Exam 2: Behavior Therapy (CNS 520)

Third-generation behavior therapies center around five interrelated core themes

1) An expanded view of psychological health, 2) A broad view of acceptable outcomes in therapy 3) Acceptance, 4) Mindfulness, and 5) Creating a life worth living

Seven key characteristics of behavior therapy

1) Behavior therapy is based on the principles and procedures of the scientific method, 2) Behavior is not limited to overt actions a person engages in that we can observe, 3) Behavior therapy deals with the client's current problems and the factors influencing them, as opposed to an analysis of possible historical determinants, 4) Clients involved in behavior therapy are expected to assume an active role by engaging in specific actions to deal with their problems, 5) This approach assumes that change can take place without insight into underlying dynamics and without understanding the origins of a psychological problem, 6) Assessment is an ongoing process of observation and self-monitoring that focuses on the current determinants of behavior, including identifying the problem and evaluating the change, and 7) Behavioral treatment interventions are individually tailored to specific problems experienced by the client

Four Areas of Development in Contemporary Behavior Therapy

1) Classical Conditioning, 2) Operant Conditioning, 3) Social-cognitive theory, and 4) Cognitive behavior therapy

Four major approaches in the recent development of the behavioral tradition

1) Dialectical behavior therapy - has become a recognized treatment for borderline personality disorder; 2) Mindfulness-based stress reduction - involves an 8 to 10 week group program applying mindfulness techniques to coping with stress and promoting physical and psychological health; 3) Mindfulness-based cognitive therapy - aimed at primarily treating depression; 4) Acceptance and commitment therapy - based on encouraging clients to accept, rather than an attempt to control or change, unpleasant sensations

Systematic desensitization three-step process

1) Relaxation training (such as progressive muscle relaxation), 2) Development of a graduated anxiety hierarchy (stimuli that elicit anxiety in particular areas are ranked), and 3) Systematic desensitization proper that involves the presentation of hierarchy items while the client is in a deeply relaxed state

Basic Steps for Self-Management (Watson and Tharp)

1) Selecting goals, 2) Translating goals into target behaviors, 3) Self-monitoring, 4) Working out a plan for change, 5) Evaluating an action plan

Who would benefit from assertion training

1) Who have difficulty expressing anger or irritation, 2) Who have difficulty saying no, 3) Who are overly polite and allow others to take advantage of them, 4) Who find it difficult to express affection and other positive responses, 5) Who feel they do not have a right to express their thoughts, beliefs, and feelings, or 6) Who have social phobias

Multimodal therapy

A comprehensive, systematic, holistic approach to behavior therapy developed by Arnold Lazarus; a model endorsing technical eclecticism; uses procedures drawn from various sources without necessarily subscribing to the theories behind these techniques; begins with a comprehensive assessment of the Basic I.D. of human functioning and the interaction among them; Grounded in social-cognitive theory and applies diverse behavioral techniques to a wide range of problems; This approach serves as a major link between some behavioral principles and the cognitive behavioral approach that has largely replaced traditional behavioral therapy; Multimodal therapists determine precisely what relationship and what treatment strategies will work best with each client and under which particular circumstances

Therapeutic Techniques and Procedures in Behavior Therapy

A hallmark of the behavioral approaches is that the therapeutic techniques are empirically supported and evidence-based practice is highly valued; Behavioral practitioners can incorporate into their treatment plans any technique that can be demonstrated to effectively change behavior; Behavior therapists do not have to restrict themselves only to methods derived from learning theory; Applied behavioral analysis, relaxation training, systematic desensitization, exposure therapies, eye movement desensitization and reprocessing, social skills training, self-management programs, self-directed behavior, multimodal therapy, mindfulness and acceptance-based approaches

A

A limitation of traditional behavior therapy is its a. de-emphasis on the role of feelings in therapy. b. lack of clear concepts on which to base practice. c. lack of research to evaluate the effectiveness of techniques. d. overemphasis on early childhood experiences. e. disregard for the client-therapist relationship.

