PSYC 501

Question 1

Acceptance and Commitment Therapy

Answer 1

What: 3rd generational behavioral therapy that says psychopathology comes from experiential avoidance and cognitive fusion. The primary goal of ACT is to create psychological flexibility. The 6 therapeutic components are: (1) be here now, (2) diffusion, (3) acceptance, (4) self as context, (5) values, and (6) committed action.
Where: ACT uses verbal and cognitive processes to undermine attention to the present moment and an attitude of acceptance
Who: Steven Hayes, third generation therapy
When: evidence of cognitive fusion, psychological rigidness
Why: This therapy is important because it is an added toolset that has proven to work for many patients. We can help clients accept their current circumstances and learn to commit to ways to feel better and move forward
EX: A patient presents with symptoms of depression and chronic pain. The pain they live with is due to an autoimmune disorder with no cure. The depressive symptoms seem to stem from the patient’s inability to change her disorder and the pain that accompanies it. The therapist recommends ACT to help the patient shift her expectations about living pain free, to living as well as she can in accordance with her values while accepting her pain and disorder.

Question 2

Ambivalence

Answer 2

What: having mixed feelings about something and seeing reasons to change and reasons not to change. There are both pros and cons to change or not in the client’s mind. The simultaneous existence of contradictory feelings and attitudes toward the same person, object, event, or situation.
Where: Motivational Interviewing, derived from the Cognitive Dissonance Theory which involves a psychological discomfort
When: used in MI and the experience of Ambivalence when treating Substance use disorders
Why: The term helps us conceptualize how a client may be feeling. Helps name an emotion that some patients do not come to understand. Giving this feeling a name can help us validate our patient’s feelings and choices
EX: Carl who has a drinking problem came to treatment because his daughter won’t let him see her kids until he gets his drinking under control. He doesn’t feel like he has a problem but wants to see his grandkids. He is now in a state of ambivalence because his values are not aligning

Question 3

Anxiety/Fear Hierarchy

Answer 3

What: a breakdown of a person’s feared stimuli into components, ordered in terms of how much subjective distress they produce. Client is led through either imaginal or in vivo exposure to each item on the hierarchy. The list is organized from the things that produce the least intense fear response (low subjective unit of distress SUDs) to the things that produce the most intense fear response (high SUDs).
Where: A tool used in exposure therapy
When: used with GAD, PTSD, etc
Why: a tool we can use to help our patients and show them that they are capable of overcoming their fear/anxiety/PTSD.
EX: : Laura has a debilitating fear of bugs and if she is even in the same room as one will have a panic attack. Using a fear hierarchy to list which situations and which bugs induce the most to least fear. The counselor will introduce a bug in a container sitting across the room, then bring the container closer, then have the bug out of the container close to her, and finally hold the bug. Each time her anxiety will be reduced until she no longer elicits anxiety.

Question 4

Assets

Answer 4

What: In the ABCPA behavioral assessment model, assets are skills or strengths an individual has that may prove useful during the therapeutic process.
Where: Behavioral assessment
When: Used to track what happens before and after a behavior, and the strengths someone has to either change that behavior or increase in frequency
Why: This is important because it helps bring positive aspects of the client into the therapy room to promote client success in reaching their goals. Helps us get a better understanding of how they may respond to treatment and how invested they are in their own therapeutic journey
EX: Mariela is experiencing depression and is feeling hopeless about the future. She doesn’t see anything changing but through conversation you discover she has a really good job and strong social support. Highlighting these aspects for the client and using them as part of her treatment plan is vital.

Question 5

Automatic Thought

Answer 5

What: Conditioned ideas that arise quickly and spontaneously in response to particular stimuli: cognitive distortions like dichotomous thinking, personalization, and emotional reasoning, etc.
Where: Cognitive Therapy
Who: Aaron Beck
When: patient and therapist monitor, identify, and categorize dysfunctional automatic thoughts; hypotheses
Why: Helping individuals to become aware of the presence and impact of negative automatic thoughts, and then to test their validity, is a central task of cognitive therapy. Automatic thoughts can help us explore those underlying assumptions and schemas that are harming the patient and causing distress
EX: Craig got a new job and his coworkers won’t sit with him at lunch. He says that he is worthless, and people don’t like him. This is an automatic thought as this appears plausible to him. In CT, the therapist will target these and get to the schema/core beliefs that Craig has.

