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Transcript of Behavior Therapy
Traditional Behavior Therapy
-Classical Conditioning - What happens PRIOR to learning that creates a response through pairing.
-Operant Conditioning - Behaviors are influenced by the consequence AFTER the behavior. This can be reinforced by a reward/eliminating aversive stimuli, or, if no reinforcement happens/if an aversive stimuli is produced, the behavior stops.
-Social Learning Approach - Behavior is learned from environmental, personal or individual behaviors, from observant learning.
-Cognitive Behavioral Theory - Operates on the assumption that what we believe influences us, how we act and feel.
Mindfulness and Acceptance-based Cognitive BT
Considered part of the 'third wave' of behavior therapies. Incorporates spirituality, meditation, emotional expression, and other considerations.
Encompasses a boarder view, with 5 core themes; expanded psychological health, expanded acceptable outcomes, acceptance, mindfulness, and creating a life worth living.
Mindfulness-being aware of oneself in the present moment, and experiencing things in a receptive but non-judgemental way.
Acceptance-striving to be in the present moment without judgement or preference, but with curiosity and kindness. It's an act of self-affirmation.
Both of these practices replace maladaptive thoughts and increase function in ones life, bringing ones thoughts back to the present and not on distractions.
These BT's are useful in depression, GAD, PTSD, personality disorders, relationship problems, etc.
History and Key Figures
-Behavior Therapy originated in the 1950'sand early 1960's.
-It was a radical departure from the dominant and traditional perspective.
-Therapists use a variety of evidence-based techniques.
-In the 70's, BT was being used in businesses and had impacts on education and psychology.
-In the 80's and 90's, increased attention was given to emotions and their role in therapy.
-Early 2000's saw continued growth and development, and this third wave include dialectical, mindfulness-based stress reduction and cognitive acceptance, and commitment therapies.
Emphasis placed on teaching clients to self manage, how to learn, use and cope with new behaviors, and how to restructure their thoughts.
Clients learn how to deal effectively with present and future problems.
Behavior therapy in a group setting includes behavior assessments, collaborative treatment goals, problem-specific treatment procedures, and objective outcomes evaluation.
Group leaders are in a teaching role. They are active, directive, and supportive. They can observe and assess behaviors in group therapy.
Member can verbalize specific behaviors the either want to work on or that they lack.
Assertiveness, modeling, coaching, meditation, social skills training, mindful techniques and most other BT techniques can all be practiced in groups.
Groups can be broken down into sub-groups to work on specific areas, such as social-skills groups, stress management groups, multimodal groups, and mindfulness and acceptance based groups.
B.F. Skinner (1904-1990)
-Considered Father of Behavioral approach to psychotherapy.
-Believed primarily in the emphasis of the effects of environment of behavior.
-He was a determinist, did not believe we have free choice. Denied that thoughts and feelings caused our actions.
-Known for his research on Operant Behavior.
Albert Bandura (b.1925)
-Known for his contributions in Social Learning Theory and observational
learning and social modeling in human
motivation , thought, and action.
-Renamed his theory Social Cognitive Theory.
Arnold Lazarus (b.1932)
-Pioneer in clinical psychology.
-Developed Multimodal psychology,
a comprehensive, systematic holistic approach - BASIC ID.
-Authority on brief, efficient, and effective psychotherapy.
Modern Behavior Therapy is.....
-Grounded in Scientific View.
-Systematic and Structured.
-Current view is NOT deterministic;we are not a product of social-cultural conditioning. Current view is that we are the producer and product of our environment.
-The aim is to give more control and freedom to client.
7 Key Characteristics of BT
1. Based on Scientific method.
2. Not limited to overt actions, but also includes cognitive factors.
3. Deals with current factors and influences.
4. Clients assume an active role and do homework.
5. Change can take place without insight or understanding of psychological problems.
6. Assessment is ongoing.
7. Interventions are tailored to each client.
1. Establish a collaborative relationship; the client-therapist is foundational. Warmth, being genuine, acceptance, etc. is necessary, but NOT enough because it's the specific change techniques that are the focus.
2. Conduct a thorough assessment.
3. Gather information for ABC model.
4. Be active consultants and problem solvers.
to be backed by empirical evidence.
