Download COGNITIVE-BEHAVIORAL THERAPY: FRAMEWORK AND

COGNITIVE‐BEHAVIORAL THERAPY: FRAMEWORK AND COMPONENTS
Elissa J. Brown, Ph.D.
Professor of Psychology
Professor of Psychology
TOPICS
● Social Learning Theory
Social Learning Theory
● Psychoeducation
● Physiological interventions
h i l i li
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● Cognitive interventions
● Behavioral interventions
● Generalizability through home
through home‐based
based practice
SOCIAL LEARNING (COGNITIVE) T
) THEORY
● Incorporation of environment in the stimulus Incorporation of environment in the stimulus ‐
> response ‐> reinforce relationship.
● Bandura argued that the novel responses argued that the novel responses
acquired through the process of successive approximation (Skinner) could occur through
approximation (Skinner) could occur through imitation.
SOCIAL LEARNING (COGNITIVE) T
) THEORY
● Social learning theory is concerned with how Social learning theory is concerned with how
people’s cognitions affect their social experiences behavior change and
experiences, behavior change, and development
○ Response‐outcome expectancies
Response‐outcome expectancies
○ Perceptions of self‐efficacy
SOCIAL LEARNING (COGNITIVE) T
) THEORY
● Using CBT to teach CBT
Using CBT to teach CBT
○ Modeling
● A process in which an observer (e.g., client or student) p
( g,
)
observes a person (i.e., the model) demonstrating a behavior from which the client can benefit.
● Observing a model provides information about: (1) what the Observing a model provides information about: (1) what the
model does and (2) consequences of those behaviors.
● Purposes of modeling: teaching, prompting, motivating, reducing anxiety, and discouraging.
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d i
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● Used by clinician to coach caregiver and caregiver to coach child (facing fears).
SOCIAL LEARNING (COGNITIVE) T
) THEORY
● Using CBT to teach CBT
Using CBT to teach CBT
○ Behavior Rehearsal
● A process in which clients or students practicing the A process in which clients or students practicing the
target behavior.
● Components of behavior rehearsal are: prompting, shaping, feedback, and reinforecement.
● Used for teaching affect regulation, social skills and parent training
skills, and parent training.
PSYCHOEDUCATION
● Provide Corrective Information
Provide Corrective Information
● Goals
○ To educate
T d t
○ To normalize
PSYCHOEDUCATION
● Topics Covered
Topics Covered
○ Exposure to family violence
○ Common emotional and behavioral responses to Common emotional and behavioral responses to
violence exposure
● Triggers
● Put in context of assessment results
○ Effective Interventions
○ Risk factors for relapse
PSYCHOEDUCATION
● Forms of information
Forms of information
○ Empirical information if available
○ Clinician
Clinician’ss experience with other children
experience with other children
○ Written literature by victims
EVIDENCE FOR EFFICACY OF PSYCHOEDUCATION
● Little research examining psychoeducation alone; gp y
;
seems to be part of package
● McMahon, Forehand, & Griest (1981)
○ Parent training with and without formal training in social learning principles (i.e., rationales for the intervention)
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p
○ Outcomes at post and 2‐month follow‐up
○ At post‐treatment, those who received social learning had higher knowledge of parenting principles
○ At follow‐up, those who received social At follow up those who received social
learning had higher knowledge, better child compliance, and trend toward better parenting skills
PSYCHOEDUCATION
● We always began with a rationale – explanation and reason for the technique
● Providing the rationale
○ Theoretical
Theoretical argument rationale (operant conditioning/ argument rationale (operant conditioning/
ABCs and shaping, observational learning)
○ Research rationale (efficacy)
○ Practical rationale
Practical rationale
○ To caregivers (you are the most important person in your child’s life
○ To patients (why would you trust me?)
T
ti t ( h
ld
t t
?)
● Begins with the psychoeducational
framework of CBT
RATIONALE FOR CBT: TRIPARTITE
MODEL/C
/ OGNITIVE TRIANGLE
Cognitive Cognitive
Reactions
Tight fists, muscle tension
Physical Reactions
“He
He did it on did it on
purpose”
Pushing, hitting, etc.
