1
Skinner: Radical BehaviorismBandura, Ellis, Beck Meicheanbaum
Behavior and Cognitive Behavior Therapy
Compare -- Contrast Humanistic Theories
Person Centered-Existential-Gestalt
Common Themes List ways in which the three approaches are
similar
Distinct aspects each approach emphasizes Central focus of each approach Unique ideas, constructs, and/or techniques
each brought to counseling practice 2
Areas of Major Emphasis
Psychoanalytic/Psychodynamic Basic drives and the contribution of early
emotional experiences to the person’s presenting concern
Humanistic The therapeutic process -- the
relationship-- and emotional states in the here and now
Behavioral observable behaviors & learning
principles; congnitions3
4
Skinner: Radical Behaviorism
Placed primary emphasis on the role of the environment in producing behavior
Applied learning principles to psychology Experimental psychologist: examined learning
principles with rats in the laboratory Books
1948 Walden Two 1953 Science and Human Behavior 1971 Beyond Freedom and Dignity
5
Behavior/Cognitive Behavior Theory
Classical ConditioningOperant ConditioningSocial Learning ApproachCognitive Behavior Therapy
6
Classical Conditioning If you pair a conditioned stimulus to a natural
stimulus, after time, the conditioned stimulus produces the same response as the natural one: Learning by association
Pavlov discovery (1900)1. Meat (us) >> Salivation (ur)2. Bell (cs)>>Meat (us) >>Salivation (ur)3. Bell (cs) >> Salivation (cr)4. Bell (cs) >> Extinguished
response
7
Wolpe: 1950 Applied classical conditioning to treat anxiety by
pairing stimuli that cause anxiety (taking an exam) with a state of relaxation, to break the connection between the stimulus and the anxious response
Exam (us)>>>Anxiety (ur)Relaxation> Images Exam>Anxiety>Relaxation (cs) (us) (ur) (cr)
Images Exam (us) >>> Relaxation (cr)Exam (us) >>> Relaxation (cr)
8
Behavior Therapy: Learning by Association: Exposure Techniques
1. Systematic Desensitization - anxiety• Relaxation training/ Anxiety hierarchy• Pairing (+) stimulus with (–) stimulus (shot-
lollipop)
2. Aversive Counter Conditioning
3. Exposure Techniques• In vivo desensitization• Flooding (in vivo, imaginary)
Anxiety: Facilitating and Debilitating
9
10
Aversive Counter-Conditioning
11
Exposure Techniques
12
13
Operant Conditioning Behavior is controlled by its
consequences
Desired Consequences – Increase Behavior Reinforcement
No consequences - Decrease Beh.
Not-desired consequences - Decrease Beh. Punishment
14
Environmental Consequences
Reinforcement Increase a behavior Positive R Adds a pleasant consequence Negative R Takes away an aversive stimulus
Punishment Extinguish a behavior Positive P: Add an aversive consequence Negative P: Takes away a desired stimulus
Lack of consequence - Extinguish behavior
15
Applied Behavioral Analysis: Functional Assessment Model
Examine the antecedents and consequences of problem behaviors Conduct a functional assessment using interviews and
direct observations (e.g. keeping a diary) to identify Antecedents: conditions that contribute to the behavior of
interest Consequences: what happens after specific behavior occurs
Behavioral treatments are devised to replace problem behaviors with more adaptive behaviors using reinforcement and extinction strategies
16
Behavior Modification Program
Reinforcement Token economy
Extinction Time out, loose privileges, punishment
Stimulus control Change environmental antecedents of problem behaviors
17
Cognitive Behavior Therapy
Emphasizes cognitive processes and self-talk as mediators of behavior change
Reciprocal Determinism Bandura
Rational Emotive Therapy Ellis Cognitive Therapy Beck Cognitive Behavior Modification
Meichenbaum
18
Bandura: Social Learning Approach
