PSY 450
Levels of Listening
"What does the client mainly need for me to understand?" Listening for content Listening for feelings "yes, but..." Christine's story Listening for themes about self, others, life "Life scripts, guiding fictions, and myths"
Domestic Violence
-minimal impact on reducing recidivism -no differences in effect sizes bt/w CBT and other therapies; none were particularly effective for this pop
Cognitive Behavior Therapies
Alber Ellis's rational emotive behavior therapy & Aaron Beck's cognitive therapy - overlap btw behavioral & cognitive
Boundaries
An organized family has clearly marked boundaries Disengaged families have rigid boundaries Enmeshed families have diffuse boundaries Dysfunctional families respond to demands for change in pathological ways
Assertiveness training
Assertion inhibits passivity & aggression in relationships
EMDR
EYE MOVEMENT DESENSITIZATION & REPROCESSING - Shapiro
Early Criticisms of EMDR
Embellishing very basic exposure and beh tech w pseudosci lang and tech.
Anger Disorders
adults-better than controls kids-skills training and multicomponent treatments were more effective in reducing aggressive behavior & improving social skills whereas problem solving treatments were more effective in reducing subjective ager -a variety of behavioral & cog. behavior treatments for anger in kids&adults show med-large effects -certain treatment methods are prob more effective for specific anger problems -Skills training-->social skills -Relaxation training-> state anger -Cog. restructuring->road rage & trait anger
Problems with ABAB (reversal) design
like Multiple baseline design-cant determine what in the treatment package accounts for behavioral change
Distancing
method to deal with upsetting thoughts objectively reevaluating them rather than automatically accepting them
Biofeedback
more effective than headache monitoring, placebo and relaxation therapies
3 C's of Behavior Therapy
1) Counterconditioning 2) Contingency Management 3) Cognitive-Behavior Modification
Empathy
"Listening deeply enough to the client to be able to resonate (feel) to it and express it back to client in one's own words" Listening not only to what is said, but what is 'unsaid' "Deep listening is miraculous for both listener and speaker. When someone receives us with open-hearted, non-judging, intensely interested listening, our spirits expand." http://www.huffingtonpost.com/matthieu-ricard/could-compassion-meditati_b_751566.html
Nocturnal Enuresis
(bed-wetting) -kids recieving psychological treatment were more likely to have stopped bed wetting at both posttreatment and follow up than meds. -most successful treatment was urine alarm- plastic pad under child or small sensor attached to pjs detects moisture from urination and starts to alarm to wake the child
Cognitive Interweave
(interlaces th-derived statements with cl generated material) is introduced if cl processing proves insuff for following reasons: o Looping (rep, unhelpful thoughts that block processing) o Insuff info o Lack of generalization o Time pressures
Obsessive-Compulsive Disorder
- antidepressants, behavior therapy, and the combo were sig. more effective than placebo -on patients self ratings: behavior therapy was sig. more effective than antidepressants & that the combo of antidepressants and behavior therapy tended to be more effective than just antidepressant -premier treatment for OCD
Evidence Based Practice
- behaviorists are involved in creating treatment manuals and documenting for the purposes of enhancing professional training and treatment selection. - identify health care interventions that have been empirically tested and supported as more effective than active placebos or alternative treatments.
Cognitive Therapy
- involves assisting cl. in ferreting out automatic thinking & ultimately in reevaluating faulty cognitions by testing them both logically and empirically -generally limits therapy to 20 hrs -adheres to treatment manuals specific to each disorder -routinely administer brief symptom checklists (BDI & BAI)
Humanistic Criticisms of Behavior Therapy
- missing humane values that can help decide what is a sig. outcome for therapy -strives only for symptom relief -dehumanization -reflects an image of humanity directed by conditions outside our control. -mindless conditioning
REBT Practicalities
- most effective in treating mildly disturbed individuals or those with a single major symptom -patients with greater inborn tendencies towards irrational thinking can be helped but therapy is longer (~1 yr). -better deeper more enduring change in 1-20 sessions -once patients have basic cognitive model move to group therapy -use of bibliotherapy & public
Systemic Therapies
- multiple meanings -can refer to therapy modality or format -# of ppl in group -treatment content or goal
Intensive Exposure Therapy Video Example
- on youtube • Video about woman with agoraphobia (Sedada) • First educate patient about nature of anxiety • Drink caffeinated water to hype up anxiety • Hierarchy begins with elevator • It's your fear. This is hard. Th reassures cl. while cl. feels the anxiety/has panic attack. Th smiles. You are doing this, this is great. • Client does elevator alone. Repeats again and again. Breaks back of fear. • Takes subway w/th and alone. Learns to drive and window shop.
Psychoanalytic Criticisms of Behavior Therapy
- quantity not quality research -no sig. differences b/w their effectiveness with outpatients -short term success -No controlled studies on enhanced isight, improved object relations, deeper self awareness -superficiality
Effectiveness of Behavior Therapy with Couples and Families
- superior over no treatment and control treatment and depending on the review occasionally over alternative, non behavioral forms of family therapy
Practicalities of Cognitive Therapies
- various ages & disorders -proven successful with children, adolescents, adults and older adults - best documented achievement has been on neurotic disorders -REBT & Cog. have been applied to couples, families, sex therapy and organizations
Preparation
-"Indoctrination Phase" • Explain EMDR (the pseudoscience), train watching/ movie viewing (useful tools for dealing with event from a distance. Pretend you are merely an observer safe in a theatre watching this scene play out/or that you are simply watching the even pass by quickly like observing a landscape from a train {better for more severe SUDS})
Humanistic Perspective Criticisms of Cognitive Therapy
-21st century cant feel enough -alienation inability to experience strong emotions (e.g horror,terror) -use emotion to fuel change
Thomas Stampfl
-Avoidance is the heart of psychopathology o Inspired by psychoanalytic content and learning theory on avoidance conditioning and extinction o Learned avoidance reduces anxiety in short term. Which we then generalize to other situations. o Child with hostile parents grows up to fear all situations where he feels evaluated=social phobia o Extinction happens when we no longer reinforce anxiety through avoidance • Response prevention=not allowing cl to avoid anx provoking stimuli
BMT
-Behavioral Marital Therapy -communication skills training, problem solving training and modifying dysfunctional relationship expectations and attributions -produced sig. changes in behavior as compared w/ control couples, maintained over time -more sig. than no treatment
Marital & Group Therapy
-CBT better than no treatment -same as behavioral marital therapy or insight oriented marital
Eating Disorders
-CBT outperforms no treatment & control treatments -individual therapy better -psychotherapy alone better than meds alone
Psychotic Disorders
-CBT produces sig. effect on measures of + & - symptoms of schizophrenia -Cl. receiving both routine care and CBT outperformed those receiving routine care and supportive therapy -does not cure schizophrenia-speeds recovery & delay reoccurrence s
Body Dysmorphic Disorder
-Cog. therapy more effective then anti depressants
Structural Therapy
-Developed by Salvador Minuchin (1922 - ) -Created to treat delinquents as systemic issue rather then individual problem -Initial focus on delinquency & anorexia nervosa
Major Players in Behavior Therapy
-Joseh Wolpe -Donald Meichenbaum -Marsha Linehan
Personality Disorders
-Linehans DBT is effective & outperforms both no treatment & treatment as usual -compared to community treatment DBT was assoc. w/ better outcomes fewer suicide attempts, less treatment dropout, lower medical risk, and other indexes of success.
