501 - Cog and Behavioral Change Flashcards
acceptance and commitment therapy (ACT)
WHAT: 3rd generation behavioral therapy
Psychopathy = experiential avoidance, over-control, unwillingness to remain in direct contact with painful experiences.
Goal = accept painful thoughts and feelings, create psychological flexibility thru mindfulness + behavioral therapy skills, align behaviors with beliefs/values to reduce dissonance
Therapist Roles =
- be here and now (be present)
- defusion (detaching from thoughts)
- acceptance (acceptance neg thots + emotions)
- self-as-context (you are the observer of your cognitions)
- values (goals + activities/beliefs that matter to you)
- committed action (doing what you need to move forward + live by your values)
EXAMPLE: A client comes to therapy with symptoms of depression. The client describes often feeling ashamed of not spending time with her friends. She often beats herself up over feeling sad and lacking motivation. The ACT therapist will guide the client in accepting their emotions as valid and experiencing them without judgment through defusion exercises. The client and therapist work to reveal that the client values her friendships, and may collaborate on behavioral goals that align with that value, such as calling a friend, even if the client doesn’t feel like it. By making a commitment to live by her values, the client may eventually create a more fulfilling life and decrease her depressive symptoms.
ambivalence
WHERE: 501 cog and behav change
WHAT: Part of motivational interviewing.
- occurs when a person has conflicting/contradictory feelings, thoughts, or attitudes toward a situation
- often arises when clients are contemplating change/dealing with the pros or cons of changing versus not changing
Therapist roles =
- talk with client thru each option (highlighting pros & cons)
- help client pick the one that best aligns with their goals and values
WHY: Ambivalence helps to facilitate change. It creates cognitive dissonance, which is an uncomfortable state only resolved by making a decision. It allows clients to gain insight into their motivations, values, and internal conflicts.
EXAMPLE: A client, Steve, has come into therapy at the request of his wife. She has become concerned about Steve’s drinking habits, to the point of moving out of the house. His wife refuses to go back until he stops drinking. Steve doesn’t see any issue with his drinking habits, but he cares about his marriage and doesn’t want to lose his wife. He is in a state of ambivalence now, as his beliefs and values are not aligning.
anxiety/fear hierarchy
WHERE: 501 cog and behav change
WHAT: Used in exposure therapies to treat phobias or panic disorder
A list of anxiety inducing stimuli ranked using subjective units of distress (SUDs). The list should be ordered from the lowest anxiety provoking stimulus (lowest SUDs score) to the most anxiety provoking stimulus (highest SUDs score). The client is exposed to the lowest item on their list until the fear response is extinguished.
WHY: The fear hierarchy is useful in exposure therapies to create a visual plan for the client, to track/display progress, and allows patients to gradually move towards their goal.
EXAMPLE: A woman comes to therapy with a phobia of clowns. The client and therapist work to create a fear hierarchy starting with imagining a clown, with being in the same room as a clown having the highest SUDs rating. The client begins with imagining a clown until she no longer feels anxiety, and then moves up to the next item in her hierarchy.
assets
WHERE: 501 cog and behav change
WHAT: Considered during a behavioral analysis.
- what the client does well
- positive aspects of or behaviors a client has/does
- used to help overcome behavioral problems
- may be internal (positive values, social competence) or external (social support, stable job).
WHY: Assets can help clients overcome challenges and achieve goals. They highlight positive aspects of a client, which may increase self-confidence and self-efficacy. In turn, highlighting assets may make the treatment plan more successful.
EXAMPLE: A client is struggling with depression. Their mood and energy have been low, and they say making dinner for themselves has become difficult. During the assessment, the client reveals they have a love of cooking and trying new recipes. Their love of cooking can be used/incorporated into their behavior plan to increase the meals they make for themselves.
automatic thought
WHERE: 501 cog and behav change
WHO: Part of Aaron Beck’s cognitive therapy.