Psychological functions involve a reciprocal interaction between:
Environment <><><> Behavior <> <> <> <>
<> Cognitive Process <>
Modeling Vicarious Learning
19
Cognitive-Behavior Techniques
1. Assertiveness Training1. Provide Information2. Examine beliefs and self-talk3. Role play assertive behaviors
Modeling – therapist demonstrates behavior
• Behavioral rehearsal – client demonstrates behavior
20
Cognitive-Behavior Techniques
2. Steps: Self-Management Program
1. Identify goal in behavioral terms
2. Behavioral assessment environmental and cognitive contingencies
3. Plan for change
4. Self-Monitoring and Self-Reinforcement Behaviors, thoughts, self-talk
5. Evaluation of action plan - results 21
22
Cognitive Behavior Theory Mental disorder- problem with thinking in which
a client distorts reality, including: Specific misconceptions Unrealistic expectations Maladaptive attributions
Therapy’ aim is to identify and change Faulty patterns of thinking Faulty premises and attitudes
Distressing emotions result from
maladaptive thinking
23
Rational Emotive Behavior Therapy: (REBT) Albert Ellis
Stresses thinking, judging, deciding, analyzing, and doing
Assumes that cognitions, emotions, and behaviors affect ach other
Is highly didactic, directive,
Emotions stem mainly from our beliefs, evaluations and interpretations
24
RET: The ABC Theory
25
RET: Therapy Process
Therapy is seen as an educational process
Clients learn: To identify and dispute irrational beliefs To replace ineffective ways of thinking
with effective and rational cognitions To stop absolutistic thinking, blaming,
and repeating false beliefs
RET: Therapy Process
Rational Emotive Imagery Imagine being in the worst situation- train
to change irrational thoughts/feelings for retional ones
Homework REBT Self-Help Form Act as if… to challenge self-limiting
Biblio-therapy – Psycho-education
26
27
Aaron Beck’s CT: Human Nature
Cognitive structures or schemas We all have implicit assumptions or premises that
influence what we attend to and how we interpret events
Confirmatory bias We tend to electively attend to events that confirm our
beliefs
Schemas and Disorders Anxiety Threat and Danger Depression Social rejection and failure
28
Cognitive Therapy (CT)
Insight-focused therapy Emphasizes changing negative thoughts and
maladaptive beliefs Theoretical Assumptions
People’s internal communication is accessible to introspection
Clients’ beliefs have highly personal meanings These meanings can be discovered by the client
rather than taught by the therapist
29
CT’s Cognitive Distortions
1. Arbitrary inferences2. Selective abstraction3. Overgeneralization4. Magnification and minimization5. Personalization6. Labeling and mislabeling7. Polarized thinking
CT’s Cognitive Distortions
Arbitrary inferences
• Gloria: relationships with the eligible men do not work out because she feels anxious and acts flippantly
Selective abstraction
• Focuses on only on one aspect of a situation: typically a negative aspect-
Overgeneralization
• This relationship did not work, no relationship will ever work
Magnification and minimization
• Emphasize negatives and minimize positives
30
CT’s Cognitive Distortions
Presonalization
• A mother blames herself for child’s problems
• A man blames himself for partner's lack of interest in the relationship
Labeling and mislabeling
Type of generalization:•I made a mistake vs. I am a looser
Polarized thinking •Either co-workers praise me or they hate me•Gloria: Men are either eligible or “icky”
31
32
Therapy Process
Teach clients to recognize, observe and monitor negative "automatic" thoughts &
Subject their automatic thoughts to reality testing: examine evidence for and against them
Clients learn to substitute realistic and accurate interpretations for biased cognitions
