PSYC-501: Principles of Cognitive and Behavioral Change Flashcards
Acceptance and Commitment Therapy
ACT is a 3rd wave behavioral intervention that encourages acceptance of distressing thoughts and emotions while promoting actions aligned with personal values. It emphasizes mindfulness, acceptance, and committed action. ACT recognizes that psychological distress is a normal part of life and emphasizes acceptance of these experiences. The goal of the therapy is to decrease cognitive fusion with beliefs. There’s a focus on mindfulness, acceptance and living a valued life despite discomfort.
6 core components:
Acceptance: Being open to and embracing difficult thoughts and emotions without trying to change them
Cognitive defusion: Recognizing that thoughts are just words, and using strategies to reduce their impact on other behaviors
Self as context: Accessing the “observer self” and is closely related to present moment awareness
Being present: Being aware of the present moment
Values: Identifying and clarifying what is important and meaningful in life
Committed action: Developing patterns of effective action that align with chosen values
For example, Sarah, experiencing chronic pain, learns mindfulness to accept her discomfort without judgement, identifies her core values and takes small, meaningful actions, like reconnecting with friends, despite her pain. This enables her to live a more fulfilling life.
Ambivalence
Ambivalence refers to the experience of seeing reasons to change and reasons not to change simultaneously. Both wanting and not wanting to change, 2 things that are incompatible. It is considered a natural part of the change process and is crucial to address within behavioral therapy. When facing change, acknowledging and exploring ambivalence is crucial in helping individuals move towards resolving their uncertainties and taking steps towards positive changes. By acknowledging and addressing ambivalence in a non-judgmental way, motivational interviewing helps individuals to navigate the conflicting feelings and motivations they may have surrounding behavior change, ultimately fostering a path towards positive changes aligned with the person’s goals and values.
For example, a client comes to therapy and wants to stop drinking alcohol, but also feels ambivalent about it. She states that alcohol has negatively impacted her health, relationship and performance in school. She wants to stop drinking because she thinks it could positively improve her life. At the same time, all her friends drink and she is afraid of losing her connection to them. She also uses alcohol to escape emotional pain, and isn’t confident in her ability to maintain sobriety since she doesn’t have any sober friends and worries how she’d cope without alcohol. Within MI, this person could work with their therapist to address ambivalence and ultimately resolve it, allowing her to build self-efficacy and make changes aligned with her goals and values.
Anxiety/fear hierarchy
Often used in exposure therapy within Cognitive Behavioral therapy, a fear and avoidance hierarchy is a tool used to systematically list specific events that elicit anxiety, ordered in terms of increasing anxiety. SUDS (subjective units of distress) are listed next to each item, starting with the least distressing item, going up to the most distressing item. The steps are: identification, ranking, exposure and desensitization. Within the fear hierarchy, the client and therapist use “subjective units of distress” aka SUDs on a scale of 1-100.
This helps individuals confront and overcome their fears gradually through exposure therapy. By facing situations incrementally, people learn to manage anxiety and reduce avoidance. They begin with least distressing and progress towards more challenging scenarios, ultimately helping them break the cycle of avoidance and reduce anxiety. It helps the therapist and client create a structured plan for gradual exposure. They then develop a plan of either in vivo, imaginary or combination. It could be gradual or prolonged exposure, Exposure can take place in session, out of session or a combination of both.
For example, a person has a fear of driving due to a car accident. with their therapist, they plan exposures to treat the anxiety. They rank fear producing situations from least to more distressing using SUDs to quantify distress. Then, they begin confronting each situation repeatedly until their anxiety decreases (habituation) before moving to the next. Finally, the individual learns that the feared situations are not as threatening as initially perceived. Hierarchy for a person with fear of driving: 1. Looking at pictures of cars, 2. Standing near a parked car, 3. Sitting in a parked car with the engine off, 4. Sitting in a parked car with engine on, 5. Driving in a quiet neighborhood, 6. driving on a busy street, 7. driving on the highway
Assets
Assets are positive resources or qualities that can be leveraged to support desired behavior or improve outcomes. Assets can include personal strengths, skills, or external resources that contribute to positive behavior change. Assets are the last A within the ABCPA framework. The ABCPA framework is often used in behavioral assessment and intervention planning. Considering the assets adds a holistic perspective, taking into account individual characteristics and strengths in the behavior change process.
For example, Alex seeks therapy due to feelings of low self-esteem and anxiety. Despite struggling academically, Alex is passionate about art and enjoys creating paintings. By recognizing and incorporating Alex’s talent and passion for art into therapy (using art as a therapeutic tool), the therapist leverages this asset to facilitate emotional expression, build self-esteem, develop positive coping skills, and set meaningful goals.
