PSYC 501: Cognitive & Behavioral Change Flashcards
Acceptance and Commitment Therapy / ACT
3rd-Wave Behavioral Therapy that builds psychological flexibility
- Steven Hayes
- Unconditional acceptance of thoughts and feelings rather than avoidance or overcontrolling
- Emphasizes adaptive learning that aligns with your values, rather than trying to eliminate or avoid unpleasant thoughts and feelings
Roots of psychological suffering:
- Cognitive fusion (Getting Stuck in Thoughts)
- Attachment to the conceptualized self (Rigid Self-Identity)
- Experiential avoidance (Resisting or Suppressing Feelings)
- Disconnection from the present moment (Lack of Mindfulness)
- Unclear values (Lack of Direction or Meaning)
- Inactions with respect to values (Not Acting in Alignment with Values)
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 utilizes ACT therapy to help the client recognize how her pain allows her to disconnect from the present moment and helps her learn to reconnect with her values and take committed action toward a meaningful life. By shifting her expectations about living pain-free to learning how to live as well as she can with her painful disorder, the cilent can work to create a life of meanful ingagement instead of phsycological suffering.
Ambivalence
- Psychologically uncomfortable state of holding contradictory or conflicting thoughts of wanting something to change but at the same time resisting the change.
- Central to MI, CBT, ACT
- Plays into Contemplation (2nd stage) of the Readiness to Change model.
- Therapist be aware of their “righting reflex” to maintain the theraputic alligance and meet client where they are at wihtout shame.
Important in therapy bc ambivalence is a natural part of the change process and by challenging internal conflict and fostering self-compassion and emotional acceptance, is often the first step toward meaningful and lasting change.
Ex: You client knows he should stop drinking but says alcohol is the only thing that helps him relax after work which is also important so it can’t really be that bad.
Anxiety/Fear Hierarchy
- Used in Exposure Therapy
- Helps clients systematically confront and reduce axiety through use of SUDs.
- Client creates a list from least anxiety provoking event/scenario to most anxiety provoking event/scenario and applys a self-reporting of Subjective Units of Distress of 0-100 measuring the intensity of the anxiety in the moment.
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. 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 (personal)
- Strengths, skill and resources that an individual possesses that contribute to their ability to succeed annd overcoming challenges
- Internal and external such as problem solving skills, resiliency, supportive relationships, education, SES, job skills, growth-mindset
- Part of the Behavioral Analysis Approach (ABCPEA model) used for behavior assessment and intervention
Antecedent (A) – The event or situation that occurs before the behavior.
Behavior (B) – The observable and measurable action the individual takes.
Consequence (C) – What happens after the behavior, which can reinforce or discourage it.
*Person *(P) – Individual characteristics, such as emotions, cognition, or personal history, that influence behavior.
Environment (E) - External factors influencing behavior
*Assessment *(A) – The ongoing process of evaluating and modifying interventions to improve outcomes.
- Often help the cleint take on a more collaborative role in their own care and increase their self-efficacy.
Important in therapy when designing a treatment plan and interventions for a client bc identification of assets highlights what the client already does well and what can be leveraged to promote positive outcomes.
Ex: In an intake session, when asked what his personal strengths are, John answers that open communicating and expressing his emotions is a strength of his and something he activly already works on. He also has a wife at home (they have a solid foundation) and he goes to the gym 3-4 times a week where he has a buddy. John also enjoys walking and listening to podcasts before going to work. These are examples of assets in John’s case that may benefit his treatment outcome. They are like built-in preexisting beneficial coping skills as John goes through the therapeutic process.
Automatic Thought
- Beck’s Cognitive Therapy
- Conditioned, spontaneous (reflexive and habitual) thoughts that are applied as a response to a particular stimulus.
- May contain patterns of negative or distorted thinking based on schemas such as
dichotomous reasoning (always and never), personalization (assumes they are responsible for things outside their control)
emotional reasoning (believes something is true because they feel it strongly) - Contributes to anxiety and depression bc thoughts occur at a surface level but are reflections of deeper cognitive distortions and core beliefs that we at one point likely intended to protech the person
Important to identify automatic thoughts to challenge core beliefs that influence emotions and behaviors, promoting healtheir outcomes and more balanced thinking.
