PSYC 3083 Counseling Psychology Final

"____________" against failure.

"Inoculation"

CBT often creates homework assignments called "____________," in which patients can test hypotheses. Ex (Katrina): If I tell my mother she can't call so often, she will stop talking to me.

"behavioral experiments"

an analysis of the contingencies maintaining the behavior.

"functional behavioral assessment"

Reinforcement types: - Fixed-ratio -BEST variable-ratio -fixed interval - variable-interval

- Fixed-ratio - schedules deliver reinforcement after every NUMBER OR AMOUNT response -variable-ratio-THE BEST reinforcement schedule in which the number of responses necessary to produce reinforcement varies -fixed interval- reinforced after every nth amount of time. -variable-interval- - reinforced on an average every nth amount of time. the 'n' is an average

Use of punishment in medicine

-Infant with uncontrollable vomiting. Physicians unable to control with medications. Psychologist used punishment to treat the vomiting. -Each time the infant began vomiting, the psychologist applied a shock to the infants leg to punish the vomiting, and eventually the vomiting stopped.

Type of punishers -pos punisher -neg punisher

-pos punisher- something unpleasant occurs after a bx -neg punisher- When something pleasant is removed after a behavior -what you do matters more than what you say

Cognitive Errors:

1) Magnify negative and minimize positive 2) Over generalize 3) Make negative, global attributions about the self. If you fail at one thing- your whole life is a failure. 4) Polarization (black and white world)/dichotomizing 5) Personalization 6) Catastrophizing

Example of role of assumptions & cognitions: Beck and the Cognitive Triad.

1) Negative self esteem 2) Negative view of the world 3) Pessimistic view of the future

Cognitive Distortions: IE.• Depressed patient is unhappy about the wall paper job he did for a neighbor and is upset that the flowers did not line up perfectly.

7. Emotional Reasoning 8. Fortune Telling 9. Labeling 10. Mental Filter 11. Mind Reading 12. Personalization 13. Should Statements

Exposure therapy use the principles of:

A) Extinction B) Prevention of escape or avoidance C) Systematic desensitization

___________ developed rational-emotive therapy, now called rational emotive behavior therapy.

Albert Ellis

______________ is a form of treatment that utilizes behavioral principles to eliminate unwanted behavior. In this therapeutic method, the unwanted stimulus is repeatedly paired with discomfort. The goal of the conditioning process is to make the individual associate the stimulus with unpleasant or uncomfortable sensations.

Aversion Therapy

Precursor to modern CBT is __________ and ____________. Learn vicariously through observation. Argued that many behaviors are situationally specific and based on expectations.

Bandura and social learning theory

Systematic Desensitization (SD) begins with ____________ & _____________ that counter fear & anxiety responses. May involve meditation or progressive relaxation & _____________________. _____________ are discussed.

Begins with training relaxation & cognitive skills that counter fear & anxiety responses. May involve meditation or progressive relaxation & cognitive reframing/reappraisal. Irrational fears/consequences are discussed.

• The application of operant conditioning techniques to: - Teach new responses - Reduce or eliminate maladaptive or problematic behavior • Begins with thorough "functional behavior assessment"

Behavior Management EXAMPLES: •girl that was smearing her poop. She did it to get attention b/c 3-4 people would come in and have her clean w/ them •girl that dove head first to the ground staff STILL allowed her to go to the mall variable ratio and is less likely to get to extinction and bad behavior of head diving will just increase •Louie the ruminator- vomit, eat, vomit again. attempt to distrct him from the bx. gave him mints after every meal he would be sucking on the mints (b/c he had no teeth) instead of vomiting

Have the patient engage in behaviors to test negative cognitions

Behavioral activation

_____________ is useful for training parents, children, husbands, girlfriends, bosses, etc.

Behavioral management

_____________ assumes that there is a belief hierarchy, which starts with core beliefs or assumptions that are the most stable and least accessible cognitions, to voluntary thoughts, which are the least stable but most accessible cognitions.