WHAT: Spontaneous thoughts that seem plausible.
Considered within downward arrow technique
- often occurs in response to a trigger (event, situation)
- may include cognitive distortions
An “automatic thought” refers to a spontaneous, often negative thought that arises in response to a situation or stimulus. These thoughts can be irrational or based on cognitive distortions, and they often contribute to emotional responses, such as anxiety or depression. In cognitive therapy, identifying and challenging automatic thoughts is a key step in changing negative thinking patterns.
Therapist role =
- with client, monitor and categorize dysfunctional automatic thoughts
- teach client to see automatic thoughts as hypotheses to be tested
WHY: Automatic thoughts can be maladaptive and persistent and need to be challenged. These distortions contribute to the maintenance of one’s anxiety/depression.
ATs can help uncover assumptions and schemas the client may have, and later help to get to the client’s core beliefs.
EXAMPLE: A client believes her coworkers at her new job don’t like her because they laugh each time she walks by, and she believes they must be making fun of her. The therapist points out that the client is personalizing and jumping to conclusions. The therapist may utilize this automatic thought within the downward arrow technique. Additionally, the therapist and client may generate a way to test the hypothesis of ‘my coworkers do not like me’.
behavioral activation therapy
WHERE: 501 cog and behavior change
WHO: Based on Lewhinson’s theory of depression
WHAT:
Psychopathy =
- ineffective problem-solving skills
- ineffective social behavior.
Behavior Activation Therapy (BA) is a therapeutic approach primarily used to treat depression. It focuses on helping individuals increase their engagement in meaningful and rewarding activities, which can improve mood and reduce depressive symptoms.
Goal =
- increase positively reinforcing activities (things enjoyed before depression, things related to values, or even everyday items that get pushed aside)
Therapist roles =
- teach client to self monitor moods
- schedule enjoyable activities
- pleasure rating after engaging in the activity.
WHY: BAT is significant as it provides a way for clients to gradually improve their quality of life, and gradually decrease avoidance and isolation behaviors. Social support is important in general, but especially for those who struggle with mental health.
EXAMPLE: A client, Sarah, comes into therapy because she is struggling with depression. Sarah reports fatigue, a low mood, low motivation, and decreased interest in things she once enjoyed. Sarah has a full-time job. She says she dreads coming from work because she feels too tired to do anything but sit on the couch until bedtime and feels guilty for the inactivity. Sarah tells the therapist she used to love painting, and would do it almost daily. The therapist may suggest that Sarah begins drawing in a sketchbook each day after work. Sarah implemented this for a few weeks and reported that she has begun looking forward to coming home after work since she knows she has an enjoyable activity to look forward to.
behavioral parent training/therapy
WHERE: 501 cog and behavioral change
WHO: Eyeburg
WHAT:
Behavioral Parent Training (BPT) or Behavioral Parent Therapy is a therapeutic approach designed to help parents manage and improve their child’s behavior, especially in cases of behavioral issues like oppositional defiant disorder, ADHD, or general conduct problems. The goal is to equip parents with effective strategies and techniques to promote positive behaviors and reduce problematic ones.
Goal =
- increase parents’ (age appropriate) instructions
- consistent and appropriate reinforcement + punishment (via token eco, pos rein, diff rein)
Therapist Roles =
teach parents to…
- interact with child positively
- set appripriate limits
- act consistantly
- be fair with discipline
- establish appropriate expectations for their child
Two phases of PCIT: child directed interactions and parent directed interactions.
WHY: PCIT can increase the responsiveness of parents. It also works to establish a secure and nurturing relationship. It may also help with behavioral issues of the child.
EXAMPLE: A couple brings their child to treatment due to behavioral problems at home. The child has been throwing tantrums and refusing to listen. The parents often yell at the child to comply, but there are no other consequences following the problem behavior. The therapist suggests PCIT so that the parents can work on setting limits and create consistent ways to rein + punish the child.
behavioral therapy
WHERE: 501 cog and behav change
WHO: Based on Pavlov’s theory of classical conditioning and was developed in response to psychoanalysis.
