501 Principles of Cognitive and Behavioral Change

Exposure with Response Prevention

(ERP) A type of exposure therapy in which the client is exposed to fearful cues and the therapist prevents escape/avoidance - makes use of both behavioral and cognitive theories. Based on classical and operant conditioning principles (breaking association between CS and CR, reinforcer maintaining behavior removed). To execute - obtain a detailed description of the situation and context of the problem, define explicit behavior, thoughts, and feelings leading up to it and explore consequences. Exposure can be GRADUATED, PROLONGED, IN VIVO or IMAGINAL. Therapist prevents escape/avoidance during exposures and reviews coping mechanisms with client. Used most often for OCD, substance use, eating disorders with binge/purge sub-type. Ex. A person with obsessive-compulsive disorder (OCD) has germ contamination phobia. A typical exposure exercise consists of shaking hands with someone (exposure), and not washing hands afterwards (response prevention).

Cognitive Therapy

. Developed by Beck; evolved into CBT. Focuses on cognitions as the origin of psychopathology. Assumptions: there are links between cognitions and behavior. Cognitive activity is potentially observable, and it can be monitored and altered. Client is considered the expert on their life and experiences and is a collaborator in the therapeutic process. Two main components are BEHAVIORAL ACTIVATION and COGNITIVE RESTRUCTURING. Proposes levels of cognitive distortions: Levels of cognitive distortions (triggered by event) Automatic thoughts: spontaneous thoughts that appear plausible. Includes dichotomous reasoning, personalization, emotional reasoning etc. Assumptions: abstract ideas that have generalized rules; often if-then statements Schemas/Core beliefs: cognitive structures that organize and process info; deepest most ingrained level of cognitions e.g. negative cognitive triad (self, world, future) Type and content are analyzed. Goals: correct faulty information processing, modify beliefs maintaining maladaptive behaviors and emotions, provide skills for adaptive thinking. Techniques: downward arrow, psychoeducation. Focus: more on PRESENT and less on past, pathology and assets, objective data v. projective tests, interventions and evaluation. Important because one of the most strongly empirically-supported treatment protocols used for numerous disorders. Ex. Grad student is contending with heightened anxiety and imposter syndrome. Studying for upcoming comps exam, she is sure she is stupid and incapable of passing. These are automatic thoughts that suggest deeper schemas and core beliefs that maintain these thoughts. Therapists employs downward arrow technique to pinpoint these core beliefs so she and client can work on hypothesizing about them and changing them.

Acceptance and Committment Therapy (ACT)

3rd wave/generation CBT developed by Steven Hayes. Says that psychopathology comes from experiential avoidance and over-control or unwillingness to remain in direct contact with painful experiences (if I ignore it it will go away/can't hurt me). Paradoxically the process of avoiding yields MORE DISTRESS. The primary goal of ACT is to create psychological flexibility through acceptance and mindfulness skills and commitment and behavior change skills. Six Components: (BDASVC) 1) Be here now: Making contact with the present moment. 2) Defusion: Separating/detaching from private thoughts; holding on to thoughts lightly, not tightly. 3) Acceptance: Opening up and making room for all experiences, including so-called unpleasant ones 4) Self-as-context: The observing self determines context and is the entity through which awareness happens. 5) Values: The goals you desire and the activities/beliefs that matter to you. 6) Committed action: Doing what you need to do to move toward and live by your values. Important because it is a newer empirically-supported treatment protocol, effective in treatment of GAD, MDD, OCD, EDs, SAD, Chronic Pain. Ex. Woman suffering from depression and constant anxiety. Been dealing with rheumatoid arthritis for years and condition is worsening. Instead of getting rid of sxs therapist helps client identify values and ways to live with her chronic condition.

Token Economy

A behavior modification system based on basic learning principles; type of contingency management; used to promote desirable behaviors and decrease undesirable behaviors. Clients earn tokens for desirable behaviors and lose tokens for undesirable ones. Exchange the tokens for meaningful objects, privileges, or activities - considered back-up reinforcers (extrinsic). Can be delivered to an individual or a group. Four features: 1) a list of target behaviors with the number of tokens lost and/or earned for performing each must be created 2) list of backup reinforcers with the price for each must created 3) Tokens must be chosen, i.e., are they coins, stickers, stamps, etc.? 4) must have procedures and rules in place for the operation of the system. Advantages: highly convenient because tokens can be given anywhere and anytime; organized, systematic, and fair; and result in increased attention to positive bx Disadvantages: rewards (back-up reinforcers) can be costly; some claim that a token economy is demeaning and considered bribery; also an authority figure must be present

Operant Conditioning

A behaviorist theory of learning attributed to B.F. Skinner, operant conditioning is the use of consequences to modify the occurrence (either increasing or decreasing) and form of a behavior. In other words, a behavior or specific response is either reinforced or inhibited according to the consequences that occur in relation to the behavior. Marked by two general principles: any response that is followed by a reinforcing stimulus tends to be repeated, and a reinforcing stimulus is anything that increases the rate at which a response occurs. Behaviors are strengthened/increased by positive/negative reinforcers and weakened/decreased by positive/negative punishers. Important because it explains why and how reinforcers/punishers affect the learning process, and how schedules of reinforcement can impact behaviors - used in treatment. Ex. Teen client tries smoking in a group of friends. Experiences positive reinforcement of getting to hang out with people they like, perceived as cool, nicotine producing dopamine, etc. Teen continues smoking. Parents catch the teen and give him extra chores around the house so he has no down time to be around those friends (positive punishment). He is unlikely to try it again.

Reciprocal Determinism

A model by Albert Bandura; describes the three way interaction between the person, the behavior, and environment. A person's behavior both influences and is influenced by the personal factors and the social environment. The person, behavior, and environment all influence and are influenced by one another. Has important implications for personal freedom. If a person is not convinced of their own agency (outcome expectations) for making change then can develop learned helplessness. Our behaviors are not rigidly controlled by external forces. We can change or create the factors that influence our behaviors. Ex. Sarah enters therapy with symptoms of depression due to the unbearably crushing nature of the current political environment in the United States. Therapist informs Sarah of reciprocal determinism and how there is a dynamic relationship between Sarah's thoughts, her environment, and her behavior. External factors shape our behavior but we also have choices. She works with Sarah to come up with ways that she can feel a sense of agency in the political environment (volunteering with voter registration, etc.), which will then influence her thoughts about the current situation and the behavioral aspects of her depressive symptoms. Sarah is Abigail. But Abigail is not living this lesson for now.

Reversal Design/ABA

A single-subject research design that systematically introduces and withdraws treatment (the independent variable) to see what happens to target behavior (the dependent variable). That is, does the target behavior "reverse" to levels observed in the initial baseline phase? Reversal design requires at least three consecutive phases: Initial baseline (A), intervention phase (B), and return to baseline conditions (A) to determine the efficacy of the intervention. The purpose of the reversal phase is to determine whether the behavior would have remained unchanged if the intervention had not been introduced. If the treatment is responsible for the change in the target bx, then the target bx will return to near baseline levels when the therapy is withdrawn in the treatment reversal phase. Limitations: Lack generalizability. Only useful when behavior is maintained by external factors. Withdrawal of tx may be unethical. Learned skill(s) may not be able to be unlearned/is not appropriate when independent variable cannot be withdrawn. Called single subject because each subject is his or her own control. Important because provides significant and quick feedback in regards to impact of intervention. Important because it is a commonly used and powerful form of research. Ex. Behavioral researchers investigating the impact of positive reinforcement via token economy in 1st grade-age students. Gather a baseline of information regarding student outbursts in the classroom. Implement positive reinforcement intervention and gather data. Remove token economy. Outbursts return.

