Week 1 Flashcards
1
Q
history of cbt
A
started late 1950s - 1960s, 1st generation behavior therapy (classical and operant conditioning)
1970s - 1980s: 2nd generation cognitive therapy (negative automatic thoughts, cognitive restructuring, Socratic dialogue.)
2000s: 3rd generation (MBCT, ACT, DBT)
2
Q
characteristics of CBT (5)
A
- focus on present
- focus on thoughts, behaviors, emotions
- problem solving approach
- goal oriented
- time limited
3
Q
first 3 phases of cbt
A
validation of patients complaints
building therapeutic relationship
explaining general treatment rationale
4
Q
second 3 phases of cbt
A
cognitive and behavioral assessment
formulating realistic plan
designing treatment plan
5
Q
last 3 phases of cbt
A
carrying out treatment plan
broadening to other areas of dysfunctioning
relapse prevention
6
Q
behavioral is the result of a…
A
complex information system with antecedence and consequent factors (ABC)
7
Q
learning
A
acquiring knowledge about the connection between events and can result in a behavioral change
8
Q
learning model in CBT
A
abnormal behavior is achieved by the same learning processes as normal behavior: the ways of developing, maintaining, and changing behavior are the same
9
Q
pros of cbt
3
A
short term , complaint driven, measurable effects
10
Q
cbt effectiveness
A
50-60% who start CBT reach recovery
11
Q
therapists beliefs and attitudes
A
- therapists rarely use manuals and dislike them even though using them results in better outcomes
- therapists believe the therapeutic alliance will do lots of the work for us
12
Q
does alliance drive therapy outcome
A
not in cbt, important to focus on early behavioral change
first 5 sessions, if there is no difference in behavior change, no sense in continuing
13
Q
how much of clinical outcome is associated with the alliance
A
clinician believes its 32%
actual evidence: 4-5%
14
Q
therapy drift
A
they underperform, they dont provide patients with best treatment
because of this reality recovery percentage is around 30%
15
Q
best indicator of therapist drift
A
experience
the more experience the lower the clinical outcome
the recently graduated are unsure more and they look in manual more
16
Q
way to beat experience
A
keep learning as a therapist
17
Q
basic principles of behavioral therapy
A
interaction of person with his or her environment
Antecedents of Behavior
Behavior
Consequences
(ABC)
behavior is maintained by its consequences
18
Q
assessment of behavioral therapy (3)
A
intake evaluation: assessing problem behavior
registration of problem behavior and antecedents / consequences or thought records
functional analysis
19
Q
functional analysis - antecedents (3)
A
discriminative stimuli
establishing operations
s-delta
20
Q
discriminative stimuli
A
events or situations that elicit the behavior and predict reinforcement or punishment
a stimuli that reinforces a particular behavior
it must come first, then the behavior.
21
Q
establishing operations
A
factors changing the reinforcing or punishing properties of a stimulus or environmental event.
e.g. drinking water after eating salty food
salty food momentarily increases the reinforcing effectiveness of drinking water
22
Q
basic principles of cognitive therapy (5)
tbidc
A
thoughts give meaning to a neutral stimulus and determine feelings and behaviors
beliefs or schemas are developed through childhood experiences and form a filter
identify thoughts
distinguish between automatic thoughts, intermediate and core beliefs
challenge and change thoughts
23
Q
mindfulness based cognitive therapy
A
non judgmental observation of present experiences, thoughts are observed, meditation
24
Q
Beck’s model assumption for treating disorders
A
distorted and dysfunctional thinking influences mood and behavior and that such biased form of thinking are common in all psychological disorders
25
drapetomania
a mental disease given to black slaves who would run away from their masters to seek freedom
26
behavioral perspective assumption
there is nothing inherently defective or deviant about persons who report emotional or behavioral problems
27
what is regarded as psychopathology in behavioral perspective
problem in living
28
three term contingency and the ABC
refers to the interaction of the person with his environment and includes three elements:
- the occasion within which behavior occurs, (antecedents of behavior)
- the behavior itself, (behavior)
- and the consequences that follow the behavior (consequences)
29
behavior and its relationship with Darwinian evolutionary principles
behavior of an individual that is functional in particular environmental contexts is selected or made more likely, whereas behavior that is not functional is not selected or becomes extinguished.