CBT • Psychotherapy is an active, collaborative process • Therapy uses pt's problem solving skills • The focus of therapy is the present

Not everyone is equally conditionable! Depends on ______, _____________, ______________, _______________, and ______________.

CNS, genetics, learning history, expectations, and preparedness.

Acquire phobias via ______________. IE.Pt. has a car accident that produces a phobia of cars. The pt. has learned to pair the pain associated with injuries obtained in a car accident with cars and now fears cars. Now pt. avoids cars, so the pt. never gets a chance to have fear extinguished - so the fear is negatively reinforced!

Classical Conditioning

Think about and plan all the needed steps to attain a goal.

Cognitive rehearsal

_____________ is a technique consists of having the client imagine himself or herself engaging in an undesirable behavior (e.g., overeating or excessive alcohol consumption). When this image is vivid, the client imagines an aversive consequence associated with the behavior (e.g., feeling nauseous). The procedure is conducted in imagination; imagined punishment- probably very powerful in real life!

Covert sensitization

Believing that your negative feelings reflect the way a situation really is.

Emotional Reasoning

CBT Example of ?ing

Example of ?ing • What evidence do you have to support this belief? • What evidence do you have to refute it? • What would happen next (and next)? • What would your (spouse/friend) say in about this situation? • What would you say to a friend in this situation? • How could you look at this situation so you would feel less depressed? How does this differ from how you look at it now?

- Reinforcers that are not inherently related to the activity being reinforced. - Others admire one's loss of weight

Extrinsic Reinforcers Ie: Others admire one's loss of weight

__________ reinforcers may undermine __________ reinforcers.

Extrinsic reinforcers may undermine intrinsic reinforcers.

______________ was developed by Francine Shapiro to deal with PTSD-like emotional problems.

Eye movement desensitization and reprocessing (EMDR)

Thought Record ... Importance of Goals

Few patients know exactly what they want to get out of counseling - "feel better" or "be more productive" or "have fewer problems" may be all they can describe. • Goals help measure progress and define results. However, goals that are too vague or unrealistic often can be frustrating and confusing for clients. • Specific goals provide smaller, reasonable change that can be monitored easily.

____________- massive exposure to fear stimulus with no escape- eventually fears extinguish. • Wolpe (1973) locked a girl with a car phobia in a car and drove her around for hours. She was hysterical at first, but eventually her fears were extinguished (no negative reinforcement could occur), and she lost her phobia of cars.

Flooding

Anticipating events will turn out badly

Fortune Telling

Hysterical personality

Hysterical personality- Freudian term- usually used for a woman that gets extremely emotional or even erratic over a wrong doing

An action intended to punish may instead be reinforcing (sending a child home from school)

I.e: kid acts bad & gets to go home & then they act bad more often

The Thought Record: example

Ie: 20 year old from the mid west lives here and his gf inanother state. He did not want to break up with his gf b/c it is his first love and if he breaks up with her it is his a failed relationship and he won't be good at love ever. Kunen realized he is a handsome young guy and he has social anxiety and has stopped socializing even though he used to be very social. He began by making him pay attention to his thoughts and realize what he was thinking.. this is called a "THOUGHT RECORD"- PURPOSE: Helps patients become aware of how controlled they are by non-conscious thoughts... This actually helped him and he was able to laugh quickly about it and realized that he was being ridiculous

3 stages of therapy: examples

Ie: A guy referred by child protection to get tested to see if he was fit to parent his children. He had 2 kids being taken by the state b/c of abuse. Kunen had to explain to him how to treat his children and that there are rules about child rearing and that they are NOT property and you can not just hit them if they do not listen. He did not understand this. No matter how much he explained to him he did not get it he thought it was ok because he turned out ok and his parents did it to him. Kunen explained that he went to jail and is having problems with child protection and abuse so this obviously was not ok. Kunen thought that maybe he would respond better to a woman therapist, but that did not help it was not the issue of authority the issue was his understanding of what is wrong and not. He even had a mental evaluation because he just did not get it.

