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Behavior and Cognitive Behavior Therapy Skinner: Radical Behaviorism Bandura, Ellis, Beck Meicheanbaum 1 Compare -- Contrast Humanistic Theories Person Centered-Existential-Gestalt Common Themes List ways in which the three approaches are similar Distinct aspects each approach emphasizes Central focus of each approach Unique ideas, constructs, and/or techniques each brought to counseling practice 2 Areas of Major Emphasis Psychoanalytic/Psychodynamic Humanistic Basic drives and the contribution of early emotional experiences to the person’s presenting concern The therapeutic process -- the relationship-and emotional states in the here and now Behavioral observable behaviors & learning principles; congnitions 3 Skinner: Radical Behaviorism Placed primary emphasis on the role of the environment in producing behavior Applied learning principles to psychology Experimental psychologist: examined learning principles with rats in the laboratory Books 1948 1953 1971 Walden Two Science and Human Behavior Beyond Freedom and Dignity 4 Behavior/ Cognitive Behavior Theory Classical Conditioning Operant Conditioning Social Learning Approach Cognitive Behavior Therapy 5 Classical Conditioning If you pair a conditioned stimulus to a natural stimulus, after time, the conditioned stimulus produces the same response as the natural one: Learning by association Pavlov discovery (1900) 1. Meat (us) >> Salivation (ur) 2. Bell (cs)>>Meat (us) >>Salivation (ur) 3. Bell (cs) >> Salivation (cr) 4. Bell (cs) >> Extinguished response 6 Wolpe: 1950 Applied classical conditioning to treat anxiety by pairing stimuli that cause anxiety (taking an exam) with a state of relaxation, to break the connection between the stimulus and the anxious response Exam (us)>>>Anxiety (ur) Relaxation> Images Exam>Anxiety>Relaxation (cs) (us) (ur) (cr) Images Exam (us) >>> Relaxation (cr) Exam (us) >>> Relaxation (cr) 7 Behavior Therapy: Learning by Association: Exposure Techniques 1. Systematic Desensitization - anxiety • • Relaxation training/ Anxiety hierarchy Pairing (+) stimulus with (–) stimulus (shot-lollipop) 2. Aversive Counter Conditioning 3. Exposure Techniques • • In vivo desensitization Flooding (in vivo, imaginary) 8 Anxiety: Facilitating and Debilitating 9 10 Aversive Counter-Conditioning 11 Exposure Techniques 12 Operant Conditioning Behavior is controlled by its consequences Desired Consequences – Increase Behavior Reinforcement No consequences Decrease Beh. Not-desired consequences - Decrease Beh. Punishment 13 Environmental Consequences Reinforcement Punishment Positive R Negative R Positive P: Negative P: Increase a behavior Adds a pleasant consequence Takes away an aversive stimulus Extinguish a behavior Add an aversive consequence Takes away a desired stimulus Lack of consequence - Extinguish behavior 14 Applied Behavioral Analysis: Functional Assessment Model Examine the antecedents and consequences of problem behaviors Conduct a functional assessment using interviews and direct observations (e.g. keeping a diary) to identify Antecedents: conditions that contribute to the behavior of interest Consequences: what happens after specific behavior occurs Behavioral treatments are devised to replace problem behaviors with more adaptive behaviors using reinforcement and extinction strategies 15 Behavior Modification Program Reinforcement Token economy Extinction Time out, loose privileges, punishment Stimulus control Change environmental antecedents of problem behaviors 16 Cognitive Behavior Therapy Emphasizes cognitive processes and selftalk as mediators of behavior change Reciprocal Determinism Bandura Rational Emotive Therapy Ellis Cognitive Therapy Beck Cognitive Behavior Modification Meichenbaum 17 Bandura: Social Learning Approach Psychological functions involve a reciprocal interaction between: Environment <><><> Behavior <> <> <> <> <> Cognitive Process <> 18 Modeling Vicarious Learning 19 Cognitive-Behavior Techniques 1. Assertiveness Training Provide Information Examine beliefs and self-talk Role play assertive behaviors 1. 2. 