PSYC 501: Cognitive & Behavioral Change Flashcards
ABA or Reversal Design
An experimental design of a single case that evaluates the efficacy of a treatment. This design in characterized by an initial recording of target behavior (A) to establish a baseline. The treatment or intervention is then implemented (B) and behaviors are recorded again. The treatment is then withdrawn (A) and behaviors are recorded a third time. If the behavior return to the baseline following the withdrawal of the intervention, it is determined that the intervention is responsible for the change. This is important in behavior modification as it can help the clinician understand what interventions are working for each specific client.
Ex: Jen records the amount of chores that her son, Greg, does in a week. After gathering her initial number, she explains to him that for each of his chores he will receive a dollar, then records the number of chores he does in a week again. She then stops giving Greg money for chores and records the number of chores he completes a third time. Jen is using an ABA design to see if Greg’s behavior is encouraged/modified by the money intervention.
Acceptance and Commitment Therapy
A third generational behavioral therapy developed by Hayes. This therapy emphasizes the acceptance of painful thoughts and feelings as a natural part of the human experience, and learning to live with pain is more adaptive than trying to eliminate it from our experience. The primary goal of ACT is to create psychological flexibility in clients. Hayes believed there were six components that contributed to psychological inflexibility: cognitive fusion, attachment to the conceptualized self, experiential avoidance, disconnection from the present moment, unclear values, and inactions with respect to values. ACT encourages clients to move toward psychological flexibility via unconditional acceptance (rather than avoidance of negative feelings/experiences) and mindful skills.
Ex: A client recovering from an eating disorder tells her therapist that she hears her thoughts telling her how unsafe it is to not count her calories and that she is “not good enough”. Her therapist employs ACT’s cognitive defusion technique to teach the client how to separate herself from her thoughts as they are “just thoughts” and they are not part of her.
A client tells her therapist that she is overwhelmed with school and that she feels inadequate. The therapist utilizes ACT by walking the client through a “thought conveyer belt” mindfulness activity. The therapist tells the client, “View your thoughts for what they are, just thoughts. Just because you think it doesn’t mean it’s true.” This is an example of ACT because of the emphasis on unconditional acceptance of one’s experience and the nonjudgmental outlook.
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
Anxiety/Fear Hierarchy
A step in graduated exposure therapy/systematic desensitization in which a person (with the help of the therapist) creates a list from least anxiety-provoking scenario to most anxiety-provoking scenario, also called subjective units of distress (SUDs). The creation of this list is usually followed by imaginal or in vivo exposure therapy starting at the bottom (least SUD) of the list and working up to the most anxiety-inducing scenario on the list. Understanding the use of an anxiety hierarchy is important for reducing anxiety through exposure therapies.
Ex: Logan presents to therapy with a fear of flying in planes but wants to overcome this fear to attend his baby sister’s wedding later this year out of the country. Logan and the therapist construct an anxiety hierarchy in order to use exposure therapy to over come his fear of flying in planes. They make a list of 7-15 scenarios involving planes with some of those being going to the airport, seeing a plane take off, boarding a plane, and being a plane during take off. After the list is made, Logan assigns a number between 1 and 100 to each scenario to rank how much anxiety it would bring him. This anxiety hierarchy is used in imaginal and in vivo exposure over the next few months as it is essential to helping Logan overcome his fear of planes.
Assets
A term from behavioral analysis approach (ABCPA model), assets are skills and strengths, both internal and external, that an individual possesses that can impact the success of therapy. Examples of this may include a supportive spouse, breathing as a coping mechanism, feels as though they are good at their job, and has a gym buddy. Assets are critical factors for behavioral therapists when designing a personalized treatment plan and interventions for a client. The identification and use of client assets often help them to take on a more collaborative role in their own care and increase their self-efficacy.
Ex: In an intake session, when asked what his personal strengths are, John answers that effectively communicating what he is meaning is often a strength of his. He also has a wife at home (they have a good relationship) and he goes to the gym 2-3 times a week. These are examples of assets in John’s case that may benefit his treatment outcome. They are like built-in preexisting beneficial coping skills and supports as John goes through the therapeutic process.
Automatic Thought
A term from Beck’s theory of cognitive therapy, automatic thoughts are conditioned, spontaneous (reflexive and habitual) thoughts that appear plausible in response to a particular stimulus. These automatic thoughts may consist of dichotomous reasoning (always and never), personalization, and emotional reasoning. The downward arrow method is used to explore what intermediate and core beliefs underly automatic thoughts. Automatic thoughts may be negative in nature and often serve a purpose of protecting the client in some way. Generally triggered by traumatic events. It is important to identify and explore automatic thoughts, especially negative automatic thoughts, to challenge negative core beliefs and improve a client’s self image, thus increasing confidence.