6. Be attentive to hunches based on clues the clients provide.
7. Summarize, reflect, clarify, use open-ended questions, and do follow up assessments.
Clients Should Experience
1. A clearly defined role.
2. To participate in sessions and outside of sessions.
4. To do homework.
5. Experiment and implement new behaviors, and to eliminate maladaptive behaviors.
This is a good example of what a
client should NOT expect!!
* A Hallmark of Behavioral approach is that the techniques are empirically supported and evidence-based. It's been researched by therapists with different populations and with many different disorders, diseases, and traumas.
Positive Reinforcement - The addition of something of value to the person as a consequence of certain behaviors.
Negative Reinforcement- The escape from or avoidance of unpleasant or aversive stimuli (motivated to exhibit a desired behavior to avoid unpleasantness)
Extinction - Withholding reinforcement from a previously reinforced response.
Positive Punishment - an aversive stimulus is added after the behavior to decrease the frequency of a behavior.
Negative Punishment - A reinforcing stimulus is removed following behavior to decrease the frequency of a target behavior.
Progressive Muscle Relaxation:
This method of BT helps people cope with stresses from daily living, anxiety, surgery prep, chronic pain, migraines, etc.
Involves muscle and mental relaxation.
Easy to learn.
Used in conjunction with other techniques.
Developed by Joseph Wolpe.
Great for those who suffer from crippling phobias.
Clients must be prepared for this technique in advance, and interviewed thoroughly.
Clients imagine anxiety-arousing scenarios and engage in behavior that competes with anxiety.
Considered a form of exposure therapy.
Is time consuming but effective and empirically researched.
Progressive Muscle Relaxation is used in this technique, and must be learned beforehand.
In Vivo Exposure and Flooding:
Variations of Systematic Desensitization.
Used to treat fears and other negative emotional responses by exposing clients to the situations that cause these problems.
Uses either imagination, or live confrontation.
In vivo exposes client to live events. Clients engage in brief and graduated live exposure events starting from the bottom of the hierarchy.
Clients learn how to deal with these exposures and utilize muscle relaxation.
Flooding involves exposure for long periods of time, and is intense.
Flooding can be imagined for certain situations that cannot be live.
Clients must be allowed to make an informed decision on these therapies.
Eye Movement Desensitization and Reprocessing:
Form of exposure therapy that will dampen the power of negative thoughts.
Uses imaginal flooding and cognition to restructure a clients thoughts.
No medications or discussions are used, it relys on the clients rapid eye movements.
Used in PTSD therapy, abuse victims, victims of crime, people dealing with anxiety, panic attacks, phobias, addictions, and depression/grief. Therapists must be trained to apply this technique.
Social Skills Training:
Form of BT that is used to teach individuals to develop and achieve skills in relating to others.
Teaches clients how to make 'small talk', having good eye contact, taking social cues and interpreting these cues and learning to act appropriately in social situations.
Breakdown of behaviors is done so the client can work on one behavior at a time.
Modeling, role-playing, reinforcement of positive outcomes, and feedback are some techniques used.
Evidence-based applications include but not limited to alcohol/substance abuse, ADD/ADHD, social anxiety, and behavioral problems.
Assertion Training :
Special form of Social Skills Training.
Historical track record back to the 1970's with women's movement groups, as more women entered the work force and higher education.
Teaches clients to stand up for themselves, to learn to say no, or those who are taken advantage of easily, who don't display much affection, who have social phobias.
Basic Assumption is that people have the right, but not the obligation, to express themselves, and that you still need to be sensitive to the rights of others.
Focuses more on negative self talk and passive behavior, and changing peoples beliefs about themselves.
Done mostly in groups, for role playing and rehearsing.
May not be suitable for certain cultural backgrounds.
Self Management Programs and Self-Directed Behavior:
Include self-monitoring, self-reward, self-contracting, and stimulus control.
Teaches people coping skills in problem situations, and they make decisions about behaviors that they want to change or control.
People have to be willing to follow basic steps.
Costs are minimal.
1. Selecting Goals-measurable, attainable, positive and significant for oneself.
2.Translate goals to target behaviors-Identify issues to change, and ways to negotiate any obstacles.
