Behavioral and Cognitive- Behavioral Psychotherapies

1. Behavioral and Cognitive- Behavioral Psychotherapies

2. Behavior Therapy Behavior therapy is not a single method but rather a large collection of techniques designed to address people’s psychological problems.Behavioral techniques are used by theorists from a wide spectrum of clinical orientations to treat both children and adults.

3. Theoretical Foundations The key assumptions underlying behavioural approaches to therapy is that the behaviours seen in psychological problems develop through the same laws of learning that influence the development of other behaviours. So behaviorist see personality, problems in personality development, and most behaviour disorders not as “things” that people have but as reflections of how the laws of learning has emerged from research on classical and operant conditioning as well as on observational learning

4. Assessment in Behavior Therapy Behavior therapy assessment is intended to identify a client’s problematic behaviours, the environmental circumstances under which those behaviours occurs, and the reinforcers and other consequences that maintain them. The behavioural assessment process does not typically employ projective personality tests, diagnostic labels, or other traditional methods. Instead, behaviour therapists perform a functional analysis or a functional assessment which examines four key areas:stimulus, organism, response, and consequence.

5. Behavior therapists are especially likely to use objectively scored quantitative assessment methods such as structured interviews, objective psychological tests, and a variety of behavioural rating forms. These measures are used partly to establish the precise nature of a client's problems and also to establish an empirical baseline level of maladaptive responding . As therapy progresses, the same measures may be administered again in order to asses and document client progress. Especially, if required for insurance purposes, behavioral clinicians may assign a DSM diagnosis to their clients, but DSM diagnosis is generally not the focus behavioralassesment

6. Because behavioral treatments developed within an empirical tradition,there is a strong commitment to research among behavioral practitioners. Behavior therapists believe that therapy methods should be guided by the results of research on learning. They also place a high value on the evaluation of treatment techniques. Behavioral therapists are particularly likely to employ assesment instruments and treatment technique whose efficacy has been estabilshed by the results of controlled research.

7. The Role of The Therapist Behavior therapists recognize the importance of the therapeutic relationship, so they are empathic and supportive in response to clients' feelings of anxiety, shame,hopelessness, distress, or confusion. However, in contrast to humanistic therapists, behavior therapists believe that the client-therapist relationship merely provides the context in which specific techniques can operate to create change. Therapeutic benefits occur when clients make changes in their environments(e.g., by reducing exposure to triggers), internal responses(e.g.,by learning relaxation to lower levels of arousal), and overt behaviors (e.g., by practicing conversational skills) Accordingly, nehavior therapists focus on these factors in therapy. They also play educational role, explaining the theory behind what they do in ways the client can understand.

8. The Goals of Behavior Therapy The primary goal of the behaviour therapists is to help the client modify maladaptive overt behaviour as well as the cognitions, physical changes, and emotions that accompany those behaviours.

9. Clinical Applications Behavior therapy is applied in a wide variety of treatment packages, each tailored to address particular sets of problamticbehaviors. the following sections are the most prominent and widely used examples

10. Relaxation Training One of the basic techniques behavior therapists use with anxious clients is progressive relaxation training (PRT).PRT involves training and then releasing various groups of muscles while focusing on the sensations of relaxation that follow.

11. Systematic Dissensitization The antianxiety treatment known as systematic desensitization (SD) was developed in 1958 by Joseph Wolpe, a South African psychiatrist. According to Wolpe (1958) “If a respone antagonistic to anxiety can be made to occur in the presence of anxiety-evoking stimuli so that it is accompanied by a complete or partial suppression of the anxiety responses, the bond between these stimuli and the anxiety responses will be weakend.

12. Virtual Reality Exposure In virtual reality (VR) exposure treatments, clients can be exposed to carefully monitored levels of almost any stimulus situation. VR technology has recently been used to help persons with substance abuse problems reduce their responsiveness to external cues or triggers that lead to craving.

13. Exposure and Response Prevention Techniques Exposure treatments entail direct exposure to frightening stimuli so that anxiety occurs and continues until it eventually disappears through the learning process known as extinction.