Ex: Your client feels uncomfortable in social settings. She reports that when she makes eye contact with someone she usually smiles but if they don’t smile back her first thought is “What did I do wrong?” or “I knew it, they don’t like me.” These thoughts are an example of personalization automatic thoughts that jump to conclusions about the reason behind someone did not smile back at your client. As a cognitive therapist, you might employ the downward arrow method to explore the underlying intermediate and core beliefs of these automatic thoughts.
Behavioral Activation Therapy
A type of behavioral therapy often used to treat symptoms of depression, developed by Lewinsohn based on Skinner’s behavioral principles. This therapy stems from the behavioral model of depression that conceptualizes depression as a lack of positive reinforcement, and depression being maintained or worsened by isolation behaviors. Behavioral activation therapy consists of clients scheduling particular activities that are positively reinforcing with the idea that those behaviors may lead to positive psychological and emotional changes as well.
Ex: Tony has recently been feeling very low. He wakes up foggy and can’t seem to motivate himself to get his school work done or to attend to the tasks of daily living. He hasn’t seen his friends in weeks, but not for lack of trying on their part. He thinks resting will help clear the fatigue but the more he rests the worse he feels. His therapist recommends behavioral activation therapy and asks Tony to identify a few activities that bring him joy. He lists seeing his friends, skiing, and reading. His therapist then asks him to schedule time to engage in each of these activities this week. At the end of the week, Tony reports that while it was difficult to schedule and even harder to go to his scheduled activities, he felt lighter and more hopeful afterward.
A freshmen student makes an appointment at their college counseling center. The student tells the therapist that they “just don’t have motivation” and that instead of going to class or socializing, the student lays in bed in their dorm. The therapist utilizes behavioral activation therapy by brainstorming how the client could engage on campus in ways that felt tolerable. Some examples may include going to at least one class a day, going to the dining hall a few times a week, or just walking around the dorm building once a day to get outside. The hope is that fighting the isolation behavior will help improve the depressive symptoms.
Behavior Therapy
Watson, Skinner and Pavlov. A type of therapy that uses principles of learning and conditioning (classical and operant) to reduce maladaptive behaviors and increase adaptive behaviors. Originating in the 1950’s, largely in response to psychodynamic schools of thought, behavior therapy focused on overt behaviors instead of unconscious processes. It is present-focused rather than past-focused and action-oriented as it requires clients to take action rather than just talking about their problems.
Ex: John is a 12 year old client whose parents brought him to therapy because he has been acting out in school, yelling at his peers when he feels angry, and throwing things in the classroom. The therapist uses principles of behavior therapy (reinforcement and punishment) in order to reduce these undesired maladaptive behaviors and to increase more adaptive behaviors.
Chaining
A technique based on operant conditioning (skinner), chaining procedures are used to teach a person to engage in a complex behavior that has multiple components or steps. The therapist conducts a task analysis that breaks down the chain into stimulus-response components. Each component is taught and cure the next component until the last behavior is reinforced. Chaining can be done backward or forward. This is an important behavior teaching technique for teaching complex or multi-step behaviors.
Ex: An ABA therapist teaches a child to wash their hands with a backward chaining method. To begin they provide hand-over-hand modeling through all steps. The last step is then left off to begin with, then gradually removing hand-over-hand modeling for each step until the child can complete the task independently.
A therapist works with a child diagnosed with autism spectrum disorder (ASD) on completing the task of washing one’s hands with a forward chaining method. The therapist breaks the whole task into smaller digestible parts as a means of teaching (i.e. turn on water + wet hands + place one pump of soap on palm + rub soap between palms/hands for 20 sec + rinse hands + turn off water + get paper towel + dry hands). This is a chaining procedure of a complex behavior because the previous task will prompt the next one until the task as a whole is complete.
Learning a dance is a sequence of steps chained together that cue the next step, working through the whole chain until the entire task (or song/dance) is completed.
Classical/Respondent Conditioning
Developed by Pavlov, classical conditioning is associative learning, notoriously exhibited in his experiment with salivating dogs. Classical conditioning happens when a neutral stimulus is paired with an unconditioned stimulus to provoke an unconditioned response. Over time, the neutral stimulus becomes conditioned to elicit the unconditioned response thus making it a conditioned stimulus and conditioned response. This is a crucial for clinicians to understanding behavioral principles to tailor treatments to clients and has helped improve treatments of certain disorders like substance use disorder.
Ex: Sally (NS) likes Jake so she decides to give Jake his favorite type of candy (UCS) (which makes him happy- UCR) every time they see each other. After many times of Sally giving Jake candy, Jake feels happy (CR) when seeing Sally (CS) even without candy.
