PSYC 501: Principles of Cognitive and Behavioral Change COPY Flashcards

1
Q

ABA Design

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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 Treatment is then withdrawn and the target behavior is remeasured once more.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.

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2
Q

Acceptance and Commitment Therapy (ACT)

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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.

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3
Q

Anxiety-Fear Hierarchy

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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.

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4
Q

Assets

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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.

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5
Q

Automatic Thought

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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.

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6
Q

Behavioral Activation Therapy

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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.

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7
Q

Behavior Therapy

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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.

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8
Q

Chaining

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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.

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9
Q

Cognitive Fusion

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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.

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10
Q

Cognitive Restructuring

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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.

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11
Q

Cognitive Therapy

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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.

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12
Q

Conditioned and Unconditioned Responses

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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.

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13
Q

Conditioned and Unconditioned Stimuli

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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.”

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14
Q

Cue Exposure Therapy

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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.

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15
Q

Decision-Balance Matrix

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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.

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16
Q

Dialectical Behavior Therapy (DBT)

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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.

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17
Q

Differential Reinforcement of Other Behavior (DRO)

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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.

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18
Q

Discriminative Stimulus

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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.

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19
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Efficacy Expectations

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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.

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20
Q

Empirically Supported Therapy/Treatment

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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.

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21
Q

Escape/Avoidance

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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.

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22
Q

Exposure with Response Prevention (ERP)

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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.

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23
Q

Extrinsic and Intrinsic Reinforcers

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Terms used in the practice of operant conditioning to describe the source of reinforcement for different stimuli. Extrinsic reinforces are those that come from the outside environment, whereas intrinsic reinforcers come from within the individual. The use of intrinsic reinforcers often maintains a behavior more so than the use of extrinsic reinforcers.

EX: A client tells their therapist that they “hate their job and feel unfulfilled.” When the therapist asks why they stay at their current job the client tells them, “Honestly just for the paycheck.” The paycheck is an example of an extrinsic reinforcer. The therapist and client brainstorm occupations that may feel more fulfilling for the client and give them a greater sense of purpose (i.e. intrinsic reinforcer). In the case of employment, the client does need a job that will pay the bills but now also understands it is possible to pay the bills and be happy to go to work.

24
Q

Functional Analysis

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A primary method of assessment used in behavior therapy. This 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.

EX: A client engages in self-harming behavior several times a week. The therapist completes a functional analysis to better understand what precedes and succeeds the behavior, as well as aspects of the client 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.

25
Q

Generalization and Discrimination

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Generalization refers to the process in which a response occurs in the presence of several similar stimuli, not just one specific stimuli. Discrimination refers to the ability to perceive and respond to differences between stimuli and not always respond in the same way (as seen with generalization).

EX: A therapist notices that a young client calls all adult women “mama.” The child has generalized the label “mama” as women, as opposed to the individual who actually fulfills that role. The therapist helps the child differentiate the child’s mother from other adult women and understand/perceive the difference between the individuals/stimuli.

26
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Exposure Therapy

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A technique used in behavior therapy often used to treat anxiety or anxiety disorders. This therapy involves repeatedly exposing the individual to stimuli that elicits their anxiety, under safe and controlled conditions. Response prevention and/or relaxation techniques are then utilized to reduce the client’s level of anxiety during the time of exposure. The client’s anxiety must peak and will naturally begin to descend due to the process of allostasis.

EX: A client is asked to write a narrative that depicts, in detail, a past sexual assault. This task will elicit anxiety in the client without actually putting them in harm’s way. As the client reads the narrative aloud to their therapist, the client is encouraged to pause and breathe when needed. Overtime the client’s anxiety will naturally begin to decline, even if the felt distress was high earlier in the session.

27
Q

Iatrogenic Effects

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A term used to refer to incidents when a therapist’s treatment and/or expectations inadvertently create or worsen a client’s conditions. This often occurs through misdiagnosis. Some diagnoses and populations are regarded as carrying a higher risk for iatrogenic effects.

EX: A therapist, with prior experience at a trauma residential facility, diagnoses a client with PTSD due to complaints of sleep disturbances. The therapist attempts to treat the underlying trauma, only to realize that such a trauma does not exist and the client actually suffers from insomnia due to anxiety. The client did not receive appropriate treatment because of the clinician’s mistake and now wonders if they do in fact have some sort of repressed trauma that is affecting their quality of sleep.

