Behavioral Therapy Fall 09
• Overview
• Originally defined as the application of modern learning theory to the treatment of clinical problems. View of human nature is that we are both the producers and the products of our environment.
• Origins in 1950's/early 60's as a departure from psychoanalytic approaches. Emerged during 70's as the second major force in psychology. During 80's, went on to explore new approaches and applications. Very popular during 90's and currently as approach to psychological problems. When first started, it was in opposition to the psychoanalytic and humanist models, but in recent years there has been more of an acceptance of humanistic principles behavioral principles can be used for self-actualization, humanistic goals.
• Prior to 50's, can trace the history of behavioral thought in work of Pavlov who established classical conditioning and then JB Watson who criticized psychology as being too subjective. Watson stressed importance of learning on behavior and had the classic 1920 experiment with Albert and the white rat. Skinner (1930's) studied operant conditioning. He believed that only overt behavior is acceptable subject of scientific investigation.
• Wolpe (1950's) is credited with developing treatment methods from behavioral principles. Wolpe postulated that behavior is composed of cognitive, motor, and most importantly in neurosis, emotional responses. Behavior is seen as responses to stimulation, external and internal, therefore the goal of therapy is to modify unadaptive stimulus-response connections using principles of experimental psychology. Wolpe defined anxiety as a persistent response of the automatic nervous system acquired through the process of classical conditioning. Anxiety is the basis of all neurotic conditions.
• Four major areas of development in behavioral therapy regarding learning
• Classical conditioning: developed by Pavlov is concerned with stimuli that automatically evoke responses. Certain stimuli (noise, food) elicit reflex responses. These stimuli are referred to as unconditioned stimuli (UCS). The responses are referred to as unconditioned responses (salivation, flexing of muscle). The connection between the UCS and the UCR is automatic, i.e., not learned. A neutral stimulus (called a conditioned stimulus or CS) can be paired with the UCS to elicit a reflex response. Pairing a CS with an UCS results in the CS alone eliciting the response, now called the CR.
• i. UCS (shock) elicits UCR (pain and fear)
• ii. UCS plus CS (tone) elicits UCR (pain and fear)
• iii. CS (tone) elicits CR (fear)
• Operant conditioning many behaviors are emitted spontaneously and are controlled primarily by their consequences. Behaviors amenable to control by altering consequences that follow them are called operants because they are responses that operate (have some influence on) the environment and generate consequences. Operants are strengthened or weakened as a function of the events that follow them. Main principles of operant conditioning:
• i. Positive reinforcement follows a behavior and the frequency of the behavior increases.
• ii. Negative reinforcement refers to the increase in the frequency of a response by the removal or avoidance of something negative immediately after the response is performed.
• iii. Punishment is the presentation of something negative or the removal of something positive that decreases the frequency of that response.
• iv. Extinction withholding reinforcement from a previously reinforced response will cause a cessation of the behavior.
• Social learning theory developed by Bandura (1977). Sees behavior as an interaction of stimulus events, external reinforcement and cognitive mediation processes. Does the person believe (self efficacy) that they have the ability to master changes in their behavior? Social learning theory combines the various concepts and says that learning is the interaction between the individual and his/her environment, as well as the beliefs he/she holds about his place in the environment.
• Cognitive behavior therapy focuses on the person's thinking about the event. Their cognition is the central role in understanding behavioral problems. (more on this next week)
Therapeutically, we don't often see pure behavior therapy today, but more a blend of behavioral and cognitive behavioral approaches. View of human nature humans are both the producer and the project of his/her environment.
• Basic Characteristics and Assumptions
• Based on the principles and procedures of the scientific method. Systematic adherence to specifications and measurement.
• Deals with current problems and factors that influence them, not historical determinants. While there may be times when it helps to have a historical context, the main emphasis in on changing current factors to change current behavior.
• Clients are expected to be active; they do things to bring about change.
• Emphasis on education, teaching new skills and transferring what is learned into client's environment. Therapist is very active what is learned in therapy is expected to transfer to client's environment.
• Focus in on assessment of overt and covert behavior, problem identification and evaluating change. Very extensive assessment process through observation, monitoring, self-reports.
• Emphasizes self-control client's initiate, conduct and evaluate own therapy. Client is responsible for the changes.
• Tailored to fit unique needs of each client. What treatment, by whom, is effective for this individual for that specific problem under which set of circumstances.
• Collaborative relationship with therapist, informed choices.
