Treatment Interventions 1 Flashcards
Behaviorists believe…
that behavior is generated and maintained by factors external to the person, by various environmental and situational stimuli
psychopathology results from problematic learned patterns
clinical interventions based on classical conditioning
involve unlearning previous problematic connections (e.g. connections that have led to phobias, anxiety, or addictions)
change is accomplished using counterconditioning or on classical extinction
counterconditioning
based on principal of reciprocal inhibition
reciprocal inhibition = two incompatible responses cannot be experienced at the same time, stronger response will inhibit the weaker
focus of treatment - weakening the maladaptive conditioned response (e.g. fear of rats) by strengthening an incompatible or antagonistic response (e.g. relaxation)
interventions based on counterconditioning (4)
aversive conditioning
desensitization
sensate focus
assertiveness training
aversive conditioning
conterconditioning technique
only used to eliminate deviant or bad behaviors (e.g. drinking, smoking, fetishes)
conditioned stimulus paired with a new and stronger stimulus
new stimulus elicits a strong negative response that is incompatible with the old conditioned response of pleasure
in vivo or in imagination
aversive conditional example
old stimulus of smoking a cigarette is paired with new stimulus of electric shock
new response of pain is stronger than and incompatible with old response of pleasure from the cigarette
learned pairing of smoking with pleasure will be weakened
example of in vivo aversive conditioning
Antabuse (disulfiram)
new response of nausea and vomiting when ingesting alcohol is incompatible with prior response of pleasure
aversive conditioning in imagination
covert sensitization
e.g. imagining cancer cells destroying one’s body as one takes a puff of cigarette
research on aversive conditioning
may have short-term benefits, but not effective in the long run and associated with high rates of recidivism
systematic desensitization
developed by Joseph Wolpe
counterconditioning technique
most commonly used to treat specific phobias
patient constructs anxiety hierarchy, patient asked to relax then gradually exposed to feared situation lowest on the hierarchy, moves up on list
imagination or in vivo
research on systematic desensitization
previous research suggested systematic desensitization was the most effective procedure for specific phobias
more recent research has concluded that treatments that emphasize prolonged and intense exposure (e.g. flooding) are most efficacious for specific phobias
sensate focus
Masters and Johnson
uses pleasure as counterconditioning response to inhibit performance anxiety
pleasure elicited by body massages that are discontinued at the first sign of anxiety
assertiveness training
counterconditioning technique
patients practice assertive responses
first role playing with the therapist, and eventually in real-life situations
classical extinction
involve presenting the conditioned stimulus without the unconditioned stimulus to the point where the conditioned stimulus no longer elicits conditioned response
examples - flooding or implosive therapy
flooding
classical extinction technique
either in vivo or in imaginzation
present CS without US (although we usually don’t know what it is)
exposure continued until fear has extinguished
e.g. exposed to spider and prevented from fleeing
research on flooding
prolonged exposure (e.g. 45 minutes) more effective than multiple, briefer periods of exposure which can actually exacerbate fear flooding with response prevention appears to be more effective than systematic desensitization for agoraphobia, OCD, and specific phobias
implosive therapy
classical extinction tehnique
developed by Stampfl
in imagination only
after patient is exposed to feared object in imagination, therapist interprets possible psychosexual themes
clinical interventions based on operant conditioning
involve reinforcement or punishment
first, conduct functional assessment of behavior to ID target behavior, antecedents, and consequences
also identifies contingencies (reinforcers and punishers) that serve to maintain the behavior
3 types of reinforcers
primary reinforcers - reinforce everyone at all ages and in all cultures (e.g. food)
secondary reinforcers - acquire their reinforcing value through training or experience (e.g. praise)
generalized conditioned reinforcers - not inherently reinforcing, but take reinforcing value because they give person access to other reinforcers (e.g. money, tokens)
shaping
person reinforced for every step taken towards achieving a target behavior
intervention strategies involving reinforcement
shaping token economies contingency contracting Premack principle differential reinforcement self-reinforcement
token economies
using tokens in a systematic and consistent manner as reinforcement for appropriate behaviors
originally implemented on schizophrenic inpatient wards - patients given tokens for self-help behaviors (e.g. grooming, making beds) and adaptive, pro-social behaviors
fined tokens for undesirable behaviors (e.g. destroying property)
applied in other institutional settings - with mentally retarded, autistic children, juvenile offenders
contingency contracting