Question 6

Behavioral Activation Therapy

Answer 6

What: This is an intervention that explicitly aims to increase an individual’s engagement in valued life activities through guided goal setting to bring about improvements in thoughts, mood, and quality of life
Where: behavioral model of depression/behavioral therapy
Who: Lewinsohn,
When: Used for clients with depression and occurs via self monitoring of activities and mood, scheduling activities and master/pleasure ratings. It is a good option to offer clients who are willing to participate in their treatment
Why: Understand and conceptualize why depression may happen on a behavioral level. Also a tool to use to help clients who come in depressed.
EX: Sarah comes to therapy because she is struggling with symptoms of always feeling tired, and not wanting to do anything anymore. Through discussion, the therapist finds out that she used to love to go on a morning walk with her dog and get dinner with her friends but doesn’t enjoy doing it anymore. Using behavioral activation and an activity schedule, they will start with taking her dog on a short walk and scheduling one dinner a week with her friends. This will provide positive reinforcement and she will find enjoyment in these activities again

Question 7

Behavioral Parent Training/Therapy

Answer 7

What: Therapist teaches parents to work with their child positively, set appropriate limits, to act consistently, be fair with discipline, and establish more appropriate expectations regarding the child. PCIT has two phases: child directed interactions and parent directed interactions. Goal: increase parent clear direct age appropriate instructions, consistent and appropriate reinforcement for desirable bxs, and consistent/appropriate punishment for non compliant/disruptive bx. Token economy, positive reinforcement, differential reinforcement, response cost.
Where: Family intervention therapy, behavioral therapy
Who: PCIT developed by Eyeberg
When: Child parent relationship is strained due to child behavior and parental management of behavior.
Why: a type of therapy that can increase parental responsiveness and establish a secure and nurturing relationship
EX: Parents bring their child to treatment because of family problems at home. Lots of fighting, and the child has begun running away from home. When the child comes back, they often get into a verbal fight, but there are no other consequences. Therapist suggests Parent-Child Training Therapy so that the parents can work on being more responsive as well as setting limits and creating a consistent way to discipline

Question 8

Behavior Therapy

Answer 8

What: type of psychotherapy that uses principles of ‘learning’ and ‘conditioning’ to reduce maladaptive behavior and to increase adaptive behaviors. Based on Pavlov’s classical conditioning theory and focused on problem bxs that were directly observable. Present focused and generally brief. Focus is on behavior itself and the contingencies and environmental factors that reinforce that behavior, not find the cause of it.
Who: Pavlov, Wolpe, Watson, or Skinner
When: used to decrease maladaptive behaviors and start positively reinforcing enjoyable activities
Why: You must clarify the client’s problem, formulate initial goals for therapy, identify target behavior, design a treatment plan, and evaluate the success of the treatment plan. A great tool to use for anxiety or depression. Helps us understand how behavior influences our everyday life
EX: Lucas, an 8 year old client, was brought to therapy because he was acting out in class, at home and throwing things when he doesn’t get his way. The therapist uses principles of behavior therapy and positive reinforcement for when Lucas does not throw something when he gets angry. He will receive a sticker every time he engages in positive behavior.

Question 9

Chaining

Answer 9

What: instructional procedure based on operant conditioning, used to teach a person to engage in a complex behavior that has multiple components. Forward chaining — teach each step along the way and Backward chaining — teach the whole sequence coaching each one along the way.
When: Used for training behavioral sequences (or ‘chains’ ) that are beyond the current repertoire of the learner such as in ABA therapy with children with autism
Why: type of skill/technique that is used for those with disabilities. You can use it with clients who are not improving with other types of behavioral therapies
EX: An autistic child learning to wash her hands independently. Therapist implements the chaining process: Task analysis breaks it down into: learning to turn on the faucet, rinse hands, lather soap, rinse hands, turn off faucet, dry hands on towel. Therapist reinforces successive elements of the chain: After child master’s step 1, the parent is sure to praise him and provide positive reinforcement. Then the child moves on to step 2 and so on. Important that the therapist goes back and works on any link in the chain process that seems weak.

Question 10

Classical/Respondent Conditioning

Answer 10

What: a form of associative learning in which an US (naturally and automatically) produces a response and is paired with a CS (previous NS) in order to evoke an UR. UR is unlearned and a natural response. Eventually, US is removed and CS elicits CR on its own. Stages: (A,E,SR,RC,CC): acquisition, extinction, spontaneous recovery, reconditioning, and counterconditioning.
Who: Pavlov, associative learning
When: can happen any time during life, used for teaching/learning
Why: Early foundation for behavioral therapy and how we see behavior as a result of a stimulus. Conceptualize how a client has learned certain behaviors that may elicit mental disorders
EX: Mary is scared of loud noises (UCS) and evokes a fear response (UCR) if you were to pair a specific image (CS) with the loud noise, this would evoke a fear response in Mary (CR) even without the loud noise occurring. This is a way to explain the maintenance of her fear response towards loud noises

Question 11

Cognitive Fusion

Answer 11

What: Part of ACT and is the over identification with one’s thoughts in a way that has a negative influence on action and awareness. This leads to psychological inflexibility and is the tendency to take thoughts literally. You think and believe the maladaptive thoughts.
Where: one of 6 core therapeutic processes in ACT
Who: Steven Hayes, ACT
When: when a client has maladaptive thoughts they can’t separate from reality in ACT
Why: help a client recognize cognitive fusion in themselves can help them detach from their thoughts and improve psychological flexibility
EX: Betsy, a 31 year old client, comes into therapy and says that she is “stupid and worthless.” This leads to her thinking she actually is stupid and worthless. This is cognitive fusion, the connection of thoughts and reality.

