PSY 2700 Exam 3

Home-School Contracts

- contract developed from work at school - reinforcer provided at home e.g. use of car, allowance, etc. - benefits wider variety of reinforcers consistency across setting greater parent-child interactions greater involvement of parents in child's school

Home-school contracts

- contracts between parents and children (about behavior in school settings) - wide variety for parents that teachers just cant offer (more options for parents to offer reinforcement for children)

Self-Control Techniques: What are we talking about?

"self-help" (i.e., big business mass media books)? in behavior modification, "self-control" equals... - techniques in which the client plays an active or even sole part in administering the intervention self-help literature does not necessarily entail self-control procedures - although there may be some overlap e.g. Burns, The Feeling Good Handbook

Example of Principle of Cognitive Therapies

- Myriam and Ted both received a "D" on Dr. Canu's exam -there response will be mediated by interpretations and thoughts based on this shared experience (could be a variety of different reasons why) - *Myriam: "Good gravy, I know that I can do better than that! I guess I've learned my lesson. I'll talk to Dr. Canu about how to study better. - *Ted: "Geeze...another failure. I am never going to pass this class. I guess I'm just not college material. I am such a loser." Cognitive therapies are useful for lots of problems... - maladaptive thought patterns (like Ted's) underlie certain clinical problems (e.g. social anxiety), and changing these provides relief - use adaptive ways to change behavior & feel better -maladaptive thought patterns do *not* really underline other clinical problems (e.g. multiple sclerosis), but changing client's cognitions can still improve adjustment

Peer- administered Contingencies: example

- administered to an elementary school setting -tutors (older kids 11-12) nominated by teachers that show good social skills - tutees nominated by teachers that show withdrawn or socially rejected - the tutors are walking around and when they notice the children struggling they remind them how to manage conflict, train prosocial interaction skills -effected the tutors themselves (if you really want to learn something you have to teach it) the social skill of the tutors was also elevated just as the tutees was.

Contingency contract strengths cont.

- agree to all positions even consequences - clients know in advance (flexible)

Consequence Salience: vicarious

- allow client the opportunity to see consequences being delivered to someone else who does the target behavior - particularly useful in school, work, or home settings with more than one child e.g. administering verbal praise to the three children in a classroom for prosocial behavior increase the prosocial behavior of others (strain et. al., 1976) e.g., distributing reward at family dinner table to children, nothing the behavior that earned them

Formalizing the plan: Contingency contracts: strengths

- allowing clients a role in negotiating the contract increases buy-in, decreases changes of aversively perceived punishments - the contracts are set up to be flexible (adaptable) - the contingencies (expectations) re made very explicit, reducing conflict and increasing chance that rewards are actually given

Target Behavior : Behavioral activation

- component of intervention for depression -increase the frequency of activities that previously were experienced as pleasurable that client has withdrawn from - target behavior= reading new suspense novels operational definition=reading a chapter of a novel a day reward = 2 points; assume same back-up reinforcers as on last slide - whats the Problem with this program? examine the *complexity* of the behavior - some target behaviors are hard to start, are actually a behavioral chain -e.g. getting in the car, driving to library or bookstore, selecting a novel, returning home, settling in to read, reading - use response priming, where the early steps of a complex behavior are initiated - here could arrange for a parents or friends to select and bring two suspense novels from best seller list, turn on light next to read, reading chair, put glass of iced tea on table next to reading chair

Contingency Contracts cont.

- contract adds a layer of responsibility & clarity -provides a reward and a penalty for not doing it -bonuses for a specific behavior ex: rent: pay 6 consecutive months in a row get $50 of next rent -all contracts are negotiable

Sampling the C's: Consequences salience

- even if reward or punishment is contingent, immediate, and consistently delivered, unless it seems *meaningful*, motivation to do target behavior may be low - one way to encourage motivation is to make the possible (particularly reinforcing) consequences more obvious *reinforcer sampling* - this entails any Procedure that provides a small sample of a reinforcing event that will promote use of that reinforcer (and therefore, motivation to earn it) - e.g. if backup reinforcer in a token economy for misbehavior at home is a cookie, baking a batch of cookies while child works or plays in kitchen (olfactory sample)