Ex: Your client feels uncomfortable in social settings and generallys just feels like she is “too much” for people to handle. When nervous, she reports that she overshares and speaks in a loud, exagerated way that she thinks turns people off. When someone does not return her level of enthusiasim in conversations, she persaonlizes this feeling and tells herself that they think “she is too much”. By using a downward arrow technique, you work to challange these automatic that exist without evidence of them being true.
Behavior Therapy
Watson, Skinner and Pavlov in response to psychodynamic schools of thought
Uses principles of learning and conditioning (classical and operant) to reduce maladaptive behaviors and increase adaptive behaviors.
- Rather than focusing on unconscious processing, it focuses on external, observeable behaviors that are monitored and measured
- Present-focused and action-oriented … requires clients to take action rather than just talking about their problems.
- Targets current behaviors by identifying what triggers the behavior and what mechanisms reinforces the behavior
Ex: Your client is seeking therapy to remain consistent with their goal of losing 60 pounds over 9 months. They currently lack the necessary motivation to stay on track with their goal and feel overwhelmed by the work that needs to be done to get healthy. You create an assests list they can tap into when feeling unmotivated and create a weekend routine that reduce their maladaptive behaviors of snacking and drinking all weekend. Creating a plan to promote healthy activies will increase your clients motivation and provide a sense of accomplishment.
Behavioral Activation Therapy
-Skinner’s Behavioral principles
- When positive reinforcement is low and avoidance is high, depression arises
- Teaches clients to engage in taking small steps towards re-engagement with meaningful and pleasurable activities to counteract cycles of escape and avoidance
- Increasing positive experiences will overtime enhance motivation, create a sense of accomplishement and improve negative moods.
Ex: Your client is an empty nester and is concerned that she is experiencing depression now that all of her children are grown and gone from the home. She says that she is not in touch with her friends and does not participate in any hobbies or social activies. She stopped working over a decade ago to care for the children and does not believe she has any transferable skills to re-enter the work force. Your client recognizes that she poured all of herself into her children and feels alone and empty. Using BAT, you create a list of of hobbies your client used to enjoy before she “poured all of herself into her children”. She identifies gardening, running and meeting a friend for lunch. Together, you collaborate to create a schedule of activies that require her to engage in each of these identified hobbies at least 1x over the next 7 days before you meet again.
Behavioral Parent Training/Therapy
- Focuses on parents abiltiy to manage and improve their child’s behavior (used in Family Systems Therapy).
- BPT is useful in cases of oppositional defiant disorder, attention deficit/hyperactivity disorder and general conduct problems.
- In response, children experience firm but loving boundaries with clear expectations of behavior and consistent consequences.
Important in therapy bc parents are empowered with tools that increase desired behaviors and promote better communication between parent and child promoting family dynamics and reducing stress for parents and children.
Ex: Your client is the mother of an 8 year old who refuses to complete their school work. The child throws tantrums at home and at school when asked to complete tasks they do not want to do. In session, you guide your client to set clear, consistent rules for behavior and how to use praise or a reward/token system for positive reinforcement. Additionally, by learning to enforce consequences without showing an emotional, reactive response, your client learns to manage their own emotional rollercoaster which allows for better communication between her and her son.
Classical/Respondent Conditioning
- Notorious experiment developed by Pavlov that demonstrates how we learn involuntary behaviors through repeated associations in everyday life.
Explains how automatic, reflexive responses can be learned or unlearned through pairing.
- 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 important for clinicians to understanding to tailor treatments to clients especially related to phobias, anxiety and substance use disorders to foster healthier responses /
Ex: Your client is in recovery for cocaine use. They miss the rave scene and would like to attend an upcoming show but are very concerned about relaps. (Even when a person stops using, being in places or around people associated with past use can trigger strong cravings.) In order to prevent relaps, your work in therapy will be imaginary as well as environmental where the focus is on the client unlearning these associations by repeatedly exposing them to triggers (techno music, light shows, sound of bar/club activity) without drug use, weakening the conditioned response.
Cognitive Therapy
- Developed by Beck and later Ellis who believes maladaptive cognitions are the root of psychological suffering.
- Problem focused approach that centers on how thoughts, beliefs and attitudes (core beliefs), and cognitions, contribute to distress.
