Behavioral interventions

What is case formulation

INDIVIDUALIZED THEORY Theory or hypothesis about a clinical case. It is an idiographic or individualized theory that accounts for not only a client's symptoms or problems but the etiology and maintenance of such difficulties. The primary function of case formulation is to guide therapy to resolve client difficulties and build client resilience. Provides an empirical hypothesis-testing approach to the individual case. Treatment is viewed within the context of single-subject experimental design (N = 1) methodology 1) it describes all of the patient's symptoms, disorders, and problems 2) it proposes hypotheses about the mechanisms causing the disorders/problems 3) it proposes the recent precipitants of the current disorders and problems, and 4) the origins of the mechanisms

Single case study design fundamentals, the IV is the ___________ and the DV is the _____________.

Intervention (or treatment) is the IV and the DV are what we should be assessing (behavioral targets) to get a measure of what you are trying to change.

Simple phobia: Diagnose/ Assess

Interview, self-report measures, naturalistic observation, more?...I don't think so. I would think it would mirror the panic/agoraphobia process.

Development of an anxiety heirarchy

Is done in implosion, flooding, and systematic desensitization. Write down about 10 cards with anxiety provoking stimuli (card might be arranged according to time, or a thematic (dogs doing things), and temporal and thematic themes combined). Then ask her for some more details about the card. Little variations will make the ratings increase and fill in more information. (use a notecard and think about scenes that would be at about every 10th value of that scene) Mixes them up and then rates them from 1-100 Subjective Units of Distress again (with the details) Then have to fill in the gaps from where things may be missing (make a new card). Need to make sure they are in a systematic hierarchical order.

interview

Is usually the first assessment method used. Besides their role in assessment, are used to establish rapport with the client and to educate the client about the behavioral approach. To gather information about a client's problem and its maintaining conditions, focus on the present and ask questions concerning what, when, where, and how and how often. Do not ask WHY.

Systematic desensitization theory

Joseph Wolpe: 1958 - reciprocal principal, a counterconditioning model Relaxation can prevent anxiety (during stimuli) and can suppress anxiety responses. So, the bond between anxiety stimuli and response will be broken and move toward extinction. NS (CS) + US-> UR (CR) relax by PMR, breathing exercises, yoga, meditation, comfort food and then pair with CS triggers that elicit the anxiety response, and move CR to be extinguished. Counterconditioning model (based on classical conditioning). Has to do with changing the bond between conditioning and certain triggers.

OCD: Medications

Medications that affect the neurotransmitter serotonin have also been found helpful (SSRI). Neither treatment or drugs are 100% effective. No choice is better than another unless they have had successful treatment with one in the past. Antidepressant medication such as Prozac is frequently prescribed for obsessive-compulsive disorder. However, in vivo flooding can be as effective as medication, and it has a lower relapse and dropout rate; moreover, clients may view in vivo flooding as more effective than medication.

PTSD: how it is understood

Mowrer's 2 factor theory: classical condition explains high levels of distress and fear that were observed in trauma victims; operant conditioning explained by PTSD avoidance and maintenance of fear over time (negative reinforced which prevents extinction of the link between the trauma cues and anxiety). Lang's information process theory of anxiety development: development of a fear network in memory that is stable and generalized Social cognitive theory: focus on the impact of trauma on a person's belief system and the adjustments that are necessary to reconcile a traumatic event with prior beliefs and expectations Ehlers and Clark cognitive model of PTSD: focuses on threat and memory, unable to see as time limited or unable to integrate with other memories. Poor autobiographical memory Dual representation theory: gains in insight depends on the similarity between the symbol and its referent, the level of information provided about the relationship between the symbol and the referent, and prior experience with symbols.