Peer- administered Contingencies: advantages

- interaction with peers is attractive, positive in itself - tutors, themselves, tend to improve their already strong behaviors - allows for greater individual attention (efficiency of resources) - mimics "real-life" better, results may generalize to other peer settings better

group contingencies

- meant to help a group do better a responsibility everyone in the group shares

Group Programs: general comments re: group programs

- more efficient, involves peers, building group cohesion - make sure that groups do not lose privileges that they normally have in implementing these new/ extra privileges should be given for the improved behavior

Formalizing the plan: Contingency contracts: Weaknesses

- not very useful with very young clients or those with serious cognitive limitations - when contracts are made between parties of different "power" (e.g., parent-children), care must be taken to fairly administer/negotiate

family Setting (contract examples: couples therapy)

- one for wife and one for husband - penalties & rewards - signature

Enhancing Performance of Behavioral Interventions Back to the ABC's: Modify Antecedents

- reminder: antecedents = stimuli & contexts that occur before and influence behaviors - Provide more prompts - these make the target behavior more obvious, increasing the likelihood it will be used ex: target behavior= clearing one's plate from the table; prompt= parent doing this, then gently saying "You can do this to for a token." - these are particularly helpful in getting the target behavior started in a program of reinforcement, or... - prompts can also be used as interventions in their own right - though tend to not have very strong effects - e.g. "buckle up- I care!" study (Geller, Bruff, & Nimmer, 1985)

Formalizing the plan: Contingency contracts

- while some interventions (e.g. token economies) have well-defined expectations, none are quite as clear as a contract -what's developed: a written agreement between clients 9those who want/need to change) and interveners (those eho ehat the change to happen), detailing what each party wants to gain: - task (observable behaviors that interveners want to see), well-defined (who, what, when , how well?) -reinforcer (what the client wants for success), well-defined (from who, what, when, how much?) observable behaviors: that the client must exhibit to earn a reward specifies punishment: if the behavior does not occur often specifies bonuses: for consistent behavior specifies how behavior will be monitored -the terms of the contract can be renegotiated

RET: Therapist-guide challenges cont.

-After getting a parking ticket, 5 minutes after the meter ran out..."I can't believe I am so stupid." -T: "what evidence is there that you are actually stupid?...Did you notice any other meters around you? any other tickets on cars?...Have any of your friends or familt ever gotten a parking ticket? Do you think that person is stupid?...what happened before you got that ticket? were you distracted, or held up? is that the same as 'stupid?' -After forgetting to mail girlfriend's letter..."there's no chance she'll ever forgive me." -T: "how much do you believe that she won't forgive you?...Has anything like this ever happened before?...What was her reaction then?...You have been together for some time, do you think that she would forget all the good things just like that?...if this happened to you, would you forgive her?...DO you maybe think that your relationship is actually stronger than that?"

RET: At the end of each Challenge

-T: "what's a better way to think about what happened? And what do the other, positive things about you that we just discussed mean?" In-session work is combined with practice tasks and thought exercises throughout the week RET has been shown to be effective at addressing -depression -anxiety -substance Abuse -Explosive Anger

A note re: biofeedback

Biofeedback is considered by many to be a "fad" treatment (give you a mental image of you physically during that behavior--picture your heart rate going down it has been tried for many conditions, including ADHD - results for that disorder are very ambiguous (see Rojas & Chan, 2005) In general, this trains individuals to modify their brainwave or other physiological activity - muscle tension, temperature, BP, HR the most reliable effect is a relaxation response the most reliable effect is a relaxation response However, a big drawback is that this "direct" means of training relaxation take much longer than PMR, deep breathing, or other relaxation techniques, at added expense - it is also difficult for clients to implement on their own

Example: Insomnia

Bootzin, 1972 - Adult insomniac, spent 3-4 hours awake EVERY NIGHT before able to go to sleep -if you are in your bed for half an hour and not asleep get up

Example of Self-Monitoring

Broden et. al. 1971 poor academic performance by 8th grader 10-s time sampling for 30 min each day recorded study behavior - occurred 30% of time assignment for girl: when you realize you aren't paying attention make check mark on this sheet - when she does this she stays on task about 75-80% of the time (on task increases) - teacher praises her for being on task - they soon are able to remove self-check and just use verbal praise from the teacher

Peer-administered contingencies

Peers can perform paraprofessional duties with minimal training - monitoring behavior -modifying environment for client success - administering consequences (reinforcement/punishment) Supervision is provided by therapist/professional - reinforcement is provided to peer-managers for job well done e.g. school-based intervention for prosocial skill development - elementary setting - "tutors" are older children (11-12 y.o.) with good social skills - "tutees" are others who are socially rejected, withdrawn - tutors trained to identify/train prosocial interaction skills, set up opportunities for tutees to practice, prompt their use of new skills (Gumpel & Frankel, 1999)

