Behavioral and cognitive therapies are far and away the largest producers

Behavioral and cognitive therapies are far and away the largest producers

Behavioral Theory and Therapy

Chapter Seven

Welcome

  • This week’s focus is on behavioral theory and therapy.
  • We should all put our science caps on. 
  • Michael Mahoney referred to psychoanalysis and behaviorism as the yin and yang of determinism (1984).

Key Figures and Historical Context

  • Three major historical stages characterize the evolution of behavioral approaches to human change:

Behaviorism as a scientific endeavor

Behavior therapy

Cognitive-behavioral therapy

 

Key Figures and Historical Context II

  • Behaviorism
  • John B. Watson
  • Experimental psychology
  • Classical conditioning leraning model
  • A new and different mechanistic view of humans
  • Behaviorists excluded consciousness and introspection.
  • They believed in determinism rather than free will.

 

Key Figures and Historical Context III

  • Little Hans and Little Albert
  • Freud explained that Little Hans’s phobia was from castration anxiety.
  • Watson showed that Little Albert could develop a phobia from classical conditioning.
  • Mary Cover Jones and Little Peter
  • Jones showed that fear could be extinguished through counterconditioning and/or social imitation.

Key Figures and Historical Context IV

  • Behavior Therapy
  • In a testament to the behavioral zeitgeist of the 1950s, three different research groups introduced the term behavior therapy to modern psychology.
  • B. F. Skinner in the United States
  • Joseph Wolpe, Arnold Lazarus, and Stanley Rachman in South Africa
  • Hans Eysenck and the Maudsley Group in the United Kingdom

 

Key Figures and Historical Context V

  • B. F. Skinner in the United States
  • Operant Conditioning
  • Thorndike’s Law of Effect
  • Negative Reinforcement
  • Positive Reinforcement

 

Key Figures and Historical Context VI

  • Joseph Wolpe, Arnold Lazarus, and Stanley Rachman in South Africa
  • Conditioning procedures were used as a means for resolving neurotic fear.
  • A conditioned negative emotional response is replaced with a conditioned positive emotional response.

Key Figures and Historical Context VII

  • Hans Eysenck and the Maudsley Group in the United Kingdom
  • Application of modern learning theory to the understanding and treatment of behavioral and psychiatric problems.

Key Figures and Historical Context VIII

  • Cognitive Behavior Modification
  • Most behavior therapists now acknowledge and work with cognition.
  • They focus on thoughts, expectations, and emotions.

Theoretical Principles

    • Behavior therapists employ techniques based on modern learning theories.

 

  • Behavior therapists employ techniques derived from scientific research.

Theoretical Principles II

  • Theoretical Models
  • Operant Conditioning: Applied Behavior Analysis
  • B. F. Skinner
  • Applied behavior analysis is a clinical term referring to a behavioral approach based on operant conditioning principles.
  • The operant conditioning position is straightforward: Behavior is a function of its consequences.
  • Operant conditioning is a stimulus-response theory.

 

Theoretical Principles III

  • Classical Conditioning: The Neobehavioristic, Mediational Stimulus-Response Model
  • Pavlov, Watson, Mowrer, and Wolpe
  • Classical conditioning is sometimes referred as associational learning.
  • An unconditioned stimulus that naturally produces a specific physical-emotional response.
  • Stimulus generalization
  • Stimulus discrimination
  • Extinction
  • Counterconditioning
  • Spontaneous recovery

 

Theoretical Principles IV

  • Key Terms
  • Stimulus Generalization
  • Generalization of a conditioned fear response to new settings, situations, or objects.
  • Stimulus Discrimination
  • Conditioned fear response is not elicited by a new or different stimulus.
  • Extinction
  • Gradual elimination of a conditioned response.
  • Counterconditioning
  • New associative learning.
  • Spontaneous Recovery
  • It occurs when an old response suddenly returns after having been successfully exitnguished.

 

Theoretical Principles V

  • Theory of Psychopathology
  • Maladaptive behavior is learned and can be either unlearned or replaced by new learning.
  • Behaviorists systematically apply following scientific methods:
  • Observe and assess client maladaptive behaviors.
  • Develop hypothesis about the cause.
  • Test behavioral hypotheses through the application of empitically justifyable intervention.
  • Observe and evaluate the results.
  • Revise and continue testing new hypotheses as needed.

The Practice of Behavior Therapy

    • When preparing to do behavior therapy, be sure to get out your clipboard, because behavior therapists take notes and think like scientists.

 

    • You are a teacher.

 

  • Help your client learn new adaptive behaviors and unlearn old maladaptive behaviors.

 

The Practice of Behavior Therapy II

  • What Is Contemporary Behavior Therapy?
  • Nearly all cognitive therapies are used in conjunction with behavior therapies.
  • There are now several new-generation cognitive-behavioral therapies. These therapies include:
  • Dialectical Behavior Therapy (DBT)
  • Acceptance and Commitment Therapy (ACT)
  • Eye Movement Desensitization Reprocessing (EMDR)

 

The Practice of Behavior Therapy III

    • Assessment Issues and Procedures

 

    • Behavior therapists directly observe their clients in their natural environment to understand the behavioral ABCs.

