Lecture 2: Behaviour therapy

Question 1

What is the aim of behaviour therapy?

Answer 1

To change factors in the environment which influence behaviour and how individuals respond to their environment. Behaviour includes motor behaviours, physiological responses, emotions and cognitions

Question 2

Which features characterize behaviour therapy?

Answer 2

• changes behaviour (decrease frequency maladaptive behaviours and increase frequency of adaptive behaviours)
• rooted in empiricism as scientific hypothesis-driven approach is used - behaviours have function and due to reinforcement/punishment. Rooted in environment and clients not blamed for behaviours
• Emphasizes maintaining factors than initial triggers
• supported by research
• behaviour therapy is active and a more directive approach. Client is engaged during treatment
• behaviour therapy is transparent in learning skills to manage themselves and provision of behavioural model

Question 3

Other systems

Answer 3

• cognitive therapy and rational emotive behaviour align with behaviour therapy as they are both more directive, transparent, evidence based, active, time-limited
• psychoanalysis differs the most from behaviour therapy as unconscious conflicts said to manifest in behaviour, less evidence-based and more reliant on interpretation by therapist
• those conducting psychoanalysis underwent psychoanalysis themselves
• psychotherapy contradicts outcomes of behaviour therapy and its effectiveness due to symptom substitution
• client-centred is non-directive

Question 4

The precursors in the history of behaviour therapy

Answer 4

• classical conditioning
• rise of behaviourism (observable behaviours should be focus of psychology and unobservable experiences should be studied)
• modelling and exposure
• rise of operant conditioning
• scientist-practitioner model which led to abandonment of psychanalysis

Question 5

What were the beginnings of behaviour therapy?

Answer 5

• development of systematic desensitization which involves gradually confronting situations by relaxing muscles
• reciprocal inhibition
• exposure treatments are now conducted in real life instead
• name shifted from conditioned to behaviour therapy
• established field of applied behaviour analysis which is a reinforcement program to treat substance-use disorders
• token economy to reinforce desirable behaviours

Question 6

What is the current status of behaviour therapy?

Answer 6

• social learning which is that observing others can contribute to desirable behaviours and included role of cognition
• third- wave of behaviour therapy which emphasizes accepting unwanted thoughts, feelings than trying to control or change them-> includes ACT, MBCT and DBT. Include teaching clients on what is important to them and living consistent with their values
• most popular treatment for managing psychological and behavioural problems. Includes own professional associations to practice behaviour and CBT

Question 7

Theory of personality

Answer 7

• Argues that each individual has unique, enduring patterns of behaviour which can be looked at with personality characteristics-> five factor model
• But behaviourists reject ability to predict behaviour and should focus behaviour on variables in the environment
• evidence supports that temperaments can influence behaviour, which current behaviourists acknowledge

Question 8

Concepts relating to classical conditioning

Answer 8

• extinction which is presenting CS in the absence of US to reduce CR
• reinstatement is repairing of US and CS

Question 9

Concepts related to operant conditioning

Answer 9

• discrimination learning is when a response is reinforced or punished in one situation but another another
• generalization is the occurrence of a learned behaviour in situations different than where the behaviour is acquired

Question 10

Vicarious learning

Answer 10

Learning about environmental contingencies by watching the behaviour of others

Question 11

Rule-governed behaviour

Answer 11

Learning about contingencies indirectly through hearing or reading information without experiencing them firsthand

Question 12

Theory of psychotherapy

Answer 12

• therapeutic relationship was not emphasized initially but later found to be important
• motivational interviewing improves motivation and commitment to change for those who are ambivalent about treatment

Question 13

Process of psychotherapy

Answer 13

• time-limited
• taught how to change problem behaviours and maintain improvements
• can occur in other settings
• works on basis of an engage client and positive expectation that treatment will be helpful
• importance of shared goals in treatment
• confidentiality
• variety of activities

Question 14

Mechanisms of psychotherapy

Answer 14

• models not based on information processing, emotional processing and cognitive reappraisal instead of learning
• emotional-processing theory which involves stimulus, response, meaning which all become associated with one another
• those with personality disorders, depression, severe anxiety, stressful life events, poor insight, poor motivation and negative patterns of communication and poor compliance with treatment have worse outcomes in CBT

Question 14

How can behavioural therapy be used for different conditions?

Answer 14

• behavioural strategies found to be effective for anxiety-based disorders
• found to be effective for depression but also non CBT found to be effective
• modest effects for bipolar
• motivational interviewing for substance use
• social-skills training, contingency management, behavioural family therapies

Question 14

Components of behavioural assessment

Answer 14

• aims include: identifying target behaviours, determining most appropriate course of treatment, impact of therapy over time and assessing final outcome of treatment. Multiple methods, multiple informants used.
• target behaviours are those that are distressing, impairing or dangerous, include behavioural deficits, behavioural excesses and problems in environment
• functional analysis is identifying variables responsible for maintaining target behaviours through inferrances
• behavioural interviews used to gain info about problem behaviour and establish consequences of target behaviour and gives samples of client’s behaviour
• monitoring forms and diaries
• behavioural observations to assess behaviour
• self-report scales to assess behaviour, but these provide little info about the individual
• psychophysiological assessment

