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- BT has undergone significant evolution since inception
- No longer is it simply a clinical application of classical and operant conditioning theory
- It is now very diverse as it overlaps with other psychotherapeutic approaches
- Its basic foundational concepts are clear and distinguishable from nonbehavioral systems.
Basic Characteristics of all Behavioral Therapy
- Symptoms seen as problems in living
- Empirically derived
- Requires patient collaboration
- Acknowledges underlying precursors of symptoms, but focuses on the present
- Sees behavior (non and abnormal) as learned
- Treatment driven by functional anaylsis of behavior (ABCs)
Applied Behavior Analysis
- Extension of Skinner's radical behaviorism
- Cognition is ignored
- Focus is on overt behavior
- To alter behavior one attempts to alter the relationship between behavior and consequences
Neobehavioristic Mediational Stimulus-Response (S-R) Model
- Recognizes that covert processes may mediate the stimulus response relationship
- Cognition is believed to follow the same principles of learning as behavior
- Imagery is often utilized
- Used with anxiety
- Systematic desensitization
What were the first 2 waves?
- Wave 1
- --Behavior therapy that focused on modifying overt behavior
- Wave 2
- --Brought into the picture cognitive factors and led to CBT
- Since the cognitive wave did not deal with people's private experience- thoughts and feelings
- 3rd wave uses scietific analysis
Comprised of a group of therapeutic approaches with overlapping conceptual and technical foundations.
Social-Cognitive Theory (CBT)
- Initially espoused by Albert Bandura
- Recognizes the interconnection between stimulus, reinforcement and congition
- Sees the critical role of vicarious learning, cognitions, self regulation and expectations
- Person is seen as the agent for change, self-directed behavior change
- The person's interpretation of the even or experience is significant
A relatively permanent change in behavior, not due to fatigue, durgs, or maturation
- Food is presented to the dog and the dog salivates; no learning invovled
- A neutral stimulus is presented to the dog (a tone); the dog does not salivate
- The tone is presented simultaneously with the food; the dog salivates
- Then the tone is presented alone and the dog salivates; learning has occurred
Why would a dog salivate to a Bell?
- The UCS and CS are repeatedly paired together until the UCR is elicited by the CS
- In other words, the CS elicits the same behavior which is now termed the CR
Would the dog salivate to other sounds
- --IF stimulus generalization occurs the dog might respond to related stimuli with the same or similar response
- --If stimulus discrimination occurs the dog might not respond
- After learning has occurred, removing the UCS ultimately results in a decreased probability that the CR will be made.
- This is because the dog learns that the bell no longer means food will follow.
- This behavior will extinguish rapidly if the UCS does not follow quickly
- After a time delay if the stimulus is represented the CR will reoccur
How is This Related to Mental Health
- Important in acquisition of physiological responses, esp. maladaptive ones
- --Relaxation response to nicotine use
- --Eating paried with stimuli that are not hunger related
- --Acquistion of phobias such as fainting at the sight of blood.
Operant or Instrumental Conditioning (B.F. Skinner)
- A response is emitted, perhaps randomly at first, and results in consequences.
- Hence, the probability of the response's future occurrence is changed.
- Any stimulus is a reinforcer if it increases the probability of a response
- A reinforcer is defined by its effects
- A punisher is defined by its effects
- Any stimulus is a punisher if it decreases the probability of a response.
- Remember in behavioral terms "positive" and "negative" are used differently than in general language
- Positive= Add
- Negative= Take Away
Operant Learning: Positive Reinforcement
If you want the behavior to increase add stimulus
Operant Learning: Negative Reinforcement
If you want the behavior to increase remove stimulus
Operant Learning: Punishment
If you want the behavior to decrease add stimulus
Operant Learning: Extinction
If you want the behavior to decrease remove stimulus
Every response is followed by a reinforcement, resulting in fast learning (acquistion) but also resulting in fast extinction
Intermittent (or partial) Reinforcement
Not every response is reinforced but this yields a stronger response ultimately.
Fixed Ratio Schedule
- Delivers reinforcement after a fixed number of responses and produces high response rate
- Ex: Commission work
- Effect: Relatively Fast Rate of Response
Fixed Interval Schedule
- Reinforces the next response which occurs after a fixed period of time elapses
- Ex: Scheduled Exam
- Effect: Response rate drops to almost zero after reward; picks up rapidly before next reward
Vairable Interval Schedule
- Deliver reinforcements after unpredictable time periods.
- Ex: Pop quizzes
- Effect: Slow steady response
Variable Ratio Schedule
- Yields the highest rates of response and greatest resistance to extinction
- Ex: Gambling, Fishing, Golf
- Effect: Constant high rate of response; may be hardest behavior to break
A symbol or a token gains reinforcement value due to its association with a real reinforcer (e.g. dollar bill)
How is this related to Mental Health?
- Reinforcing adherence
- Designing interventions carefully to be initially successful (small changes)
- Using secondary reinforcers
- Involving the family
Vicarious Learning (Modeling)
- Learning which occurs through observation
- Vicarious learning is particularly relevant to children, but applies to all ages
- By observing a model one grasps entire behaviors as well as component parts
- Vicarious learning may remain dormant until a situation warrants expression of the learned behavior.
