PSYC 501 - Principles of Cognitive & Behavioral Change

Question 1

ABA or Reversal Design

Answer 1

ABAB Design is a type of single-subject outcome research design in which a baseline is assessed (A), the treatment is introduced (B), then the treatment is removed (A), and reintroduced again (B). If the dependent variable changes with the introduction of the treatment and then changes back to baseline following the movement of a treatment, this provides strong evidence of a treatment effect.

Clinical Example: A psychologist is interested in testing the efficacy of a new behavioral treatment for ADHD and decides on a reveral design for their study. They measure an individual’s hyperactivity at baseline (pre-treatment), then introduce the treatment and assess hyperactivity again, then remove the treatment to see if hyperactivity returns to baseline. Some designs may then reintroduce the treatment again to assess behavior change again.

Question 2

Acceptance and Commitment Therapy (ACT)

Answer 2

3rd generation behavioral therapy developed by Steven Hayes. Says that psychopathology comes from experiential avoidance and cognitive fusion. Paradoxically the process of avoiding yields more distress. The primary goal of ACT is to create psychological flexibility in clients. This is done through acceptance and mindfulness skills and commitment and behavior change skills.

Six Therapeutic Components:

• Be here now: Making contact with the present moment.
• Defusion: Separating/detaching from private thoughts; holding on to thoughts lightly, not tightly.
• Acceptance: Opening up and making room for all experiences, including so-called unpleasant ones
• Self-as-context: The observing self determines context and is the entity through which awareness happens.
• Values: The goals you desire and the activities/beliefs that matter to you.
• Committed action: Doing what you need to do to move toward and live by your values.

Clinical Example: A patient presents with symptoms of depression and chronic pain. The pain they live with is due to an autoimmune disorder with no cure. The depressive symptoms seem to stem from the patient’s inability to change her disorder and the pain that accompanies it. The therapist recommends ACT to help the patient shift her expectations about living pain free, to living as well as she can in accordance with her values while accepting her pain and disorder.

Question 3

Anxiety/fear hierachy

Answer 3

Used in exposure therapy, a fear hierarchy is a breakdown of a person’s feared stimuli into components, ordered in terms of how much subjective distress they produce (SUDs). The client is led through either imaginal or in vivo exposure to each item on the hierarchy, starting with the least distressing, until they are able to tolerate the discomfort.

EXAMPLE: a soldier suffering from PTSD (Post Traumatic Stress Disorder) is now terrified by guns. Even a picture of a gun can elicit a fear response in the soldier. Handling a gun could cause a serious fear response. In this case, the soldier could choose looking at pictures of guns as the least intense fear for his anxiety hierarchy, and holding or shooting a gun could be the most intense fear for his anxiety hierarchy.

Question 4

Assets

Answer 4

In ABCPA behavioral assessment model, assets are the skills or strengths an individual has that may prove useful during the therapeutic process. For example, if an individual is highly motivated to change, that is an asset they bring to therapy with them that could impact the success of therapy.

Clinical example: You have a client that is struggling with debilitating social anxiety. He comes in because he is worried about going off to college next year; he frequently skips class now and knows that this will become a problem. During the assessment you’ve uncovered the fact that he has a very strong commitment to learning. This is an asset of his that you plan on using to help overcome some of his class skipping behaviors.

Question 5

Automatic Thought

Answer 5

According to Beck’s Cognitive therapy, automatic thoughts are conditioned ideas that arise quickly and spontaneously in response to particular stimuli.

• Can include cognitive distortions such as dichotomous thinking, personalization, emotional reasoning, etc.
• Can be maladaptive and persistent - need to be challenged
  
  • In Beck’s cognitive therapy, pt and therapist monitor, identify, and categorize dysfunctional automatic thoughts; pt taught to consider automatic thoughts as hypotheses to be tested.
  • Downward arrow technique explores underlying assumptions and schemas related to automatic thoughts

Clinical example: 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.

Question 6

Behavioral Activation Therapy

Answer 6

Developed by Lewinsohn, behavioral activation stems from a behavioral model of depression which conceptualized depression as a lack of positive reinforcement. It involves clients scheduling particular activities that are positively reinforcing, such as seeing a friend or going for a walk, and that engaging in those behaviors may lead to positive psychological and emotional changes as well.

• Occurs via:
  
  • Self-monitoring of activities and mood
  • Scheduling Activities
  • Mastery and pleasure ratings

Clinical 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, but not for lack of trying on their part. He thinks resting will help clear the fatigue but the more he rests the worse he feels. His therapist recommends behavioral activation therapy and asks Tony to identify a few activities that bring him joy. He says fresh air and seeing friends. His therapist then 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 schedule and even harder to go to his scheduled activities, he felt lighter and more hopeful afterward.

Question 7

Behavior Therapy

Answer 7

Type of psychotherapy that uses principles of learning & conditioning (classical and operant) to reduce maladaptive behaviors & to increase adaptive behaviors.

• Originally based upon Pavolv’s theory of classical conditioning & focused on problem bxs that were directly observable - ignored cognitions
• Present-focused & generally brief
• Behavior therapy began developing as a reaction to psychoanalysis
• focus is on the behavior itself and the contingencies & environmental factors that reinforce or maintain the behavior rather than exploring the underlying causes of the behavior
• During the course of therapy, the client and the therapist work collaboratively.
• Pavlov, Wolpe, Watson & Skinner all contributed to the early development of Behavior Therapy.

Clinical example: 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.

Question 8

Chaining

Answer 8

Chaining is an instructional procedure based on operant conditioning, used to teach a person to engage in a complex behavior that has multiple components.

• Therapist conducts a task analysis that breaks down the chain into stimulus-response components.
  
  • Teach one bx at a time and chain the bxs together. In this way, each response cues the next, and the last response is reinforced.
  • There are two types of chaining: forward and backward chaining
• frequently used for training behavioral sequences (or “chains”) that are beyond the current repertoire of the learner such as in ABA w/ autistic children

EXAMPLE: An autistic child learning to wash her hands independently. Therapist implements the chaining process: The therapist defines the target behavior: washing hands independently.

Question 9

Classical/Respondent Conditioning

Answer 9

Developed by Ivan Pavlov; classical conditioning is a form of associative learning in which an unconditioned stimulus (US; that naturally and automatically produces a response) is repeatedly paired with a conditioned stimulus (CS; a previously neutral stimulus) in order to evoke an unconditioned response (UR; an unlearned natural response/reaction). Eventually, the US is removed and the CS comes to elicit the CR on its own.

• Principles emphasized in Behavior Therapy
• CR is stronger if CS precedes UCS by short vs long time
• Phases of conditioning: acquisition, extinction, spontaneous recovery, reconditioning, and counterconditioning

Clinical example: Pam comes to therapy complaining of phobia of the dark. She tells the therapist that, when she was little, she was sexually molested by her uncle, who would come to her room when it was completely dark. The therapist hypothesized that classical conditioning played an important role in the acquisition of her phobia: the molestation (US), which elicited fear (UR), came to be associated with the dark (CS), which then elicited the same response (CR).

