PSYC 501: Principles of Cognitive and Behavioral Change Flashcards
ABA Design
A term used in behavioral therapy that refers to an experimental design that evaluates the efficacy of a treatment. In this type of design a baseline measurement of a target behavior is recorded prior to treatment, then treatment is implemented and the behavior is measured again. Treatment is then withdrawn and the target behavior is remeasured once more. If the behavior reverts to the baseline measurement following treatment, the treatment is understood to be responsible for the change
EX: A psychologist is interested in whether a new treatment for OCD decreases the frequency of compulsive behaviors. The psychologist collects a baseline measurement of the number of compulsions and then implements the new treatment. Then they remeasure the number of compulsions prior to withdrawing treatment and again once treatment has been removed. The frequency of compulsions did not decrease with the new treatment and instead remained consistent, meaning the new treatment was not responsible for any change.
Acceptance and Commitment Therapy (ACT)
A third generation behavioral therapy developed by Hayes. This therapy emphasizes the acceptance of painful thoughts and feelings as a natural part of the human experience. 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 inaction with respect to values. ACT encourages clients to move toward psychological flexibility via unconditional acceptance (rather than avoidance of negative feelings/experiences) and mindfulness skills.
EX: 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.
Anxiety-Fear Hierarchy
A tool use in exposure-based therapies in which a list of client’s feared situations is arranged in order of least anxiety-provoking to most anxiety-provoking. Once the hierarchy is created, the client assigns a subjective unit of distress (SUDs) rating to each of the scenarios – often ranging from 0-100. Then, the therapist works with the client to expose them to the feared situations by gradually moving up the fear hierarchy.
EX: A client diagnosed with OCD experiences recurrent/intrusive thoughts surrounding contamination fears. The client and therapist brainstorm a list of situations the client would find distressing. Some of the situations include setting her belongings down on the floor of a public place, using other people’s pens/pencils, sitting in a doctor’s office waiting room, etc. The therapist asks the client to assign a SUDs rating to each of the situations and then places them in order from least distressing to most, creating an anxiety hierarchy.
Assets
Personal skills or resources that can help a client with problem-solving and aspects of day-to-day life. 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: A therapist asks a client to brainstorm their strengths and things they do well. The client says, “I guess I’m organized and good with time management. Also people tend to tell me all their problems.” The therapist reflects the meaning of the client’s latter statement and says, “People view you as a good listener and trustworthy.” By highlighting the client’s assets the client feels more capable of change and views themselves in a more positive light.
Automatic Thought
A term coined by Beck and is often used in cognitive therapy and CBT. Automatic thoughts are images or mental activities that are habitual/immediate in response to a trigger stimuli. These thoughts occur with no effort on the client’s part (i.e. unconscious thoughts) and often serve a purpose of protecting the client in one way or another.
EX: An adolescent tells there therapist how they answered a teacher’s question wrong in front of the class. The student immediately told themself, “I’m so stupid. I can’t do anything right.” There was no effort on the student’s part to come to this conclusion, rather it was automatic. The therapist utilizes Socratic questioning to dissect the client’s automatic thoughts and understand the protective function they serve.
Behavioral Activation Therapy
A concept based on Skinner’s psychological model of change that is used in behavioral therapy and CBT, particularly in the treatment of depressive symptoms. The concept is based in the idea that avoidance and isolation behaviors serve to maintain or worsen depressive symptoms. Whereas engaging in life-fulfilling activities provide the client with positive reinforcement and encourages them to gradually re-engage with their surroundings to improve their mood.
EX: 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
This psychotherapy uses learning and conditioning principles to reduce undesired maladaptive behaviors and increase adaptive behaviors. The use of behavior therapy began in the 1950s-1960s as a backlash to psychoanalysis and sought to focus solely on observable actions, as opposed to unobservable thoughts/emotions.
EX: A mother brings her 12-year-old into therapy and tells the therapist, “She just won’t do her homework and I don’t know what to do anymore.” The therapist, utilizing a behavioral therapy approach, asks the mother what the 12-year-old doesinstead. After a brief discussion, the therapist tells the mother that in order to increase the desired behavior of completing homework, she can use the child’s desired behaviors (i.e. playing on the computer or jumping on the trampoline) as rewards/reinforcements. The therapist is not interested in the thoughts/emotions surrounding the homework avoidance but is only focused on the observable behaviors of the child.
Chaining
A part of operant conditioning when an instructional procedure is used to teach a complex behavior that has multiple components. The therapist conducts a task analysis and breaks the complex behavior down into stimulus-responsive components. Each component is taught and cues the next component until the last behavior is reinforced. Chaining can be done in a forward or backwards manner.
EX: A therapist works with a child diagnosed with autism spectrum disorder (ASD) on completing the task of washing one’s hands. 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 + 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.
Cognitive Fusion
A concept often associated with ACT where the state of mind in which a person is so fused with their thoughts that they consider them to be synonymous with fact. This is the tendency for individuals to take their thoughts literally and factually. ACT helps client with cognition defusion, meaning they observe their thoughts for what they are (which may or may not be true or reflect the environment).
EX: 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 coined by Beck and Ellis in their cognitive therapy and rational-emotive behavioral therapy (REBT), respectively. Cognitive restructuring is a technique that is designed to challenge a client’s maladaptive beliefs. Cognitive restructuring assumes that a client’s unrealistic beliefs/fault cognition are the cause of dysfunctional emotions and/or behaviors. 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
A therapy developed by Beck that focuses on the idea that psychopathology stems from a person’s reaction to their own maladaptive thoughts. Cognitive therapy postulates that there is a cognitive triad which consists of an individual’s view of themselves, of the future, and of the world. The goal of cognitive therapy is to challenge the client’s distorted cognitions and replace them with more adaptive thoughts.