Effectiveness of Behavior Therapy for Specific Disorder
-OCD; Panic Disorder; Personality Disorders; Mental Retardation; Eating Disorders; ADHD;Schizophrenia; Anger Disorders; Cigarette Smoking; Nocturnal Enuresis; Hypertension; Migrane Headaches; Insomnia; Irritable Bowel Syndrome - support the application of psychological treatments to health conditions in addition to mental disorders
Servromechanisms
-mechanisms that contribute to self-regulatory processes w/i a couple or fam -automatic devices used to correct the performance of a mechanism by means of error-sensing feedback
Behavioral Perspective Criticisms of Cognitive Therapy
-REBT-> -only a handful report properly controlled experiments on its effectiveness -half of studies no info on whether manuals were used -in half of studies no info was provided in how well the treatment adhered to REBT -vast majority of studies no formal assesment was performed on the extent to which REBT could be dist. from comparison therapies -advocating empirical but w/ so many publications- produced so much dialogue and little data -Becks-> -are we to believe that emotionally disturbed ppl are primarily victims of their own dysfunctional thinking rather than products of dysfunctional environments -target pathological environment & reinforcements not pathological cognitions -Cog. Theory-> -change in underlying conditions has not been supported by empirical studies -The behavioral tech. not the cog. tech. prob cause the consequence of improved thinking
Psychoanalytic Perspective Criticisms of Cognitive Therapy
-REBT-> -th. systematically tear apart cl. worldview -Cog. Theory-> -cl. made to feel defenseless by th. ramming away at their ego processes become more vulnerable to th.
Cognitive Therapeutic Relationship
-Uses a Socratic Dialogue -approach described as collaborative empiricism: cl. determine from evidence which thoughts may be dysfunctional -cl. discovers for themselves those thoughts that are inaccurate -aspire to be empathic and warm -trusting relationship - * identification of problematic schemas and their remediation - support & direction
Contingency Management
-a novel application of CM is to addictive disorders -aims to increase reinforcement for non drug related activities and remove such reinforcement for drug use -effective in reducing use - larger & more immediate reinforcers led to better treatment results
Effectiveness of Behavior Therapy With Children
-across various outcome measures the avg. treated kid was more improved after treatment than about 80% of those not treated -proved more effective than non-behavioral treatments regardless of client age, therapist experience or problem type -superior effectiveness of the behavioral methods over no treatment and placebo treatment - typically more effective than alternative treatments such as play therapy and insight oriented therapy
Cultural Criticisms of Behavior Therapy
-are behavioral tech. being used to encourage conformity to normative standards of the dominant social group? -behaviorists risk becoming implicit content avoiders -lack of th. responsibility -th.. values are hidden & implicit standards used to determine what & who is in need of change -focus on indiv. skill training can neglect social causes & support dominant group values. - does not focus on system, and society
Insomnia
-behavior therapy & pharmaco-therapy (meds) have the same general effectiveness for persistent insomnia -behavior therapy resulted in greater reduction in sleep latency & dont have the - side effects & addictive potentials of sleep meds
Walking the middle path
-buddhism - btw dialectical tensions as skill enhancement vs. self acceptance, affect regulation vs affect tolerance and self-efficacy vs. help seeking
Depression
-cog. therapy is superior to no treatment & placebo -continued cog. therapy reduces the % of later relapse of recurrence -cog. therapy is as effective or is slightly more effective than other psychotherapies for depression. -Along w. IPT cog. therapy is generally recognized as one of the treatment of choice for depression
ADHD
-combined treatment proved to be Superior to the intensive behavioral treatment -for most ADHD symptoms children in the combined treatment &medication groups showed significantly greater improvement than those given intensive behavioral treatment -later analyses behavioral treatment alone was equally effective to combined when intensively applied -behavior therapy, psychosit-mulant meds, and neurofeedback are all effective treatments for ADHD
Behavioral Activation
-comparable to antidepressant meds and both outperformed cog. therapy -patients treated w/ meds but put into placebo suffered more relapses than patients recieving either psychotherapy -less $ and longer lasting that meds in the treatment of depression
Mental Retardation
-contingency management procedures were sig. more effecive -indiv. treatment as opposed to group, employing contingency management seems to produce the most pos. results
Prolonged Exposure
-created by Edna Foa
Stress Inoculation
-devised by Meichenbaum - stress inoculation treatment effective in reducing both performance and state anxiety and far better than no treatment or control treatments
Marsha Linehan
-dialectical behavior therapy -for borderline personality disorders -integrated principles of Zen and mindfulness which prescribe radical acceptance
Effectiveness of REBT
-ellis conducted first research (RET)- all that was shown was he was more effective later in his career with his own psychotherapy -RET is better (75%) than those who do not have treatment; CBT better off than 87% of those w/o treatment -RET outperforms control groups and no treatment no general differences were found among behavior therapy modification, and REBT -REBT superior to placebo & no treatment but equally effective in comparison with other types of cog. & behavioral treatments -effective for older chldren & teens: cog. therapies outperformed the nonbehavioral therapies (e.g., client centered & insight oriented) -RET w/ children generally beneficial -REBT had most impact on disruptive & conduct disorders -REBT with adults effect size was higher when treatment was lengthier
Future Directions of Behavior Therapy
-experimentation: behavior therapists will rely on experimental methodology to determine which techniques work best with which disorders & behavioral self identity will experiment -by operating in empirical tradition behavioral work will necessarily become eclectic-use what works -expansion -include cognitive -move beyond treatment of just psychiatric problems into all branches of health care -value of acceptance -after 4 decades of explosive growth behavior therapy will consolidate its gains, experiment with its self identity & expand more slowly
Future Directions of Cognitive Therapy
-fastest growing -support for ellis declining whereas Becks is climbing -popular bc commitment to psychotherapy integration & dedication to empirical evidence -application to more disabling conditions
Aaron Beck
-followed evidence away from psychoanalysis to formulate a cog. theory and therapy for mental disorders -by teaching patients to examine and test their - ideas their depression improved -beck developed instruments to implement his research including: the Beck Depression anxiety Inventory, The Beck anxiety inventory, and the scale for suicidal ideation -initial clinical focus on depression but has broadened to anxiety disorders, substance abuse & personality disorders, -professor at UPenn & president of the beck center for cog. therapy and research in Penn -similarites btw ellis and beck
Behavioral Parent Training
-for treatment of childrens conduct disorders & antisocial behavior -avg. child whose parents participated in BPT was better adjusted
Chronic Pain
-generally effective in reducing severity and freq. of pain in adults and kids
Differences between Ellis and Beck
-in place of Ellis's irrational beliefs beck speaks of maladaptive cognitions, dysfunctional attitudes or depressogenic assumptions (depression causing) -fundamental ideas(cognitive triad) are viewed by Beck as not necessarily irrational -Becks therapy tends to emphasize the process of empiricism to a greater extent than Ellis's REBT -in Cog. cl. are encouraged to treat their beliefs as hypotheses whereas - -Ellis strives for philosophical conversion based on rationality and logic whereas Beck encourages reliance on the evidence to alter existing beliefs -Cog. tends to be more structured and precise than REBT