 

  • Both internal and external stimuli may be of interest.

 

The Practice of Behavior Therapy IV

  • Functional Behavior Analysis (FBA)
  • FBA can also be described as an assessment of behavioral ABCs.
  • A = the behavior’s antecedents
  • B = the behavior
  • C = the behavior’s consequences

 

 

 

The Practice of Behavior Therapy V

    • The Behavioral Interview
    • This is the most common assessment procedure; during it behavior therapists directly observe client behavior; inquire about antecedents, problem behaviors, and consequences; and operationalize the primary therapy target.

 

    • Self-Monitoring
    • Clients are trained to monitor their own behavior.
    • Self-monitoring is inexpensive and practical.
    • Clients may not make accurate recordings of their behavior.

 

  • Standardized Questionnaires
  • These are often used to determine outcomes.

The Practice of Behavior Therapy VI

  • Operant Conditioning and Variants
  • Contingency Management and Token Economies

“. . .the systematic delivery or reinforcing of punishing consequences contingent on the occurrence of a target response, and the withholding of those consequences in the absence of the target response.” (Schumacher et al., 2007, p. 823)

  • Fading is used to help generalize from token systems to the real world.

 

The Practice of Behavior Therapy VII

    • Behavioral Activation (BA)
    • BA was previously referred to as activity scheduling and used as a component of various cognitive and behavioral treatments for depression.
    • Recent research suggests BA may be as good as the whole CBT package for depressive disorders.

 

The Practice of Behavior Therapy VIII

  • Relaxation Training
  • Edmund Jacobson initially focused on Progressive Muscle Relaxation (PMR).
  • PMR is an evidence-based treatment.
  • But PMR can make some clients more anxious.

The Practice of Behavior Therapy IX

  • Systematic Desensitization and Other Exposure-Based Treatments
  • Joseph Wolpe (1958)
  • Combination of Jones’s deconditioning approach and Jacobson’s PMR procedure

“To be relaxed is the direct physiological opposite of being excited or disturbed.” (Jacobson, 1978, p. viii)

 

The Practice of Behavior Therapy X

  • Systematic Desensitization (SD) Can Involve Imaginal or In Vivo Exposure
  • SD is an exposure treatment.
  • Avoidance behavior can be negatively reinforced through operant conditioning.

 

Massed (Intensive) or Spaced (Graduated) Exposure Sessions

  • Either approach can be used effectively.

The Practice of Behavior Therapy XI

  • Virtual Reality Exposure (VRE)
  • Clients are immersed in a real-time computer-generated virtual environment.
  • VRE has been empirically validated.

 

The Practice of Behavior Therapy XII

  • Interoceptive Exposure
  • It is similar to other exposure techniques but focuses on internal anxiety signals or triggers.
  • Six introceptive exposures that reliably trigger anxiety:

Hyperventilation

Holding breath

Breathing through a straw

Spinning in circles

Shaking head

Chest breathing

The Practice of Behavior Therapy XIII

  • Other Important Exposure Treatment Components
  • Response and Ritual Prevention
  • Participant Modeling

The Practice of Behavior Therapy XIV

    • Skills Training
    • Traditional skills training targets include assertiveness and other social behavior as well as problem solving.

 

  • Assertiveness and Other Social Behavior
  • Instruction
  • Feedback
  • Behavior rehearsal or role playing
  • Coaching
  • Modeling
  • Social reinforcement
  • Relaxation training

The Practice of Behavior Therapy XV

    • Problem-Solving Therapy
    • It is a behavioral treatment with cognitive dimensions and focuses on:
    • Problem orientation: This involves teaching clients to have a positive attitude toward problems.
    • Problem-solving style: Clients are taught a rational problem-solving style.

 

Application: Case Analysis and Treatment Planning

  • Discerning differences between cognitive and behavioral therapies is difficult. Most behavior therapists use cognitive treatments, and most cognitive therapists use behavioral treatments. This is why the most popular current terminology for these approaches is cognitive-behavioral therapy.

 

Cultural and Gender Considerations

    • Some research indicates behavioral treatments are effective with minority clients; however, Craske (2010) admits that generally cognitive and behavioral therapies are not yet proven multiculturally efficacious.

 

  • Behavior therapists need to make multicultural adjustments in their practices.

Evidence-Based Status

    • Behavioral and cognitive therapies are far and away the largest producers and consumers of therapy outcomes research.

 

  • The most recent APA Division 12 list of ESTs includes 60 different treatment protocols, most of which are behavioral or cognitive-behavioral.

Concluding Comments

  • Behavior therapy deserves credit for demonstrating that particular approaches are effective—based on a quantitative scientific-medical model.

“Regard no practice as immutable. Change and be ready to change again. Accept no eternal verity. Experiment.” (Skinner, 1970, p. viii)

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