Cue Exposure Therapy

A specialized form of exposure with response prevention, often used for substance use disorders, OCD, and eating disorders. Client is exposed to a cue for eating/substance abuse/obsessive thoughts but is unable to eat, use drug, or engage in compulsions. Goal is to decrease responsiveness to cues. Based on Pavlov's classical conditioning, specifically EXTINCTION theory. Initial sessions consist mostly of repeated cue exposure; cravings will subside based on presentation of conditioned stimulus WITHOUT unconditioned stimulus. Later sessions consist of cue exposure with coping/social skills as alternative responses. Ex. Treating a client with binge eating disorder. You are working to decrease her urge to binge when presented with desired binge foods. Present her with her favorite binge snacks WITHOUT allowing for binge behavior. By preventing her from engaging in binging, you are working to break the association between having snacks around and binging. Later sessions consist of coping and social skills, i.e. alternative responses to binging (having only a couple of Oreos instead of the whole package).

Exposure Therapy

A technique used in CBT to help patients confront fears/anxieties by Taylor and Wolpe. Works by enhancing processing of feared stimuli by helping client face their fear, helping client learn that they can tolerate distress and that their expectations of the stimuli are inaccurate, allowing client to gain control of their fear and stop restricting their lives around the fear (building self-efficacy). Based on respondent and operant conditioning (something paired with scary event and now client fears it/avoidance reinforcing the fear). Two central features: anxiety MUST be induced during exposure to the stimulus. Client MUST remain in the anxiety-provoking situation long enough for their discomfort to peak and begin to decline to prevent cognitive avoidance, generally rule is a 50% reduction in SUDS. Types of exposure: in vivo, virtual reality, imaginal, prolonged, or graduated. Can include the use of a competing response. Cognitive processing is very helpful and is often thought of as the crucial component (deconstruction of thoughts that occur in response to stimulus). Criticisms: high dropout rate, can exacerbate symptoms. Used for specific phobias, PTSD, OCD, anxiety disorders. Specific techniques include systematic desensitization, flooding, interoceptive exposure (for panic disorder), cue exposure, exposure with response prevention. Important for use in treating phobias, anxiety-related conditions, PTSD, OCD, etc. Ex. Treating a client who is afraid of dogs. Even seeing a picture of a dog on Instagram stresses them out. Seeing dogs in person (which is like, everywhere) results in a significant fear response/need to leave the situation immediately (high SUDs). Using graduated exposure, imaginal, and in vivo, you are going to work your way to his being in the presence of a dog, maybe even petting one.

Automatic Thought

A term coined by Aaron Beck and part of his cognitive therapy theory, these are spontaneous thoughts that appear plausible and often occur in response to an event or situation (trigger) such as hearing a noise outside your window ("someone is breaking into my house"). Can include cognitive distortions such as dichotomous (all or nothing) thinking, overgeneralization, minimization, personalization, etc. Automatic thoughts can become persistent and intrusive to the point of becoming maladaptive, and they must be challenged. In Beck's cognitive therapy, the patient and therapist identify, categorize, and monitor dysfunctional automatic thoughts. The patient is taught to consider automatic thoughts as HYPOTHESES TO BE TESTED (what proves this is true?). Downward arrow technique explores underlying assumptions and schemas related to automatic thoughts; meant to help pt recognize how their core beliefs affect them. Important because automatic thoughts can become maladaptive and help lead to psychopathology, can reveal deeper schemas that maintain behaviors/disorders. Ex. Client recently started graduate school. Client is distressed that no one in her cohort likes her/won't talk to her. Automatically thinks in response to classmates not saying hello to her, not seeking her out to be in study groups, etc. She says no one has liked her or ever liked her. As a therapist conducting Beck's cognitive therapy , you would view this is an automatic thought riddled with absolute thinking and jumping to conclusions. Your next step might be utilizing the downward arrow technique to get at the deeper schema/core belief.

Spontaneous Recovery

A term relating to classical conditioning, an occurrence where an extinguished conditioned response reappears. The reappearance of a conditioned response that had been extinguished. This period is called spontaneous because the response seems to reappear unexpectedly. Discovered by Pavolv in his classical conditioning studies; a phenomenon of learning and memory; refers to the re-emergence of a previously extinguished conditioned response after a delay. After extinction & time interval, Conditioned Stimulus again is able to elicit Conditioned Response. Important because the phenomenon demonstrates that extinction is NOT the same thing as unlearning. While the response might disappear, that does not mean that it has been forgotten or eliminated. Thinking in terms of clinical application, important phenomenon to understand in relation to working with those working to extinguish maladaptive behaviors like substance abuse. EXAMPLE

Imaginal Exposure

A type of exposure therapy in which the client is asked to imagine feared images or situations. Can be gradual (short period, climb fear hierarchy) or prolonged (a long period of high intensity, hit those high level SUDs right away). Exposure is done via imagining scenes or discussing event repeatedly. Can help in relation to cost. Opposite of in vivo. Some types of phobias and traumas only compatible with imaginal exposure. Important because useful therapeutic technique of exposure therapy that can be more cost and time-effective than other strategies or forms of exposure therapy. Ex. Client with PTSD who has extreme fear of IEDs/explosives from time served in Iraq. Unlikely to encounter such an experience at home, he is trying to "fix" this problem so he can get back to work (another "battlefront" tour). Because you cannot fly with him to Iraq, you decide that imaginal exposure is the best route. You will ask him to repeatedly describe the traumatic event so that his anxiety spikes and then subsides.

In Vivo Exposure

A type of exposure therapy in which the client's exposure is implemented in the client's natural environment, using actual objects/situations in a safe environment. Can be gradual (short period, climb fear hierarchy) or prolonged (long period of high intensity). Opposite of imaginal. Typically produces quicker results but may face more resistance and require more time. Ex. You're working with a client that has an intense fear of snakes. After discussing it with the client, you both agree that in vivo exposure is the way to go. You start with imaginal exposure to ease in. You instruct the client to handle a snake for increasing amounts of times in the next several sessions as part of the treatment for the phobia.

Behavior Therapy

A type of psychotherapy that uses principles of classical and operant conditioning to reduce maladaptive behaviors & to increase adaptive behaviors based on directly-observable behavior. Pavlov, Wolpe, Watson, Jones, Skinner all contributed to the early development of Behavior Therapy. Behavior therapy began in response to the unscientific nature of psychoanalysis. BT focus is on the behavior itself and the contingencies & environmental factors that reinforce or maintain the behavior, rather than exploring the underlying causes of the behavior. In contrast to psychoanalysis it is scientific, active, present-focused, and learning-focused. BT is individualized, generally brief tx comprised of controlled, quantitative experiments. Aims to be evidence-based and structured. Client is the change agent and responsible for implementing techniques, but therapist-client relationship is not a sufficient condition for successful tx - tx techniques are most important. Important because many EBTs are based in behavior therapy. Ex. Second grade boy brought to therapy for ODD. Therapist uses principles of behavior therapy to reduce undesired behavior of yelling at adults when he is angry. The therapist talks to John about his anger and suggests that rather than yelling at his peers or adults when he feels angry, that he instead take a moment and think about something that makes him happy (playing video games) and take 3 deep breaths. This suggestion is meant to replace John's maladaptive bx.

Assumptions

Abstract ideas that have generalized rules; often if-then statements. Things that you consider to be true beyond proof. May affect process of attention, concentration, memory while learning. Emotions and attitudes this prior knowledge triggers may move you to consider certain evidence as true over others. Important because highlights how individuals might view the world/basic mechanisms that are upholding maladaptive thoughts and behaviors. Ex. Client thinks her new boss hates her. "If he is not smiling or offering praise then he is displeased with my performance." Therapist points out that client might be making assumptions based on existing beliefs or previous experiences. What proves this assumption to be true?

