Behavioral Models

Question 1

Assumptions of Behavioral Models

Answer 1

◦ Behavioral problems are caused by dysfunctional patterns of
reinforcement between family members
- Linear Causality
◦ Modernism Worldview
- Patterns are universally true for all humans
◦ Based in Learning Theories
- Classical Conditioning
- Operant Conditioning
- Since behavior is learned and maintained by its consequence, it can
be altered in the same way
- Behaviors will change when contingencies of reinforcement are
altered
◦ Do not need to work with whole families, but only those portions of
family involved in maintaining problematic behaviors

Question 2

Theory of Normal Development & Dysfunction

Answer 2

Normal Development
◦ Interactions involve patterns of behavior where each person’s
behavior is at once being affected and influencing the other
◦ “Giving and getting are balanced”
◦ Good communication and problem-solving skills
- Adaptability and flexibility are skills that can be taught

Dysfunction
◦ Coercion replaced reciprocity
◦ Dysfunctional behaviors are “learned responses, involuntarily
acquired and reinforced”
- No need to search for underlying meaning or structural dysfunction
- Figure out how behaviors are being reinforced

Question 3

Classical Conditioning

Answer 3

◦ 1930s: Ivan Pavlov
- Classical conditioning: animals learn to exhibit response when
previously neutral stimulus is presented
◦ Conditioned stimulus (CS)
◦ Unconditioned stimulus (UCS)
◦ Unconditioned response (UCR)
◦ Conditioned response (CR)

Question 4

Little Albert Experiment

Answer 4

John Watson
◦ Applied classical conditioning principles to humans
◦ Created phobia in young boy
◦ Outlined methods for behavior modification

Question 5

Current Uses of Behavioral Techniques

Answer 5

◦ Systematic desensitization: treatment for classically conditioned
responses
- Joseph Wolpe
1. Relaxation techniques
2. Exposure (hierarchy)
3. Exposure paired with relaxation
◦ Classical conditioning methods used primarily in treatment of
anxiety disorders, enuresis, and sexual problems (e.g. impotence,
female arousal) due to performance anxiety

Question 6

Operant Conditioning

Answer 6

◦ 1950s: BF Skinner
◦ Influencing frequency of voluntary behavior by altering its
consequence
- When desired consequence followed behavior, the frequency
increased
- When desired outcome did not follow behavior or if response was
punished, frequency decreased

Question 7

Reinforcement

Answer 7

◦ Strengthens a response
◦ + Positive: Adding a stimulus
- A mother gives her son praise (positive stimulus) for doing
homework (behavior).
- A father gives his daughter candy (positive stimulus) for cleaning
up toys (behavior).
◦ - Negative: Removing a stimulus
- Bob does the dishes (behavior) in order to avoid his mother
nagging (negative stimulus).
- Natalie can get up from the dinner table (negative stimulus) when
she eats 2 bites of her broccoli (behavior).

Question 8

Punishment

Answer 8

◦ Weakens a response
◦ + Positive: Adding a stimulus
- A child picks his nose during class (behavior) and the teacher
reprimands him (negative stimulus) in front of his classmates.
- A child grabs a toy from another child (behavior) and is sent to time
out (negative stimulus).
◦ - Negative: Removing a stimulus
- For a child that really enjoys a specific class, such as gym or music
classes at school, negative punishment can happen if they are
removed from that class (desired stimulus) and sent to the
principal’s office because they were acting out/misbehaving
(behavior).
- Siblings get in a fight (behavior) over who gets to go first in a game
or who gets to play with a new toy, the parent takes the game/toy
away (desired stimulus).

Question 9

Breaking Down the Process

Answer 9

◦ What is the behavior (that the consequence contingent on)?
◦ What is the consequence of the behavior? (i.e., What happens when
behavior occurs?)
- Positive or negative:
* Is it adding or removing something?
- Reinforcement or punishment:
* Is it pleasant or unpleasant?
* Does it increase or decrease the likelihood of behavior occurring
again?

Question 10

Operant conditioning methods

Answer 10

◦ Behavioral parent training
◦ Assertiveness training
◦ Problem solving/communication skills training
◦ Token economies

Question 11

Behavioral model - Goal of treatment

Answer 11

◦ Diminish problem behaviors and increase positive behaviors
- increase rate of rewarding interactions
- decrease rate of coercion and aversive control
◦ Establish long and short-term goals

Question 12

Cognitive Behavioral Therapy
(CBT)

Answer 12

-> Thoughts create feelings -> Feelings create behavior -> Behavior reinforces thoughts ->
◦ Form of treatment that focuses on examining the relationships
between thoughts, feelings and behaviors
◦ By exploring patterns of thinking that lead to self-destructive actions
and the beliefs that direct these thoughts, people with clinical
problems can modify their patterns of thinking to improve coping
- Patient and their therapist to search for patterns in their thinking
that can cause them to have negative thoughts which can lead to
negative feelings and self-destructive behaviors
◦ Linear Causality
- Assumption: Behavioral problems are caused by dysfunctional
patterns of reinforcement between family members
◦ Modernism Worldview
- Patterns are universally true for all humans