30
environmental determinism
overarching process associated with the selection of variations in an individual's behavior during his or her lifetime and in cultural practices over successive generations
31
contextualism
concerned with the context within which behavior is embedded or the contextual flow in which behavior occurs
32
how do behavioral therapists view motivation
a state or condition resulting from environmental events (therefore it is modifiable, something that can be increased as a result of environmental manipulations
33
4 response domains of assessing a client's behavioral repertoire
overt motor behaviors (does avoidance occur)
thoughts and mental images (does the person have negative evaluations over the world)
emotions (does the client experience negative emotions excessively)
physiological sensations (does sweating come from a response pattern)
does avoidance occur?
does person have negative evaluation about world?
does client experience negative emotions excessively?
does sweating come from response pattern?
34
how is context evaluated in behavioral assessments of clients
4
ABC's
Client's learning history
Client's current behavioral repertoire (4 domains)
Client's motivation for change
35
two subtypes that account for behavior problems in alcoholism
1. characterized by persons who display anxious dependent traits, binge drinking vs continuous episodes, and avoidant coping styles (negative reinforcement)
2. early age of onset, continuous vs episodic binge drinking and engagement in aggressive or criminal behavior when intoxicated (positive reinforcement)
36
8 characteristics of behavioral interventions
- empirical orientation
- therapist - client collaboration
- active orientation
- flexible approach
- emphasis on environment-behavior relations
- time limited and present focus
- problem and learning focus
- emphasis on both change and acceptance processes
37
generalization
CRs often occurred in the presence of stimuli that resembled or were similar to the CS in some way
38
thorndike theory
referred to as law of effect: learning process and associated behaviors are influenced by the consequences that follow behavior
39
operant as defined by Skinner in operant theory of behavior
unit of behavior that operates on the environment by producing consequences
classical conditioning: stimulus event elicits a response (S --> R) but in operant conditioning, C (consequence) is emphasized R --> C
40
Mary Cover Jones
demonstrated that a child's fear of an animal could be decreased through counterconditioning methods. Early effort to apply learning theory to behavior change (1924)
41
cbt was kickstarted by...
not until the 1970s and 1980s where cbt gained momentum, kickstarted by bandura social learning theory
42
next generation of cbt
acceptance and commitment therapy, dialectical behavior therapy
they incorporate mindfulness and acceptance principles into therapy
greater emphasis on context in which behavior occurs
43
primary goal associated with behavioral assessments
identification of potentially modifiable contextual features associated with maintenance of problematic behavior
44
medical model approach goal
evaluate presence of behavioral and physiological markers indicative of a disease and make a positive diagnosis when enough key markers are evidence
different from behavioral approaches of assessment
45
3 goals of behavioral assessments
- a clarification of the nature of the client’s problems, and identification of associated target behaviors;
- an evaluation of the extent to which the client’s problems impair his or her functioning (e.g., in the areas of family life, social and occupational functioning, personal distress);
- the identification of factors that support and maintain problem areas;
46
6 distinguishing features of behavioral assessments and therapy
- level of analysis in behavioral assessment is the act in context, or the whole person in interaction with the environment
- recognition that each person lives in a unique context, assessment is tailored to the client's uniqueness
- behavior is viewed as situationally specific rather than cross situationally general
- limited inference is used in behavioral assessment, diagnostic labels generally avoided as explanations of behavior
- clients problem areas are clearly defined in behavioral terms
- emphasis in therapy is on the development of effective behavior and competencies
47
important steps for first few contact with client
provide realistic expectations, establish warm therapeutic relationship
48
3 methods to develop a collaborative therapist-client relationship
encourage client to be involved in all aspects of therapy, highlighting importance of clients goals,
using we statements --> convey the ideas that we are a team
49
case formulation
hypothesis about the causes, precipitants, and maintaining influences of a person's psychological, interpersonal, and behavioral problems
50
importance of listening for first 10 minutes without interrupting (3) (AKA free speech)
- allows client to freely describe problem
- conveys you are genuinely interested
- you can generate hypothesis
51
what happens after free speech (4)
probe further, identify manifestations of problem
the context within which they emerge
consequences that follow
look into history of problem
52
checklist data often useful in behavioral assessment because...