Multiple Baseline Design

An experimental design in which a single transition from baseline to treatment (AB) is instituted at different times across MULTIPLE CLIENTS, BEHAVIORS, or SETTINGS (situations/conditions). Treatment is sequentially introduced for each permutation of the variable after baseline measurements have been taken. 3 types: -Across target behavior (e.g., different fears) -Across clients (e.g., several case studies) -Across settings (e.g., school vs. home) Useful when can't do an ABAB design (ethics of removing tx, can't unlearn intervention, etc.). Similar limitations of generalizability due to single-subject design. Important tool to help understand how particular interventions might affect a client/situation, helps avoid some of the ethical and logistical problems with reversal design. Ex. Joe has OCD and engages in excessive hand washing behavior. You want to study the impact of behavior therapy with Joe and see the effectiveness of the treatment, but you can't make him unlearn the behavior therapy (a la reversal design). Instead you include Sue and Dave, who have similar symptoms, in your study. Data is collected until an established baseline for each. Introduce BT at staggered intervals and note effects for each client. If everyone stays at their respective baseline until intervention is introduced we can be relatively sure that symptom reduction/behavioral change results from the intervention and not some uncontrolled variable or noise. This is a multiple baseline across subjects design.

Cognitive Fusion

Associated with ACT. The state of mind in which a person is so fused with their thoughts that they consider them to be SYNONYMOUS WITH FACT. Tendency to take thoughts literally. Can contribute to psychopathology and maladaptive symptoms/behaviors. Causes person to focus attention on the contents of their mind (thoughts, memories, assumptions, beliefs, images, etc.) rather than what they are experiencing IN THE MOMENT (through the five senses). Person then makes decisions and takes action based on their internal experience rather than what is actually happening. ACT helps client achieve DEFUSION, where they can observe thoughts and see them for what they are - that they may or may not be true, and may or may not reflect the physical world around them. Important because cognitive fusion can lead to and serve as a mechanism for maladaptive behaviors, leading to psychopathology. Defusion is a necessary mitigator against cognitive fusion. Ex. A client is struggling with cognitive fusion in that when she has a thought of "I am stupid" or "He thinks I'm stupid", the client actually believes that she is stupid. The therapist helps the client to recognize the thoughts of "I am stupid" or "He thinks I'm stupid" as thoughts and not fact. Therapist explains to the client that just because she thinks it, that doesn't mean it's true.

Systematic Desensitization

Based on Classical Conditioning principles; an exposure therapy consisting of three components: RELAXATION TRAINING, ANXIETY HIERARCHY, and PAIRED PRESENTATIONS of relaxation and anxiety hierarchy. Step 1 consists of teaching the client a competing response behavior that competes w/ anxiety; most common one progressive muscle relaxation; imagery can also be used. Step 2 consists of making the anxiety hierarchy - a list of events that elicit anxiety, ordered in terms of increasing intensity. Created by client using SUDs, ranging from 1 to 100 or 1 to 10. Step 3 is the actual desensitization. The client is told to relax all muscles in his/her body and imagine the lowest item on his/her hierarchy for 10 to 15 sec; told to signal if he/she experiences any anxiety or discomfort. If that signal is given, the client is told to stop visualizing and relax. Once relaxed, he/she imagines the scene again. After 3 or 4 trials of presentation without anxiety, the client is told to move to the next item on his/her hierarchy. Used to treat specific phobias, anxiety disorders, PTSD Mostly imaginal exposure? Ex. A client comes in with anxiety over riding elevators. She works in a large office building where taking an elevator is necessary, yet her fear has prohibited her. Anna and her therapist create an anxiety hierarchy to help. Then use systematic desensitization in which she first learns relaxation techniques and then begins facing her fears in vitro, working from least anxiety provoking (waiting in line for elevator) to most anxiety provoking (letting elevator doors close and riding it)

Behavior Activation Therapy

Based on Lewhinson's theory of depression that says depressed individuals tend to engage in increasing avoidance and isolation, which serves to maintain or worsen their symptoms. Physical and emotional symptoms make you not want to get out of bed, leave the house, etc., which negatively reinforces the feelings of isolation and loneliness. The goal of treatment is to work with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in pleasant activities. Activities are typically things enjoyed before depression, activities related to values, or even everyday items that get pushed aside, such as exercising, going out to dinner, learning new skills, showering regularly, completing chores. BAT occurs via: -Self-monitoring of activities and mood -Scheduling Activities -Mastery and pleasure ratings Ex. Client (age 22) comes in with symptoms of moderate to severe depression. Always tired, stays in bed or on the couch all day rewatching the same TV shows. Doesn't want to do anything and has a hard time taking care of self. Therapist proposes small/attainable activities to implement (a five minute walk to check the mail each day). Check in during session, monitor and adjust and add to behaviors as improvement occurs.

Conditioned/Unconditioned Responses

CR/UCR: Part of classical/respondent conditioning; the unconditioned response (UCR) is the individual's response to the unconditioned stimulus (UCS) which occurs without any conditioning. The conditioned response (CR) is the learned response to the conditioned stimulus (CS), basically the CR and the UR are the same response. Ex. Client presents problem of phobia of the dark. Client was sexually molested as a child on many occasions by father in darkened bedroom. The molestation (UCS) elicited a fear response (UCR), which came to be associated with darkness (CS), thereby eliciting the same response in any darkened space (CR = fear of the dark).

Problem-Solving Therapy

Cognitive-behavioral coping skills therapy in which clients use a series of systematic steps for solving a problem for which they specifically have sought treatment. Goal is to treat the immediate problem and teach skills to deal with future problems. Six steps: 1. Problem identification and description: clarify problem, identify obstacles, determine functional impairment, ABCs 2. Identification of goals: set goals, review antecedents, determine consequences of goals; situation vs. reaction focused goals 3. Generate solutions to achieve goals: be creative, no criticism, withhold judgment, entertain even bizarre solutions, refine and integrate 4. Decision making: identify consequences/outcomes (short & long-term) of solutions, cost-benefit of each, rank-order solutions 5. Implementation of solution/follow-up 6. Evaluate effectiveness Factors that impact effectiveness: Learning of problem-solving skills Application to real-life problems Benefiting from their application (i.e., solving the problem). Important because is a good quick behavioral approach to therapy in relation to time constraints and those in dire need of solutions NOW to help with particularly maladaptive behaviors. Ex. Caroline came to see you because she has been experiencing tiredness, sadness and loss of interest in both her job and her friends. She talks about her biggest problem being a disconnect with her daughter Anne (22 yo) that she hasn't spoken to for 3 years. Using PST you help her address this problem. As Caroline talks through the problem she is able to clarify the major problem as a concern regarding Anne's safety. While she would like the relationship restored, she identifies her goal as finding out if Anne is okay. You help her brainstorm a number of solutions. She decides to reach out by sending her a special birthday card. She feels empowered experiencing a sense of being able to do something to address one of her problems. Follow up in 10 days is arranged to assess outcome.

Individual and Group Contingency

Contingency management refers to a type of behavior therapy in which person(s) are reinforced or reward for evidence of positive behavior change. Individual/Group are forms of contingency management that emerged from behavioral therapy and are used in token economies. INDIVIDUAL (only specific individuals are involved in the token economy), GROUP (reinforcement related to satisfying a group contingency; depends on all members to satisfy contingency - promotes peer interaction and influence). Important because help enhance retention and decrease likelihood of recurrence of negative behavior. Often used in substance use/abuse. Ex. At the treatment center if the recovering alcoholic attends an AA meeting every day, he receives a token at the end of the week and he can use it to be exempted from clean-up duty. This is an example of a token economy with an individual contingency. The backup reinforcer is being able to skip out on clean-up duty. Another might be monetary compensation for drug-free urinalysis on a weekly basis. Also an individual contingency.

