Behavioral Techniques I Flashcards
Techniques to change behaviors
a. Graded task assignments
b. Behavioral rehearsal / role playing
c. Assertion training
d. Exposure (for avoidance)
a. Behavior experiments
b. “Shame attack” exercises (change belief that its horrible to be embarrassed or have negative attention)
c. Fixed role therapy
d. Bibliotherapy
Techniques to change emotions and moods
a. Activity scheduling/monitoring
b. Exposure (for anxiety)
c. Relaxation & breathing exercises
Techniques to change thoughts or cognitions
a. Behavior experiments
b. “Shame attack” exercises (change belief that its horrible to be embarrassed or have negative attention)
c. Fixed role therapy
d. Bibliotherapy
Activity Monitoring & Scheduling (for Behavior Change)
a. Using the activity chart to monitor activities
i. Assessment function
ii. Activity entries are often accompanied by some type of rating:
1. Mood rating
2. Pleasure and Mastery ratings (client rates how much enjoyment and sense of accomplishment s/he derives from various activities)
b. Practice in session
i. Assign for homework
1. Anticipate and troubleshoot problems
2. Ask client to review chart before next session
ii. Reviewing the activity chart
iii. Place on agenda for session
iv. Identify patterns and draw conclusions (over/under represented activities; balance across dimensions of life related to goals; identify activities associated w/the most/least pleasure and/or mastery considering increasing or decreasing frequency accordingly)
v. Review conclusions and implications
c. Alternative formats (i.e. daily format: time of day, activity, and comments; or narrative format) (dog ex=diary format; cat ex=narrative format)
Activity Scheduling (to Change Emotions & Mood)
a. Capitalizes on link between behavior and mood
b. Selecting target activities
c. Scheduling activities
d. Strategies to enhance participation
i. Personalized list of target services
ii. Use activity list + activity chart, daily planner/PDA, or phone to schedule activities for coming week
iii. HW: Client commits to doing a specified number of activities from list
iv. Continue to use activity chart to monitor activities and their impact on mood
v. Activity list also framed as coping tool to fend off “downward spirals”
vi. Warn clients not to expect too much (comparison should be to how they are currently feeling when doing nothing, not to how they used to feel when engaged in these activities)
Strategies to Promote Participation in activity scheduling:
i. More frequent contact with therapist
ii. Recruit significant others to help
iii. Activities involving others vs. solitary activities
iv. Start with small increments
v. Frame agreement as a “test” or “experiment” to assess effects
vi. Empathic education re: diagnosis (i.e. depression)
vii. Use client’s experience to underscore rationale
viii. Burns: Challenge “I can’t” assertions
Activity Scheduling for Depression
a. Impact of selected sxs of depression
b. Loss of energy, withdrawal, & reduced activity are common
i. Sxs lead to significantly reduced levels of positive reinforcement in day to day life
ii. Impaired concentration, attention, & memory may hinder learning & use of cognitive interventions at the outset of therapy
c. Initial focus: behavioral interventions to improve mood
i. Increasing involvement in activities (pleasure & mastery)
ii. Easier to change behavior than to directly alter mood
d. Later focus: more verbally based & cognitive interventions
Which Activities to schedule for depression?
i. Activities the client used to enjoy or derive a sense of accomplishment from, that they are no longer doing
1. Find this out by interviewing client and/or significant other
2. Formal measure (ex: pleasant events schedule)
ii. Activities identified on the basis of activity monitoring
iii. Activities should be:
1. Accessible, practical, not overly ambitious, things client is willing to try
2. Social interactions where one feels liked, approved of, engaged, &/or respected
3. Intrinsically pleasure activities
4. Activities conveying a sense of adequacy, competence, & accomplishment
5. Contribute towards problem solving/achieving goals
Why Does Increasing Activity Improve Mood?
i. Capitalize on interdependence between behavior & mood
ii. Certain activities increase mood enhancing neurochemicals
iii. Inactivity contributes to negative self-focus & rumination
iv. Activity provides a distraction that reduces such negative rumination
v. Provides opportunities for success, enjoyment, making progress, & problem solving
Activity Scheduling to Improve Time Management
a. **This might be important to fill up dead/idle time or activities to do instead of use drugs, binge, &/or ruminate
b. Use activity scheduling to:
i. Promote effective use of time
ii. Choose among conflicting priorities
iii. Proactively balance time allocated to work, relaxation, family, recreation, etc.
c. Initially, use the activity monitoring to assess client’s current use of time
i. Identify inefficiencies
ii. Reevaluate client’s choices among conflicting priorities
d. Subsequently, use the activity chart (or alternative) to:
i. Prospectively plan & write in activities for the coming week
ii. Monitor the effectiveness of the intervention
Pleasure Predicting (Burns)
a. Indicated when client’s resistance to increased activity relates to automatic thoughts such as, “I won’t enjoy it, so what’s the point of doing anything?” or “I can’t enjoy anything anymore.”
b. Technique: Induce the client to undertake activities in order to test the hypothesis that’s/he won’t enjoy them or won’t get anything out of them
i. Identify prospective activities
ii. Client predicts amount of pleasure s/he will derive (0-100 scale)
iii. Client engages in activity and rates actual pleasure experienced
iv. Compare predicted pleasure to actual pleasure
c. Rationale:
i. Depressed client’s predictions will often be distorted in a negative fashion
ii. In reality, tend to derive somewhat more pleasure than expected
d. Can be applied to other issues (e.g. anxiety, procrastination) involving negative predictions
Graded Task Assignment
a. Indicated for clients who feel overwhelmed and immobilized in the face of certain tasks
b. Breaking down tasks into smaller, manageable (achievable) parts – can be considered a shaping strategy
c. Technique can be applied to almost any task, large or small
d. Benefits
i. Task progress and completion
ii. Progress on small steps is reinforcing and likely to lead to improved mood and motivation
iii. May help to weaken thoughts that contribute to feeling overwhelmed
Stimulus Control
a. Strategies that capitulate on the control that environmental stimuli can exert over behavior
b. Interventions aim to either establish or break a connection between certain stimuli and behaviors
c. Change behavior by:
i. Eliminating from the environment those stimuli that elicit the problematic behavior (i.e. drinking buddies)
ii. Constrict or limit the stimuli that elicit the problematic behavior (i.e. not going to bars)
iii. Promote desired behavior by directing clients to create new connections between stimuli and the behavior
Contingency Management: Rewards and Punishments
a. Positive reinforcement
b. Shaping
c. Punishment
d. Aversion therapy
Behavior Rehearsal/Role Playing
a. Stimulating real-life interpersonal situations in session
b. Applications in CBT
i. Uncover automatic thoughts
ii. Develop a rational response
iii. Modify intermediate and core beliefs
iv. Learn and practice specific behavioral skills
c. Assessment Function (useful in identifying social skill deficits or other interpersonal problems)
i. Doing it early on may help you develop or see things that you wouldn’t have seen otherwise
d. Clinical Applications (developing new skills)
i. Social skill training
ii. Assertion training
iii. Preparing for a specific stressor or situation (e.g. job interview) i.e. in recovery and worried about stressor associated with relapse
e. General Format for Teaching Behavioral Skills
i. Provide rationale i.e. we all have the right to refuse a request and set boundaries
ii. Therapist demonstrates or models the skill (present good and bad examples and make sure the good examples aren’t too good)
iii. Behavior rehearsal with coaching or feedback
iv. HW to apply skill in-vivo
v. Alternate format
1. Client, playing self, demonstrate typical behavior
2. Switching roles, therapist models an alternative approach
3. Switching roles again, client practices alternative approach
vi. Consider audio/video recording
