Clinical Counseling Test 4 12 04 2012 Chapter 14 Behavioral Cognitive Behavioral Perspectives Learning Objectives Who are the researchers that paved the way to the behavioral approach to therapy What were their contributions What are the traditional techniques of behavior therapy What is the rationale for systematic desensitization How is it implemented Is it empirically supported What is the rationale for exposure therapy How is it implemented Is it empirically supported How is it different from systematic desensitization What is the goal of behavioral rehearsal What is role playing What is assertiveness training What is contingency management Know the different techniques and how they work shaping time out Grandma s rule token economy What is aversion therapy How does it work and when is it used Why did behavior therapy move toward cognitive behavior therapy What is modeling What is rational restructuring What is the cognitive model What are the goals of Beck s CBT LECTURE ONLY What are the strengths of CBT What are the limitations A Brief History 1920 Watson Rayner o Little Albert o Conditioned to fear white rats 1924 Mary Cover Jones o Peter o Afraid of rabbits and other small furry animals o reconditioning 1950s B F Skinner o Operant Conditioning o Behavior is modified by its consequences Early behavior therapy o Theoretical underpinnings were conditioning and learning theory o Ignored inner world cognitions of the patient Traditional Techniques of Behavior Therapy Broad spectrum of techniques that are complimentary Traditional Techniques of Behavior Therapy Systematic Desensitization o A technique to reduce anxiety o Rationale Reciprocal inhibition one cannot be relaxed and anxious simultaneously History Data collection Rationale for treatment Progressive Relaxation Anxiety Hierarchy imaginal HistoryData collectionRationale for treatmentProgressive RelaxationAnxiety Hierarchy imaginal Holding a snake 100 Standing near someone holding a snake 90 many others in between Seeing small snake in a cage Standing outside of the reptile 45 house at the zoo 35 Traditional Techniques of Behavior Therapy Systematic Desensitization o Research support o According to APA systematic desensitization is an empirically supported treatment for Specific Phobias Social Anxiety Traditional Techniques of Behavior Therapy Exposure Therapy in vivo o Client exposes him herself to stimuli or situations that are feared and avoided o Rationale Habituation The elimination of a response that comes from the repeated prolonged presentation of the provoking stimulus Holding a snake 100 Standing near someone holding a snake 90 many others in between Seeing small snake in a cage 45 Standing outside of the reptile house at the zoo 35 Driving on interstate 100 Driving on highway 90 many others in between Driving on slow familiar Driving in neighborhood roads 40 30 Exposure Therapy o To achieve maximum benefit o Exposure should be long o Exposure should be repeated until all fear is eliminated o Exposure should be graduated low to high o Clients must attend to feared stimulus o Exposure must provoke anxiety Exposure Therapy o Research Support According to APA exposure is an empirically supported treatment for several anxiety disorders Obsessive Compulsive Disorder OCD Panic Disorder Agoraphobia Post Traumatic Stress Disorder PTSD Specific Phobia Social Anxiety Traditional Techniques of Behavior Therapy Behavioral Rehearsal o Increasing the client s repertoire of behaviors Role playing Driving on interstate 100 Driving on highway 90 many others in between Driving on slow familiar roads 40 Driving in neighborhood 30 Teach model practice new behaviors Assertiveness training Teach clients to express how they feel without trampling rights of others Traditional Techniques of Behavior Therapy Contingency Management o Controlling behavior by manipulating its consequences o Techniques Shaping by first rewarding any behavior A desired behavior is developed by selectively reinforcing that approximates it and then behaviors that more and more resemble the target behavior Timeouts Extinguish undesired behavior by temporarily removing the person from a situation in which the behavior is being reinforced Grandma s Rule A desired activity is reinforced by allowing the client to engage in a fun behavior after the desired behavior Token Economy A system used to promote desired behavior through the control of reinforcements Desirable behaviors must be clearly specified Reinforcer must be clearly specified Backup reinforcers must be established and controlled Traditional Techniques of Behavior Therapy Aversion Therapy o When an undesirable behavior is followed by an unpleasant consequence punishment pain the behavior will diminish Immediate and consistent consequence o Usually only used as a treatment of last resort Cognitive Behavioral Therapy CBT The move toward Cognitive Behavioral Therapy 1970s cognitive therapy methods began to get blended in Techniques of Cognitive Behavioral Therapy Modeling o Observational learning Rational Restructuring o Assumes maladaptive behavior is determined by the ways in which people construe their world or by the assumptions they make about it o Therapists use argument or discussion to get clients to see that their beliefs are irrational o Albert Ellis Rational Emotive Therapy RET Beck s Cognitive Behavior Therapy o The cognitive model The way we perceive situations influences how we feel emotionally o Goals Identify negative thoughts Evaluate how realistic they are Learn to change distorted thinking Problem solve Initiate behavioral changes Examples of Cognitive Distortions Mind Reading All or Nothing Thinking Should and must statements You believe you know what others are thinking failing to consider other more likely possibilities You view the situation in only two categories instead of on a continuum You have a precise fixed idea of how you or others should behave and you overestimat e how bad it is that these expectations are not met Strengths Efficacy o Ample evidence that CBT is efficacious for many different disorders Tolin 2010 o When compared to other treatments CBT is as good or better o Especially with patients with anxiety and depressive disorders o According to APA CBT or one of its specific techniques is an empirically supported treatment for Generalized Anxiety Disorder Obsessive Compulsive Disorder Panic Disorder Post Traumatic Stress Disorder Specific Phobia Social Anxiety
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