Social Skills Training

Defined as the ability to emit behavior that is positively reinforced by others and minimize behavior that is punished by others. SS components include eye contact, smiles, attention to other, listening, affect, gestures, etc. Lack of social contact/withdrawal and social skill deficits are hallmarks of certain diagnoses (schizophrenia, depression, social anxiety). Absence of SS is correlated with an array of problems in children and adolescents (social isolation, poor academic achievement, delinquency), and adults (depression, social anxiety, social isolation). Social Skills training (SST) is a type of behavior therapy used to improve SS in people who have difficulties relating to others; increases social competence. Might utilize modeling, instruction, shaping. Used for young children beginning school or other social interactions, also for those with antisocial, ADHD, social anxiety, bipolar, schizophrenia, etc. Ex. A 14 yo enters therapy because he doesn't have any friends his age. He usually interacts with children 5 years younger than him. He has trouble engaging in simple conversations with his peers. Sherman begins social skills training in which the therapist provides rationale for certain skills and then models these skills for Sherman. Sherman then rehearses the skill with the therapist (role-play) , and after becoming proficient in that, his homework is to apply the skill with his peers. The training focused on asking appropriate questions, maintaining appropriate eye contact, and acting in a warm & friendly manner.

Classical/Respondent Conditioning

Developed by Ivan Pavlov; a form of associative learning in which an unconditioned stimulus (US; that naturally and automatically produces a response) is repeatedly paired with a conditioned stimulus (CS; a previously neutral stimulus) in order to evoke an unconditioned response (UCR; an unlearned natural response/reaction). Eventually, the US is removed and the CS comes to elicit the CR on its own. Principles emphasized and utilized in Behavior Therapy. CR is stronger if: CS precedes UCS by short vs long time. Phases of conditioning: acquisition, extinction, spontaneous recovery, reconditioning, and counterconditioning. Important because emphasizes the ways in which we learn from our environments, and can help us understand how certain behaviors, addictions, phobias, etc., work and are maintained. Ex. Pam comes to therapy complaining of phobia of the dark. She tells the therapist that, when she was little, she was sexually molested by her uncle, who would come to her room when it was completely dark. The therapist hypothesized that classical conditioning played an important role in the acquisition of her phobia: the molestation (US), which elicited fear (UR), came to be associated with the dark (CS), which then elicited the same response (CR).

Differential reinforcement or Other Behavior (DRO)

Differential reinforcement is reinforcing one behavior and putting other behaviors on extinction. When the behavior is not happening, you deliver reinforcement. A procedure that uses differential reinforcement to decrease/eliminate a target behavior. In this schedule, reinforcer is delivered after an interval of time in which the problem behavior DOES NOT occur. Based on operant conditioning principles. Reinforcement is contingent upon the ABSENCE of the problem behavior - but you do not identify an alternate behavior to reinforce, you simply reinforce all other behaviors. Goal is to DECREASE target behavior. The other behaviors are often INCOMPATIBLE with the target behavior. Can be time consuming - other schedules: DR of low rates of responding (DRL) and DR of alternative behaviors (DRA). Important b/c is part of operant conditioning and explains how we reinforce and maintain behaviors. Ex. A child has a problem with throwing tantrums when they don't get their way. Parent provides no punishment or other reinforcer when child screams. When the child is NOT screaming, the parent offers positive praise for reinforcement, in hopes to eventually make screaming/tantrum behavior extinct.

Learned helplessness

Discovered by Seligman and Maier, exposure to frequent UNCONTROLLABLE punishment produces apathy, passivity, and depression. A condition in which a person suffers from a sense of powerlessness, arising from a traumatic event or PERSISTENT FAILURE TO SUCCEED. Behavior exhibited by a subject after enduring repeated actual or perceived aversive stimuli over the outcome of a situation. i.e. ****ing everybody because we have zero gun control in this godforsaken country. It is thought to be an underlying cause of depression for some/for other mental disorders. Important because explains the mechanisms behind depression and related mood disorders. Ex. What's the point? A person is trying to climb out of a depressive episode. Faces an endless barrage of negative news. Can't get out of bed. Keeps failing at doing the most basic things like brushing teeth so why bother at all? Therapist starts with gentle behavioral activation to try to dig out of this hole.

Parent-Child Training Therapy

Family intervention therapy with goals of improving the parent-child relationship and the parent's behavior management. Therapist teaches parents to work with their child positively, set appropriate limits, to act consistently, be fair with their discipline, and to establish more appropriate expectations regarding the child. Also teaches the child better social skills; ideally strengthening the relationship improves the child's behavior. Parent Child Interaction Therapy (PCIT) problem bxs age 2-7 developed by Eyberg Accomplished in 2 phases: 1) child directed interactions to increase parental responsiveness and establish a secure and nurturing relationship 2) parent directed interactions works on improving parental limit setting and consistency in discipline. Typical child target behaviors: high rates of opposition, defiance, whining, hitting, yelling, non-compliance. Typical parental problem behaviors: excessively critical, threatening, and nagging behavior; low level of Sr+ for appropriate behavior

Fixed v. Variable

Fixed schedules of reinforcement elicit either a break and run pattern of behavior or a scalloped pattern of behavior. A fixed interval schedule has a lower response rate (slope) than a fixed ratio schedule. Variable schedules of reinforcement elicit more consistent behavioral responses. A variable ratio schedule has a higher response rate (slope) than a variable interval schedule.

Reinforcer

In operant conditioning, a consequence that strengthens a behavior and increases the frequency of the behavior. IMMEDIATE consequence that results in the strengthening of a behavior. The ability of the reinforcer to increase a behavior is through the addition of something pleasant (positive) or the removal of something unpleasant (negative) in response to a behavior. Typically reinforcers are more successful in small immediate contingencies as opposed to large delayed ones. Reinforcers can be primary - food/water or secondary - praise, tokens, money. Important because is a key component of operant conditioning in behavioral therapy in helping rewrite behaviors in people. Ex. The counselor used a positive, secondary reinforcer (star stickers) to reward her 6-year-old client each time he successfully completed homework. The counselor noticed after implementation of the reinforcer, the client consistently completed homework each week and looked forward to receiving the sticker.

Intermittent Reinforcement

Intermittent reinforcement: only some of the occurrences of the target behavior are reinforced. Interval schedules provide reinforcement after a response occurs after a certain time period. This time period can be fixed or variable. Fixed Interval schedules produce an accelerated rate of response as the time of reinforcement approaches. Ex: Students' visits to the university library show a decided increase in rate as the time of final examinations approaches. Variable Interval schedules produce a steady rate of response. Ex: Presses of the "redial" button on the telephone are sustained at a steady rate when you are trying to reach your parents and get a "busy" signal on the other end of the line.

Assets

Interrelated experiences, skills, relationships, values, that a client does well and brings to therapy. Assets can be internal (such as commitment to learning, positive values, and social competencies) and external (such as support, empowerment, boundaries, and expectations). Can be systematically used to overcome behavioral problems. Ignored in traditional DSM assessment due to focus on impairment and distress/dysfunction. Examines the client's repertoire of behaviors they already have. Assets are important in forming a thorough case conceptualization that is not built solely on symptom reduction. Ex. You have a client that is struggling with debilitating social anxiety. He comes in because he is worried about going off to college next year; he frequently skips class now and knows that this will become a problem. During the assessment you've uncovered the fact that he has a very strong commitment to learning. This is an asset of his that you plan on using to help overcome some of his class skipping bxs.

