Chapter 28

Briefly describe four components of a behavioral treatment for alcohol dependency.

(a) A motivational interview, in which the therapist asks the client questions about the problem, the answers to which act as motivational establishing operations for change; (b) coping skills training to teach clients to deal with stressors that are thought to cause excessive alcohol consumption; (c) contingency contracting to provide reinforcers for work, social, and recreational activities that do not involve alcohol; and (d) strategies to prevent relapse.

List three classes of specific phobias, and give two examples of each.

(a) Animal type (e.g., fear of spiders, birds); (b) situational type (e.g., fear of small spaces, going outside of one's home); and (c) natural environment type (e.g., fear of floods, thunder). Other types are acceptable.

List and briefly describe four components of behavioral couples therapy.

(a) Instigation of positive exchanges in which each spouse increases behaviors that are pleasing to the other partner; (b) communication training to help couples express to each other what they like and don't like; (c) problem-solving training to help spouses identify and solve problems in their relationship; and (d) programming for generality of treatment by having clients monitor critical aspects of their relationship, and encouraging clients to continue using problem-solving and other techniques.

List and briefly describe four behavioral strategies for treating obesity?

(a) Self-monitoring of foods eaten, daily caloric intake, and body weight; (b) stimulus control of eating by restricting eating to specific locations; (c) reducing eating rate by applying one or more procedures; (d) signing behavioral contracts in which clients agree to lose a certain amount of weight in order to obtain positive consequences and/or avoid negative consequences.

Describe the three components of habit reversal used to treat a habit disorder.

(a) The client learns to describe and identify the problem behavior; (b) the client learns and practices a behavior that is incompatible with or competes with the problem behavior; (c) for motivation, the client reviews the inconvenience of the problem behavior, and has a family member provide reinforcement for engaging in treatment.

What is virtual reality therapy? Give an example.

Virtual reality therapy consists of a method for presenting fear-producing stimuli through computer-generated virtual reality technology in which clients wear a head-mounted display that provides a computer-generated view of a virtual reality environment. This technology makes it possible to present fear-producing stimuli in therapy that are difficult to arrange for in-vivo exposure to them, such as violent thunderstorms.

What is the defining characteristic of exposure-based therapies? [Level 2/C] Give an example of a nonexposure therapy?

A defining characteristic of exposure-based therapies is that they involve exposure—either in imagination or in vivo—of the client to the feared stimulus or stimuli. Cognitive therapy (i.e. helping a client to overcome irrational thinking that is thought to cause problems) would be an example of a non-exposure based therapy. ACT, another non-exposure therapy, has also been used in the treatment of specific phobias.

What is a fear hierarchy?

A fear hierarchy is a list of fear-eliciting stimuli arranged in order from the least-to-the- most fear-eliciting.

What is a specific phobia?

A specific phobia is an intense, irrational, incapacitating fear of a stimulus class.

Briefly describe, with reference to an example, how acceptance procedures might be used in the treatment of an obsessive-compulsive disorder.

Acceptance procedures may also be used in the treatment of obsessive-compulsive behavior by helping an individual to accept that thoughts are not controllers of behavior. The individual may learn to think of thoughts such as worrying about germs as "mental garbage" which has no bearing on how clean they are or their worth as a person. Any appropriate example is acceptable.

Briefly describe an effective treatment for obsessive-compulsive disorder.

An effective treatment for obsessive compulsive disorder is in vivo exposure and response prevention (the client is encouraged to engage in a behavior that leads to an obsession, while the compulsive behavior is prevented). For example, an obsession about leaving the stove on when leaving the house is evoked and the individual is allowed to only check once before leaving.

Briefly describe an effective treatment for panic disorder with agoraphobia.

An effective treatment for panic disorder with agoraphobia typically includes a behavioral component involving exposure to feared situations, and a cognitive component to help change the client's misconceptions about panic attacks.

In several sentences, describe an effective treatment for posttraumatic stress disorder.

