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Skinner: Radical BehaviorismBandura, Ellis, Beck Meicheanbaum

Behavior and Cognitive Behavior Therapy

Compare -- Contrast Humanistic Theories

Person Centered-Existential-Gestalt

Common Themes List ways in which the three approaches are

similar

Distinct aspects each approach emphasizes Central focus of each approach Unique ideas, constructs, and/or techniques

each brought to counseling practice 2

Areas of Major Emphasis

Psychoanalytic/Psychodynamic Basic drives and the contribution of early

emotional experiences to the person’s presenting concern

Humanistic The therapeutic process -- the

relationship-- and emotional states in the here and now

Behavioral observable behaviors & learning

principles; congnitions3

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Skinner: Radical Behaviorism

Placed primary emphasis on the role of the environment in producing behavior

Applied learning principles to psychology Experimental psychologist: examined learning

principles with rats in the laboratory Books

1948 Walden Two 1953 Science and Human Behavior 1971 Beyond Freedom and Dignity

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Behavior/Cognitive Behavior Theory

Classical ConditioningOperant ConditioningSocial Learning ApproachCognitive Behavior Therapy

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Classical Conditioning If you pair a conditioned stimulus to a natural

stimulus, after time, the conditioned stimulus produces the same response as the natural one: Learning by association

Pavlov discovery (1900)1. Meat (us) >> Salivation (ur)2. Bell (cs)>>Meat (us) >>Salivation (ur)3. Bell (cs) >> Salivation (cr)4. Bell (cs) >> Extinguished

response

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Wolpe: 1950 Applied classical conditioning to treat anxiety by

pairing stimuli that cause anxiety (taking an exam) with a state of relaxation, to break the connection between the stimulus and the anxious response

Exam (us)>>>Anxiety (ur)Relaxation> Images Exam>Anxiety>Relaxation (cs) (us) (ur) (cr)

Images Exam (us) >>> Relaxation (cr)Exam (us) >>> Relaxation (cr)

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Behavior Therapy: Learning by Association: Exposure Techniques

1. Systematic Desensitization - anxiety• Relaxation training/ Anxiety hierarchy• Pairing (+) stimulus with (–) stimulus (shot-

lollipop)

2. Aversive Counter Conditioning

3. Exposure Techniques• In vivo desensitization• Flooding (in vivo, imaginary)

Anxiety: Facilitating and Debilitating

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Aversive Counter-Conditioning

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Exposure Techniques

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Operant Conditioning Behavior is controlled by its

consequences

Desired Consequences – Increase Behavior Reinforcement

No consequences - Decrease Beh.

Not-desired consequences - Decrease Beh. Punishment

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Environmental Consequences

Reinforcement Increase a behavior Positive R Adds a pleasant consequence Negative R Takes away an aversive stimulus

Punishment Extinguish a behavior Positive P: Add an aversive consequence Negative P: Takes away a desired stimulus

Lack of consequence - Extinguish behavior

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Applied Behavioral Analysis: Functional Assessment Model

Examine the antecedents and consequences of problem behaviors Conduct a functional assessment using interviews and

direct observations (e.g. keeping a diary) to identify Antecedents: conditions that contribute to the behavior of

interest Consequences: what happens after specific behavior occurs

Behavioral treatments are devised to replace problem behaviors with more adaptive behaviors using reinforcement and extinction strategies

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Behavior Modification Program

Reinforcement Token economy

Extinction Time out, loose privileges, punishment

Stimulus control Change environmental antecedents of problem behaviors

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Cognitive Behavior Therapy

Emphasizes cognitive processes and self-talk as mediators of behavior change

Reciprocal Determinism Bandura

Rational Emotive Therapy Ellis Cognitive Therapy Beck Cognitive Behavior Modification

Meichenbaum

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Bandura: Social Learning Approach

Psychological functions involve a reciprocal interaction between:

Environment <><><> Behavior <> <> <> <>

<> Cognitive Process <>

Modeling Vicarious Learning

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Cognitive-Behavior Techniques

