PSY4140- W4- Behaviour therapy

4 areas of development of contemporary behaviour

1. Classical conditioning - Ivan Pavlov and his dog -refers to what happens prior to learning that creates a response through pairing. -procedure based on classical cond. is Joseph Wolpe's systematic desensitization- illustrates how principles of learning derived from the experimental laboratory can be applied clinically. Desensitization can be applied to people who, through classical conditioning, developed an intense fear of flying after having a frightening experience while flying. 2. Operant conditioning: -Positive and negative reinforcement, punishment, and extinction techniques, described later in this chapter, illustrate how operant conditioning in applied settings can be instrumental in developing prosocial and adaptive behaviors. Operant techniques are used by behavioral practitioners in parent education programs and with weight management programs. 3. social cognitive theory -involves a triadic reciprocal interaction among the environment, personal factors (beliefs, preferences, expectations, self-perceptions, and interpretations), and individual behavior.

Classical conditioning

Also known as Pavlovian conditioning and respondent conditioning. A form of learning in which a neutral stimulus is repeatedly paired with a stimulus that naturally elicits a particular response. The result is that eventually the neutral stimulus alone elicits the response. -A key figure in this area is Ivan Pavlov who illustrated classical conditioning through experiments with dogs. Placing food in a dog's mouth leads to salivation, which is respondent behaviour. When food is repeatedly presented with some originally neutral stimulus (something that does not elicit a particular response), such as the sound of a bell, the dog will eventually salivate to the sound of the bell alone. However, if a bell is sounded repeatedly but not paired again with food, the salivation response will eventually diminish and become extinct.

Cognitive behavior therapy (CBT)

An approach that blends both cognitive and behavioral methods to bring about change. (The term CBT has largely replaced the term "behavior therapy," due to the increasing emphasis on the interaction among affective, behavioral, and cognitive dimensions). -operates on the assumption that what people believe influences how they act and feel

self-efficacy

An individual's belief or expectation that he or she can master a situation and bring about desired change.

B. F. SKINNER

1904-1990 -father of the behavioural approach -effect of environment on behaviour -he was a determinist- didnt believe we had free choice -feeling and thoughts exist but they dont CAUSE our actions -cause and effect btw objective, observable environment conditions and behaviour -he thought that to much focus has been given to our state of mind and motives which cannot be observed and changed directly. instead little focus had been given to environemntal factors that can be changed and observed -Reinforcement: which he applied to his own life, he would go in a tent and listen to classical music -most of his work was experimental

Self-Management Programs and Self-Directed Behavior

-"giving psychology away." This involves psychologists being willing to share their knowledge so that "consumers" can increasingly lead self-directed lives and not be dependent on experts to deal with their problems. -change can be brought about by teaching people to use coping skills in problematic situations. -strategies include teaching clients how to select realistic goals, how to translate these goals into target behaviors, how to create an action plan for change, and ways to self-monitor and evaluate their actions 1.Selecting goals. Goals should be established one at a time, and they should be measurable, attainable, positive, and significant for you. It is essential that expectations be realistic. 2. Translating goals into target behaviors. Identify behaviors targeted for change. Once targets for change are selected, anticipate obstacles and think of ways to negotiate them. 3. Self-monitoring. Deliberately and systematically observe your own behavior, and keep a behavioral diary in which you record your actions, thoughts, and feelings along with comments about the relevant antecedent cues and consequences. This diary can help you identify what you need to change. 4. Working out a plan for change. A good plan involves substituting new thoughts and behaviors for ineffective thoughts and behaviors. Devise an action program to bring about actual changes that are in line with your goals. Various plans for the same goal can be designed, each of which can be effective. Some type of self-reinforcement system is necessary in this plan because reinforcement is the cornerstone of modern behavior therapy. Discover and select reinforcers to use until the new behaviors have been implemented in everyday life. Practice the new behaviors you want to acquire or refine, and take steps to ensure that the gains made will be maintained. 5. Evaluating an action plan. Evaluate the plan for change to determine whether goals are being achieved, and adjust and revise the plan as other ways to meet goals are learned. Be willing to adjust your plan as conditions change. Evaluation is an ongoing process rather than a one-time occurrence, and self-change is a lifelong practice.

