Cognitive-Behavioral Therapy

1. Cognitive-Behavioral Therapy Michelle Fournier Sarah Peara Psyc 5790

2. Cognitive Therapy • Developed by Aaron Beck • Cognitive pertains to mental processes, such as thinking, remembering, perceiving, and planning • Attempts to modify client’s cognitive processes • Beck focused on depression

3. Behavioral Therapy • Behavioral Parent Training • Goal is to help parents learn to have more effective control of their child’s behavior • 4 steps • Precisely define targeted problem bx • Analyze the antecedent/consequences • Monitor the frequency of bx to establish a baseline

4. Behavioral Parent Training • Train parents in specific procedures for changing the targeted bx • Define rules • Changing conditions of antecedent • Procedures to positively reward compliance (reinforcement) • Discipline I.e. time out/ loss of privileges Before implicating BPT look at Gordan/Davidson’s 4 factors

5. Behavioral Marital Therapy • Goals are to increase the frequency of + bx and decrease in - bx; increase skill in communication and problem solving • Initial interview is important source of data (history) Tools • Areas of Change Questionnaire(A-C) • Martial Status Inventory (MSI) • Locke-Wallace Marital Adjustment Test (MAI) • Dyadic Adjustment Scale (DAS)

6. Behavioral Marital Therapy • Teach skills • contracts (contingency contract and good faith contract) • Modeling (done by therapist) • Defining the problem

7. Functional Family Therapy • Combines systems theory, behaviorism, cognitive therapy in an integrated approach • Therapist take position that all bx by all family members is adaptive • Focus is on cognitions/bx • Bx change and skill training (education) relabeling is crucial

8. Conjoint Sex Therapy • Behavioral sex therapist is an educator who teaches sexual physiology, techniques, changes maladaptive bx patterns & cognitions and uses direct methods to reduce anxiety & improve skill performance • Came of age w/the publication of Masters and Johnson’s Human Sexual Inadequacy (1970)

9. Conjoint Sex Therapy • Discuss general factors important in the sexual relationship such as • Flexibility in sex role • Openness or being receptive & expressive • active intimacy or involvement • Trust & commitment Assessment should be multidimensional and include physiological and medical factors

10. Conjoint Sex Therapy cont.. • It involves setting specific goals and increasing communication • Therapist plays active role: provides info, facilitates communication and corrects misinformation • Teaching methods • systematic desensitization • Assertiveness training • Sensate focus (key to anxiety reduction)

11. What is Cognitive-Behavioral Therapy? • “A set of of therapeutic procedures that attempts to change feelings and actions by modifying or altering faulty thought patterns or destructive self-verbalizations.” (Goldenberg & Goldenberg, 1991)

12. Major Theorists • Gerald Patterson • 1960’s • Began practice of applying behavioral theory to family problems. • Taught parents to act as agent of change in children’s environment. • Candy, modeling, time-out

13. Major Theorists cont… • Neil Jacobson • 1970’s • Developed clinical practice based on research • Contributed to marital therapy & DV • On leading edge of family therapy • Longitudinal research w/ couples • Some findings controversial

14. Role of the Therapist • Expert, teacher, collaborator and coach • Tailors tx to fit ea. case • Reinforces pos. alternative to target bx to rid of problem bx • Applies learning theory principals to rid of problem • Teaches communication, problem solving and negotiation skills • Acknowledges importance of therapeutic relationship.

15. Techniques • Classical Conditioning- A neutral stimulus paired with another to elicit certain emotions through association. (Pavlov’s dog, ringing the bell when presenting food). • Coaching- Therapist helps clients make appropriate responses giving verbal instructions. (Marcy, when you want Mike to stop and pay attention to you, tap him gently. Mike, this will be your cue that she needs your attention). • Contingency Contracting-Sets the terms for exchanging of behaviors and reinforcers between individuals.

16. Techniques cont… • Extinction- Previous reinforcers are withdrawn so behavior returns to original state. (Important that replacement behavior be positively reinforced to take place of extinguished). • Positive Reinforcement- Usually a material used to increase desired behaviors. (Money, medals, praise) • Quid Pro Quo “something for something”- A spouse agrees to do something as long as other does something comparable. • Reciprocity- Two people will reinforce each other at approximately equitable rates over a period of time.

17. Techniques cont… • Shaping- Process of learning in small steps. (potty training) • Systematic Desensitization- Dysfunctional anxiety is reduced through pairing with mental relaxation. • Time-Out- Removal of person from an environment in which they are reinforced for certain actions. • Job Card Grounding- Behavior mod technique used with pre & adolescents (age 11-18) . • Grounding- Disciplinary technique used with adolescents where individual is removed from stimuli, limiting reinforcement.

18. Techniques cont… • Charting- Asking a client to keep an accurate record of problematic behaviors. (Used to find a baseline before interventions). • Premack Principle- Behavioral intervention where family member must do less pleasant task before allowed to engage in pleasurable activities. • Disputing Irrational Thoughts- Using ABC format. A is the event, B is the thought, C is the emotion. (Who says all your needs should be filled in marriage?) • Thought Stopping- Therapist teaches individual to stop unproductively obsessing by yelling, “Stop”.

19. Techniques cont… • Self-Instructional Training- Form of self-management focusing on people instructing self. Can interrupt automatic behaviors encouraging more adaptive coping strategies. (Children & self-talk) • Modeling and Role Playing- Individual asked to act “as if” they were person they wanted to be. Feedback and correction given by therapist or family member.

20. Cons of CBT • Some therapist are rigid • Client picks out problem. Therapist only works on that problem and typically won’t address other maladaptive bx • Brings about linear changes, which can hinder a complete family change • Lack of spontaneity could result in losing rapport with families. Therapist & family could end up becoming frustrated and therapy won’t be as effective • Too much emphasis may be given to using methods like time out without the family members understanding the root of problem

21. Pros of CBT • Offers techniques for treating problems with children and troubled marriages • Weakness can be corrected by boarding the focus of conceptualization and scope of tx to include family systems • Greatest strength is its insistence on observing what happens and then measuring change • Developed many reliable assessment methods • Teaches general problem solving,cognitive and communicational skill (addresses distorted cognitions) • Modular tx interventions organized to meet the specific and changing needs of the individual and family

22. References Bevcar, D. S. &Bevcar, R. J. (2003). Family therapy: A systematic integration. (5th ed.). Boston: Pearson. Gladding, S. T. (2007). Family therapy: History, theory, and practice. (4th ed.). New Jersey: Pearson. Goldenberg, I. & Goldenberg, H. (1991). Family therapy: An overview (3rd ed.). Pacific Grove: Brooks/Cole. Piercy, F. P., Sprenkle, D. H., & Associates. (1986). Family therapy sourcebook. New York: The Guildford Press.