Behavior Therapy

Behavior Therapy• A set of clinical procedures relying on experimental

findings of psychological research– Based on principles of learning that are

systematically applied• Treatment goals are specific and measurable

– Focusing on the client’s current problems• To help people change maladaptive to adaptive

behaviors– The therapy is largely educational - teaching clients

skills of self-management

Four Aspects of Behavior Therapy

• 1. Classical Conditioning– In classical conditioning certain respondent behaviors, such as

knee jerks and salivation, are elicited from a passive organism

• 2. Operant Conditioning– Focuses on actions that operate on the environment to produce

consequences• If the environmental change brought about by the behavior

is reinforcing, the chances are strengthened that the behavior will occur again.

• If the environmental changes produce no reinforcement, the chances are lessened that the behavior will recur

Four Aspects of Behavior Therapy

• 3. Social Learning Approach– Gives prominence to the reciprocal interactions

between an individual’s behavior and the environment

• 4. Cognitive Behavior Therapy– Emphasizes cognitive processes and private

events (such as client’s self-talk) as mediators of behavior change

Humans Learn Through Association

• Classical conditioning– Behaviors learned through association with natural

reflexes– Temporal-spatial association of one stimulus with

another– A stimulus naturally capable of producing a certain

response is associated in time or space with another– Eventually second stimulus elicits virtually the same

response– Undesirable responses modified by breaking the

association

Techniques Based on Classical Conditioning Principles

• Counterconditioning– Systematic desensitization– Imaginal flooding– In vivo desensitization– Biofeedback

Systematic desensitization:A close up

• Relaxation training– Progressive muscle relaxation

• Awareness of tension in each muscle group• Awareness of relaxation in each muscle group• Pairing relaxation with

– Counting– Relaxing voice tone

• Relaxing without tensing• Focus on cognition, too

Systematic desensitization:A close up

• Construction of a stimulus hierarchy– Temporal relationships– Spatial relationships– Use of SUDS– Use of real and imagined scenarios

• Presentation of the hierarchy– Beginning with least threatening– Proceeds at client’s pace– Number of trials

• In vivo trials– Sound ethical judgment; agency policies– Client must be ready; proceeds at client’s pace

Humans Learn Through Direct Experience

• Operant conditioning– Behaviors are learned or maintained through experience with

rewarding, punishing, relief-giving consequences of behavior• Reinforcement

– Continuous

– Intermittent

– Extinction

• Punishment• Avoidance learning• Shaping

– Undesirable responses modified by changing consequences

Techniques Based on Operant Conditioning Principles

• Contingency Management– Assessing antecedents, behaviors, and

consequences of problem behaviors– Behavior modification

• Shaping (for acquisition of new behaviors)• Reinforcing (ensuring a stable response rate)• Extinguishing (eliminating or reducing a problem

behavior)• Token economies

Humans Learn Through Other’s Experience

• Vicarious learning– Behavior is learned or maintained by observing

behavior of others and/or outcomes that the actions produce

– Undesirable responses modified by observing different others; different outcomes

Techniques Based on Vicarious Learning Principles

• Modeling, rehearsal, & psycho-educational instruction– Modeling as a technique

• Live modeling• Symbolic modeling• Role-playing• Participant modeling• Covert modeling

– Assertiveness training– Social skills training– Stress inoculation– Self-instructional training

Research

• Abundant outcome research– Testing– Validation– Experimental processes– How, how often, and under what circumstances each technique

works

• Children and adults• Simple and complex behaviors• Social behaviors• Programs designed to help clients acquire, change,

eliminate behaviors only limited by ethics and creativity

Critique

• PROS– Individualized

treatment

– Proven efficacy in treating many problems

– Based on scientifically, treatments are data-driven

• CONS– Minute behavioral focus

may limit complexity

– Treating the problem behavior, rather than whole person

– Ethics and politics of who decides what behaviors are maladaptive

– Individual environments v social environments treated for dysfunction

Cognitive Behavior Therapy

“Big” Names associated with Cognitive Behavioral Therapy

1. Epictetus, Greek philosopher. Observed that people are not disturbed by things that happen but by the view they take of things that happen.

2. Albert Ellis, Ph.D. “grandfather of cognitive behavioral therapy.”

3. Aaron Beck, MD, a psychiatrist (University of Pennsylvania)

Characteristics of Cognitive-Behavioral Therapies:

1. Thoughts cause Feelings and Behaviors.

2. Brief and Time-Limited.

Average # of sessions = 16 VS psychoanalysis = several years

3. Emphasis placed on current behavior.

4. CBT is a collaborative effort between the therapist and the client.

Client role - define goals, express concerns, learn & implement learning

Therapist role - help client define goals, listen, teach, encourage.