Learning-Performance Distinction

Learning refers to relatively permanent changes in knowledge or behavior. Performance, on the other hand, refers to temporary fluctuations in knowledge or behavior that can be measured or observed during (or shortly after) instruction. Learning is long term, performance is short term. A concept in behaviorism that stresses the difference between the learning of a behavior and actual performance of the behavior. Learning/acquisition is primarily an internal cognitive process requiring attention and retention - it is a change in the ability and potential to do the behavior. In contrast performance is primarily an external process that requires reproduction and motivation. Tolman's animal studies helped theorize that rewards seem to affect performance over learning (concept of latent learning, not motivated to actually perform). Important because highlights the interaction between behavior and cognition in activating particular human behaviors. Ex. Client comes to therapy with issues of self-esteem and anxiety over talking to their peers at work. Therapist teaches client assertiveness and social skills. The therapist is aware of the learning performance distinction, and is sure that after modeling behavior himself, the client is given an opportunity to reproduce the new learned behaviors. Therapist wants client to PERFORM the behaviors to exhibit LEARNING and mastery of a particular skill.

Motivational Interviewing

NOT a comprehensive protocol of psychotherapy, but rather a specific method for addressing a particular clinical situation in which the client is AMBIVALENT about a particular behavior change. Three essential elements: 1) It is a type of conversation about change (listening and questioning) 2) It is collaborative 3) It is evocative- seeks to call forth person's own motivation and commitment. Might employ a decision balance matrix. Therapist utilizes empathic listening, doesn't extol merits of behavior change, actively elicits +/- of status quo vs. change from patient, & is accepting of patient (UPR). Therapist role is directive, with a goal of eliciting self-motivational statements and behavioral change from the client. Commonly used for substance abuse and eating disorders. Ex. You have a client who has moderate alcohol use disorder. Their drinking has made them late to work several times in the past few weeks, missing family obligations, decreased functionality overall. The client doesn't see their use as an actual problem and is only there at the behest of his wife. You employ motivational interviewing strategies like the Decision-Balance Matrix to help them address the pros and cons of staying the same, versus how life might change if they reduce their drinking.

Outcome v. Process Research

Outcome research attempts to evaluate the effectiveness of TREATMENTS. Individual client research designs: case studies, multiple baseline studies, etc. Large scale research design: experimental design/randomized controlled trials. Process research attempts to understand the MECHANISMS of change i.e. dismantling studies Important implications for clinical practice, including what types of txs should be used and how those txs should be provided. Studying whether the treatment actually works first then studying the why behind it. Ex. Researchers are conducting an Outcome Research Study on the effects of Exposure Therapy with Response Prevention in a group of alcoholics in order to identify the treatment as being effective or inadequate. If found to be effective, additional process research may be conducted to understand the underlying mechanisms of change.

Efficacy expectations

Part of Bandura's self-efficacy theory that says people have a wide variety of beliefs and expectancies of self, others, world, etc., that are determinants of their behavior. There are two types of expectancies: Outcome, belief that a behavior will produce a particular outcome, and self-efficacy, belief that one can perform a given behavior successfully or master a situation. Related to a person's locus of control. Ex. A person who is struggling to manage a chronic illness and feels they are not equipped to function normally in life. Therapist knows that performance and successes are an influential source of efficacy expectations, which can help the client live more effectively with their illness. Therapist works with client to come up with examples of when they felt confident that they can get back on track and improve their health by working hard and following their doctor's recommendations. This process increases the client's sense of self-efficacy that they can live and thrive with the condition.

Self Efficacy

Part of Bandura's self-efficacy theory; Self Efficacy is a belief that one can perform a given behavior successfully or master a situation. Related to person's locus of control and fundamental to behavior change. Self-efficacy or skill? - When SE (self-efficacy) is manipulated and skill is equal, SE predicts behavior. Is situation-specific and not an overall trait. Determinant of behavior initiation, maintenance, and energy expenditure. Can be increased via modeling and skills therapy. Influences a person's goals. Outcome expectations are an individual's belief that a particular course of action will ultimately produce a certain outcome. May influence whether a person puts themselves in a certain situation or not. Outcome expectations are important for motivation to change and can be either positive or negative. Ex. Client seeks treatment because his lack of social skills was affecting his job performance. He never thought he would be successful at it (outcome expectation) so he stopped trying to talk to his supervisors/coworkers and now he may lose his job. Therapist used vicarious experience (he watched models talking to "supervisors") as well as Actual Performance (role playing with the therapist) to build his self-efficacy surrounding his social skills.

Outcome Expectations

Part of Bandura's self-efficacy theory; an individual's belief that a particular course of action will ultimately produce a particular outcome. May influence whether a person puts themselves in certain situations or not. Important in motivation for change of behaviors. Can be positive or negative ("I will get better"/"I'll never get better"). Ex. A client with self esteem issues fears going to job interviews because his outcome expectations are that he will never be chosen because he is not good enough/not qualified enough. The therapist works with him to explore the origins of this belief.

Modeling

Part of Bandura's social learning theory; also referred to as vicarious/observational learning - learning that occurs through observation of other people's behaviors and consequences. Accounts for a large amount of human learning. 4 Modeling Steps: attentional, retentional, reproduction/performance, & feedback/motivation. Types of modeling: live, symbolic (TV/books), and covert (imagining). Utilized in Self-Instructional Training. Also useful when teaching certain skills. Important because tested part of social learning theory and a useful technique in working with clients. Ex. You have a client with social anxiety. They share that they have a hard time connecting with others, engaging in social conversations, etc. This lack of skill provides significant distress and they are starting to avoid social situations altogether. You employ the use of modeling social strategies like engaging in casual conversation to help them increase their skills.

Reactivity of Self-Monitoring

Part of Bandura's social learning theory; self-monitoring is the procedure by which individuals record the occurrences of their target behaviors. Monitoring a behavior typically causes it to change in the desired direction. In addition to providing a source of data, it is also used as a therapeutic strategy because it often causes reactive behavior changes in response frequency. When self-monitoring increases, corresponding reductions in undesired behaviors often occur without direct intervention. In other words, a person behaves better when being observed, even if it's by themselves. Important because highlights a person's ability to exhibit self-awareness. Also is therapeutic in that it starts leading toward desired behavior. Ex. Susan talks with her therapist about her concerns with her drinking, which has greatly increased during the COVID-19 pandemic. Her therapist assigns her to self-monitor her drinking between now and next session to get a better understanding of this problematic behavior. Based on reactivity to self monitoring, Susan finds that she drinks less wine throughout the week (less than her usual bottle of wine a day) and reports this in her next session.

Schema

Part of Beck's cognitive theory; cognitive structures that organize and process information; deepest, most ingrained level of cognition. Also called core beliefs. Types vs. content of core beliefs: types are things you feel about yourself. An example would be the cognitive triad (CBT triad) where the self = I am helpless and inadequate; the world = the world is full of insurmountable obstacles; and the future = I am worthless so there's no chance of the future being better than the present. Content of core beliefs are like abandonment/ instability; mistrust/ abuse; emotional deprivation; defectiveness/shame. These are core values that we hold to ourselves.. Can be revealed using downward arrow technique. Important because establishes the basis of cognitive therapeutic processes. Ex. A grad student is experiencing feelings in line with the cognitive triad. She feels that she is stupid and worthless, that the future is hopeless and has no meaning, and that the world is currently an absolute dumpster fire. So what is the point? Her therapist uses downward arrow technique to identify the student's core beliefs, or schemas, that are helping maintain the cognitive triad automatic thoughts and therefore her depressive symptoms.

