501- Principles of Cognitive and Behavioral Change

Question 1

Acceptance and commitment therapy

Answer 1

3rd generation behavioral therapy developed by Steven Hayes. Says that psychopathology comes from experiential avoidance and cognitive fusion. Paradoxically the process of avoiding yields more distress. The primary goal of ACT is to create psychological flexibility in clients. This is done through acceptance and mindfulness skills and commitment and behavior change skills. Six Therapeutic Components:* Be here now: Making contact with the present moment.* Defusion: Separating/detaching from private thoughts; holding on to thoughts lightly, not tightly.* Acceptance: Opening up and making room for all experiences, including so-called unpleasant ones* Self-as-context: The observing self determines context and is the entity through which awareness happens.* Values: The goals you desire and the activities/beliefs that matter to you.* Committed action: Doing what you need to do to move toward and live by your values. Clinical Example: A patient presents with symptoms of depression and chronic pain. The pain they live with is due to an autoimmune disorder with no cure. The depressive symptoms seem to stem from the patient’s inability to change her disorder and the pain that accompanies it. The therapist recommends ACT to help the patient shift her expectations about living pain free, to living as well as she can in accordance with her values while accepting her pain and disorder.

Question 2

Ambivalence

Answer 2

A state of having mixed feelings about something including seeing reasons to changes and reasons not to. It involves both wanting and not wanting to change which is not compatible. It derives from cognitive dissonance theory and motivational interviewing helps resolve dissonance. It is important to know to help conceptualize a client’s behavior as a therapist.

Clinical examples:
Want to stop drinking but also want to continue to drink.

Question 3

Anxiety/fear hierarchy

Answer 3

Used in exposure therapy, a fear hierarchy is a breakdown of a person’s feared stimuli into components, ordered in terms of how much subjective distress they produce (SUDs). The client is led through either imaginal or in vivo exposure to each item on the hierarchy, starting with the least distressing, until they are able to tolerate the discomfort. It is important because it is one of the key components in exposure therapy.
EXAMPLE: a soldier suffering from PTSD (Post Traumatic Stress Disorder) is now terrified by guns. Even a picture of a gun can elicit a fear response in the soldier. Handling a gun could cause a serious fear response. In this case, the soldier could choose looking at pictures of guns as the least intense fear for his anxiety hierarchy, and holding or shooting a gun could be the most intense fear for his anxiety hierarchy.

Question 4

Assets

Answer 4

In ABCPA behavioral assessment/analysis model, assets are the skills or strengths an individual has that may prove useful during the therapeutic process. It is helpful for a counselor to be able to identify because it can be used to reach client success and goals. Clinical example: You have a client that is struggling with debilitating social anxiety. He comes in because he is worried about going off to college next year; he frequently skips class now and knows that this will become a problem. During the assessment you’ve uncovered the fact that he has a very strong commitment to learning. This is an asset of his that you plan on using to help overcome some of his class skipping behaviors.

Question 5

Automatic thought

Answer 5

According to Beck’s Cognitive therapy, automatic thoughts are conditioned ideas that arise quickly and spontaneously in response to particular stimuli.* Can include cognitive distortions such as dichotomous thinking, personalization, emotional reasoning, etc.* Can be maladaptive and persistent - need to be challenged * In Beck’s cognitive therapy, pt and therapist monitor, identify, and categorize dysfunctional automatic thoughts; pt taught to consider automatic thoughts as hypotheses to be tested. * Downward arrow technique explores underlying assumptions and schemas related to automatic thoughts Clinical example: Your client is upset because Bob, the new co-worker, won’t talk to her. She states it is because she is worthless and no one likes her. As a therapist conducting Beck’s cognitive therapy , you would view this is an automatic thought riddled with absolute thinking and jumping to conclusions. Your next step might be utilizing the downward arrow technique to get at the deeper schema/core belief.

Question 6

Behavior activation therapy

Answer 6

Developed by Lewinsohn, behavioral activation stems from a behavioral model of depression which conceptualized depression as a lack of positive reinforcement from a client’s avoidance behaviors. It involves clients scheduling particular activities that are positively reinforcing, such as seeing a friend or going for a walk, and that engaging in those behaviors may lead to positive psychological and emotional changes as well.* Occurs via: * Self-monitoring of activities and mood * Scheduling Activities * Mastery and pleasure ratings Clinical example: Tony has recently been feeling very low. He wakes up foggy and can’t seem to motivate himself to get his school work done or to attend to the tasks of daily living. He hasn’t seen his friends in weeks, but not for lack of trying on their part. He thinks resting will help clear the fatigue but the more he rests the worse he feels. His therapist recommends behavioral activation therapy and asks Tony to identify a few activities that bring him joy. He says fresh air and seeing friends. His therapist then asks him to take a morning walk a few times a week. At the end of the week, Tony reports that while it was difficult to schedule and even harder to go to his scheduled activities, he felt lighter and more hopeful afterward.

Question 7

Behavioral parent training/therapy

Answer 7

A behavior therapy intervention involved in teaching procedures to parents effectively managing their children’s behaviors. The primary goals of behavioral parent training is to increase parents use of clear, direct and age appropriate instructions, consistent and direct reinforcemsnt for desirable behaviors, and consistent/ appropriate punishment for noncompliant and non desirable behaviors. Some skills taught and token economies and response cost. It has been applied to effective parent-child trainings.

