Wk 2 - Behavioral Therapy Flashcards
What are the 3 main ideas of behavioral therapy?
1) Classical Conditioning
2) Operant Conditioning
3) Observational Learning
What is a key idea of operant conditioning?
Law of effect - the notion that a behavior is learned through its consequences
Describe one application of operant conditioning.
Token Economies
- systems of behavioral change in which an individual is awarded a token for performing a desired behavior. Tokens can then be exchanged for other desirable things (eg. snacks, toys, recreational time)
Applied Behavioral Analysis (ABA)
- uses principles of operant learning
Describe the 2 key principles of behavioral therapy:
1) Behavior (whether internal or external) is strengthened or weakened by its consequences.
- Behaviors that are rewarded increases, behaviors that are punished will decrease
- All behaviors have been shaped by reinforcement/punishment contingencies
2) Fundamental Drive - all humans behave in adaptation to the environemnt
Describe what is considered healthy and dysfunctional according to behavioral therapy.
Health: Doing what is considered ‘useful’ in the client’s context
Disorder: Dysfunctional behaviors, either excesses or deficits for that context
What is systematic desensitisation?
Reciprocal inhibition - Repeated pairing target feared stimulus with a calm state rather than an anxious state. Helps client to associate the threatening situation with calmness instead of anxiety.
What are the two methods of habituation?
1) repeated exposure
2) flooding
How does habituation work?
Repeatedly expose the client to feared stimulus, or do flooding, and wait for the emotions to come down. Helps to reduce anxiety or fear.
What is the difference between habituation and extinction.
Habituation is the process, extinction is the outcome
What are the 2 conditions rewards need to fulfill to be effective reinforcements?
1) need to be immediate
2) specific to individual
Name one powerful generalised reinforcer.
attention
If parents’ attention is reinforcing bad behavior, what should parents do instead?
Schedule time to give attention. This should be an agreement between parent and child.
How do you restore reward sensitivity due to satiation?
Fasting
- sensitivity to reward will diminish over time if you give the reward too often
How do you identify the trigger of certain behaviors?
Careful observation
ABCs
observe what happened juts before, and after the behavior. What was going through your mind.
Describe the extinction burst.
Behaviors will get worse before they get better. If you remove certain rewards, the behavior will get worse first. Child will up the ante to make you comply and be more persistent. But as a parent you should not give in. You should persist in saying no until behavior subsides.
How is social learning theory different from the other two types of behavioral theories?
it includes a cognitive learning aspect
What are the 2 concepts associated with social learning theory
1) Modelling
2) Observation
How is social learning theory relevant to anxiety?
Vicarious learning
- some people acquire anxiety towards an object when they observe someone being fearful of something
How can social learning theory be applicable to group work programmes?
If a client discovers a way to deal with the problem, others can learn from him/her
What is the assessment and case formulation of behavioral therapy like?
Functional Analysis
ABCs of specific behaviors
Can be done through observations, self-monitoring, carer monitoring
What does treatment in Behavioral Therapy look like? 3Cs
1) Counterconditioning
2) Contingency management (working on the ends of the ABC chain)
3) Cognitive-behavioral modification
How should you get clients to track their emotions?
1) explain clearly the rationale for tracking emotions
2) choose a few specific behaviors too track (not too many)
3) just track notable events and mood. don’t need every day.
4) should track both antecedents and consequences of behavior (immediate and long-term consequences)
5) problem solve possible challenges to monitoring (eg. set it at particular time everyday)
What are the 2 kinds of consequences should we get clients to track?
1) immediate consequences
2) long term consequences
if we are doing CBT, what should we be tracking?
tracking thoughts
What are the 5 techniques of behavioral therapy?
1) Graded exposure
2) Interoceptive exposure
3) Systematic Desensitization (Progressive Muscle Relaxation)
4) Assertiveness
5) Behavioral Activation
Describe the technique of graded exposure.
Create a fear hierarchy. start lowest on the hierarchy and slowly move up on the hierarchy once client is comfortable enough and has habituated enough (ie. ratings are about 4-5/10). If ratings are stuck at 9/10, you cannot proceed up the hierarchy, need to wait for clients to be habituated a bit more.
As a therapist, what should you tell clients who are trying to face their fears/anxieties in exposure?
Anxiety comes in waves. The wave of anxiety will peak but it will come down. Each time you are exposed to your fears, you are riding the wave. Each successive wave will get smaller and smaller if you face it. If you keep running away, your waves of anxiety will stay as high.
What will cognitive theorists say about exposure?
exposure helps client to learn self-efficacy (self-confidence). helps client to learn that her expectations are misplaced.
What are 2 ways in which exposure can be done?
1) in-vivo/ real life
2) imagination
Describe interoceptive exposure.
Induce an anxiety-provoking situation in the therapy room.
Eg. panic attacks - get them to hyperventilate in the room.
1) Get her to rate from 0 -10. Go up to 8 max so she won’t go into a total meltdown. Push the client as far as possible, but not to the point that they won’t turn up for the next session.
2) Get them to pay attention their sensations and notice it.
3) Response Prevention - Don’t let the person do protective behaviors and let the client be fully exposed to the fears.
When doing interoceptive exposure, what do you have to take note of as a therapist? (4)
1) if it’s inducing panic attacks, do your due diligence and rule out all physical health problems first!