Problem-Solving Skills Training

Problem solving components: -Perspective taking -evaluation of situation -accurate assessment of response choices (i.e. actions needed) -consequences of planned action Poor problem solving skills are associated with several impairments, including... -aggressive and antisocial (delinquent) behavior, negative peer relationships, neglectful parenting, substance abuse Training to be better problem solvers: - to be more awareness of situations requiring problem solving -self-statements to cue efficient problem solving steps (self questions moving towards a solution:) - ex questions: "what am I supposed to do? What is my plan? How do I do it?" -Assertive skills to implement solution (as needed given problem!) ex: speak to other people to learn about the rules of a particular activity

CT: example

Sally passes a friend on the way to the library, who does not stop to say "hi." -thought: "she really doesn't care about me after all." -feeling: sadness; degree 80 on a 100-point scale Therapist-client Dialogue -T: Let's look at that situation again. Could there be another way of explaining what happened? -S: I don't know. -T: why else might she have rushed by so quickly? -S: I'm not sure. She might have had class. She might have been late -T: okay, now what would be the worst that could happen in this situation? -S: that she would truly not like me, I guess. That I couldn't count on her for support -T: Would you survive that? -S: yeah, but I wouldn't be happy about it? -T: and what's the best thing that could happen? -S: that she does like me. That she was just rushed then. -T: and whats the most realistic outcome? -S: I guess I do think she still likes me. -T: What's the effect of changing your thinking, here? -S: I feel better. -T: What do you think you should do about this situation? -S: Uh, What do you mean? -T: Well, have you withdrawn from her since this happened? -S: Oh yeah, I think so. I avoided her this morning at breakfast. I guess i should talk to her more, be friendlier myself.

Joe Camel

Smoking: who smoked 4 packs a day at baseline - almost 90 somedays - program administered by client himself -80 to 70 or less: 2 dollars in a jar for vacation or other reward - (for missing goals) Punishment: $20 dollars to the therapist to give to a charity of her choice (one he didn't like) -got down to 5 cigarettes a day instead of 90 (big improvement)

Great debate... S-R, or S-O-R?

behaviorists lead a charge to base intervention solely on stimulus-response theory - defined behavior change as driven by observable events, period - make some sense-principles of learning are very broadly applicable, suggesting that individual differences play limited role however, even research with animals models suggested that processes within the organism played some role in effectiveness of learning and behavior change

Modeling

by watching someone else perform target behavior, observer can learn associations, making the response more or less likely in therapy, is often a prelude to more direct behavioral change -Discussion of target behavior (conversation initiation) -Break down components (achieving correct proximity, looking person in the eye, making a greeting, bringing up an appropriate topic, nonverbal encouragement behaviors) -Demonstrating components (modeling) and remediating any deficiencies -therapist and client do a "field trip" and client unobtrusively observes as the therapist initiates conversations with strangers (modeling) -therapist and client can replay this in session, do role plays -Client attempts conversation initiation in "homework" exercises

Rational-emotive therapy (RET)

champion: Albert Ellis Premise: people suffering from certain psychological disorders (e.g. depression, anxiety) regularly employ maladaptive self-statements that fuel distress - After sleeping through a class..."I'm a worthless sack of potatoes." - After dropping a clean shirt on the floor... "I never do anything right." - After getting a parking ticket, 5 minutes after the meter ran out..." I can't believe I am so stupid." -After forgetting to mail girlfriend's letter..."There's no chance she'll ever forgive me." Therapist actively identifies and disputes the logic of such self-statements

Hayes, Brownell, & Barlow (1978)

classic case of a male sex offender -criminal record of attempted rape and exhibitionism -Chronic fantasies of violent sexual behavior i.e. BIG risk of recidivism -Program of covert sensitization in which he visualized performing exhibitionistic or sadistic behavior that was followed by aversive consequences

E.g. Tolman (1948): rat learning route in a maze

conditioned 1: rat's correct response (turns) are directly reinforced conditioned 2: as in C1, except rats are allowed to simply run around maze beforehand result: rats in C2 far outpaced their C1 peers, despite the fact that there was no difference in stimulus-response conditioning somehow, the experience (probably both knowledge and expectations) of the C2 rats made behavior acquisition easier

