PSY343 - 5. Behaviour Therapy, Cognitive Therapy, Third Wave Therapies Flashcards
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History of Behavioural Therapies
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Closely linked patterns of thoughts + values first
developed in Enlightenment that emphasize reason and
science
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History of Behavioural Therapies
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• Emerged as a therapeu1c approach in the 1950s as an
alterna1ve to psychoanalysis
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History of Behavioural Therapies
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• Derived from behaviour change principles of operant
condi1oning and classical condi1oning
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History of Behavioural Therapies
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• Focuses on observable, explicit behaviours and their
interac1ons with the immediate environment
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History of Behavioural Therapies
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Assumptions of Behavioural Therapy
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- Most abnormal behaviour is acquired and maintained according to the same principles as normal
behaviour
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Assumptions of Behavioural Therapy
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- Most abnormal behaviour can be modified through the applica1on of social learning principles
- Assessment is con1nuous and focuses on the current determinants of behaviour
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Assumptions of Behavioural Therapy
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- People are best described by what they think, feel, and do in specific life situa1ons
- Treatment is derived from theory and experimental findings of scien1fic psychology
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Assumptions of Behavioural Therapy
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• 6. Treatment methods are precisely specified, replicable, and objec1vely evaluated
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Assumptions of Behavioural Therapy
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• 7. Treatment outcome is evaluated in terms of the ini1al induc1on of behaviour change, its
generaliza1on to the real life se_ng, and its maintenance over 1me
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Assumptions of Behavioural Therapy
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• 8. Treatment strategies are individually tailored to different problems in different individuals.
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Three Branches of Behaviour Therapy
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Countercondi1oning – operates from
principles of classical condi1oning
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Three Branches of Behaviour Therapy
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• Con1ngency Management – operates from
principles of operant condi1oning
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Three Branches of Behaviour Therapy
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• Cogni1ve-Behaviour Modifica1on – integrates
cogni1ve explana1ons and techniques
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Three Branches of Behaviour Therapy
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16
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Theory of Personality
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• No comprehensive theory of personality
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Theory of Personality
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• Environmental conditions control behaviour
more than internal personality traits
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Theory of Personality
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Theory of Psychopathology
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Slightly different depending on the branch of behaviour therapy
• Countercondi1oning: condi1oned anxiety leads to behavioural disorders
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Theory of Psychopathology
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• Con1ngency Management: human behaviour (adap1ve or
maladap1ve) is largely controlled by its consequences
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Theory of Psychopathology
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• Cogni1ve-Behavioural Modifica1on: psychopathology largely
due to deficits, excesses, or inappropriate cogni1on
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Theory of Psychopathology
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23
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Goal of Therapy
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To change the client’s specific maladap1ve
target behaviour to adap1ve behaviour
through interven1ons based on empirical
learning
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Goal of Therapy
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Goal of Therapy
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Therapy Process
Countercondi1oning – anxiety is learned through
condi1oning; can be unlearned through
countercondi1oning
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Therapy Process
• Con1ngency management – behaviour modifica1on
aUempts to control con1ngencies to shape and maintain
adap1ve behaviour and ex1nguish maladap1ve behaviour
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Therapy Process
• Cogni1ve-behaviour modifica1on – train clients to modify physiological ac1vity through cogni1on; challenge inappropriate or ineffec1ve cogni1ons; enhance problem solving deficits
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Therapy Process
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History of Cognitive Therapy
In the 1960s and 1970s, others began to reconsider the role of cogni1on in
psychiatric disorders:
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History of Cognitive Therapy
• Albert Ellis developed Ra1onal Emo1ve Behaviour Therapy (REBT), which
postulates that emo1onal distress primarily originates from one's evalua1ons
of an event, not from the event itself
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History of Cognitive Therapy
• Aaron T. Beck developed Cogni1ve Therapy, which theorizes that an
individual's affect and behaviour are determined largely from the way he or
she "structures the world" based on a_tudes and assump1ons derived from
previous experience
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History of Cognitive Therapy
• Subsequently, behavioural modifica1on and cogni1ve therapy techniques were
merged to form Cogni1ve Behavioural Therapy
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History of Cognitive Therapy
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History of Cognitive Therapy
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History of Cognitive Therapy
Humans respond primarily to cogni1ve
representa1ons of their environments rather
than to their actual environments
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History of Cognitive Therapy
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History of Cognitive Therapy
• Helps clients become more conscious of
maladap1ve cogni1ons and to replace them
with more adap1ve cogni1ons
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History of Cognitive Therapy