- Can be based in the past, present or future
- Client taps into their Cognitive Triade: view of self > world > future
- Use Socratic questioning to ask open-ended, thought-provoking questions to help individuals examine their beliefs, challenge assumptions, and gain insight into their thinking patterns.
Important in therapy bc modifying faulty information processing leads to emotional resilience and a learning of lifelong to challenge distorted and maladaptive beliefs with skills to change them to be more rational and adaptive.
Ex: Your client is stuck in a dead end job but says they do not have the transferable skills necessary to do anything else. Your work focuses on their deeper core beliefs and negative self-view of their abilities to contribute to a different work force. By modifying their negative self beliefs and challenging their automatic thoughts, you aim to create an active collaboration with your client that enables them to see possible opportunities rather then only roadblocks.
Cognitive Fusion
(Mechanisim)
- Steven Hayes
- Core concept of Acceptance and Commitment Therapy (ACT)
- Tendency to unknowingly treat thoughts as literal truths without evidence rather then just mental events (emotional reasoning) resulting in emotional distress and maladaptive behaviors
- Relevant when clients get stuck in negative self appraisal or rigid thinking patterns
Important bc by recognizing cognitive fusion that worsen symptoms such as anxiety and depression, therapist will work to defuse these thoughts and guide the client to treat thoughts as just thoughts…not fact.
Ex: A client tells their therapist, “I know no one will ever love me.” The client uses “evidence” of past relationships and the fact that he father abandoned her family when she was a baby. Your client genuinely believes that there is something distinct about her that keeps others from being able to love her. This is an example of cognitive fusion as the client believes their thought as evidence of fact. ACT will help the client dismantle this negative thought pattern to see what is true (they have a good friends and a sister who adores her) vs false and enable her to practice unconditional acceptance.
Cognitive Restructuring
(therapist role)
Beck and Ellis - technique used in Acceptance and Commitment Therapy (ACT)
- Therapist guides client to examine evidence for and against their beliefs and generate alternatives and adopt healthier mindsets.
- Identifies, challenges and changes maladaptive thought into adaptive thoughts which is critical for conditions like anxiety and depression where thought patterns underline symptoms
Important bc by restructuring thoughts, clients can reduce emotional distress and maladaptive behaviors adopting healthier mindsets for livelong health.
Ex: Your clients is a student who believes he friends is upset with him bc the friend changed seats in class and moved further away from him. The therapist helps the student consider other reasons behind the friend’s actions and challenging the assumption working to create shifts in his distorted view.
Decision-Balance Matrix
- Classic pros/cons list
- Used in Motivational Interviewing during the Evoking phase and to move a client out of the Contemplative stage.
- Matrix maps out the costs and benefits of a potential behavioral change along with the costs and benefits of maintaining the current behavior.
Ex: Your client is a mother who is unsure about whether to return to work after having children. They create a decision-balance matrix and walk through the pros and cons of making this change. (Increased family income, adult interaction, self-confidence vs lack of parental structure for her children, increased child-care cost, lack of personaly flexibility) By considering motivations and barriers to change, your client is able to come to a decision based on her personal values and family goals.
Dialectical Behavior Therapy (DBT)
3rd generation behavior therapy developed by Marsha Linehan
**- Useful and shown success in treatment of challenging and persistent disorders such as suicidality/self-hard and those diagnosed with borderline personality disorder (BPD). **
- Treatment seeks to find a balance between reason mind and emotion mind to create a wise mind that understands opposing truths (two things) can coexist ie: life is really hard AND you’re doing the best your can
- Clients are taught transferable skills for lifelong application:
1. mindfulness skills
2. distress-tolerance skills
3. interpersonal effectiveness skills
4. emotion-regulation skills
Important bc its the most effective treatment for suicidality bc it combines acceptance with change which results in resiliency and improved coping skills for everyday life.
Ex: Alex is a teenage who engages in self-harm by cutting. She meets regularly with the school counselor as well as with the priest at her church but she only ever feels worse about her behavior after meeting with them. Alex would like to stop this behavior and researches therapy options. She comes across a local DBT weekend workshop and asks her parents to enroll her. What stuck out to Alex about this workshop was that it emphasized self-acceptance and quoted recovered cutters who shared stories about honoring your scars as a symbol of strength in overcome this challenge. Alex also liked their emphasis on distress tolerence and emotional regulation and believed she finally found a group who would not judge her or make her feel worse in seeking help.
