Week 2 Flashcards
1
Q
excitatory learning brain area
A
amygdala
2
Q
classical conditioning and PTSD example
A
conditioned stimulus –> unconditioned stimulus –> conditioned response
PTSD example: CS (car) –> US (car crash) –> CR (sense of threat or danger)
3
Q
PTSD patients and excitatory learning
A
failure to extinguish or inhibit the excitatory fear association
4
Q
delayed extinction learning before deployment predicted…
A
more ptsd complaints after deployment
5
Q
extinction learning
A
disappearance of behavior that is learned by association with an event
6
Q
theory behind exposure therapy
A
habituation hypothesis: anxiety levels will decrease with more exposure to stimulus
7
Q
Prof. Michelle perspective on what is central to extinction of response
A
inhibitory learning is central to extinction
8
Q
4 different ways in practicing exposure therapy
A
gradual exposure vs. flooding (immediately going to the worst step ever)
working via hierarchy vs variable practice
overexposure
allowance or removal of safety signals (good to not have them though)
9
Q
first 5 elements of case formulation
A
- problem list (behavior patterns)
- precipitants and activating situations
- hypothesized origins
- working hypothesis
- sharing and exploring formulation with the client
10
Q
last 4 elements of case formulation
A
- treatment plan
- establishing motivation for change and securing a commitment for action
- potential obstacles to effective therapy
- procedures for evaluating effectiveness of therapy
11
Q
When verbal rules function as an antecedent of behavior, such behavior is…
A
rule-governed (if i make myself vomit, I won’t get fat)
12
Q
self-efficacy and outcome expectations
A
self-efficacy: set of beliefs about ones ability to perform certain behaviors
outcome: refers to persons estimate that a given behavior will result in certain outcomes
13
Q
in social cognitive theory, positive outcome expectations function as…
A
incentives for behavior
while negative outcomes are disincentives
14
Q
hypothesized origins
A
refers to person variables, it is ones biological characteristics and learning history as related to the primary problem areas
15
Q
working hypothesis
A
seeks to explain function of problematic behavior for the individual and to specify the forms of problematic behavior that share similar functions
it is the heart of case formulation
16
Q
behavioral assessments within CBT tend to be idiographic, or…
A
idiographic, or centered on individual and his uniqueness
17
Q
4 tasks for therapist to communicate formulation to the client
A
- presenting formulation in an open and collaborative manner
- distinguishing the client from the problem
- using effective communication strategies
- dealing effectively with the issue of diagnosis
18
Q
what diagnosis is not appropriate to share
A
personality disorders, because of stigma and conceptual and psychometric difficulties associated with the concepts
19
Q
questions that can help client identify goals
A
how will you know when you have solved this problem?
what will you do differently once this problem is solved
20
Q
steps to develop a collaborative plan for therapy
A
- reaching consensus on the goals of therapy
- prioritize problem areas
21
Q
3 classes of Linehan’s stage 1 treatment targets
A
- life-threatening behaviors (suicidal behaviors)
- therapy-interfering behaviors (gazing at clock frequently, etc.)
- quality-of-life interfering behaviors (substance abuse, unprotected sexual behavior, financial problems, etc)
22
Q
contingency management strategies involve…
A
involves altering environmental conditions that occur before (antecedents) or after (consequences) behaviors of clinical interest
23
Q
behavioral contingency
A
central concept associated with contingency management
relationship between events that occasion a behavior, the behavior itself, and consequences that behavior produces
24
Q
a behavior is under stimulus control when it…
A
reliably occurs in the presence of a particular stimulus but not its stimulus
25
2 assumptions of contingency management interventions
target behavior in question is under the influence of direct-acting environmental antecedents or consequences
client has the targeted behaviors within his behavioral repertoire
26
3 steps of applying contingency management interventions
1. specifying and defining target behaviors and relevant contextual factors
2. orienting the client to contingency management
3. monitoring and attending to target behaviors
27
target behavior should be...
3
clearly defined, directly observable, and can be recorded or monitored
28
methods to change behavior by altering antecedents
remove or avoid antecedents (cue elimination)
modifying antecedents
introducing stimulus cues to alter frequency of behavior
discrimination training
arranging establishing operations to decrease / increase behavior
altering consequences to influence behavior
29
burning bridges
a dialectical behavior therapy strategy for substance abusers
involves client cutting off his or her contact with drug users and drug dealers, reducing stimuli signaling
30
approach to removing antecedents
cue elimination (good for addicts)
31
modifying antecedents strategy example
instead of having a jar of cookies, have a jar of fruits
32
introducing stimulus cues to alter frequency of behavior
examples
Rachel struggles with depression and has difficulty getting out of bed in morning. She put an alarm across her room so she would need to get up physically to turn it off.
