The First Wave - Behavioural Psychotherapy Flashcards
What were the two traditions of 20th century Behavioural First-wave Psychotherapy?
American and British traditions
Which approaches constituted the two approaches of 20th century behavioural first-wave psychotherapy?
> Behaviourism
> Learning Theory
What was the goal of the new behavioural first-wave approach to therapy?
To challenge the psychoanalytical approach (Freud, Jung)
Who was the primary influence of the US tradition?
Skinner (1904-1990)
What constitutes the US tradition of behavioural first-wave psychotherapy, in terms of aim, methods, settings?
> Behaviour modification
> Methods:
- operant conditioning, reinforcement
> Settings:
- psychiatric and other long-stay institutions
What are the targets in the US tradition of behavioural first-wave psychotherapy?
> Reduction in challenging behaviours (e.g. self harm, aggression, shouting)
> Encouraging desired behaviours (e.g. feeding, washing)
What are the two operant based approaches?
- ABC
2. Functional Analysis (applied behavioural analysis)
What is the ABC approach?
“Three-term” or “ABC Contingency”
- Antecedent specific stimulus -> Behaviour
- > Specific Consequences
What is the principle of functional analysis (applied behavioural analysis)?
> Behaviour as a function
> Purpose:
- obtain or access something positive
- escape or avoid something negative
What is functional analysis based on?
- Careful direct observation
- Record keeping using ABC charts
- Requires careful training
What are the steps of the functional analysis?
- Note the observed behaviour
- Note the situation previous to the behaviour (antecedent)
- Note what happened after (consequence)
- reactions of others
- changes in behaviours
In behaviour modification, what characterises antecedents (stimulus), behaviour (skill), and consequences (outcome) based (ABC) approaches?
> Antecedents (stimulus) based:
- simple and easy to implement
> Behaviour (skill) based:
- provide new skills and tools
- costly in time and effort to implement
> Consequences (outcome) based:
- behaviour stops without reinforcement
- hard to apply and neglects underlying purpose o behaviour
How can an extinction approach be efficient?
> Setting a continuous reinforcement before removing it completely
- leads to fastest extinction
> Provide reinforcement non-contingently or more often, when unwanted behaviour is not occurring
-> reinforce wanted behaviour
What did the study of Cohen-Mansfield and colleagues (2007) show on the nonpharmacological treatment of agitation (TREA) approach?
> 12 nursing homes allocated the TREA approach, continued with standard care
> 10 days of individualised treatment, during the 4 hours of greatest observed agitation
- > Greater reduction in mean agitation in homes using the TREA methods
- > Increased ratings of pleasure
- > Increased interest in activities
What can limit the operant approaches?
> No effective reinforcer
Person may refuse a typical reinforcer
Reinforcer may not be valued
How can a reinforcer be considered as such?
If behaviour changes as a result of its pairing with a particular response
- in some cases, person doesn’t respond in behaviour change, perhaps because the consequence is not valued
What is Premack’s principle (differential probability hypothesis)?
A behaviour, chosen frequently, is itself reinforcing
- > frequently chosen behaviour can be used as a reinforcer to alter another behaviour chosen less frequently
- widely used without us realising
How can you find a reinforcer using Premack’s principle?
Using a high frequency preferred behaviour (as reinforcer) to increase low frequency less preferred behaviour
When is Premack’s principle useful?
When reinforcers are hard to identify
- e.g. extreme inactivity in Schizophrenia
- still used in client-centered approaches
What are token economies? How do they work?
Contingency management based on the principle of secondary reinforcement
- money has no intrinsic value, can motivate and reinforce behaviour
- secondary reinforcers can be considered tokens
-> Allow us to acquire an outcome and achieve a valued purpose at later time
What are the 5 benefits of token as reinforcers?
- Easier to control and manage
- Easier to provide at time of behaviour
- Easily scalable
- exchange rate easily modifiable - Resistant to satiety effect
- > can be used more freely - Can be removed as well as awarded (response cost)
- > more acceptable and ethical
vs. withholding a material reinforcer or privilege
What are the 5 basic components of a token system?
- Nature and value of token must be explicit and understood
- Accurate and transparent means of recording tokens earned, spent or removed
- Clear and valued actual reinforcers that can be acquired through accumulated tokens
- Rules governing, earning and using tokens must be clear
- Consistent implementation, in particular not allowing access to the tangible reinforcer other than through tokens
When did token economy systems gain popularity in mental health settings? Why?
From 1970s onward
- generally successful in increasing adaptive behaviour
Which mental health disorders benefit from token economy systems?
> Learning disabilities
Neurodevelopment disorders
Addiction and substance misuse
What is the limit of AB design of clinical trials?
> Weak evidence (e.g. typical of many trials of token systems)
> Can’t control other factors over a period (e.g. change of staff)
Which type of study design provides the best evidence of effectiveness of a complex intervention in a natural setting?
Large, controlled, and multi-centered trials
What is the role of behaviour change in a person centred approach to care?
For the patient’s own benefit:
- improving quality of their life
- reducing something causing them harm or potential harm
- focus on the person, not the behaviour
Who were the primary influencers in the British tradition of 20th century behavioural first-wave psychotherapy?
> Cover-Jones (behavioural genetics, systematic exposure)
> Watson (Little Albert)
> Pavlov (classical conditioning)
> Hull (motivation in behaviour change)
Who was Mary Cover-Jones, and what was her work on?
American psychologist
- behavioural genetics
- including the study of potential of classical conditioning to remove fear
