Transcript Chapter 13: Cognitive-Behavioral Interventions March 6, 2006 Cognitive-Behavioral Therapy (CBT) • Can be used to treat specific disorders or more broad issues • e.g., bulimia, anxiety, poor.

Chapter 13:
Cognitive-Behavioral
Interventions
March 6, 2006
Cognitive-Behavioral Therapy
(CBT)
• Can be used to treat specific disorders
or more broad issues
• e.g., bulimia, anxiety, poor study habits
Anxiety-Reduction Methods
“Perhaps your performance anxiety
wouldn’t be so bad if you performed
better”
Systematic Desensitization
• Wolpe
• relaxation training
• hierarchy of fears
• step by step progression up hierarchy of
fears
Graduated Real-Life Practice
• Meyer
• a.k.a. successive approximation, graded
practice
• step by step progression along
hierarchy, facing stimuli without
relaxation
Both systematic
desensitization and graduated
real-life practice are based on
the principle of...
Stimulus Generalization
• If you extinguish anxiety by exposing
the client to a stimulus that resembles
the phobic stimulus, but is less intense,
then eventually anxiety will extinguish
when the phobic stimulus is present
Imaginal Flooding
• Formerly implosive
therapy (but now
doesn’t include
psychodynamic
material)
• Imagine the most
feared stimulus to
invoke intense anxiety
and continue until
anxiety decreases
Exposure in Vivo
• Marks
• Real-life exposure to the feared stimulus
• Evoking stimulus (ES) = the feared situation
• Evoked response (ER) = the behaviour that
the ES initiates
Operant Learning Techniques
“I think I should warn you that the flip
side of our generous bonus-incentive
program is capital punishment.”
Reinforcement
• Strengthen or maintain a behaviour
• Positive
– delivery of something
– immediate small more effective than
delayed large
• Negative
– removal of something aversive
Shaping
• A.k.a. successive approximation
• Break learning into small steps
• Reinforce small steps that get closer
and closer to the desired behaviour
Punishment
• decrease or stop behaviours
• response-contingent aversive
stimulation (RCAS)
– response
aversive stimulus
Punishment
• Response cost
– response
removal of appetitive
stimulus
Effect on Behaviour
Behaviour
Increases
Scheduled
Consequence
of the
Response
Stimulus is
Presented
Stimulus is
Withdrawn
Positive
Reinforcement
Negative
Reinforcement
Behaviour
Decreases
Punishment
RCAS
Punishment
Response
Cost
Extinction
• Disconnecting a reinforcement
contingency
Schedules of Reinforcement
• Continuous
– every response is reinforced
– rapid extinction
• Variable Ratio
– some responses reinforced in an
unpredictable pattern
– delayed extinction
What Controls Behaviour?
• Rule-governed
behaviour
– rules, laws
– affect how a
behaviour is
performed
• Contingencyshaped behaviour
– response rates,
likelihood behavior
will be performed
Applied Behaviour Analysis
• The application of operant learning
principles to treat problem behaviors
• Used to help many types of problems
with good success rate
The ABCs
• Must identify the contingency that is
operating and maintaining the problem
behaviour
• A: antecedent events
• B: behaviour
• C: consequences
Class Activity
Quickly try to think of a behaviour
in your life that you would like to
change. Discuss the ABCs with
someone near you.