operant conditioning technique in natural environment
can be utilized when there are problematic interactions between two or more people
therapist helps people ID behaviors they most want from one another and then helps them negotiate a contract for their exchange
Premack Principle
aka the principle or reinforcer relativity
uses high frequency behavior (i.e. something a person does frequently without any outside coercion) to reinforce low frequency behavior
Grandma’s rule
requiring child to eat peas before going out to play
Differential reinforcement of other behaviors (DRO)
aka differential reinforcement of incompatible responses (DRI) aka differential reinforcement of alternative responses (DRA)
combines extinction and positive reinforcement
example of DRO
hyperactive child is ignored when she speaks out of turn (extinction) but reinforced when she waits for her turn to speak
self-reinforcement
administering reinforcement to oneself
e,g. rewarding self for each pound lost
four paradigms that involve elements of aversive control of behavior
positive punishment
escape learning
avoidance learning
overcorrection
positive punishment
applying an aversive stimulus (e.g. yelling) after an undesirable behavior has been emitted
rarely used in clinical settles
e.g. thought stopping; snapping rubber band on wrist when thinking an undesirable
research on positive punishment
merely suppresses behavior, does not eliminate it
escape learning
aversive stimulus can’t be avoided altogether
but once aversive stimulus has started, can be stopped by emitting the desired behavior
e.g. animal is shocked, can get the shock to stop by pressing level
avoidance learning
can entirely avoid the aversive stimulus by emitting the desired behavior in time
e.g.red light flashes, cueing animal to press level
overcorrection
involves restitution or reparation and physical guidance
e.g. child makes mess in living room, required to clean it up as well as another room
clinical applications of social learning theory
involve modeling of adaptive behaviors to replace maladaptive ones
three variations of modeling procedures
symbolic modeling
live or in-vivo modeling
participant modeling
symbolic modeling
involve observing a film in which a model enjoys progressively more intimate interaction with a feared object or anxiety-producing setting
live or in-vivo modeling
having person observe a live model engage in graduated interactions with a feared object or anxiety-producing situation
participant modeling
live modeling plus contact with model
model gradually guides person in activities involving physically interacting with feared object or dealing with anxiety-provoking situation
Marsha Linehan’s Dialectical Behavior Therapy
for persons with borderline personality disorder
acceptance and change
four conditions of DBT
1) work in therapy for specific time period (typically a year) and within reason attend all sessions
2) if suicidal behavior present, work on reducing it
3) work on any behaviors that interfere with therapy
4) attend skills training
primary modes of DBT
individual therapy
telephone contact - help patient apply skills learned between sessions, help avoid self-injury
skills training - group (mindfulness skills, interpersonal effectiveness skills, emotion regulation skills, distress tolerance skills)
therapist consultation
Rational Emotive Behavior Therapy (REBT)
Ellis
first CBT, born out of Ellis’s dissatisfaction with psychoanalysis
Emotional disturbances result from irrational beliefs
ABC model
major components: direct instruction, persuasion, and logical dispution to modify beliefs
also includes modeling, homework, relaxation, and rehearsal
REBT ABC Model
A) Activating Event B) Belief C) Consequence or emotional/behavioral outcome Behaviorists propose direct A-->C Ellis proposes that BELIEFS about activating event result in the consequences D) Disputing intervention E) adoption of more Effective philosophy F) new Feelings (DEF is result of therapy)
Cognitive Therapy
Beck
Overlaps with Ellis with regard to cognitive focus
Differs from Ellis in that it emphasizes empirical hypothesis testing as means of changing existing beliefs
Behavioral assignments and homework presented as experiments to test beliefs
Psychological symptoms result from maladaptive thoughts
Beck and depression
depression results from maladaptive cognitive triad
negative view of self - self seen as defective and inadequate
negative view of world - events interpreted negatively and there is expectation of failure and punishment
negative view of the future - expectation of continued hardship or negative appraisal of the future
Cognitive Behavior Modification
Meichenbaum
self-instructional training and stress inoculation training
focuses on self-statements
Self-instruction therapy
Meichenbaum’s CBM
empirically supported for children with ADMD
1) therapist modeling - verbalizes steps involved
2) therapist verbalization - patient performs task while therapist verbalizes steps
3) patient verbalization - patient performs task while verbalizing steps
4) patient silently talks through task
5) independent task performance
protocol analysis
slight parallel with self-instruction therapy
person describes aloud the steps being taken to solve the task
used to gain access to people’s problem-solving strategies