Progressive muscle relaxation

A method of teaching people to cope with the stresses produced by daily living; it is aimed at achieving muscle and mental relaxation and is easily learned; after clients learn the basics of relaxation procedures, it is essential that they practice these exercises daily; Jacobson is credited with initially developing this procedure; Clients assume a passive and relaxed position in a quiet environment while alternately contracting and relaxing muscles; deep and regular breathing is also associated with producing relaxation; at the same time, clients learn to mentally "let go"; this procedure allows clients to recognize their tense muscle build up and learn the difference between a tense and relaxed state

Systematic desensitization

A procedure based on the principles of classical conditioning in which the client is taught to relax while imagining a graded series of progressively anxiety-arousing situations; eventually, the client reaches a point at which the anxiety-producing stimulus no longer brings about the anxious response; Developed by Joseph Wolpe; Clients imagine successively more anxiety-arousing situations at the same time that they engage in a behavior that competes with anxiety; gradually, or systematically, clients become less sensitive (desensitized) to the anxiety-around situations; Homework and follow-up are essential components of successful desensitization; Systematic desensitization is among the most empirically supported therapy methods available, especially for the treatment of anxiety and fears

Self-managed in vivo exposure

A procedure in which clients expose themselves to anxiety-evoking events on their own

Acceptance

A process involving receiving one's present experience without judgment or preference, but with curiosity and kindness, and striving for full awareness of the present moment; Acceptance is not resigning oneself to life's problems, but an active process of self-affirmation; Acceptance is an alternative way of responding to our internal experience; By replacing judgment, criticism, and avoidance with acceptance, the likely result is increased adaptive functioning

Negative Punishment

A reinforcing stimulus is removed following the behavior to decrease the frequency of a target behavior (such as deducting money from a worker's salary for missing time at work, or taking away the television from a child for misbehavior); Punishment should be used only after non-aversive approaches have been implemented and found to be ineffective in changing problematic behavior

Assertion training

A set of techniques that involves behavioral rehearsal, coaching, and learning more effective social skills; specific skills training procedures used to teach people ways to express both positive and negative feelings openly and directly; The basic assumption is that people have the right (but not the obligation) to express themselves; One goal is to increase people's behavioral repertoire so that they can make the choice of whether to behave assertively in certain situations; Assertion does not mean aggression; Most assertion training programs focus on clients' negative self-statements, self-defeating beliefs, and fault thinking; Assertion training is often conducted in groups; It may not be suitable for clients with a cultural background that places more emphasis on harmony than on being assertive

Operant conditioning

A type of learning in which behaviors are influenced mainly by the consequences that follow them; if the environmental changes brought about by the behavior are reinforcing, the chances are increased that the behavior will occur again; includes positive and negative reinforcement, punishment, and extinction techniques; used in parent education programs and with weight management programs

B

According to most behavior therapists, a good working relationship between client and therapist is a. a necessary and sufficient condition for behavior change to occur. b. a necessary, but not sufficient, condition for behavior change to occur. c. neither a necessary nor a sufficient condition for behavior change to occur.

Positive Punishment

An aversive stimulus is added after the behavior to decrease the frequency of a behavior (EX: such as a time-out procedure with a child who is displaying misbehavior)

E

An exposure-based procedure that involves imaginal flooding, cognitive restructuring, and the induction of rapid, rhythmic eye movements aimed at treatment of traumatic experiences is called a. relaxation training. b. flooding. c. in vivo desensitization. d. systematic desensitization. e. eye movement desensitization and reprocessing.

D

Applied behavior analysis makes use of a. none of these. b. classical conditioning techniques. c. cognitive behavioral techniques. d. operant conditioning techniques. e. all of these.

Key elements of social skills training

Assessment, direct instruction and coaching, modeling, role-playing, homework assignments; a key step involves the necessity of clients putting into action the information they are acquiring

Imaginal flooding

Based on similar principles and flows the same procedures as in vivo, except he exposure occurs in the client's imagination instead of in daily life; compared to in vivo flooding, imaginal allows no restrictions on the nature of the anxiety-around situations that can be treated (EX: airplane crash, rape, fire, flood)

A

Behavior therapy is grounded on a. the principles of learning. b. the psychodynamic aspects of a person. c. a philosophical view of the human condition. d. the events of the first 5 years of life.