Question 15

Treatment planning

Answer 15

• Treatment goals are set which should be specific and measurable, anchored in certain behaviours or outcomes, realistic and achievable, timelines for achieving goals
• functional analysis which is when strategies emerge from behavioural assessment
• diagnostic profile is based on client’s diagnosis and uses manualized protocols. Can be useful in homogenous cases

Question 16

Exposure-based strategies

Answer 16

• used mostly in anxiety disorders
• in vivo involves exposures to feared situations in real life
• imaginal exposure which is exposure to feared mental imagery
• interoceptive exposure which is experiencing frightening physical sensations until they are no longer frightening
  -exposure hierarchy which is ranking in terms of difficulty and progress with harder situations
• response prevention which is inhibiting an unwanted behaviour to remove association between stimulus and response

Question 17

Operant conditioning strategies

Answer 17

• changing patterns of reinforcement and punishment by removing stimuli that reinforce undesirable behaviours and increase desirable behaviours
• differential reinforcement is reinforcing the absence of unwanted behaviours and occurrence of desired alternative behaviours
• contingency management is changing the environment so that the unwanted behaviours are not reinforced
• aversive conditioning which is exposing unwanted consequences to decrease an undesirable behaviour but only has short-term success and relapse is common, individuals find ways to avoid negative consequences

Question 18

Relaxation training

Answer 18

These reduce the effects of anxiety and stress on the bod through diaphragmatic breathing to prevent hyperventilation, guided mental imagery to manage stress and progressive relaxation to reduce feelings of muscle tension. There is a focus on different muscle groups each week

Question 18

Stimulus control procedure

Answer 18

A behaviour being determined by a specific cue or stimulus, these aim to correct problems related to stimulus control when under the control of an inappropriate stimulus

Question 19

Behavioural activation

Answer 19

Depression maintained by lack of response contingent positive reinforcement caused by inactivity and withdrawal which leads to less opportunities with reinforcers. Core principles include: changing feeling to doing, coping strategies can maintain depression, figuring out helpful strategies involves understanding preceding events. Activity scheduling is important to become more active and engaged

Question 20

Social skills training

Answer 20

Involves using modelling, corrective feedback, behavioural rehearsal to improve abilities to communicate effectively and function better. Targets can include: eye contact, body language, speech quality, listening skills, assertiveness skills, conflict skills

Question 21

Problem-solving training

Answer 21

Involves developing effective problem-solving skills
- define problem
- identify possible solutions through brainstorming and without filter
- evaluate solutions
- choose best solutions
- implementation but this can lead to new challenges which prevent the solution from being applied
Can focus on developing other abilities like challenging negative thinking, enhancing motivation, setting priorities and goals, managing time effectively and improving organization. Also used in treating depression, GAD and others

Question 22

Acceptance-based behavioural techniques

Answer 22

• mindfulness is paying attention to the present and attend to experiences rather than the past and encouraged to accept them. Can include meditation, mindful breathing and mindful scanning etc
• ACT involves fostering acceptance and minimizing experiential avoidance to embrace private events. Take the observer role with thoughts and encourage clients to act in line with their values
• DBT combines CBT with mindfulness-based strategies for acceptance and tolerating distress and used for a wide range of problems. Unclear the mechanisms underlying their effectiveness

Question 23

What is the criteria for empirically validated treatments?

Answer 23

Controversial is when there are mixed results or effective but why it works conflicts with evidence. Strong support is when studies are well-controlled and show that treatment is superior to placebo or other treatments treatment manuals. Modest support is less stringent.

Question 24

Why are empirically supported treatments criticized?

Answer 24

Seen as flawed or incomplete as manualized treatments can cause therapist to be more technical than caring human beings. Participants tend to be different in research than mental health clinics. Others think that it makes clinicians more focussed and facilitates training and more accountable, some manuals are more flexible

Question 25

Issues with manualized treatments

Answer 25

Clients can only respond partially to treatment and provide limited info on how to adapt treatment to a certain client. Does not answer which treatment and by whom for a particular individual with a certain problem and under what circumstances is most effective. So important to pay attention to unique circumstances with respect to objective and empirical approach. This includes: being aware of biases about client, being aware of own biases, collecting data to test assumptions and collecting data to evaluate effects of intervention.

Question 26

Single case experimental designs

Answer 26

Assessed before intervention to determine a baseline, continues throughout treatment. Aspects of intervention varied or manipulated to see changes being observed. Use of reversal design which starts with baseline then intervention. Then intervention is withdrawn and reintroduced to see what happens. Needs to see effect with replications

Question 27

How can multiculturality be improved?

Answer 27

A challenge is to use methods that may not fit with cultural assumptions and beliefs or to adapt methods more consistent with values or expectations. But therapists are taught to adopt a more culturally responsive approach to learn more about how clients have been influenced by cultural experiences. Can affect reactions to the therapist and create language barriers. CBT is found for those from many cultures.