Hypertension
-individualized cog. behavior therapy more effective than single component behavior therapy, such as relaxation training, autogenic training and biofeedback
Activity Scheduling
-intervention introduced early specific daily activities are selected and evaluated on basis of how effectively they elevate mood
Cultural Perspective Criticisms of Cognitive Therapy
-may not fit with other cultures/genders -society/environment plays a role
Anxiety Disorders
-more effective than waitlist and placebo -cog. therapy & CBT outperform meds in the long run -cog. therapy as effective for OCD treatment as exposure
Effectiveness of Behavior Therapy
-most controlled outcome research has been conducted on behavior therapy and cognitive behavior than on any other system of psychotherapy
Panic Disorder
-most effective was combo of cog. restructuring and exposure -PCT panic control therapy includes elements of cog. therapy, behavior therapy, and exposure 80% success -CBT cost effective for both generalized anxiety disorder & panic disorder -treatment of choice for panic disorder
Cigarette Smoking
-no treatment & self change programs were sig. less effective than formal treatment -Most effective methods were: smoke aversion, other aversive techniques;instructional methods in work sites and hypnosis
Integrative Criticisms of Behavior Therapy
-no unifying theory -w/o an integrating theory adding more complexity -eclectic
Self-Statement Modification
-oriented around Meichenbaums self-instructional training - for kids self statement modification surpassed no treatment & placebo - for adults better than no treatment
Integrative PerspectiveCriticisms of Cognitive Therapy
-overgeneralization -Cog. th. behave as if cog. therapy is for everyone
Social Skills Training
-pat. in (SST) broadened their repertoire of skills maintained these gains several months after treatment and showed diminished psychiatric symptoms related to social dysfunctions -SST effective in improving psychosocial functioning in schizophrenia but less in preventing relapse - In children SST was effective across a broad range of behavioral difficulties, inc. aggresive externalizing behaviors and internalizing disorders
Migraine Headache
-placebo & no treatment inferior to both propranolol and relaxation/biofeedback
Homework Assignments
-produced greater outcomes than did psychotherapy alone
Multiple Baseline Design
-several of cl. behaviors measured initially -therapeutic intervention is then introduced for one of the behaviors while measurement of all other behaviors continues -if the intervention produces improvement on target behavior but not in the other behaviors it is argued that there is something about the relationship btw target beh. and modification -assumption is that other behaviors would have been = subject to nonspecfic effects such as the passing of time and the relationship with the therapist.
Social Phobia
-showed moderate to large effect sizes at post-treatment in comparison to waiting list controls -CBT resulted in maintenance of gains or modest further improvements
Problem Solving
-sig. more effective than no treatment and attention placebo; but just barely more effective than other treatments -assigning hw increased the effectiveness
Schizophrenia
-social skills training has a pos. impact but only a modest degree of skill generalization
Posstraumatic Stress Disorder
-some of most effective to date - CBT effectiveness= exposure and EMDR among children and adults
Autogenic Training
-specific self relaxation procedure -used mainly in german less in english speaking countries - used to treat phsycial disordes such as tension headaches, and hypertension, as well as psychological disorders (e.g., anxity , functional insomnia) - autogenic training worked as well no better or worse than other psychological treatments
Effectiveness of Behavior Therapy with Adules
-superior to no treatment and placebo - differences in treatment outcome has more to do with the problem type than with the psychotherapy system -Shaprio & Shapiro study showed a modest superiority of behavior and cognitive methods and corresponding inferiority of psychodynamic & humanistic - behavioral and cognitive-behavioral treatments were superior to client-centered and psychodynamic treatments - Bowers & Clum specific effects of behavior therpies are 2X as great as the nonspecific effects
Panic Disorder
-superior to no treatment and placebo control -at least as effective as pharamcotherpay and maybe even more -effective
Irritable Bowel Syndrome
-the psychological treatments were effective in reducing both physical & pyschological symptoms compared to control -insufficent # of studies to determine whether any particular type of psychological treatment was more efective -all treatments were behavioral & cog. behavioral in nature
Common Cognitive Errors
1) Overgeneralizing: if its true in 1 situation it applies to any situation that is even remotely similar 2) Selective Abstraction: The only events that matter are the failures, which are the sole measure of myself 3) Excessive Responsibility: I am responsible for all bad things, rotten events and life failures 4) Self References: I am at the center of everyone's attention particularly when I fail at something 5) Dichotomous thinking: Everything is either one extreme or the other
Counterconditioning Techniques
1) Systematic desensitization 2) Assertiveness Training 3) Sexual Arousal 4) Stimulus Control - has been used most often with verbal adults who suffer from neuroses, health disorders and personality disorders
Bowen's 8 Concepts
1) Triangulation: involving a third person into a fused relationship to relieve tension between the two http://www.youtube.com/watch?v=RhiipKE4dyw 2)Differentiation of self: 3)Nuclear Family Emotional Process Marital conflict, dysfunction in spouse, impairment in child, emotional distance 4)Family projection: the primary way parents transmit their emotional problems to a child. 5)Cut offs: managing unresolved emotional difficulties by emotionally (geographically) distancing 6) Sibling Position: birth order impacts behavior (people who grow up in the same sibling position predictably have important common characteristics) 7) Multigenerational transmission process: levels of differentiation change across generations 8) Societal Emotional Process: cultural changes in emotional processing reflect familial changes in emotional processing Helicopter parents and grade inflation
Cognitive Stages
1) become aware of thoughts 2) recognize what thoughts are awry 3) sub. accurate for inaccurate judgements 4) needs feedback to inform whether changes are correct
Similarities between Ellis & Beck
1) originally trained in psychoanalytic tradition-dissatisfied with clinical results 2) share the goal of helping cl. to become conscious of maladaptive cognititions & replace them 3) eclectic in technique 4) problem oriented, directive, and psychoeducational 5) HW as a central feature of treatment 6) bringing self-help resources to indiv cl. & public - Both believe their therapies fall under cognitive behavioral - as in REBT life events are interpreted through cog. lenses which then lead to distressing thought & disturbing behaviors
Cognitive Treatment Goals
1) reduce severe symptoms such as suicidal impulses, insomnia & weight loss 2) for symptoms relief relies on contingency management structuring assignments in a way that clients will succeed and be reinforced for their efforts 3) Assignments become more challenging with time
6 Steps of Effective Contingency Management
1. State problem in behavioral terms 2. Identify behavioral objectives 3. Take baseline measures 4. Conduct naturalistic observations 5. Modify existing contingencies 6. Monitor the results (track & identify what is changing) - Behavioral psychologist begin to identify new behaviors; try the different thing, provide education and encouragement as the cl. Moves forward.