14. Social Skills Training Social skills training encompasses many techniques, from teaching persons how to shake hands and make eye contact to ordering food in a restaurant and engaging in conversations.

15. Modeling known in clinical psychology as modeling or observational learning, is a very important mechanism in the development of human behavior Behavioral rehearsal and homework – to help clients develop, solidify, and gain confidence in the new skills they are learning in behavior therapy Aversion therapy punishment – is a set of learning based techniques in which painful or unpleasant stimuli are used to decrease the probability unwanted behaviors such as drug abuse, over eating, alcoholism

16. Sampling behavior therapy techniques • Progressive • Relaxation traning • Systemaic • Desentation • Exposure and response prevention • Virtual reality exposure • Social skills training • Aversion conditioning and punishment • Shaping and graded task assignments • Contingency contracting

17. Cognitive mediation the most basic notion in cognitive therapy is that normal and abnormal behavior is triggered by our cognitive interpretations of the events

18. Schema a cognitive framework consisting of a number of organized ideas The role of automatic thoughts – the cognitive approach strongly emphasizes the habitual nature of some thoughts, including many maladaptive thoughts

19. Beck’s cognitive therapy- Aaron beck’s approach to the treatment of depression is based on the assumption that depression and other emotions are determined largely by the way people think about their experiences Beck says that depressive symptoms result from logical errors and distortions that clients make about the events in their lives. For example, they draw conclusions about themselves on the basis of insufficient or irrelevant information e.g. When a woman believes she is worthless because she was not invited to a party They also exaggerate the importance of trivial events, As when a man decides that his vintage record collection is ruined because one record has a scratch on it. And they minimize the significance of positive events, As when a student believes that a good test score was the result of luck, not intelligence or hard work

20. He proposed that depressed individuals show a characteristics pattern of negative perceptions and conclusions about (cognitive triad) • Themselves • Their world • Their future

21. REBT rational emotive behavior therapy The therapist task in REBT is to attack, irrational, unrealistic, self-defeating belief and to instruct clients in more rational or logical thinking patterns that will not upset them

22. Assessment in cognitive therapy.- assessment In cognitive therapy is similar to that in behavior therapy, they are particularly interested in developing detailed understanding of the chronicity, intensity, and extent of the client’s automatic cognitive distortions

23. The role of the therapist – who tries to help clients identify and alter the maladaptive and often automatic hypothesis, thoughts, and attributions they hold about themselves and their worlds. Their success in doing so depends in part on having a productive and collaborative alliance

24. The goals of cognitive therapy • Educate the client about the role of maladaptive thoughts in behavior and experience. • Help clients learn to recognize when they engage in those thoughts. • Arm them with skills for challenging maladaptive thoughts and for replacing them with more accurate and adaptive ones.

25. Clinical applications Psychoeducation- early in therapy the cognitive therapist begins educating the client about the role of cognitions in disorders; education may involve mini-lectures on several topics symptoms, realistic goal setting, and behavioral activation. The self “socialization” into treatment is important in all forms of therapy, but it can be especially crucial in cognitive therapy.

26. Sarcastic questioning – named after Socrates, Socratic questions is a style of discourse in which the therapist pursues a line of questioning until the clients fundamental beliefs and assumptions are laid bare and open to analysis. Judith beck has identified types of questions that are commonly asked by therapist and clients as cognitive therapy proceeds

27. 1. What is the evidence 2. Is there an alternative explanation? 3. What is the worst that could happen? Could you/I live with it? What is the best that could happen? What is most realistic outcome? 4. What is the effect of your/my believing the automatic thought? What could be the effect of changing your/my thinking? 5. What should you/I do about it 6. What would you/I tell _____________[e.g., a friend] if he or she was in the same situation?

