The First Wave - Behavioural Psychotherapy Flashcards
What were the two traditions of 20th century Behavioural First-wave Psychotherapy?
American and British traditions
Which approaches constituted the two approaches of 20th century behavioural first-wave psychotherapy?
> Behaviourism
> Learning Theory
What was the goal of the new behavioural first-wave approach to therapy?
To challenge the psychoanalytical approach (Freud, Jung)
Who was the primary influence of the US tradition?
Skinner (1904-1990)
What constitutes the US tradition of behavioural first-wave psychotherapy, in terms of aim, methods, settings?
> Behaviour modification
> Methods:
- operant conditioning, reinforcement
> Settings:
- psychiatric and other long-stay institutions
What are the targets in the US tradition of behavioural first-wave psychotherapy?
> Reduction in challenging behaviours (e.g. self harm, aggression, shouting)
> Encouraging desired behaviours (e.g. feeding, washing)
What are the two operant based approaches?
- ABC
2. Functional Analysis (applied behavioural analysis)
What is the ABC approach?
“Three-term” or “ABC Contingency”
- Antecedent specific stimulus -> Behaviour
- > Specific Consequences
What is the principle of functional analysis (applied behavioural analysis)?
> Behaviour as a function
> Purpose:
- obtain or access something positive
- escape or avoid something negative
What is functional analysis based on?
- Careful direct observation
- Record keeping using ABC charts
- Requires careful training
What are the steps of the functional analysis?
- Note the observed behaviour
- Note the situation previous to the behaviour (antecedent)
- Note what happened after (consequence)
- reactions of others
- changes in behaviours
In behaviour modification, what characterises antecedents (stimulus), behaviour (skill), and consequences (outcome) based (ABC) approaches?
> Antecedents (stimulus) based:
- simple and easy to implement
> Behaviour (skill) based:
- provide new skills and tools
- costly in time and effort to implement
> Consequences (outcome) based:
- behaviour stops without reinforcement
- hard to apply and neglects underlying purpose o behaviour
How can an extinction approach be efficient?
> Setting a continuous reinforcement before removing it completely
- leads to fastest extinction
> Provide reinforcement non-contingently or more often, when unwanted behaviour is not occurring
-> reinforce wanted behaviour
What did the study of Cohen-Mansfield and colleagues (2007) show on the nonpharmacological treatment of agitation (TREA) approach?
> 12 nursing homes allocated the TREA approach, continued with standard care
> 10 days of individualised treatment, during the 4 hours of greatest observed agitation
- > Greater reduction in mean agitation in homes using the TREA methods
- > Increased ratings of pleasure
- > Increased interest in activities
What can limit the operant approaches?
> No effective reinforcer
Person may refuse a typical reinforcer
Reinforcer may not be valued
How can a reinforcer be considered as such?
If behaviour changes as a result of its pairing with a particular response
- in some cases, person doesn’t respond in behaviour change, perhaps because the consequence is not valued
What is Premack’s principle (differential probability hypothesis)?
A behaviour, chosen frequently, is itself reinforcing
- > frequently chosen behaviour can be used as a reinforcer to alter another behaviour chosen less frequently
- widely used without us realising
How can you find a reinforcer using Premack’s principle?
Using a high frequency preferred behaviour (as reinforcer) to increase low frequency less preferred behaviour
When is Premack’s principle useful?
When reinforcers are hard to identify
- e.g. extreme inactivity in Schizophrenia
- still used in client-centered approaches
What are token economies? How do they work?
Contingency management based on the principle of secondary reinforcement
- money has no intrinsic value, can motivate and reinforce behaviour
- secondary reinforcers can be considered tokens
-> Allow us to acquire an outcome and achieve a valued purpose at later time
What are the 5 benefits of token as reinforcers?
- Easier to control and manage
- Easier to provide at time of behaviour
- Easily scalable
- exchange rate easily modifiable - Resistant to satiety effect
- > can be used more freely - Can be removed as well as awarded (response cost)
- > more acceptable and ethical
vs. withholding a material reinforcer or privilege
What are the 5 basic components of a token system?
- Nature and value of token must be explicit and understood
- Accurate and transparent means of recording tokens earned, spent or removed
- Clear and valued actual reinforcers that can be acquired through accumulated tokens
- Rules governing, earning and using tokens must be clear
- Consistent implementation, in particular not allowing access to the tangible reinforcer other than through tokens
When did token economy systems gain popularity in mental health settings? Why?
From 1970s onward
- generally successful in increasing adaptive behaviour
Which mental health disorders benefit from token economy systems?
> Learning disabilities
Neurodevelopment disorders
Addiction and substance misuse
What is the limit of AB design of clinical trials?
> Weak evidence (e.g. typical of many trials of token systems)
> Can’t control other factors over a period (e.g. change of staff)
Which type of study design provides the best evidence of effectiveness of a complex intervention in a natural setting?
Large, controlled, and multi-centered trials
What is the role of behaviour change in a person centred approach to care?