Effectiveness of Systemic Therapies
20+ meta-analyses indicate couples & family therapies are effective; average ES = .65 Positive effects remain but taper over time Martial therapy tends to show higher effects than family therapy No difference in effectiveness among different systemic therapies No consistent outcome differences between individual & family therapy; "for now, a tie"
Practicalities of Structural Therapy
Active, short-term treatment Format follows function of therapy, usually conjoint sessions Restructure seating as a function of restructuring family Booster sessions are natural & economical
Small-N Designs
Behaviorists argue that well controlled case studies or studies with a small n can yield valid data when techniques such as multiple baseline or ABAB designs are used -good for examining efficacy of new procedures and are superb odels for conducting clinical research when only a small number of patients are available
Personality Disorders
CBT & psychodynamic effective treatments for personality disorders
Behavior therapy includes
Conceptual behaviorism, methodological behaviorism or an ill defined combo of the two
Reciprocal Inhibition
Counterconditioning
Effectiveness of Cognitive Therapy for Specific Disorder
Depression,Anxiety Disorders, Social Phobia, Panic Disorder,PTSD, Eating Disorders, Chronic Pain, Body Dysmorphic Disorder, Personality Disorders, Psychotic Disorders, Marital & Group Therapy,Domestic Violence, Homework Assignments, Differential Response
Bowen Family Systems Therapy
Developed by Murray Bowen (1913 - 1990) Views family as an emotional unit Systems thinking is used to describe the complex interactions within the family unit
Bowen's Theory of Psychopathology
Differentiation of self: ability to be objective & controlled about emotional issues Emotional illness arises when individuals are unable to differentiate from their families of origin (fusion) Fusion results in undifferentiated family ego mass Fusion leads to triangulation The child closest to parents is most likely to develop pathological symptoms Emotional cutoffs are efforts to cope with unresolved attachments to families of origin Family projection process Multi-generational transmission process
Future Directions of Exposure Therapy
Exposure=very integrative already, treatment of choice for many anxiety disorders EMDR=good with PTSD, not so good with panic disorder Practitioners of traditional talk therapy may have difficulty incorporating methods.
Bowens Therapeutic Processes
Goal: increase differentiation of self from family emotional system Detriangulate family members Change produced in one triad will cause change in all family triangles Consciousness raising Choosing
Structural Therapeutic Process
Goal: restructure families to free members to grow & relate Changing family structure involves changing rules for relating & boundaries Consciousness Raising: education, reframing Choosing (social liberation): therapist as freedom fighter
Homeostasis
Homeostasis or balance explains how living systems control steady state Feedback loops are the important control mechanisms Not linear cause & effect, but rather reciprocal effect Positive feedback loops set up runaway situations that drive systems beyond their limits Negative feedback loops decrease deviations from system rules
Precursor to Exposure Therapies
Implosive Therapy
Linehans Priorities
In order 1) Suicidal and parasuicidal 2) behaviors that threaten the process of therapy 3) problems in developing quality of life
Signals of poor listening
Inattention Performance anxiety Disapproval of client affect "why do they feel this way?" they "should/not" Therapist overcontrol Lecturing, advice giving, rescuing, etc., may have taken responsibility for improving client's life
Dialectical Behavior Therapy
Integration of all 3 C's (Counterconditioning, contingency management, and cognitive behavior modification). More complex & complete - originally dev. as an outpatient treatment for personality disorders and chronically suicidal patients has been increasingly applied to a host of other complex disorders such as deliberate self injury, substance dependence and eating disorders - blends skills training and crisis intervention methods drawn from behavior therapists with acceptance and mindfulness drawn from meditation practices - DBT addressses the dialectic- the apparent contradiction between opposing forces of changing dysfunctional behavior and accepting it
Therapeutic Content
Intrapersonal conflicts • Anxieties: caused by irrational beliefs o Defenses: rationalization most common • Self-esteem: self worth is impossible to prove o Unconditional self acceptance • Responsibility: people are responsible for how they interpret their lives ( • how their thinking/feeling) • "I get people to truly accept themselves unconditionally, whether or not their therapist or anyone loves them" Elis
Emotional Processing Theory
Must process traumatic event to recover from it. Chronic disorders are signs that this processing has not occurred.
Practicalities of Bowen's Theory
Often work with spouses or with one motivated patient Central couple is most important Strong proponent of family of origin therapy for psychotherapists Active, short-term treatments that initiate the change process Highly compatible with time-limited psychotherapy MRI Brief Therapy averages 7 sessions
Effectiveness of Family Therapy as TX Format
Particularly effective in motivating alcoholics to enter treatment Significantly lower drug use after family treatment compared to non-family therapy Multisystemic therapy (MST) is effective & cost effective in treatment of conduct disorders Family treatment of schizophrenia reduces relapse & improves outcome
Differential Response
Patient characteristics can be used to selectively assign valuable with externalizing styles & low-resistence patients
Systematic Desensitization
Progressive relaxation to inhibit anxiety response
PsychoanalticCritiques of Exposure Therapies
Reducing phobic beh is insufficient, need to get at the root cause—the unconscious conflict must be made conscious!
Effectiveness of Specific Behavioral Methods
Relaxation training, autogenic training, social skills training stress inoculation, biofeedback, behavioral activation, self statement modification, contingency management, behavioral parent training, & problem solving
Themes of life
Self: how does the client see themselves? What are the contradictions? Others: who do they trust/mistrust? We treat others much the same way we treat ourselves Life: general approach to life From surrender - cooperation - challenge - rebellion
Subsystems of Structural Therapy
Spouse: contains the couple relationship, its function, and roles. Parental: contains the parental relationship including its roles and function are maintained Sibling: contains the children's' relationship, function, and roles are contained
Structural Theory of Psychopathology
Structural theory is more concerned with what maintains psychopathology than with its causes Historical causes cannot be empirically determined & cannot be changed Dysfunctional dynamics of the family system maintain psychopathology
Contingency Management
The Environment triggers, stimuli that sustain and maintain behavior (ex. Bulimic behavior-ppl leaving) • Human behavior is controlled by its consequences (Skinner) • Reinforcements & punishments impact the probabilities of maladaptive behavior & development of new responses • Behavior chain is foundation for modifying contingencies • Child being yelled at, at school is getting attention • What's triggering behavior • Cant be overly disruptive - have been applied to disorders that have been most difficult for verbal therapies, such as impulse control problems, addictive disorders, childrens dysfunctions and the problems of severaly retarded and psychotically regressed patients.