Question 12

Cognitive Restructuring

Answer 12

What: therapeutic technique which teaches to identify and change distorted/maladaptive cognitions. It’s based on idea client has excess of maladaptive thoughts, helps client self talk and encourages client to identify and then challenge maladaptive thoughts
Where: cognitive and behavioral change, REBT (rational emotive behavior therapy), thought-stopping
Who: Aaron Beck, part of cognitive therapy
When: Relevant for challenging maladaptive thoughts
Why: This is important because it helps the client to explore more adaptive alternatives
EX: Dana comes into therapy experiencing social phobia. She has thoughts of “I will embarrass myself in front of new people.” The therapist will challenge the validity of these statements and ask “what evidence do you have for and against this belief?”

Question 13

Cognitive Therapy

Answer 13

What: uses cognitions as origin of maladaptive emotions and behaviors. Targets cognitive changes to develop adaptive emotional and behavioral responses. The client is the expert. Cognitions are triggered by automatic thoughts.
Where: 501
Who: Aaron Beck, clients with depression and maladaptive thought patterns
When: relevant when working with issues with automatic thoughts, schemas, and core beliefs (cognitive distortions)
Why: It provides skills for adaptive thinking, Goal = correct faulty information and focus more on the present. Emphasizes collaboration between therapist and client.
EX: A Grad student comes into therapy experiencing great anxiety about her comps exam in the fall. She reports having thoughts like, “I’m stupid, I can’t do this,” etc. when she sits down to study. The cognitive therapist points out these automatic thoughts and uses the downward arrow technique to begin exploring the client’s schemas and core beliefs so that they can work to change/correct them

Question 14

Cue Exposure Therapy

Answer 14

What: a specialized form of exposure therapy with response preventions and is used for SUD, OCD, and eating disorders. Client is exposed to cue for eating/substance abuse/obsessive thoughts but is unable to eat, use drugs, or engage in compulsions.
Where: exposure therapy, cbt,
Who: Ivan Pavlov (classical conditioning)
When: enhancing coping strategies and skills, used for previously mentioned disorders
Why: goal is extinction, decrease responsiveness to cues, Helps us see/understand how a client reacts to treatment, if they are ready, and observe their reaction to difficult cues
EX: The therapist uses cue exposure to help Kyra with her urge to drink alcohol by exposing her to sitting at a bar. The therapist discusses coping strategies to engage in when she is experiencing urges

Question 15

Decisional-Balance Matrix

Answer 15

What: technique used in Motivational interviewing and ambivalence in people engaged in harmful behaviors. A matrix of pros and cons of making a change or staying the same. Categories of matrix are: advantages of status quo, disadvantages of status quo, advantages of change, disadvantages of change.
Where: contemplative and determinism stages of MI when working through ambivalence
Who: James O. Prochaska (stages of change) John Norcoss
When: when a client is experiencing ambivalence
Why: Helps us understand why a client is in the position they are in. Seeing their opinions on reasons for and against change will help treatment planning and how to best approach their disorder
EX: Jeremy is partaking in motivational interviewing due to alcohol use. He is experiencing ambivalence about his drinking and whether to stop or not. Using a decision-balance matrix, Jeremy will write out the pros and cons of continuing to drink or stopping

Question 16

Dialectical Behavior Therapy (DBT)

Answer 16

What: Third generational behavior therapy that focuses on both validating and accepting a client’s experience and helping them develop strategies or problem-solving behaviors that lead to positive changes in their life. 4 main focuses: creating mindfulness, develop interpersonal effectiveness skills, emotion regulation skills, and increasing distress tolerance.
Where:
Who: Marsha Linehan, Originally for suicidality, self harm, and BPD
When: Used
Why: a valuable option for those who do not respond to other forms of treatment. And it is a great way to create positive changes in functioning and lives
EX: Marissa has been diagnosed with borderline personality disorder and is extremely suicidal with a recent trigger of a fall out with her mom. Using the validation/acceptance strategies, the therapist will validate these feelings by saying “this can be very upsetting and it makes sense that you want to alleviate your pain like this, but what would happen if we practices other ways to alleviate the pain” It creates a problem-solving environment”