Schedules of Reinforcement EXAMPLES

Ie: slot machines for gambling and not knowing what the odds are is a ratio variable Being paid every two weeks is a fixed interval and quality of your work does not matter like with goverment employees

Lack of Progress

If client isn't making progress, consider following options: 1. Break goal down into even smaller steps. 2. Problem solve what is interfering with progress toward the goal 3. Consider revising therapy plan

_____________ is a therapy technique in which feared situations are experienced in real life situations in order to decrease anxiety. Feared situations are usually faced as part of a hierarchy from the least to most anxiety-provoking.

In Vivo Exposure Therapy

- Reinforcers that are inherently related to the activity being reinforced. - Feeling stronger and looking better after exercising

Intrinsic Reinforcers Ie: Feeling stronger and looking better after exercising

Systematic Desensitization (SD) was developed by _____________. Based on ______________ and ___________.

Joseph Wolpe, MD; classical and operant conditioning principles

One behavior defines the whole person

Labeling

___________ a pioneer of CBT. Focused on self-talk; Negative self-talk programs for failure; trained patients how to talk positively and realistically to themselves.

Meichenbaum

We all have them, but this distortion refers to specific situations where we ignore either positive or negatives to one issue.

Mental Filter

Believing that we can know what a person thinks solely from their behaviors.

Mind Reading

Absolute standards for behavior cause pathology = ________________.

Musturbatory thinking

______________ involves learning new responses by observing the behavior of "model" rather than through direct experience.

Observation learning

___________-The idea is that problems and disorders are based on a lack of trainable skills. Social skills problems are either learned abnormal behaviors or represent deficits. • Example: For a shy person, make a hierarchy of fearful situations and train them to begin developing new skills.

Operant Approaches to Skills Training

Assuming that a person is at fault for some negative event.

Personalization

Force someone to smoke until he gets sick.

Punishment or aversion therapy

_________________ therapy challenges irrational beliefs.

Rational emotive behavior therapy •Like Beck's CBT, tends to be short

An individual's belief in his or her ability to manage behaviors or situations.

Self-efficacy

• To teach complex behaviors, may need to reinforce successive approximations of a desired response. • Break responses down into constituents. • Goal is to make acquisition of each step easy with few failures. • For example, training social skills, reducing shyness, teaching children motor skills.

Shaping

Statements that begin with "Shoulds" or "Musts" are often punishing demands we make on ourselves.

Should Statements

_____________ emphasizes that behavior is learned and maintained through observation and imitation of others, through positive consequences, and cognitive processes such as plans, expectations, and beliefs.

Social Cognitive Theory

Prepare what it might be like and change their response and reinforce Example: when Dr. Kunen worked at a juvenile detention center he would tell them you know Christmas is coming up how are you going to feel about being away from family so it would prepare them for what's to come instead of just coming and them getting depressed and acting out

Stress Inoculation

_________________ can reduce occurrence of phobias and other neurotic reactions.

Stress inoculation

Originally called reciprocal inhibition; a behavioral treatment for phobias, fears, and anxieties based on CLASSICAL conditioning. Based on the pairing of an anxiety provoking stimulus with a relaxation response—using fear hierarchy.

Systematic desensitization (graduated exposure)

____________ lead to ___________, which lead to ____________.

Thoughts lead to feelings, which lead to behaviors.

___________→__________→__________

Thoughts → Feelings → Behaviors Ie: woman in her mid 60s was constantly locking her door and looking out of the windows because someone broke in her home 30 years ago and she won't walk outside at night and believes that people are plotting to get her. She also checks for nearby sex offenders. Her negative thoughts which scare her causes her irrational behaviors.