28
Q

Imaginal Exposure

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A form of exposure used within behavioral therapy when the client pictures the feared stimuli and keeps the image/situation at the forefront of their mind until their anxiety response gradually declines. Imagined exposure can be gradual or direct and is often used when the feared stimulus is unethical or impossible to recreate in real life.

EX: A veteran diagnosed with PTSD is asked to imagine a distressing moment from their time in active duty. The veteran visualizes the moment he was forced to kill another human being. It would be unethical to recreate this experience in real life, therefore the clinician utilizes imaginal exposure to help the client process their trauma.

29
Q

In Vivo Exposure

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A form of exposure used within behavioral therapy when the client is exposed to the anxiety-inducing situation in real life, within safe and controlled conditions. This is often done in conjunction with relaxation techniques and the client is exposed to the anxiety-inducing situation until the anxiety declines.

EX: A client is fearful of going into a large shopping center due to a shooting that happened 16 years ago. The therapist meets the client at the local mall and walks through the facility with them. The therapist encourages the client to keep breathing and utilize coping skills practiced in session. This is an example of in vivo exposure because the client is exposed to the shopping center in real life/time.

30
Q

Learned Helplessness

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A term coined by Seligman and used in behavior therapy. This theory refers to the exposure of frequent and uncontrollable punishment, which in turn can cause psychopathology. Learned helplessness occurs when the individual has learned that they cannot control the outcome of a situation and therefore they do not attempt to control/change the outcome.

EX: An adult female client tells her therapist, “It’s not like it matters. He’s going to hit me regardless of what I say, may as well not fight it.” The client has repeatedly been exposed to physical abuse by her husband and has learned that no matter what she says or does, it will not change the husband’s decision to hit her. The client no longer tries to change his mind and has instead embodied elements of learned helplessness (which the therapist recognizes as also being a protective factor in this specific circumstance).

31
Q

Learning-Performance Distinction

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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.

EX: A group of psychologists are interested in math problem accuracy when students are given a written test versus asked to answer aloud in class. All of the students have practiced the math problems and have shown math efficiency on paper. The psychologists notice, however, that student accuracy decreases when they are asked to answer aloud. This is an example of the learning-performance distinction because all students have shown they learned the information, but only some show they are able to maintain their accuracy level when asked to speak on the spot.

32
Q

Meta-Analysis

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A term used to describe a method for systematically combining the results of multiple studies to develop a single conclusion about a research question.

EX: A group psychologists conduct a meta-analytic review of journal articles that are focused on the treatment of bipolar disorder. The psychologists review hundreds of studies and compile their findings into a conclusion about what treatment is most effective for bipolar disorder.

33
Q

Mindfulness

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A common component of 3rd generation therapies in which a nonjudgmental attention is brought to the individual’s moment-by-moment experience. Mindfulness allows the client to accept the existence of their thoughts and experiences, without attempting to change or control them. This often contributes to a decline in emotional distress and fosters insight.

EX: A client comes into therapy and presents with anxiety about an upcoming presentation at work. The therapist works with the client to recognize what the anxious thoughts are telling her about the presentation. The therapist reminds the client that there is no need to justify or elaborate, just merely state what the thoughts are without actually “doing” anything about them. The client is encouraged to focus on their breath and simply let their thoughts exist without judgment.

34
Q

Motivational Interviewing

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A therapeutic technique created for the purpose of eliciting a behavioral change. The therapist has the client explore the positive and negative aspects and maintaining their current behaviors and also from the perspective of changing the behavior. The goal of this technique is to reduce ambivalence and motivate the client to follow the behavior that best serves them (whether it is maintenance, or more often than not, a behavioral change).

EX: client tells their therapist they are unsure whether or not they should file for divorce with their wife. She explains how she and her wife were so happy together, but in recent years all they’ve done is argue. The therapist utilizes motivational interviewing techniques to help the client explore options from both the perspective of staying and the perspective of leaving. The therapist is not pushing the client to decide one way or another, but rather is trying to help the client come to their own conclusion about what they want to do with their life.

35
Q

Multiple Baseline Design

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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: A psychologist conducts a study on the treatment for three different clients diagnosed with ASD who display stimming behaviors and echolalia. A baseline measurement of the behaviors is recorded and then treatment is implemented at different times for each of the clients and for each of the behaviors in a sequential fashion. The psychologist then records data from each client after their respective time for treatment implementation.