Differential Reinforcement
Behavior tool used from operant conditioning that reduces maladaptive bx by reinforcing desirable bx and withholidng reinforcement for unwanted ones.
Reinforcement of Alternate Bx: reinforces a positive alternative and ignores reinforment of a negative one.
Ex: teach ackowledges a correct responce only when the child raises their hand first to speak. If the correct answer is blurted out in class, the teach ignores the answer.
Reinforcement of Other Bx: when reinforcement is contingent upon the absence of the problem bx – do not identify an alternate bx to reinforce.
Ex: Mother reads bedtime story to her child only when he is not sucking his thumb. When he starts sucking his thumb mother stops reading.
Reinforcement of Low Rates: reward come when bx happens below a threshold.
Ex: Child getting popcicle only if they do not get out a seat at school that day fewer than 3 times.
Escape/Avoidance
Two types of negative reinforcemnts found in behavioral psychology that explains how defense mechanisms reduce or prevent adverse stimuli and negativley reinforcing the escape/avoidant behavior
Escape is when someone leaves a situation that is causing distress. (social anxiety and you leave a party when you start to feel anxious).
**Avoidance **happens when a behavior prevents a situation from even happening. (You don’t want to feel anxious at the party so you make up the excuse that you have too much work to do to even go.)
Important to understand how fears and phobias persist and how the cycle of reinforcement interferes with extinction bc they make the individual feel “safe” when in fact they are not addressing their actual fears/phobias at all.
Therapists who recognize these bxs can design interventions in exposure-based therapies to gradually reduce these defense mechanisims and build healthier coping skills.
Ex: A client diagnosed with PTSD due to a sexual assult and tells the therapist that they drive an alternate route to work every day in order to avoid going by the house where their assault occurred. By avoiding the stimuli (i.e. the house) the client does not feel as distressed when making their daily commute even though it does add significant time to their commute. By avoiding the aversive stimuli of being reminded of the assault, your client is not in fact healthing from her trama and is in fact maintaing maladapting behaviors that do not serve her.
Exposure Therapy
Behavioral approach that specifically confronts feared stimuli under safe conditions in vivo (real-life), imaginal or via virtual reality.
- Strong therapeutic alliance is necessary for success in treatment.
- Repeatedly exposes the individual to stimuli that elicits distress, under safe and controlled conditions, where by tolerating the discomfort, they learn the expected harm/outcome is unlikely to happen, AND/OR that it is manageable.
- During exposure, the client must experience and remain with anxiety/distress until it peaks and naturally begins to decline, promoting a sense of control over their outcomes.
Important bc this process of habituation (the body’s distress subsiding over time) makes space for extinction (learned fear response weakens) allowing client to sit with the stimuli and not escape the feelings leading to healthier bx of distress tolerance and emotional regulation.
Ex: After surviving a terrible case of Covid, your client has never again able to touch or be in close proximity to another person. They always maintain a several foot distance, and never hug or shake hands. This has become a burdonsome problem for your client as he is now expected to return to work as a part of the growing “return to office” policy his company implemented for 2025. Because your sessions are via Zoom, begin your treatment with imaginal physical encounters the increase with severity according to your clients SUDs assessment.
Cue Exposure Therapy
- Type of Exposure Therapy that specializes in exposure with response prevention that targets cravings and substances (rather than anxiety and fear)
- CET focuses on breaking the link between cues and cravings
- Client is repeatedly put in a situation where a cue is presented (food) and they are prevented from engaging in a target behavior (response prevention of eating) that over time weakens cravings through extinction.
Important to understand bc even thought anxiety may arise from the cues, clients learn skills to cope with their anxious feelings making treatment highly effective in substance abuse treatment and binge eating disorders.
Ex: A client diagnosed with binge eating disorder is presented with a pizza (cue presented and exposure) sitting on a table and the therapist leaves the room first for 1 min. Upon returning, a SUD assessment is completed rating the clients distress. After multiple rounds of this process, the SUD ratings begging to decrease indicating the therapy’s effectiveness. This process is repeated multiple times over many sessions leading to the client’s ability to tolerate and manage their cravings outside of session.