Therapist's Role in Behavior Therapy

Behaviorally oriented practitioners tend to be active and directive and to function as consultants and problem solvers; they rely on empirical evidence about the efficacy of the techniques they apply to particular problems; they must possess intuitive skills and clinical judgment; They use some other common techniques such as summarizing, reflection, clarification, and open-ended questioning; • The therapist strives to understand the function of client behaviors, including how certain behaviors originated and how they are sustained; The behavioral clinician uses strategies that have research support for use with a particular kind of problem; these evidence-based strategies promote generalization and maintenance of behavior change; The clinician evaluates the success of the change plan by measuring progress toward the goals throughout the duration of treatment; outcome measures are given to the client at the beginning of treatment (called a baseline) and collected again periodically during and after treatment to determine whether the strategy and treatment plan are working; A key task is to conduct follow-up assessments to see whether the changes are durable over time; clients learn how to identify and cope with potential setbacks

Client's Experience in Behavior Therapy

Both therapist and client have clearly defined roles, and the importance of client awareness and participation in the therapeutic process is stressed; The client engages in behavioral rehearsal with feedback until skills are well learned and generally receives active homework assignments to complete between therapy sessions; The change clients make in therapy need to be transitioned to real life; Motivational interviewing is a strategy of clients are not motivated; Clients are encouraged to experiment for the purpose of enlarging their repertoire of adaptive behaviors; Clients are expected to do more than merely gather insights; they need to be willing to make changes and to continue implementing new behavior once formal treatment has ended

C

Contemporary behavior therapy places emphasis on a. helping clients acquire insight into the causes of their problems. b. encouraging clients to reexperience unfinished business with significant others by role-playing with them in the present. c. the interplay between the individual and the environment. d. a phenomenological approach to understanding the person. e. working through the transference relationship with the therapist.

Social learning approach (social-cognitive approach)

Developed by Albert Bandura and Richard Walters; A perspective holding that behavior is best understood by taking into consideration the social conditions under which learning occurs; the environmental events on behavior are mainly determined by cognitive processes governing how environmental influences are perceived by an individual and how these events are interpreted; a basic assumption is that people are capable of self-directed behavior change and that the person is the agent of change

E

Dialectical behavior therapy a. is a form of operant conditioning. b. is a long-term therapy for treating depression. c. is a form of classical conditioning. d. has no empirical support for its validity. e. is a promising blend of behavioral and psychoanalytic techniques.

Consequences

Events that take place as a result of a specific behavior being performed; events that maintain a behavior in some way, either by increasing or decreasing it (EX: a client may be more likely to return to counseling after the counselor offers verbal praise or encouragement for having come in or for having completed some homework)

Dialectical Behavior Therapy (DBT)

Formulated by Linehan, this is a promising blend of behavioral and psychoanalytic techniques for treating borderline personality disorders; emphasizes the importance of the psychotherapeutic relationship, validation of the client, the etiologic importance of the client having experienced an "invalidating environment" as a child, and confrontation of resistance; DBT is highly structured, but goals are tailored to each individual; it is not a "quick fix" approach

A

In behavior therapy it is generally agreed that a. the client should decide the treatment goals. b. goals of therapy are the same for all clients. c. the therapist should decide the treatment goals. d. goals are not necessary.

In vivo flooding

Intense and prolonged exposure to the actual anxiety-producing stimuli; remaining exposed allows the anxiety to decrease on its own; clients are prevented from engaging in their usual maladaptive responses to anxiety-arousing situations; tends to reduce anxiety rapidly

Social skills

Involve being able to communicate with others in a way that is both appropriate and effective

Social-cognitive theory

Involves a triadic reciprocal interaction among the environment, personal factors (beliefs, preferences, expectations, self-perceptions, and interpretations), and individual behavior

Mindfulness

Involves being aware of our experiencing in a receptive way and engaging in activity based on this nonjudgmental awareness; clients train themselves to intentionally focus on their present experience while at the same time achieving a distance from it; involves developing an attitude of curiosity and compassion to present experience; a process that involves becoming increasingly observant and aware of external and internal stimuli in the present moment, and adopting an open attitude toward accepting what is, rather than judging the current situation