Question 8

Behavior therapy

Answer 8

Type of psychotherapy that uses principles of learning & conditioning (classical and operant) to reduce maladaptive behaviors & to increase adaptive behaviors.* Originally based upon Pavolv’s theory of classical conditioning & focused on problem bxs that were directly observable - ignored cognitions* Present-focused & generally brief* Behavior therapy began developing as a reaction to psychoanalysis* focus is on the behavior itself and the contingencies & environmental factors that reinforce or maintain the behavior rather than exploring the underlying causes of the behavior* During the course of therapy, the client and the therapist work collaboratively.* Pavlov, Wolpe, Watson & Skinner all contributed to the early development of Behavior Therapy. Clinical example: John is a 12 year old client whose parents brought him to therapy because he has been acting out in school, yelling at his peers when he feels angry, and throwing things in the classroom. The therapist uses principles of behavior therapy in order to reduce these undesired maladaptive behaviors and to increase more adaptive behaviors.

Question 9

Chaining

Answer 9

Chaining is an instructional procedure based on operant conditioning, used to teach a person to engage in a complex behavior that has multiple components.* Therapist conducts a task analysis that breaks down the chain into stimulus-response components. There are two types of chaining: forward and backward chaining* Forward chaining is to teach one bx at a time and chain the bxs together. In this way, each response cues the next, and the last response is reinforced. * Backward chaining is where the whole sequence is taught with coaching at each step and then then coaching is removed that way with reinforcement to follow the last step. It is frequently used for training behavioral sequences (or “chains”) that are beyond the current repertoire of the learner.
EXAMPLE: An autistic child learning to wash her hands independently. Therapist implements the chaining process: The therapist defines the target behavior: washing hands independently.

Question 10

Classical/respondent conditioning

Answer 10

Developed by Ivan Pavlov; classical conditioning is a form of associative learning in which an unconditioned stimulus (US; that naturally and automatically produces a response) is repeatedly paired with a conditioned stimulus (CS; a previously neutral stimulus) in order to evoke an unconditioned response (UR; an unlearned natural response/reaction). Eventually, the US is removed and the CS comes to elicit the CR on its own.* Principles emphasized in Behavior Therapy* CR is stronger if CS precedes UCS by short vs long time* Phases of conditioning: acquisition, extinction, spontaneous recovery, reconditioning, and counterconditioning Clinical example: Pam comes to therapy complaining of phobia of the dark. She tells the therapist that, when she was little, she was sexually molested by her uncle, who would come to her room when it was completely dark. The therapist hypothesized that classical conditioning played an important role in the acquisition of her phobia: the molestation (US), which elicited fear (UR), came to be associated with the dark (CS), which then elicited the same response (CR).

Question 11

Cognitive fusion

Answer 11

A principle of psychological inflexibility in Acceptance and Commitment Therapy (ACT), cognitive fusion involves over-identifying with one’s thoughts in a way that has a negative influence on action and awareness; cognitions cause a person to do, say, or focus on things that don’t build the life they want. Helping a client recognize cognitive fusion in themselves can help them detach from their thoughts and improve their psychological flexibility (one of the six core therapeutic processes, according to ACT). A goal of
Clinical example: A client presents with anxiety which seems to be related to her role as a mother. She reports having constant thoughts about how she is failing and her children will suffer the consequences. She describes a constant stream of thoughts about her performance as a mother and feelings of shame and depression following these thoughts. The therapist identifies that the client is demonstrating cognitive fusion, and asks her to step back and see her thoughts as just thoughts, not facts.

Question 12

Cognitive restructuring

Answer 12

Therapeutic technique used in Beck’s cognitive therapy and REBT; teaches clients to identify and change distorted and maladaptive cognitions. Cognitive restructuring can help clients identify and understand the powerful link between thoughts, feelings, and behavior.* Based on the idea that the client has an excess of maladaptive thoughts* Helps client identify self-talk and thoughts* Client is encouraged to identify cognitive distortions that are maladaptive, challenge the validity of these distortions, and explore more adaptive alternatives* Crucial questions during cognitive restructuring * What is evidence for/against this belief? * What are alternative interpretations of this event? * What are the implications, if the belief is correct? EXAMPLE: A Grad student comes into therapy experiencing great anxiety about her comps exam in the fall. She reports having thoughts like, “I’m stupid and I can’t do this,” every time she sits down to study. The cognitive therapist points out these maladaptive cognitions and uses the cognitive restructuring to challenge their validity. She asks questions like “What evidence do you have for and against this belief?”