Question 10

Cognitive Fusion

Answer 10

A principle of psychological inflexibility in Acceptance and Commitment Therapy (ACT), cognitive fusion involves over-identifying with one’s thoughts in a way that has a negative influence on action and awareness; cognitions cause a person to do, say, or focus on things that don’t build the life they want.

Helping a client recognize cognitive fusion in themselves can help them detach from their thoughts and improve their psychological flexibility (one of the six core therapeutic processes, according to ACT).

Clinical example: A client presents with anxiety which seems to be related to her role as a mother. She reports having constant thoughts about how she is failing and her children will suffer the consequences. She describes a constant stream of thoughts about her performance as a mother and feelings of shame and depression following these thoughts. The therapist identifies that the client is demonstrating cognitive fusion, and asks her to step back and see her thoughts as just thoughts, not facts.

Question 11

Cognitive Restructuring

Answer 11

Therapeutic technique used in Beck’s cognitive therapy and REBT; teaches clients to identify and change distorted and maladaptive cognitions. Cognitive restructuring can help clients identify and understand the powerful link between thoughts, feelings, and behavior.

• Based on the idea that the client has an excess of maladaptive thoughts
• Helps client identify self-talk and thoughts
• Client is encouraged to identify cognitive distortions that are maladaptive, challenge the validity of these distortions, and explore more adaptive alternatives
• Crucial questions during cognitive restructuring
  
  • What is evidence for/against this belief?
  • What are alternative interpretations of this event?
  • What are the implications, if the belief is correct?

EXAMPLE: 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 can’t do this,” every time she sits down to study. The cognitive therapist points out these maladaptive cognitions and uses the cognitive restructuring to challenge their validity. She asks questions like “What evidence do you have for and against this belief?”

Question 12

Cognitive Therapy

Answer 12

Developed by Aaron Beck; evolved into Cognitive-Behavioral therapy; focuses on cognitions as the origin of psychopathology.

• Assumptions - link between cognitions and behavior, cognitive activity is potentially observable, it can be monitored, counted, altered.
• Client is considered expert and collaborator
• Two main components are BA and cognitive restructuring
• Levels of cognitive distortions (triggered by event)
  
  • Automatic thoughts: spontaneous thoughts that appear plausible. Includes dichotomous reasoning, personalization, emotional reasoning etc.
  • Assumptions: abstract ideas that have generalized rules; often if-then statements
  • Schemas/Core beliefs: cognitive structures that organize and process info; deepest most ingrained level of cognitions e.g. negative cognitive triad (self, world, future)
• Goals:
  
  • Correct faulty information processing
  • Modify beliefs maintaining maladaptive behaviors and emotions
  • Provide skills for adaptive thinking
• Techniques include: downward arrow, psychoeducation
• Focus: more on present vs. less on past, pathology and assets, objective data vs. projective tests, interventions and their evaluation

EXAMPLE: A Grad student comes into therapy experiencing great anxiety about her comps exam in the fall. She reports having thoughts like, “I’m stupid, I can’t do this,” etc. when she sits down to study. The cognitive therapist points out these automatic thoughts and uses the downward arrow technique to begin exploring the client’s schemas and core beliefs so that they can work to change/correct them.

Question 13

Conditioned and Unconditioned Responses

Answer 13

Part of classical/respondent conditioning; the unconditioned response (UR) is the individual’s response to the unconditioned stimulus (US) which occurs without any conditioning. The conditioned response (CR) is the learned response to the conditioned stimulus (CS); basically the CR and UR are the same response.

EXAMPLE: A client comes to therapy complaining of phobia of the dark. She tells therapist that she was sexually molested as a child on many occasions by her uncle who would come into her room when it was completely dark. The molestation (UCS) which elicited fear (UCR), came to be associated with the dark(CS), eventually eliciting the same response (CR=fear.)

Question 14

Conditioned and Unconditioned Stimuli

Answer 14

Part of classical/respondent conditioning; the conditioned stimulus (CS) is the neutral stimulus which gains the power to elicit the response through pairing with the US. The US is the stimulus which elicits the reflexive response without any conditioning.

EXAMPLE: A client comes to therapy complaining of phobia of the dark. She tells therapist that she was sexually molested as a child on many occasions by her uncle who would come into her room when it was completely dark. The molestation (UCS) which elicited fear (UCR), came to be associated with the dark(CS), eventually eliciting the same response (CR=fear.)

Question 15

Cue Exposure Therapy

Answer 15

A specialized form of exposure therapy with response prevention, often used for substance-related disorders, OCD, and eating disorders.

• Client is exposed to cue for eating/substance abuse/obsessive thoughts but is unable to eat, use drug, or engage in compulsions; goal is to decrease responsiveness to cues
• Based on Pavlov’s classical conditioning, specifically extinction
  
  • Initial sessions consist mostly of repeated cue exposure
  • Later sessions consist of cue exposure with coping/social skills as alternative responses

EXAMPLE: You’re treating a client that is struggling with alcohol use disorder. You are working with her to try and decrease her urges to drink when she’s out at a restaurant. She is extremely used to ordering drinks every time she goes out. You suggest cue exposure therapy and decide to go out to dinner with her at several restaurants without allowing her to order a drink. By preventing her from ordering drinks, you are helping break that association between going out to dinner and drinking

Question 16

Decision-Balance Matrix

Answer 16

Technique used in motivational interviewing and often used in working with ambivalence in people who are engaged in behaviors that are harmful to their health i.e. problematic substance abuse, over eating

• therapist asks the client to list the pros and cons of making a change or staying the same
• Constructed in a decisional matrix consisting of four blocks: advantages of the status quo, disadvantages of the status quo, advantages of changing, disadvantages of changing
• Informal measure of client’s readiness for change

EXAMPLE: 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?

Question 17

Dialectical Behavior Therapy (DBT)

Answer 17

Dialectical Behavior Therapy is a third-generation behavior therapy that focuses on both validating and accepting a client’s experience and helping them develop strategies or problem-solving behaviors that lead to positive changes in their lives.

Developed by Marsha Linehan as a treatment for suicidality, self-harm, and BPD, DBT focuses on: (1) creating mindfulness by helping clients use their wise mind (the intersection of their rational and intuitive or emotional mind), (2) developing interpersonal effectiveness skills, (3) emotion-regulation skills, and (4) increasing distress tolerance. Often consists of weekly individual and weekly group therapy sessions

It has been successful in helping clients who are resistant to other forms of treatment, such as clients with Borderline Personality Disorder, create positive changes in their functioning and lives.

Clinical example: Debbie enters therapy because she has BPD; her immediate problem is that she is frequently cutting her arms b/c of recent break up. The therapist uses DBT and validation/acceptance strategies. She tells her “Your emotions can be very upsetting, and it makes sense that you would want to alleviate them, which you do by cutting yourself. Perhaps you can learn other, less destructive ways to do that.” Saying this creates a space to use problem-solving strategies to help the client find more skillful ways of regulating her emotions.