36
Q

Outcome Expectations

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A term coined by Bandura is his work on self-efficacy. This term refers to an individual’s belief that a particular course of action will produce a certain outcome. Outcome expectations may influence whether a person puts themselves in a situation or not.

EX: An adolescent client tells their therapist, “You’re wasting your time. Therapy does not help me.” This kind of belief is clinically relevant because the client’s disbelief in the therapeutic process, their outcome expectation of therapy (or lack thereof), will not push them to engage in sessions and ultimately keep them stuck.

37
Q

Outcome vs Process Research

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Terms used in statistics in research design to describe two research methods often used in clinical/counseling psychology. Outcome research is used to assess the effectiveness of a treatment in producing change or determining the extent to which a treatment is better than the control. Process research identifies counseling variables that were involved in the impact in order to determine which variables of the treatment were effective (i.e. a dismantling study).

EX: Psychologists are interested in a new treatment for borderline personality disorder (BPD). The psychologists first conduct an outcome research design to determine if the new treatment is even effective. Once they determine that it is, the psychologists conduct a process research design to understand what specific factors of the treatment made it effective.

38
Q

Parent-Child Training Therapy

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A form of CBT based on the assumption that children are often brought into therapy due to problems caused by the parent-child interaction. The goal of this therapy is to improve the parent-child relationship and the parent’s behavior management skills (taught by the therapist). This treatment contains two stages, first a child-directed interaction and secondly a parent-directed interaction.

EX: A father brings his 7-year-old son into therapy and tells the therapist, “He just won’t listen. It’s like he hears my instruction and then just does the opposite.” After further evaluation the therapist decides that parent-child training therapy would be most effective to help the child learn to listen and follow instructions. The therapist decided this because of the father’s reaction to the boy’s lack of listening (i.e. yelling and lack of patience). With this therapy, once the parent-child relationship is improved, it is theorized the boy’s behavior will improve.

39
Q

Positive Reinforcement

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A principle coined by Skinner and used within operant conditioning. This terms refers to when a behavior is followed by a positive/desired stimulus in order to increase the likelihood that the behavior will continue to occur in the future.

EX: A therapist is asked to work with a young client on using his voice/words when he needs something, as opposed to a whining tone or tantrum. The therapist decides to utilize positive reinforcement to increase the boy’s frequency of speaking calmly/clearly. The therapist rewards the boy with words of affirmation or stickers when he successfully completes the task asked of him.

40
Q

Premack Principle

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A principle used in operant conditioning that states that high frequency behaviors can be used to reinforce low frequency behaviors. Meaning that the ability to engage in a high frequency, often desired, behavior is contingent on the performance of a low frequency behavior. The goal is to increase the low frequency behavior.

EX: A client, who is a senior in college, tells her therapist that she “can’t make [herself] work on [her] senior thesis].” The therapist decides to utilize the Premack Principle to help the client find motivation and keep herself accountable. The therapist asks the client if it would be helpful if she used desirable behaviors (i.e. scrolling on social media or going out with friends) as a reward for working on her thesis. The client agreed to try working on the thesis for an hour in order to use social media for 20-30 minutes following.

41
Q

Problem Solving Therapy

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A form of CBT designed to help clients with immediate problems develop problem solving strategies/solutions. This therapy occurs in five stages: problem identification/description, identification of goals, generation of solutions, making decisions about success of each plausible solution, and an implementation of solutions. The client is also encouraged to follow-up with this process again if the implementation of the chosen solution fails.

EX: A college student tells his therapist that he “can’t get along with [his] roommate.” The therapist decides to utilize problem solving therapy in order to help the client find solutions for how to at least be civil or cordial with his roommate. They identify the most pressing problems, make realistic goals, and then walk-through plausible solutions.

42
Q

Primary/Secondary Reinforcer

A

Terms used in operant conditioning to describe the source of reinforcement. A primary reinforcer is one that is naturally reinforcing without being taught. Primary reinforcers generally have to do with basic needs, such as food and sleep. A secondary reinforcer is one that acquires value through association with a primary reinforcer. Secondary reinforcers can be things like approval from others, candy rewards, or money.

EX: A therapist working with a pre-teen client explains to the client’s parents the difference between primary and secondary reinforcers. The parents often tell the boy, “If you don’t do your homework, you don’t get dessert.” The dessert/food item is an example of a primary reinforcer because it meets a basic need and is naturally reinforcing. The boy often eats his dessert while playing video games, making the video games a secondary reinforcement because it is associated with an activity (i.e. video games) that was learned to be desirable.