Question 13

Cognitive therapy

Answer 13

Developed by Aaron Beck; focuses on cognitions as the origin of psychopathology.* Assumptions - link between cognitions and behavior, cognitive activity is potentially observable, it can be monitored, counted, altered.* Client is considered expert and collaborator* Two main components are BA and cognitive restructuring* Levels of cognitive distortions (triggered by event) * Automatic thoughts: spontaneous thoughts that appear plausible. Includes dichotomous reasoning, personalization, emotional reasoning etc. * Assumptions: abstract ideas that have generalized rules; often if-then statements * Schemas/Core beliefs: cognitive structures that organize and process info; deepest most ingrained level of cognitions e.g. negative cognitive triad (self, world, future)* Goals: * Correct faulty information processing * Modify beliefs maintaining maladaptive behaviors and emotions * Provide skills for adaptive thinking* Techniques include: downward arrow, psychoeducation* Focus: more on present vs. less on past, pathology and assets, objective data vs. projective tests, interventions and their evaluation. This is an important part of what is now known as cognitive-behavioral therapy. It has been shown to help clients with depression and anxiety.
EXAMPLE: A Grad student comes into therapy experiencing great anxiety about her comps exam in the fall. She reports having thoughts like, “I’m stupid, I can’t do this,” etc. when she sits down to study. The cognitive therapist points out these automatic thoughts and uses the downward arrow technique to begin exploring the client’s schemas and core beliefs so that they can work to change/correct them.

Question 14

Cue exposure therapy

Answer 14

A specialized form of exposure therapy with response prevention, often used for substance-related disorders, OCD, and eating disorders.* Client is exposed to cue for eating/substance abuse/obsessive thoughts but is unable to eat, use drug, or engage in compulsions; goal is to decrease responsiveness to cues* Best when paired with coping strategies to enhance effectiveness of treatment. Based on Pavlov’s classical conditioning, specifically extinction * Initial sessions consist mostly of repeated cue exposure *
Later sessions consist of cue exposure with coping/social skills as alternative responses
Cues can be olfactory, visual, and auditoty. EXAMPLE: You’re treating a client that is struggling with alcohol use disorder. You are working with her to try and decrease her urges to drink when she’s out at a restaurant. She is extremely used to ordering drinks every time she goes out. You suggest cue exposure therapy and decide to go out to dinner with her at several restaurants without allowing her to order a drink. By preventing her from ordering drinks, you are helping break that association between going out to dinner and drinking

Question 15

Decision-balance matrix

Answer 15

Technique used in motivational interviewing or other situations where there is ambivalence and often used in working with ambivalence in people who are engaged in behaviors that are harmful to their health i.e. problematic substance abuse, over eating* therapist asks the client to list the pros and cons of making a change or staying the same* Constructed in a decisional matrix consisting of four blocks: advantages of the status quo, disadvantages of the status quo, advantages of changing, disadvantages of changing* Informal measure of client’s readiness for change
Using a client’s decisional balance matrix can help that client to work through ambivalence. EXAMPLE: You’re working with a teenager that is using substances to a dangerous extent. You are considering a substance use disorder diagnosis; the client is extremely ambivalent, and still in denial. You explain to her that it can be good to think through all of the pros and cons of change. You work with her to fill out a decision balance matrix worksheet that assesses all of the costs and benefits. After completing the worksheet, you spend time discussing and exploring her answers to see if her ambivalence has been resolved. That is, is the client more or less ready to change?

Question 16

Dialectical behavior therapy (DBT)

Answer 16

Dialectical Behavior Therapy is a third-generation behavior therapy that focuses on both validating and accepting a client’s experience and helping them develop strategies or problem-solving behaviors that lead to positive changes in their lives. The key concept is that every argument has an assertion or thesis and opposing position (antithesis) but resolution is reached to incorporate both. Developed by Marsha Linehan as a treatment for suicidality, self-harm, and BPD, DBT focuses on: (1) creating mindfulness by helping clients use their wise mind (the intersection of their rational and intuitive or emotional mind), (2) developing interpersonal effectiveness skills, (3) emotion-regulation skills, and (4) increasing distress tolerance. Often consists of weekly individual and weekly group therapy sessions has been successful in helping clients who are resistant to other forms of treatment, such as clients with Borderline Personality Disorder, create positive changes in their functioning and lives. Clinical example: Debbie enters therapy because she has BPD; her immediate problem is that she is frequently cutting her arms b/c of recent break up. The therapist uses DBT and validation/acceptance strategies. She tells her “Your emotions can be very upsetting, and it makes sense that you would want to alleviate them, which you do by cutting yourself. Perhaps you can learn other, less destructive ways to do that.” Saying this creates a space to use problem-solving strategies to help the client find more skillful ways of regulating her emotions.

Question 17

Differential Reinforcement

Answer 17

DRO is a procedure or technique based on the principles of operant conditioning often used in Applied Behavior Analysis that can lower the frequency of a target problem behavior by reinforcing a desirable behavior as an alternative. The five types are the reinforcement of incompatible behaviors, competing behaviors, compatible behaviors, any other behavior, and low response rates. It is effective because the more the client engages in the alternative behavior, the less opportunity they have to engage in the undesirable behavior. Clinical example: Curtis, a 13-year-old boy with autism, has a problem with aggression (problem bx). After conducting a Functional Analysis, the therapist was able to confirm that the target behavior (aggression) was maintained by social reinforcement. A DRO schedule was created in which he received a reward (praise) every 3 minute interval in which no aggression occurred. There was no alternate bx required for praise, simply the absence of aggression.

