Chapter 13: Cognitive-Behavioral Interventions

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Chapter 13 Cognitive-Behavioral
Interventions

• March 6, 2006

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Cognitive-Behavioral Therapy (CBT)

• Can be used to treat specific disorders or more
  broad issues
• e.g., bulimia, anxiety, poor study habits

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Anxiety-Reduction Methods
Perhaps your performance anxiety wouldnt be so
bad if you performed better
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Systematic Desensitization

• Wolpe
• relaxation training
• hierarchy of fears
• step by step progression up hierarchy of fears

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Graduated Real-Life Practice

• Meyer
• a.k.a. successive approximation, graded practice
• step by step progression along hierarchy, facing
  stimuli without relaxation

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Both systematic desensitization and graduated
real-life practice are based on the principle
of...
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Stimulus Generalization

• If you extinguish anxiety by exposing the client
  to a stimulus that resembles the phobic stimulus,
  but is less intense, then eventually anxiety will
  extinguish when the phobic stimulus is present

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Imaginal Flooding

• Formerly implosive therapy (but now doesnt
  include psychodynamic material)
• Imagine the most feared stimulus to invoke
  intense anxiety and continue until anxiety
  decreases

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Exposure in Vivo

• Marks
• Real-life exposure to the feared stimulus
• Evoking stimulus (ES) the feared situation
• Evoked response (ER) the behaviour that the ES
  initiates

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Operant Learning Techniques
I think I should warn you that the flip side of
our generous bonus-incentive program is capital
punishment.
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Reinforcement

• Strengthen or maintain a behaviour
• Positive
• delivery of something
• immediate small more effective than delayed large
• Negative
• removal of something aversive

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Shaping

• A.k.a. successive approximation
• Break learning into small steps
• Reinforce small steps that get closer and closer
  to the desired behaviour

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Punishment

• decrease or stop behaviours
• response-contingent aversive stimulation (RCAS)
• response aversive stimulus

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Punishment

• Response cost
• response removal of appetitive stimulus

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Effect on Behaviour
Behaviour Increases
Behaviour Decreases
Stimulus is Presented
Positive Reinforcement
Punishment RCAS
Scheduled Consequence of the Response
Punishment Response Cost
Negative Reinforcement
Stimulus is Withdrawn
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Extinction

• Disconnecting a reinforcement contingency

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Schedules of Reinforcement

• Continuous
• every response is reinforced
• rapid extinction
• Variable Ratio
• some responses reinforced in an unpredictable
  pattern
• delayed extinction

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What Controls Behaviour?

• Rule-governed behaviour
• rules, laws
• affect how a behaviour is performed

• Contingency-shaped behaviour
• response rates, likelihood behavior will be
  performed

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Applied Behaviour Analysis

• The application of operant learning principles to
  treat problem behaviors
• Used to help many types of problems with good
  success rate

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The ABCs

• Must identify the contingency that is operating
  and maintaining the problem behaviour
• A antecedent events
• B behaviour
• C consequences

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Class Activity

• Quickly try to think of a behaviour in your life
  that you would like to change. Discuss the ABCs
  with someone near you.

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Other Applications

• toilet training
• outbursts
• somatoform disorders
• schizophrenia
• stimulus satiation responses typically weaken
  when the reinforcing stimulus is made too
  abundant

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Token Economies

• Used with groups (e.g., psychiatric or rehab
  facilities)
• give out tokens that can later be exchanged for
  tangible rewards or privileges
• A form of secondary reinforcement

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Types of Reinforcers

• Secondary reinforcers are not inherently
  reinforcing, but through association,one learns
  that they are reinforcing
• e.g., money, grades, smiling
• Primary reinforcers are inherently reinforcing
• e.g., food, sex

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Social Skills Training

• instruction
• modeling
• behaviour rehearsal
• praise
• prompts
• coaching
• feedback
• reinforcement
• homework assignments