Question 17

Differential Reinforcement

Answer 17

What: used when there is a behavior being performed that is attempting to be changed. The goal is to decrease undesirable behavior by reinforcing a desirable alternative behavior. The five types from most to least effective are differential reinforcement of incompatible behaviors, competing behaviors, alternative behaviors, any other behavior, and low response rates
DRO - no alternative behavior is identified, and the individual reinforced only when NOT performing target bx (reinforcement contingent on absence of behavior).
DRA - decreasing a problem bx by reinforcing a desirable alternative one.
DRL - lower rate of a bx is reinforced to decrease rate and a reinforcer is given if bx occurs less than ‘x’ amount of times
Where: Applied Behavioral Analysis
When: increase/decrease a bx, not necessarily just stop it.
Why: more pt engages in desired bx the less opportunity they have to engage in undesired bx
EX: Sam, a 10-year-old boy, is throwing chairs in class when he gets frustrated learning. When he threw the chair, he got more attention from his teacher which reinforced his aggressive behavior. Using DRO, the teacher can reinforce any other behavior besides the chair throwing.

Question 18

Discriminative Stimulus

Answer 18

What: a stimulus that helps the learner distinguish between situations in which a given response will be reinforced and situations in which the same response will not be reinforced. The stimulus does not provoke the response, but instead signals to the learner that the situation is appropriate for that response.
Where: operant conditioning
When: Discriminative stimulus → response → reinforcement. Often called ABCs (antecedent, behavior, consequence). Three term contingency
Why: being able to differentiate between stimuli can help in cue exposure therapy and having patients be able to respond to the appropriate stimuli. Consequence is contingent on the occurrence of the behavior only in the presence of the specific antecedent stimuli
EX: Lucy is researching operant conditioning in children. In her process she wants to make sure the children only respond to her original stimulus, the color red. LeeAnn does not want the children to respond to magenta or pink. Only the original stimulus will elicit that response

Question 19

Escape/Avoidance

Answer 19

What: Escape - when the occurrence of bx results in termination of aversive stimulus that was already present when the behavior occurred. Avoidance - the occurrence of the bx prevents the presentation of the aversive stimulus. Both cases the bx is strengthened.
Where: operant conditioning
When: negative reinforcement. escape learning the individual has relief from the aversive stimulus and avoidance learning the individual experience relief from the anxiety of “almost” experiencing aversive stimulus
Why: understand how maladaptive behaviors have been reinforced. People escape or avoid something difficult which has led them to putting off the ‘aversive’ stimulus, but now has caused distress in their life.
EX: You are treating a client with a phobia of dogs. Like most typical phobia patients, he does not go anywhere that there might be dogs present. During the psychoeducation phase of treatment, you explain to him that avoidance is maintaining his phobia of dogs. Because he is avoiding all interactions with dogs, the potential for an unpleasant interaction with one is removed, thereby negatively reinforcing his fear

Question 20

Exposure with Response Prevention (ERP)

Answer 20

What: client is exposed to fearful cues and therapist prevents escape/avoidance both behavioral and cognitive. Obtain a detailed description of the situation and context of the problem, define explicit behavior, thought, and feelings leading up to it and explore consequences. Use coping mechanisms to prevent avoidance/escape.
Where: Exposure therapy, behavioral therapy, classical and operant conditioning
When: Empirically effective and gold standard for OCD. OCD, SUD, eating disorders with purging subtype.
Why: Therapist can help the client reinforce and use the coping mechanisms they have learned
EX: You are utilizing ERP with a client that has bulimia nervosa. You have pt eat her favorite binging food in a therapeutic setting until she begins experiencing the urge to purge (anxiety). Purging (escape) is prevented and fear gradually decreases over time. You stay w/ Pt and help her engage in coping skills. Her binge urge and associated anxiety subsides slightly after some time has passed. It shows her that the urge to purge can go away with time, without actually purging.

Question 21

Extinction

Answer 21

What: The association between CS and UCS is broken and the CR is extinguished. Behavior is no longer reinforced and thus gradually stops occurring. More effective when paired with other therapies, like DR. Learning preserved
Where: behavioral therapy, classical/operant conditioning
Who: Pavlov/Skinner
When: trying to stop a behavior
Why: Goal - eliminate or stop maladaptive bx. Important process for helping patients de-associate specific stimuli that produce anxiety, fear, or other maladaptive bx or psychological patterns
EX: A parent brings her child to therapy for frequent outbursts at home especially during dinner and before bed. The child often hides under the table or intentionally throws his food on the floor. When asked what the parents do in response to the outbursts, they report picking the child up, cuddling them, and sometimes laughing at their silly behavior. The therapist explains that the child has come to associate his behavior with positive consequences and asks the parents to ignore his outbursts going forward in an attempt to break the association between outbursts and positive consequences. Eventually, the child learns he will not receive attention. This is the process of extinction.