Question 18

Discriminative stimulus

Answer 18

*

part of operant conditioning; the stimulus or cue that is present when the behavior is reinforced; helps person learn to exhibit target bx in its presence
* Consequence is contingent on the occurrence of the behavior only in the presence of the specific antecedent stimuli.
* Discriminative stimulus → response → reinforcement
* Often called ABCs (antecedent, behavior, consequence)
* Three term contingency

EXAMPLE: During parent-child therapy, parent brings in child because they are not following the rules at home. The therapist recommends displaying pictures of clocks labeled with activities that the child should be engaged in at a specific time in the day. (7am-wake up, brush teeth, get dressed. 4pm-homework. 7pm get ready for bed, brush teeth.) The clocks serve as a discriminative stimulus by signaling to the child what and when behaviors should occur to avoid punishment and to gain reinforcement (praise)

Question 19

Escape/avoidance

Answer 19

Part of operant conditioning and types of negative reinforcement; Escape is when the occurrence of behavior results in the termination of aversive stimulus that was already present when the behavior occurred; Avoidance is when the occurrence of the behavior prevents the presentation of the aversive stimulus* In both cases, the behavior is strengthened via negative reinforcement * In escape learning, the individual experiences relief from the aversive stimulus through the escape behavior; in avoidance learning, the individual experiences relief from the anxiety of almost experiencing an aversive stimulus. EXAMPLE: You are treating a client with a phobia of dogs. Like most typical phobia patients, he does not go anywhere that there might be dogs present. During the psychoeducation phase of treatment, you explain to him that avoidance is maintaining his phobia of dogs. Because he is avoiding all interactions with dogs, the potential for an unpleasant interaction with one is removed, thereby negatively reinforcing his fear.

Question 20

Exposure with response prevention (ERP)

Answer 20

(ERP) is a type of exposure therapy in which client is exposed to fearful cues and therapist prevents escape/avoidance - both behavioral & cognitive* Obtain detailed description of the situation and context of the problem, define explicit behavior, thoughts, and feelings leading up to it and explore consequences* Exposure can be graduated or prolonged, in vivo and imaginal* Therapist prevents escape or avoidance during exposures, review coping mechanisms* Used for OCD, substance use, eating disorders with purging sub-type* Based on classical and operant conditioning principles [breaking association between CS and CR; reinforcer maintaining behavior removed]
EXAMPLE: You are utilizing ERP with a client that has bulimia nervosa. You have pt eat her favorite binging food in therapeutic setting until she begins experiencing the urge to purge (anxiety). Purging (escape) is prevented and fear gradually decreases over time. You stay w/ Pt and help her engage in coping skills. Her binge urge and associated anxiety subsides slightly after some time has passed. It shows her that the urge to purge can go away with time, without actually purging.

Question 21

Extinction

Answer 21

In the realm of Skinner and operant/classical conditioning which deals
withholding the reinforcer that was maintaining the bx
to weaken or decrease targeted bx. Learning is preserved but can take hours or days if maintained on an intermittent schedule. It can be used to assist clients in reducing maladaptive behaviors but it’s more effective when paired with other therapies like differential reinforcement.
Example:

Question 22

Functional/behavioral analysis

Answer 22

Part of clinical assessment in behavioral therapy; the primary way behaviorists identify and assess the purpose and meaning of a client’s behavior* Typically done using the ABCPA model that investigates: * The Antecedent setting characteristics (conditions under which the problem occurs) * Setting, day/time, social context can be other behaviors, cognitions, or emotions * The Behavior * explicitly identified; Overt behavior, thoughts, associated feelings; pt IFR; frequency * The behavior’s Consequences - what happens following bx? * Person variables * Expectations, skills/competencies, foals, evaluation, self-talk * Assets * What does the person do well?* Important to use behavioral descriptions rather than trait descriptions. Traits are abstract concepts and are not actually descriptive of what person does.* Classifies problems as behavioral excesses, behavioral deficits, inappropriate stimulus control, or inadequate reinforcement* Essential features: * Individualized * Focused on present * Directly samples relevant bxs * Has a narrow focus * Is integrated with therapy
EXAMPLE: A 35 year old woman has come to treatment for a problem overeating. The therapist conducts a functional analysis by examining the problem bx. The behavior (B) is overeating - considered a behavioral excess. The Antecedents (A) that she reports are feeling stressed or upset frequently at night time. The reinforcing consequences (C) of the behavior is the pleasure that comes from eating and the distraction from the upsetting emotions. However, she is also experiencing the negative consequence of gaining weight. Therapist and client come up with the list of client assets and person variables that will help in treatment plan.

Question 23

Generalization and discrimination

Answer 23

phenomena observed in classical conditioning; Generalization is when the CR occurs in the presence of other stimuli that are similar in some way to the original US.*

Discrimination is the ability to differentiate between similar stimuli; when the CR occurs only in response to the original stimulus. This is an important way to conceptualize the development of fears.

Important for case conceptualization.

EXAMPLE: In the classic “Little Albert” experiment, Watson conditioned baby Albert to fear a white rat. Some time after, researchers noticed that baby Albert was also fearful of other white fluffy things like rabbits, dogs, Santa Claus’s beard, etc. Albert had generalized his fear to other similar stimuli. If baby Albert began only showing fear in response to the white rat, he would be demonstrating discrimination.