Automatic thought
Spontaneous thoughts that occur in the immediate response to a situations and appear plausible; stem from intermediary and core beliefs. They are immediate interpretations or evaluations of events, and can significantly influence emotions and behavior.
Understanding automatic thoughts is crucial as they play a pivotal role in shaping one’s emotional reactions and behavior. By identifying and challenging these thoughts, individuals can gain insight into how their interpretations impact their feelings and actions. Helping individuals to replace unhelpful thoughts with more realistic and balanced perspectives, leading to improved emotional regulation and coping strategies.
Your client is upset because Bob, the new co-worker, won’t talk to her. She states it is because she is worthless and no one likes her. As a therapist conducting Beck’s cognitive therapy , you would view this is an automatic thought riddled with absolute thinking and jumping to conclusions. Your next step might be utilizing the downward arrow technique to get at the deeper schema/core belief.
Behavior activation therapy
From behavioral model of depression, depression was conceptualized as a lack of positive reinforcement. This therapy involves clients scheduling particular activities that are positively reinforcing. The client is also encouraged to self-monitor activities and mood. As someone engages in activities that generate positive feelings, the activities become intrinsically reinforcing, inspiring the person to do more of those things.
For example, Tony has recently been feeling very low. He wakes up foggy and can’t seem to motivate himself to get his school work done or to attend to the tasks of daily living. He hasn’t seen his friends in weeks, although they have reached out to him. He thinks resting will help clear the fatigue but the more he rests, the worse he feels. His therapist recommends behavioral activation therapy and asks Tony to identify a few activities that bring him joy. He says fresh air and seeing friends. His therapist asks him to take a morning walk a few times a week. At the end of the week, Tony reports that while it was difficult to get himself started, he felt lighter and more hopeful afterward.
Behavioral parent training/therapy
Parent Child Interactive Therapy is an evidence-based treatment consisting of 5-10 sessions designed for young children between 2 and 7 with disruptive behaviors, aggression, defiance, and attachment issues. It focuses on increasing positive reinforcement and enhancing the parent-child relationship and improving parent-child interactions to address behavioral problems effectively. It involves coaching parents in specific strategies to manage their child’s behavior and strengthen the parent child bond. It involves two phases, the parent directed interaction and the child directed interaction. Throughout, the therapist provides live coaching to provide immediate guidance and feedback to the parent as they interact with their child. PRIDE skills include: praise, reflect, imitate, describe, and enjoy. In the child-directed phase, the parent follows the child’s lead, provides positive attention, ignores disruptive behaviors, stops if behavior is aggressive or destructive, and the goal is for the parents to master PRIDE skills.
Parent Child Interaction Therapy emphasizes improving parent-child relationship, addressing behavioral issues and enhancing parenting skills. Enhancing the relationship promotes secure attachment and fosters positive interactions between parent and child. Additionally, this method equips parents with practical skills and techniques to manage challenging behaviors effectively, reducing defiance, aggression, and other disruptive behaviors in children. The PCIT empowers parents by teaching them positive and effective parenting strategies that can be applied beyond therapy sessions, leading to long lasting improvements in parent-child interactions.
In a 4 year old who exhibits disruptive behavior and defiance towards the parent, the therapist guides the parent to engage in positive interactions with the child. Using labeled praise and reflective statements to reinforce positive behaviors. In the parent-directed interaction, the therapist coaches the parent in setting clear, age-appropriate expectations and using effective discipline techniques, such as time outs for non-compliance while maintaining calm and assertive demeanor. Both phases include real-time coaching and feedback to parents, offering guidance on their interaction strategies and reinforcing effective parenting techniques. Parents learn and apply skills that enhance positive parent child interactions, reduce problematic behaviors, and create a more supportive and nurturing environment for the child’s emotional and behavioral development.
Behavior therapy
This is a type of psychotherapy that uses principles of learning and conditioning to reduce maladaptive behavior and to increase adaptive behaviors. This is based on Pavlov’s classical conditioning theory and focused on problem behaviors that were directly observable. This therapy is present focused and generally brief. The focus is on behavior itself and the contingencies and environmental factors that reinforce that behavior, not finding the cause of it.
This focuses on problem behaviors and ignored cognitions. It originally came as a reaction to psychoanalysis. Focus is on the behavior itself and the contingencies and environemental factors that reinforce or maintain the behavior rather than exploring the underlying causes of the behavior.
The steps include: clarifying the problem, formulating intial goals for therapy, identifying target beavhiro, designing a treatment plan, evaluating the success of the plan, and identifying the next target behavior.
