Behavioural Interventions Flashcards
What does behavioural theory assume that psychodynamic theory doesn’t?
That behaviour is the problem rather than a simple manifestation of some underlying psychodynamic issue
Underlying assumptions of behavioural interventions
Psychological problems are based on faulty learning or genetic loading or both combined
Seligman (1971)
Biological preparedness theory of fear conditioning
Occam’s razor
Make it simple unless it needs to be complex
You don’t need all the explanations as long as the simple one works
Theoretical basis of behaviour therapy
Classical conditioning of fear responses
Based in adaptive reflex actions that become maladaptive
What differs in anxiety disorders?
The specific cognitions
Cognitions in phobias
That object can harm me
Cognitions in PTSD
I am at risk of harm
Cognitions in GAD
Worry about uncontrollable events
Cognitions in social anxiety
Fear of negative evaluation
Cognitions in OCD
If I do not think/do X, then there will be negative consequences
Cognitions in panic disorder
I will die if I do not get away
Extinction
Unlearning a link as the link disappears
As the positive or negative event stops happening, we stop reacting to it
Habituation
Getting used to something sensory and repetitive, such as slamming a door
Reacquisition
One negative experience brings the fear back and very fast
Spontaneous recovery
The fear can recover over time, but more weakly than originally
Disinhibition
Any arousal just after extinction can result in some return of the fear
Renewal
The fear can be brought back by return to the setting where it was learned
What are the problems with extinction
Reacquisition
Spontaneous recovery
Disinhibition
Renewal
Stimulus generalisation
A similar object can come to evoke similar fears
Latent inhibition
Harder to learn to fear a familiar object than an unfamiliar one
Blocking
Learning that something is positive makes it harder to learn subsequently that it is negative
Exposure therapy basics
Anxiety reactions are normal and short lived
Interactions between physiological, cognitive, emotional and behavioural aspects
Exposing the participant to the threatening stimulus and teaching them that no harm comes to them despite the anxiety reaction
Why is our anxiety response limited?
Limited by the amount of adrenaline the body can pump
Some inter-individual differences related to cortisol
What is chronic anxiety?
Usually low level and maintained by rapid use and failure of safety behaviours
How is anxiety maintained?
Patient experiences anxiety and uses safety behaviours to calm themselves down in the short term
This enhances anxiety in the long-term as the patient never learns that the anxiety goes away anyway
Graded exposure
Gradually approaching the feared object/situation
Tolerating the anxiety until it declines
Takes several sessions of moderate anxiety
How is graded exposure delivered?
In vivo or imaginally according to the disorder
Cannot repeat the trauma in PTSD for example
Systematic desensitisation
As with graded exposure but with methods to reduce anxiety
Types of anxiety reduction in systematic desensitisation
Relaxation, biofeedback
Mindfulness/distraction
Reciprocal inhibition mechanism
Flooding
Immersion in the feared situation immediately
One or two sessions of very high anxiety
Can feel deeply unpleasant to both the patient and the psychologist
Recommendations for better exposure outcomes
Aim for high levels of fear in the session
Widen context to reduce stimulus generalisation
Vary the type, frequency and duration of practice to enhance stimulus specificity
Beware of efforts to induce calm
Behavioural modification
A general approach to modifying behaviours, based on positive and negative reinforcement patterns
Used flexibly to understand and modify behaviours that are maladaptive
Token economy
Encourage change to more pro-social behaviour via reinforcement of such behaviour
Skills training via successive approximation/chaining/shaping of behaviours
Teaching someone with a learning disability to undertake a shopping trip
Behavioural self-control/habit reversal
Identification of problems and self-directed change
Behavioural activation
Specific methods used to target low self-esteem/depression
Overcoming learned helplessness, where the person has ceased making efforts that might bring positive outcomes and reduce depressive mood
What does behavioural activation involve?
Activity planning
Activity scheduling
Making small behavioural changes
Roth & Fonagy (2005)
In most disorders, CBT is more effective than other therapies and medication
Ougrin (2011)
Compared exposure therapy with CBT via a meta-analysis
Concluded that ET is as effective as CBT in all anxiety disorders except social phobia
Jacobson et al. (1996) three conditions
Full CBT
- Addresses schemas, automatic thoughts, behaviours
Activation of thoughts
- Addresses automatic thoughts, behaviours
Behavioural activation
- Addresses behaviours only
Jacobson et al. (1996) results
No difference at all in outcomes
Harned et al. (2013)
Exposure therapy has the dubious distinction of being one of the most empirically supported yet the least used psychological treatments