3.Self-Monitor-Observe their own behavior. Keep a journal with relevant antecedent cues and consequences.
4.Plan for Change-Bring about actual change. Self-reinforcement is necessary until new behaviors are cemented in everyday life.
5. Evaluation and maintenance-evaluation is ongoing, and maintaining new behaviors is achieved.
Assessment process is multimodal, the treatment is cognitive behavioral and is empirically supported.
Grounded in social-cognitive theory, applies to many problems with diverse techniques.
Has largely replace traditional behavior therapy.
Therapy is unique to each client.
Technique was developed on the idea that we experience emotion, we think, imagine, use our senses and relate to other; at the time, BT had limited theories in this area.
Multimodal Therapy is a therapy that uses many techniques, and incorporates all elements of personality; it's multi-dimentional rather than covering one or two dimensions of a clients biological being.
It encourages therapists to improvise and tailor their treatments very specifically to each client.
Therapists are very active, and act as coaches, role-models, teachers, and consultants.
Dialectical Behavior Therapy:
Cognitive behavioral therapy for people have borderline personality disorder, for those who struggle with managing their emotions, and those who are vulnerable to self-harm and/or suicide.
Structured and tailored.
Skills are taught to help clients manage their attention (mindfulness), their emotions (regulation of) , their interpersonal skills, and how to deal with distress in situations. Teaches how to balance acceptance of themselves and incorporating change.
Treatment can take a year or more, and is done both individually, and in a group.
Relies heavily on didactic instruction, therefor the therapist
be trained in this approach; better yet to have personal experience in this form of instruction.
Mindfulness-Based Stress Reduction (MBSR):
Much of our distress comes from continually wanting things to be different from how they are.
Teaching people how to live more fully in the present.
Practice of being mindful through meditation and mindful yoga for 45 minutes per day.
Engages client in self discovery.
Good practice for stress, anxiety, and depression.
Mindfulness-Based Cognitive Therapy (MBCT):
Applied to the treatment of depression.
Adapted from MBSR, and includes cognitive behavioral therapy and interventions to deal with relapses.
To change clients awareness and negative thought processes.
It's a planned out 8 week program, that is consistent and cost-effective.
Acceptance and Commitment Therapy (ACT):
Fully accepting the present and letting go of obstacles by experiencing non-judgemental acceptance of the 'here and now'.
There is no emphasis placed on changing the clients thoughts, instead, it's acceptance of their cognitions.
Values play a role in this therapy.
Commitment is essential, as this therapy allows a client to choose the values and what's important to them in their life, and make a concrete plan for them to live by.
Good for clients who struggle with substance abuse, depression, PTSD, phobias, anxiety, etc.
A Multi-Cultural Perspective
BT focuses on behaviors and the environment, not catharsis (long held emotions and their release) Some cultures do not focus on emotions.
Clients who are looking for directive sessions and concrete planning are going to be more willing to cooperate.
Therapists and clients work collaboratively to agree upon goals and outcomes.
BT gives the client the ability to learn and practice in their own social and cultural environment. Clients learn how to self-manage.
Counselors must be knowledgeable and sensitive to different cultural issues.
Where BT has advantages with clients in a multicultural setting, a therapist must be careful also that techniques the client learns will not have an adverse effect with significant people in their lives.
Clients need to be aware of possible consequences to their newly learned behaviors, and also how to cope with any resistance to them.
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Advantages to Behavioral Therapy
One very significant advantage to Behavioral Therapy is that it's empirically supported with a focus on assessment and evaluation, and for clients under managed care, this therapy is both accountable and cost -effective.
Behavior Therapy has expanded over the years, and numerous studies and literature is available.
This therapy has branched out over time. It now includes cognitive therapies and mindfulness approaches, and allows clients to collaborate with their therapist.
Clients learn how to self-manage and be assertive, and can be an effective and brief therapy.
Limitations of Behavioral Therapy
Changes behaviors but does not account for change in feelings.
Does not provide insight.
Control and direction from the therapist.
Large body of work on research and assessment in the psychology field.
It allows a large repertoire of techniques that a therapist can draw from.
Can assist clients in forming a plan of action for change, as this therapy requires one to act, not just think about their problems.