Secondary punisher

a stimulus that has acquired punishing properties thru an association w/ other punishers ie: giving birth was painful, and seeing a pregnant woman causes emotional distress

Punishment

a stimulus weakens or reduces the probability of the response that it follows

For really stuck people, CBT uses ______________ and _______________.

behavioral activation and cognitive rehearsal

Behavioral management can be used to address almost any _________________ such as stealing, destruction of property, self-injurious behaviors, rumination, feces smearing.

behavioral problem

CBT is also effective with children in correcting ___________ and teaching ___________. The CBT therapist can model more appropriate on task behaviors by talking out loud. EX; "Hmm, this is hard and I might make some mistakes, but I know if I keep trying I can be successful."

cognitive errors; positive self-talk

People may alter their thinking/feelings/ behaviors by dealing with __________ and _________________.

conscious and "semi-conscious" processes.

Beck has found that ____________ are more critical of themselves than of others. _____________ can help such patients gain insight into their thinking errors. CBT therapists __________ rather than directly challenging pt's to help pt's reach better conclusions.

depressed persons; Role playing; ask questions

CBT: For Beck, the goal is to identify __________ (Ellis = irrational).

dysfunctional cognitions

Early experiences can create emotional and behavioral problems by creating _________ or ___________. Many of these are "automatic." Not fully conscious, fast, well practiced.

dysfunctional or irrational cognitions

Others argue that EMDR is simply _____________or _________________. As effective as CBT, SSRI's, and exposure therapy for PTSD in some studies.

exposure or desensitization therapy

The basic idea of Systematic Desensitization is that one cannot be both __________ and _________ at the same time.

fearful and relaxed

During behavioral management, conduct a _____________ to determine conditions when the behaviors are most likely to ________ and what is the __________.

functional behavioral analysis; occur; reinforcing contingency

Exposure Therapy: Pt. & therapist create a ________________ regarding planes. Lowest fear = 1 (picture of a plane); highest fear = 10 (riding on a plane)

hierarchy of fears

CBT believes that ____________ - that is, feelings that occur in the presence of dysfunctional beliefs, may be easier to change

hot cognitions

Exposure Therapy: Then exposed to the next level in the hierarchy, which may be holding a model plane, and practices relaxation and rational thinking. Eventually gets on plane- in vivo exposure vs. ______________.

in vitro = imaginal

Three types of ______________, which we all have to some degree, are more common and extensive among disturbed individuals. 1

irrational beliefs; • I must be competent and achieving and I must win the approval of important people. I am a rotten person when I don't achieve and don't win the approval of others. • Others must treat me fairly and they are worthless when they don't. • I need and must have the things I want. I can't deal with frustrations. The world is rotten when I don't get what I want.

Ellis believes that _____________ lead to _________ that lead to _________.

irrational beliefs; failures; shame

Behavior therapists (AABT) rely heavily on the science of _____________ and are concerned with the individual's _______________.

learning theory; learning history.

Observer __________ the behavior

learns

Levels of thought:

o Core beliefs—I am not lovable o Assumptions—there is no true justice o Strategies—I need to always be on alert for injustice o Automatic thoughts and images—People are always unfair with me

Behavioral management techniques include:

o Extinction o Time out o Restitution o Response cost Ie: One guy was stealing his roommate's clothes & when caught not only had to return the clothes but had to also do the other guy's laundry. Then the stealing decreased .... BUT then it began to happen again. They figured out that it was the guy who was having his clothes originally stolen taking his own clothes and hiding it under the guy who initially was stealing his clothes. He did this b/c he wanted his laundry to continue being done Therefore the restitution would be returning the clothes back.

Model ___________ the behavior

performs

Exposure Therapy: Pt. trained in _____________ or ______________, and learns appropriate self-talk. Pt. starts holding a picture of a plane, while relaxing and talking rationally about planes.

progressive or deep relaxation techniques

Self-efficacy predicts ability to ___________.

quit smoking

CBT has been criticized for not being particularly _________________, since CBT tends to focus on a ______________________, and not the context in which these occur.

sensitive to multicultural issues; single individual's thoughts and feelings

Social skills training uses ___________, ___________, ____________, and ______________.

shaping, covert practice, feedback, and therapist reward.

