PSYC 501 Principles of Cognitive & Behavioral Change

Question 1

ABA or reversal design

Answer 1

a single-subject research design that systematically introduces and withdraws treatment (the independent variable) to see what happens to target behavior (the dependent variable). That is, does the target behavior “reverse” to levels observed in the initial baseline phase?
A = baseline
B = treatment
A = reversal of treatment; intervention withdrawn
The purpose of the reversal phase is to determine whether the behavior would have remained unchanged if the intervention had not been introduced
If the treatment is responsible for the change in the target bx, then the target bx will return to near baseline levels when the therapy is withdrawn in the treatment reversal phase.
Limitations:
Lack generalizability
Only useful when behavior is maintained by external factors
Withdrawal of tx may be unethical
Learned skill(s) may not be able to be unlearned
Called single subject because each subject is his or her own control

EXAMPLE: Researchers are investigating the effects praise has on childhood bx issues like tantrums. 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. To prove that the praise is responsible for the change, the researchers ask the parents to remove the praise and collect data once more. This is an example of an ABA Design because baseline measurements were taken, praise was introduced, and then withdrawn/reversed.

Question 2

Acceptance and commitment therapy

Answer 2

3rd generation CBT developed by Steven Hayes. Says that psychopathology comes from experiential avoidance and over-control or unwillingness to remain in direct contact with painful experiences. 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.
EXAMPLE: A woman suffers from depression and anxiety and comes into tx. The patient identifies parenting as an important value. Woman’s daughter will graduate from high school soon and she would like to attend graduation but she is afraid of not being able to find the energy. If she does not attend the graduation , she is not living in accordance with her parenting value. Instead of making therapy about how to get rid of her depression, therapy is about how to be at her daughter’s graduation in spite of her sxs. (psychological flexibility) the therapist ACT in hopes that the client can become more accepting of her feelings and thoughts so that she can tolerate them better.

Question 3

Anxiety/fear hierarchy

Answer 3

used in systematic desensitization; a detailed list of stimuli that trigger a fear response in the client. The list is organized from the things that produce the least intense fear response (low subjective unit of distress SUDs) to the things that produce the most intense fear response (high SUDs).

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

one aspect investigated using behavioral analysis; what the client does well
Assets can be internal (such as commitment to learning, positive values, and social competencies) and internal (such as support, empowerment, boundaries, and expectations)
Can be systematically used to overcome behavioral problems
Ignored in traditional DSM assessment
Examines the client’s repertoire of behaviors they already have
Also assessed when conducting a positive asset search

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 bxs.

Question 5

Automatic thought

Answer 5

term coined by Aaron Beck; part of Beck’s cognitive therapy; spontaneous thoughts that appear plausible and often occur in response to an event or situation (trigger)
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; meant to help pt recognise how their core beliefs affect them
Contribute to and maintain depression/anxiety

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

Behavior activation therapy

Answer 6

based on Lewhinson’s theory of depression that says depressed individuals tend to engage in increasing avoidance and isolation, which serves to maintain or worsen their symptoms.
The goal of treatment is to work with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in pleasant activities
Activities are typically things enjoyed before depression, activities related to values, or even everyday items that get pushed aside.
Examples include exercising, going out to dinner, learning new skills, showering regularly, completing chores.
Occurs via:
Self-monitoring of activities and mood
Scheduling Activities
Mastery and pleasure ratings

EXAMPLE: Brandy, age 18, comes into therapy because she is struggling with symptoms of depression. Brandy complains of always feeling tired, lethargic and not wanting to engage in activities that she used to enjoy, such as going out for coffee in the mornings. Brandy finds it difficult to get out of bed in the mornings, which in turn adds to her feelings of lethargy. Brandy’s therapist suggests that throughout the week, Brandy try turning on some music when she wakes up (something uplifting) and listen to it as she makes her bed. After a week of this and Brandy monitoring how it this scheduled activity affects her lethargy, the therapist suggests that Brandy add the activities of brushing her teeth and washing her face. After engaging in these scheduled activities and adding a little bit of behavior activation at a time, Brandy begins to feel less lethargic.