An effective treatment for posttraumatic stress disorder is long-term vicarious exposure to the event or events that caused the problem. This may be done through imagination, talking about the event with a therapist, or writing about it. This way, the emotions elicited by the stimuli related to the trauma will extinguish and the debilitating attempts to avoid those stimuli will decrease.

In applications of CM approaches to nicotine and opiate addictions, how is substance-use measured?

Analysis of CO levels in the breath is used as a measure of whether an individual has refrained from smoking. Urine samples are used to measure abstinence from opiate drugs.

List and briefly describe four types of anxiety disorder.

Any four of the following: (a) Specific phobia: a persistent, irrational fear of a circumscribed stimulus or stimuli organized around some theme, such as fear of heights. (b) Panic Disorder: attacks that may include heart rate abnormalities, sweating, trembling, shortness of breath (smothered feeling), choking feeling, chest pain, nausea, dizziness, feeling of unreality, numbness or tingling, chills/hot flashes, fear of going crazy, losing control or fear of dying. These attacks seem to come "out of the blue." (c) Agoraphobia: which literally means fear of the marketplace, and is an intense fear of going out in public or leaving the confines of one's home. (d) Generalized Anxiety Disorder (GAD): constant worry and feeling anxious over things that most people consider trivial, unimportant, or unlikely. Individuals are so consumed by anxiety that it interferes with normal functioning, often including inability to sleep at night. (e) Obsessive Compulsive Disorder (OCD): unwanted, intrusive thoughts (obsessions) or feeling impelled to engage in repetitive, unproductive behaviors (compulsions). The obsessive thoughts and compulsions tend to go together. For example, obsessive thoughts about germs are relieved by compulsive hand-washing. (f) Posttraumatic Stress Disorder (PTSD): Impaired functioning due to an attempt to avoid thinking about a traumatic event or events (e.g., accident, sexual abuse, etc.) and avoidance of stimuli that are reminders of the event(s).

Briefly describe, with reference to an example, how cognitive therapy might be used in the treatment of an obsessive-compulsive disorder.

Cognitive therapy can be used in treating obsessive compulsive disorder by changing an individual's self-statements. For example, if someone has obsessive thoughts about turning off the stove every time they leave the house, they may tell themselves, "The stove is off, I didn't even use it today." Any appropriate example is acceptable.

Why do empirically supported therapies often turn out to be behavioral or cognitive behavioral therapies?

ESTs typically are behavioral or cognitive-behavioral treatments because the behavioral approach emphasizes basing treatments on well-established principles, measuring the outcomes of treatments in objectively-defined behaviors, and altering treatments that are not producing satisfactory results.

What are empirically supported therapies (ESTs)?

Empirically supported therapies (ESTs) are therapies that have been proven to be effective in scientifically conducted clinical trials.

Briefly describe the behavioral characteristics of clinical depression.

For individuals suffering from clinical depression, their appetite is usually reduced, they experience decreased energy and increased fatigue, and they report an impaired ability to think, concentrate, or make decisions, and they often experience a sense of worthlessness or guilt.

What are two criticisms of the current emphasis on ESTs?

For treatments to be well-established, they must meet the following criteria: (a) at least two well-controlled studies with random assignment of participants demonstrating that the treatment is better than a pill or psychological placebo (either a therapeutically ineffective pill or a psychological procedure) or is equivalent to an existing established treatment; (b) the treatment is described precisely in a manual; (c) client characteristics in the research were clearly specified; and (d) research was conducted in at least two independent research settings.

Briefly describe four types of eating disorders. For which has behavior therapy been most effective?

Four types of eating disorder include: (a) bulimia nervosa, in which the client is malnourished, obsessed with being thin, and engages in frequent binges followed by purging or taking laxatives; (b) anorexia nervosa, in which the client rarely eats or eats very little; (c) binge eating disorder in which the client binges but may be normal weight or greater than normal weight; and (d) obesity, in which the client is sufficiently overweight to cause a health risk. Behavioral therapy has been most effective for obese clients in weight reduction (whether they binge or not). - Bulimia nervosa and anorexia nervosa have proven to be very resistant to treatment.