During the course of therapy, the client and the therapist work collaboratively. Pavlov, Wolpe, Watson, and Skinner all contributed to the early development of behavior. therapy.
John is a 12 year old client whose parents brought him to therapy because he has been acting out in school, yelling at his peers when he feels angry and throwing things in the classroom. The therapist uses principles of behavior therapy in order to reduce these undesired maladaptive behaviors and to increase more adaptive behaviors.
Chaining
Teaching complex behaviors by breaking them down into smaller, manageable steps and then linking these steps together to form a sequential chain of actions. Each time the client completes a goal behavior, they are positively reinforced. This helps individuals to learn and execute multi-step tasks or behaviors systematically, particularly beneficial for those with learning disabilities or developmental disorders.
For example, for people with autism, teaching a daily living skills like brushing teeth involves breaking down the task into smaller steps and teaching each step separately before linking them together into a chain, facilitating the mastery of the entire skill.
Classical/Respondent Conditioning
Classical conditioning involves forming an association between two stimuli, resulting in a learned response. There are three basic phases of this process.
The first part of classical conditioning process requires a naturally occurring stimulus that will automatically elicit a response. Salivating in response to the smell of food is a good example of a naturally occurring stimulus. During this phase of the process, the unconditioned stimulus (UCS) results in an unconditioned response (UCR). Presenting food (the UCS) naturally and automatically triggers a salivation response (the UCR).
At this point, there is also a neutral stimulus that produces no effect - yet. It isn’t until the neutral stimulus is paired with the UCS that it will come to evoke a response.
During the second phase of the classical conditioning process, the previously neutral stimulus is repeatedly paired with the unconditioned stimulus. As a result of this pairing, an association between the previously neutral stimulus and the UCS is formed.
At this point, the once neutral stimulus becomes known as the conditioned stimulus (CS). The subject as now been conditioned to respond to this stimulus. The conditioned stimulus is a previously neutral stimulus that, after becoming associated with the unconditioned stimulus, eventually comes to trigger a conditioned response.
Once the association has been made between the UCS and the CS, presenting the conditioned stimulus alone will come to evoke a response - even without the unconditioned stimulus. The resulting response is known as the conditioned response (CR).
The conditioned response is the learned response to the previously neutral stimulus.
For example, Watson’s experiment with Little Albert is an example of the fear response. The child initially showed no fear of a white rat, but after the rat was repeatedly paired with loud, scary sounds, the child began to cry when the rat was present. This illustrates how phobias can form through classical conditioning.
Cognitive Fusion
The tendency to take thoughts literally and believe that they are accurately describing how things are rather than seeing them as what they are, just thoughts. Overidentifying with one’s thoughts in a way that has a negative influence on action and awareness. This is a principle in psychological inflexibility.
This is one of the aspects of psychological inflexibility that is targeted within ACT. Cognitive diffusion is the attitude and involves letting go of the idea that one’s thoughts are valid descriptions and explanations of one’s experiences so that they can be seen only as thoughts. When a person becomes fused with their thoughts, they perceive them as facts for truths. This can lead to distress, avoidance behaviors, and hinder the ability to live a rich and meaningful life.
For example, a person with social anxiety thinks “I’m going to make a fool of myself and everyone will think I’m awkward.” Then, they believe this thought and feel fear, shame and anxiety. They may avoid social situations to prevent the perceived embarrassment. By learning to diffuse from cognitive fusion, individuals can gain psychological flexibility allowing. them to experience thoughts without getting entangled in them, so. that they can choose actions that align with their values, even amidst uncomfortable thoughts and emotions.
Cognitive restructuring
This is a fundamental technique in CBT aimed at helping individuals identify and modify unhelpful or distorted thought patterns, beliefs, and perceptions that contribute to emotional distress or maladaptive behaviors. It involves challenging and replacing irrational or negative thoughts with more rational, balanced, and realistic ones. This is used in Rational Emotive Behavior Therapy and Beck’s Cognitive therapy. It addresses the cognitive component of psychological issues, and acknowledges that our thoughts significantly influence our emotions and behavior. By identifying and challenging negative thought patterns, individuals can experience improvements in their emotional well-being and behavioral responses.
Betty wasn’t invited to a dinner with friends, and thinks “My friends don’t like me”. The cognitive therapist points out these maladaptive cognitions and uses cognitive restructuring to challenge their validity. “What evidence do you have for and against this belief”
The client shares that she has been invited to many other things, and that her friends have said they enjoy spending time with her.