Question 18

Differential reinforcement of other behavior (DRO)

Answer 18

DRO is a procedure or technique based on the principles of operant conditioning often used in Applied Behavior Analysis that can lower the frequency of a target problem behavior. When using DRO, no alternative behavior is identified, an individual is reinforced only when NOT performing the target behavior for some interval of time. The procedure works by removing the external reinforcement associated with a behavior, thus decreasing the likelihood that the behavior will be performed.

Clinical example: Curtis, a 13-year-old boy with autism, has a problem with aggression (problem bx). After conducting a Functional Analysis, the therapist was able to confirm that the target behavior (aggression) was maintained by social reinforcement. A DRO schedule was created in which he received a reward (praise) every 3 minute interval in which no aggression occurred. There was no alternate bx required for praise, simply the absence of aggression.

Question 19

Efficacy Expectations

Answer 19

Part of Bandura’s self-efficacy theory that says people have a wide variety of beliefs and expectancies of self, others, world, etc. that are determinants of behavior.

Two types of expectancies:

• Outcome: belief that a behavior will produce a particular outcome [independent of SE]: “if I do this, good things will happen.”
• Self- Efficacy: belief that one can perform a given behavior successfully or master a situation: “I can do this”
  
  • Related to person’s locus of control
  • Fundamental to behavior change
  • Is situation specific and not an overall trait
  • Determinant of behavior initiation, maintenance, and energy expenditure
  • Can be increased via modeling and skills therapy
  • Influences a person’s goals

Client expectations about the efficacy of therapy are a key determinant in therapy success, so assessing a discussing a client’s outcome expectations of the therapeutic process is important.

EXAMPLE: Frank comes to therapy with feelings of anxiety related to leading small groups at work. He believes that he is not equipped with the skills to speak publicly.. Therapist knows that Actual performance accomplishments are the most influential source of efficacy expectations. Therapist works w/ Frank on his efficacy expectations by providing experiences where Frank can feel as though he is able to successfully lead a small group, done through role play and various exercises.

Question 20

Empirically-supported therapy/tx (EST)

Answer 20

Part of clinical practice; EST interventions that have been found to be efficacious for one or more psychological conditions

• Prior to 90s, there were no specific guidelines regarding which treatments for which conditions. In 93, a task force was appointed by the APA to develop a set of criteria for, and provisional list of, ESTs.
• ESTs are therapies that have demonstrated: (criteria for EST)
  
  • (a) superiority to a placebo in two or more methodologically rigorous controlled studies,
• or*
  
  • (b) equivalence to a well-established treatment in several rigorous and independent controlled studies,
• or*
  
  • (c) efficacy in a large series of single-case controlled designs (>9)

EXAMPLE: Jane uses CBT in her practice to treat generalized anxiety disorder because it is an empirically supported tx. She stays up to date on new research and findings in order to assure she is providing the best treatment to her clients.

Question 21

Escape/Avoidance

Answer 21

Part of operant conditioning and types of negative reinforcement; Escape is when the occurrence of behavior results in the termination of aversive stimulus that was already present when the behavior occurred; Avoidance is when the occurrence of the behavior prevents the presentation of the aversive stimulus

• In both cases, the behavior is strengthened via negative reinforcement
  
  • In escape learning, the individual experiences relief from the aversive stimulus through the escape behavior; in avoidance learning, the individual experiences relief from the anxiety of almost experiencing an aversive stimulus.

EXAMPLE: You are treating a client with a phobia of dogs. Like most typical phobia patients, he does not go anywhere that there might be dogs present. During the psychoeducation phase of treatment, you explain to him that avoidance is maintaining his phobia of dogs. Because he is avoiding all interactions with dogs, the potential for an unpleasant interaction with one is removed, thereby negatively reinforcing his fear.

Question 22

Exposure with Response Prevention (ERP)

Answer 22

(ERP) is a type of exposure therapy in which client is exposed to fearful cues and therapist prevents escape/avoidance - both behavioral & cognitive

• Obtain detailed description of the situation and context of the problem, define explicit behavior, thoughts, and feelings leading up to it and explore consequences
• Exposure can be graduated or prolonged, in vivo and imaginal
• Therapist prevents escape or avoidance during exposures, review coping mechanisms
• Used for OCD, substance use, eating disorders with purging sub-type
• Based on classical and operant conditioning principles [breaking association between CS and CR; reinforcer maintaining behavior removed]

EXAMPLE: You are utilizing ERP with a client that has bulimia nervosa. You have pt eat her favorite binging food in therapeutic setting until she begins experiencing the urge to purge (anxiety). Purging (escape) is prevented and fear gradually decreases over time. You stay w/ Pt and help her engage in coping skills. Her binge urge and associated anxiety subsides slightly after some time has passed. It shows her that the urge to purge can go away with time, without actually purging.

Question 23

Extrinsic and Intrinsic Reinforcers

Answer 23

Part of operant conditioning; reinforcers are consequences that occur after a behavior and increase its frequency

• Extrinsic: reinforcers that come from outside an individual (money, praise from others, fame)
• Intrinsic: reinforcers come from within an individual; an activity can be inherently intrinsically motivating (sense of a job well done, pride)
  
  • more effective at maintaining behaviors

EXAMPLE: A parent brings a child into your office because they refuse to complete their homework; the only way the child will complete the homework is if the parents give him money (an extrinsic reinforcer). The therapist explains to the parents that intrinsic reinforcers are more effect for maintaining a bx. The therapists works to develop an intervention strategy and possibly uncover intrinsic reinforcers.

Question 24

Functional Analysis

Answer 24

Part of clinical assessment in behavioral therapy; the primary way behaviorists identify and assess the purpose and meaning of a client’s behavior

• Typically done using the ABCPA model that investigates:
  
  • The Antecedent setting characteristics (conditions under which the problem occurs)
    
    • Setting, day/time, social context can be other behaviors, cognitions, or emotions
  • The Behavior
    
    • explicitly identified; Overt behavior, thoughts, associated feelings; pt IFR; frequency
  • The behavior’s Consequences - what happens following bx?
  • Person variables
    
    • Expectations, skills/competencies, foals, evaluation, self-talk
  • Assets
    
    • What does the person do well?
• Important to use behavioral descriptions rather than trait descriptions. Traits are abstract concepts and are not actually descriptive of what person does.
• Classifies problems as behavioral excesses, behavioral deficits, inappropriate stimulus control, or inadequate reinforcement
• Essential features:
  
  • Individualized
  • Focused on present
  • Directly samples relevant bxs
  • Has a narrow focus
  • Is integrated with therapy

EXAMPLE: A 35 year old woman has come to treatment for a problem overeating. The therapist conducts a functional analysis by examining the problem bx.The behavior (B) is overeating - considered a behavioral excess. The Antecedents (A) that she reports are feeling stressed or upset frequently at night time. The reinforcing consequences (C) of the behavior is the pleasure that comes from eating and the distraction from the upsetting emotions. However, she is also experiencing the negative consequence of gaining weight. Therapist and client come up with the list of client assets and person variables that will help in treatment plan.

