LECTURE 1: exposure and behavioral activation Flashcards
(19 cards)
Waves of behaviour therapy
- First wave: based on behaviourism - all behaviours are learned trough conditioned interaction with the environment. Focus on observable behaviour, and ignored the unobservable part
- Second wave: based on cognitive + behavioural. Mental unobservable processes play a role in learning.
Cognitive behaviour therapy
A family of psychological interventions that are based on cognitive and/or behavioural principles. Psychological problems are based, in part, on:
1. Faulty unhelpful ways of thinking (schema’s).
2. Learned patterns of unhelpful behaviour.
We try to understand behaviour with the underlying cognitions.
Exposure
Purposefully creating anxiety/fear and repeatedly expoing people to this, in the absence of their feared outcome. This leads to fear-extinction/ attenuation of fear.
Two-process model of fear (Mowrer)
- Fear is acquired through classical conditioning.
- Fear is maintained through operant conditioning.
Classical conditioning
ONSET OF FEAR
A type of learning in which a previously neutral stimuli elicits a reaction after being repeatedly paired with a biologically potent stimuli (causes a reflexive reaction). That previously neutral stimuli will now trigger a conditioned response.
Operant conditioning
MAINTENANCE OF FEAR
A type of learning through reinforcements (rewards) and punishments of behaviour.
- Positive: something is added.
- Negative: something is removed:
- Reinforcement: leads to more.
- Punishment: leads to less.
This causes maintenance of fear through avoidance: fear stimuli is avoided, and the positive outcome to this is never learned.
Fear-structure
How fear is programmed in our mind. A fear structure consists of 3 types of information:
1. About the feared stimulus.
2. About the individual’s verbal, behavioural and physiological responses to the stimuli.
2. About the meaning ascribed to the stimulus and to the responses. (My heart beats fast –> I must feel fear).
2 theories of fear-extinction
- Emotional processing theory: new fear-structure overwrites the old one.
- Inhibitory learning theory: both structures keep to exist and compete.
(1) Emotional processing theory
During exposure, the fear-structure is corrected. For this to happen, certain demands need to be met:
1. High anxiety at the start of exposure - fear structure has to be activated.
2. New information, incompatible with the old information, must be introduced into the fear-structure.
Correction of the fear structure is indicated by habituation: fear reduction during sessions and over the course of therapy. (NOT predictive of therapy outcome!)
(2) Inhibitory learning theory
During exposure we are NOT correcting the old fear-structure, but we are creating a NEW competing non-fear structure. This new structure should be as easily-accessible/ easily-retrievable as possible.
Demands:
1. New information, incompatible with the old information, must be introduced.
2. Accessibility and retrievability of non-threat associations should be enhanced.
This also explaines reaquisition of fear: old fear-structure wins in retrieval.
Strategies for enhancing inhibitory learning
- Expectancy violation
- Remove safety behaviours
- Variability
- Reinforced extinction
- Attentional focus
- Mental reinstatement / retrieval cues
Behavioural activation (BA)
The structured scheduling of specific activities for the client to complete in their daily lives, that function to increase contact with positive reinforcement (pleasure, joy, mastery, connection). NOT only focus on joy!
History of BA
- 1970: Lewinson said that depression is a cycle of low mood and low activation that needs to be breaked.
- 1980: Beck said that depression is caused by distorted thinking, focus on cognitions (+BA).
- 1995: Jacobson did a component analysis for CBT for depression, to see what the working components are.
Component analysis of CBT Jacobson)
- Facilitative factors / strategies (common in every therapy)
- Behavioural activation strategies
- Core belief strategies (cognitive)
- Automatic thought strategies (cognitive)
The analysis showed that the cognitive strategies did NOT make the therapy more effective. –> Just BA is as effective as full CBT.
The goal of BA
To increase (the rate of) contact with positive reinforcement, this can generate change and maintain behaviour.
BA’s model of psychopathology (depression)
Reinforcement (lower healthy and higher depressed behaviour) –> Mood (increased depressed mood) –> Behaviour (lower activation and higher avoidance) –> Depression (higher symptoms)
BA FOCUSSES ON BREAKING THROUGH THIS CYCLE!
(Reinforcement and Mood are hard to separate, because no positive reinforcement (no joy) = low mood).
- Negative reinforcement of depressed behaviour: I won’t go outside, because then people will think I’m a loser.
- Positive reinforcement of depressed behaviour: your partner gives you attention because you are sick in bed all day.
BA mostly focusses on positive reinforcement for healthy behaviour: what will give people a meaningful life (joy, master, connection, pleasure).
BA’s model of treatment
Treatment (BA) –> Behaviour (more activation, lower avoidance) –> Reinforcement (more healthy behaviour, lower depressed behaviour) –> Mood (lower depressed mood –> Depression (less depressive symptoms)
What is important in BA treatment
- Validate + listen first
- Highlight vicious cycle and explain
- Suggest activation to break this cycle
- Psychoecudation!
- Outside-in approach: act according to a plan instead of a feeling.
How?
- Schedule activities that cause positive reinforcement.
- Personalise these activities.
- Talk about values of client and relate them to activities.
- Grading tasks: break down activities into smaller parts.
- Prepare client for obstacles (problem solving skills, social skills, imaginary rehearsal).
When it didn’t work:
- Analyse what happened
- Be emphatic and hopeful
- Discourage self-blame / self-hate