Exposure with Response Prevention (ERP)
Behavioral technique rooting in classical conditioning where clients face a feared stimuli and DO NOT engage in escape/avoidant behavior (targets fears, phobias, anxiety, OCD)
* ERP focuses on breaking the link between obsessions and compulsions
- Prevents performing coping/compulsive/avoidant behavior (escape/avoidance) and instead tasked with “riding out” the anxiety and learning that all is still well which leads to extinction
- Overtime, maladaptive avoidances will dissipate by breaking the reinforcement cycle that maintains symptoms leading to extinction
Ex: Your client has OCD and reports having to lock their car 9 times before they can leave a parking lot. This takes place regardless of their location and if they lose count they have to start over reporting they could lose 30 minutes out of every day counting car alarm beeps. In your sessions, you practice in-vivo and together visit the office parking lot where you observe your client lock their car and instruct them to walk away and stand on the sidewalk where they are to focus on their surrounding and located 5 unique things. The observation is to serve as a calming mindfullness exercise. You repeat this process several times at the beginnnig of each session and monitor their anxiety with a SUD assessment.
Extinction
- Extinction is the goal of Exposure therapy
- Process where a behavior weakens and dissipates because the reinforcer (operant conditioning) or unconditioned stimulus (classical conditioning) is no longer presented.
- Could be a simple association that takes hours or days to weaken or may take repeatedly more exposure over time
Classical: Pavlov
Bell = Treats / Involuntary Association
Operant: Skinner
Sit = Treat / Voluntary (action) Reward or Punishment
Important for clinicians to understand that decreasing unwanted behaviors by removing reinforces will foster more adaptive and healthier behavior patterns.
Ex:
Functional / Behavioral Analysis
A primary method of assessment used in behavior therapy.
- Method examines the antecedent of a behavior, the behavior itself, the consequences of the behavior, the client’s personal variables, as well as their assets (i.e. ABCPA model).
- The functional analysis is better used to understand a behavior within context and also within the client as a unique individual.
Important bc by recognizing these patterns, therapist can adjust triggers, consequence or both to reduce maladaptive behaviors and increase adaptive one.
Ex: A client engages in cutting, a self-harming behavior several times a week. The therapist completes a functional analysis to better understand what precedes (anger toward her father for divorcing her mother and moving away) and succeeds and the behavior (feeling of pain but also a calmness comes over her), as well as aspects of the client (mother refuses to talk with child about her father leaving) that makes the behavior unique for them. This process helps paint a clearer picture for the therapist to understand when/why the client has historically engaged in the self-harming behavior.
Generalization and Discrimination
Key to classical / respondent conditioning and describe how someone learns to respond to various stimuli.
Generalization happens when a conditioned response occurs in the presence of other stimuli that are similar in some way to the original stimulus.
Discrimination is the ability to differentiate between similar stimuli so that the conditioned response occurs only in response to the original stimulus.
This is important to understand as fears and phobias can spread to new things (generalization) causing widespread psychological harm with multiple triggers overwhelming an individual. Also critical for case conceptualization to understand how many reactional bx you are working to eliminate.
Ex: You client was mauled by a dog and now has PTSD. They are terrified of all dog regardless of size, breed, gender and termperament (generalization).
In Vivo Exposure vs Imaginal Exposure
- Form of exposure used within behavioral therapy when the client is exposed to the anxiety-inducing situation with the purpose of gradually reducing the feared response.
Both teach that the feared outcome is less dangerous then they believe, eventually reducing avoidance and distress.
**In Vivo **= In real life, within safe and controlled conditions. Done in conjunction with relaxation techniques until the anxiety declines.
Ex: Your client who has PTSD after surviving a dog mauling, walks with you around your office complex which is located in a college commuinity with where many students walk their dog on the sidewalks. Together, you walk for only a few minutes while your client practices breathing exercises. When needed you stop to take breaks in a “safe space” of their choosing. Then you beging. After 3 “walk and talk sessions”, you client recognizes that althought they are still nervous, their body is calmer and her breathing is not as rapis as a dog approaches her.
