Behavioral and

Cognitive-Behavioral

Psychotherapies

BEHAVIOR THERAPY

It is not a single method but rather a large collection of techniques designed to address people’s psychological problems.

Included are systematic desensitization, exposure therapies, relaxation training, biofeedback, assertiveness training, operant conditioning and other reinforcement-based treatments, sensate focus for sexual dysfunction, “bell-and-pad conditioning” to prevent bed-wetting, and many others.

Theoretical Foundations

Classical Conditioning occurs when a neutral stimulus comes just before another stimulus that automatically triggers a reflexive response.

Operant Conditioning occurs when certain behaviors are strengthened or weakened by the rewards or punishments that follow those behaviors.

Assessment in Behavioral Therapy

Behavioral therapy assessment is intended to identify a client’s problematic behaviors, the environmental circumstances under which those behaviors occur, and reinforcers and other consequences that maintain them. In behavioral assessment process, behavior therapists perform a functional analysis or functional assessment which examines four key areas: stimulus, organism, response and consequence. It also includes the assessment of cognitions and emotions as well as of observable behaviors.

Assessment in Behavioral Therapy

Behavior therapists are especially likely to use objectively scored quantitative assessment methods such as structures interviews, objective psychological tests, and a variety of behavioral rating forms. These measures are used partly to establish the precise nature of a client’s problem and also to establish baseline level of maladaptive responding.

THE ROLE OF THE THERAPIST

They are empathic and supportive in response to client’s feelings of anxiety, shame, hopelessness, distress or confusion. They also play an educational role explaining the theory behind what they do in ways the client can understand.

GOALS OF BEHAVIORAL THERAPY

To help the client modify maladaptive overt behaviors as well as the cognitions, physical changes, and emotions that accompany those behaviors.

CLINICAL APPLICATIONS

Broad Spectrum Behavior Therapy. Behavior therapists employ a variety of specific techniques not only for patients but for the same patient of different points in the overall treatments.

Relaxation TrainingProgressive Relaxation Training (PRT),

one of the basic techniques behavior therapist used. It is an abbreviated version of a method pioneered by Edmund Jacobson in 1938 and popularized in the 1960s by Joseph Wolpe.

PRT involves tensing and then releasing various groups of muscles while focusing on the sensations of relaxation that follow. Generally, about six sessions are devoted to relaxation training, and the instructions can easily be taped and played at home for practice. In some instances, hypnosis may be utilized to induce relaxation; in other instances, the patient may be asked to imagine relaxing scenes or sometimes breathing exercised are used.

Systematic Desensitization (SD) also known as antianxiety treatment was developed in 1958 by Joseph Wolpe. This idea is to teach patients to relax and then, while they are in the relaxed state, to introduce a gradually increasing series of anxiety-producing stimuli. Eventually, the patient becomes desensitized to the feared stimuli by virtue of having experienced them in a relaxed state.

TECHNIQUES AND PROCEDURESSD begins with the collection of a

history of the patient’s problem including information about specific precipitating conditions and developmental factors which may require several interviews and often include the administration of questionnaires. The principle reason for all of this is to pinpoint the locus of the patient’s anxiety as well as to determine whether SD is the proper treatment.

Virtual Reality Exposure is an alternative treatment for those patients who suffered from anxiety disorders.

Exposure and Response Prevention Techniques entail direct exposure to frightening stimuli, but the idea is not to prevent anxiety. Instead, exposure to feared stimuli-is arranged so that anxiety occurs and continues until it eventually disappears through the earning process known as “extinction”.

Exposure treatments are especially popular in cases of Obsessive-Compulsive Disorder. It is also used extensively with agoraphobia and panic attacks that often precede the development of agoraphobia, for binge craving in Bulimia, and for other problems.

Social Skills Training often include in the treatment of adult disorders such as schizophrenia, depression, anxiety, and a variety of childhood disorder including delinquency, attention deficit hyperactivity disorder, autistic spectrum disorders, and even behavior problems resulting from fatal alcohol syndrome.

Social Skills Training encompasses many techniques, one of the most popular techniques is the Assertiveness Training, which is designed to (a) teach clients how to express themselves appropriately if they do not already have the skills to do so, and/or (b)eliminate cognitive obstacles to clear self expression.

Modeling or Observational Learning an important mechanism in the development of human behavior. It has been used to treat many clinical problems including social withdrawal among adults and children, Obsessive-compulsive behaviors, unassertiveness, antisocial conduct, physical aggressiveness and early infantile autism.The simplest modeling approach involves having a client observe live or videotaped models fearlessly and successfully perform behaviors that the client avoids.

Behavioral Rehearsal and HomeworkBehavior therapists establish practice

sessions and situations whose demands are minimal, thus maximizing the client’s chances of early success.

Aversion Therapy and PunishmentAversion Therapy is a set of learning-based

techniques in which painful or unpleasant stimuli are used to decrease the probability of unwanted behaviors such as drug abuse, alcoholism, overeating, smoking, and disturbing sexual practices.

COGNITIVE THERAPY

All therapeutic interventions involve thought processes, but cognitive therapies are specifically directed toward identifying and changing clients’ maladaptive cognitions. These cognitions may include a client’s belief, causal explanations, schemas, self-statements and problem solving strategies.

THEORETICAL FOUNDATIONS

Cognitive MediationPerhaps the most basic notion in

cognitive therapy is that normal and abnormal behavior is triggered by our cognitive interpretations of events, not by the events themselves. A cognitive model would suggest that our thoughts about events will shape our emotional and our behaviors.