ABAB (reversal) design
The person measured repeatedly: before intervention (baseline A) ->During the time when the intervention is in effect (B)-> during a subsequent period when the intervention is temporarily discontinued (return to baseline A)-> And again under the influence of the therapeutic intervention (B) - The rationale behind this design is that if the clients behavior improves during the periods when treatment is given and worse when treatment is withdrawn- then the treatment presumed to be casually responsible for the change
Therapeutic Listening
Therapeutic: able to tolerate the emotions of client without defending or fusing with them Therapist seeks to understand client both emotionally and intellectually "We have two ears and one mouth so that we can listen twice as much as we speak." ~Epictetus
Bowens Therapeutic Relationship
Therapists do not allow themselves to be triangulated Maintain an objective "I" position Therapists act as models of autonomous, responsible, & differentiated behavior Therapists rely on observation & reason (not empathy) to understand family
Emotional Disturbances
activating events are always processed through some irrational belief -originally 12 irrational beliefs- now distinguished btw dysfunctional inferences & core dogmatic musts from which they are usually derived
Positive Feedback Loop
an increase in any component part of the loop will in turn increase the next even in the circular sequence, increase deviations and serve as a self-destructing mechanism, drives the system beyond the limits within which it can function
3 Basic Approaches to Cognitive Restructuring
ask 1) whats the evidence? 2) whats another way of looking at it? 3) so what if it happens?
Schemas
cl. underlying cog. organization
Problems with Multiple Baseline Design
cannot say just which changes in the environment produced the behavior changes. Was it changes in concrete contingencies for example or was it the result of experimenter demands for expectations?
Irrational Beliefs (iBs) and dysfunctional attidues
constitue ppls self disturbing philosophies - musturbatory thinking "i must" & catastrophizing(molehills into mountains)
Behavioral Mandate
demonstrate competency in scientifically est. methods
Disattribution Technique
disabuse themselves of the belief that they are entirely responsible for their plight.
Phases of EMDR
done in a period of weeks, 6 sessions, 90 min on avg (longer than average sessions) 1) Preparation (indoctrination phase) 2) Assesment 3) Desensitization 4) installation -Body scan—breathing, relaxing (about 6 sessions total) Closure Cognitive interweave
Relaxation Training
effect size ranged from .43-.66 for the treatment of heath related symptomology and were largest for nonsurgical samples w/ hypertension, headaches and insomnia
Open Systems
energy can be freely transported into, w/i and out of system. info most important type of energy
Negative Feedback Loop
est. a balance among the deviations of different events w/i the loop. decrease deviations help maintain stability
Publication Bias
exists in BMT lit. small sample studies with small effect are systematically missing compared with other studies
DBT
includes individual psychotherapy (1-2 X per week), hw, group skills training (1 a week for 2 hrs. for 1st year- mindfulness), telephone consultation and case consultation for therapists(weekly)
Family Rules
may be defined as: Generic: typical, expected, hierarchical Idiosyncratic: irregular, unexpected
Social Listening
not interrupting, encouraging visual cues Most often reciprocal
Threat
o "Threat" (often hard to identify)→alarm→I'm sure my heart skipped a beat→Physical symptoms of anxety→Oh no, something's wrong→Physical symptoms worsen→I'm having a heart attack→Safety behavior of sitting down—If I hadn't sat down, I would've had a heart attack! → Back to threat again
Avoiding Situation
o Avoiding situation→feel better→think about later ("was so bad I couldn't do it!")→feel even worse when faced with situation later→avoidance→living life more awkwardly in order to avoid more and more→fear becomes assoc w/new things to avoid (fear becomes it's own evidence)
Process of Implosive Therapy
o Begin with most fearful situation (being covered in bugs) o For repressed or cognitively avoided thoughts (fears of becoming anally explosive enraged, sexual urges), imagine intensely the "dynamic cues" with th's help. • Cl observed for physical signs of anxiety, and th increases stimuli/cues to provoke and extinguish more anxiety • Difficult because th must stay with cl till anxiety is extinguished, otherwise cl becomes more sensitized to stimuli
Respondent (classical ) Learning
o Classical/not consciously learned=Pavlovian concept of ucs (buzzer) paired with automatic response (a shock that naturally causes fear)→cs (dog learns to assoc. buzzer with pain and fears buzzer noise)—this is conditioned anxiety
Humanistic Critiques of Exposure Therapies
o Emotion evoked from external sources, not from a place of deep, intrinsic meaning. o Should "be with" cl, not "do to" clients. Better to affirm traumatic experience. Not very compassionate to intensify anxiety.
Integrative Critiques of Exposure Therapies
o Exposure and EMDR are naturally integrative therapy systems incorporating elements from behavioral and cognitive traditions o Need to find what aspects of therapies cause them to work. Is catharsis the key? Is it facing avoided fears? Is it counterconditioning? Basically take the magic out of it and get the science done to see what works best for specific clients.
Therapeutic Process of Prolonged Exposure Therapy
o Intensive (direct & immediate exposure) • Implosive therapy does intensive exposure until client extinguishes response. This is difficult on cl and th. If cl runs away before extinguishing response, cl will become even more fearful and avoidant. • Implosive is very effective, low percentage of cl have reoccurrence of symptoms. o vs. gradual (slow & incremental exposure)—exposure done with a hierarchy (usually imaginal→in vivo) o Imaginal (imagining fear stimuli) • Counterconditioning with breathing training done before put in anxiety state • And Education about physical/emotional reaction to trauma • Recount dramatic memories in session and listen to memory tape between sessions. Repeat until lose emotional power. o vs. in vivo (actual place or tactile material) o Total (patient begins with 100% SUDS level) vs. partial response prevention (50% SUDS level) o Response prevention (ex. OCD rituals/ running away)—to see catastrophic conclusions not occur (won't die in elevator) o Habituation (once 50% reduction of anxiety is achieved). Cl: I'm not comfortable, but I can cope.—then terminate session o Leads to emot processing—basically cog restructuring—learn remembering events is not the same as experiencing events/feared consequences do not happen/ anxiety does fade o Not as effective for substance abuse ("cue exposure"), better for OCD, PTSD, phobias
Operant (instrumental) learning
o Operant/consciously learned=Dog jumps over barrier (to get away from buzzer noises) and anxiety is reduced, a powerful negative reinforcer. • Reinforces increase beh/Punshiment decreases beh. Note positive reinforces introduce something desirable and negative reinforces take something undesirable away. With anxiety negative reinforcement is very powerful in maintaining avoidant behavior.
Cognitive Behavioral Critiques of Exposure Therapies
o Prolonged exposure is a CBT method and should not be equated as an evocative therapy o EMDR violates rules of scientific community by training people in their method before proving it effective, and eye movement etc. are probably not valid. Take the EM out of the EMDR.
Cultural Critiques of Exposure Therapies
o Traumatized people require compassion and respect, not these ends justify the means methods. o Relationship is not empathetic or caring enough. o Should advocate for prevention of crimes that perpetrate traumatic experiences. Focus on creating a better society/preventative model.
