Wk 2 - Behavioral Therapy

Question 1

What are the 3 main ideas of behavioral therapy?

Answer 1

1) Classical Conditioning
2) Operant Conditioning
3) Observational Learning

Question 2

What is a key idea of operant conditioning?

Answer 2

Law of effect - the notion that a behavior is learned through its consequences

Question 3

Describe one application of operant conditioning.

Answer 3

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

Question 4

Describe the 2 key principles of behavioral therapy:

Answer 4

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

Question 5

Describe what is considered healthy and dysfunctional according to behavioral therapy.

Answer 5

Health: Doing what is considered ‘useful’ in the client’s context
Disorder: Dysfunctional behaviors, either excesses or deficits for that context

Question 6

What is systematic desensitisation?

Answer 6

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.

Question 7

What are the two methods of habituation?

Answer 7

1) repeated exposure

2) flooding

Question 8

How does habituation work?

Answer 8

Repeatedly expose the client to feared stimulus, or do flooding, and wait for the emotions to come down. Helps to reduce anxiety or fear.

Question 9

What is the difference between habituation and extinction.

Answer 9

Habituation is the process, extinction is the outcome

Question 10

What are the 2 conditions rewards need to fulfill to be effective reinforcements?

Answer 10

1) need to be immediate

2) specific to individual

Question 11

Name one powerful generalised reinforcer.

Answer 11

attention

Question 12

If parents’ attention is reinforcing bad behavior, what should parents do instead?

Answer 12

Schedule time to give attention. This should be an agreement between parent and child.

Question 13

How do you restore reward sensitivity due to satiation?

Answer 13

Fasting

- sensitivity to reward will diminish over time if you give the reward too often

Question 14

How do you identify the trigger of certain behaviors?

Answer 14

Careful observation
ABCs
observe what happened juts before, and after the behavior. What was going through your mind.

Question 15

Describe the extinction burst.

Answer 15

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.

Question 16

How is social learning theory different from the other two types of behavioral theories?

Answer 16

it includes a cognitive learning aspect

Question 17

What are the 2 concepts associated with social learning theory

Answer 17

1) Modelling

2) Observation

Question 18

How is social learning theory relevant to anxiety?

Answer 18

Vicarious learning

- some people acquire anxiety towards an object when they observe someone being fearful of something

Question 19

How can social learning theory be applicable to group work programmes?

Answer 19

If a client discovers a way to deal with the problem, others can learn from him/her

Question 20

What is the assessment and case formulation of behavioral therapy like?

Answer 20

Functional Analysis
ABCs of specific behaviors

Can be done through observations, self-monitoring, carer monitoring

Question 21

What does treatment in Behavioral Therapy look like? 3Cs

Answer 21

1) Counterconditioning
2) Contingency management (working on the ends of the ABC chain)
3) Cognitive-behavioral modification

Question 22

How should you get clients to track their emotions?

Answer 22

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)

Question 23

What are the 2 kinds of consequences should we get clients to track?

Answer 23

1) immediate consequences

2) long term consequences

Question 24

if we are doing CBT, what should we be tracking?

Answer 24

tracking thoughts

Question 25

What are the 5 techniques of behavioral therapy?

Answer 25

1) Graded exposure
2) Interoceptive exposure
3) Systematic Desensitization (Progressive Muscle Relaxation)
4) Assertiveness
5) Behavioral Activation

Question 26

Describe the technique of graded exposure.

Answer 26

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.

Question 27

As a therapist, what should you tell clients who are trying to face their fears/anxieties in exposure?

Answer 27

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.

Question 28

What will cognitive theorists say about exposure?

Answer 28

exposure helps client to learn self-efficacy (self-confidence). helps client to learn that her expectations are misplaced.

Question 29

What are 2 ways in which exposure can be done?

Answer 29

1) in-vivo/ real life

2) imagination

Question 30

Describe interoceptive exposure.

Answer 30

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.

Question 31

When doing interoceptive exposure, what do you have to take note of as a therapist? (4)

Answer 31

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

Question 32

Can all kinds of fears be treated with exposure therapy?

Answer 32

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.

Question 33

What are 2 possible challenges of using exposure technique in conquering fears/anxiety?

Answer 33

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

Question 34

What is 1 way you can explain the behavioral therapy to the client?

Answer 34

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.

Question 35

Explain systematic desensitisation.

Answer 35

• 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

Question 36

When do you use the technique of assertiveness?

Answer 36

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)

Question 37

Why is assertiveness a behavioral therapy?

Answer 37

Response substitution technique - Changing the response to change the outcome

Question 38

How do you provide someone with assertiveness training?

Answer 38

Teach interpersonal skills - learning to relate effectively to people by not being overly passive or aggressive.
Practice using role plays and homework assignments

Question 39

When is Behavioral Activation usually used.

Answer 39

Often with people with depression

Question 40

Describe behavioral activation.

Answer 40

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.

Question 41

What are 3 possible challenges of Behavioral Activation.

Answer 41

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

Question 42

If you have to use punishment, what are the 3 guidelines for use?

Answer 42

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

Question 43

What are 4 key clinical applications of behavioral interventions?

Answer 43

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

Question 44

What are some primary reinforcers?

Answer 44

food and sex

Question 45

What are conditioned reinforcers?

Answer 45

positively reinforcing because they are associated with gaining desired outcomes. they are not the desired consequence itself. (eg. money, attention)

Question 46

What are the 2 schedules of reinforcement?

Answer 46

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

Question 47

What is shaping?

Answer 47

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.

Question 48

Describe how anxiety can result from simple classical conditioning.

Answer 48

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

Question 49

Describe how anxiety can develop from vicarious conditioning.

Answer 49

Observing someone’s fear of a stimulus might result in the observer acquiring a fear of that stimulus.

Question 50

Describe the possible assessment techniques used in behavioral therapy. (3)

Answer 50

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.

Question 51

What are some drawbacks of using punishment? (3)

Answer 51

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)

Question 52

What are some criticisms of behavioral theory? (4)

Answer 52

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.

Question 53

What are some cultural advantages of behavioral therapy?

Answer 53

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

Question 54

What are a cultural criticism of BT?

Answer 54

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