2
indicates frequency and severity of problem behavior
frequently suggest specific behavioral targets
53
what two broad categories to categorize problematic behaviors
behavioral excesses and behavioral deficits
54
behavioral excesses
when a person displays forms of behavior that are excessive in terms of frequency, intensity or duration
55
behavioral deficits
when persons do not demonstrate an adequate range of behavior in a variety of contexts, or do not display adequate flexibility when adjust behaviors in accordance with shifting circumstances
56
two reasons for behavioral deficits
1. past environments did not adequately model, shape, or reinforce such behaviors
2. absent behaviors have been learned at one time and are part of the person's repertoire
57
examples of coping skills targeted for strengthening within CBT (5)
problem solving skills, social skills, self-regulation skills, mindfulness skills and acceptance skills
58
what 3 types of individuals is acceptance helpful with?
for individuals who are
overly reactive,
highly sensitive
and impulsive.
59
3 reasons for evaluating degree of functional impairment associated with client's problems
1. degree and pervasiveness of impairment indicate the severity of the problem
2. level or nature of impairment can have relevance for the choice, course, or emphases of therapy interventions
3. psychological disorders are often defined by presence of behavioral patterns associated with subjective distress or impairment in social and occupational funcitoning
60
3 example questions for evaluating severity
Has this problem resulted in avoiding situations?
What difficulties has this problem caused you?
Have you had difficulty sleeping?
61
when assessing family and social situation , it is important to distinguish between what 4 factors?
1. avoidance tendencies
2. social skills deficits
3. suppression of social behavior by environment
4. low rate of positive reinforcement for social behavior
62
what areas should be assessed for impairements of functioning (7)
personal functioning
family and social relations
occupational and school functioning
legal difficulties or proceedings
health and medical status
current life situation and quality of life
suicide risk and other risks
63
example questions for establishing antecedents of target behaviors
what is happening right before the problem occurs?
64
example questions for evaluating associations that learning history or personal variables have with target behaviors
what was going on in your life then?
when did the problem first begin?
65
example questions for evaluating the consistency of problem behaviors with values or goals
how might life be like if this were not a problem for you?
66
two types of antecedents that set the occasion for behavior
discriminative stimuli
establishing operations
67
discriminative stimuli
events that provide information about likelihood that reinforcement or punishment will follow the engagement in some type of behavior.
e.g. upcoming social interaction, presence of alcohol
68
establishing operations (aka motivational operations)
references the influence that environmental events or conditions have on behavior by altering the reinforcing or punishing properties of other environmental events
e.g. withdrawal symptoms of alcohol abuse, drinking related rules (if i drink, I'll have more fun)
69
rule governed behavior
refers to those behaviors influenced by verbal rules that specify the operating contingencies associated with behavior.
e.g. If I speak (behavior) in front of a large audience (antecedent condition / context), I will be evaluated negatively and humiliated (consequence)
70
factors that increase or maintain behavior
positive reinforcement and negative reinforcement
71
positive reinforcement
occurs when behavior results in the application or provision of a reinforcing event, which increases the probability of the behavior in future similar situations
72
negative reinforcement
occurs when behavior results in the removal or termination of an aversive event or condition, which increase the probability of the behavior in future similar situations
73
abuse of reinforcers
when substance abuse is instrumental in producing pleasant or desirable consequences (euphoria), it is regarded as positively reinforced behavior
when substance abuse produces relief (escape) from aversive states, it is regarded as negatively reinforced behavior
74
two types of punishment
positive punishment and negative punishment
both decrease future likelihood of punished behavior under similar stimulus conditions
75
positive punishment
occurs when behavior results in the application or provision of an aversive event, which decreases probability of behavior in future situations
76
negative punishment
occurs when behavior results in the removal of a reinforcing event, which decreases probability of behavior in future situation
77
another type of process that results in elimination of behavior other than the two punishments
extinction: occurs when previously reinforced behavior reliably fails to produce reinforcing consequences. If it fails at reliably reinforcing behaviors, then the behavior will drop out over time
78
reinforcer
an operation that increases behavior frequency over time
79
punisher
an operation that decreases behavior over time
80
type of consequences in reinforcements, punishments and extinction
pos. reinforce: rewarding
neg. reinforce: relieving
extinction: frustrating
pos. punish: aversive
neg. punish: penalizing
81
two important considerations when examining consequences of behavior
1. definition of what constitutes a reinforcer or punisher is determined by the effect the consequence has on future behavior
2. whether consequences are short term or immediate vs long term or delayed
82
person variables
aka organismic variables
include biological characteristics of the individual and the effects of past learning
e.g. genetic predisposition, physical appearance, etc.