Question 22

Functional/Behavioral Analysis

Answer 22

What: the primary way of behaviorists to identify and assess the purpose and meaning of a client’s behavior. Uses ABCPA model. Individualized, focused on present, directly samples relevant bx, narrow focus.
Antecedent- what happens before the bx,
Behavior - the bx itself, explicitly identified,
Consequences - what happens after the bx,
Person variables - expectations, variables, skills, self talk, or evaluation,
Assets - what does the person do well? Use behavioral descriptors, not traits.
Where: clinical assessment in behavioral therapy.
When: used to identify a behavioral problem
Why: help us deliberately narrow down on a maladaptive bx of a client. Use this chart to visualize to the client how this bx keeps occurring and can lead into treatment options. Once the client develops self-awareness, from the chart, we can talk about ways to decrease the maladaptive bx.
EX: A 35 year old woman has come to treatment for a problem with overeating. The therapist conducts a functional analysis by examining the problem bx. The behavior (B) is overeating - considered a behavioral excess. The Antecedents (A) that she reports feeling stressed or upset frequently at night time. The reinforcing consequences (C) of the behavior is the pleasure that comes from eating and the distraction from the upsetting emotions. However, she is also experiencing the negative consequences of gaining weight. Therapist and client come up with the list of client assets and person variables that will help in treatment plan

Question 23

Generalization and Discrimination

Answer 23

What: Generalization- when the CR occurs in presence of other stimuli that are similar in some way to the original US. Discrimination- the ability to differentiate between similar stimuli
Where: Classical conditioning
Who: Little Albert
Why: important for exposure therapy, also a way for therapist to conceptualize client’s fears
EX: In the classic “Little Albert” experiment, Watson conditioned baby Albert to fear a white rat. Some time after, researchers noticed that baby Albert was also fearful of other white fluffy things like rabbits, dogs, Santa Claus’s beard, etc. Albert had generalized his fear to other similar stimuli. If baby Albert began only showing fear in response to the white rat, he would be demonstrating discrimination

Question 24

Exposure Therapy

Answer 24

What: type of therapy exposes clients under safe and controlled conditions to anxiety provoking stimuli. The goal of this therapy is to allow clients to help gain control of their fear and stop restricting their lives around it. It enhances processing of feared stimuli and they learn that they can tolerate the distress as well as their expectation of stimuli are inaccurate. It involves extinction and habituation. A few keys to exposure therapy are anxiety must be induced during exposure, the anxiety must peak and begin decline, and consent with a strong therapeutic relationship are important. There are 2 paradigms, brief/graduated and prolonged/intense and this can be done in vivo or imaginal.
Where: behavioral therapy, technique used in cognitive behavioral therapy.
Who: Taylor and Wolpe
When: SUD, anxiety, panic disorders, eating disorders, OCD
Why: cognitive processing is very helpful and many think it is a crucial component. Combining both the cognitive and behavioral aspects can help us understand and treat the patient from more than one perspective/approach. therapeutic alliance is important because the dropout rate is very high.
EX: : Eric, is doing exposure therapy for his fear of rats. This will be done in a graduated paradigm and will be done starting imaginally and then in vivo. He will first picture a rat next to him and then on him. Later in sessions, the therapist can bring a rat into session to have him experience anxiety around it and reduce it. This can also be done in the natural environment.

Question 25

In vivo vs Imaginal Exposure

Answer 25

What: In vivo exposure involves facing the fear directly in real life and the natural environment. Clients can serve as their own change agents and people in the clients life can be taught how to perform in vivo exposure. Imaginal exposure involves vividly imagining the fear and is useful for events that can not be seen in real life like war, natural disasters and trauma.
Where: different exposure therapies
When: anxiety, SUD, eating disorders, panic disorder, PTSD. Can be gradual (short period, climb fear hierarchy) or prolonged (long period, high intensity)
Why: This is important because both of these types of exposure allow the client to be immersed in their fear and target the anxiety provoking reaction to the fear in a safe environment.
EX: You’re working with a client that has an intense fear of snakes. After discussing it with the client, you both agree that in vivo exposure is the way to go. You instruct the client to handle a snake for increasing amounts of times in the next several sessions as part of the treatment for the phobia.

Question 26

Learned Helplessness

Answer 26

What: exposure to frequent uncontrollable punishment produces apathy, passivity, and depression. A condition in which a person suffers from a sense of powerlessness, arising from a traumatic event or persistent failure to succeed. Failing to use actions that may be available. Lack of control over environmental things
Where: CBT/501
Who: Seligman and Maier
When: person learns its helpless in aversive situations that control is lost and so they give up
Why: can explain maladaptive thought patterns and behaviors that have led to depression
EX: Gina is experiencing depression and is feeling worthless and that there is nothing to live for. Both of her parents died in the same year when she was young and she experienced bullying at a young age. These are a few events she has not had control over but years later is not setting any goals or putting work in to get better. Gina has learned helplessness and it is reinforcing her depression.