In vivo exposure

Involves client exposure to the actual anxiety-evoking events rather than simply imagining these situations; involves repeated systematic exposure to fear items, beginning from the top of the graduated anxiety hierarchy; clients engage in a brief, graduated series of exposures to feared events; clients learn responses incompatible with anxiety, such as muscle relaxation; Clients carry out self-directed exposure exercises at home; In some cases, the therapist may accompany clients as they encounter feared situations, such as going on an elevator with a client who has a phobia of elevators

Positive reinforcement

Involves the addition of something of value to the individual (such as praise, attention, money, or food) as a consequence of certain behavior; the stimulus that follows the behavior is the positive reinforcer; A form of conditioning whereby the individual receives something desirable as a consequence of his or her behavior; a reward that increases the probability of its recurrence; The key principle in the applied behavior analysis approach is to use the least aversive means possible to change behavior, and positive reinforcement is known to be the most powerful change agent

Major Premise of Multimodal Thearpy

It is that breadth is often more important than depth; the more coping responses a client learns in therapy, the less chance there is for a relapse

Four Modules that DBT Skills are Taught

Mindfulness (helps clients embrace and tolerate the intense emotions they experience when facing distressing situations), interpersonal effectiveness (involves learning to ask for what one needs and learning to cope with interpersonal conflict), emotion regulation (includes identifying emotions, identifying obstacles to changing emotions, reducing vulnerability, and increasing positive emotions), and distress tolerance (aimed at helping individuals to calmly recognize emotions associated with negative situations without become overwhelmed by these situations; clients learn how to tolerate pain or discomfort skillfully)

B

Mindfulness and acceptance-based approaches a. have no legitimate place in behavior therapy. b. have received empirical support as an effective form of therapy. c. are a part of traditional behavior therapy. d. have not yet been accepted into the behavioral tradition. e. have no research evidence to support the value of the techniques used.

A

Mindfulness practices rely on a. experiential learning and client discovery. b. negative reinforcement. c. high intellectual abilities. d. didactic instruction. e. positive reinforcement.

Behavior Therapy's view of human nature

Modern behavior therapy is grounded on a scientific view of human behavior that accommodates a systematic and structured approach to counseling; the person is the producer AND the product of his/her environment (which differs from the deterministic assumption); The current trend in behavior therapy is toward developing procedures that give control to clients and thus increase their range of freedom; Behavior therapy aims to increase people's skills so they have more options for responding; People are freer to select from possibilities that were not available to them earlier, which increases individual freedom

Antecedent events

Ones that cue or elicit a certain behavior (EX: a client who has trouble going to sleep, listening to a relaxation tape may serve as a cue for sleep induction)

Cognitive Behavior Therapy (CBT)

Operates on the assumption that what people believe influences how they act and feel; an approach that blends both cognitive and behavioral methods to bring about change; represents the mainstream of contemporary behavior therapy and is a popular theoretical orientation among psychologists; Today only the integrative therapies are more popular than CBT; CBT had replaced behavior therapy as the accepted designation, and the field began emphasizing the interaction among affective, behavioral, and cognitive dimensions; Contemporary behavior therapy has much in common with cognitive behavior therapy in which the mechanism of change is both cognitive (modifying thoughts to change behaviors) and behavioral (altering external factors that lead to behavior change)

Key principles of operant conditioning

Positive reinforcement, negative reinforcement, extinction, positive punishment, and negative punishment; The goal of reinforcement is to increase target behavior, but the goal of punishment is to decrease target behavior

Behavior Therapy

Practitioners focus on directly observable behavior, current determinants of behavior, learning experiences that promote change, tailoring treatment strategies to individual clients, and rigorous assessment and evaluation; this approach refers to the application of diverse techniques and procedures which are supported by empirical evidence; Has been used to treat anxiety disorders, depression, PTSD, substance abuse, eating/weight disorders, sexual problems, pain management, and hypertension; Used in the fields of developmental disabilities, mental illness, education/special education, community psychology, clinical psychology, rehabilitation, business, self-management, sports psychology, health-related behaviors, medicine, and gerontology

A

Prolonged/intense exposure—either in real life or in imagination—to highly anxiety-evoking stimuli is called a. flooding. b. in vivo desensitization. c. systematic desensitization. d. self-management training. e. eye movement desensitization and reprocessing.