For the patient’s own benefit:
- improving quality of their life
- reducing something causing them harm or potential harm
- focus on the person, not the behaviour
Who were the primary influencers in the British tradition of 20th century behavioural first-wave psychotherapy?
> Cover-Jones (behavioural genetics, systematic exposure)
> Watson (Little Albert)
> Pavlov (classical conditioning)
> Hull (motivation in behaviour change)
Who was Mary Cover-Jones, and what was her work on?
American psychologist
- behavioural genetics
- including the study of potential of classical conditioning to remove fear
What did the Case of Peter led by Mary Cover-Jones (1924) consist of?
> Peter, boy, less than 3
- afraid of white rabbits and other furry objects (conditioned stimuli)
- not afraid of wooden rabbits
> Experiment:
- once or twice per day, some gaps
- over several months
> Assessment: ‘Stages of tolerance (A-Q)’
- A = rabbit in room leads to fear
- Q = Peter allows rabbit to nibble finger
What were the stages of toleration based on, in Mary Cover-Jones’ Case of Peter (1924)?
> Systematic series (exposure/stimulus hierarchies)
> Gradual unthreatening presentation (exposure)
> Modelling, observational/social learning:
- see other children playing with rabbit without fear
How did Mary Cover-Jones measure Peter’s degree of toleration in her experiment (1924)?
Observable behaviour:
- ability to tolerate the rabbit’ presence, no fear
How did Mary Cover-Jones use classical conditioning in her Case of Peter (1924)?
> Sweets as positive unconditioned stimulus
> Paired rabbit and food
- rabbit presented in cage some feet away from Peter when giving him the sweets
- repeatedly, gradually bringing rabbit closer, to point where Peter allowed rabbit to play with him
What was the result of Mary Cover-Jones’ Case of Peter (1924)?
Change conditioned response to rabbit from fear to positive or neutral
What was Mary Cover-Jones’ legacy to behavioural psychotherapy?
> Established many principles and methods of later behavioural psychotherapy
- deconditioning
- systematic exposure
- stimulus hierarchy
- observation and modelling
- systematic measurement of behaviour
- objective measurement
> Application of evidence and theory
> Experimental approach
> Methodological innovations
Who was Joseph Wolpe and what was his work?
South African psychologist
- experiments in animals on fear conditioning and deconditioning
- used punishment techniques
- applied to treatment of neurosis
> ‘Assertiveness’ training for shell shock patients
What did the clinical studies of Joseph Wolpe suggest?
A more effective method that could be found in the method described by Mary Cover-Jones in her Case of Peter
What was Joseph Wolpe’s principle of reciprocal inhibition?
You can’t be anxious and afraid if you are carrying out behaviours of relaxation and fearlessness
Which method did Joseph Wolpe develop from the work of Mary Cover-Jones?
What constituted it?
Systematic Desensitisation
- Stimulus hierarchies: graded list set by patient and therapist
- Systematic graded exposure
- Response prevention: patients learned the experienced anxiety reduces on its own
- Subjective units of distress (SUD)
- Relaxation training
What did the subjective units of distress (SUD) consist of, in Wolpe’s systematic desensitisation?
> Once patient was comfortable with low distress in easiest situation on stimulus hierarchy (list), treatment move on to the next step
> In a single session, or over several sessions, depending on the severity of the phobia
What did the relaxation training consist of, in Wolpe’s systematic desensitisation?
Prior to exposure treatment, so the patients had the skills to reduce their level of anxiety
- subjectively and the physical symptoms
= reciprocal inhibition
-> being relaxed in presence of feared object/situation thought to enable counter-conditioning
What did Joseph Wolpe’s systematic desensitisation become?
A mainstay of behaviour therapy for the treatment of a range of anxiety disorders
What is imaginal desensitisation introduced by Wolpe?
The nature of anxiety that the stress can occur when a person imagines a step on the hierarchy list as well as it is actually experienced
Which evidence backs the concept of imaginal desensitisation?
Brain imaging studies that show physiological equivalence of real and imagined exposure to fearful stimuli
What is in-vitro desensitisation?
A person imagines the steps on the stimulus hierarchy list, the gradual exposure
What are the benefits of in-vitro desensitisation?
- Broaden the range of target problems that can be treated (e.g. fear of heights)
- Allows patient to practice exposure between sessions
What is the limit of in-vitro desensitisation?
Only effective with patients able to conjure strong and convincing visual images
What is in-vivo desensitisation?
A person experiences the gradual exposure, going trough the steps on the stimulus hierarchy list
- more effective than in-vitro desensitisation
What is the place of classic systematic desensitisation approaches today?
They are rare, replaced by more effective cognitive and cognitive behavioural approaches
- still incorporating some of Wolpe’s original methods
Who is Albert Bandura and what is his contribution?
Canadian psychologist
> Deconditioning by observation
> Social Learning Theory
> Cognitive Revolution (1960)
- we can learn without being directly reinforced ourselves
What did Albert Bandura’s experiments of the Bobo doll (1961) show?