Question 27

Learning-Performance Distinction

Answer 27

What: stresses the difference between the learning of a behavior and actual performance of the behavior. Learning - internal cognitive process requiring attention and retention. Change in ability and potential to do the behavior. Performance - external process that requires reproduction and motivation.
Where: concept in behaviorism
Who: Tolman showed the difference between learning/performance with his rat study. Rewards seem to affect performance over learning. Rats developed cognitive maps of mazes.
When: teaching a behavior and seeing how well a person has retained that information and/or how well they can execute that bx
Why: understanding the distinction can help us in using behavior as a positive reinforcer (for depression) for good things, but only if the person is ‘performing’ this behavior accurately. We need to know if patients learn the skills we teach them, but are they performing them outside the room, in everyday life?
EX: Client comes to therapy with issues of self-esteem and anxiety over talking to their peers at work. Therapist teaches client assertiveness and social skills. The therapist is aware of the learning performance distinction, and is sure that after modeling behavior himself, the client is given an opportunity to reproduce the new learned behaviors.

Question 28

Mindfulness

Answer 28

What: emphasized acceptance of psychological discomfort and the practice of being fully aware and accepting of the present moment. Observe thoughts and feelings rather than judge them
Where: core theme in 3rd generational behavior therapies-ACT, MBCT, DBT
Who: ^ used in these therapies
When: used in 3rd generation therapies like ACT, DBT and MBCT to help people move towards acceptance, work on goals, create a life worth living and be an observer to your situation and emotions.
Why: Goal is not to relax but to foster non judgmental observation of the current state. Teaching / guiding clients with this skill is very helpful in creating self-awareness. Mindfulness can bring attention to present problems and therefore help accept these problems. It seems to be the basis of many modern therapies that have proven effective.
EX: Therapist is going to teach mindfulness skills to help a pt cope with PTSD symptoms. Pt describes feeling distracted and preoccupied with unpleasant thoughts about the past , (rumination) or the future (worry) . Therapist introduces mindfulness by saying that part of mindfulness is being in touch with the present moment and an aspect of this skill is being an active participant in experiences instead of just “going through the motions.”

Question 29

Modeling

Answer 29

What: process in social learning theory that occurs through observation of other people’s behaviors and consequences. 4 modeling steps: (A,R,R/P, F/M): attentional, retention, reproduction/performance, and feedback/motivation. The types of modeling are symbolic (tv, books) and covert (imagining).
Where: part of social learning theory, Vicarious learning - one individual demonstrates behavior and is reinforced/punished for it, another watching the bx is either more/less likely to perform.
Who: Albert Bandura (social learning)
When: used in self instructional training and when teaching certain skills
Why: knowing this concept can help therapists understand how children may pick up on certain habits from parents via modeling and then also how to change them
EX: A couple brings their child into therapy due to violent outbursts in school. It was discovered that through the process of modeling, the young boy had learned the violent behavior from his father. He learned that violence is the best way to get your way. This served as proper motivation for the behavior to continue.

Question 30

Motivational Interviewing

Answer 30

What: Collaborative, conversational, person-centered counseling style to address ambivalence about change extending from cognitive dissonance theory. Particular attention to language is important as MI is designed to strengthen personal motivation and commitment to a goal by eliciting a person’s own reasons for change.
Where: Substance Use Disorders, stages of change (transtheoretical model)
When: used especially when the client is feeling ambivalence
EX: Danny comes to therapy for his alcohol abuse. He states that “he has fun drinking with his friends and doesn’t want to stop” but his family thinks he has a problem as he just got fired from his job for being drunk. He is reaching a state of ambivalence and through socratic questioning, decisional balance matrix he finds the personal motivation to change and stop drinking “so I can get a job again”

Question 31

Negative Reinforcement

Answer 31

What: removal of something aversive following the behavior, increasing the likelihood the behavior will occur in the future. Includes escape and avoidance = types of negative reinforcement.
Where: operant conditioning/behavioral
Who: Eric Skinner, operant conditioning
When: this is used to increase behavior
Why: This is important because it is very relevant in the maintenance of fears, anxiety and phobias as well as the treatment of them. can help explain why patients may be repeating maladaptive behaviors, it is because they have negatively reinforced them and understanding fears/phobias, etc.
EX: Erica comes into therapy because she is experiencing extreme social anxiety, she attempts to go to places with her friends but she experiences anxiety when she is there that “no one likes her or wants her there” to avoid this she leaves and goes home. This is negatively reinforcing her avoidance behaviors associated with her social anxiety.