• Emphasis is on practical applications apply interventions to every day behavior. Moves from simple to complex, easy to hard, less threatening to more threatening.
• Therapy is typically brief, and procedures are developed with culture-specific values in mind.
• Therapeutic Process
• Problem identification and assessment task is to identify and understand the presenting problem. Therapist seeks detailed information about problems, such as initial occurrence, severity, and frequency. Also ask what has been done to cope with problem, what does client think about the problem. What specific environment and personal variables are thought to be maintaining the behavior? Past experiences (history taking) is important to the degree that the experiences are still active in directly contributing to the client's distress. Ask what, when, where, and how. No why questions. Listen to self-reports and check for inconsistencies and evasiveness. Use self-monitoring journals, records. Behavioral observations of others (example, teachers who record how often something happens.)
• Goal setting done in collaboration with the client what are the client's goals. They must be measurable, concrete, understood and agreed upon. Process goal setting:
• i. Counselor provides rationale for goals, explains role of goals in therapy, purpose of goals and client's role in process.
• ii. Client identifies desired outcomes by specifying positive changes desired.
• iii. Counselor helps client accept responsibility for change.
• iv. Cost-benefit effect of all goals is explored and discussion of positive and negative aspects of the goals. (demo decisional balance tree)
• v. Client and counselor decide on which goals to pursue and if agreement cannot be reached, referral is given.
• Once goals are agreed upon, therapist conducts a functional assessment to determine the conditions that maintain the behavior, gather information about antecedents and consequences and the dimensions of the problem. Then a change plan is designed toward accomplishing the goals, and strategies are implemented to promote behavioral change. Finally, therapist and client evaluate success of plan, make changes and appropriate, readjust plan as needed, and after completion, monitor and conduct follow-up assessments.
• Therapeutic techniques a variety of assessment and measurement instruments are used for data gathering and monitoring changes. It is very clear what changes are occurring from the outcome data. Basic principles of operant conditioning are commonly applied in this model. In addition, thorough functional assessments are essential to setting up a change plan. See textbook for description of functional assessment. Other techniques that are common include:
• Relaxation training with guided imagery used for an array of problems and situations
• Systematic desensitization based on classical conditioning. Pair non-anxiety provoking images with anxiety provoking. First teach relaxation training, then develop hierarchy of anxiety. Desensitization is last step and uses the hierarchy of anxiety start with less threatening and move to most threatening. When done uses imagination it is called systematic desensitization, but can also be done in vivo and then it is considered one type of an exposure therapy. Person gradually is exposed to the feared situations.
• Flooding is another exposure therapy. Instead of gradual exposure, the anxiety-provoking stimuli are presented for a long period of time. This can be done through imagination or in vivo. The idea is that if someone is exposed to intense, prolonged anxiety-provoking stimuli and cannot engage in anxiety-reducing behavior, eventually the maladaptive behavior will be curbed and the anxiety will diminish. Based on principles of extinction in conditioning.
• EMDR (video) eye movement desensitization and reprocessing. Idea is that the client restructures their cognitions and reprocesses information by visualizing the traumatic image, verbalizing the cognitions, and then while tracking the therapist's index finger (or lights on a machine) as it moves rapidly back and forth they work on relaxation and verbalizing images, thoughts and feelings. The negative cognitions are replaced with healthy, positive cognitions and the trauma no longer evokes the same anxiety.
• Assertiveness training teaching effective communication so that people can express their needs and improve interpersonal relationships. Help passive people express anger in constructive ways and angry people get needs met without hurting others.
• Self-management programs and self-directed behavior educationally based, used for a variety of problems such as smoking, eating, drinking. Teach people ways of coping, changing behavior and help them set up plans for change.
• Multimodal therapy please read this section of the book. I will not cover it during lecture.
• Dialectical behavior therapy DBT is a new form of behavioral and psychoanalytic blended techniques. I don't have any training in this area and cannot address it fully.
Strengths and Limitations of model behavioral approaches are being adapted to fit into many other forms of therapy. This model and the techniques associated with it tend to help people see goal achievement and actively engage clients in the process. Clients who are more comfortable with action plans and problem solving find this model is a good fit for them. It is good from a multicultural perspective because it allows for the client's environment and backgrounds. Limitation is that it can be used to narrowly and if not well trained can be simply a grab bag of techniques. It also does not allow expression of feelings and therefore may not be appropriate for certain problems. Clients are not gaining insight nor are they getting to root cause of any problems.
Videos and homework review.
Homework for next week: p. 137 from Student Workbook
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