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Rathus - Behaviour Analysis (CBT) > Behavioural Analysis Class Notes > Flashcards

Behavioural Analysis Class Notes Flashcards

1
Q

Basic Principles of CBT

(9)

A
  1. evolvoing formulation of patient’s problems & behaviours
  2. strong therapy relliance
  3. collaboration & active participation
  4. goal- and problem-oriented focus
  5. initally emphasis present; unless past is deeply effecting present
  6. education - patient as own therapist + can prevent relapse; give tools to change life
  7. aims to be time limited
  8. structured sessions
  9. techniques to modify thinking, mood, BEH
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2
Q

Central questions in:

cognitive therapy; and

behavioural therapy

A
  • Cog: What’s going on in the client’s mind?
  • BEH: What are the controlling behaviours?
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3
Q

CBT therapists are interested in which elements of the human/client?

(6)

A
  • Thoughts, Behavior, Emotion, & Body Sensations, in the Context of Environment
  • case conceptualization will talk about all of these things
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4
Q

CBT Treatment Overview

(4)

A
  1. develop therapuetic relationship
  2. plan Tx and structure
  3. identify + altering dysfunctional/problematic behaviours; including antecedents, consequences, and contexts
  4. HW to facilitate change and application of new leanrign between sessions
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5
Q

Components of CBT

(12)

A
  1. setting (behaviourally) specific goals
  2. evidence-based
  3. science + art
  4. use of experiments; open to revision and approach
  5. more interested in problems and controlling variables/functions THAN diagnosis
  6. focused
  7. time lmited
  8. present-oriented
  9. active
  10. directive
  11. measurable gains
  12. testable hypotheses
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6
Q

Misconceptions about CBT

(3)

A
  1. CBT is a toolbox/set of techniques; (M)
    * More flexible thought, ability to adapt, improvise based on principles* (T)
  2. CBT is just a band-aid; (M)
    * Take all components into play, not just the symptom and nothing else* (T)
  3. CBT doesn’t value the relationship; (M)
    * Works from collaborative empiricism* (T)
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7
Q

3 CBT Pillars

A
  1. Good therapy
  2. Good conceptualization
  3. Good strategies

Relationship is also important too

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8
Q

Good CBT Therapy is about the Relationship.

What 3 components did Carl Rogers (1957) have to say about this?

A
  • Empathy
  • Genuineness
  • Unconditional positive regard
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9
Q

CBT Core

A

žInteractions among behaviors, thoughts, and emotions

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10
Q

CBT Core Behavioural Questions

(5)

A
  1. Under what circumstances does this prob occur?
  2. What are the BEH elements of the prob?
  3. What are the controlling variables?
    * -Stimuli, cues, context, triggers
    - What reinforces & punishers follow*
  4. Does the person lack certain BEH skills?
  5. What are the neg effets of the person’s BEH
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11
Q

CBT Core Cognitive Questions

(5)

A
  1. What are the cog elements of the prob?
  2. To what extent are there unhelpful circumstances?
  3. To what extent do core beliefs shape the thinking?
  4. To what extent do info processing biases distort what info is attended to and remembered?
  5. To what extent does the person engage in maladaptive mental coping stratgies?

E.g., I messed up X part of this, will never get job - hone in on the negative

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12
Q

CBT Core Emotional Questions

(5)

A
  1. What are the emo elements of the prob?
  2. What are the subjective feeling states?
  3. What physiologial sensations are experienced?
  4. To what extent have emotional responses been classically conditioned?
    * E.g., see people and get scared to talk*
  5. How has the learning history shaped, thoughts, emotions, and behaviours?
    * E.g., punishment for being playful, induldged and thus entitled?*
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13
Q

Case Conceptualiztions in CBT

(5)

A
  1. ID targets
  2. Conduct functional analysis
  3. ID mechanisms
    * What’s causing the prob to persist*
  4. ID functional outcomes
  5. *Use BEH, Emo, Cog systems throughout*

EXAMPLE: Depression

  • Mechanism: distorted thoughts, inactivity, poor prob solving
  • Fx Outcome: can’t work
  • Target mechanisms; or - e.g., activating BEH
  • Target outcomes - e.g., return to work
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14
Q

Behavioural Interventions - Central Triggers

(5)

A
  • Triggers of behaviors
  • Behaviors themselves
  • Contingencies for behaviors
  • Skills deficits
  • Negative effects of behaviors
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15
Q

CBT Behavioural Interventions

(7)