Briefly illustrate an example of how in vivo flooding might be used to treat a specific phobia.

In vivo flooding may be used to treat agoraphobia by placing a person in a crowd where he or she will be safe and should not incur any aversive stimuli. The individual's fear will be elicited at full intensity and when nothing bad happens, his or her fear will hopefully decrease or extinguish. Other appropriate examples are acceptable.

Describe a general behavioral approach to the treatment of sexual dysfunction.

On the assumption that anxiety is an important factor in many cases of sexual dysfunction, behavioral treatment usually involves exposure programs in which couples engage in pleasurable stimulation of each other in a relaxing atmosphere without expectation of, or pressure to, engage in intercourse. Both partners shift the goal from performance to that of experiencing pleasure.

Briefly illustrate an example of how participant modeling might be used to treat a specific phobia.

Participant modelling may be used to treat arachnophobia by the therapist modelling an approach to the feared stimulus (spider). The modelling may occur in a graded fashion. For example, the therapist models approaching a spider in a cage, then places it closer to the client, then removes the spider and holds it near the client and eventually asks the client to touch or hold it. At each step the client is praised for modelling the therapist. Any appropriate example is acceptable.

Using an example, briefly describe the three phases of systematic desensitization of a specific phobia.

Systematic desensitization for arachnophobia (fear of spiders): (1) therapist helps individual to develop a fear hierarchy, of 10-25 stimuli related to the feared stimulus that are ordered from least feared to most feared (e.g., from being outside to actually seeing a spider); (2) client learns deep muscle relaxation: tension-relaxation applied to muscles of all areas of the body that allows the individual to be able to relax deeply in minutes (after several training sessions); (3) actual therapy: the client relaxes and imagines the least fear- inducing scene on the list (being outside), then relaxes for 15-30 seconds. This continues from least-to-most fear-inducing scenes on the list unless the client experiences anxiety, then the therapist returns to the previous scene. By the last scene (seeing an actual spider), the client should be able to encounter a spider without distress.

Define systematic desensitization.

Systematic desensitization is a procedure for overcoming a phobia by having a client in a relaxed state successively imagine the items in a fear hierarchy.

What are the components of Sobell and Sobell's program for problem drinkers.

The Sobell and Sobell program teaches problem drinkers to use goal-setting to drink in moderation, to control "triggers" for drinking, to learn problem-solving skills to avoid high risk situations, to engage in self-monitoring to detect controlling cues and maintaining consequences of drinking behaviors, and to practice all of the above with various homework assignments.

What is the behavioral theory of depression referred to as behavioral activation? In a sentence, state what is behavioral activation treatment for depression designed to do?

The behavioral theory of depression referred to as behavioral activation states that "individuals become depressed when there is an imbalance of punishment to positive reinforcement in their lives." Behavioral activation treatment of depression is designed to block avoidance behaviors that prevent the individual from coming into contact with reinforcers, and to encourage the client to engage in activities identified as reinforcing in a functional analysis.

What is the distinction between obsessions and compulsions, and how might they be related?

The distinction between obsessions and compulsions is that obsessions are repetitive thoughts which tends to evoke anxiety and compulsions are repetitive overt actions that tend to reduce anxiety. Obsessions and compulsions tend to go together in that obsessions seem to cause anxiety that can only be reduced by engaging in compulsive behavior.

Describe the fundamental difference between flooding and systematic desensitization.

The model for systematic desensitization is counterconditioning, establishing a relaxation response to the feared stimuli, whereas the model for flooding is extinction. With flooding, the assumption is that if an individual is exposed to the feared stimuli and is not allowed to escape from them, and no aversive event follows, then the fear response to the stimuli will extinguish.