Why Focus on Theory?

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Why Focus on Theory?• Guide your interventions to be maximally

effective/efficient for unique clients and situations• Empirical studies (and ESTs) are never sufficient

– can never be enough studies– research findings always require interpretation– there are always exceptions (moderators)

• Very often therapists need to improvise– if fewer sessions than recommended– if client does not respond to standard procedures– if client does not cooperate (e.g., culture, world-view)– if client has a problem not in DSM, “atypical”, or “NOS”

• Allows for technical eclecticism• Orient clients (expectancies and collaboration)

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Becoming a Good Therapist

1. Learn principles of behavior and behavior change

2. Learn techniques, observe therapy

3. Practice, practice, practice!

4. Have CBT supervisors view your videotapes and give you feedback

5. Incorporate new research (PSY6023)

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Specific things to learn

1. How to do a thorough person-specific analysis of proximal causes

2. Understand effective ways to change problematic thinking and emotions

3. Understand treatment failures– failures to generalize to real world– return of problem behaviors/emotions

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What is Behaviorism?

1. Principles of learning derived from science

2. Does not acknowledge internal “diseases”

3. Leads to superficial change (symptom substitution)

4. A set of technical language that alienates others

5. It is coercive/controlling, limits free will

6. It oversimplifies human complexities

7. Is too deterministic, claiming that responses are only determined by immediate stimuli (S-R)

8. It feels dehumanizing, ignoring most thinking and feeling and the uniqueness of each person

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Behaviorism Myths

3. Little evidence for symptom substitution

5. It is generally not coercive/controlling

5. It does not limit free will

6. Behavioral theory is complex in considering a variety of causes including thinking

7. No longer a stimulus-response theory

8. It does not have to feel dehumanizing, if so it is based on your thinking and/or conditioning

8. It does not ignore thinking and feeling and very much considers uniqueness of each person

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Which Therapy Orientation?

1. Free association2. Free responses to ambiguous

auditory stimuli3. Analysis of patients feelings

toward therapist and how they resemble feelings toward others

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The Functions of CBT

1. Increase abilities for effective behavior to live a valued life

2. Improve motivation and salience of true goals

3. Decrease thoughts/emotions that interfere with effective behaviors or quality of life

4. Increase distress tolerance and acceptance5. Restructure the environment to promote

effective behaviors (antecedents and consequences)

6. Ensure generalization to natural environment

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What is CBT?

Interventions guided by CBT theories– Functional analysis– Problem solving

1. Skills training

2. Cognitive modification

3. Exposure strategies

4. Mindfulness/meditation

5. Contingency management

6. Homework

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The Therapist’s Influence

• Verbal teaching (didactic/instruction)

• Modeling (intentional and inadvertent)

• Reinforcement and punishment– verbal– nonverbal (intentional and inadvertent)

• careful observation: the counting horse

– natural versus arbitrary

The Therapist’s Influence

• Modeling– Negative judgment of others (validation)– Positive judgment (praise)– Failure model (validation)

• Reinforcement– of judgment (by laughing)– of self-criticism (by reassuring or praise)– of suicidality (by providing more help)

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The Teacher’s Influence

• Verbal teaching (didactic/instruction)

• Modeling (intentional and inadvertent)

• Reinforcement and punishment– Verbal– Nonverbal (intentional and inadvertent)

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• Praise• Being yelled at and criticized• Food• Physical pain• Fear• Gaining weight (obesity)• Time-out from recess (child)• Beep (stacked squares) SEraser

What are Effects of These Consequences?

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Function (causal relations) depends on• the disorder• the person (genetics + learning history)

• external context (physical or interpersonal)

• recent external events/stimuli• internal context

– biological changes (e.g., hunger)– emotions– mental perspective or thinking– drug intoxication

Function Varies Considerably

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What is CBT?

Interventions based on a commitment to the scientific analysis of:

• causes of psychopathology• change strategies

– efficacy/effectiveness– mechanisms of change

• operational definitions of causes, behaviors, and change processes

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What is CBT?

• CBT is driven by science

• CBT is diverse and evolving

• CBT is active and collaborative– self-monitoring– learning new coping skills and behaviors– practice in and out of sessions

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What is CBT?

What is behavior therapy?

What is radical behaviorism?

What is (applied) behavior analysis?

What is cognitive therapy?

What is cognitive-behavior therapy?

What’s the difference??