Modeling
observational learning in which the behavior of therapist (the model) acts as a stimulus for similiar thoughts, attitudes and behaviors on the part of the client -through this clients an aquire new behaviors
Counterconditioning
reciprocal inhibition->w/ the client you find an activity that is counter opposite to their symptom (doing the healthy opposite, acting as if ex. plane) desensitization relaxing sympathetic nervous symptom at every step of the way. • Based on classical (respondent) conditioning (jump to high alert by person/event) • Follows directly from the work of Pavlov • Techniques include systematic desensitization, assertiveness training & stimulus control (ppl who are angry not assertive
Feedback Loops
seen as the most important control mechanisms -two events can be related in a circular manner, pos. or neg. feedback loop
Problems with Small-N Designs
small-n designs lack the power and control afforded by more traditional research designs
Cognitive Triad
the basic ideation in depression 3 themes 1) events are interpreted negatively 2) depressed indiv. dislike themselves 3) the future is appraised negatively - not necessarily irrational
Content Specificity Hypothesis
the underlying cognitions are assumed to vary specifically with the behavior disorder of the client
Eating Disorders
the use of behavioral (and cog. behavioral) resulted in favorable outcomes
Clinical Representativeness
their similarity to the actual clients, therapists and settings in real life clinical practice, -research studies particularly weak
Stress Sensitization
what it takes to activate fight/flight sympathetic nervous system response is less and fear response gets stronger over time
Joseph Wolpe
• (1915-1997) • Psychoanalytic in his early years • Used deep relaxation to inhibit anxiety • Reported success with 90% of clients • Major & controversial figure in the establishment of behavior therapy • Believed that these war vets learned that these stimulus is associated with great parel to themselves/loved ones they learned it so you can unlearn • Desensitization • Began to start assertiveness training • Controversial bc he was confident in himself claimed 90% success rate - pref. the theoretical interpretations of conditioning in hulls principles of behavior
Albert Ellis
• 1913-2007) • first demonstrated rational-emotive therapy (RET) in 1957 • Goal: maximize pleasure and minimize pain • Changed name RET to rational-emotive behavior therapy (REBT) • A charismatic, prolific, & controversial figure • "by not caring too much about what people think, I'm able to think for myself and propagate ideas which are very often unpopular and I succeed. • Maybe influenced by psychoanalytical style in direct contrast or comparision • Elis struggled with someone struggled with having a patient come in and talk for years about parents/dreams challenge slow moving therapy. • Believed in short term therapy focus on the here and now. • He didn't want to figure out why beliefs occurred but wanted client to be aware • Level of responsibility is very high (taking control of your life in this moment) • Neurosis is a high class word for whining • Albert Elis is one of the biggest names with regard to CBT • As a young man AE was awkward man had a lot of difficulty asking women out • Stopped asking people out, started asking women out before someone said yes (more than 100) • As a young man from personal and ancient philosophy how we think about things influences how we feel about things then how we ask about things
EMDR Practicalities
• 75-90 min sessions to return people to emotional equilibrium, 4-6 total sessions (shorter than prolonged exposure) • Used by many integrative/eclectic therapists, can be used with kids, can be modified • Workshop training available • EMDR Humanitarian Assistance Program, low to free costs for some
Practicalities of Exposure Therapy
• 8-12 sessions, 1-2 hrs in duration in a soundproof room • Homework between sessions • Training widely available from cog and beh therapists
Edna Foa
• A Sketch of Edna Foa • One of most respected in field, currently working w/vets with PTSD (soldiers raped by other soldiers). Credited for understanding PTSD outside combat contexts, and for seeing trauma along a continuum. Also worked w OCD and social phobia. • Born in Israel in 1937 • Spent most of education & career in behavior therapy • Became dissatisfied with talk therapy • Wolpe's student • Collaborated with colleagues in examining exposure therapy for anxiety disorders • Premier proponent of prolonged exposure
Major Characteristics of Behavior Therapy
• Abnormal behavior is acquired & maintained by same principles as normal behavior • Continuous assessment focuses on current determinants of behavior (th. Is always looking for things that trigger behavior) • Focus on thoughts, feelings & actions in specific situations • Treatment is specified, replicable & tailored to people (each individual has diff triggers different plans) • Outcomes should generalize to real-life & be maintained over time. • Much of psychopathology is learned (if you can learn something you can unlearn something) • Punisher is there to decrease likelihood to decrease behavior • Habituation (an underlying principle in exposure) • Internal praise of external • Techniques should generalize to real world and should maintain over time. • The symptom is the problem behavior is not viewed as deeply rooted issue • Primacy of behavior • The importance of learning • The directive and active nature of treatments • The importance of assessment and evaluation • the use of persons in everyday life - behavior therapists vary greatly
ABC's of REBT
• Activating (A) events • Beliefs (B) about activating events • Emotional consequences (C) of beliefs • "If something is irrational that means it wont work. It usually unrealistic." • Ex: Bankruptcy:
EMDR's Therapeutic Process
• Adaptive information processing (AIP) model: trauma activates info processing system, which then takes info to adaptive resolution=transforms traumatic info and shifts feelings, thoughts and sensations→changes in identiy • Counterconditioning via desensitization & cognitive restructuring (borrows from exposure and behavior therapies) o Teaches deep breathing, relaxation, affective distancing o Positive restructuring (cog restruc)—think about it differently o Uses a hierarchy of desensitization o Eye movements and tapping are add-ons • Consciousness raising (how get traumatized? Well, I was raped, etc....) & catharsis (experience again in new way) operate, but not as central mechanisms
The Neurotic Paradox
• Although avoidance of anxiety provoking material helps in the short-term, it worsens the condition in the long -term - "Threat" & "Avoidance"
Behavioral Theory of Psychopathology
• Anxiety is a response of sympathetic nervous system • Anxiety is cause of most behavioral disorders • Anxiety can be conditioned to any stimuli • Thoughts associated with threatening stimuli can elicit anxiety • Strong genetic piece • Frontal lobe is looking for where the danger is
Theory of Psychopathology
• Anxiety is conditioned response controlled by two factors: respondent (classical) and learning & operant (instrumental) learning • Conditioning accounts for acquisition & extinction of fear • Conceptualizes pathology in terms of both behavioral & emotional processing theory o The classically conditioned anxiety=motivating force/drive that activates avoidance response; while operant conditioned anxiety reduction is instrumental in reinforcing avoidance
Stimulus Control
• Avoid problem and replace with healthier alternative • Look for physical problems to tell about physiological issues • For social anxiety • Wolpe in beg was trying to help patient experience something else besdies anxiety is step 1 • Wolpes was sensitive to the idea that there are some relationship that's are not safe (may put them at greater risk) • Th. Are careful to select minimally effective response to effect client • Anecdotally most recovery therapy for someone who's being abused/battered
Main Qualities of Self-Disturbing Philosophies
• Beliefs are rigid & dogmatic (musturbatory thinking) • Beliefs generate unrealistic & over-generalized attributions (catastrophizing) • "we teach people that they upset themselves. We cant change the past
Fusion
• Blending/melding together • The thought and the thing it refers to become stuck together as one o Defusion techniques: remember that you are not your thoughts o Noticing yourself noticing- (do I want this thought to drive the bus today?) o Thanking your mind (remember something-mortality/survival this moment is precious) o Singing (to give you the sense the noise in your head is just noise- is it useful to you or not) • Use meditation • Amygdala fighting to survive- automatic
EMDR Therapeutic Relationship
• Characterized by empathy, trust what cl. is saying, & safety • Clinicians communicate respect for client courage, but not during active processing o However, don't push you past what you are able to do, wait for cl to be ready • Safe haven created through rapport, teaching relaxation, "stop signal" o Safe words used/cl in charge of pace, relaxation helps reign in the amygdala
Installation
• Client installs strength of + cog. (cognitive restructuring) till SUDS is low 0/1
Therapeutic Process of Exposure Therapy
• Clients given clear rationale for treatment • Taught anxiety coping skills (breathing retraining) • Given homework (45 min exposure) • Between 9-2 sessions, lots of homework. • Maintenance sessions as needed • Note: don't start immediately after trauma. Give victims something to do (rebuild house after hurricane), then give counseling. Start soon but not too soon. Don't rip scab off in the beginning. • http://www.youtube.com/watch?v=vzzDkzmXbDU o Person regains realistic perception of the world. Not always dangerous. And one is not always incompetent.~Foa o Corrective info comes from the world and allows for more varied behavior o Cl realizes that she has been telling a story that is not happening now (has a had a hard time recognizing story is in the past because of brain and body being in arousal). o See story as just a story and story changes (guilt, shame, should've's, would've's and could've's disappear). Something that happened, not something that was their fault. "It becomes an organized story rather than a fragmented story," "They are able to put things together. They find all kinds of new perspectives to look at what happened to them."