Question 25

Generalization and Discrimination

Answer 25

phenomena observed in classical conditioning; Generalization is when the CR occurs in the presence of other stimuli that are similar in some way to the original US.

• Discrimination is the ability to differentiate between similar stimuli; when the CR occurs only in response to the original stimulus

EXAMPLE: In the classic “Little Albert” experiment, Watson conditioned baby Albert to fear a white rat. Some time after, researchers noticed that baby Albert was also fearful of other white fluffy things like rabbits, dogs, santa claus’s beard, etc. Albert had generalized his fear to other similar stimuli. If baby Albert began only showing fear in response to the white rat, he would be demonstrating discrimination.

Question 26

Exposure Therapy

Answer 26

a technique used in cognitive-behavior therapy to help pts confront fears/anxieties; pioneered by Taylor and Wolpe

• Works by:
  
  • enhancing processing of feared stimuli by helping client face their fear
  • helping client learn that they can tolerate the distress and that their expectations of the stimuli are inaccurate
  • allowing client to gain control of their fear and stop restricting their lives around fear (build self-efficacy)
• Based on respondent (something paired with scary event now client fears it) and operant conditioning (avoidance reinforces the fear)
• 2 central features: anxiety MUST be induced during exposure
  
  • client MUST remain in the anxiety-provoking situation long enough for their discomfort to peak and begin to decline - prevent cognitive avoidance
    
    • A general rule of thumb is a 50% reduction in SUDs (sub. units of distress)
• Types of exposure: in vivo, VR, or imaginal; prolonged (high intensity, long period) or graduated (fear hierarchy & short period); can include the use of competing response (like in SD - PMR) or not
  
  • Cognitive processing is very helpful, and many think it is a crucial component
• Criticisms: high dropout rate in some cases, could exacerbate some sxs pt is experiencing
• Used for specific phobias, PTSD, OCD, anxiety disorders, etc.
• Specific techniques: SD, Flooding, Interoceptive Exposure (panic disorder), cue exposure, exposure with response prevention

EXAMPLE: You’re treating a soldier suffering from a phobia of guns. Even a picture of a gun can elicit fear in the soldier. Handling a gun would cause a serious fear response so he puts that at the top of his fear hierarchy as his most intense fear. You are going to use graduated exposure and gradually expose him to less intense fears until you work your way up to handling a gun.

Question 27

Iatrogenic effects

Answer 27

Part of clinical practice;

What: adverse effects of complications caused by or resulting from treatment; making things worse through treatment; inadvertent

EXAMPLE: Critical incident stress debriefing has been found to increase one’s risk for developing PTSD and is no longer used because of its iatrogenic effects.

Question 28

Imaginal exposure

Answer 28

A type of exposure therapy in which the client is asked to imagine feared images or situations

• Can be gradual (short period, climb fear hierarchy) or prolonged (long period, high intensity)
• Exposure is done via imagining scenes or discussing event repeatedly
• Opposite of in vivo.
• Some types of phobias and traumas only compatible with imaginal exposure

EXAMPLE: You are working with a combat veteran that developed PTSD in response to stepping on an IED. He is trying to “fix” this problem so he can get back to work (on the battlefield). Because you cannot fly with him to Iraq, you decide that imaginal exposure is the best route. You will ask him to repeatedly describe the traumatic event so that his anxiety spikes and then subsides.

Question 29

In vivo exposure

Answer 29

A type of exposure therapy in which the client’s exposure is implemented in the client’s natural environment; using actual object/situation in safe environment

• Can be gradual (short period, climb fear hierarchy) or prolonged (long period, high intensity)
• Opposite of imaginal
• Typically produces quicker results but may face more resistance and require more time

EXAMPLE: You’re working with a client that has an intense fear of snakes. After discussing it with the client, you both agree that in vivo exposure is the way to go. You instruct the client to handle a snake for increasing amounts of times in the next several sessions as part of the treatment for the phobia.

Question 30

Learned Helplessness

Answer 30

Discovered by Seligman & Maier; exposure to frequent uncontrollable punishment produces apathy, passivity, and depression

• a condition in which a person suffers from a sense of powerlessness, arising from a traumatic event or persistent failure to succeed
  
  • Person learns it’s helpless in aversive situations, that control is lost, and so it gives up
• I.e. prostitutes, depressed, homeless, immigrants
• It is thought to be an underlying cause of depression for some as well as other mental disorders

EXAMPLE: One of your homeless patients at the community health clinic seems to be exhibiting learned helplessness. She appears apathetic and depressed; she never wants to set any goals. After getting to know her better you being to understand that the learned helplessness likely tied to the many hardships the client has faced.

Question 31

Learning-performance distinction

Answer 31

A concept in behaviorism that stresses the difference between the learning of a behavior and actual performance of the behavior

• Learning/acquisition is primarily an internal cognitive process requiring attention and retention - it is a change in the ability and potential to do the behavior
• Performance is primarily an external process - it requires reproduction and motivation
• Tolman’s animal studies indicate that rewards seem to affect performance over learning
  
  • Thought rats developed a “cognitive map” of the maze.
  • Group 3 (no food reward for first ten days, rewarded on 11th day)
  • Very quickly (i.e. much faster than acquisition in the always reinforced group), the animals’ performance matched that of the animals which had always been reinforced.
  • Tolman called this latent learning- the animals that were not always reinforced were learning, but because they had no food motivation to complete the task, their performance was not indicative of what they had learned.

EXAMPLE: Client comes to therapy with issues of self-esteem and anxiety over talking to their peers at work. Therapist teaches client assertiveness and social skills. The therapist is aware of the learning performance distinction, and is sure that after modeling behavior himself, the client is given an opportunity to reproduce the new learned behaviors.

Question 32

Meta-analysis

Answer 32

A research technique that integrates and compares empirical findings from multiple studies in order to determine if and to what degree a treatment is effective. Meta-analyses use a statistical measure called effect size to assess the degree of change a particular treatment induces, on average, in participants.

Clinical example: A therapist is looking for evidence of a particular treatment for a patient with social anxiety disorder. She locates a meta-analysis that estimates the impact of the treatment by comparing 15 experimental studies over the past 10 years. The meta-analysis found that the treatment produced a modest degree of change (.56) in patients that received it.

Question 33

Mindfulness

Answer 33

A core theme of 3rd generation behavior therapies like ACT, DBT, and MBCT, mindfulness emphasizes acceptance of psychological discomfort. It is the practice of being fully aware and accepting of the present moment.

