Behavioral

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Behavioral Cognitive Treatments
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• Behavior Therapy
• Defined "The attempt to alter human behavior
  and emotion in a beneficial manner according to
  the laws of modern learning theory." --Eysenck

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• Quick review of learning theories
• Classical CS paired with UCS CS eventually
  produces CR in absence of UCS
• Watson Rayner (1920) Little Albert
• Pavlov's dogs

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• Operant
• Positive (adding something)
• Punishment (adding bad)
• Reward (adding good)
• Negative (removing something)
• Punishment
• Reward
• Social learning theory (observational learning)
• Bandura's BOBO doll experiments.

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• Behavioral therapists classify abnormal
• behavior as excesses or deficits
• Excess behavior occurs more strongly/frequently
  and causes problems for the person (e.g.,
  aggression)
• Deficit behavior does not occur
  strongly/frequently enough and causes problems
  (e.g., social skills--often a problem in
  schizophrenia or social anxiety disorder)

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• 3 ways in which behavioral and other
• therapies differ
• behavior therapy is more directive
• goals of behavioral therapy are more
  circumscribed (behavior change rather than
  reconstruction of personality)
• behavior therapy has empirical underpinnings
  (intuitive, since behaviors and the laws that
  govern them are more readily observable than
  personality characteristics)

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• Behavioral therapy techniques based upon
• classical conditioning
• Systematic desensitization (counterconditioning)
  pair feared object with relaxation (e.g., muscle
  relaxation)
• example
• Flooding client exposed to feared object w/o
  being able to escape eventually, response is
  diminished--client cannot maintain it

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• Implosive therapy more psychodynamic than
  flooding client exposed to feared object in
  addition to images based on psychodynamic
  conflicts
• Aversive conditioning a stimulus previously
  associated with an undesired behavior is paired
  with an aversive stimulus (often used for
  paraphilias)

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• Systematic desensitization, flooding, and
  implosive therapy are often used with anxiety
  disorders
• Therapists ( clients) tend to prefer systematic
  desensitization because it does not generate as
  much distress and it is more practical

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• Behavioral therapy techniques based upon
• operant, or instrumental conditioning
• Token economy clients get tokens for good
  behavior they can exchange them for desired
  things most often used in group/institutional
  settings parents do this with stickers

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• Shaping systematic reinforcement of successive
  approximations to a desired behavior often used
  to treat speech problems in autistic children
• Stimulus control identify event that triggers
  unwanted behavior change that stimulus

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• Behavioral therapy techniques based upon
• social learning
• Modeling often used in assertiveness training
• Behavioral therapy is very often paired
• with cognitive therapy (CBT).

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• Rational-Emotive Therapy (RET)
• Cognitive therapies are all based on the
  assumption that emotional disorders result from
  maladaptive thought patterns. The task of
  therapy, therefore, is to restructure these
  maladaptive cognitions.
• The two most prominent forms of cognitive
  treatment are Elliss rational-emotive therapy
  (RET) and Becks cognitive therapy.

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• Brief history and rationale
• Ellis rational emotive therapy (RET) was the
  first of the modern cognitive interventions to
  gain widespread clinical acceptance.
• Ellis was trained psychodynamically but he became
  more interested in exploring clients cognitions
  and changing their irrational beliefs.

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• According to the principles of RET, emotional
  disorders are rooted in peoples irrational
  beliefs, which are distortions of objective
  reality.
• Ellis listed 12 irrational core assumptions that
  could be at the root of most emotional
  disturbances. Some examples of these irrational
  ideas are
• It is absolutely necessary to be loved by
  everyone for everything you do.
• It is easier to avoid lifes difficulties and
  responsibilities than to face them.
• People have virtually no control over their
  emotions.

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• A-B-C model
• In everyday situations, individuals do not always
  consciously or deliberately tell themselves these
  irrational assumptions. Rather, such assumptions
  appear to be automatic and pervasive because
  people repeat them so often that these
  assumptions become overlearned responses.

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• According to RET, it is not the experience itself
  but how the individual perceives that experience
  that causes anxiety and depression. This
  perceptive process is illustrated by Ellis A-B-C
  analysis of depression.

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• Ellis links the environmental or Activating event
  (A) to the emotional Consequences (C) by the
  intervening Belief (B)
• Example in the middle of a phone call, the
  connection is interrupted ? person assumes she is
  not worth talking to ? feels depressed.

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• Techniques
• In RET, the therapist helps the client identify
  irrational ideas and replace them with more
  constructive, rational thoughts.
• In doing so, the therapist must directly
  challenge the clients irrational ideas and then
  model rational reinterpretations of disturbing
  events.

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• Together, the therapist and client work on
  cognitive rehearsals aimed at substituting
  rational self-statements for previously
  irrational interpretations.
• Often, the therapist assigns behavioral tasks
  that are designed to develop rational reactions
  to replace the clients formerly irrational
  assumptions.

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• Evaluation
• The effectiveness of RET remains to be proven.
  Part of the difficulty in doing this lies in
  specifying the treatments procedural components
  that is, RET has never been manualized.
• It is difficult to empirically test
  non-manualized treatments due to the lack of
  reliability that can occur when different
  therapists interpret and apply a theory in
  different ways (for lack of a manual that details
  each step in the therapy).

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• In response to criticism of the conceptual and
  empirical bases of RET, Ellis has argued that his
  approach has been misinterpreted however, RET
  has still not been manualized.
• The data from studies using RET suggest that this
  type of therapy can be effective for some
  disorders like depression and anxiety, but the
  studies are few and some of the findings are not
  consistent across studies.

