Behavior and Cognitive Behavior Therapy Skinner: Radical Behaviorism Bandura, Ellis, Beck Meicheanbaum 1 Skinner: Radical Behaviorism Placed primary emphasis in the role of the environment in producing behavior Applied learning principles to psychology Developed theory primarily working with rats in an experimental laboratory Books 1948 1953 1971 Walden Two Science and Human Behavior Beyond Freedom and Dignity 2 Behavior/ Cognitive Behavior Theory Classical Conditioning Operant Conditioning Social Learning Approach Cognitive Interventios 3 Classical Conditioning If you pair a conditioned stimulus to a natural stimulus, after time, the conditioned stimulus produces the same response as the natural one: Learning by association Pavlov discovery (1900) 1. Meat (us) >> Salivation (ur) 2. Bell (cs)>>Meat (us) >>Salivation (ur) 3. Bell (cs) >> Salivation (cr) 4. Bell (cs) >> Extinguished response 4 Wolpe: 1950 Applied classical conditioning to treat anxiety by pairing stimulus that causes anxiety (taking an exam) with a state of relaxation, to break the connection between the stimulus and the anxious response Exam (us)>>>Anxiety (ur) Relaxation> Images Exam>Anxiety>Relaxation (cs) (us) (ur) (cr) Images Exam (us)>>> Relaxation (cr) Real Exam (us)>>> Relaxation (cr) 5 Operant Conditioning Focuses on actions that operate on the environment to produce consequence If the environmental change brought about by the behavior is reinforcing, probabilities that the behavior will be repeated increase If the environmental changes produce no reinforcement or a punishment, probabilities that the behavior will be repeated decrease 6 Environmental Consequences Reinforcement Increases the behavior Punishment Positive R Negative R Adds a pleasant consequence Eliminates aversive stimulus Decreases the behavior Adds an aversive consequence Take away a positive stimulus Lack of consequence Decreases behavior 7 Bandura: Social Learning Approach Psychological functions involve a reciprocal interaction between: Environment <><><> Behavior <> <> <> <> <> Cognitive Process <> 8 Cognitive Behavior Therapy Emphasizes cognitive processes and private events (such as client’s self-talk) as mediators of behavior change Rational Emotive Therapy Ellis Cognitive Therapy Beck Cognitive Behavior Modification Meichenbaum 9 Behavior Therapy Today 1/2 Person is product and producer of his/her environment Uses a systematic and structured approach to counseling Emphasizes changing overt behaviors and solving specific problems versus gaining insight 10 Behavior Therapy Today Clients are expected to assume an active role in therapy Emphasizes the assessment of effectiveness of interventions Applied Behavioral Analyses: assessment of environmental contingencies of behaviors 11 Applied Behavioral Analysis: Functional Assessment Model Examine the antecedents and consequences of problem behaviors Conduct a functional assessment using interviews and direct observations (e.g. keeping a diary) to identify the internal\external conditions contributing to the behavior of interest 12 Applied Behavioral Analysis: Functional Assessment Model Facilitate Behavioral Change Behavioral treatments are devised to replace problem behavior(s) with more adaptive behavior(s) using reinforcement and extinction strategies 13 Behaviorism: Therapy Techniques 1/3 1. Systematic Desensitization • • 2. 3. Aversive Counter Conditioning Exposure Techniques • • 4. Relaxation training Anxiety hierarchy In vivo desensitization Flooding (in vivo, imaginary) Modeling 14 Behaviorism: Therapy Techniques 2/3 5. Assertiveness Training • • • • Information Examination of beliefs and self-talk Role playing Behavioral rehearsal 15 Behaviorism: Therapy Techniques 3/3 6. Behavioral Modification Programs • • • Reinforcement Extinction Token economy Time out, loose privileges, punishment Stimulus control Changing environmental antecedents 16 Behaviorism: Therapy Techniques 3/3 7. Self Management Programs – active coping behaviors a. b. c. d. e. Identify goal Express goal in behavioral terms Self Monitoring- Behavioral assessment Develop plan for change that includes Self-Reinforcements Evaluation of action plan - results 17 Cognitive Behavior Theory Distressing emotions are typically the result of maladaptive thinking Mental disorder seen as a disorder of thinking in which a client distorts reality, including: Specific misconceptions Unrealistic expectations Maladaptive attributes 18 Cognitive Behavior Theory Therapy’ aims are to identify and change Faulty patterns of thinking Faulty premises and attitudes 19 Rational Emotive Behavior Therapy: (REBT) Albert Ellis Stresses thinking, judging, deciding, analyzing, and doing Cognitions <> Emotions <>Behaviors have a reciprocal cause-and-effect relationship Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations 20 RET: 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 21 RET: The ABC Theory 22 RET: Therapy 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 23 Aaron Beck’s Cognitive Therapy (CT) Insight-focused therapy Emphasizes changing negative thoughts and maladaptive beliefs 24 Aaron Beck’s Cognitive Therapy (CT) Theoretical Assumptions People’s internal communications are 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 25 Beck’s Cognitive Therapy 1/2 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 Automatic thoughts: personalized notions that are triggered by particular stimuli that lead to emotional responses 26 Beck’s Cognitive Therapy 2/2 Goals: To change the way clients think Identify clients’ automatic thoughts Reach the core schemata and Schema restructuring 27 CT: Human Nature Cognitive structures or schemas Confirmatory bias function as implicit assumptions or premises that influence what one attends to and how one interprets events Selectively attend to events that confirm our own initial beliefs Schemas and Disorders Anxiety Depression Threat and danger Social rejection and failure 28 CT’s Cognitive Distortions 1. 