Download Elissa J. Brown, Ph.D. Professor of Psychology TOPICS - AF-CBT

9/15/2015
COGNITIVE‐BEHAVIORAL THERAPY: THEORY, CASE CONCEPTUALIZATION, AND ASSESSMENT
Elissa J. Brown, Ph.D.
Professor of Psychology
TOPICS
● Defining cognitive‐behavioral therapy (CBT)
● The role of the therapeutic relationship
● Theories of behaviorism
● Case conceptualization
● Assessment
DEFINITION
● What is Cognitive‐Behavioral Therapy?
1
9/15/2015
COGNITIVE‐BEHAVIORAL THERAPY: THEMES AND CHARACTERISTICS
● Scientific
● Active
● Present focus
● Self‐control and self‐evaluation
● Learning focus
COGNITIVE‐BEHAVIORAL THERAPY: THEMES AND CHARACTERISTICS
● Collaborative
● Individualized
● Stepwise progression
● Short‐term
● Treatment package
THERAPEUTIC RELATIONSHIP
● What is the role in Cognitive‐Behavioral Therapy?
● Necessary, but not sufficient
2
9/15/2015
COGNITIVE‐BEHAVIORAL THERAPY: THERAPEUTIC RELATIONSHIP
● Functions of Therapeutic Empathy in CBT (Thwaites & Bennett‐Levy, 2007)
○ Establishing the therapeutic relationship
g
g
○ Assessment and data gathering
○ Facilitating case conceptualization
○ Enabling CBT techniques
○ Maintenance of therapeutic relationship
○ As a therapeutic agent
COGNITIVE‐BEHAVIORAL THERAPY: THERAPEUTIC RELATIONSHIP
● Research ○ One of the strongest predictors of treatment process (attendance, attrition) and outcomes in children, adolescents, and adults across disorders ,
,
and therapies (Karver & Caporino, 2010; Shirk et al., 2008)
COGNITIVE‐BEHAVIORAL THERAPY: THERAPEUTIC RELATIONSHIP
● Research ○ Early in treatment, youths who received manual‐guided treatment had significantly higher observer‐rated alliance than those g
who received usual care (Langer, Weisz, & McLeod, 2011)
3
9/15/2015
THEORIES OF BEHAVIORISM: PAVLOVIAN/RESPONDENT CONDITIONING
●Pavlov’s Conditioning Paradigm:
UCS
UCR
• Loud Noise
• Fear
CR
CS
• Toy
• Fear; same but weaker than above
THEORIES OF BEHAVIORISM: PAVLOVIAN/RESPONDENT CONDITIONING
● Wolpe:
○ Stimulus generalization‐application of learned response to stimuli associated with the CS
○ Stimulus discrimination
Stimulus discrimination‐creation
creation of a new of a new
response by making the stimuli significantly different from the original CS
THEORIES OF BEHAVIORISM: PAVLOVIAN/RESPONDENT CONDITIONING
● Wolpe:
○ Shaping‐moving from the newly conditioned stimulus (associated with calm) to the originally conditioned stimulus (associated with (
fear) in increments
● Explains the initiation of fear and triggers through traumatic events
4
9/15/2015
THEORIES OF BEHAVIORISM: PAVLOVIAN/RESPONDENT CONDITIONING
●Pavlov’s Conditioning Paradigm:
UCS
UCR
• Loud Noise
• Fear
CR
CS
• Fear; same but weaker than above
• Toy
THEORIES OF BEHAVIORISM: SKINNERIAN/OPERANT CONDITIONING
● Skinner’s Conditioning Paradigm:
Stimulus
Response
Reinforcer
Antecedent
Behavior
Consequence
THEORIES OF BEHAVIORISM: SKINNERIAN/OPERANT CONDITIONING
● Explains maintenance of fear through avoidance
● Explains triggers
● Explains coercive cycle of aggression and role l i
i
l f
i
d l
of parenting / reinforcement
5
9/15/2015
CASE CONCEPTUALIZATION IN CBT
● Functional analysis/functional behavioral assessment (Gresham et al., 2001)
● Analysis of the intent or function of the behavior
● Variables to be assessed: ○ Antecedents
○ Behavior
○ Consequences
THEORIES OF BEHAVIORISM: SKINNERIAN/OPERANT CONDITIONING
● Skinner’s Conditioning Paradigm:
Stimulus
Response
Reinforcer
Antecedent
Behavior
Consequence
FUNCTIONAL ANALYSIS: IDENTIFYING DETAILS OF
PROBLEM BEHAVIOR
● Parameters of problem behavior
○ Frequency: How many times a day/week/month does the behavior occur?
○ Duration: How long does it last?
Duration: How long does it last?
○ Intensity: How upset/angry/anxious do you/your child get?
○ Pervasiveness: In what settings does the
behavior occur?
6
9/15/2015
IDENTIFYING ANTECEDENTS/TRIGGERS
● Antecedents
○ When does the behavior occur?
○ Who is present when the behavior occurs?
○ What activities or events precede the occurrence What activities or events precede the occurrence
of the behavior?
○ Does the child engage in any other behaviors prior to the behavior?
○ What is the person thinking or feeling?
IDENTIFYING CONSEQUENCES
● Consequences
○ What happens after the behavior occurs?
○ What do you do when the behavior occurs?
○ What do other people do when the behavior What do other people do when the behavior
occurs?
○ What does the individual get or get out of following the behavior?
COMMON FUNCTIONS
● Attention
○ Adolescent says self‐deprecating or self‐
destructive things
● Escape
p
○ Child engages in misbehavior right before math class
7
9/15/2015
COMMON FUNCTIONS
● Reward
○ Adult goes to work to receive salary
○ Child tantrums in supermarket cereal aisle
● Sensory Stimulation
Sensory Stimulation
○ Child on the spectrum engages in perseverative
behaviors
BEHAVIORAL ASSESSMENT
● Methods
○ Unstructured interviews
○ Semi‐structured Diagnostic Interviews
○ Direct Observation
Direct Observation
○ Questionnaires
○ Psychophysiological measures
○ Archival records
BEHAVIORAL ASSESSMENT
● Considerations
○ Reliability
○ Validity
○ Utility
8
9/15/2015
FUNCTIONAL ANALYSIS FOR AF‐CBT
● Role of Assessment/Constructs to Assess
○ Antecedents: history of conflict, stressors
○ Problematic behavior in children/caregivers
● Conduct problems
● Aggression
● Anxiety and avoidance (PTSD)
FUNCTIONAL ANALYSIS FOR AF‐CBT
● Role of Assessment/Constructs to Assess
○ Reinforcers
● Parenting behaviors
● Risky behavior (e.g., gang activity, substance use)
b
)
● In AF‐CBT, we link assessment findings to treatment components
WEB‐BASED RESOURCES FOR ASSESSMENT
● www.Mfba.net
○ Forms for behavioral assessment and intervention plans
● www.outcometracker.org
○ System for self‐monitoring
● http://www.psychologytools.org/cbt.html
○ Built for military but many of them fit nicely with civilian populations as well, especially Mood Tracker, which has won several awards for best mobile app.
9