43
Q

Reactivity of Self-Monitoring

A

A term used to describe how the observation/recording of one’s behavior reacts with the problem behavior. This can either be problematic or beneficial as the client is more aware of their behavior and may adjust the behavior on their own. The best course of action is to have the client monitor “good” behaviors instead of “bad” behaviors.

EX: A therapist believes their 18-year-old client is struggling with an undiagnosed restrictive eating disorder. The therapist asks the client to write down everything they eat over the next week and to bring it session. The client is even more aware of their caloric intake because of this assignment and feels compelled to consume even less than normal. This is an example of how reactivity to self-monitoring can be problematic because the client adjusted their behavior in a maladaptive way.

44
Q

Reciprocal Determinism

A

A concept that opposes exclusive emphasis on environmental determination of responses and asserts that a reciprocal relationship exists among environment, behavior, and the individual. Meaning that reciprocal determinism maintains that the environment influences behavior, behavior influences the environment, and both influence the individual, who also influences them.

EX: An adult client tells their therapist that they “just hate their job.” The therapist utilizes an outlook of reciprocal determinism to understand that it’s not only the environment of the job itself that bothers the client, but also their reaction to that environment and vice versa.

45
Q

Reinforcer

A

A term used in operant conditioning to describe the consequence of a behavior that increases the likelihood that the behavior will be repeated. This consequence is usually pleasant or desired.

EX: A client is in distress because she has issues with saving. She feels it is having a negative impact on her life financially and having stressful thoughts about not having enough money. This client is also trying to quit smoking. The therapist suggests to the client to monitor her smoking every day. Every time she has an urge to not smoke and does not go outside indulge in her urge, she should deposit $5 into her bank account. The money is a reinforcer for her fighting the urge to partake in a bad habit.

46
Q

Schedules of Reinforcement

A

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: A therapist works with an adult client who is a kindergarten teacher. The therapist explains the difference between the five possible schedules of reinforcement and asks the client if they’ve tried something like this to help with difficulties she has been having with her students. The client was most interested in implementing a variable ratio reinforcement schedule for her student’s behavior. A few weeks later the client expressed a noticeable difference in her students, which in turn helped improve her anxiety around going to work.

47
Q

Schema

A

A term coined by Piaget to refer to an organized cognitive framework that helps to interpret information. Schemas are the organized units of information about the world by which we perceive and categorize new information/experiences. Humans tend to seek out information that support previously constructed schemas.

EX: An adult client experience sexual abuse as a child by his uncle. Because of the abuse and relationship issues in his teens/early adulthood, the therapist has an understanding that the client has a schema of sexual behavior equating danger. The client’s experiences have caused him to categorize his negative sexual experiences into a schema that matches his lived experience/perception.

48
Q

Self-Efficacy and Outcome Expectations

A

Self-efficacy refers to one’s belief that they can successfully perform a behavior. Self-efficacy is fundamental for behavior change due to the intrinsic belief/faith in one’s own abilities. Outcome expectations refer to one’s prediction that their behavior will produce a particular result. Self-efficacy influences outcome expectations as those with higher self-efficacy are more likely to predict a positive outcome for a behavior – both of which are vital for treatment progress/success (i.e. client needs to believe that not only will the treatment help, but that they are capable of making that happen).

EX: A client comes into therapy and admits struggling with substance use. The client tells the therapist that they know substance abuse treatment has helped others struggling find sobriety/recovery. However the client doubts that will be true for them. The client is expressing uncertainty in their self-efficacy as well as outcome expectations to some degree. The therapist understands that both these elements need to be worked on in order for treatment to be effective.

49
Q

Self-Reinforcement

A

A term used in operant conditioning where the individual delivers their own consequences as contingent on their own behavior. The primary issue with self-reinforcement is that the individual is in charge of evaluation and subsequently reinforcing/punishing their own behavior which leaves the possibility for dishonesty. At the same time, it creates self-accountability for the client.

EX: A client struggling with self-harming behavior decides to utilize self-reinforcement in an attempt to stop engaging in the maladaptive behavior. At the end of each day, if the client successfully fought urges to self-harm that day then they reinforce/reward themselves with their favorite Ghirardelli chocolate square. On occasion the client justifies the self-harming behavior and still allows themselves the reinforcement at the end of the day – depicting one of the main issues with self-reinforcement.