5. Teaches the benefit of remaining calm or at least neutral when faced with difficult situations. (If you are upset by your problems, you now have 2 problems: 1) the problem, and 2) your upsetness.

6. Based on "rational thought." - Fact not assumptions.

7. CBT is structured and directive. Based on notion that maladaptive behaviors are the result of skill deficits.

8. Based on assumption that most emotional and behavioral reactions are learned.  Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting.

9. Homework is a central feature of CBT.

Rational Emotive Behavioral Therapy (REBT)

• Stresses thinking, judging, deciding, analyzing, and doing

• Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship

• Is highly didactic, very directive, and concerned as much with thinking as with feeling

• Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations

The Therapeutic Process

• Therapy is seen as an educational process• Clients learn:

– To identify and dispute irrational beliefs that are maintained by self-indoctrination

– To replace ineffective ways of thinking with effective and rational cognitions

– To stop absolutistic thinking, blaming, and repeating false beliefs

View of Human Nature

• We are born with a potential for both rational and irrational thinking

• We have the biological and cultural tendency to think crookedly and to needlessly disturb ourselves

• We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk

• We have the capacity to change our cognitive, emotive, and behavioral processes

ABC’s of REBT

A →B → CA = Activating Event

B = Beliefs, Thoughts, Attitudes, Assumptions

C = Consequences, Feelings, Emotions, Behaviors, Actions

The Self-Defeating Rules (Irrational Beliefs)Ellis suggested that a small number of core beliefs underlie most unhelpful emotions and behaviours. Core beliefs are underlying rules that guide how people react to the events and circumstances in their lives. Here is a sample list of such of these:

1. I need love and approval from those around to me.2. I must avoid disapproval from any source.3. To be worthwhile as a person I must achieve success at whatever I do.4. I can not allow myself to make mistakes.5. People should always do the right thing. When they behave obnoxiously,

unfairlyor selfishly, they must be blamed and punished.6. Things must be the way I want them to be.7. My unhappiness is caused by things that are outside my control – so there is

nothing I can do to feel any better.8. I must worry about things that could be dangerous, unpleasant or frightening –

otherwise they might happen.9. I must avoid life’s difficulties, unpleasantness, and responsibilities.10. Everyone needs to depend on someone stronger than themselves.11. Events in my past are the cause of my problems – and they continue to influence

my feelings and behaviours now.12. I should become upset when other people have problems, and feel unhappy

when they’re sad.13, I shouldn’t have to feel discomfort and pain.14, Every problem should have an ideal solution.

Aaron Beck’s Cognitive Therapy (CT)

• Insight-focused therapy• Emphasizes changing negative thoughts and

maladaptive beliefs• Theoretical Assumptions

– People’s internal communication is accessible to introspection

– Clients’ beliefs have highly personal meanings– These meanings can be discovered by the client

rather than being taught or interpreted by the therapist

Theory, Goals & Principles of CT• Basic theory:

– To understand the nature of an emotional episode or disturbance it is essential to focus on the cognitive content of an individual’s reaction to the upsetting event or stream of thoughts

• Goals:– To change the way clients think by using their automatic

thoughts to reach the core schemata and begin to introduce the idea of schema restructuring

• Principles:– Automatic thoughts: personalized notions that are triggered by

particular stimuli that lead to emotional responses

Depression and Negative Schemas

Negative schemas:

• Always present

• Unconscious

• Become activated with stressful events

Example

• Person with negative schema involving rejection will become depressed when a partner leaves him or her

Beck’s Cognitive Therapy: First Sessions

• Identify and changing maladaptive thoughts

• First sessions: therapist explains cognitive theory of emotional disorders (negative cognitions contribute to distress)

• Middle Sessions: Client is taught to identify, evaluate and replace negative automatic thoughts were more positive cognitions

• Therapist is a collaborator (fellow scientists in therapy)

• Final Sessions: solidify gains, focus on prevention of recurrence

CT’s Cognitive Distortions

• Arbitrary inferences

• Selective abstraction

• Overgeneralization

• Magnification and minimization

• Personalization

• Labeling and mislabeling

• Polarized thinking

CT’s Cognitive Triad

• Pattern that triggers depression:– 1. Client holds negative view of themselves– 2. Selective abstraction: Client has tendency to

interpret experiences in a negative manner– 3. Client has a gloomy vision and projections

about the future

Constructivist Narrative Perspective (CNP)

• Focuses on the stories people tell about themselves and others about significant events in their lives

• Therapeutic task:– Help clients appreciate how they construct their

realities and how they author their own stories