Relaxation Techniques

deep breathing (moves your stomach) progressive muscle relaxation (PMR) (often pairs with other techniques) - repeated tension and relaxation in distinct muscle groups -trains the "relaxation response"

When is "self-control" used? (cont.

delayed negative consequences - immediate reward - delayed risk (very bad to moderately bad)

Team-based contingencies

e.g. getting 1st - 2nd grade students to brush their teeth effectively (swain et. al., 1982) - 6/7 y/o don't brush teeth very well

Group Contingencies example

e.g. reducing "missing" cash from registers (Marholin & Gray 1976) - cash wandering its way out of the register - brought group together to figure out the problem - decided to let there be less than 1 % in the cash register they could keep (by offering rewards) helped them keep up with the money

Lotteries example

e.g. reducing absenteeism in a distribution center (pedalino & Gamboa, 1974) - in distribution center (a lot of people didn't come to work, showed up late etc.) - if person came on time and got to leave work on time every time. there name got placed in a lottery to get a free paid day off every month - winner for distribution center and employees

Changing the B: Tweaking target behaviors

e.g. reducing smoking - client is a two-pack-a-day smoker (40 cigarettes) - reinforcement program is devised to reward non-smoking - target behavior = not smoking during 1 day - reward = 10 tokens - back-up reinforcers (available at end of any day) dessert (2 cookies) = 5 tokens bubble bath = 5 tokens long-distance call to friend (20 minutes) = 5 tokens rental movie= 10 tokens dinner out = 20 tokens new shoes = 40 tokens -what's the problem with this program? examine the *difficulty* of the target behavior - perhaps the demand is too great, making it very hard to earn reinforcement - temporarily reduce difficulty to get target behavior going

CT: Basic steps

educate the client about the cognitive model of depression -thoughts--> mood, a cycle -negative cognitive triad Gradually assist client to see how automatic thoughts follow patterns -build client's skills at identifying feelings and related automative thoughts Negative triad: come from present, and future thoughts (notice when mood starts to slip and thoughts change) start to challenge maladaptive beliefs - build client's ability to evaluate situations and possible consequences logically, identify feasible alternative explanations for perceived negative events -fashion homework experiences to further challenge negative beliefs

Group Programs: lotteries

encourage behavior change in a group of people in an efficient way - lower number of reinforcers are needed - limited number of tangible reinforcers given out e.g. reducing absenteeism in a distribution center (pedalino & Gamboa, 1974)

consequence sharing

ex: military training - one person not running fast enough so everyone has to run more if this one person doesn't run fast enough - that night people give him punishment that wasn't planned and it can escalate really quickly

Contingency Contract: weaknesses example

ex: parents: interveners children: clients difficult to do (parent have power so it may be a slippery slope) -parents may not listen to children's negotiation (just because they can)

RET: Therapist-guided challenges

general rules: discuss evidence for the irrational thought (usually little to none) and illustrate how other interpretations better account for the event - After sleeping though a class..."I'm a worthless sack of potatoes." -T: "is that right?...are you really worth the same as sack of potatoes?!"... The last time you were in class, were all the students there? ...What do you thin of those who were missing?... Are they worthless too?... Does missing that class really mean you are worthless?... is there some other reason besides your self-worth that you missed class? -After dropping clean shirt on the floor..." i never do anything right." -T: "You've never done anything right? I find that hard to believe...is that really the case?... what are some examples of things that you have done right, no matter how long ago?...How had was dropping the shirt on the floor, anyway?

Group Programs: consequence sharing

here the target behavior for one person is monitored (target of change), but others in the group share in the consequences - for reinforcement-based programs... shared punishment could lead to reprisal, other social problems inherently builds peer support and encouragement - e.g. classmates, coworkers, siblings, spouses, etc.

