect against excess

1. Forgiveness/Mercy

2. Humility/Modesty

3. Prudence

4. Self-regulation

Character Strengths:Transcendence

strength that forge connections to larger universe and provide meaning

1. Appreciation of beauty and excellence

2. Gratitude

3. Hope and optimism

4. Humor and playfulness

5. Spirituality

According to positive psychology, what causes distress?

Excess of other strength and strength in extreme forms

PERMA Model

P => positve emotions

E => engagement

R => relationships

M => meaning

A => accomplishment

According to positive psychology, what does a full life entail?

• A full life entails happiness and life satisfactions and is more than the sum of its components 

• PERMA can be pursued simultaneously and interrelatedly

• Engagement and meaning most correlated with life satisfaction 

  • Cannot chase positive emotions only

Steps of assessing strengths

1. Identify ⇒ identify signature strengths

2. Obtain ⇒ obtain narratives about their use

3. Incorporate ⇒ incorporate them into the treatment plan

Mechanisms for Positive Psych

1. Broaden and build resources for coping

2. Reappraise negative memories

3. Reeducation of attention

Some important cultural considerations to consider when implementing Positive Psychotherapy

• Definition of happiness

• Cultural context

• Therapists must:

  • Understand manifestations of strengths

  • Discuss culture

  • Understand meaning of strengths

What is the education for the oppressed model in Multicultural Psych?

• Dominant models maintain inequality 

• Develop critical consciousness

Reevaluation co-counseling

• Individuals listen to each other to recover from effects of racism, classism, sexism and other types of oppression

  • Empathizing the shared experiences 

  • Co-counseling - like group therapy 2+ people outside of the therapist

What are some reasons we consider culture?

• It is something that everyone has and brings into therapy

• Culture must be considered within therapy

• Includes:

  • Beliefs, emotions, behaviors, attitudes, expectations, interpersonal style, treatment selection, and treatment response

Stages of Minority Identity Development

• Stage 1: conformity 

• Stage 2: dissonance

• Stage 3: resistance-immersion

• Stage 4: introspection

• Stage 5: synergistic

Stages of Sexual Orientation Development

• Stage 1: confusion

• Stage 2: comparison

• Stage 3: tolerance

• Stage 4: acceptance

• Stage 5: pride

• Stage 6: synthesis

Collectivistic

•  a culture in which an individual’s identity is associated with their relationship with others 

  • Relational values, prefer interdependence, communication, and sharing

Individualistic

•  culture in which an individual’s identity is independent from others 

  • Define themselves in terms of their individual traits, attitudes, abilities, and agencies

Western countries tend to be more …

individualistic

Intersectionality

the impacts of class, race, gender, sexual orientation, immigrants status, ability, and religion on individuals

ADDRESSING framework

• Developed by Pamela Hays that highlights cultural complexities and interacting cultural influences in the conceptualization of identity 

  • Age 

  • Developmental and Acquired Disabilities

  • Religion

  • Ethnicity

  • Socioeconomic status

  • Sexual orientation

  • Indigenous heritage

  • National origin

  • Gender

How does cultural adaptation occur?

• Involves diverse people in development 

• Includes collectivistic values

• Attend to religion

• Pay attention of relevance of acculturation

• Acknowledge effects of oppression

Cultural competence

• the set of knowledge, behaviors, attitudes, skills, and policies that enables a practitioner to work effectively in a multicultural situation

Cultural competence Steps

1. Cultural Destructiveness

2. Cultural Incapacity 

3. Cultural Blindness

4. Cultural Pre-competence 

5. Cultural Competence

Features of Culturally Competent Therapists

Therapists should:

• Value diversity 

• Manage dynamics of difference

• Acquire and incorporate cultural knowledge into their interventions

• Increase their multicultural skills 

• Conducts self-reflection and assessment 

• Adapt to diversity and cultural context of their clients

Ethnocentric

multicultural sensitivity which includes denial, defense, and minimization

Ethnorelative

multicultural sensitivity which includes acceptance, adaptation, and integration

Goals of Multicultural Therapy

• Address cultural trauma

• Experience is valuable knowledge

In Multicultural Therapy Healing results from …

• Empowerment

• Sharing multiple perspectives 

• Anchored in meaningful and relevant contexts

Therapeutic Alliance in multicultural therapy

• Recognize client’s expectation for the therapists role

• Respond according to client’s needs

• Work towards cultural congruence in worldviews

Multicultural assessment

a process-oriented tolls that leads to culturally appropriate treatment

Multicultural assessment Components

4 primary components

• Explanatory model of distress

• Cultural formulation and analysis 

• Cultural genogram

• Ethnocultural assessment

Cultural empathy

learned ability to understand experiences of culturally diverse individuals 

• Informed by cultural knowledge and interpretations

• Empathic witness

4 Aspects of a Proper Dialogue on Cultural Differences and Similarities

• Suspend:  suspend preconceptions

• Recognize:  recognize clients may be different from other members of their group 

• Consider:  consider how client-therapist differences may affect therapy 

• Acknowledge:  acknowledge that power, privilege and oppression might affect interactions

Interethnic transference

overcompliance, mistrust, denial, ambivalence

Intraethnic transference

views therapist as omniscient or omnipotent, traitor (betrayal of culture); autoracist

Interethnic countertransference

deny cultural differences, become overly curious about differences at the expense of psychological needs, guilt or pity

Intraethnic countertransference

over identification; shared victimization;  distancing; survivor's guilt, cultural myopia (can’t see clearly)

What are the mechanisms of multicultural therapy?

• Cultural considerations

• Develop resilience

• Meaning making

• Manage cultural trauma

Describe the evidence base for multicultural therapy

• Inconclusive results and low validity for ethnic matching

  • Competence, compassion, sharing worldview as more important

• Culturally competent therapists enhance client satisfaction with treatment

Licensing

restricts practice of a profession

• typically overseen by state boards

• requirements and restricts can vary

Certification

restricts use of a name

Lack of Psychologists

56% of Americans with mental illnesses ack access to care

Care-seeking has increasingly shifted away from long-term therapy and towards …

brief interventions from mental health providers

primary care physicians