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History of CBT:The Pendulum Swings

• Introspection psychology – problematic

• 1st wave of CBT– Watson – extreme behavioral– Skinner – “radical” behavioral, less extreme

• 2nd wave of CBT: Cognitive revolution

• 3rd wave of CBT:– contextual approaches– integrative approaches

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History of CBT:Your Mentorship Lineage

• William James

• Albert Bandura (Stanford)

• Gerald Davison (USC)

• Marsha Linehan

• Milton Brown

• you

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Early Behavioral Theory

Behavior is controlled by its Antecedents and Consequences

To a Behaviorist:

All forms of “behavior” can cause other “behaviors”

“Cognitions are not causes”

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Current stimuli can control current responses

• bell => salivation

• white rat => fear

• “close” => contraction of pupils

• bedroom => alertness + anxiety+worry

• being in any car => sleepiness + sleep

• size of plate => amount of food eaten

• darkness (outside) => TV (no chores)

Stimulus Control

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Stimulus ControlControl responses by controlling antecedents:• remove conditioned stimuli• remove discriminative stimuli• remove opportunities to behave• prevent problematic conditioning

Examples:• remove binge foods (cigarettes) from home• rearrange the space in which eating occurs• rearrange the space in which person sleeps• do not read or watch TV in bed

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Why the Cognitive Revolution?

Evidence against behavioral theories:

• lack of S-R consistencies between people– individuals respond differently to same stimuli

• intermittent reinforcement effects

• observational learning

• cognitions/awareness correlate with learning

• cognitive dissonance effects

• overjustification effects (rewards)

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ABC’s of Cognitive Therapy

AActivating

Event

BBelief

C Consequence(emotion/behavior)

Thoughts and beliefs determine emotions and behavior.

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ABC’s of Cognitive Therapy

Examples:

• student getting bigger belly

• person hunched over at Home Depot saying “Don’t kill yourself…”

• letter from Board of Psychology

• at Target, I turned around and my daughter was gone

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The Big Debate

The Role of Cognition (B) in Dysfunctional Emotions

and Behaviors (C)

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Cognitive Mediation of Emotions and Behaviors

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John Watson’s Behaviorism

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Insisting always cognitive mediation:

• impedes search for other causes– external antecedents/context– cognitive learning in context– role of mental context vs. cognitive content– consequences for problem and target

behaviors

• clients fabricate plausible thoughts

Disadvantages of Early Models

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Modern CBT Theory

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The Failure of Catharsis

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A Reformulation of Differences

Pure “Behavior” Therapy• John Watson (pure externalism)

Behavioral-Cognitive Therapy• B.F. Skinner (the least cognitive)

• Steven Hayes (contextual Skinnerian)

• Albert Bandura (50-50)

• Arthur Staats (50-50)

Cognitive-Behavioral Therapy (the most cognitive)

• Aaron T. Beck• Albert Ellis (more behavioral than Beck)

Three Ways to Reduce Suffering and Stop Problem Behaviors

1. Change problematic thoughts

2. Reduce negative emotions

3. Change the way you relate to your thoughts and emotions (internal context)

3rd Wave of CBT

• Acceptance and Commitment Therapy

• Dialectical Behavior Therapy

• Mindfulness-based Cognitive Therapy

• Mindfulness-based Stress Reduction

• Mindfulness-based Relapse Prevention

• Mindfulness-based Therapy for GAD

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1. Classical (respondent) conditioning

2. Operant (instrumental) conditioning

…to help us effectively navigate our world– make use of signals effectively prepare us for

important events and opportunities

Two Primary Forms of Learning

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1. Classical (respondent) conditioning

2. Operant (instrumental) conditioning

Both usually co-occur and interact

Both signals and responses:– can occur outside of awareness– can be inside or outside the person

Two Primary Forms of Learning

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UCS = important evocative stimuli, usually not learned (e.g., injury or food)

UCR = “natural” response to a UCS

CS = stimuli (usually neutral) that acquire potential to elicit a new response

CR = the learned response

Respondent Conditioning

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Original Theory: stimulus substitution

1.A previously neutral stimulus functions as the evocative stimulus with which it has been paired

2.The response transfers to the neutral stimulus such that it is no loner neutral

3.The number temporal pairing of CS-UCS determines the CR strength


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Pavlovian Experimental Apparatus

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Little Albert Experiment

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Respondent ConditioningCS UCS UCR CR .

T1 bell => orientingT2 food => salivationT3 bell+food => salivationT4 bell => salivation

T1 rat => orientingT2 noise => startle/fearT3 rat + noise => startle/fearT4 rat => fear/crying

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Generalization Gradient

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• Salivation can be conditioned to almost any neutral stimulus—buzzers, lights, touches

• One dog was conditioned to salivate when it received an electric shock. At first the shock was very weak so as to be barely perceptible. As the shock was increased in strength it was found that a very strong shock produced no sign of pain or displeasure. There was no quickening of the heartbeat or breathing which usually accompanies an unpleasant event. Instead the shock was followed by mouth-watering and tail wagging.


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CS UCS UCR CR .

T1 bell => orienting

T2 light => pupils contract

T3 bell+light => pupils contract

T4 bell => contraction

CS can also be the spoken word “contract,” which can cause the pupils to contract

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Learning principles apply to both overtbehaviors and private behaviors

• Internal/private stimuli can become CS– thinking– emotions– heart beat

• reinforcement and punishment can alter:– internal responses

• thinking• emoting

– involuntary or reflexive behaviors• cough• bruxism

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Verbal Conditioning

• Command your pupils to “contract”

• Command your temperature to drop

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Interoceptive Conditioning

• Exteroceptive conditioning– Ex: overtly spoken words: “CONTRACT”

• Interoceptive conditioning– Ex: sub-vocal speech: “CONTRACT”

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Our brains are not stupid!!