A
  1. žSituation Selection and Stimulus Control
  2. žContingency Management
  3. žDirect Behavioral Prescriptions
  4. žActivity Scheduling
  5. žGraded Task Assignment;
  6. žExposure
  7. žBehavioral Skill Training
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16
Q

Situation Selection (5)

&

Stimulus Control (2)

A
  • Stimuluation Control
    • manipulating your enviroment to alter/remove cues
    • look to antecedents
    • for BEH you want to increase/decrease
    • more preventative
    • narrowing: engage in BEH only at specific times/places
  • Situation Selection
    • enter/avoid certain environments to increase/decrease liklihood of BEH
    • situation mis-selection: happens when client can’t accurately predict emo state in certain situations
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17
Q

Discriminitive Stimulus

(2)

A
  • informs us about contingencies
    • whether we are reinforced/pnished for a particular behaviour
    • E.g., speed trap
  • Cues
    • Positive – tell us to do something
    • Negative – tells us NOT to do something
    • If cues inconsistent; BEH becomes erratic
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18
Q

How do you differentially treat internal and external discrimination cues?

A
  • Internal
    • use cog-level interventions
  • External
    • use situation selection & stimulus ctrl
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19
Q

What are stimulus ctrl BEH to decrease or stop a behaviour?

(3)

A

E.g., based on cig smoking

  • build neg cues into enviro
    • E.g., look at photo of fam member when you want to smoke
  • remove pos cues from enviro
    • E.g., ashtrays, lighters, no smoke breaks
  • creating barriers
    • E.g., leave cigs in car

Stiumuls Ctrl – manipualte/alter your enironment to change behavior

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20
Q

What are stimulus ctrl BEH to increase or start a behaviour?

(2)

A

E.g., built on getting in shape/taking walks during class breaks

  • build pos cues into enviroment
    • E.g., leave tennis shoes in office
  • remove/lessen barriers to BEH
    • E.g., don’t schedule meetings in small breaks
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21
Q

Fine tuning stimulus ctrl for clients;
what do you do for each of the following?

  • fearful
  • limited capacity for self-control
  • unwanted behaviours
A
  • fearful
    • approach
  • limited capacity for self-control
    • judicious avoidance
  • unwanted behaviours
    • add barriers
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22
Q

Situation Selection is a type of _________

A

Stimulus Ctrl

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23
Q

Negative Reinforcement is a reinforcement that ____

A

gives escape or release removing something adversive

E.g., taking aspirn relieves the pain from a headache

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24
Q

Examples of Negative & Positive Reinforcement

(4 each)

A
  • Negativet
    • pills for headache
    • drink to reduce anxiety
    • study to reduce stress
    • giving to stop yelling
  • Pos
    • treats, money, praise, attn
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25
Q

Premack Principle

A
  • Reinforcing a lower frequency with a higher frequency behavior
  • IMPORTANT - frequency refers to if you had absolute choice of schedule; think higher and lower preferences BEH
  • if you have two adversives, but they would prefer one over the other, both get done. More prefered becomes the reinforcer
    • E.g., can’t do HW until clean room
  • E.g.,
    • reinforce studying with going out
    • reinforce veggies with dessert
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26
Q

Contingency management to:

  • Increase BEH (1)
  • Decrease BEH (6)
A
  • Increase
    • Premack principle
  • Decrease
    • punishment (add adversive)
    • penality (remove desirable)
    • extinction
    • differential reinforcement of other BEH
    • differential reinforcement of lower rate of BEH
    • noncontingent (free) reinforcement
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27
Q

Why is too much punishment not great?

(3)

A
  • can lead to suppression + more hiding
  • doesn’t take out of repitrore; doesn’t teach learning
  • can harm relationship
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28
Q

Punishment & Penalty

A
  • punishment
    • adding an adversive
  • penalty (neg punishment)
    • remove something desirable
29
Q

Extinction & Behavioural Burst

A
  • extinction
    • removal of reinforcer for BEH
  • behavioural burst
    • increase in BEH after you remove the reinforcer before it becomes extinct
30
Q

Differential reinforcement of other behavior (DRO)

A
  • contingency management to decrease BEH
  • reinforce something incompatible
  • E.g., reinforcing reading but not watching TV
31
Q

Differential reinforcement of a lower rate of behavior (DRL)

A
  • Contingency management decrease BEH
  • Reinforce incremental decreases in behavior
32
Q