Behavioral Reactions
PHYSIOLOGICAL INTERVENTIONS
● Goals
○ To ameliorate physiological reactivity
○ To promote sense of mastery
To promote sense of mastery
● Skills
○ Diaphragmatic breathing
○ Muscle relaxation
○ Mindfulness
○ Exercise
COGNITIVE INTERVENTIONS
● Goals
○ To challenge maladaptive thinking
p
y
○ To promote sense of mastery
● Skills
○ Cognitive restructuring
Cognitive restructuring
○ Problem solving
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pp g
○ Thought stopping
○ Worry time
○ Visualization
COGNITIVE INTERVENTIONS
● In Beck’s Cognitive Therapy, the client’s beliefs g
py,
are tentative hypotheses; we test the validity of the hypotheses by gathering evidence that refutes (or supports) them
refutes (or supports) them
● Cognitive Therapy Steps
○ Identify automatic thoughts (reaction to triggers)
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g (
gg )
○ Analyze the cognitive distortions in automatic thoughts
○ Gather the evidence
Gather the evidence
○ Use the evidence to develop an alternative thought
COGNITIVE INTERVENTIONS
● Can be linked with behavioral interventions Can be linked with behavioral interventions
(e.g., activation in vivo exposure)
● With young children, just coping statements
With young children just coping statements
BEHAVIORAL INTERVENTIONS
● Goals
○ To minimize avoidance
○ To build competences
To build competences
● Skills
○ Imaginal exposure
○ Parent training
○ Social skills training
○ Communication training
HOMEWORK: T
: THEORY AND DEFINITIONS
● Monitoring and practice conducted outside of Monitoring and practice conducted outside of
session
● Pavlovian: Stimulus generalization‐application Pavlovian: Stimulus generalization application
of learned response to stimuli associated with the CS
the CS.
● Skinnerian: Increase consistency of contingencies to behavior
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i
b h i
HOMEWORK: T
: THEORY AND DEFINITIONS
● Considered to facilitate change by providing Considered to facilitate change by providing
clients opportunity to:
○ Practice skills
Practice skills
○ Generalize skills to daily lives
○ Assume active roles in the change process
Assume active roles in the change process
● Give therapists the opportunity to monitor progress and assess it
d
motivation (Karver & Caporino, 2010)
HOMEWORK: R
: RESEARCH
● Majority of studies (Gonzalez et al., 2006; ajo ty o stud es (Go a e et a ., 006;
Neimeyer et al., 2008; Westra et al., 2007) show that homework compliance is associated with:
○ Retention in therapy
○ More positive CBT outcomes
● Depression
● Anxiety
● Substance abuse
○ Better outcomes associated with specific therapist behaviors (e.g., discussing barriers to completing homework)
barriers to completing homework)
HOMEWORK: : “H
HOW TO”
● Providing the Rationale
Providing the Rationale
○ Frequency: How many times a day/week/month does the behavior occur?
does the behavior occur?
○ Duration: How long does it last?
○ Intensity: How upset/angry/anxious do you/your Intensity: How upset/angry/anxious do you/your
child get?
○ Pervasiveness: In what settings does the
Pervasiveness: In what settings does the
behavior occur?
WEB‐B
BASED RESOURCES
●
●
●
●
Association for Behavioral and Cognitive Therapies
National Child Traumatic Stress Network
National Center for Telehealth and Technology (T2)
Recommended Readings:
Recommended Readings:
○ Goldfried, M.R., & Davidson, G.C. (1994). Clinical Behavior Therapy. New York, NY: John Wiley & Sons, Inc.
○ Friedberg, R.D., McClure, J.M., & Garcia, J.H. (2009). Cognitive Friedberg, R.D., McClure, J.M., & Garcia, J.H. (2009). Cognitive
therapy techniques for children and adolescents: Tools for enhancing practice. New York, NY: The Guilford Press.
○ Ledley, D.R., Marx, B.P., & Heimberg, R.G. (2010). Making Cognitive Behavioral Therapy Work:
Making Cognitive‐Behavioral Therapy Work: Clinical Process for New Practitioners, second edition. New York, NY: The Guilford Press.