Question 7

Behavior therapy

Answer 7

a 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
six steps: clarifying the problem, formulating initial goals for therapy, identifying target behavior, 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 & Skinner all contributed to the early development of Behavior Therapy.

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. The therapist talks to John about his anger and suggests that rather than yelling at his peers when he feels angry, that he instead take a moment and think about something that makes him happy (like playing beach volleyball) and take 3 deep breaths. This suggestion is meant to replace John’s maladaptive bx.

Question 8

Chaining

Answer 8

part of operant conditioning;an instructional procedure 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.
Task analysis breaks it down into: learning to turn on the faucet, rinse hands, lather soap, rinse hands, turn off faucet, dry hands on towel. Therapist reinforces successive elements of the chain: After child master’s step 1, the parent is sure to praise him and provide positive reinforcement. Then the child moves on to step 2 and so on.Important that the therapist goes back and work on any link in the chain process that seems weak.

Question 9

Classical/respondent conditioning

Answer 9

a form of learning discovered by Ivan Pavlov; 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

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

Confounding variable

Answer 10

part of research; factors other than the independent variable that may affect the dependent variable
Controlling extraneous variables:
Random selection and/or random assignment
Counterbalancing
Utilizing blind or double-blind studies
Also called extraneous variables; 4 types: situational, participant, and demand characteristics
Threatens internal validity

EXAMPLE: You are conducting a study on memory at a local community college. Depending on the composition of your sample, age could be a confounding variable because in general younger people have better memory. That is, age would have an effect on the dependent variable.

Question 11

Cognitive fusion

Answer 11

associated with ACT. The state of mind in which a person is so fused with their thoughts that they consider them to be synonymous with fact; tendency to take thoughts literally
Can contribute to psychopathology and maladaptive sxs
Causes person to focus attention on the contents of their mind (our thoughts, memories, assumptions, beliefs, images etc) rather than what they are experiencing through the five senses.
Person then makes decisions and takes action based on their internal experience (thoughts, memories etc) rather than what is really going on in the world.
ACT helps client achieve defusion- where they can observe thoughts and see them for what they area - they may or may not be true, and may not reflect the physical world.

EXAMPLE: A client is struggling with cognitive fusion in that when she has a thought of “I am stupid” or “He thinks I’m stupid”, the client actually believes that she is stupid. The therapist helps the client to recognize the thoughts of “I am stupid” or “He thinks I’m stupid” as thoughts and not fact. Therapist explains to the client that just because she thinks it, that doesn’t mean it’s true.

Question 12

Cognitive restructuring

Answer 12

therapeutic technique used in Beck’s cognitive therapy and REBT; teaches clients to identify and change distorted and maladaptive cognitions
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 13

Cognitive therapy

Answer 13

developed by 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)
Type and content are analyzed
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 14

Conditioned and unconditioned responses

Answer 14

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 15

Conditioned and unconditioned stimuli

Answer 15

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 16

Contingency

Answer 16

part of learning principles and behavior therapy ; an if/then relationship between a behavior and its consequences, i.e. a schedule of reinforcement.
The delivery of the reinforcer is contingent upon a certain behavior or response.
Commonly used in behavioral modification.
Schedules of reinforcement may be continuous or partial/intermittent.
Intermittent schedules of reinforcement tend to make the behavior or response more resistant to extinction.
Used in Contingency Management

EXAMPLE: At the treatment center if the recovering alcoholic attends an AA meeting every day, he receives a voucher at the end of the week and he can use it to be exempted from clean-up duty. This is an example of an individual contingency in which AA attendance (bx) is reinforced with the exemption from clean-up (consequence)

Question 17

Cue exposure therapy

Answer 17

a specialized form of exposure 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; cravings will subside based presentation of CS without US
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 18

Decision balance matrix

Answer 18

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 changing 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 19