Albert Bandura

-1925 -modeling is a powerful process that explains diverse forms of learning -explored social learning theory and the prominent role of observational learning and social modeling in human motivation, thought, and action -theoretical approach : Social Cognitive Theory - how we function as self-organisations, proactive, self reflective, self regulating beings -broadened the scope of behaviour therapy by exploring the inner cognitive-affective forces that motivate human behaviour -existential qualities inherent in SCT -four areas of research: (1) the power of psychological modeling in shaping thought, emotion, and action; (2) the mechanisms of human agency, or the ways people influence their own motivation and behavior through choice; (3) people's perceptions of their efficacy to exercise influence over the events that affect their lives; and (4) how stress reactions and depressions are caused.

Historical Background

-1950/1960s -contemporary behaviour therapy: many theoretical approaches and theories and many techniques 1960's albert Bandura developed social learning theory which combined classical and operant conditioning with observational learning 1960: cognitive behavioural approaches sprang up focus on representations of the environment rather than on characteristics of the objective environment . 1980's - impact of the practice of therapy. - ^ role of emotions in therapeutic change as well as to the role of biological factors in psychological disorders. -developments of the field: (1) the continued emergence of cognitive behavior therapy as a major force and (2) the application of behavioral techniques to the prevention and treatment of health-related disorders. 1990s's -the Association for Behavioral and Cognitive Therapies (ABCT) 2000's -third generation/third wave of behaviour therapy. -includes dialectical behavior therapy (DBT), mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), and acceptance and commitment therapy (ACT)

operant conditioning technique

-applied behavior analysisis that it offers a functional approach to understanding clients' problems and addresses these problems by changing antecedents and consequences (the ABC model) -we respond in predictable ways because of the gains we experience (positive reinforcement) or because of the need to escape or avoid unpleasant consequences (negative reinforcement). -Positive reinforcement involves the addition of something of value to the individual (such as praise, attention, money, or food) as a consequence of certain behavior. The stimulus that follows the behavior is the positive reinforcer. -a child earns excellent grades and is praised for studying by her parents. -recommended to be used by practitioners -Negative reinforcement involves the escape from or the avoidance of aversive (unpleasant) stimuli. The individual is motivated to exhibit a desired behavior to avoid the unpleasant condition. For example, a friend of mine does not appreciate waking up to the shrill sound of an alarm clock. She has trained herself to wake up a few minutes before the alarm sounds to avoid the aversive stimulus of the alarm buzzer -extinction, which refers to withholding reinforcement from a previously reinforced response. extinction can be used for behaviors that have been maintained by positive reinforcement or negative reinforcement. -An approach to dealing with problematic behavior is to eliminate the connection between a certain behavior (tantrums) and positive reinforcement (attention). In this example, if the parent ignores the child's tantrum-related behaviors, these behaviors will decrease -punishment, sometimes referred to as aversive control, in which the consequences of a certain behavior result in a decrease of that behavior. The goal of reinforcement is to increase target behavior, but the goal of punishment is to decrease target behavior. -therapist dont like using thsi technique -In positive punishment an aversive stimulus is added after the behavior to decrease the frequency of a behavior (such as a time-out procedure with a child who is displaying misbehavior). -negative punishment a reinforcing stimulus is removed following the behavior to decrease the frequency of a target behavior (such as deducting money from a worker's salary for missing time at work, or taking television time away from a child for misbehavior).

dialectical behavior therapy (DBT)

A blend of behavioral and psychoanalytic techniques aimed at treating borderline personality disorders; primarily developed by Marsha Linehan.

mindfulness-based cognitive therapy (MBCT)

A comprehensive integration of the principles and skills of mindfulness applied to the treatment of depression.

