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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