Process is collaborative an interactive: Socratic dialogue
33
Beck’s Approach to Depression: Cognitive Triad
1. Have a negative view of themselves; attribute setbacks to themselves w/o looking at the environment
2. Tend to interpret experiences in a negative manner.
• Screen out positive experiences not consistent with negative view of themselves (selective abstraction)
3. Gloomy vision and projections about the future
34
Ellis Vs. Beck
Ellis is more directional and confrontational in pointing out and refuting irrational thoughts
Beck helps clients discover their distorted patterns of thinking Collaborative empiricism Guided discovery
client and therapist examine and evaluate beliefs and modify and correct client’s misconceptions
35
Contributions Beh- Cog Beh
Focus on short-term behavioral goals
Emphasis on evaluation of therapy outcome
Empirical evidence of positive results
36
Limitations
May lead to symptom substitution Too much therapist power and control
Lack of attention to relationship issues
No processing of emotions and feelings Focus only on cognitive issues
37
Meichenbaum: Cognitive Behavior Modification
Is primarily a self-instructional therapy that Focuses on helping clients become aware of their self-
talk, - cognitive restructuring - and acquire practical coping skills to deal with problems
and behaviors Process of Change
1. Self observation
2. Start a new internal dialogue
3. Learn new behaviors
Phase 1: Self-Observation
Observe thoughts, feelings, actions, Realize how client contributes to own
problems Leads to new cognitive structures – see
problems in a new light
Phase 2: Start New Internal Dialogue
Identify maladaptive behaviors Recognize more adaptive options Develop adaptive internal dialogue
to guide behaviors New behaviors impact cognitive
structures
Phase 3: New Skills
Teaches more effective coping skills Practice in real- life situations Continue monitoring/changing internal
dialogue Observe behaviors Assess outcomes
41
Coping Skills Program:Stress Inoculation
Stress management techniques for present and future problems
Three phases: 1. Conceptual phase
2. Skills acquisition and rehearsal
3. Application and follow-through
42
Conceptual Phase Collaborative relationship (Rogers) Didactic presentation of the role cognitions and
emotions play in stress (Ellis) Guided discovery to identify own self-talk and
how it creates stress (Beck) Systematic observation and monitoring of
maladaptive behaviors and their related self-talk (Behavioral)
New cognitive structures = see problems in a new light (Beck)
43
Skills Acquisition and Rehearsal
Give clients behavioral and cognitive coping techniques to apply to stressful situations Rehearse new self-statements Relaxation training Social skills training Time management instruction Making changes in everyday life
44
Application and Follow-Through
Arrange for transfer and maintenance of change from therapy to the real world Homework assignments of increasing complexity Results of assignments are carefully evaluated
Follow-up and booster sessions are scheduled in 3-, 6-, and 12 months intervals
45
Contributions
Focus on short-term behavioral goals
Emphasis on evaluation of therapy outcome
Empirical evidence of positive results
46
Limitations
May lead to symptom substitution Too much therapist power and control
Lack of attention to relationship issues
No processing of emotions and feelings Focus only on cognitive issues
Multimodal Therapy: Lazarus
Holistic approach to behavior modificationTechnical eclecticismHuman experience
interplay of genetics, environment and social learning
can be accounted by examining the BASIC ID
BASIC ID
Framework for assessment and therapy B – behavior A – affective processes S – sensation- five senses I – imagery C – cognition I – interpersonal relations D – physiological aspects - health
Therapy Process
Therapy is guided by what is best for the client Starts with a thorough assessment of the BASIC
ID profile BASIC ID determines the tone or quality of the
person’s functioning Therapist functions as trainer, educators,
consultant, role model Emphasize skill learning
New Applications and Integrations (end of Behavior Chapter #9)
Mindfulness and Acceptance- Based Cognitive Therapies: Emotional Regulation Dialectical – Behavior Therapy (DBT)
Combines CBT and Psychodynamic Highly structured- requires training - Borderline PD Minimum 1-year of frequent outpatient treatment
Mindfulness-Based Stress Reduction (MBSR) Mindfulness-Based Cognitive Therapy (MBCT) Acceptance and Commitment Therapy (ACT)
50
Mindfulness and Acceptance Mindfulness
How to live more fully in the present (Ext) Interventions: yoga, meditation Experiential learning and self-discovery (Ext-
Gestalt -Rogers) Practice – In session and home-work
Acceptance (rather than challenge cognitions) change awareness of and relation to
negative thoughts (Ext) acceptance (nonjudgmental awareness) of
cognitions (Rogers)51