Example of imagined scenario

imagination of the client - he is imagining something terrible happening to him (arrested and his family leaving him)

Not = Avoidance (at least in the long run)

in approach #1 (reducing exposure to the S^D to help change behavior), avoidance of S^D initially is strict (most common stimulus control) However, as person gains more control over target behavior (i.e. it is occurring with less frequency), forms of the S^D may start being re-introduced (gradually more intense) -Bakery window example (stick Boy): ex: = $200 or 300 a month at stick boy -tried stimulus control -avoid driving by stick boy (2 weeks) -drive by and stay in the left lane (2 weeks) -drive in right hand lane (2 weeks) -go in stick boy everyday and not buy anything (had to let stick boy know this) (2 weeks) -just buy a loaf of bread (only) could be used for addicts coming out of rehab (need someone to be there to help them through it)

Cognitive Therapy (CT) of Depression (Beck, 1995)

in some fundamental ways, this is quite similar to RET *more thought placed on the in-between thoughts (I think?) differences: while self-talk (here termed "automatic thoughts") is an important focus, the underlying beliefs are also a direct target - "I will never be able to pass Behavior Change' is likely indicative of a broader belief, like "I am worthless" or "I am a failure A little less confrontational - Instead of thoughts and beliefs being "challenged: and framed as "irrational," these are hypotheses to be tested more emphasis on corrective, behavioral experience - client is given behavioral assignments for out-of-session time e.g. go see a comedy (eg. Game night); act of seeing the film (and hopefully better mood during/after) challenges thought that person will never be able to get out and do things (and enjoy them)

Covert Conditioning

instead of directly reinforcing or punishing the client to change target behavior, *Client imagines performing the target punishment... -covert sensitization (aversive consequence): imaging does the behavior -covert response cost: pay the fine - covert modeling*: images someone else doing something reinforcement... -covert positive reinforcement -covert negative reinforcement -covert modeling* ...or being ignored -covert extinction ex: imagine yourself speaking effectively in-front of a crowd (which can help you be amore effective speaker)

Group Programs: Team based Contingencies

like a group contingency, except the group is divided into two or more "teams" that compete against each other re" the target behavior - consequences vary for how well each team does - 1st best, 2nd best, 3rd best and so on... e.g. getting 1st - 2nd grade students to brush their teeth effectively (swain et. al., 1982)

Stimulus Control

many behaviors are associated with stimuli to (S^D) increases the likelihood of the behavior - e.g. a "bus stop" sign prompts adaptive waiting behavior in self-driven stimulus control, the client is in charge of manipulating S^D to change behavior *change the environment for the individuals ex: breaking up: two kinds - clean break (you are doing stimulus control) - it is okay to be friends *doing it for a reason have relationship and engage in specific behaviors - that person makes you do certain things (discriminative stimulus): thoughts and act as if you are still together 1. Avoiding or reducing S^D which prompt maladaptive behavior 2. Consistently pairing an S^D with an adaptive behavior to increase the frequency ex: rubber band on arm--see it, I need to call my mom (she wants me to call me more often) 3. shifting association for a behavior from a maladaptive S^D to an adaptive S^D --petafile (trying to not erase biological sexual response from children to adults--so they will respond in a way that is adaptive)

Other relaxation applications

migraine headaches (Gutkin et al. 1992) * are associated with muscle tension - 4 severe, chronic headache sufferers (adults) - 10 sessions of PMR training (& at-home practice) - PRM resulted in tripling of headache-free days Arthritic pain (Varni, 1981) - three hemophiliac patients with chronic pain due to damage and bleeding in their joints - pain most days of the week - 8-10 weeks training in deep breathing, imagery (of previous situations not associated with pain) - post-treatment: pain at most 1 day a week, maintained over a year after treatment ends

Application: Insomnia

quire common in US adult (30-40%)--very common - disrupts success at school, work productivity, life satisfaction emotional well-being stimulus control is an effective treatment - many people associate the bedroom and their bed with many other behaviors beside sleep *as college student might be the only private place you have in your home* -watch TV -reading books, newspapers, magazines -doing homework -paying bills and -balancing checkbook -writing letters -talking on the phone worrying -Thinking about the day, and about tomorrow -as bob Eubanks would say "making whoopee"*

Imagery-Based flooding

recap: flooding= intentional, graduated exposure of the client to feared stimulus - reduces association between stimulus and fear through habituation instructing the client to use imagery to "encounter" the stimulus often produces similar effects for certain disorders, in vivo flooding is difficult and/or unethical, and imagery-based techniques are the best alternative -e.g. Post Traumatic Stress Disorder (PTSD) -Case of Joseph (6 y.o. Lebanese boy; Saigh, 1986)

Therapist Input

stimulus control responsibilities - explaining the principle of discriminative stimuli and motivation for behavior (our environment changes so we need to be ready for that) - discussing procedures of stimulus control (how the stimulus control will work for the patient) - assessment of individual to determine S^D of problematic behavior (specifically identify the stimulus that is causing the specific behavior) - assisting individual to define a step-by-step stimulus control plan (each step) - providing motivation and consultation as need (let the client start the process--client has any problems contact the therapist) The rest is up to the client! *make sure they are ready for change--if not this might not be a good idea for them*

