Module 7 behavioural approaches Flashcards
explain the origins of behavioural approaches
Maladaptive behaviour stems from learning-it is not inherent.
Adaptive behaviours can be strengthened.
Behaviours are context driven, and influenced by before/after environments.
Behavioural change requires specifying behaviour targets and working in the present.
Behavioural interventions are warranted when behaviours interfere with achieving client goals/outcomes/ambitions /values or have a contribution to a negative outcome.
CLASSICAL CONDITIONING; eg Pavlov. 2 unassociated stimuli are learnt to be associated to form a conditioned response.
Can explain some phobias.
OPERANT CONDITIONING; learn that a behaviour leads to consequences. An outcome which increases behaviour frequency=reinforcer. In this model, positive=add something, and negative=remove something.
Increase a behaviour frequency by adding something pleasant (positive reinforcement) or take away something unpleasant (negative reinforcement).
Decrease a behaviour by adding something aversive (positive punishment) or remove something pleasant (negative punishment).
Important to also reward positive steps along the way to mastering a desired behaviour.
SOCIAL LEARNING THEORY; Albert Bandura, The importance of observing/modelling the behaviours/emotions/reactions of others.
Considers how both environment and cognitions, influence learning and behavior.
There are 3 models;
1. Overt-use live models in front of client
2. Symbolic-use eg video or cartoon etc models
3. Covert (also known as imaging)-client imagines scenario/outcome etc.
outline why behavioural approaches can be successful
Characteristics of clients who seem to have the most success from behavioural interventions, include:
1. A strong goal orientation-ie motivated by achieving goals or getting results.
2. An action orientation;people who need to be active or participating in a helpful process.
3. An interest in changing 1-3 precise behaviours.
BEHAVIOURAL INTERVENTION SKILLS
1. Describing behaviours-help client understand complex behaviours-break down into simpler steps/sequences
2.Modifying behaviours-help client change behaviours
3.Contracting-help client with commitment, record-keeping and timelines for change.
4.Supporting/Reinforcing;help with encouragement and help assess levels of progress.
BEHAVIOURAL INTERVENTIONS
1. Social Modelling-use examples from various sources to teach client what to change.
2.Role-play & Rehearsal;use simulations to become more familiar. Relies on practice and feedback.
3.Anxiety Reduction Methods;help client manage muscular/kinesthetic responses to stimuli, to counter learned anxious responses.
4.Symptom Prescription;instruct client to engage and actually control their symptom rather than avoiding it.Note only use when safe/not completely counter productive.eg encourage client to allow anxiety at specific time when will have less impact but is then under client’s control. Sometimes prescribe the opposite behaviour eg controlling staying awake, which allows clients to learn letting go in time, such that they can fall asleep.
5. Self-management;client learns to observe and manage behaviours over time. Includes self-monitoring /recording, self contract, and self-reward. One of the most successful tools. But counsellor needs to help client set up and structure.
During self-monitoring, it is particularly important to pay attention to the moments leading up to a behaviour client wishes to reduce (eg cigarette smoking), but for behaviours client wants to increase eg moment of positive regard, is more important to pay attention to moments after event.
Charting and plotting progress overtime can be very beneficial.
SUCCESSIVE APPROXIMATION=process of learning easier parts of a complex skill before moving on to harder parts.
SKILL TRAINING-a behavioral intervention which involves composite of modelling, rehearsal, successive approximation, and feedback.
ASSERTION TRAINING-tool for overcoming social anxiety. Those who benefit from this have often absorbed the message that the rights of others supersede their own. Typically need to learn to be able to make requests, refuse requests, express positive and negative opinions, to initiate/continue/terminate social relations.
describe the kind of presenting issues can be treated using behavioural approaches
ANXIETY
has physiological, behavioural, affective and cognitive components. (Somatic anxiety-bodily sensations, cognitive anxiety-intrusive thoughts, unable to think clearly, performance anxiety-typically avoid situation)
1. RELAXATION TRAINING;
Most common form is Progressive Relaxation (or Muscle Relaxation).Used for Generalized Anxiety, stress, hypertension,psychosomatic disorders, insomnia, and an adjunct to general counselling. Also helps trust/rapport with counsellor. Basic premise is that anxiety and relaxation are 2 incompatible states.