Schema

Part of Piaget's theory of cognitive development; the basic building blocks of knowledge or a way of organizing information; shapes how one sees and responds to the world; become more numerous and elaborate with age; sometimes accommodation is needed if the existing schema does not work and needs to be changed to take on new info; when new objects or info do fit into existing schema it is called assimilation. Important because schemas help us quickly put information within a frame of reference, important to understand how they work in that assimilation and accommodation come into play in various forms of psychotherapy in rewriting existing schemas of self. Type and content are analyzed in cognitive therapy. Ex. A parent brings their child into therapy who is young and unsure of what to expect or what will be expected of him by the therapist. Due to assimilation, the child viewed the therapist as an authority figure. That is, the child used his/her existing schema or knowledge to understand what the therapist is

Schedules of Reinforcement

Part of Skinner's operant conditioning, precise rules that are used to present or to remove reinforcers or punishers following a specified behavior. rule that dictates which occurrences of a behavior will be reinforced. Two basic schedules, continuous reinforcement: behavior is reinforced EVERY TIME. Continuous reinforcement is most useful when client first learning to engage in target behavior. Once established usually switched an intermittent schedule. Intermittent schedules enhance transfer, generalization, and long-term maintenance. Continuous is EVERY TIME. Intermittent follows particular schedules: Interval or Ratio. Interval schedules require a minimum amount of time that must pass between successive reinforced responses (e.g. 5 minutes). Responses which are made before this time has elapsed are not reinforced. Interval schedules may specify a fixed time period between reinforcers (Fixed Interval schedule) or a variable time period between reinforcers (Variable Interval schedule). Ratio schedules require a certain number of operant responses (e.g., 10 responses) to produce the next reinforcer. The required number of responses may be fixed from one reinforcer to the next (Fixed Ratio schedule) or it may vary from one reinforcer to the next (Variable Ratio schedule). Extinction is also an important schedule of reinforcement, in which the reinforcement of a response is discontinued. Discontinuation of reinforcement leads to a progressive decline in the occurrence of the previously reinforced response. Ex. A couple brings their child in to a counselor due to violent behavior towards peers and younger sibling. Therapist suggests they start with a Continuous Reinforcement Schedule which would reinforce his adaptive behavior (playing nicely with his sister) every time he performed them. This is most useful when a child is first learning a behavior such as sharing toys.

Primary/Secondary Reinforcer

Part of Skinner's operant conditioning; a primary reinforcer is something that is naturally reinforcing without its value being taught- e.g. food, sex, sleep. Secondary reinforcer is one which has a value that has to be taught or learned, frequently through association with a primary reinforcer e.g. money, tokens, approval, etc. Important to differentiate between the types of reinforcers that can be utilized in leading to behavioral change. Ex. A token economy is used with a young boy who exhibits outbursts in the classroom. He earns tickets (secondary reinforcer) and once he earns enough tickets he gets to have a pizza party with his school counselor (primary reinforcer).

Punishment

Part of Skinner's operant conditioning; in general punishment decreases a behavior's frequency. The addition of a punishment OR the removal of something desirable results in a reduction of a behavior. -Positive punishment: the addition of an aversive stimulus that decreases bx -Negative punishment: the removal of a desirable stimulus that decreases bx Extinction may take hours or days if maintained on intermittent schedule, punishment effect is instant. Used in aversive control: the use of an aversive outcome, such as punishment or negative reinforcement, to control behavior, and eliminate undesirable behavior. Disadvantages/difficulties using aversive control: -Need to continue punishment -Punishment can induce respondent emotional states: aggression, fearfulness -Use of escape or avoidance behavior by recipient/client -Modeled to others who may use or misuse it -Punishment only temporarily suppresses the target behavior and does not establish A NEW DESIRABLE BEHAVIOR Punishment may sometimes replace on undesirable behavior with another → i.e. when a child becomes better at lying. Abigail has to stand in the corner when her parents realize she is not practicing piano. Next time she just lies better about having practiced so she does not have to stand in the corner. Standing in the corner is a negative punishment because time is taken away in which she could be playing with her doll house or reading Ramona Quimby books. Ultimately it is better to use reinforcement. Important because it is a tool that many parents and individuals use to decrease the occurrence of undesired behavior but, as mentioned, it does not increase any desired behaviors and can in fact create new negative behaviors. Ex. During parent-child therapy the counselor suggests the family no longer use spanking as a form of punishment on the child when he acts out at school; this form of punishment is leading to negative emotional and behavioral consequences in the child - it is not effective. Instead suggests they increase positive reinforcement instead. Or Abigail/Erin and not practicing the piano.

Positive Reinforcement

Part of Skinner's operant conditioning; the addition of an desirable stimulus following a behavior causing behavior to increase in frequency. Can be used in CONTINGENCY MANAGEMENT management to change bxs. Drug use associated with strong positive reinforcement -- feelings of euphoria, happiness, energy, increased concentration, whatever drug effect it may be. Important because is a huge reinforcer in developing and prolonging potentially harmful behaviors a la drug addiction (apart from the neurochemical effects taking place). Ex. A married couple comes to therapy because they are feeling inadequate when it comes to the parenting of their toddler. The child has been acting out, throwing tantrums, and has started getting physical with his younger sister. The therapist suggests that they start positively reinforcing the adaptive behaviors that he displays in order to encourage an increase in frequency. When he plays nice with his sister, he gets desired positive attention from his parents (praise).

Conditioned/Unconditioned Stimuli

Part of classical/respondent conditioning; the conditioned stimulus (CS) is a NEUTRAL stimulus that gains the power to elicit the response through pairing with the UCS. The UCS is the stimulus which elicits the reflexive response without any conditioning. Ex. Client presents problem of phobia of the dark. Client was sexually molested as a child on many occasions by father in darkened bedroom. The molestation (UCS) elicited a fear response (UCR), which came to be associated with darkness (CS), thereby eliciting the same response in any darkened space (CR = fear of the dark). Darkened spaces was a neutral stimulus until she experienced negative/harmful events that turned it into a conditioned stimulus.

Functional Analysis

Part of clinical assessment in behavioral therapy, the primary way behaviorists identify and assess the purpose and meaning of a client's behavior. Typically done using the ABCPA model. A: Antecedent setting characteristics (conditions under which the problem occurs) B: Behavior (explicitly identified, overt behavior, thoughts, associated feelings, frequency) C: Consequences, what happens following the behavior? P: Person Variables (the client's expectations, skills/competencies, foals, evaluation, self-talk A: Assets (what does the person do well). It is important to use BEHAVIOR descriptions rather than TRAIT descriptions. Traits are abstract concepts and are not actually descriptive of what a person DOES. Classifies problems as behavioral excesses, behavioral deficits, inappropriate stimulus control, or inadequate reinforcement. Essential features: individualized, focused on present, directly samples relevant behaviors, has a narrow focus, and is integrated with therapy. Important model for use in generating effective conceptualization of particular behaviors. Ex. A 31 year old woman has come to treatment for a problem overeating. The therapist conducts a functional analysis by examining the problem bx. The behavior (B) is overeating - considered a behavioral excess. The Antecedents (A) that she reports are feeling stressed or upset frequently at night time. The reinforcing consequences (C) of the behavior is the pleasure that comes from eating and the distraction from the upsetting emotions. However, she is also experiencing the negative consequence of gaining weight. Therapist and client come up with the list of client assets and person variables that will help in treatment plan.

Iatrogenic effects

Part of clinical practice, adverse effects of complications caused by or resulting from treatment; making things worse through treatment and inadvertent. A disorder (iatrogenic illness) precipitated, aggravated, or induced by the clinician's attitude, examination, comments, or treatments. Important because clinicians must be cognizant of how their therapeutic practices might cause adverse effects - increase self awareness. Also be on the lookout for other effects that might occur due to particular medications or medical treatments in relation to mental health condition. Ex. Certain antidepressants (like fluoxetine) may increase suicidal thoughts in patients. This increase is an iatrogenic effect of the medication and needs to be monitored in relation to the patient's progress.

