12) Behavioural Experiments Flashcards
How do the aims of behavioural experiments (1) differ to the aims of cognitive therapy (2)
Aims of CT
* Assist client to identify and reality-test unhelpful cognitions which underlie repeated negative patterns of emotion and behaviour, and
* To develop and test new, more adaptive cognitions that can give rise to a more positive experience of the self, others, and the world
Aims of BEs
* Similar to those of CT: They are used to help identify, test unhelpful cognitions
List some methods for reappraising/changing assumptions and core beliefs (5)
- Socratic dialogue in therapy situation
- Role-play and post- reflection/discussion
o Self and significant other
o Different aspects of oneself (child-adult; emotion-reason) - Imagery, analysis and discussion
- Behavioural experiments
- Learning/discovery tasks (HW) directed at cognitive restructuring
List and outline what happens withins the 4 stages of cognitive restructuring. (4;3;3;3)
1) Prep
* Understanding client’s belief structures
* Overcoming resistance: validation responses
* Highlighting need for change (a la motivational interviewing)
* Identifying NATs, thinking biases, beliefs
2) Prep
* Select beliefs amenable to change (manuals may help)
* Building a case for change (e.g., gathering evidence that supports a reappraisal)
* Select one or more CT techniques worth trialling
3) Effect Change
* Socratic questions directed at the specific assumption/belief targeted for change
* Allow time for emotional processing
* Review effects, If necessary, change approach/technique/method
4) Consolidate change
* If effective, use techniques to consolidate change
* Use multiple approaches and methods that converge on same belief
* Tailor technique to what is most effective for client
What are the 2 stages of cognitive restructuring for a BE?
- What is the precise prediction that I am testing and wanting to change?
- How can it be disproved?
What is the most powerful method for bringing about change in cognitive therapy? Why?
BEs - disorders don’t arise from events per se, but to the meanings individuals give to these events
Describe the cognitive vs. behavioural perspective regarding behavioural experiments.
- “for the behaviour therapist, the modification of behaviour is an end in itself; for the cognitive therapist it is a means to an end- namely cognitive change” (Beck et al., 1979, p. 119).
- Cognitive therapy assumes BEs work because they provide hard evidence related to clients’ beliefs
What is the empirical evidence for BEs? (2)
Fairly recent, so still awaiting large RCTs
* One recent review of 14 studies concludes, “some evidence that BEs were more effective than exposure therapy alone” (McMillan & Lee, 2010)
One study compared automatic thought records with BEs to raise levels of awareness of internal processes.
* Produced same levels of awareness
* BEs produced greater cognitive and behavioural change
* Auto thought records believed “with the head” but not always “with the heart”
* BEs more likely to be believed and accepted (bc experienced)
Identify the cognitive, affective, and behavioural components of BEs. (6)
- BEs address problem of
o I can see the alternative, but I still don’t feel any different - Experiential learning
- Emotional arousal
- Encode into memory
- Practice new plans & behaviours
- Learn through reflection
Identify steps in the process of devising effective BEs. (4;1;3;3;1)
- Planning : designing the BE
o identify beliefs for change
o specify predictions
o specify evidence for/against - Experience: conduct the BE itself
- Observation of the outcome
o examining what happened
o did the evidence support the predictions? - Reflection and learning:
o making sense of BE
o drawing key conclusions - Planning: following up BE
Identify 3 purpose that BEs can be used for
- Elaborating formulation
- Testing negative cognitions
- Conducting and testing new perspectives
For the purpose of: 1) elaborating formulation or 2) testing negative cognitions, what
* BE design would you choose? (3)
* Type of BE (3)
* Level of cognitions targeted (3).. but mainly which one?
* what settings? (4)
BE design
* Hypothesis- testing experiments
* Test Ha
* Test Ha v Hb
* Test Hb
Type of BE
* Hypothesis- testing experiments
* Test Ha
* Test Ha v Hb
* Test Hb
Level of cognition
* Automatic thoughts
* **Conditional assumptions **
* Core beliefs
Settings
* Time & place
* In tx time
* Consulting room
* In vivo
Homework
For the purpose of: conducting * testing new perspectives, what
* BE design would you choose? (1)
* Type of BE (3)
* Level of cognitions targeted (2)
* what settings? (7; 3)
BE design
* Discovery experiments: H vague or absent
Types of BE
* Observational experiments
* Direct observation (modelling)
* Surveys
* Information gathering other sources
Level of cognitions
* Preparation for reappraisal
* New assumptions and beliefs
Settings: People
* Client
* Therapist
* Stooges
* Family
* Friend
* Work
* General public
Settings: Resources
* Tape recorder
* video
* record sheets etc
Identify and define the 3 types of hypothesis-testing BEs.
Test hypothesis A
* Tests validity of current unhelpful cognition
Tight chest means, impending disaster, “I’m going to have a heart attack”
* In session hyperventilation test
Hypothesis A vs hypothesis B
* Compares unhelpful cognition with new potentially more helpful perspective
Tight chest means…”this could just be anxiety”
BEs test whether “heart attack” vs “anxiety” hypotheses better account for symptoms
Testing Hypothesis B
* Directs client’s attention towards situations and behaviours that are likely to provide evidence to support a new perspective
Strange physical sensations are quite normal and nothing to be afraid of
Define discovery BEs.
Give an example in relation to a SAD person who self-monitors excessively
- Clients have no clear hypothesis about the process maintaining a problem or what would happen if they behaved in a different way
- E.g. socially anxious person who self monitors excessively
Asked to have conversation in session “as usual”
Then with attention away from self
May discover she enjoys conversations more
Identify and describe the 2 types of BEs
Active
* Clients take the lead role
* Unhelpful cognition or behaviour identified and client deliberately thinks or acts in a different way in the problem situation
* Real or simulated situations (e.g. role plays)
Observational
* Direct observation (modelling)
E.g., therapist handling spider in phobia
* Surveys or other sources (e.g., internet)
Gather factual information or opinions about problematic situations
Friend, family, colleagues, “experts”, or therapist
* Information gathering other sources