OCD: how it is understood

Mowrer's the two-process theory of avoidance learning: Neutral stimuli become associated with fearful thoughts via classical conditioning & anxieties are maintained via negative reinforcement. Obsessions with contamination and dirt appear to have evolutionary roots Attempting to suppress unwanted thoughts may increase those thoughts OCD clients have high expectations of negative outcomes and over evaluate the negative consequences for a variety of actions. OCD clients have an excessive sense of responsibility and self-blame. Five dysfunctional assumptions

Simple phobia: how it is understood

Mowrer's two factor theory: classical pairing, negatively reinforced through escape/ avoidance

Social anxiety disorder: how it is understood

Mowrer's two factor theory? Social situation (NS) paired with (UCS) -> UCR (fear) and is maintained by negative reinforcement of avoidance or escape of situation More? .....when in front of an audience, socially anxious people perceive others as inherently critical and as having standards they are unlikely to meet --> avoid --> negative reinf

ABCD

One type of treatment in B, then make a clinical decisions to go to C, and D do another type of therapy. Maybe therapy only works in this order.

Hierarchies with disorders are done for:

Phobias, OCD, social anxiety disorder, assertiveness, panic d/o, agoraphobia. The therapist should create the hierarchy for OCD.

"general neurotic syndrome" or "negative affect syndrome"

Possible that the differences in the expression of emotional disorder symptoms is simply a trivial variation in the manifestation of a broader syndrome. May explain the comorbidity of emotional disorders. Consistent with the "triple vulnerability" models.

Prochaska & DiClemente (1988) 5 stages of therapeutic change:

Pre-contemplation (unaware and no intention to change) Contemplation (aware and seriously thinking of change) Preparation (prepared to take action in next month) Action (Where real change occurs) Maintenance

Reification is problematic

Process whereby some concept gradually attains the status of an existing entity (problem of circularity) the adjective has become the causal factors now Behaviorists: Can not treat ADHD, can treat the symptoms. So, get away from this approach and do a functional analysis. Behavior occurs (is maintained) of influence by the reinforcing/punishing consequences that follow it.

Naturalistic observation, simulated observation, and role-playing as well as self-recording

Reactivity is a problem with these assessment methods

OCD challenges near the end of treatment

Reassure client that functioning without rituals is normal for the client may find themselves with a considerable void in their daily routine after treatment. Address fears that symptoms will return if any behavior similar to the ritual is performed.

Symptom substitution

Refers to the notion that treating behaviors—rather than their so-called "underlying causes"—will result in another maladaptive behavior (symptom) replacing the treated behavior. Not true about bx therapy: 1. Based on the mistaken premise that behavior therapy treats symptoms (problem behaviors), which is not true. It directly treats what is maintaining conditions, which are the cause. 2. There is no empirical support for symptom substitution's occurring in behavior therapy.

A cognitive behaviorial version of a functional analysis is

S = stimulus or "antecedent" factors which occur before target behavior O = organismic variables relevant to target behavior (thoughts, attitudes, beliefs about what is happening to them) R = the response = the target behavior C = consequences of target behavior

PTSD: Medications

SSRI

Social anxiety disorder: Medications

SSRI, antidepressants, benzodiazapines (short lasting and addicting), beta blockers ?

SD proper

Signal the therapist when the client is relaxed. Never want them to get anxious, have to keep them relaxed the whole time. Signal by raising your finger and allow you to relax again. Therapist gives the first scene. Have her imagine it, says it a few times, and remain relaxed for about 25 seconds, If it looks like she is doing ok, then let image go, take a deep breath, I'm going to present another scene. Signals getting nervous, let image go, take a deep breath and signal that you are relaxed. (I should have known that this was too big of a jump for you). Let's come up with a level 45 now and keep you relaxed, keep coming up with scenes until get to the end.

Flooding theory

The client's over-arousal (fear) to stimuli that are not objectively dangerous is maintained by the fact that they can escape or avoid such stimuli (Mowrer's two factor). Escape or avoidance behavior of a person who never stays around them long enough to discover that their fears are harmless is continually rewarded by the thoughts and feelings of relief at having prevented what he/she presumes would be disastrous consequences. In this theory the individual is provided with actual or imagined exposure to feared stimulus.