Empirically-supported therapy/treatments

Part of clinical practice. ESTs are interventions that have been found to be efficacious for one or more psychological conditions. Prior to the '90s, there were no specific guidelines regarding which treatments served which conditions. In 1993, a task force was appointed by the APA to develop a set of criteria for and a provisional list of ESTs for various conditions. They are therapies that have demonstrated: a) superiority to a placebo in two or more methodologically rigorous controlled studies, or b) equivalence to a well-established treatment in several rigorous and independent controlled studies, or c) efficacy in a large series of single-case controlled designs. Important because provides essential treatment protocols for competent psychotherapy practice. Ex. Jane uses CBT in her practice to treat generalized anxiety disorder because it is an empirically supported tx. She stays up to date on new research and findings in order to assure she is providing the best treatment to her clients.

Successive Approximation

Part of operant conditioning and SHAPING; successive approximations are increasingly complex steps towards a desired complex or new bx. Bxs are rewarded as they are repeated and begin to resemble desired bx more and more. Ex. Shaping therapy is based on conditioning behavior: Patients are trained individually to perform increasingly difficult tasks with their affected arm, and then are rewarded for improvement. Tasks involved everyday activities, such as pressing a light switch, moving a chair and pulling up socks. Patients received encouragement from clinical staff as a reward after completing a task. Small approximations of the ultimate desired task help lead to the ultimate desired behavior (full range of motion in the arm).

Self-Reinforcement

Part of operant conditioning and self-management/self-instruction; process by which clients administer reinforcers to themselves for performing target bxs. Rewarding oneself for appropriate behavior or the achievement of an identified goal. For example, after studying, I get a glass of wine. Manipulation of consequences: performance is evaluated against a standard (helping establish/reinforce intrinsic reward). Institute reward/punishment system and make remote/distal reinforcement of target behavior more proximal (complete a 5k in two months, work towards smaller goal - looking at long term reinforcement).

Discriminative Stimulus

Part of operant conditioning, an antecedent event or stimulus that indicates that a certain response will be reinforced. Indicates that a "reward" is available. Helps the person learn to exhibit target behaviors in the presence of the discriminative stimulus. Created when the response is reinforced in its presence, but not when it is absent​. For example, a child requests to watch TV and historically, he is granted more screen time when his Mom has to get on a conference call for work, but never when she doesn't have to take a call. Ex. During parent-child therapy, parent brings in child because they are not following the rules at home. The therapist recommends displaying pictures of clocks labeled with activities that the child should be engaged in at the specific time in the day. (7am-wake up, brush teeth, get dressed. 4pm-homework. 7pm get ready for bed, brush teeth.) The clocks serve as a discriminative stimulus by signaling to the child what and when behaviors should occur to avoid punishment and to gain reinforcement (praise).

Extrinsic and Intrinsic Reinforcers

Part of operant conditioning, reinforcers are consequences that occur after a behavior and increase its frequency. Anything can be a reinforcer so long as it increases the frequency of a desired behavior. Extrinsic: reinforcers that come from outside and individual (money, praise from others, fame). Intrinsic: reinforcers that come from within an individual, an activity can be inherently intrinsically motivating (sense of a job well-done, pride) - more effective at maintaining behaviors. Important because anything can be a reinforcer, and a therapist needs to understand that extrinsic and intrinsic elements can be reinforcers to determine those that might work best with a client. Ex. A parent brings a child into your office because they refuse to complete their homework; the only way the child will complete the homework is if the parents give him money (an extrinsic reinforcer). The therapist explains to the parents that intrinsic reinforcers are more effect for maintaining a bx. The therapists works to develop an intervention strategy and possibly uncover intrinsic reinforcers.

Negative Reinforcement

Part of operant conditioning, the removal of an aversive stimulus in order to increase the frequency of a behavior. Important because this form of conditioning often leads to maladaptive behavior i.e. avoidance in agoraphobia. Ex. Client experiences severe social anxiety and avoids social engagements until basically stays in house all the time altogether. The client is using negative reinforcement - repeated removal of the aversive stimulus of engaging with others - and thereby increasing the behavior of avoiding all social engagement. Removes the unease of being around others

Shaping

Part of operant conditioning. Shaping is a procedure used to establish a behavior that is not presently performed by an individual. Closer approximations of the final desired behavior are reinforced while at the same time extinguishing previous approximations of the behavior. Important in terms of developing desired adaptive behaviors in the clinical setting. Ex. Shaping therapy is based on conditioning behavior: Patients are trained individually to perform increasingly difficult tasks with their affected arm, and then are rewarded for improvement. Tasks involved everyday activities, such as pressing a light switch, moving a chair and pulling up socks. Patients received encouragement from clinical staff as a reward after completing a task.

Chaining

Part of operant conditioning; an instructional procedure used to teach a person to engage in a complex behavior that has multiple components. Therapist conducts a task analysis that breaks down the chain into stimulus-response components. Teach one bx at a time and chain the bxs together. In this way, each response cues the next, and the last response is reinforced. There are two types of chaining: forward (teach each step along the way, don't add until one is mastered) and backward chaining (teach the whole sequence coaching each one along the way). Frequently used for training behavioral sequences (or "chains") that are beyond the current repertoire of the learner such as in ABA w/ autistic children. Important because chaining details ways in which a client can learn desired behaviors based on what is most suitable for them. Ex. Teaching a child skills. Washing hands. Entire process can be broken down via task analysis into several steps of behavioral components (turning on sink, running hands under water, getting soap, etc.). Forward chaining provides positive reinforcement after each step before adding a new one.

Meta-analysis and Effect Size

Part of research methods; a statistical procedure that integrates and compares empirical findings from MULTIPLE STUDIES. Provides a more comprehensive answer to questions about the effectiveness of a treatment. Purpose is to combine multiple effect sizes: a quantitative measure of the strength of a phenomenon; refers to magnitude of an effect. By placing the emphasis on the most important aspect of an intervention - the size of the effect - rather than its statistical significance (which conflates effect size and sample size), it promotes a more scientific approach. For these reasons, effect size is an important tool in reporting and interpreting effectiveness. An effect size is exactly equivalent to a 'Z-score' of a standard normal distribution. For example, an effect size of 0.8 means that the score of the average person in the experimental group is 0.8 standard deviations above the average person in the control group. Ex. A researcher conducts a meta-analysis of various studies on the relationship between caffeine and anxiety ratings. A comparison across studies produces a correlation coefficient of 0.8 which is considered a large effect size. In other words, the effect size reflects a strong relationship between the caffeine and anxiety.

Confounding Variable

Part of research; factors OTHER THAN the independent variable that may affect the dependent variable. A variable that, if removed, results in a change in the outcome variable by a clinically significant amount. To control extraneous variables, randomly select subjects/random assignment, counterbalance, and utilize blind or double-blind studies. Also called extraneous variables. Reduce through research design and analysis used. Threatens internal validity of a study. Important because can impact validity of a study thereby decreasing its utility/generalizability. Ex. You are conducting a study on memory at a local community college. Depending on the composition of your sample, age could be a confounding variable because in general younger people have better memory. That is, age would have an effect on the dependent variable.

Generalization and discrimination

Phenomena observed in classical conditioning. Generalization is when the conditioned response occurs in the presence of other stimuli that are similar in some way to the original Unconditioned Stimulus. Discrimination is the ability to differentiate between similar stimuli; when the CR occurs only in response to the original stimulus. Important to understand as it relates to classical conditioning and therefore might apply in use with clients? Ex. In the classic "Little Albert" experiment, Watson conditioned baby Albert to fear a white rat. Some time after, researchers noticed that baby Albert was also fearful of other white fluffy things like rabbits, dogs, santa claus's beard, etc. Albert had generalized his fear to other similar stimuli. If baby Albert began only showing fear in response to the white rat, he would be demonstrating discrimination.