Basic Characteristics and Assumptions

-behavior therapy is based on the principles and procedures of the scientific method -characteristic of behavioral practitioners is their systematic adherence to precision and to empirical evaluation.;therapists state treatment goals in concrete objective terms to make replication of their interventions possible. -Treatment goals are agreed upon by the client and the therapist. -therapist assesses problem behaviors and the conditions that are maintaining them. -Evaluation methods are used to discern the effectiveness of both assessment and treatment procedures -deals with the client's current problems and the factors influencing them today rather than analyzing possible historical determinants. -functional assessment, or what Wolpe referred to as a "behavioral analysis." Behavior therapy recognizes the importance of the individual, the individual's environment, and the interaction between the person and the environment in facilitating change. -Rather than simply talking about their condition, clients are required to do something to bring about change. -learning is viewed as being at the core of therapy--> Clients learn new and adaptive behaviors to replace old and maladaptive behaviors. -assumes that change can take place without insight into underlying dynamics and without understanding the origins of a psychological problem.

Therapist's Function and Role

-functional assessment (or behavioral analysis) to identify the maintaining conditions by systematically gathering (A) information about situational antecedents (B) the dimensions of the problem behavior (C) the consequences of the problem. --> known as the ABC model and the goal of a functional assessment of a client's behavior is to understand the ABC sequence. This model of behavior suggests that behavior(B) is influenced by some particular events that precede it, called antecedents (A), and by certain events that follow it, called consequences (C).

Therapeutic Goals

-increase personal choice and to create new conditions for learning. -client, with the help of the therapist, defines specific treatment goals at the outset of the therapeutic process. -a formal assessment takes place prior to treatment to determine behaviors that are targets of change. -Continual assessment throughout therapy -important to devise a way to measure progress toward goals based on empirical validation.

Multimodal Therapy

-is a comprehensive, systematic, holistic approach to behavior therapy developed by the late Arnold Lazarus -applies diverse behavioral techniques from a variety of theories to a wide range of problems.

social learning approach (or the social-cognitive approach)

A perspective holding that behavior is best understood by taking into consideration the social conditions under which learning occurs; developed primarily by Albert Bandura and Richard Walters (1963). -involves a triadic reciprocal interaction among the environment, personal factors (beliefs, preferences, expectations, self-perceptions, and interpretations), and individual behavior. -A basic assumption is that people are capable of self-directed behavior change and that the person is the agent of change. -eg. of social learning is ways people can develop effective social skills after they are in contact with other people who effectively model interpersonal skills. -self-efficacy

Operant conditioning

A type of learning in which behaviors are influenced mainly by the consequences that follow them

progressive muscle relaxation technique

-method of teaching people to cope with the stresses produced by daily living. -achieving muscle and mental relaxation and is easily learned -practice daily -Jacobson (1938) -Clients are given a set of instructions that teaches them to relax. They assume a passive and relaxed position in a quiet environment while alternately contracting and relaxing muscles. -Deep and regular breathing -mentally "let go," perhaps by focusing on pleasant thoughts or images. -instructed to actually feel and experience the tension building up, to notice their muscles getting tighter and study this tension, and to hold and fully experience the tension -relax all the muscles while visualizing the various parts of the body, with emphasis on the facial muscles. -The arm muscles are relaxed first, followed by the head, the neck and shoulders, the back, abdomen, and thorax, and then the lower limbs. -can become a habitual pattern if practiced daily for about 25 minutes each day. -stress and anxiety --The therapist uses a quiet, soft, and pleasant voice to teach progressive muscular relaxation. The client is asked to create imagery of previously relaxing situations, such as sitting by a lake or wandering through a beautiful field. It is important that the client reach a state of calm and peacefulness. The client is instructed to practice relaxation both as a part of the desensitization procedure and also outside the session on a daily basis.

Therapeutic Techniques and Procedures

-must be shown to be effective through objective means. -therapeutic techniques are empirically supported and evidence-based practice is highly valued -therapeutic procedures used by behavior therapists are specifically designed for a particular client rather than being randomly selected from a "bag of techniques."

behaviour therapy

-practitioners focus on directly observable behavior, current determinants of behavior, learning experiences that promote change, tailoring treatment strategies to individual clients, and rigorous assessment and evaluation.