Implosion theory

The client's over-arousal (fear) to stimuli that are not objectively dangerous is maintained by the fact that they can escape or avoid such stimuli. Escape or avoidance behavior of a person who never stays around them long enough to discover that their fears are harmless is continually rewarded by the thoughts and feelings of relief at having prevented what he/she presumes would be disastrous consequences. In this theory it is provided through an imaginal means. (1) the use of hypothesized anxiety-producing cues, (2) the exaggeration of scenes to heighten anxiety, and (3) the elaboration of scenes as they are presented.

physiological measurement

The most frequent measures are heart rate (most common), blood pressure, respiration rate, muscle tension, and skin electrical conductivity (a common measure of anxiety). These responses are used to assess complex behaviors, such as feeling anxious and being sexually aroused. Can be costly for equipment, are no more valid than other measures, some instruments are not portable and those that are portable may be less accurate.

Functional analysis

The process of assessing the conditions that maintain a behavior and the application of the laws of operant conditioning to establish the relationships between stimuli and responses. A = Antecedent (similar to "situation"/trigger) B = Behavior (similar to "response") C = Consequence (outcome)

Social anxiety disorder: Diagnose/ Assess

The simple process for interacting with people and forming relationships provokes overwhelming terror and is often avoided (generalized and non-generalized) clinical interview, self-report (social interaction anxiety scale or the social phobia and anxiety inventory), feedback and treatment contract interview, clinician administered measures of social anxiety & behavioral assessment

How does a behaviorist view counter-transference

The therapist should be aware of countertransference schemas as they apply to him/her. He/she should monitor his/her own feelings that indicate countertransference. Further, the assistance of and discussion with supervisors and colleagues is useful in regard to countertransference even in experienced therapists. In behavioral therapy, it is important/ foundation of maintaining a healthy client-therapist relationship. Countertransference will not relate to change in the client (catharsis). Is this right??? - I think so. I had written down: "Is transference/countertransference the most efficacious way to proceed with therapy? Probably not."

checklist, rating scale, rating scales

With a _____________, the informant indicates those behaviors that are problematic for the client. With a _________________, the informant evaluates each behavior by indicating how frequently it occurs or how severe it is. Thus, __________ provide more information.

Assertion training theory

Wolpe's theory Learned to behave unassertively (distress, displacement onto wife, dog, others) Assertive responses are incompatible with anxiety. Why don't people respond assertively? Lack of modeling (skills deficit), punished/ consequences in the past for being assertive, rewarded for being aggressive or passive, anticipate that bad things are going to happen to them.

What is behavior therapy?

a broadly defined set of clinical procedures whose description and rationalle often relies on experimental findings of psychological research (term first used by Lindsley, Skinner's student, in the late 1950s) Behavior is a function of one's environment.

Implosion steps

1) Assessment 2) Educational Phase 3) Development of avoidance hierarchy: therapist will develop 4) IT Proper 5) Homework assignments

Systematic desensitization steps

1) Assessment 2) Educational Phase 3) Relaxation Training 4) Development of anxiety hierarchy: Develop by patient 5) SD Proper

Flooding steps

1) Assessment 2) Educational Phase 3) Development of avoidance hierarchy 4) Flooding Proper (actual or imagined exposure to feared stimulus) 5) Homework assignments

Self efficacy determines if a person will

1) attempt a task 2) effort they will expend to complete the task 3) time they will spend on the task

Three response channels of anxiety

1) self report (cognitive): anticipate that bad things will happen to you; being judged 2) physiological: heart rate/respirations/electrodermal activity 3) behavioral: avoidance

Role playing from a behavioral perspective involves

1. Assessment: allows one to determine if behavior is occurring due to a skill deficit vs. anxiety response especially about assertiveness Benefit: therapeutic since it is practice in a safe setting plus provides ongoing assessment 2. Intervention for behavioral rehearsal: a. identify client's personal rights b. distinguish between nonassertive, assertive, and aggressive responses c. identify and change· irrational thoughts supporting unassertive behavior

Panic disorder: CBT treatment

1. Education (anxiety is perpetuated by feedback loops among physical, cognitive, and behavioral response systems) Anxiety: preparation for future threat Panic: fight-flight emotion elicited by imminent threat. 2. Self-monitoring (enhances objective self-awareness and increase accuracy in self-observation 3. Breathing retraining: many panic patients describe symptoms of hyperventilation as being similiar to panic attack symptoms 4. Applied relaxation: (train in PMR)--- so basically use Systematic desensitization!!! 5. Cognitive restructuring: encouraged to use an empirical approach to examine the validity of his or her thoughts by considering all the available evidence; correct distorted thinking 6. Exposure: designed to disconfirm misappraisals and extinguish conditioned emotional responses to external situations and contexts through in vivo exposure and interoceptive exposure (deliberately induce feared physical sensations a number of times and long enough so misappraisals are disconfirmed and conditioned anxiety responses are extinguished.