Question 32

Operant Conditioning

Answer 32

What: any response that is followed by a reinforcing stimulus tends to be repeated, and a reinforcing stimulus is anything that increases operant bx. the use of consequences to modify the occurrence and form of behavior. Bx is strengthened/increased via positive and negative reinforcement - increasing bx by either adding desirable stimulus or removing aversive stimulus. Punishment. Reinforcement = increase bx and punishment = decrease a bx.
Where: law of effect, part of behaviorism
Who: Eric Skinner
When: used when trying to increase or decrease a bx
Why: helps us conceptualize depression, anxiety, OCD - all of which are thought to be persistent disorders because the patient is either positively or negatively reinforcing a stimulus, resulting in maladaptive behavior, how we conceptualize the way a bx persists, or stops, can help us better understand our patient and how to approach treatment
EX: The schizophrenic pt was very anti-social. In order for the pt to increase his social activities, the therapist instructed staff to only allow the pt to watch TV after he engaged in 30 minutes of social activities. This reward of watching TV (POS. reinforce) increased his social bx indicating operant conditioning had been implemented and was successful.

Question 33

Positive Reinforcement

Answer 33

What: The addition of a positive/desirable stimulus following a behavior causing that behavior to increase in frequency. Can be used via contingency management to change bx
Where: operant conditioning in behaviorism
Who: Eric Skinner
When: part of behavioral activation was designed based on positive reinforcement ideas.
Why: It is important to understand the maintenance of problem behaviors and behavioral activation was based on this principle.
EX: In behavioral activation, a client who is depressed will make a plan to go on a walk every morning to help start their day. After the walk, the client feels a bit more motivated to complete another task. This is positive reinforcement improving depressive symptoms

Question 34

Premack Principle

Answer 34

What: Refers to a process/learning principle by which one attempts to increase the frequency of a particular bx by making the performance of that bx contingent on performing a more frequently occurring bx. Not done simultaneously & High probability behavior must not be occurring so often that it loses its effectiveness in motivating clients to engage in the low-probability behavior.
Where: Used in operant conditioning as a reinforcement tactic
Who: Premack
Why: Therapists can use this tool to make a bx increase by doing something the client enjoys, increasing patients overall wellbeing.
EX: If the behavior of a child brushing their teeth is not performed, but they will play on the phone every night before bed, before they play on their phone, they must brush their teeth first.

Question 35

Punishment

Answer 35

What: principle of operant conditioning used to decrease a behavior. Positive punishment - adding aversive stimulus to decrease bx. Negative punishment - taking away desirable stimulus to decrease bx.
Where: When conditioning behavior; effects are instant and extinction may take hours but it only temporarily suppresses the target bx and does NOT establish a new desirable one.
Who: Eric Skinner, operant conditioning
When: getting rid of a behavior quickly
Why: Knowing the disadvantages of this can help therapists to understand how punishment may bring about aggression and fearfulness. Both of which could result in anxiety or PTSD, especially if punishment is repeated.
EX: A parent uses spanking as a form of positive punishment when their child is acting out. This is leading to negative emotional and behavioral consequences in the child. Adding the aversive stimulus to the situation after maladaptive behavior is performed

Question 36

Self-Monitoring

Answer 36

What: a method used in behavioral management in which individuals keep a record of their behavior (e.g., time spent, form and place of occurrence, feelings during performance), especially in connection with efforts to change or control the self.
Where: used in all kinds of therapy
Why: Self monitoring, like direct observation, is subject to reactivity of monitoring in that a person may decrease an undesired behavior unconsciously when they start monitoring that behavior. Those with high self monitoring capabilities are able to alter their behavior to fit a wide variety of situations yet those with low self monitoring are more consistent across situations.
EX: Melanie came to therapy presenting symptoms of OCD - she was frequently washing her hands and it had come to severely disrupt her personal, professional, & social life. The therapist asked Melanie to keep a diary and self-monitor her bx, keeping track of how many times she washed her hands and how long it took for her to complete these behaviors. This would help the therapist get a better picture of her compulsions.

Question 37

Reciprocal Determinism

Answer 37

What: the three way interaction between the person, behavior and environment. All 3 influence one another. the person, behavior, and environment all influence and are influenced by one another. Our behaviors are not rigidly controlled by external forces. We can change or create the factors that influence our behaviors.
Where: key concept in social learning theory
Who: Albert Bandura, modeling
Why: great way to explain to clients how their lives are influenced by the environment and the bx they perform
EX: Chris comes to therapy because he has low self-esteem from a recent rejection of a job. During psychoeducation, the therapist informs Chris the relationship between thoughts, environment and his behavior. The therapist suggests that he applies to other jobs and change his environment, which will influence his thoughts about his self-esteem and will decrease his depressive feelings

Question 38

Schedules of Reinforcement (FR, FI, VR, VI, CRF Schema)

Answer 38

What:
Fixed Ratio: bx rewarded after successful performed a specific number of times (think of an restaurant punch card)
Fixed Interval: bx is reinforced after it is successfully performed in a specific amount of time (think of a paycheck)
Variable ratio: bx reinforced after bx is performed a random and varying number of times, no predictability (think gambling)
Variable Interval: bx reinforced after bx is performed a random and varying number of times
Continuous Reinforcement: bx is reinforced every time it occurs, (useful when first learning it)
Who: Eric Skinner
When: want to schedule times where the bx is performed
Why: Teaching children proper behavior, ABA therapy
EX:
FR: A child must answer five questions in the classroom before getting a piece of candy.
FI: a child receives access to a preferred toy after they engage in a non preferred task for x amount of time (2 min), You have a child with ADHD and if he stays in his seat for 5 min, he receives access to preferred toy.
VR: Random drug test for a client in a substance use recovery program?
VI:
CRF: Really important when the client is learning, but not great at maintaining this schedule.