Client History
• Clients support system and distress tolerance (EMDR culls out people who probably need the most by picking those with the most support and most resilient factors. Won't see you if you don't have these things.)
REBT Therapeutic Processes
• Consciousness raising (aware of irrational thinking patterns) • Counter counditioning (replace irrational thinking with rational thinking) • Contingency management (rearrange reinforcements to support behavior changes) • "The best years of your life are the ones in which you decide your problems are your own. You do not blame them on your mother, the ecology or the president. You realize that you control you own destiny".
Francine Shapiro
• Discovered deliberate eye movements made her thoughts less distressing o But may have been her walk in the park was relaxing=exercise, sunshine, had thought about her cancer over and over (exposure not eyes movements) • Founder of EMDR Institute & EMDR Humanitarian Assistance Program • Controversial for controlling early EMDR training before tested (also when others tried eye mvmt/tapping techniques, she said they did it wrong and that was why it didn't work), early on promised relief from PTSD in just a few sessions
Effectiveness of Exposure Therapy
• Effective in treating PTSD, OCD, specific phobias, & social phobia • Small % of clients experience symptom exacerbation o Pyschodynamic/psychoanalytic criticism—not treating underlying cause. Counterargument—if symptom relief allows for functioning, who cares!—critique not found to be valid • Low relapse rates—once through it, won't avoid it. (prof ex. of riding roller coasters) • Treatment of choice for many anxiety disorders • Just as effective if not more effective than meds
Acceptance and Commitment Therapy
• Empirically based • Based upon 6 core principles: o Defusion o Expansion: part of defusion aspect; being in touch (think of breathing where you use all parts opening up allowing the feeling- ride that way let it pass) the rise & peak of an emotion quickly shift o Connection o The observing self o Values o Committed Action • The noise in head just sound you are not your thoughts or experiences you are something more and outside of that • Defusion, expansion, connection, the observing self core of mindfulness • Fusion with memory/thought- If that thought begins to feel important, true, threatening, & commands then you are beginning to fuse w/ your thoughts: Begin to control your feelings/actions you have fused with the thought
Behavioral Therapeutic Process
• Environmental contingencies shape maintain & extinguish behavior • Behavior modification systematically controls contingencies to shape behavior • Change the contingencies & the behavior will change. o Each new behavior change going to take several weeks to identify o Our species is quick to learn esp if severe
Categories of Problems
• Excess- excessive response (e.g., washing hands so times a day) • Deficits lack of response (e.g. rarely interacting with people. • Inappropriateness- responses inappropriate to situation (e.g., flashing others)
Therapeutic Relationship
• Exposure therapist acts like an effective, firm parent. You can do this, you must do this and I am here. • Not concerned with being genuine, empathy but not during exposure itself, pos regard saying cl are stronger than they think • Clients trust of therapist allows them to stay in presence of feared stimuli. Relationship important! • Therapist models confidence. o Has gone through own therapy first, so can handle motor-mirror neuron response. Have to stay in role. Not treat populations you have not worked through. Th who have worked through own trauma can use it as a tool to show clients that they can do this. But only share what is beneficial to client. Sharing could hurt cl. Could demotivate (I'll never b as healthy as you.) Maybe check first. What would it mean to you if I had been through this? Not been through this?
Physical Aspects of Anxiety
• Fear is productive, keeps you alive • Some people have a naturally active fear response, and for some people the active fear response gets turned on by trauma • Stress sensitization—what it takes to activate fight/flight sympathetic nervous system response is less and fear response gets stronger over time • Afterburn of anxiety symptoms takes a while to wash out. • The thinking part of your mind, the frontal lobe, takes the long path when telling the amygdala to shut down response. Why doing something is better than thinking something. Breathing is faster route to off switch. • SSRIs used to recalibrate system. Person may feel numb at first. Exercise/meditation also helps recalibrate • PTSD—when emotions are high, impedes problem solving and memory. So memory of event feels jumbled. Can remember before and after. And people avoid thinking about actual event.
Demons
• Harris refers to demons as negative thoughts or imagery that are unhelpful and keep you in your comfort zone • The aim is to accept that the demons are there and let them just "be" • If you believe that they are true, scare you then they have control then they can take you away from what you want to do. • What you do want not what you don't want
Watson Video
• Human beings shaped solely by environment • Studied 100s of babies • Tabula rasa- blank state where we are born • Baby albert • Fears are learned • Wasn't until bowlby, ainsworth compassionate care
Systems Therapies
• Individuals can only be understood within their social context o Contextless is meaninglessness • Patient is the entire system o Identified patient (IP)- externalizing the stress chaos or dysfunction in situation (lighting rod...middle child- more likely to exhibit behaviors that are problematic-low threshold for stimuli- children have no separation from parents everybody gets to have their own emotions- the more difficulty have) • The whole is greater than the sum of its parts o Systems=parts of an organization (people)+relationships among those parts • "All happy families resemble one another, each unhappy family is unhappy in its own way"
Types of Contingency Managment
• Institutional control • Self-control ( the individual is going to engage in own system of rewards and punishments; client led, if you set the framework is going to be more effective for them than what they say) ) • Mutual control or contracting (might occur btw. Loved ones, around intimacy in long term relationships) • Therapist control (when you form a contract with a client, ex: for a highly avoidant client client that wasn't showing up; the act of giving over power) • Aversive control (last resort tactic, Ex: child developmentally delayed self injurious behavior head banging, pair shock
Interpersonal Conflicts
• Intimacy & sexuality: both can be appreciated without being constrained by beliefs of necessity and "should's" (ex. Dating friends ex bf) • Communication: thinking problems o Communication reveals the character of cognitions • Hostility results from 1) aggressive temperament 2) frustrating event 3) distorted thinking about the event • Control: controlling others typically involves the "tyranny of the should's" • Enmeshment- stuck together
Behavioral Therapeutic Relationship
• Its importance varies according to behavioral method • Accurate observation is criticial for effective treatment • Therapists establish secure relationship as a precondition for psychotherapy • Therapist modeling is crucial. ( you model trust, confidence, faith in them an actively phobic therapist is going to have trouble working with phobic cl./ one step ahead more adaptive) o Does not think that relationship is the catalyst to change relationship to get trust- actively challenging their behaviors.