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History of Cognitive Therapy
The premise of Cogni1ve Behavioural Therapy (CBT) is that how people think
affects how they feel emo1onally and how they behave
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History of Cognitive Therapy
• Thoughts, emo1ons, behaviours interact and influence one another as part of a
reciprocal system; interven1on at any one point of the system affects chance
throughout the system
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History of Cognitive Therapy
• Just as ways of thinking, feeling, and behaving can be learnt, so can they be
unlearnt or modified
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History of Cognitive Therapy
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Key Concepts
Automa1c Thoughts – repe11ve, habitual self-statements (posi1ve or nega1ve),
that we say to ourselves oken outside of our awareness
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Key Concepts
• Occur spontaneously in response to situa1on, they do not arise from
reasoning
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Key Concepts
• Underlying Assump1ons - Oken shaped as If-Then statements, rules for living
(e.g., “If I am nice, then people will like me “)
• Core Beliefs – the most deeply-seated, stable beliefs about ourselves, they
underlie and produce automa1c thoughts
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Key Concepts
• Influence informa1on processing and organize understanding about ourselves,
others, and the future
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Key Concepts
* Remain dormant un1l ac1vated by stress or nega1ve life events
* They are difficult to access and difficult to change
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Key Concepts
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Theory of Psychopathology
Psychopathology originates in the clients
preconscious construc1ons of reality, which
represent the person’s underlying cogni1ve
organiza1on
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Theory of Psychopathology
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Theory of Psychopathology
• Content specificity hypothesis – underlying
cogni1ons vary with the behavioural disorder
of the client (e.g., cogni1ve triad in
depression)
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Theory of Psychopathology
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Goals of Therapy
To challenge thoughts about a par1cular situa1on by iden1fying the
cogni1ve distor1ons
• To help people iden1fy less threatening alterna1ves (in thinking,
behaviour)
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Goals of Therapy
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Goals of Therapy
* To test out these alterna1ves in the real world
| * To challenge the assump1ons that lead to the automa1c thoughts
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Goals of Therapy
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Therapy Process
Ini1al Stage
| • Symptom relief
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Therapy Process
* Middle and Later Stage
| * Focus shiks from client’s symptoms to client’s paUerns of thinking
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Therapy Process
• Termina1on
• Therapy ends when client’s goals have been reached and the client feels about
to prac1ce his or her new skills independently
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Therapy Process
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Therapy Process
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The Therapeutic Relationship
Collabora1ve Empiricism – The therapist and client are co-inves1gators, examining
the evidence to support or reject the client`s cogni1ons. Interpreta1ons or
assump1ons are treated as testable hypotheses
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The Therapeutic Relationship
• Guided Discovery – The therapist serves as a guide who elucidates problem
behaviour and errors in logic by designing new behavioural experimetns that lead
to the acquisi1on of new skills and perspec1ves
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The Therapeutic Relationship
• Socra1c Dialogue – The therapist engages in informa1onal ques1oning,
listening summarizing, and asking analy1cal/synthesizing ques1ons to promote new learning, clarify problems, and examine the meaning of
events for the individual
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The Therapeutic Relationship
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The Therapeutic Relationship
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Therapy Techniques
Cogni1ve restructuring – modifying the thinking process
• Thought Records - Iden1fying significant events and associated feelings,
automa1c thoughts, and behaviours
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Therapy Techniques
* Distancing – crea1ng space between person and their thoughts
* Relaxa1on, mindfulness, and distrac1on techniques
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Therapy Techniques
• Exposure - Gradually facing ac1vi1es which may have been avoided in the past
• Experimenta1on - Trying out new ways of behaving and reac1ng outside of
therapy
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Therapy Techniques
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Therapy Techniques
• Between-session homework – Helps client maintain gains, generalize skills outside
of therapy; produce greater outcomes than in-session only work (Kazan1s et al.,
2000)
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Video of Cognitive Therapy
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History of ‘Third Wave’ Behavioural Therapies
Third wave behavioural therapies (e.g., ACT,
DBT, mindfulness-based approaches)
incorporate acceptance and mindfulness
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History of ‘Third Wave’ Behavioural Therapies
• Integra1on of Western and Eastern
| philosophies
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History of ‘Third Wave’ Behavioural Therapies
• Focus on no1cing and accep1ng experience
| rather than trying to control it
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History of ‘Third Wave’ Behavioural Therapies
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History of Dialectical Behaviour Therapy
Developed within the context of chronically suicidal pa1ents with Borderline Personality Disorder (BPD)
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History of Dialectical Behaviour Therapy
• Clients experienced change focused strategies as
invalida1ng, which led to increased emo1on
dysregula1on
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History of Dialectical Behaviour Therapy
• Emo1on dysregula1on - difficul1es increasing,
| decreasing or maintaining emo1on as required or in a specific context
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History of Dialectical Behaviour Therapy
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Dialectical Behaviour Therapy
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Acceptance
Dialec1cal Behaviour Therapy
Valida1on, Mindfulness
Problem Solving,
Behavioural Analysis
Change
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Dialectical Behaviour Therapy
Synthesis
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Dialectical Behaviour Therapy
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Theoretical Foundation of DBT
Learning Theory
• All behaviour is learned and behavioural change occurs
via the principles of learning.