28. Therapist use a number of variations on these questions, and they also model ways of thinking that provide rational alternative responses. They might also engage in deliberate exaggeration of a clients maladaptive beliefs. Cognitive therapists commonly ask clients to quantify their statements by rating scale from 0 to 100. For example, some experience or emotion. So if a clients states says that he is “the biggest loser in the world”

29. Therapist: really? In the whole world? • Client: practically. I feel like the biggest loser. • T: okay. I understand. You feel pretty incompetent compared with other people. • C: yeah. • T: in your view, where would you say you fall on a scale of 0 is absolutely the biggest loser. • And 100 is the most competent person. Where • C: oh, I don’t know, pretty low, maybe 8. • T: can you think of people who would be near 0? • C: no job, in jail, child molester, no friends, alcoholic, ignorant • T: ok let’s look at your situation. How far away from the 0 are you in reality • C: well, I still have a job, a family, and some friends. I’m not a child molester • T: and what would someone, say, at about 20 to be like? Or 50? Do you have anything in • common with them? • In this example, the therapist has encouraged the client to be more explicit about his belief that he is a loser, to quantify it, and then uses Socratic questioning.

30. Refuting and replacing maladaptive thoughts – to help clients overcome this tendency, cognitive therapists ask them to repeatedly practice challenging maladaptive beliefs. So depressed clients whose negative attributional style leads them to interpret events in the most negative way are pushed to consider alternate attributions. This reattribution training is illustrated in the following example 44 year old client with an elderly mother living alone in the same town:

31. T: what went through your mind when your mother said she was unhappy? • C: that is was my fault, that I don’t do enough to help her. • T: and what does that thought mean about you? • C: that I should do more, that I’m lazy an uncaring person. I should take her out more. It’s my fault she’s unhappy. • T: I understand that you fell concerned when your mother says she’s having a bad day, and I understand your empathy for her. But do you think that you caused her to have a bad day. Is there any other reason she might have a bad day? • C: well, her arthritis has been active lately • T: anything else? • C: it’s getting close to the time my father died; she always goes through a bad time in February • T: ok , maybe you are the cause of her bad day, but it’s also possible there could be other causes outside

32. COGNITIVE BEHAVIOR THERAPY Cognitive behavior therapy combines the theories and techniques of behavior therapy and cognitive therapy. It is a systematic approach tested methods. The behavioral and cognitive approaches have merged over the last several years, resulting in cognitive behavior therapy or CBT. This merger happened because behaviorally oriented clinicians recognized the importance of cognitions in various disorders. Behavioral and cognitive approaches come primarily from the empirical tradition in clinical psychology. Many of the

33. techniques used were originally conceived and develop in research settings. Clinicians share a strong belief that clinicians should use methods that have been shown to be effective in carefully controlled research settings. Both Approaches also emphasize ongoing collection of data during therapy to track therapeutic effectiveness. Both emphasize client’s symptoms in which they are occur and deemphasize historical factors or global personality.

34. Theoretical foundation The theoretical foundations of the CBT are essentially those of the behavioral and cognitive approaches. Most who adopt CBT think that the addition of cognitive principles and practices to the behaviorist theoretical framework that leads to a clear description of how normal and abnormal behavior can be changed

35. Clinical Applications The combination of these two psychotherapy means that cognitive behavior therapists have at their disposal the full array of interventions that have been developed behaviorally and cognitively oriented clinicians. The used of interventions depends on their clients.

36. Two methods of CBT 1. Relapsed Prevention – is a cognitive-behavioral intervention designed to help clients who are trying to overcome alcoholism or other substance use disorders. Relapse intervention is to teach clients to monitor risky cognitions and to replace with different thinking strategies. Alan Marlatt and Judith Gordon believe that relapse is most likely when clients engaged in thoughts (such as “I owe myself a drink”) that lead to relapse. Once a relapse episode occurs , guilt and shame tend to generate negative self evaluations. (“I’ve let my family down”; I’m a complete failure”) which increases probability of continued drinking, an outcome also known as abstinence violation effect.

37. 2. Dialectal Behavior Therapy – it is a form of cognitive behavior therapy used to help clients who display the impulsive behavior, mood swings, and fragile self image. Many of these clients are adolescents who display multiple disorders

38. Prepared by: Karen Carmesis Julius Caesar Gajasan George Bryan Dayaon MargarethZabay Presented to: Dr. Ryan Coroña