Cognitive Fusion
A component of Acceptance and Commitment Therapy (ACT), cognitive fusion is a state of mind when a person is so fused with their thoughts that they are unknowingly and automatically accepting their thoughts as true/fact. In other words, a person “fuses” their thoughts with their identity. Recognizing cognitive fusion in a client can indicate cognitive defusion in which they observe their thoughts for what they are (which may or may not be true or reflect the environment).
Ex: A client presents with anxiety which seems to be related to her role as a mother. She reports having constant thoughts about how she is failing and her children will suffer the consequences. She describes a constant stream of thoughts about her performance as a mother and feelings of shame and depression following these thoughts. The therapist identifies that the client is demonstrating cognitive fusion, and asks her to step back and see her thoughts as just thoughts, not facts.
A client tells their therapist, “I know no one will ever love me.” The client uses “evidence” of past relationships and genuinely believes that there is something innate about them that keeps them from being loved by others. This is an example of cognitive fusion as the client believes their thought as fact. ACT will help the client break apart their thought from truth and practice unconditional acceptance.
Cognitive Restructuring
A term from cognitive theory (Beck) that explains how maladaptive thoughts are challenged and changed into adaptive thoughts. Cognitive restructuring assumes that unrealistic beliefs/faulty cognitions are the cause of pathology. By changing the maladaptive beliefs, it is believed that changes in emotions and behaviors will follow.
Ex: A college student tells their therapist how he and a couple buddies usually sit together during their chemistry lectures. Last week, one of them chose to sit in the back of the lecture hall away from the others. He tells the therapist, “I must have done something to upset him. He hates me.” The therapist helps restructure the client’s thought by offering alternative reasons for the friend’s behavior and in turn challenge the client’s maladaptive thought/assumption that he did something wrong.
Cognitive Therapy
Developed by Beck and later Ellis, this is a type of therapy that is based on the premise that one’s cognitions directly impacts an individual’s feelings, behaviors, and overall functioning. Believe maladaptive cognitions are the root of psychological suffering. The goal of cog therapy is to challenge distorted and maladaptive beliefs to change them to more rational and adaptive thoughts. Beck believed in challenging the automatic thoughts and testing your hypotheses. REBT Ellis believed irrational thoughts caused psychopathology. Used to treat mood disorders.
Ex: example in messages from Lexi
Conditioned and Unconditioned Responses
UCR: The regular & measurable response to the unconditioned stimulus without pairing over time. Natural.
CR: The response which usually resembles the UCR & as a result of the continued pairing of the CS & UCS follows the CS. Conditioning requires pairing.
Ex: an unconditioned response is when someone blinks if air is blown into their eye. A conditioned response is when they blink after a high pitch tone that has been paired with a burst of air into their eye even when the air is not present.
Conditioned and Unconditioned Stimuli
UCS: A stimulus which, at the onset of an experiment, evokes a regular & measurable response
CS: A stimulus which (a) does not evoke the UCR, in this respect being neutral, and (b) is paired with the UCS for experimental purposes
Ex: An unconditioned stimulus is a burst of air blown into someones eye. It elicits the person to blink automatically/naturally. A conditioned stimulus is a high pitched tone that is paired with the burst of air. After multiple pairings, the high pitched tone elicits the person to blink even when the burst of air is not present.
Cue Exposure Therapy
A type of exposure therapy in which a person is put in a situation where a cue is present and the person is prevented from engaging in target behavior. The person is repeatedly exposed to the cue without engaging in the behavior to eventually extinct the target behavior, removing the association. Used in substance abuse treatment and binge eating disorder.
Ex: A client diagnosed with binge eating disorder is presented with a box of donuts (cue presented and exposure) in session and prevented from binging on the donuts. This activity is done multiple times over many sessions.
Decision-Balance Matrix
A term used in motivational interviewing. The matrix maps out the costs and benefits of a potential behavioral change along with the costs and benefits of maintaining the current behavior. The goal of using the matrix is to create cognitive dissonance/remove ambivalence in the client and ideally motivate them to make a decision about which behavior they would like to choose in a decision making process.
Ex: A client comes in unsure about whether to quit her job or not. With the clinician, they walk through the pros and cons of changing and staying the same to compare the costs and benefits of each choice. The goal is to help the client come to a decision.
Dialectical Behavior Therapy (DBT)
A therapy developed by Linehan as a treatment for individuals who are suicidal and individuals diagnosed with borderline personality disorder (BPD). The treatment sought out to find a balance between both validation/acceptance strategies and problem-solving strategies. Clients are taught mindfulness skills, distress-tolerance skills, interpersonal effectiveness skills, and emotion-regulation skills.