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• Video of Ellis with Gloria

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• Becks Cognitive-Behavioral Therapy (CBT)
• Brief history
• Developed by Aaron Beck, who also came from a
  psychodynamic background. In contrast to the
  Freudian notion that basic drives control the
  individual and his intellect, Beck believes that
  this relationship operates in the opposite
  direction that is, that, to some extent, our
  intellect influences our drives. Beck originally
  developed his theory for the treatment of
  depressed individuals.

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• The core principle of Becks cognitive therapy is
  that holding negative assumptions leads to having
  negative moods, which, in turn, increases the
  probability of more negative thinking in what
  becomes a vicious cycle.
• Beck argues that people who fall into this
  pattern become victims of their own illogical
  self-judgments.

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• Rationale
• Beck argues that depressed individuals feel as
  they do because their thinking is biased toward
  negative interpretations.
• Throughout the persons life, these
  interpretations build on one another and become
  schemas (recall that a schema is a body of
  knowledge that an individual has stored in
  memory).

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• According to Beck, the negative distortions and
  schemas maintain the cognitive triad a negative
  views of the self, the world, and the future.
• Well look at some of the principal cognitive
  biases of the depressed individual.

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• Arbitrary inference refers to the process of
  drawing a specific conclusion in the absence of
  evidence to support the conclusion or when the
  evidence is contrary to the conclusion (example
  person down the street does not wave ? does not
  want to talk to me, she must hate me).

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• Selective abstraction consists of focusing on a
  detail taken out of context, ignoring other more
  salient features of the situation and
  conceptualizing the whole experience on the basis
  of this fragment (example did poorly on a
  difficult question in exam-- even if did well on
  the rest of exam ? I am stupid).

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• Overgeneralization refers to the pattern of
  drawing a general rule or conclusion on the basis
  of one or more isolated incidents and applying
  the concept across the board to related and
  unrelated situations (previous example I am
  stupid in all of my classes, Ill never amount to
  anything).

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• Magnification and minimization are reflected in
  errors in evaluating the significance or
  magnitude of an event that are so gross as to
  constitute a distortion (example normally do
  reading, but forget to do reading for class one
  day ? I am going to fail the class because I did
  not read for today).

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• Personalization refers to the clients tendency
  to relate external events to himself when there
  is no basis for making such a connection
  (example encounter religious zealot on the
  Pentacrest yelling you must repent for all of
  your sins ? assume that it is aimed at you
  because you are such an awful person).

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• Absolutistic, dichotomous thinking (a.k.a., all
  or nothing) is manifested in the tendency to
  place all experiences in one of two opposite
  categories for example, flawless or defective,
  saint or sinner, etc.
• Often, in describing himself, the client selects
  the extreme negative categorization (example
  like to play basketball but cannot enjoy it
  unless you make every shotdistorted cognition
  cannot play unless I do it perfectly).

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• Strategies
• A variety of cognitive and behavioral strategies
  are utilized in cognitive therapy to combat the
  cognitive distortions and biases.
• Cognitive techniques are aimed at delineating and
  testing the client's specific misconceptions and
  maladaptive assumptions.

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• highly specific learning experiences designed to
  teach the client
• 1) to monitor his negative, automatic thoughts
• 2) to recognize the connections between
  cognition, affect, and behavior
• 3) to examine the evidence for and against his
  distorted automatic thoughts
• 4) to substitute more reality-oriented
  interpretations for these biased cognitions
• 5) to learn to identify and alter the
  dysfunctional beliefs which predispose him to
  distort his experiences

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• In addition, to help clients challenge their
  dysfunctional assumptions, therapists raise
  number of questions. For example, in the case of
  a client who felt he was a total failure, Beck
  would ask some of the following questions
• How do you define failure? What are your
  standards?
• Have there been degrees of failure that is, were
  some failures more total than others?
• If some experiences were only partial failures,
  did they also represent partial successes?
• Were there some areas in your life (friends,
  family, schoolwork, recreation) in which you did
  not fail?
• Even if you did fail in specific areas, does it
  follow that you cannot improve and become more
  successful?
• Do failures in reaching a goal make you a failure
  as a person?

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• Another strategy used by cognitive therapists is
  to require clients to do homework assignments.
• For example, clients might be required to
  identify and challenge the dysfunctional
  cognitions associated with their problems using
  dysfunctional thought records

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• The explicit use of behavioral methods is a
  fundamental feature of cognitive therapy.
  Clients do behavioral tasks to help correct
  dysfunctional cognitions and disprove maladaptive
  expectations.

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• Instead of arguing with clients about whether
  their cognitions are valid or helpful, therapists
  collaborate with them in devising specific tasks
  that will help them assess this for themselves.
• For example, Beck recommends that clients treat
  their beliefs as hypotheses and test them using
  their own behaviors as experiments to examine the
  accuracy of those beliefs.

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• Evaluation
• A major advantage of Becks cognitive therapy is
  that it is clearly defined. Because it is
  adequately implemented and differs procedurally
  from alternative methods, cognitive therapy has
  consequently lent itself to research on treatment
  outcome. Becks cognitive therapy has been shown
  effective in controlled outcome research.

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• It has been tested extensively in the treatment
  of depression and consistently produced positive
  results.
• Evidence has shown that cognitive treatment is
  also effective in treating anxiety disorders
  (e.g., panic disorder) and eating disorders
  (i.e., bulimia and anorexia).
• However, the reasons for its success in treating
  these disorders remains to be fully established.
  That is, the causal link has not been
  established.