Cognitive Therapy
Aaron Beck was influential in cognitive therapy. This therapy focuses on cognitions as the origin of psychopathology, Cognitive activity is potentially observable and therefore can be monitored, counted, and altered. The client is the expert. Cognitions are triggered by automatic thoughts. Analyze schemas/core beliefs which are structures that organize and process info; deepest most ingrained level of cognitions. The goal is to correct faulty information and focus more on the present. Emphasizes the collaboration between therapist and client. Techniques include downward arrow and cognitive restructuring. This therapy can be used for anxiety and depression and the theory states that maladaptive thoughts are behind the development of mental disorders.
A grad student comes into therapy experiencing great anxiety about her comps exam in the fall. She reports having thoughts like “I’m stupid” and “I’m going to fail” when she sits down to study. The cognitive therapist points out these automatic thoughts and uses the downward arrow technique exploring the client’s schemas and core beliefs so that they can work to change/correct them.
Cue Exposure Therapy
This represents a specialized technique within CBT, frequently used in treating substance related disorders, eating disorders and OCD. This method involves deliberate exposure to cues triggering the desire for substance use or eating behavior without following through on the behavior itself. Response prevention aims to curtail escape and avoidance, behaviors that temporarily alleviate anxiety, thereby reinforcing the link between cues and urges. The overarching objective of CET is extinction, where repetitive exposure leads to a reduction in cravings over time. Incorporating coping strategies and skills further enhances its efficacy. This focuses on reducing cravings or urges, diverging fro fear-based responses. Previously, drug or alcohol related cues would elicit strong reactivity. However, through exposure followed by response prevention, extinction gradually occurs. Eventually, the individual becomes capable of encountering drug-related stimuli without triggering a reactive response. This is helpful in preventing relapse.
For example, a client undergoing CET for alcohol related cues might sit in a bar or observe someone else drinking. During these sessions, coping strategies would be discussed and practices to manage urges, particularly in social situations where others might offer drinks. This controlled exposure allows for the gradual desensitization to alcohol-related cues while learning effective ways to cope with and reduce the urge to drink.
Decisional Balance Matrix
This technique involves exploring and discussing the pros and cons of change behaviors and the pros and cons of status quo. It helps the client gain insight into their motivations, ambivalence, and concerns about changing their behavior. This technique comes from motivational interviewing. By engaging in this exercise, the therapist aims to collaboratively explore the client’s thoughts and feelings about change, validate their experiences, and help t hem clarify their motivations and concerns. The goal is to facilitate the client’s own exploration of change and strengthen their commitment to move toward a decision that aligns with their values and goals.
You’re working with a teenager that is using substances to a dangerous extent. You are considering a substance use disorder diagnosis; the client is extremely ambivalent, and still in denial. You explain to her that it can be good to think through all of the pros and cons of change. You work with her to fill out a decision balance matrix worksheet that assesses all of the costs and benefits. After completing the worksheet, you spend time discussing and exploring her answers to see if her ambivalence has been resolved. That is, is the client more or less ready to change?
Dialectical Behavior Therapy
This is a 3rd wave therapy. Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others. DBT was originally created by Marsha Lineman to treat BPD, but has been adapted to treat other mental health conditions such as PTSD. It can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviors like eating disorders or substance use disorders. This type of therapy includes group therapy, individual therapy and sometimes phone coaching.
One important benefit of DBT is the development of mindfulness skills. Aware of what’s happening inside you and around you in a nonjudgemental way. This strategy can help a person stay calm and avoid engaging in automatic negative thought patterns and impulsive behavior.
During the beginning of treatment, serious and self-destructive behaviors are addressed first. Then, interpersonal effectiveness, emotional regulation skills and ability to tolerate distress. Then, focus moves to self-esteem and interpersonal relationships. Finally, finding ways to experience greater happiness, stronger relationships and pursue life goals.
For example, Anna Marie has BPD. She begins attending 3x a week group for BPD, where she is able to practice interpersonal effectiveness skills, distress tolerance and learn mindfulness techniques. Through engaging in the treatment, her relationships improve and she no longer cuts herself when she feels upset.
Differential reinforcement
This is a behavioral principles within CBT that involves reinforcing certain behaviors while extinguishing others. Behavior can be modified through reinforcement or lack thereof, shaping new behaviors while reducing or eliminating unwanted ones. There are several kinds of differential reinforcement including DRI- differential reinforcement of incompatible behavior, DRA - differential reinforcement of alternative behavior, and DRO differential reinforcement of other behavior. This concept is crucial as it provides a systematic and structured approach to modifying behavior, allowing individuals to learn new more adaptive behaviors by reinforcing them positively. Allows people to replace undesirable habits with healthier alternatives, promoting positive change and improving functioning.
For example, a child who frequently hurled objects at other people was reinforced for throwing objects at anything but a person (DRO). Although throwing things at inanimate objects is undesirable, it is less undesirable than injuring people.