Premack Principle

Principle of operant conditioning discovered by Premack. Behavior A occurs more frequently than the behavior (B) that you desire to increase, so the individual must perform B prior to the opportunity to engage in A. A more desirable activity (e.g. such as eating chocolate) can be used to reinforce a less desirable one (such as writing an essay). Higher probability bxs - whether considered enjoyable or not - can serve as reinforcers for lower probability bxs. Relative frequency of occurrence of a behavior is typically used as a measure of probability because FREQUENCY approximates PROBABILITY. High probability behaviors do not need to be pleasurable to serve as reinforcers but those that are aversive generally do not function as reinforcers. High probability behavior must not be occurring SO OFTEN that it loses its effectiveness in motivating clients to engage in the low-probability behavior (endless pellets given to pigeons). Important because can be used with clients to increase probability of desired behaviors. Ex. A grad student does not want to study. She likes white wine. She is more likely to study when she engages in the behavior of drinking sauvignon blanc. Thus, by drinking white wine WHILE studying, she increases her studying behavior.

Ratio Schedules

Ratio schedules provide reinforcement after a certain number of responses. This number can be fixed or variable. In general, ratio schedules of reinforcement are more effective than interval schedules. Fixed Ratio schedules support a high rate of response until a reinforcer is received, after which a discernible pause in responding may be seen, especially with large ratios. Ex: Salespeople who are paid on a "commission" basis may work fervently to reach their sales quota, after which they take a break from sales for a few days Variable Ratio schedules support a high and steady rate of response. Ex:illustrated by the gambler who persistently inserts coins and pulls the handle of a "one-armed bandit."

Decision-Balance Matrix

Technique used in motivational interviewing and often used in working with ambivalence in people who are engaged in behaviors that are harmful to their health, such as problematic substance use, overeating, self harm, etc. Ambivalence means they think they need to change but aren't committed to it either way. Or maybe they don't think they need to change or don't see it as a problem at all. With a decision-balance matrix the therapist asks the client to list the pros and cons of making a change or staying the same. Constructed in a decisional matrix consisting of four blocks: advantages of status quo, disadvantages of status quo, advantages of changing, disadvantages of changing. Informal measure of client's readiness for change. Important as a tool to present clear evidence and thinking on the aspects of change. Important in encouraging clients to engage in change behaviors as well as treatment adherence. Ex. You're working with a teenager that is using substances to a dangerous extent. You are considering a substance use disorder diagnosis; the client is extremely ambivalent, and still in denial. You explain to her that it can be good to think through all of the pros and cons of change. You work with her to fill out a decision balance matrix worksheet that assesses all of the costs and benefits of not changing her behaviors vs. changing her substance use habits. After completing the worksheet, you spend time discussing and exploring her answers to see if her ambivalence has been resolved. That is, is the client more or less ready to change?

Dialectical Behavior Therapy

The overarching goals of DBT are to develop a dialectical worldview, to develop an ability to except one's current situations and at the same time make changes, and to develop skills such as mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. Developed by Marsha Linehan as a treatment for suicidality, self-harm, and BPD. A third-wave CBT that teaches explicit strategies for tolerating unpleasant emotions and letting them pass without doing anything to worsen them or trigger them again. There is an empathic understanding and validation of the client's emotions. This allows the client to remain amenable to the therapist's suggestions for change. The second core strategy is problem-solving and creating change. This comes from 1st and 2nd generation behavior therapies such as skills training, exposure therapies, contingency management, and cognitive restructuring. DBT focuses on providing therapeutic skills in four key areas: MINDFULNESS, INTERPERSONAL EFFECTIVENESS, EMOTION REGULATION, & DISTRESS TOLERANCE. Mindfulness skills (finding a reasonable response that exists in the middle of one's reasonable mind v. emotional mind v. wise mind). Interpersonal effectiveness skills (observing and describing own emotions, goes hand-in-hand with mindfulness). Emotion regulation (understanding the functions of emotions, the action urge that accompanies each emotion, whether to heed or oppose these urges). Distress tolerance skills (being able to manage actual or perceived stress/distress in a healthy way). Often consists of weekly individual and weekly group therapy sessions. Ex. Debbie enters therapy because she has BPD; her immediate problem is that she is frequently cutting her arms b/c of recent break up. The therapist uses DBT and validation/acceptance strategies. She tells her "Your emotions can be very upsetting, and it makes sense that you would want to alleviate them, which you do by cutting yourself. Perhaps you can learn other, less destructive ways to do that." Saying this creates a space to use problem-solving strategies to help the client find more skillful ways of regulating her emotions.

Mindfulness

Therapeutic technique often used as a part of therapy; An Eastern concept developed in the religion of Buddhism, the practice of being fully aware and accepting of the present moment. An individual learns to observe and accept thoughts and feelings rather than judge, accept, or fuse with them. Has been incorporated into several third-generation cognitive behavioral therapies, including Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT). Goal is not to induce relaxation but foster NON-JUDGMENTAL OBSERVATION OF CURRENT STATE. Mind as conveyer belt: experience all sensations/thoughts as they come along, observe, label, categorize, no analysis/evaluation. Mind as sky: clouds are feelings and thoughts - observe breath, in and out. Important because is an empirically-supported component of third wave therapies. Helps clients accept thoughts rather than attaching import or meaning to everything; can lead to more adaptive behavior. Ex. Therapist works with client with GAD. Uses mindfulness techniques to help client deal with feelings of distraction and preoccupation with unpleasant thoughts or worries. Therapist introduces mindfulness by saying that part of mindfulness is being in touch with the present moment and an aspect of this skill is being an active participant in experiences. Works with client to acknowledge worry and ruminations without becoming consumed by them.

Cognitive Restructuring

Therapeutic technique used in Beck's cognitive therapy and REBT; teaches clients to identify and change distorted and maladaptive cognitions. Based on the idea that the client has an excess of maladaptive thoughts. Helps client identify self-talk and thoughts. Client is encouraged to identify cognitive distortions that are maladaptive, challenge the validity of these distortions, and explore more adaptive alternatives. Crucial questions during cognitive restructuring: What is evidence for/against this belief? What are alternative interpretations of this event? What are the implications if the belief is correct or true? (hypothesizing on cognitions). Important b/c is a common therapeutic technique used in cognition-based therapies. Ex. A grad student comes into therapy experiencing great anxiety about her comps exam in the fall. She reports having thoughts like, "I'm stupid and I can't do this," every time she sits down to study. The cognitive therapist points out these maladaptive cognitions and uses the cognitive restructuring to challenge their validity. She asks questions like "What evidence do you have for and against this belief?"

Spontaneous Remission

Unexpected, sudden disappearance of a disorder/sxs. This occurs without treatment or with the use of an ineffective treatment. Most people will improve on their own within 12-24 months, most likely to occur with the first twelve months. Eysenck used this to criticize psychoanalytical therapy, saying that it was not effective. Ex. A person who has suffered from depression for several months suddenly notices/reports significant decrease in symptoms despite no treatment interventions or logical explanation for improvement.

Anxiety/Fear Hierarchy

Used in systematic desensitization combining relaxation techniques and gradual exposure; a detailed list of stimuli that trigger a fear response in the client. The list is organized from the things that produce the least intense fear response (low subjective unit of distress SUDs) to the things that produce the most intense fear response (high SUDs). Important because helps client understand how anxiety is triggered, how it manifests, and how it is impairing daily functioning. Made together during therapy session. Important as a collaborative tool to understand how a client experiences anxiety/fear, and can be used to help guide treatment. Ex. Woman has extreme fear of flying. She and therapist rate what causes the least to most intense fear responses regarding flying (low is packing for the trip, high is arriving at the airport, boarding the plane). Utilize their list to practice imagined exposure to work on fear.