83
functional response classes
groups of behaviors that produce similar outcomes, even though they may assume several forms
e.g. self harm, phobic behavior, substance abuse, etc.
84
functional analysis example
discriminative stimuli (social interaction) + establishing operations (withdrawal symptoms) --> person variables (restricted coping skills) --> behaviors (consumption of alcohol)
--> reinforcing consequences (taste of alcohol) and aversive consequences (onset of withdrawal symptoms)
85
self-monitoring
assessment procedure in which client collects data on behaviors of interest as they occur within naturalistic settings
86
what can self-monitoring be useful in (3)
identifying antecedents that precede behaviors of interest, also provides insight into frequency of behaviors, also can provide info on which treatment was most useful in providing behavioral change
87
functional analysis
examines causes and consequences of behavior
the classic ABC can be used to collect information
88
functional analytic psychotherapy assumptions
therapeutic environment is a social context that has similarities to interpersonal situations that clients participate in outside of therapy
89
role play situations
a way for therapists to observe clients social behavior in simulated environment (a direct observation technique)
90
important things to address before closing initial interview
check if there is anything that is important to know, ask for further questions, any discomforts during sessions, also summarize main points of sessions
91
first 4 important steps initial interview
- Provide the client with a description of what to expect during the first few sessions, and work with the client to establish a warm and collaborative therapeutic relationship.
- Convey that CBT is an action-oriented therapy and that the
client will have an active role in making decisions about his
or her treatment and in carrying out therapy-related activities.
- Broadly assess the client’s functioning, including strengths and behavioral skills.
- Emphasize what the client does and describe relevant behaviors in behavioral terms.
92
middle 4 important steps initial interview
in brief:
- identify antecedents
- explore consequences of relevant behavior
- assess history of problem areas
- evaluate level of impairment associated with behavior
- Identify the circumstances or situations in which the client is more likely to engage in clinically relevant patterns of behavior.
- Explore the consequences that clinically relevant behavior
patterns often produce, with emphasis placed on the processes that account for the maintenance of these behaviors over time.
- Assess the history associated with the client’s problem areas; consider any biological conditions that might be associated with such behavior patterns.
- evaluate the level and pervasiveness of impairment associated with clinically relevant behaviors.
93
last 4 important steps initial interview
- Consider and implement methods for assessing behaviors of
clinical interest.
- Continue to develop, explore, and refine hypotheses concerning how clinically relevant behavior patterns might be related; that is, work toward the development of a case formulation.
- Inquire about the existence of other important areas that were
not discussed before closing the initial interview, explore the
client’s overall sense of the therapeutic process thus far, and
anticipate with the client what the next meeting or two might
cover
94
EST
empirically supported therapies
95
the EST approach is...
protocol driven and variable centered (i.e. on diagnosis or symptom presentation)
96
behavioral assessment vs EST approach
behavioral assessment is tailored to individual client
97
two phases to narrowing down client's problem areas
broadly surveying possible problem areas
transitioning from broad survey to focal assessments
98
techniques to broadly surveying possible problem areas
client's complaint, broadband questionnaires, diagnostic interviews
99
multi-problem clients often display some combination of:
(6)
bbdfep
behavioral excesses
behavioral deficits
difficulties in stimulus control
failures to display appropriate behavior in relevant contexts
excessively high or low performance standards
problems in self-regulation or control
100
second and third phase of narrowing down client's problem areas
second: focus narrows, end of this phase includes definition of clients problem area, a diagnosis, or some other means of classification
third: focus narrows further, goal of this phase is to identify specific target behaviors and design intervention strategies linked to assessment information
101
nomothetic principles
general principles
102
case formulation consists
identification of a set of problem areas and generation of hypotheses about factors associated with their development and maintenance
103
assumptions associated with behavioral formulations (3)
1. behavior and environmental context are not seen as parts to be analyzed separately, they are analyzed as a unit
2. distinguish development of a psychological condition, and the maintenance of the condition over time
3. problematic behavior indicates absence of alternative and effective behaviors in a person repertoire
104
EX/RP
exposure and ritual prevention
105
EX/RP teaches...