WHAT: Used in tx of substance abuse, EDs, or anxiety.
- collaborative
- brief
- active
- present focused
- learning focused
The underlying causes of the behaviors are not explored
Goal =
- use learning and conditioning principles to modify behavior (patterns)
Therapist roles =
- create individualized treatment plans with stepwise progression
- targets observable behaviors + antecedents + consequences
Procedure =
1) clarify problem
2) create goals
3) identify target bx
4) design tx plan (stepwise progression)
5) evaluate success of tx plan
6) identify next target bx, rinse and repeat
Variations of BT include schedules of reinforcement, behavioral activation therapy, and systematic desensitization.
WHY: BT is a short-term treatment option, so clients often see change more quickly compared to other forms of therapy. It is low-cost, making it accessible to more populations. It is effective in helping clients develop concrete goals, learn skills, and identify helpful coping strategies. It may also bring awareness to and provide insight into clients’ behavioral patterns.
EXAMPLE: A client in therapy, Gina, expresses that she has a habit of biting her nails and wants to stop this behavior. She identified the triggers of having an urge to bite her nails as hunger, boredom, anxiety, and feeling roughness on the nail or cuticle. Gina and the therapist formulated a plan that included strategies for recognizing triggers and instead engaging in a behavior that is incompatible with nail biting. These may include chewing gum, using a stress/fidget toy, or keeping her hands in her pockets. Additionally, Gina and her therapist may establish rewards if Gina reaches certain milestones (no nail biting for x hours, etc.). This plan provides behaviors to replace the target behavior, as well as provides incentives to not engage in the target behavior.
chaining
WHERE: 501 cog and behav change
WHERE: Used to teach behaviors that are not in the repertoire of the learner. Typically used with clients who have ASD or intellectual disabilities.
WHAT: “Chaining” is a behavioral therapy technique used to teach complex behaviors by breaking them down into smaller, manageable steps. Each step in the chain is linked to the next, creating a sequence of actions that leads to a final goal.
Used to teach NEW behaviors that have mult steps + must be done in a specific order
Procedure =
1) task analysis to break down bx into stimulus-response components
Forward Chaining =
- each behavior taught one at a time
- learned must independently complete a step to move onto next one
- each bx/response serves as cue for next step
- learner reinforced after each step done indep
Backward Chaining =
- entire sequence taught with assistance
- assistance removed from last step in each new trial
- last step performed independently is reinforced
WHY: Chaining is important as it teaches clients to become proficient in new, multistep behaviors. Each behavior in the task analysis offers clear instruction to the learner of what is expected of them. It allows the therapist to monitor progress of each step, and adjust the procedure or provide assistance where needed. As clients complete each step and learn new behaviors, it aids in confidence and self-efficacy. This serves as reinforcement to try learning additional skills and to use their newly learned skills in other contexts.
EXAMPLE: A child with ASD is being taught to wash their hands independently using backward chaining. The therapist creates a task analysis for hand washing: turn the water on, put soap on hands, rub hands together, rinse hands, turn the water off, and dry hands. First, the therapist assists the child in completing all the steps by guiding their hands and verbally coaching them through the procedure. Then, the therapist will guide and coach them through all the steps except for the last one (hand drying). If the learner successfully dries their hands independently, they are reinforced. During the next trial, assistance will be removed from turning the water off as well. This is repeated until the learner masters all steps of the procedure.
classical/respondent conditioning
WHO: Developed by Pavlov
WHAT: A form of associative learning in which a neutral stimulus (NS) is paired with a stimulus that naturally and involuntarily elicits a response from the subject, known as the unconditioned stimulus (UCS) and the unconditioned response (UCR). The NS is presented first, then the USC is presented. This is repeated until the NS elicits a response without the UCS being presented, making the NS a conditioned stimulus (CS). The response elicited from the CS is known as the conditioned response (CR).