33
discrimination training
delivery of reinforcers or punishers for behavior in a given stimulus situation but not in other stimulus situations.
you have trained your dog to jump in the air whenever you say the command, "Jump!" In this instance, discrimination refers to your dog's ability to distinguish between the command for jumping and similar commands such as sit, stay, or speak
34
when discrimination training is successful...
individual learns to discriminate between situations in which certain behavior is appropriate or not appropriate. Client will more likely attend to relevant cues (SD) in a given situation and ignore irrelevant cues (S^)
35
S^
denotes a discriminative stimulus that signals unavailability of reinforcement or punishment for a particular behavior.
36
discrimination training and anxiety disorder
helps client learn to only engage in avoidance behavior in present of cues that signal actual threat or danger (SD) and ignore irrelevant cues.
37
stimulus generalization
occurs when behavior that has been reinforced in one context increases in frequency or intensity in other contexts in which behavior has not been previously reinforced.
38
discrimination training most appropriate when clients problem behaviors result from...
inappropriate stimulus generalization (e.g. PTSD - generalization of trauma associations to cues that were previously neutral)
39
arranging establishing operations examples
3
avoid grocery shopping on an empty stomach to avoid purchasing junk food
methadone to decrease heroin use (suppresses withdrawal symptoms)
satiation therapy
40
satiation therapy
aka oversatiation therapy
delivery of more reinforcers than is optimal or preferred, this might make behavior less desirable
41
strategy to reduce behavior maintained by positive reinforcement
noncontingent
42
noncontingent
means that reinforcers are delivered on the basis of the passage of time and are independent of displays of the target behavior
43
reinforcement is idiographic
what does this mean
what is reinforcing to one client may not be reinforcing and indeed may be punishing to another client
44
types of reinforcement schedules (since scheduling of reinforcement influences extent to which it increases future behavior)
continuous schedule (involves providing reinforcement (praises client) after each instance of a particular behavior)
variable ratio schedule (provides reinforcement after a varying number of responses)
45
continuous vs variable ratio schedules
continuous most effective at helping client learn new behavior
46
two ways for using contingency management strategies
1. use consequences within the therapeutic relationship
2. set up formal or informal reinforcement, extinction, or punishment systems, or assist the client in doing so.
47
behavioral interventions that use reinforcers to develop, increase, or strengthen behavior
shaping and modifying reinforcement contingencies
48
shaping
involves the reinforcement of successive approximations to a final desired response
generally used to develop a skill or establish a behavior not in persons repertoire.
49
paraphernalia
equipment needed for a particular activity
50
matching law
frequency, intensity and time that an individual spends engaging in a particular behavior is directly proportional to the reinforcement value of the behavior
51
premacking
an approach for increasing low-rate behaviors
makes engagement in high frequency behaviors contingent on engagement in the low-frequency behaviors targeted to be increased
you can only use smartphone only if you have gone for a walk
52
functional analyses of problem behavior will often...
identify reinforcers that support the behavior
53
differential reinforcement of other behavior (DRO)
delivered when target behavior does not occur within a specified interval
therapist and client determine how long client must go without engaging in target behavior to obtain the reinforcement
54
differential reinforcement of alternative behavior (DRA)
delivered after display of an alternative behavior that is functionally similar to target behavior but different in topography (form)
client and therapist need to agree on the alternative behavior or acceptable range of behavioral alternatives
55
examples of reinforcement contingencies that might accompany extinction procedures
2
DRO (differential reinforcement of other behavior)
DRA (differential reinforcement of alternative behavior)
56
extinction burst
side effect of extinction procedures
undesired target behavior sometimes temporarily increases in frequency or intensity after positive reinforcement is shown
57
positive punishment procedures in CBT
infrequently used in CBT, they are abandoned because of their equivocal effectiveness and a host of negative effects such as dehumanization of client, mistrust in therapist, impracticality, etc
58
covert sensitization
positive punishment procedure method, used to reduce behavioral excesses
therapist instructs client to imagine participating in the target behavior, then asks to imagine co-occurrence of some type of aversive event (nauseous).
59
negative punishment in cbt
and its AKA
only used punishment procedure in cbt
described as response cost interventions
60
example of response cost interventions
fines, speeding ticket, time out
61
self-management strategies
when a person engages in a behavior or set of behaviors to infleunce occurrence of another behavior
62
behavioral contracting
method for formalizing agreements reached between a client and therapist concerning the client's behavior (e.g. if she practices anger skills 3 times a week, she can buy herself a gift)
63
3 categories habit behaviors fall into
nervous habits, motor or vocal tics, and stuttering
64
treating habit disorders methods
2
awareness training
competing response training
65
competing response training
instruction in ways to immediately stop target behavior as soon as client is aware that it is hapepning and is followed by performing an alternative behavior
66
counter-conditioning
animal example
involves substitution of an adaptive alternative response (relaxation) for a maladaptive response (excessive anxiety)
For example, the dog that lunges at the window when a delivery person walks by is displaying an emotional response of fear or anxiety. Classical counter-conditioning would be accomplished by pairing the sight, sounds and approach of the delivery person with one of the dog’s favored rewards to change the emotional state to one that is calm and positive.