How is Modeling related to mental health?
- Modeling is an effective technique for treating dental and medical phobias
- Clinicians are viewed as role models and therefore patients may learn more from observation than words
- Related to why support groups are effective
- Helps in understanding why so many problems are intergenerational
Examples of the Third Wave
- Dialectical Behavior Therapy (DBT)
- Acceptance and Commitment Therapy (ACT)
Dialectical Behavior Therapy (DBT)
- The dilectic is: Acceptance and Change
- Examples- eating disorders, borderline PD
- --Observe or attend to emotions without trying to terminate painful ones
- --Describe a thought or emotion-- "I feel unloved" is not "I am unloved"
- --Be nonjudgmental- avoid polar positions, extremes
- --Stay in the present- the client wants to pull the past into present ("Let's look at the calendar, today's date is...)
- --Focus on one thing at a time
DBT Involves Two Components
- Individual- talk about the previous week
- --Discuss self injurious and suicidal behaviors
- --Therapy interfering behaviors
- --Quality of life issues
- --Mindfulness skills
- --Interpersonal effectiveness skills
- --Emotion reuglation skills
- --Distress tolerance skills
- A set of clinical proceudres relying on experimental findings of psychological research
- -Based on principles of learning that re systemically applied
- --Treatment goals are specific and measurable
- -Focusing on the client's current problems
- --To help people change maladaptive to adaptive behaviors
- -The therapy is largely educational-teaching clients skills of self-management
- In Vivo Desensitization
- -Brief and graduated exposure to an actual fear situation or event
- -Prolonged and intensive in vivo or imaginal exposure to sitmuli that evoke high levels of anxiety, without the opportunity to avoid them.
- -Eye Movement Desensitiziation and Reprocessing (EMDR)
- --An exposure- based therapy that involves imaginal flooding, cognitive restructuring, and the use of rhythmic eye movements and other bilateral stimulation to treat traumatic stress disorders and fearful memories of clients
- Psychotherapy is an information processing and uses an eight phase approach to address the experiential contributors of a wide range of pathologies
- --It attends to the past experiences that have set the groudwork for pathology
- --The current situations that trigger dysfunctional emotions, beliefs, and sensations, and the positive experience needed to embrace future adaptive behaviors and mental health.
EMDR (Slide 2)
- During treatment various procedures and protocols are used to address the entire clinical picute
- One of the procedural elements is "dual stimulation" using either bilaterial eye movements, tones, or taps
- During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus.
- During that time, client's generally experience the emergence of insight, changes in memories, or new associations.The clinician assists the client to focus on appropriate material before initiation of each subsequent set.
Eight Phases of Treatment
- The first pahse is a history taking session during which the therapist assesses the clien'ts readiness for EMDR and develops a treatment plan.
- During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state
- In phase three through six, a target is identified and processed using EMDR procedures.
- After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client
- Although eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens.
- After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upton the client's report the clinician will facilitate the next focus of attention.
Four Aspects of Behavior Therapy
- Classical Conditioning
- -Certain respondent behaviors, such as knee jerks, and saliavtion are elicited from a passive organism
- Operant Conditioning
- -Focuses on action sthat operate on the environment to produce consequences
- --If the environmental change brought about by the behavior is reinforcing, the chances are strengthened that the behavior will occur again. If the environmental changes produce no reinforcement, the chances are lessened that the behavior will recur.
- Social-Learning Approach
- -Gives prominence to the reciporcal interactions between an individual's behavior and the environment
- Cognitive Behavior Therapy
- -Emphasizes cognitive processes and private events (such as client's self talk) as meidators of behavior change.
Functional Assessment of Behavior (A-B-C Model)
- Relaxation Training- To cope with stress
- Systematic Desensitization- For anxiety and avoidance reactions
- Modeling- Observational learning
- Assertion Training-Learning to express one's self
- Social Skills Training- Learning to correct deficits in interpersonal skills
- Self-Management Programs- "giving psychology away"
- Multimodal Therapy- a technical eclecticism
- Applied Behavior Analysis- training new behaviors (particularly effective in working with developmentally delayed individuals)
- Dialectical Behavior Therapy- learning emotional regulation and mindfulness (designed for the treatment of borderline PD)
- Mindfulness -Based Stress Reduction Therapy- Meditation and yoga
- Acceptance and Commitment Therapy- Learning accpetance and non-judgment of thoughts and feelings as they occur.
Application of BT to Group Counseling
- --Rely on empirical support
- --Emphasize self-managment skills and thought restructuring
- Are typically brief
- --Use a brief, directive, psychoeducational approach
- --Conduct behavioral assessments
- Leaders and Members
- --Create collabrative, preciese treatment goals
- --Devise a specific treatment plan to help each member meet goals
- --Objectively measure treatment outcome
Limitations of BT
- Heavy focus on behavioral change may detract from client's experience of emotions
- Some counselors believe the therapist's role as a teacher deemphasizes the important relational factors in the client-therapist relationship
- Behavior therapy does not place emphasis on insight
- Behavior therapy tends to focus on symptoms rather than underlying causes of maladaptive behaviors
- There is potential for the therapist to manipulate the client using this approach
- Some clients may find the directive approach imposing or too mechanistic