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Concepts ch 8-9
Behavior Therapies
- Based on learning theory: No personality theory here!!
- Special qualities of bx therapy:
- empirically based and supported
- talking is not the center of therapy
- THERAPEUTIC RELATIONSHIP is not central
- The WHAT of change: behavior (as opposed to mental, cognitive, or emotional)
- The HOW of change: application of principles from learning theory (either respondent or operant)
Classical (respondent):
- know the basic terms and the principles.
- Pavlov and J.B. Watson
Implosive:
- Thomas Stampfl
- Psychopathology:
"The symptoms and defense mechanisms that characterize psychopathology are learned avoidance responses that
serve to reduce anxiety."
- Note that Mowrer's 2-factor theory is employed here.
- A complex series of CS's leads to stronger avoidance bxs; much more resistent to extinction.
- Therapy:
- use extinction to extinguish learned avoidance responses. B/c avoidance is no longer allowed, subject is forced to
remain in the presence of the anxiety-eliciting stimulus. (response prevention)
-- Process:
- Catharsis: client imagines as vividly as possible whatever stimulus scence the psychotherapist describes and to
experience as fully as possible the intense anxiety and other aversive emotions elicited by the scenes. If the scene causes
anxiety, then increase the anxiety in order to break through the defenses. Stay with the scene until anxiety decreases.
-- Therapeutic Relationship:
- need not be developed; possible to present anxiety eliciting scenes by tapes or films.
- relationship is important b/c clinicians must help clients remain with anxiety eliciting stimuli in the presence of
intense and troubling emotion. TRUST must be built.
-- Practicalities:
- therapists must be able to overcome their own dread of creating anxiety in others.
- individual format (problems are intrapersonal in nature)
-- Research:
- shown to outperform no treament, consistently outperform placebo therapy, and generally perform in a
comparable, if not superior, manner to alternative psychotherapies
- best suited for adults suffering from anxiety and trauma disorders.
Flooding is the more behavioral model
Exposure Therapy:
- Edan B. Foa
- Psychopathology:
- anxiety is a conditioned response controlled by learning principles
- conditioning accounts for acquisition of fear; extinction accounts for fear reduction
- avoidance of anxiety brings immediately relief, but more eventual misery
- CONCEPT: anxiety based pathologies are conceived of in terms of both traditional behavior therapy and an
emotional processing theory.
- Therapy:
-- Goal: to "reverse the behavioral conditioning and to correct the patient's erroneous cognitive and emotional processes."
-- Process:
- intentional, prolonged contact with feared stimulus and the active blocking of the associated avoidance ( response
prevention)
- can be done gradually or all-at-once
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- can be done through imaginal exposure or in vivo exposure (using imagined stimuli or real-life stimuli, respectively)
- response prevention can be total or partial
-- Therapeutic Relationship:
- therapist operates like an effective but firm parent
- TRUST is essential, confidence if modeled; tough love
- Practicalities:
- parallel to implosive therapy
- 8-12 sessions
- homework is assigned
- Research:
- results in decreased levels of anxiety maintained over time
- Effective for PTSD
- Effective for OCD: although treatment is not a panacea
- Panic disorder: effective, strong effect
- social phobia: effective
- treatment of choice for specific phobias
EMDR
- Francine Shapiro
- Psychopathology:
- human processing system geared toward state of mental health
- when the processing system is blocked, pathology occurs
- traumatic information is unresolved, static; locked in the neurophysiology
- UNBLOCKING the system and processing the memories will heal
- Therapy:
- desensitization and cognitive restructuring are by-products of neurophysiological changes in the trauma.
- Multiple Phases:
- eye movement during thinking of event, feelings, etc.
-- Therapeutic Relationship:
- empathy, trust, safety
- however, no empathic statements during trauma processing
- Practicalities:
- usually few sessions of longer length
- usually combined with other treatment methods
- providing pro bono services
- Research:
- for PTSD, effective; greater effect the more controlled the study
- function of eye movements not certain
Future of Exposure Therapies:
- EMDR and Exposure are most promising
- few clinicians use implosive tx
- txist resistance to exposure therapies is strong
Operant (Instrumental) Conditioning
- know the basic processes and terms
- know Mowrer’s 2-factor theory
Systematic Desensitization:
- based on operant model: anxiety is learned by conditions, can be unlearned
- Joseph Wolpe (called his process: reciprocal inhibition) we call it: counterconditioning
- 1. Provide rationale
- 2. Relaxation training
- 3. Create anxiety hierarchy
- 4. Gradual exposure to conditioned stimuli while relaxed = extinction of anxiety
**You cannot be tense while you are relaxed.**
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Assertiveness Training:
- uses instruction, shaping, behavioral rehersal, cognitive restructuring, modeling all to change internal and external
behaviors.
- to help ppl assert themselves correctly: not over-assertion (hostility, violence) or under-assertion (passive, downtrodden),
or passive-aggressive.
Contingency Management:
- aka: Behavior Modification
- Behavioral analysis: discover the reinforcements that are maintaining problem behaviors or what reinforcements to provide
in order to create a new target behavior.
- Works with: Behavioral Deficits and Excesses:
Deficits: bxs that should be emitted are not
-- shaping is required
-- e.g., token economies
Excesses: bxs that should not be emitted are
-- e.g, pedophilia
-- uses aversive control, punishment, covert sensitization
Cognitive Behavioral Modification:
WHAT:
- cognitive process that are: a) cognitive deficits or b) cognitive excesses or c) inappropriate of ineffective cognitions
HOW:
- Deficits: supply information: e.g., bio-feedback
- Excesses: thought stopping (by use of punishment or distraction); rational restructuring, CBM, problem-solving