• An individual learns to observe and accept thoughts and feelings rather than judge, accept=t, or fuse with them.
• Goal is not to induce relaxation but foster non-judgmental observation of current state
  
  • Mind as conveyer belt: experience all sensations/thoughts as they come along, observe, label, categorize, no analysis/evaluation
  • Mind as sky: clouds are feelings and thoughts
  • Observe breath, in and out

EXAMPLE: Therapist is going to teach mindfulness skills to help a pt cope with PTSD symptoms. Pt describes feeling distracted and preoccupied with unpleasant thoughts about the past , (rumination) or the future (worry) . Therapist introduces mindfulness by saying that part of mindfulness is being in touch with the present moment and an aspect of this skill is being an active participant in experiences instead of just “going through the motions.”

Question 34

Modeling

Answer 34

part of Bandura’s social learning theory; also referred to as vicarious/observational learning - learning that occurs through observation of other people’s behaviors and consequences

• Accounts for a large amount of human learning.
• 4 Modeling Steps: attentional, retentional, reproduction/performance, & feedback/motivation
• Types of modeling: live, symbolic (TV/books), and covert (imagining)
• Utilized in Self-Instructional Training
• Also useful when teaching certain skills

EXAMPLE: A couple brings their child into therapy due to violent outbursts in school. It was discovered that through the process of modeling, the young boy had learned the violent behavior from his father. He learned that violence is the best way to get your way. This served as proper motivation for the behavior to continue.

Question 35

Motivational Interviewing

Answer 35

developed by Miller & Rollnick; was not developed as a comprehensive system of psychotherapy, but rather, a specific method for addressing a particular clinical situation in which the client is ambivalent about a particular behavior change

• 3 essential elements:
  
  • It is a type of conversation about change (listening and questioning)
  • It is collaborative
  • It is evocative- seeks to call forth person’s own motivation and commitment
• Might employ a decision balance matrix
• Therapist utilizes empathic listening, doesn’t extol merits of behavior change, actively elicits +/- of status quo vs. change from patient, & is accepting of pt
  
  • Role is directive, with a goal of eliciting self-motivational statements and behavioral change from the client in addition to creating client discrepancy to enhance motivation
• Commonly used for substance abuse and eating disorders

EXAMPLE: Client comes to therapy for alcohol abuse.The primary goal of MI is to resolve ambivalence and resistance and move clients into a commitment to change. Client moves from “I am not interested in reducing my alcohol use. I’m having fun with my friends.” to: “If I stop drinking I will feel better and maybe do better in school, which will make my parents and myself happier.”

Question 36

Multiple Baseline design

Answer 36

a type of experimental design (outcome research) that evaluates the effects of a tx on a particular class of variables- different target bxs, different pts, or different settings.

• Treatment is sequentially introduced for each permutation of the variable after baseline measurements have been taken.
• 3 types:
  
  • Across target behavior (e.g., different fears)
  • Across clients (e.g., several case studies)
  • Across settings (e.g., school vs. home)
• Useful when can’t do an ABAB design (ethics of removing tx)
• Similar limitations of generalizability

EXAMPLE: Researchers are investigating the effects praise has on tantrums using a Multiple Baseline Design. They send therapists to visit the homes of the children and acquire a baseline of each child’s bxs. Researcher then teaches the parents how to properly use praise as form of positive reinforcement. Therapists then come back to the home to measure the frequency of tantrums. In order to examine its effectiveness in another setting, the bx is observed in school as well. Therapists take baseline measurements in the school, teach teachers how to properly utilize praise, and then measure frequency of tantrums again.

Question 37

Negative Reinforcement

Answer 37

Part of B.F. Skinner’s operant conditioning/behavior therapy, negative reinforcement is a consequence for a behavior that removes something aversive following the behavior, increasing the likelihood the behavior will occur in the future.

• Includes escape: behavior that results in the termination of aversive stimulus that was already present when the behavior occurred
• And avoidance: behavior that prevents the presentation of the aversive stimulus

Clinical example: A client presents with anxiety surrounding entering her bathroom. She recently fainted in the room and hit her head, causing her to bleed a lot and resulting in a visit to the ER. Since then, the room has made her uncomfortable and she has avoided going in it. The therapist explains that her anxiety is being maintained by her avoidance of the room via the process of negative reinforcement. Because the room causes her feelings that are unpleasant, her avoidance of the room itself is strengthened by the removal of that unpleasant feelings.

Question 38

Operant Conditioning

Answer 38

Discovered by Skinner, based on Thorndike’s law of effect, part of Behaviorism; involved the use of consequences to modify the occurrence and form of behavior.

• Behavior is either strengthened/increased via positive and negative reinforcement, or weakened/decreased through positive and negative punishment.
  
  • Positive/negative reinforcement: increasing the frequency of a behavior by: adding a desirable stimulus or removing an aversive stimulus
  • Positive/negative punishment: decreasing the frequency of a bx by: adding an aversive stimulus or removing a desirable stimulus.

EXAMPLE: The schizophrenic pt was very anti-social. In order for the pt to increase his social activities, the therapist instructed staff to only allow the pt to watch TV after he engaged in 30 minutes of social activities. This reward of watching TV (POS. reinforce) increased his social bx indicating operant conditioning had been implemented and was successful.

Question 39

Outcome Expectations

Answer 39

Outcome expectations are part of Mischel’s cognitive-affective System which emphasizes the dynamic forces that interact to lead to specific behaviors. How we think, feel, and what we believe all impact how we behave and our interpretations of our behavior and the outcomes. Outcome expectancies refer to our beliefs about whether or not a behavior will produce a specific outcome. “If I do this, good things will happen.”

• May influence whether a person puts themselves in certain situations or not
• Important in motivation for changing
• Can be positive and negative

EXAMPLE: A client with self esteem issues fears going to a job interview because his outcome expectations are that he will be chosen because the competition will always be more qualified. The therapist works with him to explore the origins of this belief.

Question 40

Outcome vs. Process Research

Answer 40

Outcome research measures the effectiveness of a specific treatment on a dependent variable of interest. It answers the question, “does this treatment work?”

• Individual client research designs: case studies, multiple baseline studies, etc.
• Large scale research design: experimental design - RC

​Process research attempts to understand the mechanisms of change

• I.e. dismantling studies
• This research has important implications for clinical practice, including what types of txs should be used and how those txs should be provided

EXAMPLE: Researchers are conducting an Outcome Research Study on the effects of Exposure Therapy with Response Prevention in a group of alcoholics in order to identify the treatment as being effective or inadequate. If found to be effective, additional process research may be conducted to understand the underlying mechanisms of change.