EX: A 22-year-old client tells their therapist, “I just hate myself and so does everyone else.” From a cognitive therapy perspective, the therapist understands that the client’s maladaptive belief of hating oneself is part of the root of their overall distress/psychopathology. The therapist helps challenge and adapt the client’s distorted cognition(s) in order to improve their overall view of themselves, others, their future, and the world.
Conditioned and Unconditioned Responses
Terms coined by Pavlov in his development of classical conditioning. The unconditioned response is the automatic natural reaction to the unconditioned stimulus – the unconditioned response is not something that is taught. The conditioned response is the learned reaction to a previously neutral stimulus – the conditioned response is taught through repeated pairings.
EX: A client expresses immense anxiety when someone rings her doorbell. She often gasps, runs into an enclosed room away from the front door of her home, and finds herself shaking/crying. This is an example of a conditioned response and something she learned, as it is not a natural reaction to a seemingly neutral stimulus. An unconditioned response may be feeling slightly startled at the sound of the doorbell due to the unexpected noise naturally catching the person off guard.
Conditioned and Unconditioned Stimuli
Terms coined by Pavlov in his development of classical conditioning. The conditioned stimulus is a neutral stimulus which gains the power to elicit the response through pairing with the unconditioned stimulus. The unconditioned stimulus is the stimulus which elicits the reflexive response without a learning process/conditioning.
EX: An adult client tells their therapist that they have noticed an intense wave of anxiety when they hear their garage door opening. When asked to elaborate, the client tells the therapist that for months his wife has come home from work very irritable and that she often yells at him for “little things.” The previously neutral stimulus of the garage door opening has become a conditioned stimuli due to the pairing with anticipation of being yelled at “for nothing.”
Cue Exposure Therapy
A therapy commonly used to treat substance use that is based on principles of Pavlov’s classical conditioning. In cue-exposure therapy the individual is repeatedly exposed to cues that were previously associated with a certain behavior such as drug use. The behavioral response is then blocked or prevented. The goal is to habituate the individual to the cue, without the behavior occurring, so that the cue no longer elicits the behavioral response.
EX: A client who has been sober from alcohol use for 8 months is tasked with the challenge of going back to a local bar & grill where the client often met friends for drinks. The client goes to the restaurant with his sponsor and only orders food and a water. This is an example of cue-exposure therapy because the client is being exposed to a cue (i.e. the bar & grill) that was previously associated with heavy alcohol-consumption. The client successfully does not engage in the drinking behavior and allows himself to habituate to the environment/cue.
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 this matrix is to create cognitive dissonance in the client and ideally motivate them to change their behavior in an adaptive way.
EX: A client is undecided about whether or not they will quit their job and pursue employment elsewhere. The therapist walks the client through a decision-balance matrix to discuss the pros and cons of both staying at the current job and finding a new job. Ultimately the client decides that there are more pros associated with switching jobs and that those pros outweigh the cons of staying at the current job.
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 Behavior (DRO)
A concept used in the context of operant conditioning. DRO occurs when an individual is reinforced after a certain amount of time in which the undesired response has not occurred, and any other behavior has occurred. DRO is often unrealistic and quite time consuming, though it is often used in conjunction with extinction of the undesired response.
EX: A therapist works with a client, who has developmental delays, on keeping their hands in their “own bubble.” The therapist sets a specific amount of time, starting with two minutes, the client will work towards keeping their hands to themselves. When the client successfully keeps their hands off the therapist/other individuals for the set time frame, the client is reinforced. The client is allowed to engage in other behavior during this time and is reinforced for doing so.
Discriminative Stimulus
A term used in Skinner’s operant conditioning to describe a stimulus which helps the learner distinguish between situations in which a response will be reinforced and situations in which the same response will not be reinforced. The discriminative stimulus does not provoke the response itself, but instead signals to the learner that the situation is appropriate for that response.
EX: A therapist works with a 6-year-old boy on distinguishing when it is okay for him to speak in class and when it is not. The therapist gives the boy a “talking stick” to signal that speaking is appropriate. The boy is reinforced for talking when he holds onto the stick and is not reinforced when he speaks in class without being given the talking stick first. The talking stick is a discriminative stimulus because it does not make the child talk, rather it serves as a signal that it is appropriate to do so.
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: A client tells their therapist that they cannot use recommended coping skills and that they are just a “lost cause.” The client believes that the coping skills will not help and they will engage in the undesired behavior regardless. The therapist realizes they need to work on the client’s efficacy expectations in order to get them to engage in treatment.
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
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.
Exposure with Response Prevention (ERP)
A technique used in behavioral therapy that is based on principles of Pavlov’s 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.
EX: A client diagnosed with OCD engages in ERP to gradually work up their anxiety/fear hierarchy with their therapist. The client often has intrusive obsessions about loved ones dying and then engages in organization compulsions for relief. The therapist asks the client to “mess up” a stack of books in the therapist’s office, which brings up the client’s obsessive thoughts. The client is then asked to refrain from engaging in “fixing” or “organizing” behaviors. Oftentimes the presence of the therapist during ERP is enough to keep the client from engaging in compulsive behaviors.
