Chapter 13:

Cognitive-Behavioral Interventions

March 6, 2006

Cognitive-Behavioral Therapy (CBT)

• Can be used to treat specific disorders or more broad issues

• e.g., bulimia, anxiety, poor study habits

Anxiety-Reduction Methods

“Perhaps your performance anxiety wouldn’t be so bad if you performed

better”

Systematic Desensitization

• Wolpe

• relaxation training

• hierarchy of fears

• step by step progression up hierarchy of fears

Graduated Real-Life Practice

• Meyer

• a.k.a. successive approximation, graded practice

• step by step progression along hierarchy, facing stimuli without relaxation

Both systematic desensitization and graduated real-life practice are based on

the principle of...

Stimulus Generalization

• If you extinguish anxiety by exposing the client to a stimulus that resembles the phobic stimulus, but is less intense, then eventually anxiety will extinguish when the phobic stimulus is present

Imaginal Flooding

• Formerly implosive therapy (but now doesn’t include psychodynamic material)

• Imagine the most feared stimulus to invoke intense anxiety and continue until anxiety decreases

Exposure in Vivo• Marks

• Real-life exposure to the feared stimulus

• Evoking stimulus (ES) = the feared situation

• Evoked response (ER) = the behaviour that the ES initiates

Operant Learning Techniques

“I think I should warn you that the flip side of our generous bonus-incentive

program is capital punishment.”

Reinforcement• Strengthen or maintain a behaviour

• Positive – delivery of something– immediate small more effective than delayed large

• Negative– removal of something aversive

Shaping

• A.k.a. successive approximation

• Break learning into small steps

• Reinforce small steps that get closer and closer to the desired behaviour

Punishment

• decrease or stop behaviours

• response-contingent aversive stimulation (RCAS)– response aversive stimulus

Punishment

• Response cost– response removal of appetitive

stimulus

Effect on Behaviour

Stimulus is Presented

Stimulus is Withdrawn

Behaviour Increases

BehaviourDecreases

Positive Reinforcement

Negative Reinforcement

PunishmentRCAS

PunishmentResponse

Cost

ScheduledConsequence of the Response

Extinction

• Disconnecting a reinforcement contingency

Schedules of Reinforcement

• Continuous– every response is reinforced– rapid extinction

• Variable Ratio– some responses reinforced in an

unpredictable pattern– delayed extinction

• Rule-governed behaviour

– rules, laws

– affect how a behaviour is performed

• Contingency-shaped behaviour

– response rates, likelihood behavior will be performed

What Controls Behaviour?

• The application of operant learning principles to treat problem behaviors

• Used to help many types of problems with good success rate

Applied Behaviour Analysis

The ABCs

• Must identify the contingency that is operating and maintaining the problem behaviour

• A: antecedent events

• B: behaviour

• C: consequences

Class Activity

Quickly try to think of a behaviour in your life that you would like to change. Discuss the ABCs with

someone near you.

Other Applications

• toilet training

• outbursts

• somatoform disorders

• schizophrenia

– stimulus satiation= responses typically weaken when the reinforcing stimulus is made too abundant

Token Economies

• Used with groups (e.g., psychiatric or rehab facilities)

• give out tokens that can later be exchanged for tangible rewards or privileges

• A form of secondary reinforcement

Types of Reinforcers

• Secondary reinforcers: are not inherently reinforcing, but through association,one learns that they are reinforcing– e.g., money, grades, smiling

• Primary reinforcers: are inherently reinforcing– e.g., food, sex

Social Skills Training

• instruction• modeling• behaviour rehearsal• praise• prompts• coaching• feedback• reinforcement• homework assignments

Social Skills Training

• Generally, best for those who are in the community or are likely to be discharged

• key is a combination of modeling with role-playing aimed at specific skills (e.g., expressing feelings, starting a conversation)

Rehearsal Desensitization

• used when social anxiety is also present

• incorporates systematic desensitization elements

• move through hierarchy from low anxiety to high anxiety items

Problem-Solving Therapy

• Siegel & Spivack

• Training exercises dealing with problem identification, goal definition, solution evaluation, evaluation of alternatives, and selection of the best solution

• e.g., identifying emotions in others, perspective taking

Cognitive Modification Procedures

“My back is fine. My mind went out”

Self-Instructional Training

• Meichenbaum

• Teaching patients to use self-guiding speech

Stress-Inoculation Training

• Educational phase: learn that unhelpful thinking patterns produce and maintain unpleasant emotions and dysfunctional behviours

• Rehearsal phase: patient makes coping self-statements to help deal with stressful events

• Application phase: practice using coping skills while confronting actual stressors

Constructive Narrative

• clients viewed as “storytellers and makers of meaning”

• clients can reframe stressful events, “normalize” their experience, develop a “healing theory” of what happened, and build new “assumptive worlds” and ways to view themselves

Rational-Emotive Behavior Therapy

• Ellis

• “enable people to observe, understand, and persistently dispute irrational, grandiose, perfectionist shoulds, oughts and musts”

ABCs

• A: activating event

• B: beliefs

• C: consequence (emotional)

• most believe A causes C

• goal is to accept that B is very important in causing C

• rational vs irrational beliefs

ABC and D

• D: disrupting irrational beliefs

• challenge unrealistic and damaging beliefs

• e.g., “Why is it terrible if things do not go your way?”

Cognitive Therapy

• Beck

• challenge irrational beliefs

• and encourage client to attempt real life experiments to challenge faulty assumptions

• 3 fundamental concepts

1. The Cognitive Triad

• Depressed people have pessimistic thoughts about their:– self

– world

– future

2. Cognitive Schemas

• Global, absolute beliefs

• are activated during depressive episodes, and lie dormant between episodes

• established early in life

3. Cognitive Distortions

• Specific exaggerations of the negative aspects of a situation

Do certain thinking patterns correlate with certain mood

states?

The Situational Self-Statement and Affective State Inventory

• “Imagine that you had studied really hard for your midterm and expected to get an A. However, when the marks came back, your mark was a C”

What feelings would you likely experience? A) Depression

B) Disappointment

C) Anger

What thoughts would likely cross your mind?

A) “I should drop out of school”

B) “It was an unfair exam”

C) “I wish I had done better”

Cognitive Restructuring

• Lazarus

• multimodal therapy model– BASIC ID

• behavior• affect• sensation• imagery• cognition• interpersonal relations• drugs/diet

Cognitive Restructuring

• Corrective self-talk

• point out errors in form and content thinking

• ignorance/misinformation

Coping and Problem Solving

• Goldfried• general problem solving strategies and

coping skills• 4 areas of focus

– problem solving– relaxation– cognitive restructuring– communication skills

Key Names

• Beck

• Lazarus

• Meichebaum

• Ellis

• Goldfried

• Wolpe

• Meyer

Summary- Key Concepts• Anxiety Reduction Methods

– systematic desensitization, graduated real-life practice, imaginal flooding, exposure in vivo

• Operant Learning Techniques– reinforcement, punishment,applied behavior analysis,

token economies, social skills training, problem solving

• Cognitive Modification Procedures– self-instructional training, stress-inoculation training,

rational-emotive behavior therapy, cognitive therapy, coping and problem solving

Thanks!!