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Theoretical Foundation of DBT
• Zen Philosophy
• Suffering stems from being aUachment to things being a
par1cular way and decreasing suffering involves
accep1ng reality.
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Theoretical Foundation of DBT
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Theoretical Foundation of DBT
Dialec%cal Philosophy
• There is no absolute truth; extreme posi1ons can both
contain a kernel of truth. Change involves the synthesis
of elements from each pole.
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Theory of Personality
Biosocial Theory in DBT:
• Emo1on dysregula1on is the result of an
interac1on between a biological sensi1vity to
emo1on AND an environment that is
invalida1ng
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Theory of Personality
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Theory of Personality
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Theory of Psychopathology
Emo1on dysregula1on is the underlying issue
| driving problema1c behaviours
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Theory of Psychopathology
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Theory of Psychopathology
• Func1on of impulsive or self-destruc1ve
behaviours: An aUempt to solve the problem
of emo1on dysregula1on
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Theory of Psychopathology
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Goals of DBT
Eliminate life-threatening behaviors
• Self-harm, suicidal behaviours/thoughts
• Address anything that gets in the way of therapy (both client and therapist behaviours)
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Goals of DBT
* Absences, lateness, not being prepared, conflict, etc.
| * Address issues that impact quality of life
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Goals of DBT
• Rela1onships, work/employment, housing, substance use,
| mood and/or anxiety problems, etc.
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Goals of DBT
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How are these goals achieved?
Individual Therapy
• Weekly sessions
• Personalized applica1on of skills
• Diary cards and homework
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How are these goals achieved?
* Skills Group
* Teaches effec1ve ways to cope with distress
* Mindfulness, Emo1on Regula1on, Interpersonal Effec1veness, and Distress Tolerance
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How are these goals achieved?
* Homework to generalize skills
| * Phone and in-person coaching
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How are these goals achieved?
* Access support to use the skills in moments of crisis and “in real life”
* Consulta1on Team
* Provides support and mo1va1on to therapists
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How are these goals achieved?
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DBT Modules
Content of Group Sessions by Module:
| •Mindfulness: Awareness and acceptance of the present moment
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DBT Modules
• Distress Tolerance: Having urges without ac1ng on them
• Emo%on Regula%on: Understanding emo1ons; increasing posi1ve and
decreasing nega1ve emo1ons
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DBT Modules
• Interpersonal Effec%veness: Asking for what you want in a way that makes
the other person want to give it to you
• Walking the Middle Path: Learning “both-and” thinking, how to validate self
and others, and principles of behaviourism
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DBT Modules
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DBT Modules
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Therapeutic Relationship
Warm, genuine, direct, transparent
• Valida1on:
• Seeing the world from another’s perspec1ve
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Therapeutic Relationship
• Communica1ng to another that his/her feelings,
thoughts, behaviours make sense or are
understandable in some way
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Therapeutic Relationship
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Therapy Techniques
Behavioural analysis
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Therapy Techniques
• Exposure
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Therapy Techniques
• Mindfulness
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Therapy Techniques
• Behavioural experiments
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Therapy Techniques
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Psychotherapy Research
Lambert and Oogles (2004) found that behaviour and cogni1ve therapies result in greater improvements than other theore1cal orienta1ons, especially psychodynamic therapy
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Psychotherapy Research
• When allegiance effects are controlled for, behavioural and
cogni1ve therapies show equivalent effects to other
treatments
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Psychotherapy Research
• Third Wave Therapies
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Psychotherapy Research
* DBT effec1ve for trea1ng Borderline Personality Disorder
| * Equivalent to other BPD-specific treatments (eg. mentaliza1on-based tx)
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Psychotherapy Research
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