clinical psychology spring 2015 kyle stephenson. overview – day 9 behavioral theories behavior...
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Clinical Psychology
Spring 2015Kyle Stephenson
Overview – Day 9•Behavioral theories•Behavior therapies
▫Systematic desensitization▫Contingency management▫Exposure therapy
•Cognitive behavioral therapies▫Rational Emotive Therapy▫Beck’s Cognitive Therapy▫Dialectical Behavior Therapy
•Strengths & weaknesses•Efficacy
Origins of the Behavioral Approach•Origins:
▫Scientific approach to human behavior▫Learning theory▫Classical conditioning▫Operant conditioning
Overview – Day 9•Behavioral theories•Behavior therapies
▫Systematic desensitization▫Contingency management▫Exposure therapy
•Cognitive behavioral therapies▫Rational Emotive Therapy▫Beck’s Cognitive Therapy▫Dialectical Behavior Therapy
•Strengths & weaknesses•Efficacy
Systematic Desensitization▫Assessment and briefing patient▫Relaxation training
Muscle tensing then release Possible use of hypnosis Breathing exercises
▫Development of anxiety hierarchy
Difficulties identified Ordered by anxiety level Low to moderate to extreme Relaxation practiced at each level of hierarchy
Systematic Desensitization•Rationale
▫Counterconditioning: the substitution of relaxation for anxiety
▫Extinction of behaviors: when the patient repeatedly visualizes
anxiety-generating situations but without ensuing bad experiences, the anxiety responses are eventually extinguished
▫Habituation▫Positive reinforcement
•Changing behavior by manipulating consequences▫Common with children and adolescents
•Examples▫Shaping/ successive approximation:
attempts at a desired behavior are rewarded until it is achieved
▫Time out: removal of patient from environment in which unwanted behavior is reinforced
▫Token economy: provision of symbolic reinforcer that can be exchanged for specific rewards later
Contingency Management
Exposure Therapy•Emotional-processing theory (Foa & Kozak, 1986)
▫Fear structures Schemas regarding threat Likelihood or severity of threat is
overestimated Threat perceptions are maintained through
avoidance behaviors▫How to disconfirm fear structures?
Exposure, why? Habituation
▫(Makes sense, but may not actually be mechanism) New learning
•nice overview
Exposure Therapy
•Client placed into anxiety causing situation▫Testing threat perceptions and allowing for
creation of new schemas •Message from scientist-practitioners•Examples
▫Exposure treatment for Panic Disorder▫Exposure and response prevention for OCD▫Prolonged Exposure for PTSD
Sample Hierarchy: OCD
• Touch top of shoes• Touch door near
knob• Touch doorknob• Touch public
bathroom flusher• Touch bottom of
shoes• Touch street• Touch inside of trash
can• Touch porta-potty
under lid
• SUDS: 45
• SUDS: 70
• SUDS: 100
AVOID!
Relief!
Short-term relief, long-term anxiety maintenance
Message: The situation or sensations really are dangerous, intolerable
Avoidance behavior prevents new learning
An
xie
ty/F
ea
r
Time
Avoidance
AVOID! Message: The situation or sensations are not as dangerous as they feel; they are tolerable
Short-term distress, long-term anxiety reductionA
nxie
ty/F
ear
Time
Exposure
Exposure Therapy•Ingredients of effective exposure therapy
▫Long duration of exposures For within-session habituation
▫Repetition to extinction of anxiety For between-session habituation
▫Graduated process To build confidence in clients
▫Active attention to feared stimuli To counteract avoidance
▫Exposure must provoke anxiety To activate fear structure
Overview – Day 9•Behavioral theories•Behavior therapies
▫Systematic desensitization▫Contingency management▫Exposure therapy
•Cognitive behavioral therapies▫Rational Emotive Therapy▫Beck’s Cognitive Therapy▫Dialectical Behavior Therapy
•Strengths & weaknesses•Efficacy
Cognitive-Behavioral Therapy
•Cognitive-Behavioral Therapy (CBT)▫Combine behavioral treatments with
attention to cognitions (thoughts)▫Goals expanded from focusing just on
observable behavior▫Now, also attempted to modify content of
thoughts, or at least the person’s relationship to his/her thoughts
Cognitive-Behavioral Therapy
•Rational restructuring▫Relabeling of situations, more realistically▫Modification of the internal “self-talk”▫Rational Emotive Therapy (RET)
Activating events (A) Beliefs/thoughts (B) Consequences (C) Therapist as a teacher; correct “illogical”
thinking•example
Cognitive Model
Cognitive-Behavioral Therapy•Beck’s Cognitive Therapy for Depression
▫Utilizes cognitive & behavioral methodology
▫Modify dysfunctional patterns of thinking▫Wide array of techniques including
Increase pleasurable activities Identify and challenge maladaptive,
automatic thoughts Search for more accurate and/or helpful ways
of thinking or coping
Identification and Challenging of Distorted Thoughts•Class activity
Overview – Day 9•Behavioral theories•Behavior therapies
▫Systematic desensitization▫Contingency management▫Exposure therapy
•Cognitive behavioral therapies▫Rational Emotive Therapy▫Beck’s Cognitive Therapy▫Dialectical Behavior Therapy
•Strengths & weaknesses•Efficacy
Cognitive-Behavioral Therapy
•Strengths▫Efficacy▫Efficiency▫Evidence based▫No evidence for symptom substitution▫Breadth of application▫Scientist Practitioner / Clinical Scientist
model
Cognitive-Behavioral Therapy
•Limitations▫Dehumanizing?▫What about growth and existential
meaning?▫Manipulation & control▫Do these effects generalize to real-world
clients? I think the biggest issue – who does it work
for and when?▫Lack of a unifying theory?
(Your book says this, but I disagree somewhat)
Overview – Day 9•Behavioral theories•Behavior therapies
▫Systematic desensitization▫Contingency management▫Exposure therapy
•Cognitive behavioral therapies▫Rational Emotive Therapy▫Beck’s Cognitive Therapy▫Dialectical Behavior Therapy
•Strengths & weaknesses•Efficacy
Does CBT work?
•Yes
Efficacy
•Hundreds of studies have suggested that CBT is consistently better than no treatment and slightly more effective than many other types of therapy, especially for anxiety disorders and depression.
•Managed care providers (insurance companies, VA) have begun to specify that they only want CBT to be done and won’t support some other treatments.
Take-Home• CBT is the most popular and (maybe) most
effective method of treatment practiced by therapists.
• Most modern treatments include both behavioral and cognitive interventions aimed at changing behaviors, thought content, and people’s relationship with their experiences.
• There are many different CBT interventions for a very wide variety of psychological problems, some of which have been tested more than others.