WHERE: Often used to treat phobias or panic disorders.
WHY: Classical conditioning is significant as it demonstrates the way learning (learned responses) can impact one’s emotions, cognitions, and behaviors. The principles of classical conditioning help to explain and predict the behaviors. Classical conditioning is effective in modifying automatic and involuntary, but learned, behaviors, such as fear and anxiety.
EXAMPLE: Jane comes to therapy following a mugging. It occurred when she was in a parking garage alone and the experience was traumatizing for her. As a result, she can not enter a parking garage without feeling intense fear and anxiety. This is an issue as Jane uses this parking garage each day for work. She has been having to leave earlier in the morning to allow time for her to find alternative parking. The therapist explains in this case, the mugging is a UCS with a UCR of fear and anxiety. It is a natural response that was not learned. The parking garage is now a CS and the fear Jane feels when entering a parking garage is now a CR. Before the mugging, Jane had no issue parking her car before work. However, because of the pairing of the CS (parking garage) with the mugging (UCS), the parking garage now elicits a CR (fear and anxiety). The CR would otherwise not occur without this learned association.
cognitive fusion
WHERE: 501 cog and behav change
WHERE: Is associated with/a component of ACT
WHAT: Component of ACT
- when someone is so ‘fused’ with their thoughts, they see them as truth
- they may pay too much attention to the contents of their mind (thoughts, assumptions, beliefs, etc.)
- make decisions/take actions based on their internal experience, rather than what’s actually happening in their environment
- can contribute to psychopathology and symptoms
WHY: Addressing cognitive fusion is crucial in therapy because it helps individuals gain distance from their thoughts, reduce emotional distress, improve self-awareness, and enhance their ability to act in alignment with their values and goals.
EXAMPLE: A therapy client, Dan, is telling his therapist that he’s anxious about his approaching college finals.
He said he hasn’t bothered studying much since he believes he’s not good at memorizing notes and bad at school in general. The therapist may intervene and remind Dann that just because he believes these things about himself, does not mean they’re true. The therapist may offer alternative beliefs, such as trying a different method of studying to aid in retention.
cognitive restructuring
WHERE: 501 cog and behav change
WHO: Part of Beck’s cognitive therapy
WHAT: Used in tx for depression or anxiety
Cognitive restructuring is a therapeutic process used in cognitive-behavioral therapy (CBT) to help individuals identify and change negative or distorted thought patterns. The goal is to replace harmful thoughts with more balanced and realistic ones, which can lead to improved emotional responses and behaviors.
Psychopathy =
- clients’ symptoms maintained by maladaptive thoughts
Therapist roles =
- teaching and collabing with client to identify and modify distorted cogs + replace them with healthier ones
Crucial questions asked =
- What is the evidence for/against this belief?
- What are alternative interpretations of this event?
- What would it mean if this belief is true?
WHY: Cognitions influence one’s behavior and emotions. By replacing a stress-causing cognition with a more healthy one, the person’s emotions and behaviors are likely to change in a positive way as well. Teaching CR aids in one’s ability to emotionally regulate. Being able to recognize and invalidate harmful thoughts puts the client in the position to influence events and outcomes in their life.
EXAMPLE: A therapy client, Jane, is in session and telling the therapist about her new job. She says she has been unsuccessful in making friends with her coworkers because they don’t like her and think she is incapable. The therapist identifies these are faulty cognitions and works with Jane to restructure them. The therapist may ask Jane what evidence she has that the coworkers don’t like her. Then, ask if there are any other explanations for why they may have laughed as you were walking past. Jane and the therapist will collaborate in finding different and more healthy beliefs to replace the faulty ones with.
cognitive therapy
WHERE: 501 cog and behav change
WHO: Aaron Beck
WHAT: Used to treat anxiety or depression
- assumes cogs can be observed, monitored, counted, altered
- cogs influence behavior
Psychopathy =
- cogitions !!!