Question 41

Parent-child Training Therapy

Answer 41

Family intervention therapy with goals of improving the parent-child relationship and the parent’s behavior management

• Therapist teaches parents to work with their child positively, set appropriate limits, to act consistently, be fair with their discipline, and to establish more appropriate expectations regarding the child
• Also teaches the child better social skills; ideally strengthening the relationship improves the child’s behavior
• Parent Child Interaction Therapy (PCIT) problem bxs age 2-7 developed by Eyberg
• Accomplished in 2 phases:
  
  • child directed interactions to increase parental responsiveness and establish a secure and nurturing relationship
  • parent directed interactions works on improving parental limit setting and consistency in discipline
• Typical child target behaviors: high rates of opposition, defiance, whining, hitting, yelling, non-compliance
• Typical parental problem behaviors: excessively critical, threatening, and nagging behavior; low level of Sr+ for appropriate behavior

EXAMPLE: Parents bring their child to treatment because of family problems at home. Lots of fighting, and the child has begun running away from home. When the child comes back, they often get into a verbal fight, but there are no other consequences. Therapist suggests Parent-Child Training Therapy so that the parents can work on being more responsive as well as setting limits and creating a consistent way to discipline

Question 42

Positive Reinforcement

Answer 42

part of Skinner’s operant conditioning; the addition of an desirable stimulus following a behavior causing behavior to increase in frequency

• Can be used in contingency management to change bxs
• Drug use associated with strong positive reinforcement – feelings of euphoria, happiness, energy, increased concentration, whatever drug effect it may be.

EXAMPLE: A married couple comes to therapy because they are feeling inadequate when it comes to the parenting of their toddler. The child has been acting out, throwing tantrums, and has started getting physical with his younger sister. The therapist suggests that they start positively reinforcing the adaptive behaviors that he displays in order to encourage an increase in frequency. When he plays nice with his sister, he gets attention from his parents

Question 43

Premack Principle

Answer 43

In operant conditioning, the Premack principle refers to a process by which one attempts to increase the frequency of a particular behavior by making the performance of a more frequently occurring behavior to be contingent upon it. For example, if someone wanted to develop a meditation practice, but had trouble making it a habit, they could make something they do frequently like brushing their teeth, contingent upon the performance of meditation. I can’t brush my teeth until I have meditated.

Example: Sandra came to a child therapist complaining that her son Tommy watches TV all day and never does his homework or plays outside. The therapist proposed a plan based on the Premack principle in which Tommy would be allowed to watch an hour of TV for every hour he spent either doing homework or playing outside.

Question 44

Problem Solving Therapy

Answer 44

developed by D’Zurilla & Goldfried; cognitive-behavioral coping skills therapy in which clients use a series of systematic steps for solving a problem for which they specifically have sought treatment

Goal is to treat the immediate problem and teach skills to deal with future problems

Six steps:

1. Problem identification and description: clarify problem, identify obstacles, determine functional impairment, ABCs
2. Identification of goals: set goals, review antecedents, determine consequences of goals; situation vs. reaction focused goals
3. Generate solutions to achieve goals: be creative, no criticism, withhold judgment, entertain even bizarre solutions, refine and integrate
4. Decision making: identify consequences/outcomes (short & long-term) of solutions, cost-benefit of each, rank-order solutions
5. Implementation of solution/follow-up
6. Evaluate effectiveness

Factors that impact effectiveness:

• Learning of problem-solving skills
• Application to real-life problems
• Benefiting from their application (i.e., solving the problem)

EXAMPLE: Caroline came to see you because she has been experiencing tiredness, sadness and loss of interest in both her job and her friends. She talks about her biggest problem being a disconnect with her daughter (22 yo) that she hasn’t spoken to for 3 years. Using PST you help her address this problem. As Caroline talks through the problem she is able to clarify the major problem as a concern regarding Anne’s safety. While she would like the relationship restored, she identifies her goal as finding out if Anne is okay. You help her brainstorm a number of solutions. She decides to reach out by sending her a special birthday card. She feels empowered experiencing a sense of being able to do something to address one of her problems. Follow up in 10 days is arranged to assess outcome

Question 45

Primary/Secondary Reinforcer

Answer 45

Part of Skinner’s operant conditioning; a primary reinforcer is something that is naturally reinforcing without its value being taught- e.g. food, sex, sleep

• Secondary reinforcer is one which has a value that has to be taught or learned, frequently through association with a primary reinforcer e.g. money, tokens, approval, etc.

EXAMPLE: A token economy using secondary reinforcers is implemented for alcoholics at a tx center. Pts receive vouchers if attend group therapy. Vouchers (secondary reinforcers) are used to attain sweets & candy (primary reinforcer).

Question 46

Punishment

Answer 46

part of Skinner’s operant conditioning; in general punishment decreases a behavior’s frequency

• Positive punishment: the addition of an aversive stimulus that decreases bx
  
  • E.g. shocking mice
• Negative punishment: the removal of a desirable stimulus that decreases bx
  
  • E.g. time out
  • Extinction may take hours or days if maintained on intermittent schedule, punishment effect is instant
• Used in aversive control: the use of an aversive outcome, such as punishment or negative reinforcement, to control behavior, and eliminate undesirable behavior.
• Disadvantages/difficulties using aversive control:
  
  • Need to continue punishment
  • Punishment can induce respondent emotional states: aggression, fearfulness
  • Use of escape or avoidance behavior by recipient/client
  • Modeled to others who may use or misuse it
  • Punishment only temporarily suppresses the target behavior and does not establish new desirable behavior
  • Punishment may sometimes replace on undesirable behavior with another → i.e. when a child becomes better at lying
  • Punishment can be reinforcing to the punisher
• Generally better to use reinforcement or combine w/ DRO

EXAMPLE: During parent-child therapy the counselor suggests the family no longer use spanking as a form of punishment on the child when he acts out at school; this form of punishment is leading to negative emotional and behavioral consequences in the child - it is not effective. Instead suggests they increase positive reinforcement instead.

Question 47

Reactivity of self-monitoring

Answer 47

Part of Bandura’s social learning theory; Self-monitoring is the procedure by which individuals record the occurrences of their target behaviors.

• In addition to providing a source of data, it is also used as a therapeutic strategy because it often causes reactive behavior changes in response frequency
  
  • Rather than focusing on reducing a student’s undesired behavior, self-monitoring strategies develop skills that → an increase in appropriate behavior
  • When self-monitoring skills increase, corresponding reductions in undesired behaviors often occur w/out direct intervention
• Person behaves better when being observed, even if its by themselves

EXAMPLE: Counselor sees Joe who complains of depression. Joe completes a depression scale prior to the session and his score is not in the clinical range. During the session Joe also minimizes the extent of depression. Counselor has him monitor depressive and “fun” episodes for 1 week. and there are many more depressive vs. fun times. In light of the difference in the scale and self-monitoring, counselor decides to re-administer the depression scale to Joe, requesting that he not try to either minimize or maximize his responses in the hopes that this limits his reactivity of self monitorin

Question 48

Reciprocal Determinism (PEB)

Answer 48

A model by Albert Bandura; describes the three way interaction between the person, the behavior, and environment.

• The person, behavior, and environment all influence and are influenced by one another

EXAMPLE: Larry enters therapy with feelings of depression and low self-esteem due to being unsuccessful in his work. The therapist educates his client about reciprocal determinism, and explains the dynamic relationship between his thoughts, the environment, and his behavior. He says that the environment is a factor in shaping human behavior, but we also have choices. Larry suggests that he can find a job at which he can succeed, (change the environment) which in turn will influence his thoughts about himself which may influence his depressive symptoms (behavior).