50
Q

Shaping

A

A term used in operant conditioning to describe a method of teaching a novel behavior. In shaping, the individual is reinforced for successfully completing a behavior or any behavioral response that comes close to the target behavior. The reinforcement of behaviors that are close to the target encourages the client to continue working toward the desired target behavior – known as successive approximations.

EX: A therapist works with a client diagnosed with down syndrome. The therapist decides to use principles of shaping to help teach the client how to fasten his own shoes. The therapist offers reinforcement when the client successfully Velcros his own shoes as well as when the client engaged in the motion but didn’t line the Velcro up. This is an example of shaping because even when the client does not successfully complete the task, they are still reinforced to encourage them to continue working towards the target behavior.

51
Q

Social Skills Training

A

A form of individual or group behavioral therapy that helps individuals improve social skills. Said individuals usually (but not exclusively) suffer from social anxiety, depression, personality disorder, or developmental disorders. Social skills training generally begins with an assessment of one’s social skills deficits and impairments and is preceded by performing actions such as role play, corrective feedback, instruction, reinforcements, modeling, and homework assignments.

EX: A therapist works with a client diagnosed with high-functioning autism spectrum disorder (ASD) to increase their social skills. In their social skills training sessions, the therapist helps the client learn appropriate social proxemics. If the client stands an appropriate distance from peers, it is hoped that others will not disengage with the client so much and allow them to create social connections.

52
Q

Spontaneous Recovery

A

This term refers to the phenomenon in which a previously extinguished conditioned response re-emerges after a period of time. This event signifies that extinction is not the same as “unlearning” a behavior.

EX: A young client worked diligently with her therapist to stop biting her nails. The client successfully met her goal, but months later noticed the behavior had started again. This is an example of spontaneous recovery because the nail-biting behavior had ceased and then after a period of time it re-emerged.

53
Q

Spontaneous Remission

A

A phenomenon in which symptoms improve or resolve unexpectedly and with no clinical explanation.

EX: A client struggling with depressive symptoms had long refused to engage in therapeutic or medication interventions. After a few months with no treatment, the client noticed a significant improvement in their depressive symptoms. The client had stopped engaging in all treatment attempts and there appeared to be no logical explanation for the remission of their depressive symptoms.

54
Q

Successive Approximations

A

A term used in behavior therapy during the process of shaping. This term refers to gradually taking increasingly complex steps toward a desired target behavior. The behaviors are rewarded as they are are repeated and as they more closely resemble the desired final behavior.

EX: A therapist works with a client with social anxiety. The client hopes to engage in brief conversation with peers at school, outside of her “safe” locations. The therapist utilizes successive approximations in the process of shaping to help the client build up skills toward the target behavior. For example, they brainstormed locations at school they would be progressively harder for the client to speak up in.

55
Q

Systematic Desensitization

A

A first-generation exposure therapy created by Wolpe which combines exposure therapy with relaxation techniques. Client engages or imagines anxiety-arousing sitations, simultaneously engaging in competing with anxiety (relaxation) techniques. The goal is for the client to gradually (systematically) become less sensitive (desensitized) to anxiety provoking situation in hopes to reduce overall fear/anxiousness.

EX: An adolescent client comes into therapy with a fear of dogs, specifically Dobermans. The therapist utilizes systematic desensitization to gradually expose the client to Dobermans while simultaneously using relaxation techniques. The therapist helps the client first just visualize the breed, then they watch videos, view one from beyond a fence, walk by one on a sidewalk, and ultimately pet a Doberman.

56
Q

Token Economy

A

A term used in operant conditioning and behavior modification. This is a technique based on the systematic reinforcement of a target behavior and is used to motivate clients to perform desired behaviors. Clients earn ‘tokens’ for desired behaviors and may lose ‘tokens’ for undesired behaviors. Tokens can then be exchanged for a desired reward and can be used with an individual or with a group.

EX: A therapist facilitates a group for children with behavioral concerns. The therapist implements a token economy for the children. When the clients engage in appropriate target behaviors, the therapist rewards them with tokens (i.e. laminated circles of cartoon gold coins). The therapist also takes tokens away if/when a client engages in a maladaptive behavior. Once the clients collect a total of 10 tokens, they are able to turn them in for a prize out of the therapist’s “prize box” (i.e. small toys, fidgets, etc.).