Dialectical behavior therapy

Answer 19

a 3rd wave CBT developed by Marsha Linehan as a treatment for suicidality, self-harm, and BPD; a third-generation CBT that seeks to creat acceptance that allows change
There is an empathic understanding and validation of the client’s emotions. This allows the client to remain amenable to therapist’s suggestions for change
The second core strategy of DBT is problem-solving and creating change. This comes from 1st and 2nd generation behavior therapies such as skills training, exposure therapies, contingency management, and cognitive restructuring.
DBT focuses on providing therapeutic skills in four key areas - mindfulness, interpersonal effectiveness, emotion-regulation, and distress tolerance
Mindfulness skills (finding a reasonable response that exists in the middle of one’s reasonable mind vs. emotional mind vs. wise mind);
Interpersonal effectiveness skills (teaching how to be assertive but not aggressive; problem-solving);
Emotion-regulation skills (observing and describing own emotions, goes hand-in-hand with mindfulness);
and distress tolerance skills
Often consists of weekly individual and weekly group therapy sessions

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 20

Differntial reinforcement of other behavior (DRO)

Answer 20

a procedure that uses differential reinforcement to decrease/eliminate a target behavior; in this schedule, reinforcer is delivered after an interval of time in which the problem bx does not occur; based on operant conditioning principles
Reinforcement is contingent upon the absence of the problem behavior- but you do not identify an alternate behavior to reinforce, you simply reinforce all other behaviors
Goal is to decrease the target behavior
the “other” behaviors are often incompatible with the target behavior
Can be time consuming
Other schedules: DR of low rates of responding (DRL) and DR of alternative behaviors (DRA)

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 21

Discriminative stimulus

Answer 21

part of operant conditioning; the stimulus or cue that is present when the behavior is reinforced; helps person learn to exhibit target bx in its presence
Consequence is contingent on the occurrence of the behavior only in the presence of the specific antecedent stimuli
Discriminative stimulus → response → reinforcement
Often called ABCs (antecedent, behavior, consequence)
Three term contingency

EXAMPLE: During parent-child therapy, parent brings in child because they are not following the rules at home. The therapist recommends displaying pictures of clocks labeled with activities that the child should be engaged in at the specific time in the day. (7am-wake up, brush teeth, get dressed. 4pm-homework. 7pm get ready for bed, brush teeth.) The clocks serve as a discriminative stimulus by signaling to the child what and when behaviors should occur to avoid punishment and to gain reinforcement (praise)

Question 22

Efficacy expectations

Answer 22

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]
Self- Efficacy: belief that one can perform a given behavior successfully or master a situation
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

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 23

Empirically supported therapy/treatments

Answer 23

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 24

Escape/avoidance

Answer 24

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 25

Exposure with response prevention

Answer 25

(ERP) 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 26

Extrinsic and intrinsic reinforcers

Answer 26

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 27

Functional anlysis

Answer 27

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 28

Generalization and discrimination

Answer 28

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 29

Exposure therapy

Answer 29

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 30

Iatrogenic effects

Answer 30

part of clinical practice; 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 31

Imaginal exposure

Answer 31

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 32

Individual and group contingencies

Answer 32

two forms of contingency management that emerged from behavioral therapy; used in token economies
There are 3 types:
Individual: only specific individuals are involved in the token economy
Group: reinforcement related to satisfying a group contingency; depends on all members to satisfy contingency
Promotes peer intx and influence

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 33

In vivo exposure

Answer 33

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 34

Learned helplessness

Answer 34

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 35

Learning-performance distinction

Answer 35

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 36

Meta analysis and effect size

needs ex

Answer 36

part of research methods; a statistical procedure that integrates and compares empirical findings from multiple studies
Provides a more comprehensive answer to questions about the effectiveness of a treatment
Purpose is to combine multiple effect sizes: a quantitative measure of the strength of a phenomenon; refers to magnitude of an effect
By placing the emphasis on the most important aspect of an intervention - the size of the effect - rather than its statistical significance (which conflates effect size and sample size), it promotes a more scientific approach. For these reasons, effect size is an important tool in reporting and interpreting effectiveness.
can be directly converted into statements about the overlap between the two samples in terms of a comparison of percentiles.
An effect size is exactly equivalent to a ‘Z-score’ of a standard Normal distribution. For example, an effect size of 0.8 means that the score of the average person in the experimental group is 0.8 standard deviations above the average person in the control group