Schemas also called as schematas, the organized knowledge structures that influence how we perceive, interpret, and recall information.

Schemas can be built around actions objects, persons, and situations; they can be helpful guides in everyday life. They can also create problems, as when schemas lead o inaccurate stereotypes about particular categories of people or things. They also serve as filters that influence how persons perceive themselves and their relations to the world.

The Role of Automatic Thoughts.The cognitive approach strongly

emphasizes the habitual nature of some thoughts, including many maladaptive thoughts. Negative schema-driven thoughts can occur so quickly that we are not consciously aware of having them, let alone of being influenced by them.

Cognitive therapists view our maladaptive cognitions as learned habits that are near the surface and accessible by simple questioning and conversation. Accordingly, they use the term automatic rather than unconscious to describe client’s maladaptive and self-defeating cognitions.

As cognitively oriented clinicians worked on identifying clients’ automatic thoughts, they noted that persons with certain disorders were inclined to employ some cognitive distortions more than others; this is called a negative attributional style.

Beck’s Cognitive TherapyAaron Beck’s approach to the treatment of

depression is based on the assumption that depression and other emotions are determined largely by the way people think about their experiences. Beck says that depressive symptoms result from logical errors and distortions that clients make about the events in their lives.

Beck proposed that depressed individuals show a characteristic pattern of negative perceptions and conclusions about (a) themselves, (b) their world, and (c) their future.

 

Rational Emotive Behavior TherapyAlbert Ellis proposed that psychological

problems result not from external stress but from the irrational ideas people hold, which lead them to insist that their wishes must be met in order for them to be happy.

The therapist’s task in REBT is to attack these irrational, unrealistic, self-defeating beliefs and to instruct clients in more rational or logical thinking patterns that will not upset them.

ASSESSMENT

Assessment in cognitive therapy is interested in developing a detailed understanding of the chronicity, intensity, and extent of the client’s automatic cognitive distortions. They usually used rating scales, self-report, and standardized instruments. They also pay particular attention to assessing factors that will support or limit the client’s to engage in the tasks required in cognitive therapy. These tasks include adopting a “thinking” attitude toward symptoms and emotional experiences, and tolerating the sometimes challenging and even confrontational approach adopted by therapists.

ROLE OF THERAPISTS

They are also empathic and supportive in recognizing the distress associated with the client’s emotional experiences, but they also make it clear that the client has an important role to play in treatment.

They also built on education about how maladaptive schemas, self-defeating beliefs, negative attributional styles, and other cognitive factors create and maintain psychological disorders.

GOALS OF COGNITIVE THERAPY

To educate the client about the role of maladaptive thoughts in behavior and experience’

To help clients learn to recognize when they engage in those thoughts, and

To arm them with skills for challenging maladaptive thoughts and for replacing them with more accurate and adaptive ones.

Clinical Applications

Psycho education - It involves mini lectures on symptoms, realistic goal setting, and behavioral activation, how thoughts affect feelings, the automatic nature of thoughts, strategies for challenging thoughts and the like.

Socratic QuestioningNamed after the philosopher Socrates, it is

a style of discourse in which the therapist pursues a line of questioning until the client’s fundamental beliefs and assumptions are laid bare and open to analysis.

Refuting and Replacing Maladaptive thoughts

- Clients are often quite tenacious in holding onto their self-defeating beliefs and attributions.

Confirmation bias- clients are like everyone else in seeking to preserve their core beliefs even including beliefs about themselves that make them anxious, insecure, and unhappy.

Reattribution TrainingTo help clients overcome those tendencies, cognitive therapists ask them to repeatedly practice challenging maladaptive beliefs.They encouraged clients to consider the internal versus external dimension of attributions.Decatastrophizing- helping clients evaluate their catastrophic predictions. Used particularly with anxious and socially phobic clients, is designed to help them see that there are graduations in discomfort and their most feared scenarios may in fact be tolerable.

Thought Recording and Multicolumn Records

Keeping written records of events that have emotional significance with clients often begin with two-column thought record. This procedure is designed to provide practice in recognizing automatic and often maladaptive cognitions.

COGNITIVE-BEHAVIORAL THERAPY

An approach to psychotherapy based originally on Behavioral Therapy, it involves the extension of the modification and relearning procedures to cognitive processes.

THEORETICAL FOUNDATIONSThe addition of cognitive principles and

practices to the behaviorist theoretical framework leads to a clear, persuasive, and evidence-based description of how normal and abnormal behavior develops and can be changed.

 

CLINICAL APPLICATIONS

RELAPSE PREVENTION is designed to help clients who are trying to overcome alcoholism or other substance use disorders. Once a relapse episode occurs, guilt and shame

tend to generate a cascade of negative self-evaluations which increases the probability of continued drinking is called Abstinence Violation Effect.

DIALECTICAL BEHAVIOR THERAPY- pioneered by Marsha Linehan is often used to help clients who display the impulsive behavior, mood swings, fragile self-image and stormy interpersonal relationships associated with borderline personality disorder. DBT helps these clients develop skill at containing their erratic behaviors, but after these “containment” goals have been reached, the therapist helps the client to confront any traumatic experiences- such as physical or sexual abuse in childhood- that might have contributed to their current emotional difficulties.

Group 5

Cuadra, Karla KamillePili, Ara BelleOller, DiesebelSancho, Selah Marie