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Introduction to
Clinical Psychology:
Science, Practice and Ethics
Chapter 13
Cognitive-Behavioural
Interventions
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Behaviour Therapy
Techniques
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Anxiety Reduction Methods
 Systematic Desensitization
 Graded Real-Life Practice
 Imaginal Flooding and Exposure In-Vivo
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Systematic Desensitization
 Wolpe (1958) Psychotherapy by reciprocal
inhibition
 Reciprocal Inhibition “If a response
antagonistic to anxiety can be made to occur in
the presence of anxiety-provoking stimuli so that
it is accompanied by a complete or partial
suppression of the anxiety responses, the bond
between the stimuli and the anxiety response
will be weakened” (Wolpe, 1958, p.71).
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Systematic Desensitization
 Anxiety Hierarchy
 Relaxation training
 Exposure (real life or in imagination) to
hierarchy items while relaxing
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Exposure therapy
 In-vivo or in imagination
 Graded or maximal (flooding)
 Characteristics of effective exposure
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Longer duration better than shorter
Repeat until anxiety subsides
Graduated
Client must attend to feared stimulus
Client must experience anxiety
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Behaviour Therapy for OCD:
Exposure plus Ritual Prevention
 15 sessions over three weeks
 Each session – 2 hours
 In-vivo exposure with response prevention (e.g.,
contaminate hands without washing)
 Imaginal exposure (e.g., prolonged imagination
of worst-case)
 Homework – practice exposure between
sessions
 Maintenance – planned booster sessions
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Exposure therapy: Evaluation
 Highly effective for anxiety-based
problems where avoidance is prominent
 Treatment of choice
 Agoraphobia (70% - significant improvement)
 OCD (75% - significant improvement)
 Important component of treatment for
panic disorder
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Operant Learning
 Positive reinforcement
 Negative reinforcement
 Punishment
 Response Cost
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Effect on Behavior
Behavior Increases
Stimulus
Presented
Stimulus
Withdrawn
Behavior Decreases
Positive
Reinforcement
Punishment
Negative
Reinforcement
Response Cost
(Response-Contingent
Aversive Stimulation)
(Punishment)
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Operant Conditioning Continued
 Extinction
 Schedules of Reinforcement
 e.g., Variable ratio
 Applied Behavior Analysis
 Antecedents (discriminative stimuli)
 Behaviours
 Consequences (forms of reinforcement)
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Operant Interventions
 Time out
 Contingency contracting
 Token Economy
 Punishment
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Social Skills Training and Problem
Solving
 Social Skills Training Techniques
 Problem-Solving Techniques
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Cognitive Modification Procedures
 Self-Instructional Training
 Stress Inoculation Training
 Constructive Narrative
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Meichenbaum’s Stress Inoculation
Training
 Clients can be taught to use self-talk (or
self-instructions) to modify their behaviour
 “inoculate” clients against future stressors
 Stress Inoculation Training
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Preparing
Confronting
Coping with feeling overwhelmed
Self-congratulations
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Albert Ellis:
Rationale Emotive Behavior
Therapy
 Started writing about RET in 1950s
 Influenced by Stoic philosophers (e.g.,
Epictetus “Men are not disturbed by things
but the view they take of them”)
 Emotions are consequences of thoughts
and beliefs
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Ellis’s ABCs
A – Activating Event
C - Consequence
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Ellis’s ABCs
C - Consequence
A – activating event
B - Beliefs
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Ellis’s Therapy
 Challenge should, ought-to, must
(“musturbating”)
 Emotive-evocative
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Role play
Modeling
Exhortation
Unconditional acceptance
 Integrates behaviour therapy techniques
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Beck’s Cognitive Therapy
 Originally developed for treatment of
depression
 Depressive Triad
 Negative view of self
 Negative view of world
 Negative view of future
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Cognitive Distortions
 All-or-none thinking
 Selective abstraction
 Catastrophizing
 Overgeneralization
 Mind reading
 Magnification/minimization
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Cognitive Therapy
 Education about cognitive model
 Monitor thinking
 Challenging the validity of automatic
thoughts
 Socratic questioning
 Includes behavioural techniques (e.g.,
activity scheduling, assertiveness training)
 Challenging beliefs
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Beck’s Cognitive Therapy
 Extensively studied
 Effective treatment for depression
 An important component of treatment for
all anxiety disorders
 Effective component of Rx for bulimia
nervosa
 Has been developed for a variety of
problems (e.g., personality disorders,
substance abuse)
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CBT: Specific Applications
 Panic Disorder
 Phobias
 Obsessive Compulsive Disorder
 Generalized Anxiety Disorder
 Post-Traumatic Stress Disorder
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Evaluation of CBT
 Has been applied successfully to a variety of problems
 Depression
 Anxiety disorders
 Panic disorder, OCD, PTSD, Phobias, GAD
 Bulimia nervosa
 Alcohol use disorders
 Sexual dysfunction
 Most common type of therapy to appear on lists of
empirically supported treatments
 More research on CBT than other psychotherapies
 Relatively easy to learn (semi-structured; concepts not
too difficult)
 Dominant model in contemporary clinical psychology
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CBT: Holistic Approach:
Multi-Modal Therapy
 B – Behaviour
 A – Affect
 S – Sensation
 I – Imagery
 C – Cognition
 I – Interpersonal
 D – Drugs/Diet
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