3. • Modeling – therapist demonstrates behavior Behavioral rehearsal – client demonstrates behavior 20 Cognitive-Behavior Techniques 2. Steps: Self-Management Program 1. Identify goal in behavioral terms 2. Behavioral assessment environmental and cognitive contingencies 3. Plan for change 4. Self-Monitoring and Self-Reinforcement Behaviors, thoughts, self-talk 5. Evaluation of action plan - results 21 Cognitive Behavior Mental disorder- problem with thinking in which a client distorts reality, including: Specific misconceptions Unrealistic expectations Maladaptive attributions Therapy’ aim is to identify and change Theory Faulty patterns of thinking Faulty premises and attitudes Distressing emotions result from maladaptive thinking 22 Rational Emotive Behavior Therapy: (REBT) Albert Ellis Stresses thinking, judging, deciding, analyzing, and doing Assumes that cognitions, emotions, and behaviors affect ach other Is highly didactic, directive, Emotions stem mainly from our beliefs, evaluations and interpretations 23 RET: The ABC Theory 24 RET: Therapy Process Therapy is seen as an educational process Clients learn: To identify and dispute irrational beliefs To replace ineffective ways of thinking with effective and rational cognitions To stop absolutistic thinking, blaming, and repeating false beliefs 25 RET: Therapy Process Rational Emotive Imagery Homework Imagine being in the worst situation- train to change irrational thoughts/feelings for retional ones REBT Self-Help Form Act as if… to challenge self-limiting Biblio-therapy – Psycho-education 26 Aaron Beck’s CT: Human Nature Cognitive structures or schemas Confirmatory bias We all have implicit assumptions or premises that influence what we attend to and how we interpret events We tend to electively attend to events that confirm our beliefs Schemas and Disorders Anxiety Depression Threat and Danger Social rejection and failure 27 Cognitive Therapy (CT) Insight-focused therapy Emphasizes changing negative thoughts and maladaptive beliefs Theoretical Assumptions People’s internal communication is accessible to introspection Clients’ beliefs have highly personal meanings These meanings can be discovered by the client rather than taught by the therapist 28 CT’s Cognitive Distortions 1. 2. 3. 4. 5. 6. 7. Arbitrary inferences Selective abstraction Overgeneralization Magnification and minimization Personalization Labeling and mislabeling Polarized thinking 29 CT’s Cognitive Distortions Arbitrary inferences • Gloria: relationships with the eligible men do not work out because she feels anxious and acts flippantly Selective abstraction • Focuses on only on one aspect of a situation: typically a negative aspect- Overgeneralization • This relationship did not work, no relationship will ever work Magnification and minimization • Emphasize negatives and minimize positives 30 CT’s Cognitive Distortions Presonalization • A mother blames herself for child’s problems • A man blames himself for partner's lack of interest in the relationship Labeling and mislabeling Type of generalization: • I made a mistake vs. I am a looser Polarized thinking • Either co-workers praise me or they hate me • Gloria: Men are either eligible or “icky” 31 Therapy Process Teach clients to recognize, observe and monitor negative "automatic" thoughts & Subject their automatic thoughts to reality testing: examine evidence for and against them Clients learn to substitute realistic and accurate interpretations for biased cognitions Process is collaborative an interactive: Socratic dialogue 32 Beck’s Approach to Depression: Cognitive Triad 1. 2. Have a negative view of themselves; attribute setbacks to themselves w/o looking at the environment Tend to interpret experiences in a negative manner. • 3. Screen out positive experiences not consistent with negative view of themselves (selective abstraction) Gloomy vision and projections about the future 33 Ellis Vs. Beck Ellis is more directional and confrontational in pointing out and refuting irrational thoughts Beck helps clients discover their distorted patterns of thinking Collaborative empiricism Guided discovery client and therapist examine and evaluate beliefs and modify and correct client’s misconceptions 34 Contributions Beh- Cog Beh Focus on short-term behavioral goals Emphasis on evaluation of therapy outcome Empirical evidence of positive results 35 Limitations May lead to symptom substitution Too much therapist power and control Lack of attention to relationship issues No processing of emotions and feelings Focus only on cognitive issues 36 Meichenbaum: Cognitive Behavior Modification Is primarily a self-instructional therapy that Focuses on helping clients become aware of their selftalk, - cognitive restructuring - and acquire practical coping skills to deal with problems and behaviors Process of Change 1. 