2.SYSTEMATIC DESENSITISATION-based on the learning principles of classical conditioning. Uses Counterconditioning. Progressively once relaxed, exposed to minor anxiety-provoking scenario, to more, in controlled steps after having been ok with previous levels. Best tx for phobias. Inappropriate to do actually dangerous exposures. Takes an average of 10-30 sessions. Includes deep muscle relaxation training, construction of the hierarchy of emotion-provoking scenarios, and graduated pairing with relaxation state & imagery. do 3-5 items per half hour session. always end on a no anxiety item. Always go back to deep relaxation if any anxiety. Need to record items reached and duration of presentation etc. Always re-commence next session with an achieved item.
DEPRESSION
Behavioral activation is a goal of cognitive behavioral therapy (CBT), which aims to help people engage more often in enjoyable activities and improve their problem-solving skills. Cognition is not ignored, and changing cognitions is still a part of the therapy. Change in behaviour leads to changes in cognition and change in behaviour leads to a change in emotions.
examine the use of rewards in counselling and try these out on ourselves.
CONTRACTING-clients more likely to succeed if write and sign a formal contract with themself. Non legal but helps. The terms of the contract need to be well defined, achievable, and using rewards that are meaningful to client etc. Client must believe is equitable.Occasionally, might be beneficial to include sanctions eg if not achieve goal etc.Especially useful for children/adolescents because the terms are so concrete. For children, especially important that tasks have subcomponents which are also reward. Work better for many small rewards than 1 rare large one. Also best if at least some rewards the child is able to dispense themself eg free time, drawing etc.
REWARDS-need to be something client values, and appropriate and not in opposition to the overall goal. Counsellor needs to help structure what reward, how is given, and when. Sometimes rewards cannot be immediate but might give tokens etc to be cashed in later.Can work out value etc. Or can also gain reward by telling a significant other re progress. Rewards should always be given after success (or at least partial progress), not before. Rewards may be current reinforcers or potential (eg will occur sometime in the future eg new car etc).
GEMS
- Client must be able to understand relationship between behaviour and consequence before can commit to change. This appreciation takes time.
2.Models must be presented in ways that appeals to the client/can relate to. - Models who show coping as opposed to mastery of a skill etc may appeal more to clients.
- Behavioural rehearsal of role play is most useful when
a) client does not have certain skills and needs to acquire
b) client needs to learn to discriminate b/n appropriate/inappropriate behaviors
c). client’s anxiety re using skills needs to be dramatically reduced before can use the skills. - Behavioural practice can often reveal the truth re how client behaves as opposed to their description.
- There is a tendency for counsellors to terminate practice sessions too soon, before the client is truly comfortable.
HIERARCHIES OF DESENSITISATION
ie client and counsellor construct a hierarchy of least to most anxiety-provoking situations.Usually 10-20 items/situations, often rated on “Subjective Units of Disturbance Scale of 0 (no emotion) to 100 (complete panic).Client can rate them. Ideally have 1 item every 10 points.
1.Spatial-temporal;items relate to eg. distance from feared object or eg. time left before feared event. Useful for reducing anxiety re feared object/person/event
2.Thematic hierarchy-fear may increase/decrease depending on surrounding context. eg Fear of heights worse if clifftop has no safety rail etc.
3.Personal hierarchy-eg uncomfortable ruminations. Useful for overcoming conditioned responses to eg loss of job, relationship dissolution etc, avoidance behaviour etc.
CLIENT COMMITMENT TO SELF MANAGEMENT
- Will likely fail if goals are imposed by counsellor or society, as opposed to being client’s true goals.
2.A critical element of any self managed program is client needs to use the intervention frequently and consistently.
3.Clients using self reminders are very helpful-carrying a written list often works well. - Escape plans need to be revealed not hidden eg I’ll study every day except Sunday…or if my friend comes over….
- May be helpful to enlist positive support from someone.
- Counsellor needs to provide positive reinforcement and feedback and check in regularly.
DIALECTICAL BEHAVIOUR THERAPY
Uses affective & cognitive behavioural interventions with the goal that improved behaviour options will become self -evident once sufficiently demonstrated. Often uses groupwork and role-play.