Therapist roles =
- bring awareness to faulty assumptions/maladaptive beliefs
- work with client to correct them by finding contradictive evidence
3 levels of cog distortions =
1) automatic thoughts (spontaneous, plausiable)
2) assumptions (if… then… rules)
3) schemas/core beliefs (most ingrained level)
WHY: CT provides skills for adaptive thinking and cognitive flexibility. These skills allow the client to counteract faulty cognitions and learn to think in a more rational and realistic way
EXAMPLE: For example, a client comes to therapy with anxiety about starting a new job. The client claims her coworkers don’t like her because they laugh each time she passes by their desks, meaning they must be making fun of her. The therapist will identify this belief as faulty/distorted, and work with the client to find evidence to disprove it. Additionally, the therapist may use the downward arrow technique to learn about and eventually change the client’s schemas/core beliefs.
cue exposure therapy
WHERE: 501 cog and behav change
WHO: Based off of classic condin, Pavlov
WHERE: Used in the treatment of phobias, substance abuse, OCD, or eating disorders.
WHAT: Form of ERP. Used to treat phobias, substance abuse, OCD, or EDs
Cue exposure therapy is a psychological treatment primarily used for conditions like substance use disorders, phobias, and anxiety disorders. The therapy involves exposing individuals to cues or triggers that are associated with their problematic behavior or fear, in a controlled and supportive environment. The aim is to reduce the conditioned response to these cues, thereby diminishing cravings, anxiety, or avoidance behaviors.
Procedure =
- client exposed to cue that usually triggers their problem behavior
- client is prevented from engaging in the bx
- coping skills taught to substitute bx (relaxation)
Goal = decrease responsiveness to the cues thru extinction
In classical conditioning terms…
US - cue to engage in prob bx
UR - prob bx
CS - cue to engage in prob bx
CR - no prob bx! coping skills
prob bx extinguished <3
WHY: CET offers progress to be easily tracked by both therapist and client, and they can witness responsiveness decrease to cues. Witnessing a reduction in responsiveness may also increase confidence and self-efficacy. The skills learned in CET allow for long-term maintenance, as clients are able to generalize skills in different contexts to a variety of cues, even after treatment ends– promoting independence and autonomy.
EXAMPLE: Jane is in therapy for her OCD. She struggles with compulsive behaviors, such as feeling as if she needs to flick a light switch on and off six times before leaving a room. If she doesn’t do this, she feels strong compulsions to go back to the room and ‘fix’ it, or else she feels dread and anxiety. Her therapist suggests cue exposure. The therapist asks Jane to turn off the light in the therapy room, and then the two of them step outside. The therapist prevents Jane from reentering the room to turn the light switch on and off.
decision-balance matrix
WHERE: 501 cog and behav change
WHERE: Used in motivational interviewing
WHAT: Used in motivational interviewing. Serves as (informal) measure of readiness to change
A decisional balance matrix is a tool used in behavioral change interventions, particularly in motivational interviewing and health psychology. It helps individuals weigh the pros and cons of changing a behavior versus maintaining their current behavior. This process can clarify motivations and guide decision-making.
Goal =
- reduce ambivalence in clients (esp when engaging in harmful bx)
- create cognitive dissonance that motivates client to make a decision
Therapist roles =
- gather info on pros and cons of continuing and stopping a bx
WHY: The DBM provides clarity and organization for a client so they can make a rational and informed decision. It fosters a sense of accountability and responsibility for the outcomes of the decision– in turn promoting autonomy and self-empowerment.