Question 12

Behavioral model - Stance of the Therapist

Answer 12

◦ Teacher, coach, model, and reinforcer
◦ Responsible for:
- Designing treatment
- Assigning homework
- Finding ways to generalize progress to outside life
- Building in processes that help maintain progress
◦ Treat clients in vivo (outside office where problems actually occur)

Question 13

The CBT Model

Answer 13

Beck, 1976
◦ Emotional problems are driven by patterns of negative thinking
- It is not situations that cause distress
- It is the way that people interpret, make sense of, and react to
situations
◦ Problems can be alleviated by changing thinking patterns 4 key
elements of psychological distress:
1. Thoughts (maladaptive automatic thoughts/core beliefs)
2. Feelings (emotions)
3. Feelings (Physical sensations)
4. Behavior
◦ All of these elements are related; change in one element can
produce change in another (systems!)
- Negative changes can create “vicious cycles”

Question 14

The Formation of Core Beliefs

Answer 14

◦ Deepest level of cognition
◦ Global and absolute beliefs
◦ rather than specific about a situation or event
◦ Global ex: “Everyone hates me” vs. “Joe hates me”
◦ Absolute ex: “I am a bad person” vs. “If I don’t get along with
everyone, I am a bad person.”
◦ Can be about one’s self, others, or the world
◦ Often originated from childhood experiences
◦ (+) experiences lead to (+) core beliefs ¡ (-) experiences lead to (-) core
beliefs
◦ May be latent
◦ Triggered only by specific events

Question 15

Goals of Treatment in CBT

Answer 15

◦ Break vicious cycles by creating positive changes in one or more
elements of the psychological distress
◦ Diminish problem behaviors and increase positive behaviors
- increasing rate of rewarding interactions
- decreasing rate of coercion and aversive control
◦ Goals & Interventions are paired with the 4 elements of
psychological distress
1. Cognitive interventions: produce changes in thoughts and beliefs
2. Behavioral interventions: change behaviors
3. Self-soothing interventions: change physical feelings
4. Emotions are indirectly affected by all types of interventions

Question 16

Downward Arrow Technique

Answer 16

◦ Can be used to tease out rules and beliefs underlying the person’s
negative automatic thoughts (NAT) about themselves, others, or the
world
◦ Questions to draw out core beliefs from the NAT:
- What’s so bad about that?
- What does this mean about you?
- What would be so difficult about that?
- What does that mean about other people?
- What does this mean about the world?

Question 17

Behavioral Exposure

Answer 17

◦ Repeatedly approaching a feared (but relatively safe) stimulus in
such a way that distress decreases over time.
- In vivo exposure – situations, places, people
- Imaginal exposure – trauma memory

Question 18

Rationale for Prolonged Exposure

Answer 18

◦ Based on ideas from classical conditioning
- Systematic desensitization: Desensitize clients to anxiety provoking
situations
◦ Gradually approach anxiety-related situations and anxiety/ trauma
memory
- Process the stressful, feared, or traumatic event
- Differentiate memory from trauma/fear; memories are not
dangerous
◦ New learning:
- Habituation/Extinction
- Change extreme fear/trauma-related beliefs
* World is dangerous, people are untrustworthy, self is
incompetent, anxiety is dangerous and will spiral out of control
◦ Life becomes less restricted
◦ Sense of mastery and competence

Question 19

Subjective Units of Distress
(SUDS)

Answer 19

◦ Can you think of a situation in which you felt this way?
◦ 0 You feel absolutely no distress. You are calm and relaxed.
◦ 2.5-4.9 You feel a mild level of anxiety, but you can still cope with the
situation. You are a little more alert or nervous.
◦ 5.0-6.5 You feel a moderate amount of distress that is becoming
difficult to cope with. You might be distracted by anxiety, or behaving
in ways to avoid anxiety, but are still attending to what is happening
◦ 6.5-8.5 You feel a high level of distress that is difficult to cope with.
You’re more concerned with your anxiety and how to escape, and
less able to concentrate on what’s happening around you.
◦ 8.5-10 You feel a severe to extreme level of distress and you think
you cannot cope. Your body response is so overwhelming that you
can’t possibly stay in the situation any longer.

Question 20

Behavioral Parent Training
(Parent Skills Training)

Answer 20

◦ Gerald Patterson
◦ Decrease symptomatic behavior and increase preferred behavior in
children
◦ Parents acquire skills to solve their own problems in the future
- Time out: used to extinguish bx by removing child from situation in
which bx could be reinforced
- Behavioral contracting: signing written contracts for specified
behaviors
- Home Token Economies: child given tokens/points for desired
behavior; fined for undesired behavior. Tokens can be exchanged
later for specified reinforcers
- Shaping: behavior is reinforced in steps for successive
approximations to target behavior (ex: toilet training)
- Contingency Contracting: communicate and negotiate preferences
for behavior
- Punishment