Exposure Therapies
• Less depth oriented, more on the surface • Look at the effects of avoidance and learned anxiety • Avoidance is heart of psychopathology • Directly confront feared stimuli & activate intense emotions • Particularly useful in treatment of anxiety & trauma, specific phobia
Behavioral Theory of Psychopathology
• Maladaptive behaviors reflect a deficit in cognitive activity • Problems are characterized by: o Lack of coping response o Use of inappropriate cognitive responses (e.g., mislabeling o Ineffective strategies for problem solving
Effectiveness of EMDR
• Outperforms no treatment • As effective as other exposure methods • Listed as "probably efficacious" for civilian PTSD • Eye movements/tapping have not been proven necessary component o Magic feather (like in Dumbo). No harm done to ppl. But harm done to science—psychology has been struggling for credibility. • Remains controversial
EMDR Theory of Psychopathology
• Psychopathology occurs when information processing is blocked on a neurological level. o From science we know that when affective systems are high, cognitive functioning isn't good • Trauma is trapped or locked in the neurophysiology of the brain o Parts ppl argue w—trauma changes the physiological structure of your brain (no support), eye mvmts/tapping untangle the brain (no support)→but lay population easily buys this pop science • Everyday stimuli trigger re-experience of traumatic event (prob related to conditioning more than above point)
REBT's Theory of Psychopathology
• Psychopathology occurs when irrational beliefs cause emotional consequences • Psychopathology explained by ABC's o A→B→C o Not A→C • "Self esteem is the greatest sickness known to man or women because it's conditional." • When a person is what-if's dk why they are not moving forward unwilling to accept it
Sexual Arousal
• Relaxation and arousal inhibit sexual anxiety • A lot of conflict can be built around sex • Sexual anxiety- sensate focus (relaxation techniques for sex- take sex off the table, as a general rule; what you start with is physical contact not of a sexual nature in the beginning, aware of what feeling useful to rape victims, erectile dysfunction, trauma, very effective)
Therapeutic Relationship
• Seen primarily as precondition for effective treatment • Therapists demonstrate unconditional acceptance for client as person but not necessarily liking • Therapists evaluate client's beliefs & behaviors (not as a person) • Self disclosure is common o You are not your thoughts/behaviors o Is my sharing in the best interest of the client how does it help them in this moment
Cognitive-Behavior Modification
• Symptom substitution- cat rat (not a lot of research says not solid argument) learn a set of skills to learn to deal with their issue. • Behaviorism was established as a radical alternative to mentalist theories • Conditioning replaced cognition as the critical determinate of human behavior (that learning aspect replaced cog. Not held in pure form) • Cognition gradually reintroduced in treatment of human disorders • Most behavior therapists now incorporate cognitive techniques
Assessment
• Target specific trauma • - cog., + cog. (map out thoughts—should've been there—surrounding the trauma—any pos cog to combat neg cog?—why not your fault? Well, was a war zone) • Validity of Cognition (V of C) scale (how true do you believe these thoughts to be from 1 to 10?) S.U.D. (subjective units of distress 1-10) scale—how distressed?
The Thinking Self vs. The Observing Self
• The thinking self makes judgments, comments on our actions, feelings, records our past and anticipates our future o It is alike a radio that constantly broadcasts • Observing self (actuated with soul, being separate from thinking self; always there watching always watching cannot be injured) is not a thought or feeling rather it is a viewpoint from which you can observe thoughts and feelings o "awareness" o example sky weather • The noise in the back of head never shuts up- underlying thoughts have power to shift thoughts and actions • Anything that has the power to change your path are thoughts that you've fused with.
A Major Alternative: Mindfulness/Acceptance Therapies
• The third wave of CBT • Incorporates Buddhist or Eastern principles of mindfulness & acceptance • Third wave therapists train clients to be mindful of distressing behaviors & beliefs & accept them o Theory of pathology: pathology arises from lack of acceptance of uncomfortable thoughts and our struggles against them. o Amygdala- emotional internal and external stimuli- for the potential of life threatening to you causes you to act (9-11 stairs) o Elis identified distorted thinking regulate fear & aggression
Gloria & Ellis Video
• Therapist is genuine, open, actively listening • Therapist shares their beliefs, ideas + philosophers in life • Active confrontation of illogical/irrational • Beliefs→ unconditional acceptance of client a lot always warmth • May not commiserate with client pain -believes this fosters more negative feelings • Ellis is doing the heavy lifting putting puzzle together and presenting it
REBT Basic Human goals/values
• To survive • To be relatively free from pain • To be reasonably satisfied/content • However: human beings are innately born to "think crooked" • "There are three musts that hold us back: I must do well. You must treat me well and the world must be easy" • We want to be happy by ourselves, with others • We want to be happy in intimate relationships, information ally, educationally, vocationally, economically & recreationally • Musterbastionally- 3 musts • Elis said the more we engage in rigid thinking the more we create our own unhappiness • The role of the therapist is to be a direct interventionist- identify for them as you listen to the content, begin to help them challenge the validity of their beliefs, how the beliefs effect behavior, thoughts & feelings. • Believed no body could make you feel anything ( diverging greatly from psychoanalysis) how you perceive it
Foundation for Behavior Therapy
• Traditionally learning theory was seen as the ideological foundation for behavior therapy although there was never agreement as to which learning theory (pavlovs, hulls, Skinners, Mowrers, or others)
Desensitization
• Trauma recollection, specific eye movement /tapping to untangle trauma in brain
Expansion
• Values vs. Goals o A value is a direction we desire to keep moving in, an ongoing never ending process o A goal is a desired outcome that can be achieved or completed. o "What would you do if you knew you could not fail?"
O'Leary and Wilson's list of characteristics of behavior Therapy
• most abnormal beavior is acquired and maintained according to the same principles as normal behavior • Assessment is continous and focuses on the current determinants of behavior • Ppl are best described by what they think, feel and do in specific life situations • Treatment is derived from theory and experimental findings of scientific psychology • Treatment methods are precisely specified and replicable • Treatment is individually tailored to different problems and different people • Treatment goals and methods are mutually contracted with the client • Research evaluates the effects of specific techniques on specific problems • Outcome is evaluated in terms of the intitial induction of behavior change its generalization to real life settings and its maintenance over time. • Maladaptive behavior itself is seen as the problem that needs to be changed. • Baseline measures of target behaviors need to be established before therapy in order to determine whether the therapy is producing any change in the rate or intensity of responding • Although behaviorists agree on approaching treatment as data based experimental but disagree on what the data or experimental methd should look like