2. 3. Self observation Start a new internal dialogue Learn new behaviors 37 Phase 1: Self-Observation Observe thoughts, feelings, actions, Realize how client contributes to own problems Leads to new cognitive structures – see problems in a new light Phase 2: Start New Internal Dialogue Identify maladaptive behaviors Recognize more adaptive options Develop adaptive internal dialogue to guide behaviors New behaviors impact cognitive structures Phase 3: New Skills Teaches more effective coping skills Practice in real- life situations Continue monitoring/changing internal dialogue Observe behaviors Assess outcomes Coping Skills Program: Stress Inoculation Stress management techniques for present and future problems Three phases: 1. 2. 3. Conceptual phase Skills acquisition and rehearsal Application and follow-through 41 Conceptual Phase Collaborative relationship (Rogers) Didactic presentation of the role cognitions and emotions play in stress (Ellis) Guided discovery to identify own self-talk and how it creates stress (Beck) Systematic observation and monitoring of maladaptive behaviors and their related selftalk (Behavioral) New cognitive structures = see problems in a new light (Beck) 42 Skills Acquisition and Rehearsal Give clients behavioral and cognitive coping techniques to apply to stressful situations Rehearse new self-statements Relaxation training Social skills training Time management instruction Making changes in everyday life 43 Application and Follow-Through Arrange for transfer and maintenance of change from therapy to the real world Homework assignments of increasing complexity Results of assignments are carefully evaluated Follow-up and booster sessions are scheduled in 3-, 6-, and 12 months intervals 44 Contributions Focus on short-term behavioral goals Emphasis on evaluation of therapy outcome Empirical evidence of positive results 45 Limitations May lead to symptom substitution Too much therapist power and control Lack of attention to relationship issues No processing of emotions and feelings Focus only on cognitive issues 46 Multimodal Therapy: Lazarus Holistic approach to behavior modification Technical eclecticism Human experience interplay of genetics, environment and social learning can be accounted by examining the BASIC ID BASIC ID Framework for assessment and therapy B– A– S– I – C– I – D– behavior affective processes sensation- five senses imagery cognition interpersonal relations physiological aspects - health Therapy Process Therapy is guided by what is best for the client Starts with a thorough assessment of the BASIC ID profile BASIC ID determines the tone or quality of the person’s functioning Therapist functions as trainer, educators, consultant, role model Emphasize skill learning New Applications and Integrations (end of Behavior Chapter #9) Mindfulness and Acceptance- Based Cognitive Therapies: Emotional Regulation Dialectical – Behavior Therapy (DBT) Combines CBT and Psychodynamic Highly structured- requires training - Borderline PD Minimum 1-year of frequent outpatient treatment Mindfulness-Based Stress Reduction (MBSR) Mindfulness-Based Cognitive Therapy (MBCT) Acceptance and Commitment Therapy (ACT) 50 Mindfulness and Acceptance Mindfulness How to live more fully in the present (Ext) Interventions: yoga, meditation Experiential learning and self-discovery (Ext- Gestalt Rogers) Practice – In session and home-work Acceptance (rather than challenge cognitions) change awareness of and relation to negative thoughts (Ext) acceptance (nonjudgmental awareness) of cognitions (Rogers) 51