Introduction to Behaviorism & Cognitive Behavior Therapies

1. Introduction to Behaviorism & Cognitive Behavior Therapies Anne Farrell, Ph.D. New York Medical College

2. Introduction and goals • Background • Knowledge and experience • Goals • Familiarize participants with tenets of behaviorism and basis for cognitive behavior therapies • Background and interrelationships • Common adult and pediatric applications • References and resources

3. Behavior Therapy • Commonly used to treat • anxiety, mood, eating disorders, parasuicidality • impulse, anger control disorders, disruptive behavior • sexual dysfunction, substance abuse • behavioral medicine and compliance • Two models of conditioning • Classical (Pavlovian) conditioning model • Operant (Skinnerian) conditioning model

4. Classical conditioning • “Pavlovian” conditioning model • unconditioned reflexes (UCR) • salivation, eye blink • Contingency: pair with neutral stimulus (UCS) • bell, tone, bang, ash • Conditioning (CS) • Previously neutral stimulus becomes conditioned stimulus • Conditioned response (CR) • Reflex now occurs in response to CS • Common examples?

8. Classical conditioning • Relation to specific disorders • Post-traumatic stress • Specific phobias (Little Albert) • Panic disorder with agoraphobia • Related principles • Contingency, extinction, generalization, discrimination • Schedules of reinforcement and resistance • Background • First applied as BT by Wolpe, Lazarus

9. Operant Conditioning • Skinnerian conditioning (“B-mod”) • consequences of a behavior change future probability of occurrence • key influence • association between response and consequences • Thorndike’s Law of Effect • positive outcomes strengthen behaviors • negative outcomes weaken them

10. Operant Conditioning (Skinner) Positive reinforcement • Probability of response  when it is followed by a rewarding stimulus • examples Negative reinforcement • Probability of response  when it is followed by removal of an unpleasant stimulus • examples Punishment • frequency of response  due to consequence

11. Operant Conditioning Principles • timing • learning is more efficient under immediate rather than delayed circumstances • shaping • reward successive approximations of desired behavior • primary reinforcement • reinforcer is innately satisfying • secondary reinforcement • reinforcer acquires its value through experience

12. Schedules of Reinforcement • Continuous reinforcement • response is reinforced every time it occurs. • Partial reinforcement • a response is reinforced only part of the time. • Schedules: rules for partial reinforcement • fixed ratio: after set # target responses • variable ratio*: after average (unpredictable) # of responses • fixed interval: after a fixed amount of time • variable interval: after an unpredictable amount of time

13. Resistance to extinction

14. Operant Conditioning extinction • a response is not reinforced and it decreases spontaneous recovery • occurs in operant conditioning (and CC) discrimination • learning to repeat only reinforced responses generalization • giving the learned response to similar stimuli Applied behavioral analysis (ABA): • operant conditioning principles to change behavior

15. BT and disorders • Assumptions about etiology? • Anxiety disorders • Acquired – classical conditioning • Maintained – operant conditioning • Role of avoidance • Highly reinforcing • Manualized treatments • Barlow: panic disorder, GAD • Stress innoculation, panic induction, biological challenge • Foa: OCD, PTSD • Exposure with response prevention • Relaxation strategies and retelling • Frequently combined with meds, cog therapies

16. Basics of CBTs • Assessment and intervention • Empirical support for practice • Characteristics of treatment • Active, structured, focused • Past v. present v. future • Brief therapies • Change is achieved by • Altering connections between troublesome situations and habitual reactions to them • Challenging and changing distorted beliefs and thoughts that relate to dysfunction

17. Applications • Operant conditioning • Applied behavior analysis (ABA) • Single case designs • Children with autism, challenging behavior • Educational interventions • Functional behavioral assessment (FBA) and behavior intervention plans (BIP) • Mandated under IDEA • Generic parenting strategies • Reinforcement and punishment • ABCs • Antecedent – behavior - consequence

18. Single case design (ABA)

19. Cognitive therapies • Emerge from behavioral models • Use BT techniques • Assume interrelationship among cognition, affect, behavior • Beck, Ellis, Young • Situation, thoughts, feelings, behavior • Common elements: • Ellis (RET): core irrational ideas • Beck (CT): maladaptive beliefs • Young: Early maladaptive schemas

20. CBT techniques • Relaxation and imagery • Self monitoring (mood monitoring, impulse control, self-mutilation) • Exposure • Response prevention • Flooding • Behavioral rehearsal • Thought stopping • Coping statements • Cognitive disputation

21. Outcomes • Empirical support evidenced via • Single case design (A-B-A-B) • Controlled studies • Comparison to no treatment, wait-list, placebo-controls; comparison to other therapies and combinations of therapies • Meta-analyses • Group differences expressed in sds

22. Resources • Association for the Advancement of Behavior Therapy (AABT.org) • American Institute for Cognitive Therapy (AICT.com) • Ellis Institute, Beck Institute • National Institutes of Mental Health – • Web site – Facts about…