Cognitive-Behavioral Therapies,

Part I

PSYC 4500: Introduction to Clinical Psychology

Brett Deacon, Ph.D.

November 27, 2012

Reminder

• Please complete course evaluations!

Questions for Herbert et al. (2000) response paper, due Tuesday 12/3

• 1. Why do think EMDR has become so popular among therapists?

• 2. What can be concluded about EMDR from the observation that component studies generally find that imagery without eye movements is as effective as standard EMDR?

• 3. Which one of the FiLCHeRS (essential features of science) do you find most troublesome about EMDR?

Cognitive-Behavioral Therapy

• Encompasses variety of related therapies

• Behavior modification techniques

• Cognitive modification techniques

• Combinations of these

• Gradual evolution toward emphasis on cognitive factors (AABT ABCT)

Characteristics of CBT

• Brief and time-limited (M = 16 sessions)

• A good therapeutic relationship is important, but not the focus (i.e., necessary but not sufficient)

• Rooted in science and philosophy

• Direct relationship between psychopathological processes and treatment strategies

• Emphasis on outcome research

Characteristics of CBT

• From ABCT website: http://www.abct.org/dPublic/?m=mPublic&fa=WhatIsCBTpublic

• The therapist and client work together with a mutual understanding that the therapist has theoretical and technical expertise, but the client is the expert on him- or herself.

• The therapist seeks to help the client discover that he/she is powerful and capable of choosing positive thoughts and behaviors.

• Treatment is often short-term. Clients actively participate in treatment in and out of session. Homework assignments often are included in therapy. The skills that are taught in these therapies require practice.

• Treatment is goal-oriented to resolve present-day problems. Therapy involves working step-by-step to achieve goals.

• The therapist and client develop goals for therapy together, and track progress toward goals throughout the course of treatment.

Behavior Therapy

• Based on behavioral principles of learning and behavior change

• Classical conditioning

• Operant conditioning

• Vicarious conditioning

• Direct relationship between learning principles that caused the problem and those used to treat it

Basic Operant Techniques

• Reinforcement – increase the likelihood of a

specific behavior• Positive reinforcement – rewarding positive behavior

with a desirable stimulus (e.g., behavioral activation,

therapist encouragement)

• Negative reinforcement – removing undesirable

stimulus (e.g., avoidance, nagging)

Basic Operant Techniques

• Punishment – decrease the likelihood of a

specific behavior

• Positive punishment (aka “response-

contingent aversive stimulation,”)

• Negative Punishment – remove desirable

stimulus to extinguish undesirable behavior

(e.g., Ignoring)

Applying the Behavioral Model

• Token economy

• Shaping/successive approximations

• Time out

• Modeling

• Aversion therapy (e.g., alcohol)• http://www.youtube.com/watch?v=KZag1zlecGI

Cognitive Modification Procedures

• One example: Rational Emotive Behavior Therapy (REBT)

• Developed by Albert Ellis in 1950s

• Basic idea: we are not disturbed by events, but by how we view them

REBT

• The REBT philosophy:

• Preference vs. demand is the dividing line between emotional health and disturbance

• Dissatisfaction is different from and does not lead to disturbance

• Feelings are not externally caused

• Irrational beliefs cause unhealthy emotions

REBT

• Healthy vs. unhealthy emotions

• Sadness vs. depression

• Annoyance vs. anger

• Apprehension vs. fear

• Regret vs. shame

Typical Way of Thinking

A → C Activating Consequence

Event (Emotion)

REBT Model

A → B → C Activating Belief Consequence

Event (Emotion)

REBT Model

A → B → C Fail an exam “I am stupid. I’ll never graduate. Despair

I should just drop out.”

Fail an exam “This stinks, but it’s not the end of the Disappointment

world. I’ll study harder next time.”

REBT

• Clients usually present with problems with C

• They usually blame A for their problems

• REBT focuses on B

• Dispute irrational Bs and replace with rational Bs

Beck’s Cognitive Therapy

• Independently developed by Aaron Beck in 1950s

• Similarities with REBT

• Cognitive schemas – global, absolute beliefs

• Cognitive distortions – in-situation errors in thinking• All or nothing thinking• Mind reading

Basics of “Cognitive Restructuring”

• Disputing inaccurate thoughts

• 1. Identify the specific, inaccurate thought

• 2. Examine the evidence for and against that thought

• 3. Generate a more accurate and adaptive way of thinking

Integrating Cognitive and Behavioral Strategies

• How can we combine cognitive and behavioral strategies so we can best modify a problem?

• Behavioral experiments – testing the accuracy of negative beliefs in the real-world

Behavioral Experiments

• Devise an experiment to test the following beliefs:

• The embarrassment of appearing foolish will be intolerable

• I won’t have anything to say if I talk to other people

• I will run out of air if I stay in an enclosed space for too long

• If I don’t check the stove the house will burn down

• I can’t tolerate not knowing for sure if I have cancer

• I will pass out if I hyperventilate for too long

• If I think about something bad happening, it will happen

REBT

• Video of Albert Ellis with Gloria

• Pay attention to A-B-C model, identifying, and disputing beliefs

• What’s it like to be a patient in REBT?

• What’s it like to be a therapist in REBT?

• A disclaimer about Albert Ellis

Albert Ellis Video Clips

• http://www.youtube.com/watch?v=2cOLJBPQZRA