Question 49

Reinforcer

Answer 49

In operant conditioning, a reinforcer is a consequence that strengthens a behavior and increases frequency.

• The ability of the reinforcer to increase a behavior is through the addition of something pleasant (positive) or the removal of something unpleasant (negative) in response to a behavior
• Typically reinforcers are more successful in small immediate contingencies as opposed to large delayed ones
• Reinforcers can be primary - food/water or secondary - praise, tokens, money

EXAMPLE: The counselor used a positive, secondary reinforcer (star stickers) to reward her 6-year-old client each time he successfully completed homework. The counselor noticed after implementation of the reinforcer, the client consistently completed homework each week and looked forward to receiving the sticker.

Question 50

Schedules of Reinforcement

Answer 50

Part of B.F. Skinner’s operant conditioning, a schedule of reinforcement is a plan for when and how often to provide a reinforcer for a particular behavior. There are 5 different schedules including continuous reinforcement (CRF) in which a behavior is reinforced every time it occurs, fixed ratio (FR) in which a behavior is rewarded after it is successful performed a specific and set number of times, fixed interval (FI) in which a behavior is reinforced after it is performed successfully in a specific time period, variable ratio (VR) in which a behavor is reinforced after a behavior is performed a random and varying number of times, and variable interval (VI) in which a behavior is reinforced after a time period that varies.

• Fixed vs. Variable:
  
  • Fixed schedules of reinforcement elicit either a break and run pattern of behavior or a scalloped pattern of behavior. A fixed interval schedule has a lower response rate (slope) than a fixed ratio schedule.
  • Variable schedules of reinforcement elicit more consistent behavioral responses. A variable ratio schedule has a higher response rate (slope) than a variable interval schedule.

EXAMPLE: Couple brings their child to treatment because of violent behavioral problems. Therapist suggests they start with a Continuous Reinforcement Schedule which would reinforce his adaptive behavior (playing nicely with his sister) every time he performed them. This is most useful when a child is first learning a behavior such as sharing toys.

Question 51

Schema

Answer 51

Part of Beck’s cognitive theory; a schema or “core belief” is a cognitive framework that helps individuals organize and interpret information. Schema influence how we think, what we pay attention to and how we behave. According to Beck, they are the deepest, most ingrained levels of cognition about ourselves, the world, and the future. Schema influence our assumptions and automatic thoughts.

• Types vs. content of core beliefs: types are things you feel about yourself. An example would be the cognitive triad (CBT triad) where the self= I am helpless and inadequate; the world= the world is full of insuperable obstacles; and the future=i am worthless so there’s no chance of the future being better than the present. Content of core beliefs are like abandonment/ instability; mistrust/ abuse; emotional deprivation; defectiveness/shame. These are core values that we hold to ourselves.
• Can be revealed using downward arrow technique

Clinical example: A Grad student comes into therapy experiencing great anxiety about her comps exam in the fall. She reports having thoughts like, “I’m stupid, I can’t do this,” etc. when she sits down to study. The cognitive therapist points out these automatic thoughts and uses the downward arrow technique to begin exploring the client’s schemas/core beliefs so that they can work to change them.

Question 52

Self efficacy and Outcome expectancies

Answer 52

Components of Mischel’s cognitive-affective system and Bandura’s self-efficacy theory.

Self- Efficacy is a belief that one can perform a given behavior successfully or master a situation; “I can do this.”

• Related to person’s locus of control
• Fundamental to behavior change
• Self-efficacy or skill?
  
  • When SE (self-efficacy) is manipulated and skill is equal, SE predicts behavior
• Is situation specific and not an overall trait
• Determinant of behavior initiation, maintenance, and energy expenditure
• Can be increased via modeling and skills therapy

Influences a person’s goals

Outcome expectations: an individual’s belief that a particular course of action will ultimately produce certain outcomes. “If I do this, good things will happen.”

• May influence whether a person puts themselves in certain situations or not
• Important in motivation for changing
• Can be positive and negative

What: Self efficacy is one’s beliefs in their ability to perform some particular behavior. For example, I am athletic and quick to learn new sports is an example of a belief about self-efficacy in the realm of athletic performace. Outcome expectanices are beliefs about the outcome of a particular behavior. For example, if I engage in some athletic endeavor, I will likely win. Our beliefs about outcomes are fundamental to behavioral change and can be directly influenced by our self-efficacy in a particular behavioral realm.

Why: Both self-efficacy and outcome expectancies expand on ideas in behavioral therapy surrounding what elicits and maintains specific behaviors. Our cognitions and beliefs about our own abilities and the future influence our behavior in meaningful ways.

Clinical Example: Client seeks treatment because his lack of social skills was affecting his job performance. He never thought he would be successful at it (outcome expectation) so he stopped trying to talk to his supervisors/coworkers and now he may lose his job. Therapist used vicarious experience (he watched models talking to “supervisors”) as well as Actual Performance (role playing with the therapist) to build his self-efficacy surrounding his social skills.

Question 53

Self-Reinforcement

Answer 53

Part of operant conditioning and self-management/self-instruction; process by which clients administer reinforcers to themselves for performing target bxs.

• Manipulation of consequences: performance is evaluated against a standard (notice the intrinsic reward)
• Institute reward/punishment system
• Make remote/distal reinforcement of target behavior more proximal (complete a 5k in two months, work towards smaller goal - looking at long term reinforcement)

Clinical Example: A client presents with symptoms of restlessness and depression. Upon assessment, it is clear that the client has spent an increased amount of time on social media and that seems to be contributing to her symptoms. She’s motivated to spend less time scrolling so her therapist recommends instituting a self management program which include stimulus control (removing social media apps from her phone; leaving her phone in a room when engaging in other activities) and self-reinforcement. If the client spends less than 60 minutes scrolling in a particular day, she moves $5 into a special account she’s using to save $ for an upcoming vacation.

Question 54

Shaping

Answer 54

Part of operant conditioning; used to establish a new behavior not in client’s repertoire. Each successive approximation of the behavior (similar to the desired response) is reinforced

• Done by dividing bx at hand into a series of smaller steps
• Reinforce for bxs that are more and more similar to desired bx
• Eventually person only reinforced for desired bx

EXAMPLE: Let’s say Johnny has social anxiety. You are trying to get him ready to give a speech in front of the classroom. Given that Johnny is shy, he wouldn’t be able to give a speech right away. So, instead of promising Johnny some reward for giving a speech, shaping can be used and rewards should be given to behaviors that come close. Like, giving him a reward when he stands in front of the class. And then when he goes in front of the class and say hello. Then, when he can read a passage from a book. etc…

Question 55

Social Skills Training

Answer 55

Social Skills Training is a type of a component of behavior therapy. Social skills are behaviors that are socially rewarding such as listening, smiling, turn-taking, eye contact, affect. Social skills training is used to teach or improve the social skills of individuals.

