CBT I

Question 1

describe cognitive behavioral therapy

Answer 1

• prevailing treatment approach in health today
• CBT is at least as effective as ADs medication in treatment of mild to moderate depression (non-psychotic; non-bipolar)
• it is cost effective, relatively brief and supported by a strong body of empirical research

Question 2

describe CBT treatments involving classical conditioning

Answer 2

• employ counterconditioning and/or extinction
• aimed at breaking the conditioning that has lead to the CS being followed by a problematic CR
• essentially pt is being trained to “unlearn” the problematic behavior
• an example: systematic desensitization

Question 3

describe systematic desensitization

Answer 3

• involves counter conditioning–presenting patient with the fearful CS while in state of relaxation
• the gradual pairing of the anxiety-provoking CS with relaxation results in eventual elimination of the CR (anxiety)
• based on principle of reciprocal inhibition–anxiety and relaxation are mutually antagonistic–patient cannot experience them concurrently

Question 4

describe the use of systematic densitization in treatment of a phobia

Answer 4

Question 5

describe the steps in systematic densitization in treating a phobia

Answer 5

• patient initially trained in progressive muscle relaxation
• next, an anxiety hierarchy of fear-eliciting scenes related to the CS is constructed
• when treatment begins, patient is asked to visualize the least disturbing scene while in relaxed state
• then, if no anxiety is experienced, the next most anxiety-eliciting scene is imagined, and so on

Question 6

describe imaginary vs in vivo systematic densensitization

Answer 6

• research suggests that systematic desensitization carried out imaginally is as effective as in vivo
• in vivo desensitization may be initiated after 70-80% of hierarchy scenes are successfully completed imaginally, making it more likely treatment gains will generalize to the “real world”

Question 7

describe other exposure therapies based on classical extinction (exposure, implosion, flooding)

Answer 7

• exposure: gradual exposure to the fearful stimulus
• implosion: abrupt, prolonged imaginal exposure to the fearful stimulus
• flooding: abrupt, prolonged, full intensity (in-vivo) exposure to the fearful stimulus

Question 8

summarize the 4 types of exposure therapies

Answer 8

Question 9

Answer 9

imaged and gradual = systematic desensitization

Question 10

Answer 10

graded in vivo exposure

Question 11

Answer 11

imagined + relaxation = reciprocal inhibition

habituation = consistent exposure WITHOUT relaxation (without counterconditioning component)

Question 12

describe behavioral sex therapy

Answer 12

• performance anxiety inhibits arousal–may involve “spectatoring”–anxious observation of one’s own state of arousal
• sensate focus exercise: similar to SD but involving mutual pleasuring exercises rather than progressive muscle relaxation
• sexual arousal and anxiety are mutually antagonistic
• treatment involves gradually pairing anxiety-eliciting stimuli in sexual situation with mutual pleasuring

Question 13

describe aversion therapy

Answer 13

also involves counterconditioning

• the CS (children) previously associated with sexual arousal is paired with a US that naturally elicits an unpleasant response (shock)

Question 14

describe aversion therapy effectiveness in sex offenders

Answer 14

• although aversion therapy would not be expected to completely eliminate sexual attraction to children, it can provide patient with greater control over the behavior
• group therapy with other perpetrators involves peer pressure, support and education–a promising approach to treatment of a very difficult behavior

Question 15

describe exposure and response prevention in treating OCD

Answer 15

• ERP: exposure, followed by prevention of the ritualistic avoidance behavior
• first-line treatment for OCD
• involves both classical and operant features

Question 16

describe CBT used in treating PTSD

Answer 16

• most behavioral treatments involve exposure (real or virtual) to the fear provokoing CS without the US
• this is simply extinction, which eventually leads to decay of the CS/CR bond and a reduction in anxiety
• the VA Hospital System in the US uses 2 types of CBT in the treatment of PTSD:
  
  • prolonged exposure
  • cognitive processing therapy

Question 17

describe the 2 VA therapies for PTSD

Answer 17

• prolonged exposure: patient gradually exposed to CSs asscoiated with the trauma & remains in their presence until anxiety lessens
• congitive processing therapy: addresses irrational & upsetting thoughts patient may have related to the trauma
  
  • for example:
    
    • blaming oneself for the trauma or response to it
    • now viewing the world as a dangerous place
  • such dysfunctional thoughts are challenged and patient is taught more adaptive ways of viewing situation

Question 18

describe treatments based on operant conditioning

Answer 18

• contingency management: simply using reinforcement to encourage dersirable behaviors and punishment or extinction to eliminate undesirable behaviors
  
  • parents restrict teen’s driving privileges contingent upon family curfew noncompliance
  • nursing staff respond less immediately to a complaining pt’s overuse of “call button”

Question 19

describe other treatments based on operant conditioning (time out, shaping, biofeedback)

Answer 19

• time out: contingent upon misbehavior, a child is removed from all sources of reinforcement (neg. punishment)
• shaping: creating a new desirable behavior by reinforcing successive approximations of it
  
  • often used when working with pt populations with limited speech
• biofeedback: providing auditory or visual feedback to pt contingent upon modification of physiological correlates of anxiety and pain
  
  • ex: EMG feedback indicating level of tension in neck/back in treatment of tension headaches

Question 20

describe differential reinforcement of other behaviors

Answer 20

• DRO: reinforcement is delivered after a specified time period during which the undesirable behavior is not performed
  
  • time-dependent rather than response dependent
• ex: 6 yr old Billy hits other children at school. Rather than punishing for hitting behavior, the teacher positively reinforces him for each 5-min interval in which he does not engage in the hitting behavior

Question 21

describe the Premack Principle

Answer 21

• based on the premise that if a person wants to engage in a highly enjoyable behavior, then being permitted to engage in that behavior can itself be used as a reinforcer for completing a less enjoyable activity
• ex: 6 yr old Sally really enjoys riding her little bicycle, but she does not enjoy picking up her clothes of the floor. Utilizing the Premack principle, her mother allows Sally to ride her bike contingent upon Sally picking up her clothes

Question 22

describe contingency contracts and token economies (treatments based on operant conditioning)

Answer 22

• contingency contracts: a therapeutic understanding, usually involving a family or couple and the therapist
  
  • contingencies pertaining to desirable and undesirable behaviors are made explicit and agreed to by all parties
• token economies: operant-based systems often employed in residential treatment facilities, prisons and half-way houses
  
  • secondary reinforcers (eg tokens) are used to reinforce desirable behaviors–tokens are redeemed by pt for merchandise and privileges

Question 23

describe the ABAB single-case design

Answer 23

• allows us to establish the effectiveness of a single-case behavioral intervention
• the A-B-A-B experimental design involves an initial baseline stage (A) followed by a treatment intervention stage (B) which then repeated
• the clinician initially establishes the baseline frequency of the target behavior (A) and then notes whether this frequency changes when treatment is introduced (B)
• the treatment is then withdrawn, and it is noted whether the behavior returns to baseline
• finally, the treatment is reinstated, and it is noted whether the behavior again improves

Question 24

given an example of ABAB therapy

Answer 24

• a 6 year old boy diagnosed with autism spectrium disorder is enrolled in daily 30-min. speech therapy sessions. He is being trained to respond to the therapist when spoken to.
• behavioral internvention: giving the boy a small piece of candy for each response
• outcome variable: the number of responses made by the boy are counted and recorded

Question 25

describe what an A-B-A-B experimental design graph would look like

Answer 25