Question 21

Behavioral Couples Therapy

Answer 21

◦ Robert Liberman & Richard Stuart
◦ Couples write contracts listing behavioral changes they desired from
each other, frequencies of behavior, and exchanges for behavior
◦ Skills:
1. Teaching couples to speak in clear behavioral terms rather than
complaining
2. Positive behavioral processes
3. Improving communication
4. Teaching methods to distribute power and make decisions
equitably
5. Teaching problem-solving skills

Question 22

Functional Family Therapy

Answer 22

◦ James Alexander
◦ Integration of systems theory, behaviorism, and cognitive therapy
◦ Two steps:
1. Therapist first identifies interactional sequences embedded and
the function (e.g., regulates distance or closeness) that the
sequence serves
2. Identifies cognitions (beliefs, thoughts, attitudes) that family
members have about the problem, themselves, and one another
◦ Treatment goal: provide new behavior patterns to meet individual
functions of each family member

Question 23

Cognitive Family Therapy

Answer 23

◦ Aaron Beck (1970s)
◦ Individuals hold a set of conscious and unconscious core beliefs
(schema) about themselves and families through which they
interpret and evaluate each other’s behavior
◦ Goal of therapy: examine and correct distorted cognitions

Question 24

Cognitive Behavioral Sex Therapy

Answer 24

◦ Exercises “aimed at overcoming negative, self-defeating feelings and
images regarding sexual experiences”
◦ Treatment goals:
- Insight
- Anxiety reduction (performance anxiety: “spectatoring”)
- Sexual enhancement
- General relationship enhancement
- Physical-medical techniques
◦ Sensate focus
- Treatment for performance anxiety/spectatoring
* lower anxiety levels as couples work through series of exercises
designed to replace anxiety with pleasure
- Systematic desensitization
* Constructs hierarchy of anxiety provoking situations and/or
images and gradually faces each situation until level of anxiety
no longer interferes with pleasure
◦ Therapy ends when client’s goals are completed

Question 25

CB Sexual Techniques (Piercy et al.)

Answer 25

◦ Bridge maneuvers
- Anorgasmia in intercourse
◦ Coital alignment techniques
- Improve sexual performance
◦ Systematic desensitization
- Sexual/performance anxiety
◦ Masturbation or self-stimulation
- Anorgasmia
◦ Orgasmic reconditioning
- Fetishes
◦ Stop-start (pause technique)
- Premature ejaculation
◦ Squeeze technique
- Premature ejaculation

Question 26

Dialectical Behavioral Therapy
(DBT)

Answer 26

Marsha Linehan- UW
◦ Dialectical worldview: synthesis sought between two extreme
viewpoints
- No statement about absolute truth
- Goal: Synthesis of “acceptance” and “change” which is a process the
develops over time in transactions between people
◦ Behavioral: focuses on present behavior and current factors which
are controlling that behavior
◦ Main techniques: validation and problem solving

Question 27

DBT Theory of
Borderline Personality Disorder

Answer 27

◦ Disorder is a consequence of an emotionally vulnerable individual
growing up within an “Invalidating Environment”
- Personal experiences, emotions, and responses of child are
disqualified and “invalidated” by significant people
* Climate of high standards of self-control and self-reliance
- Prevents client from developing ability to label and understand
emotions or trust own responses or skills to manage them
- Extreme, oscillating behaviors are attempt to gain acceptance in
order to have feelings acknowledged
◦ Client’s autonomic nervous system reacts excessively to relatively
low levels of stress and takes longer than normal to return to
baseline once the stress is removed

Question 28

DBT - Stance of the Therapist

Answer 28

◦ Patients cannot fail in DBT.
- If things are not improving, it is the treatment that is failing.
◦ Communication: reciprocal communication (responsiveness and
warmth) and irreverent communication (confrontational and
challenging)
- Accepting of patient as she is but still encouraging of change
- Centered and firm yet flexible when the circumstances require it
- Nurturing but benevolently demanding

Question 29

DBT - Stages of Treatment

Answer 29

◦ Pretreatment Stage: assessment, commitment, and orientation to
therapy
◦ Stage 1: Focuses on suicidal behaviors, therapy and quality of life
interfering behaviors, and problem-solving skills
◦ Stage 2: Post-traumatic stress related problems
◦ Stage 3: Self-esteem and individual treatment goals

Question 30

DBT - Commitment to Therapy

Answer 30

◦ Clients are required to:
1. Work in therapy for a specified period of time (usually 1 year) and
to attend all sessions (within reason)
2. If suicidal behaviors or gestures are present, she must agree to
work on reducing these
3. To work on any behaviors that interfere with the course of therapy
(“therapy interfering behaviors”)
4. To attend skills training

Question 31

Modes of DBT Treatment

Answer 31

◦ Individual therapy
◦ Telephone contact
◦ Group skills training (4 modules of DBT)
1. Core mindfulness skills
2. Interpersonal effectiveness skills: strategies for asking for what
one needs, saying “no”, and coping with interpersonal conflict
3. Emotion modulation skills: tolerating and surviving crises and
accepting life as it is in the moment
4. Distress tolerance skills: identify/increase mindfulness to
emotions, reduce vulnerability to “emotion mind”; apply distress
tolerance techniques
◦ Therapist consultation