Clinical example: A client presents with problems surrounding social anxiety. She says she does not often engage in social interactions. The therapist notices she has trouble making eye contact with her when speaking and that she does not often see nonverbal behavioral expressions of warmth (smiling). She recommends social skills training and explains that learning to improve her ability to make eye contact and perform appropriate nonverbal affiliative expressions will likely increase the rewards she experiences in social situations, make her mroe liekly to do so in the future, and ultimately decrease her anxiety in this realm.

Question 56

Spontaneous Recovery

Answer 56

Discovered by Pavolv in his Classical Conditionig studies, spontaneous recovery is a phenomenon of learning and memory. It refers to the re-emergence of a previously extinguished conditioned response after a delay.

• after extinction & time interval, CS again is able to elicit CR
  
  • extinction is not the same as unlearning
  • strong positive or negative association with behavior stays in memory - not forgotten

EXAMPLE: A couple that you are counseling comes in one day frustrated after having used extinction to get rid of their toddler’s tantrums at night. They have seemingly returned just as strong. They feel inadequate and as though they have failed. Therapist explains the concept of spontaneous recovery and urges them to stick with it saying that it will dissipate again.

Question 57

Spontaneous Remission

Answer 57

Unexpected, sudden disappearance of a disorder/sxs. This occurs without treatment or with the use of an ineffective treatment.

• Most people will improve on their own within 12-24 months, most likely to occur with the first twelve months
• Eysenck used this to criticize psychoanalytical therapy, saying that it was not effective

EXAMPLE: a person who has suffered from depression for several months suddenly notices/reports significant decrease in symptoms despite no treatment interventions or logical explanation for improvement.

Question 58

Successive Approximations

Answer 58

Part of operant conditioning and shaping; successive approximations are increasingly complex steps towards a desired complex or new bx.

Successive approximations are responses or behaviors that approach or are similar to some target behavior that is being learned by an organism. Successive approximations are reinforced in a learning procedure called shaping, and allows for organisms to learn new or complex target behaviors. For example, Skinner taught pigeons to turn in a circle by reinforcing successive approximations of the target behavior, and ignoring behaviors that were unrelated to the target.

EXAMPLE: Johnny has social anxiety. You are counseling him to get him ready to give a speech in front of the classroom. Given that Johnny is shy, he wouldn’t be able to give a speech right away. So, instead of promising Johnny some reward for giving a speech, shaping can be used and rewards should be given to behaviors that come close or successive approximations such as when he stands in front of the class, when he goes in front of the class and says hello, when he can read a passage from a book. etc.

Question 59

Systematic Desensitization

Answer 59

Developed by Wolpe; based on CCing principles; a first generation exposure therapy that included exposing clients to anxiety-provoking stimuli in a brief, graduated fashion and pairs exposure with relaxation training to inhibit the anxiety.

• Step 1 consists of teaching the client a competing response- bx that competes w/ anxiety; most common one PMR; imagery can also be used
• Step 2 consists of making the anxiety hierarchy- a list of events that elicit anxiety, ordered in terms of increasing intensity. Created by client using SUDs, ranging from 1 to 100 or 1 to 10.
• Step 3 is the actual desensitization. The client is told to relax all muscles in his/her body and imagine the lowest item on his/her hierarchy for 10 to 15 sec; told to signal if he/she experiences any anxiety or discomfort. If that signal is given, the client is told to stop visualizing and relax.
  
  • Once relaxed, he/she imagines the scene again. After 3 or 4 trials of presentation without anxiety, the client is told to move to the next item on his/her hierarchy.
• Used to treat specific phobias, anxiety disorders, PTSD

EXAMPLE: A client comes in with anxiety over riding elevators. She works in a large office building where taking an elevator is necessary, yet her fear has prohibited her. Anna and her therapist create an anxiety hierarchy to help. Then use systematic desensitization in which she first learns relaxation techniques and then begins facing her fears in vitro, working from least anxiety provoking (waiting in line for elevator) to most anxiety provoking (letting elevator doors close and riding it)

Question 60

Token Economy

Answer 60

A behavioral modification system that employs the principles of operant conditioning to motivate clients to avoid undesirable behaviors and perform desirable behaviors. Participants receive tokens for performing desired behaviors that can be used to purchase goods or privileges (backup reinforcers).

Four features:

• a list of target behaviors with the number of tokens lost and/or earned for performing each must be created
• list of backup reinforcers with the price for each must created
• Tokens must be chosen, i.e., are they coins, stickers, stamps, etc.?
• It must have procedures and rules in place for the operation of the system.

Advantages: highly convenient because tokens can be given anywhere and anytime; organized, systematic, and fair; and result in increased attention to positive bx

Disadvantages: rewards (back-up reinforcers) can be costly; some claim that a token economy is demeaning and considered briber; also an authority figure must be present

Clinical Example: At the treatment center if the recovering alcoholic attends an AA meeting every day, he receives a token at the end of the week and he can use it to be exempted from clean-up duty. This is an example of a token economy with an individual contingency. The backup reinforcer is being able to skip out on clean-up duty.

Question 61

Discriminative Stimulus

Answer 61

Part of: Operant conditioning

Who: B.F. Skinner

Where: Behavior Therapy

What: a cue that is present when a specific behavior is reinforced. When the discriminative stimulus is present, the behavior is reinforced. When any other stimulus is present, the behavior is not reinforced. Often used in discrimination training. In other words, the cue has been part of a process of differential reinforcement.

Why: Having the ability to help clients discriminate between particular stimuli is a critical learning process that can help individuals shape more adaptive behaviors through reinforcement.

Clinical example: A therapist is helping a child with autism develop more adaptive social skills. She helps the child first identify cues and discriminate between social cues that require a response. The therapist waves to the child. If the child waves back or says, “hi”, the therapist reinforces that behavior with praise. If the child looks away or does not wave, her behavior is not reinforced. The therapist also demonstrates that a wave is not required if a person does not make eye contact or wave to her. Throughout this process, the child learns that waving is a discriminative stimulus and waving or saying hello in return is an adaptive response.

Question 62

Extinction

Answer 62

Part of: Behavioral therapy and both respondent and operant conditioning

Who: Pavlov/Skinner

What: in Classical conditioning, extinction is a phase in which the CS no longer elicits the CR after repeated presentations of the CS without the UCS. In other words, the association between the CS and UCS is broken and the CR is extinguished. In Operant Conditioning, extinction of a behavior happens when the behavior is no longer reinforced and, thus, gradually stops occurring

Why: Extinction is an important process for helping patients de-associate specific stimuli that produce anxiety, fear, or other maladaptive behavior or psychological patterns

Clinical Example: a parent brings her child to therapy for frequent outbursts at home especially during dinner and before bed. The child often hides under the table or intentionally throws his food on the floor. When asked what the parents do in response to the outbursts, they report picking the child up, cuddling them, and sometimes laughing at their silly behavior. The therapist explains that the child has come to associate his behavior with positive consequences and asks the parents to ignore his outbursts going forward in an attempt to break the association between outbursts and positive consequences. Eventually, the child learns he will not receive attention. This is the process of extinction.