Panic disorder: Diagnose/ Assess

1. in-depth interview 2. Take data on frequency, intensity, and duration of panic attacks, and details of avoidance behavior 3. Medical evaluation to rule out several medical conditions 4. Self-monitoring (objective self-awareness can reduce negative affect and provide feedback for judging progress 5. Several standardized self-report inventories provide useful info 6. behavioral tests to measure degree of avoidance or specific interoceptive cures and external situations

Implosion therapy proper

1st. Explain how your anxiety continues because you can escape and avoid things. So you have to stay in contact with most feared anxiety provoking thing, until anxiety dissipates. 2nd. First did a severe description (that was harsh looking) Feel him bite your face, and the blood is coming out and poison is coming into your face. He is snapping at your ear. Starting to bite at your eyes. Let him bite... Slammed his hand down on the table. 3rd. Expect to see anxiety begin to decline down (may last 15 minutes) and dissipate. 4th. Ask them geez, how are you feeling now? What do you make of that? 5th. I guess I handled that okay and I survived and calmer now (Bandura's self-efficacy notion)

AB design

A Get some attempt for a baseline or natural occurring frequency. Do treatment in B. Think about what specific things you are doing that bring about change in this client under these circumstances

Panic disorder: how it is understood

A learned fearfulness of certain bodily sensations associated with panic attacks; a phobia of bodily sensations "Fear of fear" is caused by 2 factors: 1) interoceptive conditioning - conditioned fear of internal cues, such as heart rate 2) misappraisal of bodily sensations as unpredictable and uncontrollable Emerge from a diathesis between life stressors and physiological/ psychological vulnerabilities Expectancies of the US are violated during extinction

Baseline, treatment, baseline, treatment B go back to treatment. More assured that it will change. (don't want to end on a no-treatment condition)

ABAB

Carl Rogers about resistance

Actions produce reactions and may be difficult to change. Therapists need to look at their own contributions to clients who are not making progress.

Panic disorder: Terminate

After successful combining exposure to feared and avoided agoraphobic situations with deliberate induction of feared sensation into those situations. Last session (12) reviews the principles and skills learned and provides the patient with a template of coping techniques for potential, high-risk situations in the future.

checklist or rating scale

Are completed by someone other than the client, such as a parent, teacher, or spouse. They list potential problem behaviors, are efficient, and are completed retrospectively (so reactivity is not a concern). Typically are used to assess target behaviors, they also can be used to identify maintaining conditions. Can be used for initial screening purposes, as global measures of change, and sometimes they are used to select target behaviors. The utility depends on informants' accurately observing the client's behaviors and then making reliable ratings.

direct self-report inventory

Are questionnaires containing brief statements or questions that require a simple response or rating. Used primarily for covert (thoughts and feelings) behaviors. They are highly efficient and are often used for initial screening. Their validity depends on clients' responding honestly and accurately, client may not do this because they want to present oneself in a favorable light (for example, to please the therapist), the tendency to overestimate or underestimate one's own behaviors, and the frequent discrepancy between what people say and what they do.

Radical approach of BF Skinner?

Argues that behavior, rather than mental states (psychodynamic), should be the focus of study in psychology. He emphasizes the importance of reinforcement and the relationships between observable stimuli and responses.

How does a behaviorist view resistance?