Question 37

Mindfulness

Answer 37

herapeutic technique often used as a part of therapy; An Eastern concept developed in the religion of Buddhism, 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, acceptt, or fuse with them.
Has been incorporated into several third-generation cognitive behavioral therapies, including Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT).
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 38

Modeling

Answer 38

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 39

Motivational interviewing

Answer 39

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 40

Multiple baseline design

Answer 40

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 41

Negative reinforcement

Answer 41

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

EXAMPLE: You are treating someone with opiate use disorder. They have tried many times to get sober and have failed to stay sober due to withdrawal symptoms. Coming from a behaviorist perspective, you conceptualize this as a case of negative reinforcement. The patient experiences negative withdrawal sxs such as sweating, vomiting, etc (aversive stimulus) that is removed when they use the drug. Using the drug is negatively reinforced and more likely to keep happening.

Question 42

Operant conditioning

Answer 42

type of learning 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 43

Outcome expectancies

Answer 43

part of Bandura’s self-efficacy theory; an individual’s belief that a particular course of action will ultimately produce certain outcomes.
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 44

Outcome vs process research

Answer 44

types of research; outcome research attempts to evaluate the effectiveness of txs
Individual client research designs: case studies, multiple baseline studies, etc.
Large scale research design: experimental design - RCT
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 45

Parent-child training therapy

Answer 45

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 46

Positive reinforcement

Answer 46

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 47

Premack principle

Answer 47

principle of operant conditioning discovered by Premack; higher proability bxs- whether considered enjoyable or not- can serve as reinforcers for lower probability bxs
Relative frequency of occurrence of a behavior is typically used as a measure of probability because frequency approximates probability
High probability behaviors do not need to be pleasurable to serve as reinforcers but those that are aversive generally do not function as reinforcers
High probability behavior must not be occurring so often that it loses its effectiveness in motivating clients to engage in the low-probability behavior.
Can increase the frequency of a low frequency, desired behavior (LFB) by arranging for a more frequently occurring behavior (HFB) to be contingent upon it

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 48

Problem solving therapy

Answer 48

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 49

Primary/secondary reinforcer

Answer 49

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 50

Punishment

Answer 50

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 51

Reactivity of self monitoring

Answer 51

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 monitoring

Question 52

Reciprocal determinism

Answer 52

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
Has important implications for personal freedom
Our behaviors are not rigidly controlled by external forces. We can change or create the factors that influence our behaviors.

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 53

Reinforcer

Answer 53

in operant conditioning, a consequence that strengthens a behavior and increases frequency;
The ability of the reinforce 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 54

Schedules of reinforcement

Answer 54

part of Skinner’s operant conditioning; a rule that dictates which occurrences of a behavior will be reinforced.
Two basic schedules, continuous reinforcement: behavior is reinforced EVERY TIME.
Continuous reinforcement is most useful when client first learning to engage in target behavior
Once established usually switched an intermittent schedule. Intermittent schedules enhance transfer, generalization, and long-term maintenance.
Intermittent reinforcement: only some of the occurrences of the target behavior are reinforced
Interval schedules provide reinforcement after a response occurs after a certain time period. This time period can be fixed or variable.
Fixed Interval schedules produce an accelerated rate of response as the time of reinforcement approaches.
Ex: Students’ visits to the university library show a decided increase in rate as the time of final examinations approaches.
Variable Interval schedules produce a steady rate of response.
Ex: Presses of the “redial” button on the telephone are sustained at a steady rate when you are trying to reach your parents and get a “busy” signal on the other end of the line.
Ratio schedules provide reinforcement after a certain number of responses. This number can be fixed or variable.
In general, ratio schedules of reinforcement are more effective than interval schedules.
Fixed Ratio schedules support a high rate of response until a reinforcer is received, after which a discernible pause in responding may be seen, especially with large ratios.
Ex: Salespeople who are paid on a “commission” basis may work feverously to reach their sales quota, after which they take a break from sales for a few days
Variable Ratio schedules support a high and steady rate of response.
Ex: illustrated by the gambler who persistently inserts coins and pulls the handle of a “one-armed bandit.”
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 55