Question 39

Self-Efficacy

Answer 39

What: an individual’s subjective perception of their capability to perform in a given setting or to attain desired results. Modeling and behavior therapy can strengthen self-efficacy. Acquisition and performance to change it
Who: Albert Bandura, cognitive affective theory and self efficacy theory
Why: a primary determinant of emotional and motivational states and behavioral change. How a client feels about themselves will affect how they improve in therapy
EX: Client seeks treatment because his lack of social skills was affecting his job performance. He never thought he would be successful at it (outcome expectation) so he stopped trying to talk to his supervisors/coworkers and now he may lose his job. Therapist used vicarious experience (he watched models talking to “supervisors”) as well as Actual Performance (role playing with the therapist) to build his self-efficacy surrounding his social skills.

Question 40

Shaping

Answer 40

What: part of operant conditioning; used to establish a new behavior not in the client’s repertoire. Each approximation of the behavior is reinforced
Done by dividing bx at hand into a series of smaller steps
Reinforce for bxs that are more and more similar to desired bx
Eventually person only reinforced for desired bx”
Where: operant conditioning
When: usually used with ABA therapy
Why: establishes complex behaviors for the client
EX: Let’s say Johnny has social anxiety. You are trying to get him ready to give a speech in front of the classroom. Given that Johnny is shy, he wouldn’t be able to give a speech right away. So, instead of promising Johnny some reward for giving a speech, shaping can be used and rewards should be given to behaviors that come close. Like, giving him a reward when he stands in front of the class. And then when he goes in front of the class and says hello. Then, when he can read a passage from a book

Question 41

Skills Training

Answer 41

What: component of behavior therapy. Treatment packages to teach a client if they have one of 4 deficiencies - (K, P, D, M): knowledge, proficiency, discrimination, and motivation. Specific maladaptive skills necessary for daily function. Grounded in CBT. Main focus is to improve social functioning/social skill deficit that have resulted in pathology.
Where: Behavioral therapy, modeling, can be used in CBT . Basic assumption is that pathology comes from ineffective social behavior/problem solving that yields negative consequences and self defeating patterns of behavior.
When: Behavioral therapy, modeling, can be used in CBT
Why: main focus = to improve social skill deficit that has created pathology = treatment. Goal - generalization of skills training taught to be used in real life
EX: A 14 yo enters therapy because he doesn’t have any friends his age. He usually interacts with children 5 years younger than him. He has trouble engaging in simple conversations with his peers. Sherman begins social skills training in which the therapist provides rationale for certain skills and then models these skills for Sherman. Sherman then rehearses the skill with the therapist (role-play) , and after becoming proficient in that, his homework is to apply the skill with his peers. The training focused on asking appropriate questions, maintaining appropriate eye contact, and acting in a warm & friendly manner.

Question 42

Systematic Desensitization

Answer 42

What: a form of gradual and imaginal exposure therapy using progressive muscle relaxation and counterconditioning. The client imagines successively more anxiety-arousing situations while engaging in a behavior that competes with anxiety
When: Exposure therapy
Why: The client has a lot of control over the process, it is efficient and effective. The goal of this is to reduce and eliminate the anxiety associated with a particular stimulus.
EX: Grace comes to therapy for a fear of elevators. With her therapist, they will create a fear hierarchy and learn relaxation techniques. Then the client will imagine the fearful situations while engaging in the relaxation to compete with the anxiety.

Question 43

Token Economy

Answer 43

What: standard treatment package; system that employs the principles of operant conditioning to motivate clients to avoid undesirable bx and perform desirable bx. Participants revise tokens for performing desired bx that can be used to purchase goods or privileges.
Where: Behavior Therapy
When: usually used when teaching children certain behaviors, behavior therapy
Why: important bc use with child clients or people with autism in ABA therapy. Advantage -convenient, organized, and fair. Disadvantages - costly, demeaning, bribery claims.
EX: At the treatment center, if the recovering alcoholic attends an AA meeting every day, he receives a token at the end of the week and he can use it to be exempted from clean-up duty. This is an example of a token economy with an individual contingency. The backup reinforcer is able to skip out on clean-up duty.