EXAMPLE: A client, Steve, has come into therapy at the request of his daughter. She has become concerned about Steve’s drinking habits, even though he says he doesn’t see any issue with it. The therapist inquires about the potential benefits and drawbacks if Steve were to continue drinking the way he does, as well as the benefits and drawbacks of Steve discontinuing his drinking. After the matrix is completed, Steve and the therapist evaluate all aspects and discuss Steve’s ambivalence and whether his readiness to change level has altered.
dialectical behavior therapy (DBT)
WHERE: 501 cog and behav change
WHERE: Used to treat depression, borderline personality disorder, suicidality, and self-harm
WHAT: DBT is a 3rd generation CBT.
- trust and security between therapist and client
- encourage self acceptance + growth without judgement
Goal =
- problem solving
- creating change via skills training, exposure therapy, contingency management, cog restruc
Therapist role =
- empathic understanding and validation (leaves client more open to therapist’s suggestions for change)
- accepting atmosphere to allow change in client
Skills in 4 key areas =
- mindfulness skills (observing and being present for internal experiences, keeping a non-judgmental stance)
- interpersonal effectiveness skills (problem-solving, assertiveness vs aggressiveness)
- emotional regulation skills (observing and describing emotions–similar to mindfulness)
- distress tolerance (how to healthily cope with distress without self-destruction)
DBT often consists of both individual and group treatment sessions.
WHY: DBT emphasizes skill building as a core strategy of treatment. The generalization of skills learned in treatment, such as communication skills and coping with distress, allows for long-term maintenance. DBT also fosters a validating and supporting environment that promotes resilience and empowerment to clients to overcome adversity.
EXAMPLE: Maggie is a client in therapy who struggles with emotional regulation and maintaining her relationships. Maggie tells her therapist she doesn’t trust her boyfriend and has lashed out at him in the past because she believes he has been lying and cheating on her. Instead of the therapist asking what evidence Maggie has for that assumption, the therapist employs validation/acceptance strategies and may say something along the lines of “Your emotions and worries can be very upsetting, so it makes sense why you may have such a strong reaction to them. Maybe you could try communicating these worries to your boyfriend in a different way.”
The therapist is creating a space where Maggie feels safe to share things because she trusts her therapist not to pass judgment. This trust may extend into willingness, such as when the therapist suggests Maggie change her communication style.
differential reinforcement
WHERE: 501 cog and behav change
WHERE: Used within behavioral therapy, or ABA therapy
WHAT: Used in bx therapies
Differential reinforcement is a behavioral technique used in behavior modification that involves reinforcing a specific behavior while withholding reinforcement for other behaviors. This approach is often used to increase desirable behaviors and decrease undesirable ones.
Types of differential reinforcement schedules =
- DRO (Other behavior): Providing reinforcement when the undesired behavior does not occur during a specified period. For example, a child might receive praise for not engaging in tantrums for a certain time.
- DRA (alternative behavior): Reinforcing a desirable alternative behavior instead of the undesired behavior. For example, a child who tends to shout for attention might be reinforced for using a polite request instead.
- DRL (Low rates of behavior): Reinforcing a behavior only when it occurs at a lower frequency. For instance, a student might be reinforced for raising their hand to speak no more than three times during a class period.
-DRI (Incompatible behavior): Reinforcing a behavior that is physically incompatible with the undesired behavior. For instance, if a child is prone to hitting others, they might be reinforced for keeping their hands in their pockets.
Neg punish used only
WHY: Differential reinforcement allows therapists to focus on a specific behavior to modify or shape it towards set goals. DR does not use positive punishment, meaning it can modify/discontinue certain behaviors without the negative consequences punishment brings. Additionally, differential reinforcement provides alternative behaviors (if not the desired behavior) for the subject to engage in. This allows for faster learning and less confusion.
EXAMPLE: James is a first-grader with ASD
who has been disrupting the classroom by loudly tapping his pencil on the desk. After conducting a functional analysis, his therapist determined that this behavior was maintained by social reinforcement (his teacher and classmates paying attention to him). To decrease this behavior, the therapist decides to implement a DRO schedule in which James will receive praise for every 1 hour he does not disrupt the class with his pencil tapping.