2. 3. 4. 5. 6. 7. Arbitrary inferences Selective abstraction Overgeneralization Magnification and minimization Personalization Labeling and mislabeling Polarized thinking 29 Ct’s Therapy Process Socratic dialogue collaborative an interactive process to: Teach clients to recognize, observe and monitor "automatic" thoughts and assumptions Subject their automatic thoughts to reality testing Substitute realistic and accurate interpretations for the biased cognitions 30 Beck’s Approach to Depression: Cognitive Triad 1. Have a negative view of themselves and attribute setbacks to themselves w/o looking at the environment 2. Interpret experiences in a negative manner, screening out positives 3. Have a gloomy vision and projections about the future 31 Ellis Vs. Beck Ellis is more directional and confrontational in pointing out and refuting irrational thoughts Beck helps clients discover their distorted patterns of thinking Collaborative empiricism Guided discovery client and therapist examine and evaluate beliefs and modify and correct client’s misconceptions 32 Meichenbaum: Cognitive Behavior Modification Is primarily a self-instructional therapy that focuses on helping clients become aware of their self-talk, and acquire practical coping skills to deal with problematic situations Process of Change 1. 2. 3. Self Observation Starting a new internal dialogue Learning new skills 33 Coping Skills Program: Stress Inoculation Teaches clients stress management techniques to be applied to present and future problems Consists of three phases 1. 2. 3. Conceptual Phase Skills acquisition and rehearsal Application and follow-through 34 Conceptual Phase Collaborative relationship Didactic presentation of role that cognitions and emotions play in stress Guided discovery to identify their own selftalk and how it creates stress Systematic observation and monitoring of maladaptive behaviors and their related selftalk 35 Skills Acquisition and Rehearsal Giving clients behavioral and cognitive coping techniques to apply to stressful situations Rehearsing new self-statements Relaxation training Social skills training Time management instruction Making changes in their everyday lives 36 Application and FollowThrough Phase Arranging for transfer and maintenance of change from therapy to the real world Clients practice in homework assignments of increasing complexity Results of these assignments are carefully evaluated Follow-up and booster sessions are scheduled in 3-, 6-, and 12 months intervals 37 Contributions and Limitations Focus on short-term behavioral goals Emphasis on evaluation of therapy outcomes Empirical evidence of positive results May lead to symptom substitution because underneath causes are not addressed Too much power and control from therapist Lack of attention to relationship issues No processing of emotions and feelings Focus only on cognitive issues 38 Multimodal Therapy Comprehensive approach to behavior modification Developed by Arnold Lazarus Technical eclecticism Based on social learning theory Therapy is guided by what is best for the client 39 Basic Concepts Experience includes: moving, feeling, sensing, imagining, thinking, and relating to one another Humans are the product of: genetic endowment, physical environment, and social learning history People vary in the aspects of experience they emphasize Framework for assessment and therapy Dimensions of human experience B– A– S– I – C– I – D– behavior affective processes sensation imagery cognition interpersonal relations physiological aspects Behavior Change Most problems arise from faulty social learning Therapist-client relationship similar to a trainer-trainee relationship Homework assignments to facilitate transfer of learning Therapy starts with comprehensive assessment of BASIC ID dimensions Interventions Behavior Affective processes Extinction, counter-conditioning, reinforcement; behavioral assessment Owning and accepting feelings; catharsis Sensation Tension release, relaxation exercises Interventions Imagery Cognition Cognitive restructuring; irrational thoughts; Interpersonal relation Systematic desensitization; coping imagery Social skills, assertive training; modeling; role playing; Physiological aspects Referrals; addiction treatment Cognitive/Behavioral vs Psychodynamic vs Existential Richard’s recounting of the loneliness in his childhood Therapists possible responses? Talks at length about his loneliness; when questioned about evidence, states he is not lonely at all Possible meaning? 45 Cognitive/Behavioral vs Psychodynamic vs Existential Feels lonely on Saturday – call the list of friends – is this a good solution? “Wife took everything from me” Beck – “lets check the evidence to see if it is true” – Other possible responses? Need a woman to be happy- Beck – disputed the belief 46