Other Applications
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toilet training
outbursts
somatoform disorders
schizophrenia
– stimulus satiation= responses typically
weaken when the reinforcing stimulus is
made too abundant
Token Economies
• Used with groups (e.g., psychiatric or
rehab facilities)
• give out tokens that can later be
exchanged for tangible rewards or
privileges
• A form of secondary reinforcement
Types of Reinforcers
• Secondary reinforcers: are not
inherently reinforcing, but through
association,one learns that they are
reinforcing
– e.g., money, grades, smiling
• Primary reinforcers: are inherently
reinforcing
– e.g., food, sex
Social Skills Training
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instruction
modeling
behaviour rehearsal
praise
prompts
coaching
feedback
reinforcement
homework assignments
Social Skills Training
• Generally, best for those who are in the
community or are likely to be
discharged
• key is a combination of modeling with
role-playing aimed at specific skills
(e.g., expressing feelings, starting a
conversation)
Rehearsal Desensitization
• used when social anxiety is also present
• incorporates systematic desensitization
elements
• move through hierarchy from low
anxiety to high anxiety items
Problem-Solving Therapy
• Siegel & Spivack
• Training exercises dealing with problem
identification, goal definition, solution
evaluation, evaluation of alternatives,
and selection of the best solution
• e.g., identifying emotions in others,
perspective taking
Cognitive Modification
Procedures
“My back is fine. My mind went out”
Self-Instructional Training
• Meichenbaum
• Teaching patients to use self-guiding
speech
Stress-Inoculation Training
• Educational phase: learn that unhelpful
thinking patterns produce and maintain
unpleasant emotions and dysfunctional
behviours
• Rehearsal phase: patient makes coping selfstatements to help deal with stressful events
• Application phase: practice using coping skills
while confronting actual stressors
Constructive Narrative
• clients viewed as “storytellers and
makers of meaning”
• clients can reframe stressful events,
“normalize” their experience, develop a
“healing theory” of what happened, and
build new “assumptive worlds” and
ways to view themselves
Rational-Emotive Behavior
Therapy
• Ellis
• “enable people to observe, understand,
and persistently dispute irrational,
grandiose, perfectionist shoulds, oughts
and musts”
ABCs
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A: activating event
B: beliefs
C: consequence (emotional)
most believe A causes C
goal is to accept that B is very important
in causing C
• rational vs irrational beliefs
ABC and D
• D: disrupting irrational beliefs
• challenge unrealistic and damaging
beliefs
• e.g., “Why is it terrible if things do not go
your way?”
Cognitive Therapy
• Beck
• challenge irrational beliefs
• and encourage client to attempt real life
experiments to challenge faulty
assumptions
• 3 fundamental concepts
1. The Cognitive Triad
• Depressed people have pessimistic
thoughts about their:
– self
– world
– future
2. Cognitive Schemas
• Global, absolute beliefs
• are activated during depressive
episodes, and lie dormant between
episodes
• established early in life
3. Cognitive Distortions
• Specific exaggerations of the negative
aspects of a situation
Do certain thinking patterns
correlate with certain mood
states?
The Situational Self-Statement
and Affective State Inventory
• “Imagine that you had studied really
hard for your midterm and expected to
get an A. However, when the marks
came back, your mark was a C”
What feelings would you likely
experience?
A) Depression
B) Disappointment
C) Anger
What thoughts would likely cross your
mind?
A) “I should drop out of school”
B) “It was an unfair exam”
C) “I wish I had done better”
Cognitive Restructuring
• Lazarus
• multimodal therapy model
– BASIC ID
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behavior
affect
sensation
imagery
cognition
interpersonal relations
drugs/diet
Cognitive Restructuring
• Corrective self-talk
• point out errors in form and content
thinking
• ignorance/misinformation
Coping and Problem Solving
• Goldfried
• general problem solving strategies and
coping skills
• 4 areas of focus
– problem solving
– relaxation
– cognitive restructuring
– communication skills
Key Names
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Beck
Lazarus
Meichebaum
Ellis
Goldfried
Wolpe
Meyer
Summary- Key Concepts
• Anxiety Reduction Methods
– systematic desensitization, graduated real-life
practice, imaginal flooding, exposure in vivo
• Operant Learning Techniques
– reinforcement, punishment,applied behavior
analysis, token economies, social skills training,
problem solving
• Cognitive Modification Procedures
– self-instructional training, stress-inoculation
training, rational-emotive behavior therapy,
cognitive therapy, coping and problem solving
Thanks!!