Noncontingent (free) reinforcement

A
  • Contingency management to decrease BEH
  • unpair the behavior with its reinforcer
  • E.g., if child yelling to obtain attention, give lots of attention freely at other times so less incentive to engage in the behavior
33
Q

Components of contingency management

A

1. Define target BEH

    • objective, clear, complete
      2. Self-monitor
      3. Conduct functional analysis
    • what comes before and after
      4. Select your contignencies
    • reinforcers; intervention should rely on
    • punishers; overcorrection, time out, response cost
      5. Promp-Praise-Ignore
      6. Token economy
      7. Self-ctrl strategies
      8. Reinforce clinically relevant BEH in session
      9. Getting desired repertorie into person’s BEH
34
Q

Types of Punishers

Time out

Response Cost

Overcorrection

A
  • Time out
    • take away reinforcers
    • never be cruel or overdone
  • Response cost
    • a punishment – give up something
    • E.g., donating to something you help
  • Overcorrection
    • aka: restitution or positive practice
    • idea is to teach positive opposite BEH
    • E.g., kids makes a HUGE mess, make them clean up their mess and others
35
Q

žPrompt-Praise-Ignore

A
  • step in contingency management
  • Prompt (to start the behavior, get it in the repertoire)
    E.g., study, make eye contact, pick up the clothes
  • Praise when client engages in desired behavior
  • Ignore when client engages in unwanted behavior (using withdrawal of attention as penalty or response cost, or as extinction)
36
Q

What are some self-control strategy steps?

A
  • identify target and monitor
  • conduct functional analysis
  • intervene w/ stimulus ctrl
  • self-reinforce desired BEH
  • Devise a contingency contract w/ specified renforcers and penalities
  • compteting response trainin
37
Q

Contingency Management:
Getting the desired BEH in the person’s repertoire

(5)

A
  • shaping
  • successive approximations
  • chaining – breaking down BEH
  • task analysis – smaller tasks as needed
  • modeling
38
Q

Graded Task Assignment

A
  • Def: Breaking a complex task into ore manageable assignments
  • E.g., getting a job, starting an excercise routine, talking with a fmaily memeber about a difficult subject
39
Q

How are graded task assignments different from chain analysis or task analysis?

A
  • Chaining & Task Analysis
    • Smaller behaviours
    • E.g., editiing a resume – break this down into small steps
  • Graded Task Assignment
    • Larger issue
    • E.g., applying to grad school – break this down into assignments
40
Q

Behavioural Activation

A
  • Tx for depression
  • Two pronged-approach
    • monitor daily activities via self-monitoring and rating of activities
    • perscribed phase based on activities that give mastery and sense of pleasure
  • Key is to link with values/priorities
41
Q

What is exposure therapy most used for – broadly?

And what is the mechanism of defence
used for said item?

A
  • anxiety
  • avoidance is a negative reinforcer for anxiety
42
Q

Evidence Based Tx for Anxiety DO

and components

A
  • Only CBT
  • These forms of CBT have multiple components:
    • exposure
    • cognitive restructuring
    • skills training
      E.g., social skills training, relaxation, breathing training

Note: Relaxation and breathing can actually be an escape, so you sometimes don’t need

43
Q

Why choose exposure therapy compared to other cognitive theories?

A
  • exposure is the active ingredient in CBT for anxiety DO
    • exposure alone is just as effective as more complex CBTs
    • cognitive therapy alone < effective than combined CT
  • Exposure is effective for all anxiety DO
    • cognitive therapy doesn’t work for some specific phobias
  • Disorder examples
    • EMDR: added eye movements do not increase treatment efficacy
  • OCD: exposure & response prevention alone works just as well as ERP + CT
  • PTSD: PE alone is just as effective as PE + SIT and PE + CT
44
Q

How effective is exposure therapy for anxiety DO?

A
  • 60-85% show clinically significant improvements
    • 68% of PTSD clients remit from PTSD
    • 77% of panic disorder clients no longer experience panic attacks at the end of treatment
    • 83% of OCD clients show significant improvement
    • No other Tx as effect for Panic DO
45
Q

How is fear acquired?

(3)

A
  • conditioning
    • neg event paired w/ previously neutral object
    • e.g., parking lot associated w/ mugging
  • vicarious learning
    • observing another person be afraid or hurt in specific situation
    • e.g., afraid of flying post 9/11
  • info transmission
    • being told that specific objects/situations are dangerous (by others, media, etc)
    • e.g., read aricles about lack of regular washing hands
46
Q

Why choose exposure therapy?