As therapists, we are always prime components in the resistance equation: we push to hard and the client pushes back Putting the "resistance label" on the client interferes with the possibility for doing something different. Suggestion: reverse your know-it-all therapeutic posture (interpretation) and present yourself as naïve/puzzled, a co-investigator of how to get the client unstuck from his/her quagmire ("Columbo" approach) Develop a problem-solving stance

What are the basic elements of anxiety interventions

Assessment Education (If SD then do relaxation training here) Anxiety Hierarchy Proper implementation Homework

Simple phobia: Treatment

Assessment Help educate client and allow to choose treatment that is the best fit Anxiety Hierarchy (Teach relaxation if doing Systematic Desensitization) Implosion, Flooding, or Systematic Desensitization (in vivo or imagined; imagined only with implosion) Homework Termination

Collaborative emperism

Began with Beck, a way to engage with the client as a co-investigator and use evidence based treatments to initiate change

multimethod, multimodal

Behavioral assessment is ______________ (using more than one method of assessment) and _____________ (assessing more than one mode of behavior).

Social anxiety disorder: Treatment

CBT - commonly treated in a group setting (role plays, support from others with similar problems, vicarious leaning, information exposure stemming from group participation, people to challenge distorted thinking 1. psychoeducation 2. training in cognitive restructuring 3. exposures (hierarchal) with cognitive restructuring before, during, and after each exposure provides client with confidence and motivation to try in real world and allows for feedback the client wouldn't get in the real world. 4. advanced cognitive restructuring: notice common themes in client's automatic thoughts, move beyond situation specific automatic thoughts by applying the downward arrow technique, review all previous homework that involved automatic thoughts 5. termination

Panic disorder: Treatment overview

CBT most commonly used and most effective natural environment of in vivo exposure therapist driven exposure then client driven exposure homework assignments

role-playing

Clients enact problem situations to provide the therapist with samples of how they typically behave in those situations. It is especially useful in assessing social skills, such as assertive behaviors. It is efficient form of assessment and no special physical arrangements are needed because the relevant environmental conditions are imagined—clients act as if they were in the problem situation. Reactivity is a problem, acting different then they would in a realistic situation. Many clients initially feel uneasy or awkward engaging in this assessment, but most clients can "get into" it. The therapist also must be able to play roles realistically, which requires specific knowledge of how other people interact with the client. This includes avoiding stereotypic concepts of role relationships, such as how fathers "typically" deal with sons.

Eight types of behavioral assessments

Clinical interview Checklist and rating scales Self-monitoring/recording Systematic naturalistic observation Simulated observation Role-playing Physiological measurement Direct self-report

B design

Collect data over a period of time. Start treatment immediately when the person comes in.

simulated observation

Conditions are set up to resemble the natural environment in which the client's problem is occurring. The observation often takes place in a room that allows observers to see and hear the client through a one-way mirror and intercom. Can test hypotheses concerning external maintaining conditions by systematically varying them and observing changes in the client's target behavior. Having the observers out of sight generally minimizes reactivity. Simulated observation is more efficient than systematic naturalistic observation in terms of the observers' time. Limitation of simulated observation concerns the ability to generalize from observations made under a simulated condition to the client's natural environment.

Termination

Consider if the client is actually behaving differently to determine termination. Should be an evaluation involving both the client and the therapist and consider treatment generalization. The client should be able to tell you if they are actually behaving differently. Remember: collaborative empiricism. The client is becoming a scientist too and there is an ongoing joint examination of if defined goals are being met, which keeps the endpoint in view for both. Can offer phone number to contact if needs arise, space sessions further apart, or set up a booster session. Can schedule a follow up session. Client should be aware of the measurable progress they made and be able to tell you about it. Throughout the sessions, you are increasing self-efficacy. Ask the client about this Do you think you can continue to when we are not seeing each other as frequently or anymore? How confident are you about your ability to carry on with less support from the therapy sessions?

systematic naturalistic observation

Consists of observing and recording a client's specific, predetermined overt target behaviors as the client naturally engages in them. Precise definitions of the behaviors, including criteria for differentiating each target behavior from similar behaviors, are essential. Need inter-observer reliability for accuracy, need training and behaviors should be clearly defined. Also should be done unobtrusively and an adaptation period should occur. Weaknesses: personal biases, invasion of privacy and time-intensive. Also reactivity.