Question 24

Exposure therapy

Answer 24

a technique used in cognitive-behavior therapy to help pts confront fears/anxieties; pioneered by Taylor and Wolpe* Works by: * enhancing processing of feared stimuli by helping client face their fear * helping client learn that they can tolerate the distress and that their expectations of the stimuli are inaccurate * allowing client to gain control of their fear and stop restricting their lives around fear (build self-efficacy)* Based on respondent (something paired with scary event now client fears it) and operant conditioning (avoidance reinforces the fear)* 2 central features: anxiety MUST be induced during exposure * client MUST remain in the anxiety-provoking situation long enough for their discomfort to peak and begin to decline - prevent cognitive avoidance * A general rule of thumb is a 50% reduction in SUDs (sub. units of distress)* Types of exposure: in vivo, VR, or imaginal; prolonged (high intensity, long period) or graduated (fear hierarchy & short period); can include the use of competing response (like in SD - PMR) or not * Cognitive processing is very helpful, and many think it is a crucial component* Criticisms: high dropout rate in some cases, could exacerbate some sxs pt is experiencing* Used for specific phobias, PTSD, OCD, anxiety disorders, etc.* Specific techniques: SD, Flooding, Interoceptive Exposure (panic disorder), cue exposure, exposure with response prevention
It is important to strengthen the therapeutic alliance to account for high dropout rates. EXAMPLE: You’re treating a soldier suffering from a phobia of guns. Even a picture of a gun can elicit fear in the soldier. Handling a gun would cause a serious fear response so he puts that at the top of his fear hierarchy as his most intense fear. You are going to use graduated exposure and gradually expose him to less intense fears until you work your way up to handling a gun.

Question 25

In vivo vs. imaginal exposure

Answer 25

Imaginal: a type of exposure therapy in which the client is asked to imagine feared images or situations ● Can be gradual (short period, climb fear hierarchy) or prolonged (long period, high intensity) ● Exposure is done via imagining scenes or discussing event repeatedly ● Some types of phobias and traumas only compatible with imaginal exposure EXAMPLE: You are working with a combat veteran that developed PTSD in response to stepping on an IED. He is trying to “fix” this problem so he can get back to work (on the battlefield). Because you cannot fly with him to Iraq, you decide that imaginal exposure is the best route. You will ask him to repeatedly describe the traumatic event so that his anxiety spikes and then subsides. In Vivo: a type of exposure therapy in which the client’s exposure is implemented in the client’s natural environment; using actual object/situation in safe environment ● Can be gradual (short period, climb fear hierarchy) or prolonged (long period, high intensity) ● Typically produces quicker results but may face more resistance and require more time These are both effective in treating disorders. EXAMPLE: You’re working with a client that has an intense fear of snakes. After discussing it with the client, you both agree that in vivo exposure is the way to go. You instruct the client to handle a snake for increasing amounts of times in the next several sessions as part of the treatment for the phobia.

Question 26

Learned helplessness

Answer 26

Discovered by Seligman; exposure to frequent uncontrollable punishment produces apathy, passivity, and depression* a condition in which a person suffers from a sense of powerlessness, arising from a traumatic event or persistent failure to succeed * Person learns it’s helpless in aversive situations, that control is lost, and so it gives up* a lack of external behavioral control. It is thought to be related to the development and maintenance of depression for some as well as other mental disorders EXAMPLE: One of your homeless patients at the community health clinic seems to be exhibiting learned helplessness. She appears apathetic and depressed; she never wants to set any goals. After getting to know her better you being to understand that the learned helplessness likely tied to the many hardships the client has faced.

Question 27

Learning-performance distinction

Answer 27

A concept in behaviorism that stresses the difference between the learning of a behavior and actual performance of the behavior* Learning/acquisition is primarily an internal cognitive process requiring attention and retention - it is a change in the ability and potential to do the behavior* Performance is primarily an external process - it requires reproduction and *motivation** Tolman’s animal studies indicate that rewards seem to affect performance over learning * Thought rats developed a “cognitive map” of the maze. * Group 3 (no food reward for first ten days, rewarded on 11th day) * Very quickly (i.e. much faster than acquisition in the always reinforced group), the animals’ performance matched that of the animals which had always been reinforced. * Tolman called this latent learning- the animals that were not always reinforced were learning, but because they had no food motivation to complete the task, their performance was not indicative of what they had learned. EXAMPLE: Client comes to therapy with issues of self-esteem and anxiety over talking to their peers at work. Therapist teaches client assertiveness and social skills. The therapist is aware of the learning performance distinction, and is sure that after modeling behavior himself, the client is given an opportunity to reproduce the new learned behaviors.

Question 28

Mindfulness

Answer 28

A core theme of 3rd generation behavior therapies like ACT, DBT, and MBCT, mindfulness emphasizes acceptance of psychological discomfort. It is the practice of being fully aware and accepting of the present moment.* An individual learns to observe and accept thoughts and feelings rather than judge, accept=t, or fuse with them.* Goal is not to induce relaxation but foster non-judgmental observation of current state * Mind as conveyer belt: experience all sensations/thoughts as they come along, observe, label, categorize, no analysis/evaluation * Mind as sky: clouds are feelings and thoughts * Observe breath, in and out. It allows contact with the present and separation of thoughts from reality. EXAMPLE: Therapist is going to teach mindfulness skills to help a pt cope with PTSD symptoms. Pt describes feeling distracted and preoccupied with unpleasant thoughts about the past , (rumination) or the future (worry) . Therapist introduces mindfulness by saying that part of mindfulness is being in touch with the present moment and an aspect of this skill is being an active participant in experiences instead of just “going through the motions.”