Mindfulness and Acceptance-Based Approaches

-third wave -Mindfulness is "the awareness that emerges through having attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment by moment" -clients train themselves to intentionally focus on their "present experience with acceptance" (Siegel, 2010) and develop an attitude of curiosity and compassion toward present experience. -veterans may be better able to observe repetitive negative thinking and prevent extensive engagement with maladaptive ruminative processes -Many therapeutic approaches are incorporating mindfulness and meditation, as well as other contemplative practices, in the counseling process, and this trend seems likely to continue Acceptance is a process involving receiving one's present experience without judgment or preference, but with curiosity and kindness, and striving for full awareness of the present moment

Consequences

Events that take place as a result of a specific behavior being performed. -a client may be more likely to return to counseling after the counselor offers verbal praise or encouragement for having come in or for having completed some homework. A client may be less likely to return if the counselor is consistently late to sessions.

Antecedent events

Ones that cue or elicit a certain behavior. -trouble going to sleep, listening to a relaxation tape may serve as a cue for sleep induction. Turning off the lights and removing the television from the bedroom may elicit sleep behaviors as well.

behavioral assessment interview

Questioning that enables the therapist to identify the particular antecedent and consequent events that influence or are functionally related to an individual's behavior.

functional assessment/behavioral analysis

The process of systematically generating information on the events preceding and following the behavior in an attempt to determine which antecedents and consequences are associated with the occurrence of the behavior.

mindfulness-based stress reduction (MBSR)

This program applies mindfulness techniques to coping with stress and promoting physical and psychological health.

reinforcement

a specified event that strengthens the tendency for a response to be repeated. It involves some kind of reward or the removal of an aversive stimulus following a response.

Exposure therapies

are designed to treat fears and other negative emotional responses by introducing clients, under carefully controlled conditions, to the situations that contributed to such problems. -either through imagination (used first) or in vivo (live) (second) -Two variations of traditional systematic desensitization are in vivo exposure and flooding.

Systematic Desensitization

based on the principle of classical conditioning, by Joseph Wolpe, -successively more anxiety-arousing situations at the same time that they engage in a behavior that competes with anxiety -Gradually, or systematically, clients become less sensitive (desensitized) to the anxiety-arousing situation-form of exposure therapy -A three-step process is carried out in the desensitization process: (1) relaxation training- as above (2) development of a graduated anxiety hierarchy- ranked list of situations that elicit increasing degrees of anxiety or avoidance. (3) systematic desensitization through presentation of hierarchy items while the client is in a deeply relaxed state.- The desensitization process begins with the client reaching complete relaxation with eyes closed. A neutral scene is presented, and the client is asked to imagine it. If the client remains relaxed, he or she is asked to imagine the least anxiety-arousing scene on the hierarchy of situations that has been developed. The therapist moves progressively up the hierarchy until the client signals that he or she is experiencing anxiety, at which time the scene is terminated. Relaxation is then induced again, and the scene is reintroduced again until little anxiety is experienced to it. Treatment ends when the client is able to remain in a relaxed state while imagining the scene that was formerly the most disturbing and anxiety-producing. -Gradually, they can expose themselves to daily-life situations as a further way to manage their anxieties.

Social Skills Training

broad category that deals with an individual's ability to interact effectively with others in various social situations; it is used to help clients develop and achieve skills in interpersonal competence. -A popular variation of social skills training is anger management training, which is designed for individuals who have trouble with aggressive behavior.

Mindfulness-Based Cognitive Therapy (MBCT)

comprehensive integration of the principles and skills of mindfulness applied to the treatment of eight-week group treatment program of two-hour weekly sessions adapted from Kabat-Zinn's -techniques from MBSR with teaching cognitive behavioral skills to clients -Mindfulness is a way of developing self-compassion, which is a form of self-care when facing difficult situations.