teaches an individual to approach, rather than avoid, fear-producing stimuli (exposure) coupled with the prevention of fear-neutralizing rituals (response prevention)
106
underlying cause of ocd is...
multifactorial, complex interaction between, genetic, physiological, and behavioral factors
107
two-factor model of fear
early learning model of ocd, proposes that when an individual is faced with a situation that elicits a physiological fear or anxiety state, an unconditioned behavioral to escape that state is initiated. If the action is successful in reducing anxiety, it is strengthened (negative reinforcement)
108
EX/RP is based on assumption that
if an individual is systematically exposed to stimuli that elicit obsessional thoughts and associated anxiety, and is prevented from escaping, the anxiety will diminish over time through process of extinction
109
EX/RP research effectiveness
60 to 90 percent effectiveness, 50 to 80 percent symptom reduction
110
Caroline primary OC symptoms
fear that she will cause harm to those around her by spreading bad energy or illness which will result in injury, harm or death to friends, family, etc in her proximity. Feelings of dust on hands and tongue
pathological sense of responsibility for preventing harm
111
Caroline rituals
flick her fingers to remove dust, closing hands to contain dust, praying to God to protect those around her, etc.
112
goal for Caroline
confront feared stimulus and deliberately elaborate or focus upon the fears in the moment, rather than to engage in attempts to stop obsessions and discomfort from occurring.
113
2 commandments of successful EX/RP
patients should
1. expect to feel uncomfortable
2. should not try to fight the discomfort
114
how many session will most patients respond well in
12 to 15 sessions, 60 to 90 minutes each
115
session 1 goals EX/RP
5
RPPTB
review of ocd symptoms
psychoeducation
present functional model of OCD and rationale for EX/RP
teach symptoms monitoring and rating (SUDS)
begin development of fear hierarchy
116
session 2 goals EX/RP
3
continue fear hierarchy
plan for exposure exercises
develop strategies for ritual prevention
117
session 3 - 12 goals EX/RP
4
bawa
begin in session therapist guided exposure tasks with response prevention
assign out of session homework
work through hierarchy
assess ocd symptoms periodically
118
session 13 - 15 goals EX/RP
3
conduct final exposures
take steps to promote generalization and maintenance
prepare for future challenges and create plan for relapse prevention
119
yale-brown obsessive compulsive scale (Y-BOCS)
gold standard instrument for assessing ocd symptoms in adults
120
what to do when patient is focused on cause of ocd
say that ocd is a neurobehavioral disorder whose causes are not yet fully understood
121
primary goal of ex/rp is
to help person understand how their rituals are currently maintained, not how they came to be in the first place
122
4 most important aspect of successful exposure are...
1. conduct exposure exercises that are manageable
2. refrain from all ritualistic behavior during that exposure
3. continue the exposure until it can be performed with relative ease both inside and outside of therapy sessions
4. conduct the exposure repeatedly
123
5 common reasons to noncompliance of treatment exercises
lack of motivation, disagreement, poor therapist-client match, moving too rapidly on hierarchy, comorbid conditions (depression, anxiety)
124
4 common barriers to treatment
1. noncompliance of exposure exercises
2. unintentional subtle avoidance
3. when patient's family members become involved in rituals
4. comorbid psychological disorders
125
reassurance seeking questions problem
unintentional subtle avoidance
when answering these questions, it reinforces OCD
common in ocd patients
answer the question by saying "Who is asking, you or OCD?"
126
caroline indicators of positive prognosis (3)
She is seeking treatment, has social support, and a symptoms profile amenable to EX/RP.