Question 29

Modeling

Answer 29

part of Bandura’s social learning theory; also referred to as vicarious/observational learning - learning that occurs through observation of other people’s behaviors and consequences* Accounts for a large amount of human learning.* 4 Modeling Steps: attentional, retention, reproduction/performance, & feedback/motivation* Types of modeling: live, symbolic (TV/books), and covert (imagining)* Utilized in Self-Instructional Training* Also useful when teaching certain skills. Vicarious reinforcement is also an important part of modeling where if you see someone being reinforced for something, you are more likely to do that thing. EXAMPLE: A couple brings their child into therapy due to violent outbursts in school. It was discovered that through the process of modeling, the young boy had learned the violent behavior from his father. He learned that violence is the best way to get your way. This served as proper motivation for the behavior to continue.

Question 30

Motivational interviewing

Answer 30

Miller and Rollnick, a person centered counseling technique that was not developed as a comprehensive system of psychotherapy, but rather, a specific method for addressing a particular clinical situation in which the client is ambivalent about a particular behavior change* 3 essential elements: * It is a type of conversation about change (listening and questioning) * It is collaborative * It is evocative- seeks to call forth person’s own motivation and commitment* Might employ a decision balance matrix* Role is directive, with a goal of eliciting self-motivational statements and behavioral change from the client in addition to creating client discrepancy to enhance motivation* Commonly used for substance abuse and eating disorders. The four processes are engaging, focusing, evoking, and planning. The four spirits are acceptance, collaboration, evocation, and compassion. EXAMPLE: Client comes to therapy for alcohol abuse. The primary goal of MI is to resolve ambivalence and resistance and move clients into a commitment to change. Client moves from “I am not interested in reducing my alcohol use. I’m having fun with my friends.” to: “If I stop drinking I will feel better and maybe do better in school, which will make my parents and myself happier.”

Question 31

Negative reinforcement

Answer 31

Part of B.F. Skinner’s operant conditioning/behavior therapy, negative reinforcement is a consequence for a behavior that removes something aversive following the behavior, increasing the likelihood the behavior will occur in the future.* Includes escape: behavior that results in the termination of aversive stimulus that was already present when the behavior occurred* And avoidance: behavior that prevents the presentation of the aversive stimulus. Often relevant to understanding the maintenance of anxiety, fears, and phobias to tailor interventions to overcome it. Clinical example: A client presents with anxiety surrounding entering her bathroom. She recently fainted in the room and hit her head, causing her to bleed a lot and resulting in a visit to the ER. Since then, the room has made her uncomfortable and she has avoided going in it. The therapist explains that her anxiety is being maintained by her avoidance of the room via the process of negative reinforcement. Because the room causes her feelings that are unpleasant, her avoidance of the room itself is strengthened by the removal of that unpleasant feelings.

Question 32

Operant conditioning

Answer 32

Discovered by Skinner, part of Behaviorism; involved the use of consequences to modify the occurrence and form of behavior.* Behavior is either strengthened/increased via positive and negative reinforcement, or weakened/decreased through positive and negative punishment. * Positive/negative reinforcement: increasing the frequency of a behavior by: adding a desirable stimulus or removing an aversive stimulus * Positive/negative punishment: decreasing the frequency of a bx by: adding an aversive stimulus or removing a desirable stimulus. The behavior following a positive stimulus is likely to be repeated and the behavior following a negative stimulus is likely to decrease. Identifying reinforcers and punishments can be useful to understanding problem behaviors and designing interventions for them. EXAMPLE: The schizophrenic pt was very anti-social. In order for the pt to increase his social activities, the therapist instructed staff to only allow the pt to watch TV after he engaged in 30 minutes of social activities. This reward of watching TV (POS. reinforce) increased his social bx indicating operant conditioning had been implemented and was successful.

Question 33

Positive reinforcement

Answer 33

part of Skinner’s operant conditioning; the addition of an desirable stimulus following a behavior causing behavior to increase in frequency* Can be used in contingency management to change bxs* Drug use associated with strong positive reinforcement – feelings of euphoria, happiness, energy, increased concentration, whatever drug effect it may be. Behavioral activation was designed based on the principle of positive reinforcement. EXAMPLE: A married couple comes to therapy because they are feeling inadequate when it comes to the parenting of their toddler. The child has been acting out, throwing tantrums, and has started getting physical with his younger sister. The therapist suggests that they start positively reinforcing the adaptive behaviors that he displays in order to encourage an increase in frequency. When he plays nice with his sister, he gets attention from his parents

Question 34

Premack principle

Answer 34

In operant conditioning as a reinforcement tactic, the Premack principle refers to a process by which one attempts to increase the frequency of a particular behavior by making the performance of a more frequently occurring behavior to be contingent upon it. A behavior that occurs at a high rate can be used to reinforce a behavior occurring at a low rate. Example: Sandra came to a child therapist complaining that her son Tommy watches TV all day and never does his homework or plays outside. The therapist proposed a plan based on the Premack principle in which Tommy would be allowed to watch an hour of TV for every hour he spent either doing homework or playing outside.