67
systematic desensitization
involves presentation of progressively more anxiety provoking stimuli in imagination while the client is relaxed
68
interoceptive exposure
exposure to feared bodily sensations
69
operant behaviors
escape and avoidance, this leaves the original CS-US pairing intact
70
Emotional processing theory (EPT)
fear is represented as a memory structure that involves stimuli, responses, and cognitive meaning elements.
This memory structure functions to help people escape danger.
71
how exposure works in terms of EPT
repeated exposures over time theoretically allow for the client’s integration of new, non–fear-related memories, resulting in the meaning elements related to the client’s fear becoming divorced from the stimuli that previously elicited them
72
Modern learning theory explanations of how exposure therapy works have emphasized...
inhibitory learning processes and the development of new
learned associations with feared stimuli
facilitates the development of new associations of the CS with alternative stimuli through inhibitory learning processes.
73
inhibitory learning
involves acquiring competing and nonthreatening associations in which the CS also predicts the nonoccurrence of threatening events and a variety of nonthreatening outcomes
client afraid of spiders will find out that holding them will result in nonthreatening actions, they just crawl around.
74
can exposure interventions be used in anger?
when anger is related to perceived threat, it is appropriate.
e.g. person has road rage to avoid being late, being late is the threat,
75
using functional analysis to guide exposure therapy
3 steps
- assessment of clinical problem areas to determine if exposure should be considered
- examination of client's emotional reactions of fear response
- clarification of avoidance-escape or safety behaviors as well as potential reinforcers associated with such behaviors
76
5 types of exposure interventions
a. imaginal exposure
b. vivo exposure
c. informal exposure
d. interoceptive exposure
e. cue exposure
77
when to use imaginal exposure
(3)
a. when it is either difficult to expose the client to relevant stimuli in real life
b. when flexibility of client's or therapists imagination is useful in concocting effective scenarios that trigger emotional responses
c. as a precursor for in vivo exposure
78
prolonged exposure (PE)
a form of imaginal exposure, used in PTSD, therapist asks client to imagine and recount a specific traumatic event in considerable detail
79
which exposure to use for the client with:
Fear of particular events,
people, places, animals, or objects, often
related to PTSD, OCD,
specific phobias, social
anxiety disorder, among
other problems
vivo exposure
to the
feared and avoided
events, people, places,
animals, or objects, and
prevention of the avoidance response
80
which exposure to use for the client with:
Fear or other emotional
responses to situations
that are not readily
reproducible in “real life”
or fear of recollections
of trauma (e.g., as in
PTSD)
imaginal exposure - to the situation or recollections in the client’s imagination
81
which exposure to use for client with:
Suppressing or avoiding
an emotional response
in session
informal exposure - to the emotion or topic that is avoided or suppressed
82
which exposure to use for client with:
maladaptive emotional
responses, including
but not limited to fear
or anxiety (e.g., shame,
envy, anger, irritation,
sadness)
Opposite action, which
involves exposure to the
emotion-eliciting stimuli,
in combination with acting in a manner opposite
to the action urge related
to the emotion
83
which exposure to use for client with:
drug or alcohol use, urges or cravings to use drugs or alcohol
cue exposure to drug or
alcohol use cues
84
which exposure to use for client with:
fear and avoidance of specific bodily sensations
Interoceptive exposure
to the specific bodily
sensations, by engaging
in activities that produce those sensations
(e.g., spinning for fear of
dizziness; exercise for
elevated heart rate or
sweatiness; staring in a
mirror for depersonalization; breathing quickly for
hyperventilation
85
vivo exposure
involves exposing client to emotionally evocative stimuli in real life
86
informal exposure
involves therapist exposing the client to stimuli that elicit emotional responses in an ad hoc manner during therapy sessions (ad hoc = when necessary)
87
interoceptive exposure
involves client encountering particular feared bodily sensations
88
cue exposure (CE)
CE involves therapist presenting substance-related cues to client, but client consumption of substance is blocked
CS (drug cues) is not paired to UCS (drug use)
89
opposite action
involves acting in a manner that is opposite to urge that accompanies a particular emotion.
90
5 important considerations for exposure therapy
eermg
- effective pacing and scheduling of exposure interventions
- eliminating safety signals
- response (or ritual) prevention
- monitoring SUDS ratings
- give client control over exposure
91
pacing of exposure (2 types)
gradual exposure
flooding
92
safety signals
stimuli that, when present, signal to the individual that feared outcomes are unlikely to occur. Important to not have these.
93
response (or ritual) prevention
involves blocking behaviors that are associated with escape from or avoidance of feared stimuli. Common for OCD
94
SUDS
rating of client's distress level of exposure