Ex: A 20-year-old female is referred to a weekly DBT group that is held in her hometown. The group is facilitated by a therapist trained in DBT and they follow the manual as outlined by Linehan. The group begins with mindfulness training and revisits this module for a period of two weeks after completing each of the other three modules (interpersonal effectiveness, emotion regulation, and finally distress tolerance). When completed on a weekly basis, the group can cycle through all modules twice in any given year.
Differential Reinforcement of Other Behaviors (DRO)
A concept used from operant condition in which reinforcement is contingent upon the absence of the problem bx – do not identify an alternate bx to reinforce. Reinforcer is delivered after an interval of time in which the problem bx does not occur. DRO is time consuming, but can be used in conjunction with extinction or target behaviors. Usually just for self injurious behavior.
Ex: Example in messages from Lexi
Discriminative Stimulus
From operant conditioning. A stimulus (negative or positive) associated with a reinforcer (negative or positive) which helps a learn distinguish between situations where reinforcement is provided or not. It is used on the three term contingency (ABC). The discriminative stimulus does not provoke the response itself, but instead signals to the learner that the situation is appropriate for that response.
Ex: example in messages from Lexi
Efficacy Expectations
Efficacy expectations refer to an individual’s belief in whether or not they can successfully execute the behaviors required to produce a desired outcome. These efficacy expectations can influence whether or not a person will attempt the behaviors. They are often influenced by the person’s past accomplishments, verbal persuasion, and/or emotional arousal.
Ex: “If I believe that I will be good at therapy then it will work”
Example in messages from Lexi
Empirically-Supported Therapy/Treatment
An empirically supported treatment (EST) needs empirical evidence in its favor from at least two well-designed randomized clinical trials, a series of single-case experimental design studies, OR a meta-analysis. Therapists utilize ESTs in order to practice evidence-based treatment and give the client the best possible care.
Ex: A therapist wants to find an empirically supported treatment of anorexia-nervosa. Several peer-reviewed journal articles show statistically significant results in favor of CBT as a treatment for anorexia. By being a competent consumer of research and distinguishing what treatments are empirically supported and what treatments are not, the therapist is able to utilize evidence-based practice and give the client effective treatment.
Escape/Avoidance
A term from operant conditioning, escape or avoidant behaviors are performed when an individual wishes to “get rid of” an unpleasant stimuli or response. Negative reinforcement is at work by removing the aversive/unwanted stimuli, which in turn gives the individual relief and ultimately reinforces the avoidant behavior.
Ex: A client diagnosed with PTSD tells the therapist that they drive an alternate work to route every day in order to avoid going by the house where their sexual assault occurred. By avoiding the reminder/stimuli (i.e. the house) the client does not feel as distressed when making their daily commute. This encourages the alternate route, though it adds significant time and often makes them late for work, because it removes the aversive stimuli of being reminded of the assault.
Example in messages from Lexi
Exposure with Response Prevention (ERP)
A technique used in behavioral therapy that is based on principles of classical conditioning. With ERP, the individual is repeatedly exposed to the feared stimulus that previously led a, usually undesired, behavior. The client is then prevented or blocked from performing said behavior and is instead tasked with “riding out” the anxiety. Overtime, by preventing the behavioral response, the urge to respond in such a manner will dissipate. This treatment is used with clients with anxiety disorders, panic disorders, OCD and phobias.
Ex: Example in messages from Lexi
Extinction
A term from classical conditioning explaining the method of removing a behavior. withholding the reinforcer that was maintaining the bx. Extinction may take hrs/days if maintained on intermittent schedule, punishment effect is instant
CS does not elicit CR as a result of repeated presentations w/o UCS, yet learning is preserved
Multiple Baseline Design
3 types
Across target bx (e.g., same client, different fears)
Across clients (e.g., several case studies, same bx)
Across settings (e.g., same client, same bx, different setting, such as school vs. home)
An experimental approach in which 2+ behaviors are assessed to determine their baseline frequency and then an intervention is applied to one of the behaviors while the others are unaffected. After a period, the intervention is then applied to the next behavior until it has been applied in a sequential fashion to all the behaviors of the design. This allows for inferences to be made about the effect of the intervention.
Ex:
Schedules of Reinforcement
(FR, FI, VR, VI)
How reinforcement is presented to reinforce
A term used in operant conditioning that refers to the contingencies describing the relationship between a behavior and its consequences. These schedules can be fixed ratio, fixed interval, variable ration, variable interval, or continuous reinforcement. ‘Ratio’ is related to the number of performances of the behavior, whereas ‘interval’ is related to amount of time. ‘Fixed’ refers to the timing of reinforcement being stagnant, whereas ‘variable’ allows for flexibility of reinforcement. Variable schedules have more stable rates of response and a higher resistance to extinction.
Ex: You have client with autism that you’re trying to teach to wash their hands.