Question 35

Punishment

Answer 35

part of Skinner’s operant conditioning; in general punishment decreases a behavior’s frequency* Positive punishment: the addition of an aversive stimulus that decreases bx * E.g. shocking mice* Negative punishment: the removal of a desirable stimulus that decreases bx * E.g. time out * Extinction may take hours or days if maintained on intermittent schedule, punishment effect is instant* Used in aversive control: the use of an aversive outcome, such as punishment or negative reinforcement, to control behavior, and eliminate undesirable behavior.* Disadvantages/difficulties using aversive control: * Need to continue punishment * Punishment can induce respondent emotional states: aggression, fearfulness * Use of escape or avoidance behavior by recipient/client * Modeled to others who may use or misuse it * Punishment only temporarily suppresses the target behavior and does not establish new desirable behavior * Punishment may sometimes replace on undesirable behavior with another → i.e. when a child becomes better at lying * Punishment can be reinforcing to the punisher* Generally better to use reinforcement or combine w/ DRO EXAMPLE: During parent-child therapy the counselor suggests the family no longer use spanking as a form of punishment on the child when he acts out at school; this form of punishment is leading to negative emotional and behavioral consequences in the child - it is not effective. Instead suggests they increase positive reinforcement instead.

Question 36

Self-monitoring

Answer 36

A method of gathering info used in behavior management in which clients keep a record of their own behavior. This helps bring more self-awareness to one's own behavior. Self-monitoring is a method of gathering information used in behavior management in which clients keep a record of their own covert (behavior) and overt (thoughts, moods, etc.) behaviors. This is especially in connection to a problem behavior and with efforts to change. Self-monitoring can help identify maintaining conditions of a behavior, bring more self-awareness, and provide a continuous measure of change. It could result in self-monitoring reactivity and underreport symptoms, and can be used as an intervention to help influence adaptive behavior change.

Question 37

Reciprocal determinism

Answer 37

A model by Albert Bandura from social learning theory; describes the three way interaction between the person, the behavior, and environment.* The person, behavior, and environment all influence and are influenced by one another It can be useful in interventions because it has important implications for personal freedom. PEB triangle. EXAMPLE: Larry enters therapy with feelings of depression and low self-esteem due to being unsuccessful in his work. The therapist educates his client about reciprocal determinism, and explains the dynamic relationship between his thoughts, the environment, and his behavior. He says that the environment is a factor in shaping human behavior, but we also have choices. Larry suggests that he can find a job at which he can succeed, (change the environment) which in turn will influence his thoughts about himself which may influence his depressive symptoms (behavior).

Question 38

Schedules of reinforcement- FR, FI, VR, VI CRF Schema

Answer 38

Part of B.F. Skinner’s operant conditioning, a schedule of reinforcement is a plan for when and how often to provide a reinforcer for a particular behavior. There are 5 different schedules including continuous reinforcement (CRF) in which a behavior is reinforced every time it occurs...not good for maintenance because the person can get sick of it but good for when someone is learning (when you're teaching your dog to sit, reinforce everytime they sit, fixed ratio (FR) (a child must answer 5 questions which could be done in one day or over the course of one week, no time constraint, in a classroom before getting a piece of candy) (EXAMPLE coffee punch card) (can be a 1:1 ratio) in which a behavior is rewarded after it is successful performed a specific and set number of times, fixed interval (FI) (pay check you get every 2 weeks) (client recieves access to a preferred toy after they engage in a nonpreferred task for 2 minutes everytime) in which a behavior is reinforced after it is performed successfully in a specific time period that does not change, variable ratio (VR) (slot machine gambling) (the most reinforcing because you don't know when its going to come...start with continuous reinforcement and move to variable ratio. in which a behavior is reinforced after a behavior is performed a random and varying number of times (random drug tests for substance use recovery client), and variable interval (VI) in which a behavior is reinforced after a time period that varies.* Fixed vs. Variable: * Fixed schedules of reinforcement elicit either a break and run pattern of behavior or a scalloped pattern of behavior. A fixed interval schedule has a lower response rate (slope) than a fixed ratio schedule. * Variable schedules of reinforcement elicit more consistent behavioral responses. A variable ratio schedule has a higher response rate (slope) than a variable interval schedule. Continuous has the potential for satiation but is most useful at first. EXAMPLE: Couple brings their child to treatment because of violent behavioral problems. Therapist suggests they start with a Continuous Reinforcement Schedule which would reinforce his adaptive behavior (playing nicely with his sister) every time he performed them. This is most useful when a child is first learning a behavior such as sharing toys.

Question 39

Self-efficacy

Answer 39

Part of Bandura's social learning theory that refers to the belief an individual has in reference to competency. The higher a person's self-efficacy can depend and vary with different tasks. You need a combination of acquisition and performance that achieves changes. Self-efficacy is a core component of Bandura's theory of perceived self-efficacy and refers to the belief that an individual has that they can be successful in performing a given behavior or task. The level of perceived self-efficacy determines whether individuals will attempt a task, the effort they will expend to complete it, and the time they will spend on it. The higher a persons SE, the more persistent they'll be in the face of setbacks. It is situation specific and varies with a particular task. According to Bandura, modeling & behavior therapies can strengthen PSE, but a combination of acquisition (attention/retention) and performance (reproduction/reinforcement) is necessary to achieve changes in efficacy. It's strengthened by performance accomplishments, vicarious experience, verbal persuasion, and emotional arousal. It is a primary determinant of behavioral initiation, maintenance, and change. Increasing self-efficacy might be a priority in therapy in order to promote motivation and persistency with a client since higher self-efficacy is an important element in successful CBT.