Classical conditioning (respondent conditioning/Pavlovian Conditioning)

Refers to what happens prior to learning that creates a response through pairing; Ivan Pavlov illustrated this through experiments with dogs; a form of learning in which a neutral stimulus is repeatedly paired with a stimulus that naturally elicits a particular response - the result is that eventually the neutral stimulus alone elicits the response; Desensitization can be applied to people who, through classical conditioning, developed an intense fear of flying after having a frightening experience while flying; This technique of classical conditioning illustrates how principles of learning derived from the experimental laboratory can be applied clinically

Self-management

Strategies in self-management programs include self-monitoring, self-reward, self-contracting, and stimulus control; the basic idea is that change can be brought about by teaching people to use coping skills in problematic situations; In self-management programs, people make decisions concerning specific behaviors they want to control or change; Self-management strategies have been applied to many populations and problems, such as panic attacks, helping children cope with the fear of the dark, increasing creative productivity, managing anxiety in social situations, encouraging speaking in front of a class, increasing exercise, control of smoking, and dealing with depression

Mindfulness-Based Stress Reduction (MBSR)

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Therapeutic Goals in Behavior Therapy

The general goal of behavior therapy are to increase personal choice and to create new conditions for learning; The client, with the help of the therapist, defines specific treatment goals at the outset of the therapeutic process; Assessment and treatment occur together, but a formal assessment takes place prior to treatment to determine behaviors that are targets of change; Continual assessment throughout therapy determines the degree to which identified goals are being met; Contemporary behavior therapy stresses clients' active role in deciding about their treatment; Goals must be clear, concrete, understood, and agreed on by the client and the counselor

self-efficacy

The individual's belief or expectation that she/he can master a situation and bring about desired change; Bandura

Punishment

The process in which a behavior is followed by a consequence that results in a decrease in the future probability of a behavior; The goal of reinforcement is to increase target behavior, but the goal of punishment is to decrease target behavior

Functional assessment (behavioral analysis)

The process of systematically generating information on the events preceding and following the behavior in an attempt to determine which antecedents and consequences are associated with the occurrence of the behavior; the goal of the functional assessment is to understand the ABC sequence

Negative reinforcement

The termination or withdrawal of an unpleasant stimulus as a result of performing some desired behavior; involves the escape from or the avoidance of aversive (unpleasant stimuli); the individual is motivated to exhibit a desired behavior to avoid the unpleasant condition (EX: a friend has trained herself to wake up a few minutes before the alarm sounds to avoid the aversive stimulus of the alarm buzzer)

Behavioral assessment interview

The therapist's task is to identify the particular antecedent and consequent events that influence, or are functionally related to, an individual's behavior; a set of procedures used to get information that will guide the development of a tailor-made treatment plan for each client and help measure the effectiveness of treatment

ABC Model

This model of behavior posits that behavior (B) is influenced by some particular events that precede it, called antecedents (A), and by certain events that follow it called consequences (C)

Relationship Between Therapist and Client in Behavior Therapy

Today, most behavioral practitioners stress the value of establishing a collaborative working relationship with their clients; The skilled behavior therapist conceptualizes problems behaviorally and makes use of the client-therapist relationship in facilitating change; Most behavioral practitioners contend that factors such as warmth, empathy, authenticity, permissiveness, and acceptance are necessary, but not sufficient, for behavior change to occur

Exposure therapies

Treatment for fears and other negative emotional responses by carefully exposing clients to situations or events contributing to such problems; involves systematic confrontation with a feared stimulus, either through imagination or in vivo (live); imaginal exposure can be used prior to implementing in vivo exposure; desensitization, in vivo exposure, and in vivo flood are different types of exposure therapy; Some clients may not elect these exposure treatments due to the discomfort associated with prolonged and intense exposure; It is important that clients understand that anxiety will be induced as a way to reduce it; Using exposure as a sole treatment procedure is not always sufficient for success

True

True or false: A program of behavioral change should begin with a comprehensive assessment of the client.

False

True or false: Acceptance and commitment therapy (ACT) is based on helping clients control or change unpleasant sensations and thoughts.

True

True or false: Behavior therapists look to current environmental events that maintain problem behaviors and help clients produce behavior change by changing environmental contingencies.

True

True or false: Behavior therapists tend to be active and directive, and they function as consultants and problem solvers.