(4)

A
  • most effective part of CBT
  • brief and efficient; 12-18 sessions
  • can be administered by clinicians with little prior CBT experience
  • exposure is most consistent with DBT; which emphasizes BEH of cognitive
47
Q

Difference btwn normal and problematic fear

A
  • Normal Fear
    • perception of real threat that disappears when danger is removed
  • Problematic Fear
    • disruptively intense; excessive response
    • responses resistant to modification
    • occurs where minimal risk

•CRITICAL POINT: We would not do exposure to a fear that is justified

48
Q

Exposure therapy drop-out and comparative rates

A
  • Tx dropout is <= any other Tx
    • exposure = 20%
    • cog/SIT = 22%
    • exposure + CBT = 27%
    • EMDR = 19%
  • Tx dropout with severe DBT clients is the same for DBT w/ and w/o an exposure-based PTSD protocol
49
Q

Concerns that expsoure therapy makes clients worse

(3)

A
  • false
  • Sx exaccerbation is extremely rare
    • <5% clients show PTSD increase
  • Severe BPD getting DBT and exposure-based therapy
    • 0% show increase in PTSD increase
    • self harm urges rare; <10%
    • rates of suicide may be < DBT
50
Q

Example of how fear is acquired using blood-injury phobia as an example.

Walk through the steps

A
51
Q

How is fear maintained?

A
  • avoidance of anxiety-provoking things
    • internal cues;
      e.g. thoughts, memories, physical sensations, emotions
    • external cues;
      e.g., people, place,s objects, smells, situations
  • avoidance BEH mechanism
    • decrease anxiety –>
      increase sense of safey; or –>
      alleviate uncomfortable sensations
  • problematic or unhelpful beliefs that fuel fear
    • over-estimation of liklihood or severity of neg outcomes
    • neg beliefs about anxiety or self
  • avoidance BEH examples
    • •Emotional:
      Focusing on secondary emotions (e.g., anger) rather than fear, suppressing emotions.

•Cognitive:
Distraction, daydreaming, dissociation, mental rituals that reduce anxiety (e.g., counting to 10 repeatedly).

•Behavioral:
Leaving the situation, bringing safety signals into the situation (e.g., support people), taking anti-anxiety meds or drinking alcohol, avoiding interacting during social situations.

52
Q

Cycle of Fear Maintainence…

and Rationale for exposure

A
  • Cycle:
    Btwn avoidance and unhelpful beliefs
  • Rational:
    stop avoidance

•Consequences of avoidance:

  • Decreases short-term anxiety.
  • Increases long-term anxiety b/c decreases opportunity for corrective learning – testing the accuracy of unhelpful beliefs.

•If continue to believe things are dangerous and you can’t cope with them, you are more likely to avoid.

53
Q

Rationale for Exposure: Corrective Learning

def, goal, what’s learned

A
  • corrective learning
    • weakening old aossications and creating new associations
  • overarching goal
    • stop avoidance so that clients can learn their problematc beliefs are problematic
  • New learning that takes place
    • feared outcomes are unlikely to happen
    • neg outcomes are unlikely to be catastrophic
    • anxiety can be tolerated and decreases over time
    • able ot cope effectively with stressful situations
54
Q

4 Core Elements of Exposure

A
  1. Cue exposure
  2. Corrective learning
  3. Response prevention
  4. Enhance ctrl
55
Q 
Exposure Element: 
Cue Exposure (4)
A
  • Deliberate and planned exposure to a stimulus that elicits a fear
    • emphasize deliberate nature
  • expsoure to feard stimulus is typically:
    • repeated (across sessions and HW)
    • prolonged (~30-45 mins)
  • Exposure doesn’t include simply referening a feared stimulus or reinterpreting its meansing
    • these may have an incidental expsoure component, but are not formal expsoure
56
Q 
Exposure Element:
Correcticve Learning (3)
A
  • goal is “not-reinforced” exposure
    • probelamtiv emotion must NOT be reinforced
  • expsoure must occur in the absence of an actual threat so that a corrective learning experience occurs
  • can’t guarangee safey, but need to choose exposure tasks that are minimal to low risk
57
Q

Expsoure Element:
Response Prevention

A
  • must block avoidance and escape responses for new learning to occur
  • this can include various types of c/overt avoidance responses
    • cog (e.g., dissociation, distration)
    • emo (e.g., numbing, secondary emo)
    • BEH (e.g., not looking at the cue, leaving the expsoure situation, compulsions & rituals
  • also block action urges and expression associatied with problematic emotions
    • E.g., avoiding eye contact, tense body, slumped posture
58
Q