Question 40

Shaping

Answer 40

A type of learning technique part of operant conditioning; used to establish a new behavior not in client’s repertoire. Each successive approximation of the behavior (similar to the desired response) is reinforced* Done by dividing bx at hand into a series of smaller steps* Reinforce for bxs that are more and more similar to desired bx* Eventually person only reinforced for desired bx. EXAMPLE: Let’s say Johnny has social anxiety. You are trying to get him ready to give a speech in front of the classroom. Given that Johnny is shy, he wouldn’t be able to give a speech right away. So, instead of promising Johnny some reward for giving a speech, shaping can be used and rewards should be given to behaviors that come close. Like, giving him a reward when he stands in front of the class. And then when he goes in front of the class and say hello. Then, when he can read a passage from a book. etc.…

Question 41

Skills training

Answer 41

A component of behavior therapy and part of modeling that refers to treatment packages designed to over come a client's deficits. The goal of skills training is The basic assumption is that psychopathology results from ineffective social behavior and problem solving that does not yield consequences therefore a self-defeating pattern of behavior.

Question 42

Systematic desensitization

Answer 42

Developed by Wolpe; based on CCing principles; a first generation exposure therapy that included exposing clients to anxiety-provoking stimuli in a brief, graduated fashion and pairs exposure with relaxation training to inhibit the anxiety.* Step 1 consists of teaching the client a competing response- bx that competes w/ anxiety; most common one PMR; imagery can also be used* Step 2 consists of making the anxiety hierarchy- a list of events that elicit anxiety, ordered in terms of increasing intensity. Created by client using SUDs, ranging from 1 to 100 or 1 to 10.* Step 3 is the actual desensitization. The client is told to relax all muscles in his/her body and imagine the lowest item on his/her hierarchy for 10 to 15 sec; told to signal if he/she experiences any anxiety or discomfort. If that signal is given, the client is told to stop visualizing and relax. * Once relaxed, he/she imagines the scene again. After 3 or 4 trials of presentation without anxiety, the client is told to move to the next item on his/her hierarchy.* Used to treat specific phobias, anxiety disorders, PTSDEXAMPLE: A client comes in with anxiety over riding elevators. She works in a large office building where taking an elevator is necessary, yet her fear has prohibited her. Anna and her therapist create an anxiety hierarchy to help. Then use systematic desensitization in which she first learns relaxation techniques and then begins facing her fears in vitro, working from least anxiety provoking (waiting in line for elevator) to most anxiety provoking (letting elevator doors close and riding it)

Question 43

Token economy

Answer 43

A behavioral modification system that employs the principles of operant conditioning to motivate clients to avoid undesirable behaviors and perform desirable behaviors. Participants receive tokens for performing desired behaviors that can be used to purchase goods or privileges (backup reinforcers).Four features:* a list of target behaviors with the number of tokens lost and/or earned for performing each must be created* list of backup reinforcers with the price for each must created* Tokens must be chosen, i.e., are they coins, stickers, stamps, etc.?* It must have procedures and rules in place for the operation of the system. Advantages: highly convenient because tokens can be given anywhere and anytime; organized, systematic, and fair; and result in increased attention to positive disadvantages: rewards (back-up reinforcers) can be costly; some claim that a token economy is demeaning and considered briber; also an authority figure must be present. It can be used to treat diverse clients with diverse behaviors. Clinical Example: At the treatment center if the recovering alcoholic attends an AA meeting every day, he receives a token at the end of the week and he can use it to be exempted from clean-up duty. This is an example of a token economy with an individual contingency. The backup reinforcer is being able to skip out on clean-up duty.

Question 44

Schemas

Answer 44

Mental concepts from Beck's cognitive theory that are also called core beliefs. Who: Beck What: a cognitive framework that helps individuals organize and interpret information. Influence how we think, what we pay attention to an how we behave. The deepest more ingrained levels of cognition about ourselves, the world, and the future. They influence our assumptions and automatic thoughts. Types - things you feel about yourself and Content - core beliefs are like abandonment, mistrust, emotional deprivation, etc. (core values we hold to ourselves). Where: cognitive theory When: exploring our innermost thoughts and feelings using the downward arrow technique Why: knowing a person's schemas can give us a closer look into how they truly feel about themselves and how this could impact pathology of a mental disorder. Schemas are mental concepts in Beck's cognitive therory, also called core beliefs, that refer to broad cognitive frameworks an individual has of the self, others, or the world that endure despite objective reality. They serve as templates for processing a wide range of experiences and can influence our assumptions and automatic thoughts. They can also generate significant psychological distress, including depression, anxiety, interpersonal conflicts, and addictive behaviors. The most common broad schemas associated with psychological problems include: abandonment, mistrust/abuse, emotional deprivation, defectiveness/shame, and social isolation/alienation. Thus, a goal of treatment in cognitive therapy is to help the client develop more realistic, present-oriented schemas to replace ones developed in childhood or through traumatic experiences.