Flooding

either in vivo or imaginal exposure to anxiety-evoking stimuli for a prolonged period of time. -Imaginal flooding is based on similar principles and follows the same procedures except the exposure occurs in the client's imagination instead of in daily life. -In vivo flooding consists of intense and prolonged exposure to the actual anxiety-producing stimuli. -exposure therapies are among the most potent behavioral procedures available for anxiety-related disorders, and they can have long-lasting effects

In Vivo Exposure

exposure to the actual anxiety-evoking events -hierarchy of situations for the client to encounter in ascending order of difficulty. -clients learn responses incompatible with anxiety, such as responses involving muscle relaxation. -a therapist could go with clients in an elevator if they had phobias of using elevators

Eye Movement Desensitization and Reprocessing (EMDR)

is a form of exposure therapy that entails assessment and preparation, imaginal flooding, and cognitive restructuring in the treatment of individuals with traumatic memories. -the use of rapid, rhythmic eye movements and other bilateral stimulation to treat clients who have experienced traumatic stress. -eight phases and a three-pronged methodology to identify and process (1) memories of past adverse life experiences that underlie present problems, (2) current situations that elicit disturbance, and (3) needed skills that will provide positive memory templates to guide the client's future behavior". -dealing with posttraumatic stress disorders

Dialectical Behavior Therapy (DBT)

ooriginally for chronically suicidal individuals diagnosed with borderline personality disorder (BPD) -blend of behavioral and psychoanalytic -analytic therapy, DBT emphasizes the importance of the psychotherapeutic relationship, validation of the client, the etiologic importance of the client having experienced an "invalidating environment" as a child, and confrontation of resistance. DBT treatment includes both acceptance- and change-oriented strategies. Mindfulness procedures are taught to develop an attitude of acceptance =-helping clients make changes in their behavior and environment while communicating acceptance of their current state -Zen teachings and practices to integrate mindfulness and acceptance-based techniques in therapy -Interpersonal effectiveness teaches clients to ask for what they need and how to say "no" while maintaining self-respect and relationships with others.

Client's Experience in Therapy

provides the therapist with a well-defined system of procedures to employ. -receives active homework assignments (such as self-monitoring of problem behaviors) to complete between therapy sessions. Behavior clinicians emphasize that changes clients make in therapy need to be translated into their daily lives. -clients to be motivated to change, and they are expected to cooperate in carrying out therapeutic activities -Motivational interviewing (see Chapter 7), which honors the client's resistance in such a way that his or her motivation to change is increased over time, is a behavioral strategy that has considerable empirical support -it is only when the transfer of changes is made from the sessions to everyday life that the effects of therapy can be considered successful.

Relationship Between Therapist and Client

stress the value of establishing a collaborative working relationship with clients but contend that warmth, empathy, authenticity, permissiveness, and acceptance are necessary, but not sufficient, for behavior change to occur. -The client-therapist relationship is a foundation on which behavioral strategies are built to help clients change in the direction they wish.

Mindfulness-Based Stress Reduction (MBSR)

training program to relieve medical patients of stress, pain, illness, and other forms of suffering. The eight-week structured group program involves training people in mindfulness meditation, and today instructors are often not mental health clinicians. -learning how to live more fully in the present rather than ruminating about the past or being overly concerned about the future.

Application to Group Counseling

treatment principles rooted in classical conditioning, operant conditioning, and social learning theory. -emphasize teaching clients self-management skills and a range of new coping behaviors, as well as how to restructure their thoughts. -A distinguishing characteristic of behavioral practitioners is their systematic adherence to specification and measurement. -The specific unique characteristics of behavioral group therapy include (1) conducting a behavioral assessment, (2) precisely spelling out collaborative treatment goals, (3) formulating a specific treatment procedure appropriate to a particular problem, and (4) objectively evaluating the outcomes of therapy.

Acceptance and Commitment Therapy (ACT)

unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility -involves fully accepting present experience and mindfully letting go of obstacles.