2) try not to do flooding. we want to give clients early wins and successes. this will give them confidence to continue, and we don’t want them to drop out. graded exposure is better.
3) if you push clients too far over the edge, you have to apologise and own it.
4) notice your own fears of as a therapist. don’t let your own fears interfere with effectiveness of the therapy
Can all kinds of fears be treated with exposure therapy?
Maybe NOT if they have a trauma experience. May risk getting the person to have a flashback. In this case, do trauma-focused work first.
What are 2 possible challenges of using exposure technique in conquering fears/anxiety?
1) need to manage high levels of emotions in sessions. pre-empt it to client with good rapport and clear rationale.
2) risk of no shows is very real and client may end therapy prematurely
What is 1 way you can explain the behavioral therapy to the client?
Change in perspective technique. Get client to pretend to be therapist and help the therapist with a similar fear. Draw out the plan from clients and give the plan back to them.
Explain systematic desensitisation.
- Pairing exposure with a calming state rather than an anxious state.
- Progressive Muscle Relaxation: teach clients to tense and relax various muscle groups. after clients master this, they can then simply relax progressive muscle groupings without the tensing part.
- once client is calm, introduce feared stimuli.
- when clients experience anxiety during exposure, bring down the anxiety through muscle relaxation or calming imagery.
- move up the ladder when client is ready
When do you use the technique of assertiveness?
When the threat is another person. Used for people who are either overly passive (can’t speak their mind about what matters to them) or overly aggressive (can’t say positive affirming things about others)
Why is assertiveness a behavioral therapy?
Response substitution technique - Changing the response to change the outcome
How do you provide someone with assertiveness training?
Teach interpersonal skills - learning to relate effectively to people by not being overly passive or aggressive.
Practice using role plays and homework assignments
When is Behavioral Activation usually used.
Often with people with depression
Describe behavioral activation.
Getting clients to do activities to increase clients’ self-efficacy, and undo learnt helplessness.
Aim is to alter processes of:
- withdrawal being reinforced over time
- not reinforced enough for pleasurable, mastery, social activities.
What are 3 possible challenges of Behavioral Activation.
1) Plan is not followed through
2) Client is not convinced that it will be helpful
3) Client feels you are not listening to how hard it can be
If you have to use punishment, what are the 3 guidelines for use?
1) must be immediate and consistent (does not raise anxiety while waiting unnecessarily)
2) delivered in a calm and collected way (Avoid abuse)
eg. timeout, response cost (surrender smth reinforcing)
3) Explanation and demonstration of alternative behaviors
What are 4 key clinical applications of behavioral interventions?
1) DBT
2) ABA and Positive Behavioral Support (eg. ASD)
3) Parenting programmes - help parents understand the function of their child’s behavior. give parents behavioral modification skills for child’s behavioral problems.
4) functional family therapy - communication skills to alter interaction patterns at home. delinquent adolescents
What are some primary reinforcers?
food and sex
What are conditioned reinforcers?
positively reinforcing because they are associated with gaining desired outcomes. they are not the desired consequence itself. (eg. money, attention)
What are the 2 schedules of reinforcement?
Continuous reinforcement - given after every response
Intermittent reinforcement - given after some responses and not others. Behavior reinforced intermittently is extremely resisitant to extinction!!! whereas continuous schedules produce much less resistance
What is shaping?
A process of teaching a new desired behavior. After initial response is established, the therapist will only reinforce responses that move a step closer to the desired response. Responses that gradually more closely resemble the desired behavior are reinforced in progression. Modelling/demonstration of the behavior can be used.
Describe how anxiety can result from simple classical conditioning.
During a threatening situation, some stimulus in the situation is associated with the anxiety. After a while, the individual feels anxious when exposed to the stimulus.
eg. sound of gunfire in war can induce anxiety even in non-battle situation
Describe how anxiety can develop from vicarious conditioning.
Observing someone’s fear of a stimulus might result in the observer acquiring a fear of that stimulus.
Describe the possible assessment techniques used in behavioral therapy. (3)
1 )Functional Analysis
- ABCs
- Multiple target behaviors may be identified
- Create hypotheses about the conditions maintaining the target behavior
- Establish baseline of target behavior (ie. frequency count of target behavior)
2) direct observation across various life situations. self-monitoring to monitor frequency of a behavior.
3) informal assessment - structured interview.
What are some drawbacks of using punishment? (3)
1) punishment only suppresses behavior. such behavior is likely to reappear when the contingencies are no longer in effect
2) individual will just avoid punishment by avoiding the punisher. not effective
3) punishment can result in aversive emotional states (Eg. shame, anger, frustration, anxiety, depression)
What are some criticisms of behavioral theory? (4)
1) too cold-hearted and impersonal due to scientific approach. ignores the importance of emotion in human behavior
2) rights and freedom of clients
3) more applicable to discrete and narrowly define problems (eg. phobias) rather than more complex ones
4) neglect of client’s past. and the role of interpersonal relationships in the development and maintenance of psychological dysfunction.
What are some cultural advantages of behavioral therapy?
1) structured, therapist’ directiveness, de-emphasis on emotion, problem focused –> appeal to Asian clients
2) Emphasis on environmental factors may be less blaming for the client
What are a cultural criticism of BT?
Ignores sociopolitical context of client’s lives. who defines what is adaptive and maladaptive? emphasis on rational scientific approach is a reflection of Eurocentric values