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Social Skills Training

• Generally, best for those who are in the
  community or are likely to be discharged
• key is a combination of modeling with
  role-playing aimed at specific skills (e.g.,
  expressing feelings, starting a conversation)

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Rehearsal Desensitization

• used when social anxiety is also present
• incorporates systematic desensitization elements
• move through hierarchy from low anxiety to high
  anxiety items

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Problem-Solving Therapy

• Siegel Spivack
• Training exercises dealing with problem
  identification, goal definition, solution
  evaluation, evaluation of alternatives, and
  selection of the best solution
• e.g., identifying emotions in others, perspective
  taking

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Cognitive Modification Procedures
My back is fine. My mind went out
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Self-Instructional Training

• Meichenbaum
• Teaching patients to use self-guiding speech

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Stress-Inoculation Training

• Educational phase learn that unhelpful thinking
  patterns produce and maintain unpleasant emotions
  and dysfunctional behviours
• Rehearsal phase patient makes coping
  self-statements to help deal with stressful
  events
• Application phase practice using coping skills
  while confronting actual stressors

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Constructive Narrative

• clients viewed as storytellers and makers of
  meaning
• clients can reframe stressful events, normalize
  their experience, develop a healing theory of
  what happened, and build new assumptive worlds
  and ways to view themselves

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Rational-Emotive Behavior Therapy

• Ellis
• enable people to observe, understand, and
  persistently dispute irrational, grandiose,
  perfectionist shoulds, oughts and musts

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ABCs

• A activating event
• B beliefs
• C consequence (emotional)
• most believe A causes C
• goal is to accept that B is very important in
  causing C
• rational vs irrational beliefs

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ABC and D

• D disrupting irrational beliefs
• challenge unrealistic and damaging beliefs
• e.g., Why is it terrible if things do not go
  your way?

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Cognitive Therapy

• Beck
• challenge irrational beliefs
• and encourage client to attempt real life
  experiments to challenge faulty assumptions
• 3 fundamental concepts

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1. The Cognitive Triad

• Depressed people have pessimistic thoughts about
  their
• self
• world
• future

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2. Cognitive Schemas

• Global, absolute beliefs
• are activated during depressive episodes, and lie
  dormant between episodes
• established early in life

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3. Cognitive Distortions

• Specific exaggerations of the negative aspects of
  a situation

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Do certain thinking patterns correlate with
certain mood states?
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The Situational Self-Statement and Affective
State Inventory

• Imagine that you had studied really hard for
  your midterm and expected to get an A. However,
  when the marks came back, your mark was a C

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• What feelings would you likely experience?
• A) Depression
• B) Disappointment
• C) Anger
• What thoughts would likely cross your mind?
• A) I should drop out of school
• B) It was an unfair exam
• C) I wish I had done better

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Cognitive Restructuring

• Lazarus
• multimodal therapy model
• BASIC ID
• behavior
• affect
• sensation
• imagery
• cognition
• interpersonal relations
• drugs/diet

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Cognitive Restructuring

• Corrective self-talk
• point out errors in form and content thinking
• ignorance/misinformation

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Coping and Problem Solving

• Goldfried
• general problem solving strategies and coping
  skills
• 4 areas of focus
• problem solving
• relaxation
• cognitive restructuring
• communication skills

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Key Names

• Beck
• Lazarus
• Meichebaum
• Ellis
• Goldfried
• Wolpe
• Meyer

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Summary- Key Concepts

• Anxiety Reduction Methods
• systematic desensitization, graduated real-life
  practice, imaginal flooding, exposure in vivo
• Operant Learning Techniques
• reinforcement, punishment,applied behavior
  analysis, token economies, social skills
  training, problem solving
• Cognitive Modification Procedures
• self-instructional training, stress-inoculation
  training, rational-emotive behavior therapy,
  cognitive therapy, coping and problem solving

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• Thanks!!