True

True or false: Behavioral techniques can be effectively incorporated into a group counseling format.

False

True or false: Multimodal therapy consists of a series of techniques that are used with all clients in much the same way.

True

True or false: Operant conditioning was mainly developed by B. F. Skinner.

True

True or false: Relaxation training has benefits in areas such as preparing patients for surgery, teaching clients how to cope with chronic pain, and reducing the frequency of migraine attacks.

True

True or false: The emphasis of contemporary behavior therapy is on evidence-based treatments.

False

True or false: Typically, the goals of the therapeutic process are determined by the therapist.

Extinction

When a previously reinforced behavior is no longer followed by the reinforcing consequences, the result is a decrease in the frequency of the behavior in the future; withholding reinforcement from a previously reinforced response (EX: a child has temper tantrums, and much of the behavior is reinforced from the parents attention - a parent uses extinction when during and after a child's temper tantrum, the parent ignores the behavior)

B

Which is not true as it applies to multimodal therapy? a. The therapist makes a comprehensive assessment of the client's level of functioning at the outset of therapy. b. Great care is taken to fit the client to a predetermined type of treatment. c. Therapists adjust their procedures to effectively achieve the client's goals in therapy. d. Therapeutic flexibility and versatility are valued highly. e. The approach encourages technical eclecticism.

C

Which is not true as it is applied to behavior therapy? a. Therapy should focus on behavior change and not attitude change. b. Therapy is not complete unless actions follow verbalizations. c. Insight is necessary for behavior change to occur. d. A good working relationship between client and therapist is necessary for behavior change to occur.

A

Which is not true of dialectical behavior therapy (DBT)? a. DBT is a blend of Adlerian concepts and behavioral techniques. b. DBT was formulated for treating borderline personality disorders. c. DBT relies on empirical data to support its effectiveness. d. DBT emphasizes the importance of the client-therapist relationship. e. DBT incorporates mindfulness training and Zen practices.

B

Which of the following is not considered one of the basic characteristics of contemporary behavior therapy? a. Emphasis is on using evidence-based treatment interventions. b. The therapy is an experiential and insight-oriented approach. c. Experimentally derived principles of learning are systematically applied to help people change their maladaptive behaviors. d. There is an attempt to develop culture-specific procedures and obtain clients' adherence and cooperation in a treatment program. e. The focus is on assessing overt and covert behavior directly, identifying the problem, and evaluating change.

Eye movement desensitization and reprocessing (EMDR)

an exposure-based therapy that involves three basic phases - 1) assessment and preparation, 2) imaginal flooding, and 3) cognitive restructuring, and the use of rhythmic eye movements and other bilateral stimulation; used to treat traumatic stress disorders and fearful memories of clients; Developed by Francine Shapiro and designed to assist clients in dealing with PTSD and has been applied to a variety of other populations (sexual abuse victims, rape survivors, accident victims, etc.); Shapiro emphasizes the importance of the safety and welfare of the client when using this approach; Because of the powerful reactions from clients, it is essential that practitioners know how to safely and effectively manage these occurrences; It is unclear of the lateral eye movements create change, or the pairing with cognitive techniques is doing the work

The BASIC I.D.

the cognitive map linking each aspect of personality; complex personality of human beings can be divided into seven major areas of functioning: behavior (Overt behaviors, including acts, habits, and reactions that are observable and measurable), affective responses (Emotions, moods, and strong feelings), sensations (Basic senses of touch, taste, smell, sight, and hearing), images (How we picture ourselves, including memories, dreams, and fantasies), cognitions (Insights, philosophies, ideas, opinions, self-talk, and judgments that constitute one's fundamental values, attitudes, and beliefs), interpersonal relationships (Interactions with other people), and drugs, biological functions, nutrition, and exercise

Social skills training

this training involves a broad category that deals with an individual's ability to interact effectively with others in various social situations; a treatment package used to teach client skills that include modeling, behavior rehearsal, psychoeducation, feedback and reinforcement; individuals who experience psychosocial problems that are partly caused by interpersonal difficulties are good candidates for social skills training; Used with alcohol/substance abuse, attention deficit/hyperactivity disorder, bullying, social anxiety, emotional and behavioral problems in children, behavioral treatment for couples and depression