1. Assertiveness Training1. Provide Information2. Examine beliefs and self-talk3. Role play assertive behaviors

Modeling – therapist demonstrates behavior

• Behavioral rehearsal – client demonstrates behavior

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Cognitive-Behavior Techniques

2. Steps: Self-Management Program

1. Identify goal in behavioral terms

2. Behavioral assessment environmental and cognitive contingencies

3. Plan for change

4. Self-Monitoring and Self-Reinforcement Behaviors, thoughts, self-talk

5. Evaluation of action plan - results 21

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Cognitive Behavior Theory Mental disorder- problem with thinking in which

a client distorts reality, including: Specific misconceptions Unrealistic expectations Maladaptive attributions

Therapy’ aim is to identify and change Faulty patterns of thinking Faulty premises and attitudes

Distressing emotions result from

maladaptive thinking

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Rational Emotive Behavior Therapy: (REBT) Albert Ellis

Stresses thinking, judging, deciding, analyzing, and doing

Assumes that cognitions, emotions, and behaviors affect ach other

Is highly didactic, directive,

Emotions stem mainly from our beliefs, evaluations and interpretations

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RET: The ABC Theory

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RET: Therapy Process

Therapy is seen as an educational process

Clients learn: To identify and dispute irrational beliefs To replace ineffective ways of thinking

with effective and rational cognitions To stop absolutistic thinking, blaming,

and repeating false beliefs

RET: Therapy Process

Rational Emotive Imagery Imagine being in the worst situation- train

to change irrational thoughts/feelings for retional ones

Homework REBT Self-Help Form Act as if… to challenge self-limiting

Biblio-therapy – Psycho-education

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Aaron Beck’s CT: Human Nature

Cognitive structures or schemas We all have implicit assumptions or premises that

influence what we attend to and how we interpret events

Confirmatory bias We tend to electively attend to events that confirm our

beliefs

Schemas and Disorders Anxiety Threat and Danger Depression Social rejection and failure

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Cognitive Therapy (CT)

Insight-focused therapy Emphasizes changing negative thoughts and

maladaptive beliefs Theoretical Assumptions

People’s internal communication is accessible to introspection

Clients’ beliefs have highly personal meanings These meanings can be discovered by the client

rather than taught by the therapist

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CT’s Cognitive Distortions

1. Arbitrary inferences2. Selective abstraction3. Overgeneralization4. Magnification and minimization5. Personalization6. Labeling and mislabeling7. Polarized thinking

CT’s Cognitive Distortions

Arbitrary inferences

• Gloria: relationships with the eligible men do not work out because she feels anxious and acts flippantly

Selective abstraction

• Focuses on only on one aspect of a situation: typically a negative aspect-

Overgeneralization

• This relationship did not work, no relationship will ever work

Magnification and minimization

• Emphasize negatives and minimize positives

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CT’s Cognitive Distortions

Presonalization

• A mother blames herself for child’s problems

• A man blames himself for partner's lack of interest in the relationship

Labeling and mislabeling

Type of generalization:•I made a mistake vs. I am a looser

Polarized thinking •Either co-workers praise me or they hate me•Gloria: Men are either eligible or “icky”

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Therapy Process

Teach clients to recognize, observe and monitor negative "automatic" thoughts &

Subject their automatic thoughts to reality testing: examine evidence for and against them

Clients learn to substitute realistic and accurate interpretations for biased cognitions

Process is collaborative an interactive: Socratic dialogue

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Beck’s Approach to Depression: Cognitive Triad

1. Have a negative view of themselves; attribute setbacks to themselves w/o looking at the environment

2. Tend to interpret experiences in a negative manner.

• Screen out positive experiences not consistent with negative view of themselves (selective abstraction)

3. Gloomy vision and projections about the future

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Ellis Vs. Beck

Ellis is more directional and confrontational in pointing out and refuting irrational thoughts