PTSD: Diagnose/ Assess

Criteria: witness, experienced, or otherwise been confronted with an event that involved actual or threatened death, serious injury, or threat to physical integrity and respond in intense fear, helplessness, or horror Assessment may be difficult due to shame, avoidance, or unaware they experienced a trauma. Interview (using a detailed behavioral prompt), structured behavioral interview, self-report instruments & psychophysiological assessments

multiple baseline treatment designs

Evaluates the effects of a therapy for multiple tar- get behaviors, clients, or settings—depending on the purpose of the study. One purpose is to ascertain whether the therapy is effective for multiple target behaviors; Second purpose is to determine whether the therapy is effective with different clients; Third purpose is to assess whether the therapy is effective in different settings (such as at home and at work). If the therapy is responsible for the changes in a target behavior, then change should occur only when the therapy is introduced and not before.

OCD: Treatment

Exposure and response prevention (EX/RP) is the most effective approach Information gathering and treatment planning Generate a treatment plan with hierarchy Describe homework Treatment period: Exposure to anxiety-producing obsession (EX) and prevention of compulsion (RP) (about 90 minutes) (Sounds like in-vivo flooding to me) Gradually move through hierarchy of stimuli Optimal frequency of sessions has not yet been established: daily sessions over 1 month (severe) to much less frequent (highly motivated clients with mild OCD). Home visit (treatment best done in patient's normal environment) Maintenance period Patient may try to replace rituals with more subtle rituals. Instruct patient to resist these subtle ones too. Avoid arguments; use hierarchy If becoming emotionally overloaded, then take a break and instruct patient to calm down.

What kind of therapy to use in OCD?

Exposure and response prevention (check to make sure they have not changed their safety behaviors, could even be subtle)

EMDR what is it?

Eye Movement Desensitization and Reprocessing, still controversial; founded by Shapiro, must have specific training in order to do it. Therapeutic components: 1) Targeting: Five aspects of the Target that need to be defined/assessed: a. image b. negative cognition c. positive cognition: VOC Scale d. emotions and disturbance level: SUD e. physical sensations 2) Activating the Information-processing system: Eye movements Barlow: a cognitive-behavioral treatment aimed at facilitating information processing of traumatic events and cognitive restructuring of negative, trauma-related cognitions.

Mower's Two Factor Theory of Fear

Fears are developed through classical conditioning, whereby previously neutral cues became associated the UCS that elicit UCR. Once developed, it is maintained through operant conditioning (negative reinforcement of fear avoidance/escape behaviors).

Assertion training steps

Five components: 1) Assessment 2) Educational phase 3) Development of AT hierarchy: collaboratively 4) Steps in role playing and behavioral rehearsal: a. identify client's personal rights b. distinguish between nonassertive, assertive, and aggressive responses c. identify and change· irrational thoughts supporting unassertive behavior d. practice specific responses (social reward and coaching) 5) Homework assignments

Assessment of anxiety can be measured by looking at the _____ of behavior

Frequency, duration, intensity, and amount of by product

5 dysfunctional assumptions of OCD

Having a thought = an action Failing to prevent harm to self or others = having caused the harm in the first place Responsibility is not attenuated by other factors (low probability of occurrence) Not neutralizing when an intrusion or wanting the harm involved = seeking or wanting the harm to happen One must exercise control over one's thoughts.

It is easier to ______ your way into a new way of behaving than to _____ your way into a new way of ________.

act; think; acting

Simple phobia: Medications

antidepressant; SSRI ?

What is an obsession

are persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause marked anxiety or distress. Common obsessions are repeated thoughts about causing harm to others, contamination, and doubting whether one locked the front door.

ABA

baseline, treatment, baseline go back to baseline, and take away therapy, because it is hard to do (can't take back therapy) But there are practice effects.

Triple vulnerability that underlies anxiety, anxiety disorders, and related mood disorders

biological vulnerability, general psychological vulnerability (ex: more vulnerable to anx in general), and a specific psychological vulnerability emerging from early learning (ex: learn specific beliefs which leads to higher vulnerability to anx).