Study of influence of observation of agression in children
- 72 children
- female and male adult models
-> children imitated aggressive behaviour that they had observed
What was the influence of Bandura’s Bobo doll experiments (1961)?
Influenced greatly the debate on children’s exposure to violent behaviour on TV, and video games more recently
What is the principle of intergenerational transmission of fear through observational learning?
Child observing a parent demonstrating fear of spider
-> child develops the same fear
What does the therapeutic modelling of fear consist in?
A patient observing another person in a situation they find distressing
> Coping modelling: both have same fear
- observer (fear)
- person modelling behaviour (fear)
> Mastery modelling:
- observer (fear)
- person modelling behaviour of no fear
What is the principle underlying therapeutic modelling?
Seeing someone doing something despite being afraid is a more powerful way to help us overcome our own fears
vs. seeing someone fearless doing the same thing
What is the prevalence of dental fear underlined by Oostink and colleagues (2009)?
Study of 2000 Dutch adults, 18-93 years
- dental fear 4th most common fear (24.3%)
- 3.7% had diagnosable dental phobia
What is the dental fear model?
Vicious cycle of dental fear:
Dental fear -> delayed rising (avoidance) -> dental problems -> symptom driven symptoms -> dental fear
What is the consequence of the prevalence of dental phobia?
> Dental phobia has become a target of behaviourist approaches
- e.g. systematic desensitisation
> Dentists themselves trained to deliver the interventions to remove obstacles to treatment
What is response desynchrony?
When the rate of change of different outcome indicators can vary
How did the use of augmented reality by Botella and colleagues (2011) for cockroach phobia benefit the participants?
> Participants viewed a live video of their hands, over which a virtual cockroach walked
-> novel use of mobile technology
> Rating before and after:
- additional drop in fear across a single session
- considerable drop in avoidance
What is active avoidance?
Distancing from situation (antecedent) when encountered
- adaptive behaviour
What is passive avoidance?
Avoiding the situation in the first place
When is avoidance adaptive and when does it become maladaptive?
> Avoiding a likely event = adaptive
> Avoiding an unlikely event = maladaptive
- person adjusts his/her action but limits her opportunities
What is the Pavlovian (classical) conditioning explanation of avoidance learning?
A neutral stimulus is conditioned to become aversive and provoke a conditioned response
What is the operant (instrumental) conditioning explanation of avoidance learning?
In a conditioned avoidance response, exposure to the aversive outcome depends on wether or not the animal makes the defined response
What is the reinforcer for Watson and early behaviourists?
It must be observable
What is the reinforcer in avoidance learning?
Omission of a pending avoidance event
- something that not yet occurred is reinforcing
- > fear variable
What is the Two-Factor theory of avoidance learning developed by Orval Mowrer (1947)?
Fear = covert behaviour
- internal and unobservable
- Classically conditioned fear response
- Operant process
- fear as intervening variable
- reinforcer = reduction of fear
-> An increase in avoidance behaviour towards antecedent (conditioned fear stimulus) is negatively reinforced by fear reduction
What is the basis of the criticisms against the Two-process (factor) model of avoidance?
Both processes (classical and operant conditioning) are not always necessary for the development and maintenance of avoidance behaviour
What are the 4 criticisms against the Two-process (factor) model of avoidance?
- Avoidance continues after deconditioning or extinction
- Success of systematic desensitisation does not require elimination of fear at each exposure
- Animals can learn to avoid in the absence of aversive conditioned stimulus
- Human avoidance learning does not depend on early fear conditioning
- > Social (observational, instructional) learning
What are the 5 cognitive explanations of avoidance behaviour set forth by Robert Rescorla and Allan Wagner?
- Focus on information about aversive stimulus or outcome
- Uncertainty or prediction error is necessary for learning
- Element of surprise helps us learn to avoid danger
- Uncertainty is aversive and humans/animals behave to reduce uncertainty
- Waiting and not knowing is worse than the eventual outcome
How did Robert Rescorla and Allan Wagner demonstrated the safety signal predictor?
> Box A
- presence of light signals shock
- absence of light signals no shock -> safety signal
- > shock is predicable
> Box B
- no signal (no light)
- > shock is unpredictable
What did we learn with safety behaviour?
Influential in understanding the maintenance of maladaptive avoidance:
- mere probability is not enough to conquer fear
- even small chance of something happening is to much for some people (e.g. walking in grass, flying on a plane)
- > they will express behaviours that seemingly reduce the uncertainty even more, with aim of helping them feel safe
(e. g. look carefully, make noise, use a stick)
How do safety behaviours become maladaptive?
> Safety behaviour has in our minds reduced the uncertainty of the null accounts of an aversive event
-> temporary reduction of anxiety
BUT we remain fearful and avoidant in long term, relying on safety behaviours
> We can become dependent on safety behaviours
- we learn we are safe because of safety behaviour
- this mechanism may maintain phobia
- may become problematic (e.g. OCD)