Primary punisher

something obviously punishing ie: electric shock

Shapiro argued that EMDR (eye movements left and right while working on issues helps to neurologically reprocess __________.

traumatic memories.

Behavior Therapist's argue that ________ and ____________ is important to the therapeutic relationship.

trust and understanding

Why Monitor Progress? • • • • •

• Better use of counseling time • Can alter goals / outcomes as needed • Instill feelings of hope and success • Keeps clients engaged in process • Avoids "distractions" in sessions while still recognizing that at times there may need to be a shift of focus.

Characteristics of Automatic Thought:

• Characteristics of Automatic Thought • A stream of self-talk • Specific and discrete • Telegraphic • Plausible • Content unique to patient and problems

CBT: General thinking problems EXTREME:

• Consistently negative • Catastrophic • Unscientific • Pollyannaish

CBT: General thinking problems IDEALISTIC:

• Demanding • Obsessive • Comfort seeking • Overly broad

The Thought Record PURPOSE: • Helps patients become ___________ • Helps patients see _______________ • Helps patients see _______________

• Helps patients become aware of how controlled they are by non-conscious thoughts • Helps patients see the situations in which these unwanted thoughts occur • Helps patients see the relationships among thoughts, behaviors, and feelings

Beck & Weishar identified 3 stages of therapy: • Initial stage: • Middle stage: • Later stage:

• Initial stage: Build relationship, educate patient about relationship between thoughts and feelings; define problem; giving some initial relief thru problem solving. Therapist is active in this stage. • Middle stage: Getting patient to identify and challenge automatic thoughts. Underlying schemas (or core beliefs) can be examined. Patient learns to assume responsibility for identifying problems and solutions (and homework). • Later stage: Client is able to use cognitive therapy to solve own problems without therapist. Learns to deal with setbacks. Inoculation or relapse prevention occurs at this stage (may include occasional booster sessions).

Structure of a typical CBT session:

• Mood check • Setting the agenda • Bridging from last session • Work on the day's agenda - the process often involves Socratic dialog - a form of questioning that helps pt's arrive at their own conclusions (see next slide) • Homework assignment - use thought records - or try an experiment • Summary and feedback from patient

Low self-efficacy is associated with:

• Negative self-evaluation • A focus on failures and problems rather than on successes • Quitting prematurely • SUDS • Depression and anxiety disorders

Problems w/ punishment

• People often administer punishment inappropriately (e.g., for their convenience, too much, too little, too inconsistently) • The recipient responds with anxiety, fear, or rage. • The effectiveness is often temporary • Most misbehavior is hard to punish immediately. • Punishment conveys little information. • An action intended to punish may instead be reinforcing (sending a child home from school) • The behavior of the punisher may be copied!

Behavior Management: - The application of operant conditioning techniques to: • • - Begins with thorough "____________"

• Teach new responses • Reduce or eliminate maladaptive or problematic behavior - "functional behavior assessment"

Thought Record Explores: • • • • • • •

• The situation • The mood • Automatic thoughts • Evidence supporting the "hot thought" • Evidence that contradicts the "hot thought" • Alternative or balanced thought • Possible mood or behaviors

Angry person's irrational thoughts:

• What's the core belief (or assumption)? Life is unfair. • Possible automatic thoughts: I should not have to sit in traffic. I do not deserve to be treated this way. I always have bad luck like this. My life sucks. Assumption: I'm going to be fired. • Feelings: Adrenalin rush leads to increased BP & HR, stomachache, feels agitated, anger, fear • Behavior: Race in and out of traffic, yelling, cursing, angry gestures, honk horn, etc.

Schedules of Reinforcement (2) - Continuous Reinforcement - Intermittent (Partial) Reinforcement

•Continuous Reinforcement - A particular response is always reinforced. - Use when establishing a new behavior •Intermittent (Partial) Reinforcement - A particular response is sometimes but not always reinforced. - Fixed-ratio, variable-ratio, fixed interval, and variable-interval. - VR maintains behavior at the highest levels