OCD: Diagnose/ Assess

characterized by recurrent obsessions and/or compulsions that interfere substantially with daily functioning Yale-Brown Obsessive Compulsive Scale; obsessive compulsive inventory revised (self-report tool) Structured interview to assess obsession and compulsions, degree of interference with functioning Inquire about external fear cues rated on with Subjective Units of Discomfort (from 0 to 100) Inquire about internal fear cues (images, impulses, or abstract thoughts), feared consequences, strength of the belief (patients with poor insight do not respond well to exposure and response prevention), avoidance and rituals (to prevent), & mood states

What is intraceptive conditioning

conditioned fear of internal stimuli (involved in panic disorder)

PTSD: 4 Kinds of Treatments

coping skills focused treatments, exposure based treatments (more efficient technique), cognitive therapy (use daily diaries, or monitor thoughts and taught to dispute their unrealistic or exaggerate thoughts), and combination treatments (affective and interpersonal regulation; cognitive processing therapy) and EMDR.

Agoraphobia: how it is understood

emerge from a diathesis between life stressors and physiological/ psychological vulnerabilities. Individuals report that panic preceded their development of avoidance

Multimethod assessment

helps overcome the limitations of single methods and provides more complete information about clients' problems and because it examines different facets of the problem behavior, can result in more effective treatment.

4 characteristics of behavioral therapy

individualized, stepwise fashion, treatment packages (two isn't always better than one) and brevity

self-recording/ monitoring

involves clients' observing and keeping records of their own behaviors. It is time efficient and can be used to assess both covert (thoughts) and overt behaviors. Problems: First, usefulness depends on the client's ability and willingness to make careful and candid recordings. Second, this interrupts ongoing activities and if the target behavior occurs frequently, numerous interruptions will occur. Not surprisingly, clients may find self-recording irritating, which can result in their failing to record. The third problem is reactivity, where completing this activity influences the performance of the behavior.

Modeling

is a form of observational learning (process by which people are influenced by observing others' behaviors). Through observing one learn's two things: 1) what the person did 2) what happened to the person as a result of the person's actions

10 Assumptions of behavioral therapy

is based upon testable hypotheses while traditional psychotherapy is not considers symptoms as evidence of faulty learning (both "healthy" and "unhealthy") considers symptoms to be the cause of anxiety not vice versa rejects the "medical/disease model" the problem is the behavior Symptom = Problem focuses on the symptom encourages clients to engage in specific actions/behaviors to alleviate their problems focuses on the here and now/present recognizes the importance of the therapeutic relationship Insight is not necessary for change Change does not occur through catharsis

According to behavior therapists, problems from the past are being maintained in the present because of _____________. Additionally, behavior therapists believe that you can __________________, but not change the events.

learning approaches (being reinforced in some way, shape, or kind); change your current perceptions of past events

cognitive restructuring

learning to treat anxiety provoking thoughts and beliefs as hypotheses and to explore whether there are more helpful or realistic ways of viewing the situation, self, and others: addressing dysfunctional cognitions frees up attentional resources to focus on social task at hand; ask helps take credit for successes and cope with disappointments after exposures.

Panic disorder: Medications

many more patients receive medications than treatment, because physicians are first life defense.

Agoraphobia

refers to avoidance or endurance with dread of situations from which escape might be difficult or help unavailable in the event of a panic attack, or in the event of developing symptoms that could be incapacitating and embarrassing Barlow: a behavioral response to the anticipation of such bodily sensations or their crescendo into a full-blown panic attack, continues to be supported by experimental, clinical, and longitudinal research.

What is a compulsion

repetitive behaviors or mental acts of which the goal is to prevent or reduce anxiety or distress. Common compulsions include hand washing, checking, and counting.

What type of medication is used in anxiety treatment/ what works/doesn't work

shown to be effective in reducing anxiety disorder symptoms are the selective serotonin reuptake inhibitors (SSRIs; e.g., Paxil), tricyclic antidepressants (e.g., Anafranil), Monoamine Oxidase Inhibitors (MAOIs; e.g., Nardil), and benzodiazepines (e.g., Klonopin). In panic disorder, greater relapse following exposure combined with anxiolytics (especially high-potency, short-acting drugs) compared to exposure alone may be attributable to medications functioning as safety signals. Don't use benzodiazepines with CBT for panic/ or emotional disorders- may elicit safety behaviors

Perceived self-efficacy is

the belief that people have that they can be successful at a task (common cognitive mechanism of change for all therapies) Done in bx therapy through acting.

3 major ways that fear is learned

traumatic experiences observational learning informational transmission