Applications of Self-Control: Self-monitoring

systematic observation of your own behavior (overtime) different that self-assessment, which is a one-time examination of potential "problem" - This can be done in reference to many resources, including the internet (e.g. WebMD), handbooks (e.g. DSM-IV), etc. -self-assessment is a good thing, but in itself doesn't create much change self-monitoring can produce behavior change - reactivity

Cognitive Therapy

the direct target of change is the thoughts of the clients (which changes the way the person feels and is adjusted to their lives)

Group Programs: group contingencies

these are behavioral contracts in which the criterion for reinforcement is based on the group's behavior very useful in settings where the same behavior is to be encouraged by all group members e.g. reducing "missing" cash from registers (Marholin & Gray 1976)

Results

this program worked for him

Principle of Cognitive Therapies

thoughts and beliefs directly influence behaviors (including affective-emotional responses)

Prompts

to maximize effect of prompts - deliver immediately prior to opportunity to do target behavior - specify what the target behavior is - deliver in a polite, undemanding wat -immediately follow the target behavior (if it happens) with reinforcement Do Not Count on prompts working on their own - these are best used to improve effectiveness of reinforcement - many everyday examples where these do not work on their own... "eat your broccoli!" "do your homework early!" "speed limit 65 MPH"

Alternate Response Training

training a cline to replace one (maladaptive) behavior with another (adaptive) behavior a very common application: treatment of anxiety disorders via use of relaxation techniques physiological: -heart rate increases -blood pressure increases - a relaxed state is *incompatible* with anxiety - when client can maintain (even with therapist support) a relaxed state in a setting that normally cues anxiety, this eventually cues anxiety, this eventually can replace the anxiety response

When is "self-control" used?

usually to change behavior that has an immediate positive consequence (reward) but delayed aversive consequences (punishment) - smoking - drinking - using illicit drugs - unprotected sex - oversleeping - overeating - staying up too late - leaving dishes - leaving laundry * all have negative consequences * have to engage in self-control to not do these things, because if I don't something bad will happen. Self-control is exercised when the individual forgoes the immediately rewarding activity to avoid the expected, delayed loss

Stress Inoculation Training

version of cognitive intervention meant to improve coping responses for events that are objectively aversive - e.g. spinal tap, bone marrow aspiration, surgery, chronic pain due to medical condition (all of these are objectively bad--painful) -"mind over body" intervention (can train people to use cognitive relaxation--imagery techniques) As discussed, relaxation and imagery can be used to alleviate stress and pain...*cognitive* (at least, cognitive-behavioral) strategies Strategies -train clients to identify signs of stress (when it is rising) -e.g. physiological changes: fast, breathing, heart pounding, trembling -Train clients to employ relaxation techniques when signs appear -develop and train clients to employ positive self-statements (about procedures or situation) Results - Better emotional and physical adjustment, resilience in future hardships

Joseph

was a Lebanese boy--suicide bomber set of bomb (6 y/o) in the middle of all of this. - loses a couple of people in his family - he develops PTSD - once his story was told maybe it can be divided in certain prices --before it goes of (less distress) --when it goes off (distressing) --after it goes off (most distressing) - try to show him that thinking about the trauma is not something he should be anxious about (not to make it alright because its not) but be able to think about the trauma. Graph: slide 49 - on a 5 point scale for each piece - ask him to relive the first part of his day - T: stops him on the first part and stops him (and ask how he feels: still anxious) - tells it again (don't feel as anxious) - next day: the first part and then the next part... -same process until the end - the worst part came down to a 3 (which is better) but the other moments anxiety has subsided.

The Point is...

when these things occur, the bedroom, (inappropriately) becomes S^D for things other than sleep * when you enter your bedroom--your brain thinks of all the different things--and they don't involve sleep - these activities activate the body and mind, getting ready to do them (even unconsciously) leads to extended sleep latency by employing stimulus control-setting rules (see table 10-2) 1. that the bedroom is only to be slept (or whoopeed) in --retraining your brain that your bedroom is just for sleeping 2. that if one cannot fall asleep one leaves that room until ready to try again --if you cant sleep get out of bed and doing something else when you are exhausted - rebuilds the association of going to bed and staying in bed prompting (SD) Sleep