Beck helps clients discover their distorted patterns of thinking Collaborative empiricism Guided discovery

client and therapist examine and evaluate beliefs and modify and correct client’s misconceptions

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Contributions Beh- Cog Beh

Focus on short-term behavioral goals

Emphasis on evaluation of therapy outcome

Empirical evidence of positive results

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Limitations

May lead to symptom substitution Too much therapist power and control

Lack of attention to relationship issues

No processing of emotions and feelings Focus only on cognitive issues

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Meichenbaum: Cognitive Behavior Modification

Is primarily a self-instructional therapy that Focuses on helping clients become aware of their self-

talk, - cognitive restructuring - and acquire practical coping skills to deal with problems

and behaviors Process of Change

1. Self observation

2. Start a new internal dialogue

3. Learn new behaviors

Phase 1: Self-Observation

Observe thoughts, feelings, actions, Realize how client contributes to own

problems Leads to new cognitive structures – see

problems in a new light

Phase 2: Start New Internal Dialogue

Identify maladaptive behaviors Recognize more adaptive options Develop adaptive internal dialogue

to guide behaviors New behaviors impact cognitive

structures

Phase 3: New Skills

Teaches more effective coping skills Practice in real- life situations Continue monitoring/changing internal

dialogue Observe behaviors Assess outcomes

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Coping Skills Program:Stress Inoculation

Stress management techniques for present and future problems

Three phases: 1. Conceptual phase

2. Skills acquisition and rehearsal

3. Application and follow-through

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Conceptual Phase Collaborative relationship (Rogers) Didactic presentation of the role cognitions and

emotions play in stress (Ellis) Guided discovery to identify own self-talk and

how it creates stress (Beck) Systematic observation and monitoring of

maladaptive behaviors and their related self-talk (Behavioral)

New cognitive structures = see problems in a new light (Beck)

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Skills Acquisition and Rehearsal

Give clients behavioral and cognitive coping techniques to apply to stressful situations Rehearse new self-statements Relaxation training Social skills training Time management instruction Making changes in everyday life

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Application and Follow-Through

Arrange for transfer and maintenance of change from therapy to the real world Homework assignments of increasing complexity Results of assignments are carefully evaluated

Follow-up and booster sessions are scheduled in 3-, 6-, and 12 months intervals

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Contributions

Focus on short-term behavioral goals

Emphasis on evaluation of therapy outcome

Empirical evidence of positive results

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Limitations

May lead to symptom substitution Too much therapist power and control

Lack of attention to relationship issues

No processing of emotions and feelings Focus only on cognitive issues

Multimodal Therapy: Lazarus

Holistic approach to behavior modificationTechnical eclecticismHuman experience

interplay of genetics, environment and social learning

can be accounted by examining the BASIC ID

BASIC ID

Framework for assessment and therapy B – behavior A – affective processes S – sensation- five senses I – imagery C – cognition I – interpersonal relations D – physiological aspects - health

Therapy Process

Therapy is guided by what is best for the client Starts with a thorough assessment of the BASIC

ID profile BASIC ID determines the tone or quality of the

person’s functioning Therapist functions as trainer, educators,

consultant, role model Emphasize skill learning

New Applications and Integrations (end of Behavior Chapter #9)

Mindfulness and Acceptance- Based Cognitive Therapies: Emotional Regulation Dialectical – Behavior Therapy (DBT)

Combines CBT and Psychodynamic Highly structured- requires training - Borderline PD Minimum 1-year of frequent outpatient treatment

Mindfulness-Based Stress Reduction (MBSR) Mindfulness-Based Cognitive Therapy (MBCT) Acceptance and Commitment Therapy (ACT)

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Mindfulness and Acceptance Mindfulness

How to live more fully in the present (Ext) Interventions: yoga, meditation Experiential learning and self-discovery (Ext-

Gestalt -Rogers) Practice – In session and home-work

Acceptance (rather than challenge cognitions) change awareness of and relation to

negative thoughts (Ext) acceptance (nonjudgmental awareness) of

cognitions (Rogers)51