**Imaginal ** relay on mental imagery which the client vividly pictures the fear-inducing scenario until their anxiety gradually declines. This is useful and necessary when in vivo exposure is not a viable option.
Your client is terrified of flying. Since visiting the inside of an airport or booking several flights is not a viable therapy option, you use mental imagry along with audio tracks of planes in flight while your client imaines the steps of take off.
Learned Helplessness
- Coined by Seligman
- Occurs when an individual has “learned” that they cannot control the outcome of a situation and therefore they do not attempt to control/change the outcome.
- Leads to passive or hopeless behavior which is stonly linked to depression
- This is important to understant because without a sence of control, individuals may not set goals to acheive more positive outcomes and instead live in a cycle of negative helplessness.
Ex: Your client has a learning disorder resulting from a car accident when they were younger. They have stuggled with school their enitre life and believe that no matter what, they will never be smart enought to do well in school bc of their LD. Because of this belief, they no longer even attempt to study and have been skipping school to surf during the day. They are being threated with expulson and the parents are bringing her to therapy to address his negative belief of helplessness.
Learning-Performance Distinction
A term coined by Bandura in his social learning theory. Learning is a primarily internal process during which the individual practices a behavior and retains memory of it. Performance is primarily an external process in which the individual reproduces the behavior and receives reinforcement. Behaviors may be learned but not performed due to lack of reinforcement.
Important to consider when designing intervention.
Ex: A child is not performing well academically in the classroom. Should we assume that they have not learned the material?
A doctor is working with a patient who reports not engaging in a regular exercise regimen (even though that was the doctor’s recommendation on the last visit)
Mindfulness
Core element of 3rd generation therapies focused on nonjudgmental attention to one’s immediate experience. ACT, DBT
- Mindfulness is not about “relaxing” - it is about acceptance of all thoughts without reacting or labeling them as “good” or “bad”.
- By being present in the moment, and treating thoughts like passing clouds w/o holding or controlling them, client learns to accept what they are experiencing - physically (heart racing), mentally (brain buzzing) and emotionally (angry). Used for anxiety, depression, emotional regulation and distress tolerance.
- Working to maintain acceptance of thoughts allows for pschoolgical flexibility and breaks the cycle of rumination allowing for a decline in emotional distress.
Ex: Your client is working with you on distress tolerance to minimizing their anger. They are sharing a story with you in session about and experience they had the evening before when they felt the familiar sensation of rage coming over them. Their heart started racing, their limbs got warm and they want to burst out yelling and at the exact same time they knew what would be best would be to take several deep breaths and maybe even walk walk out the front door and take a walk up and down the street. In this moment, just the mere idea they were considering an alternative to screaming helped them feel more powerful. In that moment, she took a deep cleansing breath, closed her eyes and counted to 5 before opening them again and placing her hands on the cold counter. Bc she desperatly wanted to get ahead of what normally would be a huge fight involving the whole family, your client said they were able to pause just long enought to not flip the rage switch and in doing so likely saved the entire family’s evening.
Modeling
- Bandura’s Social Learning theory of modeling by watching others
- Social learning theorists believe that majority of learning behaviors, thoughts and feelings is done this way, making it crucial to lifespan development.
- Can be direct (observing someone live in person) or symbolic (watching a demonstration in a video or image)
4 Steps of Modeling:
Attentional (paying attention and recognizing a behavior’s value)
Retention (remembering what was observe)
Reproduction (practicing the behavior)
Motivation (wanting to perform it - influenced by feedback or reinforcement)
Ex: A child is rasied in a home with a mother who is terrified of spiders. The child repeatedly sees her screem and hide every time there is a spider nearby and the child recognizes that they are to be scared of spriders for which the appriate responce is to screem and hide when you see one. This behavior is reinforced when the mother also hides with the child until the spider moves on or until someone else comes to take care of the spider.
Motivational Interviewing
MI = Miller / A collaborative, person centered method of conversation
- Effective, collaborative and person centered technique that identifies cognitive dissonance and works to align behavior modification to the clients values and goals
- By addressing the conflict between the client’s goals and current behaviors, therapy helps the client explore the pros and cons of their currenting decisions making process (decisional balance grid) in an accepting and compassionate way.