Expsoure Element:
Enhance Ctrl

A
  • clients…
    • active collaborators in selecting exposure
    • never forced into expsoure tasks
    • can choose not to do an exposure task
    • can choose to stop in the middle of a taks
      – principle of controlled escape
      *
59
Q

Types of Exposure

(5)

A
  • In vivo
  • Imaginal
  • Interoceptive
  • In virtuo
  • Opposite action
60
Q

In Vivo Exposure

(4)

A
  • exposure in real life
  • desinged ot counteract avoidance of situations that ellict fear
  • used in most expsoure Tx
  • typically used for:
    • people – strangers, abusr dopelgangers
    • places – crowded stores, hospitals, schools
    • things – animals, doorknobs, beer smell, songs
    • activities – public speaking, being hugged, driving
61
Q

Imaginal Exposure

(4)

A
  • exposure done in imaginatin
  • designed to counteract avoidance of thoughts, memoreis, and images that elicit fear
  • clients typically describe the imagined situation out loud and record it
  • typically used for:
    • past trauamtic events
    • feared outcomes that can’t be simualted in real life
      e. g., contracting HIV
    • distressing mental images
      e. g., sexually abusing children
    • done as early step in fear heirarchy
      e. g., imagine flying before getting on plane
62
Q

Interoceptive Exposure

(4)

A
  • exposure to physical sensations
  • designed to counteract avoidance of specific body cues that elicit fear
  • most often used to treat panic DO
  • typically done via excercises that induce panic-type sensations:
    • difficulty breathing (e.g., breathe throuh a straw)
    • increased heart rate ( e.g., run in place)
    • dizziness (e.g., spin in chair)
63
Q

In Virtuo Exposure

(3)

A
  • exposure with virtual reality
  • most often used for flying
  • has been applied to other specific phobias and PTSD
    e. g., spiders and combat vets, respectively
64
Q

Opposite Action

A
  • involves enagaging in BEH that’s opposite to the “action urge” that is eleicited via cue exposure
  • can be applied to any unjustified emotion
  • extends response prevention beyond eliminating dysfunctional BEH to also include increasing Fx BEH
  • opposite action –> all the way
65
Q

How do you make exposure work?

A
  • DO NOT allow avoidance BEH before, during, after exposure
  • Don’t stop exposure until anxiety decreases significantly; ideally don’t end until habitiuaiton has occured

Types of examples:

  • Distraction
  • Rituals
  • Anti-anxiety meds
  • Alcohol
  • Reassurance seeking
  • Bringing support people
  • Avoiding eye contact
  • Leaving out details
  • Dissociation
  • Stopping prematurely
  • Chit-chat
  • Using DBT skills
  • Prayer
  • Body posture
  • Speaking quietly
66
Q

What do you do if habitiuaiton does not occur in exposure therapy?

*This doesn’t mean failure. If intended task completed = success

A
  • focus on achieveable BEH goals
    • E.g., stay in situaiton for 20mins w/o leaving
    • E.g., touch toilet seat and don’t watch hand for 1hr
  • emphasize matery + fear toleration over reduction
    • E.g., “great job doing something very hard!”
  • if avoidance BEH are not present, corrective learning can still occur
  • repeat exposures until they no longer elicit very much anxiety
    • the more you repeat and exposure taske, the more habituation will occur OT
    • repeat exposure until peak guideline SUDs <30
  • do exposure in different contexts reults in less relapse
    • Internal context e.g.,
      meds, mood state, amt of sleep, hunger level
    • External context e.g., location, time of day, presence of others
67
Q

SUDs

A

subjective units of distress

  • start by writing SUDs fro 0-100 amt of distress
  • once do, write experienced SUDs
68
Q

Exposure Therapy Steps

A
  1. Orienting clients to exposure Tx
    1. Necessary for clients to fully understand benefits + challenge
    2. Explain how fear is maintained
    3. Explain rationale for exposure
    4. Prepare clients ot feel anxious
    5. Orient to therapist’s role
  2. Assessment and Heirarchy construction
    1. Assessment questions
    2. Conduct a chain analysis of episodes of prob anxiety
    3. Exposure hierarchy
    4. Choose items with a range of SUDs
    5. Match exposure task to the client’s fear(s)
    6. Choose items that involve acceptable and every day risks
    7. Choose items that minimize the likelihood of relapse
  3. Conducting an Exposure Session

Rathus - Behaviour Analysis (CBT) (3 decks)

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