Schema

Answer 55

part of Beck’s cognitive theory; cognitive structures that organize and process information; deepest, most ingrained level of cognition. Also called core beliefs
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

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 56

Self-efficacy and outcome expectations

Answer 56

both terms part of Bandura’s self-efficacy theory; Self- Efficacy is a belief that one can perform a given behavior successfully or master a situation
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.
May influence whether a person puts themselves in certain situations or not
Important in motivation for changing
Can be positive and negative

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 57

Self reinforcement

needs ex

Answer 57

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)

Question 58

Shaping

Answer 58

part of operant conditioning; used to establish a new behavior not in client’s repertoire, Each approximation of the behavior 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 59

Social skills training

Answer 59

S defined as the ability to emit behavior that is positively reinforced by others and minimize behavior that is punished by others.
SS components include eye contact, smiles, attention to other, listening, affect, gestures, etc.
Lack of social contact/withdrawal and social skill deficits are hallmarks of certain diagnoses (schizophrenia, depression, social anxiety).
Absence of SS is correlated with an array of problems in children and adolescents (social isolation, poor academic achievement, delinquency), and adults (depression, social anxiety, social isolation)
Social Skills training (SST) a type of behavior therapy used to improve SS in people who have difficulties relating to others; increases social competence
Might utilize modeling, instruction, shaping
Used for young children beginning school or other social intxn, antisocial, ADHD, social anxiety, bipolar, schizophrenia, etc.

EXAMPLE: A 14 yo enters therapy because he doesn’t have any friends his age. He usually interacts with children 5 years younger than him. He has trouble engaging in simple conversations with his peers. Sherman begins social skills training in which the therapist provides rationale for certain skills and then models these skills for Sherman. Sherman then rehearses the skill with the therapist (role-play) , and after becoming proficient in that, his homework is to apply the skill with his peers. The training focused on asking appropriate questions, maintaining appropriate eye contact, and acting in a warm & friendly manner.

Question 60

Spontaneous recovery

Answer 60

discovered by Pavolv in his CC studies; a phenomenon of learning and memory; 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 61

Spontaneous remission

Answer 61

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 i 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 62

Successive approximations

Answer 62

part of operant conditioning and shaping; successive approximations are increasingly complex steps towards a desired complex or new bx.
Bxs are rewarded as they are repeated and begin to resemble desired bx more and more

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 63

Systematic desensitization

Answer 63

developed by Wolpe; based on CCing principles; an exposure therapy consisting of three components: relaxation training, anxiety hierarchy, and paired presentations of relaxation and anxiety hierarchy
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
Mostly imaginal exposure?

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 64

Token economy

Answer 64

a behavior modification system based on basic learning principles; type of contingency management; used to promote desirable behaviors and decrease undesirable behaviors.
Clients earn tokens for desirable behaviors and lose tokens for undesirable ones
Exchange the tokens for meaningful objects, privileges, or activities- considered back-up reinforcers
Can be delivered to an individual or a group
Work in multiple settings
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
Steps to create: (not on card)
Select bxs to change (use ABCs): target bx can be the same or different than the problem bx; target behavior can be an incompatible or alternative bx BOTH need to be operationalized and observable
Establish baselines of target bxs; Bxs ranked and assigned point value
ID backup reinforcers (best if client-generated; cannot be necessities; consider price, frequency, primary vs secondary)
Chose tokens
Consider use of punishment.Generally best to explore positive reinforcement as first option. If being used it should be combined with DRO and should be delivered after EVERY occurrence of the undesirable bx.
Continue to evaluate token economy and take measurement of target bxs

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.