- MI reduces ambivalence to change and enhances motivation by drawing out client’s own reasons for the change. Useful with dealing with health related bx and reasons for change.
Ex: Your client has a newborn baby and knows they must reduce the frequency of late night partying. They tell you that most nights they are exhausted anyway but they feel weird and like a loser telling the guys they cannot hang out like they used to. They also know they need to drink less at home and feel pretty awful that his wife is doing 75% of the late night feedings. In working with this client to draw out his intrinsic motivations to change, you ask open ended questions, use the downward arrow technique, and frequently incorporate affirmative responces. Together you make a decisional balance grid. Your client decides they do want to reduce the number of nights he goes out as well as how much he drinks at home.
Operant Conditioning
- Learning process where consequences are used to increase or decrease a type of behavior.
- Skinner’s principle relays on 2 principals:
- Any response followed by a reinforcing stimulus tends to be repeated.
- A reinforcing stimulus is anything that increases the rate at which an operant response occures.
- If bx lead to a desirable outcome (reinforcement), that bx is more likely to be repeated.
- Conversely, bx followed by unpleasant consequences or the removal of a pleasant stimulus my decrease in frequency.
Important to understand bc Operant Conditioning enable clients to strengthen or weaken bx depending on the consequences.
Negative Reinforcement
Behavioral principle from Skinner’s theory of Operant Conditioning where behaviors are shaped by consequences .
- NR increases behaviors bc it escapes or avoid and unpleasant stimulus or aversive consequences. (Unlike punishment that decreases bx, NR strengthens bx by taking away what is undesirable)
Negative Reinforcement has 2 forms:
Escape: ending an aversive situation that is happening (leaving a noisy room, leaving a party)
Avoidance: preventing the aversive situation before it even starts (making an excuse to not go the party)
Important and critical to understand when addressing mechanisms of action and how behaviors can be maintained due to escape/avoidance bxs.
Ex:
Positive Reinforcement
Skinner’s Operant Conditioning process of adding a desirable stimulus right after a behavior thereby increasing the chances of that bx happening again strengthening those behaviors patterns over time.
Important and critical to understand when addressing mechanisms of action and how behaviors can be strengthened due to positive reinforcement.
Ex: Your client’s daughter has a severe learning disorder and delayed cognitive abilities. Your client is stressed to the max and starting to loose her control during the morning routine of getting everyone out of the house. The child’s PT said your client should not get her dressed anymore bc she is capable of doing it on her own but it takes so long that it is making the entire family late for school. You teach your client about positive reinforcement and recommend that she implement a reward system for every time her child gets dressed on her own and to the breakfast table before her siblings.
Punishment
Key concept in Skinner’s Operant Conditioning
- Behavior principle that involves delivering an immediate consequence that decreases a behavior.
- Positive Punishment adds an aversive stimulus (eg: reprimand) while a Negative Punishment removes a reinforcing stimulus (eg: fines) // both decrease frequency of the bx.
- Effectiveness depends:
Immediacy (how quickly it follows)
Contingency (how consistently it follows the same behavior next time)
Individual Differences (unique for each person)
Magnitude (more intense may be more effective)
Important in therapy to understand and address maladaptive behaviors ethically and effectively when treating those who behavior modification and to understand best how effective treatment outcomes will be based on their unique needs.
Ex:
Self-Monitoring
- CBT technique of taking inventory of and recording one’s own behaviors, thoughts or moods.
- Highly effective bc it increases self-awarness and clients to identify patterns and triggers that progress over time.
- When not fully adopted the exercise is not as effective bc does not have buy in from client and can feel burdensome resulting in accurate or lack of reporting.
Important to understand bc when used effectively, it encourages clients to take ownership of their behaviors creating opportunity for more focused and personalized change efforts.
Ex:
Reciprocal Determinism
- Banduras Social Learning theory highlights the constant and reciprocal influence a person, their behavior and their environment.
Each element directly affects the other elements.
Important to understand for motivation and bx change bcit aids in designing interventions that take into account personal beliefs about self/others/world, environmental support and a client’s direct actions.
Ex: A therapist sees a child client that is having trouble making friends at school. The therapist learns that the child is bullying other students at school. This influences his environment that makes other students not want to be his friend, which also influences his thoughts about himself. Reciprocal determinism explains how each of these factors influence one another.
Self-efficacy (+Outcome Expectations)
Bandura Social Learning Theory
Self-efficacy: Fundamental to behavior change bc refers to one’s belief that they can successfully perform a behavior
Combination of acquisition (attention/retention) and performance (reproduction/reinforcement) necessary to achieve changes
Can be domain-specific in that client may feel a sense of self efficacy in one area (work ) but not another (relationships)
Outcome expectations refer to one’s prediction that their behavior will produce a particular result.
Important for successful outcomes of therapy and common factor that accounting for 15% of expectancy that change is possible and that not only will the treatment help, but that they are capable of making change happen on their own.
Ex:
Shaping
Operant Conditioning technique for teaching a new and novel behavior by reinforcing successive approximations toward a goal target.
Successive Approximations happen when the reinforcement of behaviors that is close to a target goal resulting in the encouragement of the client to continue working toward the desired target behavior.
Used in Applied Behavioral Analysis for Autism by rewarding any behavior that gets closer to the goal by gradually raising expectations.
Ex: A therapist is trying to teach a child how to say I want juice. The therapist starts by reinforcing the client saying “I” and after that has been mastered, the therapists “I want”. Lastly, “I want juice.” The child learning to say “I want juice” is the novel behavior achieved through shaping.
(Social) Skills Training
CBT approach used when skill deficits perpetuate a client’s difficulties - common in depression, anxiety and schizophrenia/
Aim is to improve social skills, assertiveness, problem solving and coping strategies by targeting 4 gaps:
- Knowledge (does the client know the skill?)
- Proficiency (can they perform it?)
- Discrimination (do they recognize when to use it?)
- Motivation (are they encouraged to apply it?)
Therapist will use modeling, behavior rehearsal, role-playing, coaching and feedback and homework to build and refine learned skills.
Ex: Your client suffers from a lack of assertiveness at work and is always taking on more a heavier work load than their peers. You work through role-plays to practice engagement in profession assertive communication and assign homework for the client to continue practicing in the mirror at home.
Systematic Desensitization
Wolpe’s first generation exposure therapy
Process:
- Combines relaxation training with graded exposure to a feared stimuli teaching coping responses such as muscle relaxation.
- Next they create an anxiety hierarch and rank their fears from least to most distressing working with the client to move through the expressed fear hierarchy from least anxiety provoking to most.
- Can use in vivo or imaginary as you work through each scenario and apply relaxation techniques making sure to take a step back or pause before moving onto the next distressing item as needed.
Wolpe viewed process as counterconditioning where the relaxation block the anxiety response.
Ex: Trevor and his therapist decide to use systematic desensitization to overcome his fear of going to the mall. They start by creating a list of scenarios related to going to the mall that provoke anxiety and then rank them in how much anxiety they cause him (anxiety hierarchy with SUDs). The therapist then teaches Trevor some relaxation techniques to use in the moment when he feels the anxiety rising. After Trevor has learned the relaxation techniques, he and the therapist start with the scenario on the list that has the lowest anxiety rating and slowly works his way through the list until he reaches the highest ranked scenario on the list. Through these encounters, Trevor uses his relaxation techniques to combat the anxiety and eventually is able to go to the mall with significantly reduced levels of anxiety.
Token Economy
Behavior modification tool used in Operant Conditioning
- Technique based on the systematic reinforcement of a target behavior through use of tokens (points, candy, stars) and is used to motivate clients to perform desired behaviors.
Tokens can be earned or lost based on bx. Can be individual or group based.
4 key elements:
- Clearly defined treats, privileges or actives used as rewards
- Backup reinforcers (known process for how you can exchange or use tokens)
- Type of token being offered and perceive value by client
- Clear rules
Ex: A teacher wants her students to remain at their desk working on their assignments. She puts together a token economy in which they are rewarded with a “dollar” (token) every 2 minutes if they remain working at their desk (desired behavior). If they get up from their desk during work time, they lose a “dollar”. At the end of every day they get to trade in their “dollars” for a treasure out of the treasure box or choose to save up for a bigger treasure later in the week. Over time, the time interval increases from 2 minutes to 3 minutes then 4 minutes and continues as the behavior is consistently accomplished.