Conditioning is not simplistic.

Conditioning effects depend on many factors…based on what is useful

Rescorla-Wagner Theory

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Conditioning is not a stupid process by which the organism willy-nilly forms associations between any two stimuli that happen to co-occur. Rather, the organism is better seen as a strategic information seeker striving to predict its world to increase good outcomes and avoid harm. If one thinks of classical conditioning as developing between CS and US under just those circumstances that would lead a scientist to conclude that the CS causes the US, one has a surprisingly successful heuristic for remembering the facts of what it takes to produce associative learning.


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Stimuli only become signals when

• they give the person time to prepare– CS precedes the UCS (forward conditioning)

• meaningful associations form– US-CS contingency is necessary (depends on)– CS predicts that things will get better or worse– US-CS contiguity is not sufficient

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CS signal a change in the probability or severity of a UCS

–the UCS depends on the CS (to some extent)–the UCS is contingent upon the CS–expectation things will get better or worse

Thus, no CR will develop if:–CS => UCS frequently AND–UCS occurs as frequently in the absence of the CS

US-CS Contiguity is Not Sufficient Contingency is Necessary

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Conditioning occurs when the organism is surprised…

and there are stimuli that can make the surprising situation more predictable (expectancies – “if…then…”)


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US-CS Contiguity is Not Sufficient Contingency is Necessary

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Behavior-Consequence Contiguity is Not Sufficient Contingency is Necessary

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US-CS Contiguity is Not Sufficient for Conditioning to Occur

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US-CS Contiguity is Not Sufficient for Conditioning to Occur

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Outdated Theories ofRespondent Conditioning

Stimulus substitution theory is limited:

• CR often differs from UR

• sometimes CR is opposite to UR

• different CS (paired with same US) have different CRs

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Outdated Theories ofRespondent Conditioning

Different CS (associated with same US) have different CRs

CS UCS CR / UCRshock quick burst of activity

sound less activityvisual evade/block

food swallowingsound more activity (general)visual pecking

Milton Brown

CR after conditioning

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UCS CS UCR CR .

heroin euphoria

analgesia

needle dysphoria

garage hypergesia

sad*

* Interoceptive conditioning


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Respondent Conditioning of an Opponent Process

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Operant Conditioning

Is a stimulus added or removed as a consequence?

Does the behavior increase or decrease?

add remove

increase

decrease

Ex. negative reinforcement – increase in the probability of a behavior occurring in the future when removing an aversive stimulus after the behavior occurs.

positive

reinforcment

negative

reinforcment

positive punishment

negative

punishment

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Two-Factor Theory:UCS are Primary Reinforcers

CS are Conditioned Reinforcers

Antecedents:

• sight of food (CS) elicits salivation

• sight of food (SD) elicits eating behavior

Consequences:

• food in mouth (UCS) elicits salivation (UCR)

• food in mouth (SR) reinforces eating

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Two-Factor Theory:UCS are Primary Punishers

CS are Conditioned Punishers

Antecedents:

• light (CS) elicits fear (HR increase)

• light (SD) elicits fleeing

Consequences:

• shock (UCS) elicits fear (HR increase)

• shock (SP) punishes staying

• escape from shock (SR) reinforces fleeing

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Operant Conditioning in Context:Discriminative Stimuli

Skinner’s three-term contingency: A-B-C

• Discriminative stimuli (A) are the specific stimuli that signal that specific behaviors (B) will be reinforced or punished (C)

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Operant Conditioning

• Negative reinforcement and positive reinforcement are often indistinguishable

• Positive punishment is usually followed by neg. reinforcement of an opposite behavior

• Negative punishment is usually followed by pos. reinforcement of an opposite behavior

• SD and consequences are often CS

Change the Environment

• Stimulus control• Contingency management

• How and where?– in client’s natural environment– in therapy sessions– dragging out new behavior in sessions– contingency contracts (not natural)– therapy vacation/termination


What responses get reinforced? How?

Internal or external reinforcement?

– depression

– substance abuse

– anxiety disorder

– anger

What consequences should change?

Alternative ways to get reinforcers?


Contingency management in therapy–adolescent contract

–LA sliding scale contract

–LA getting more exercise and regulating sleep

–make phone calls more available

–end non-productive phone calls

First Contingency Contract

2 pts exercise < 8 am (time stamp receipts)

1 pt exercise > 8 am

1 pt work < 8 am (3 pts max)

points session fee

1 200

4 140

5 80

7 20

0 $0

2nd Contingency Contract

Cardio exercise machine (verified with photo)any level of intensity< 8 am $4 per minute (fee reduction)> 8 am $1 per minute

minutes session fee EXAMPLES0 20030 (< 8 am)8050 (< 8 am)050 (> 8 am)150120 (> 8 am) 80

New Contingency Contract

Target Behaviors• work before 7am (verified with printout)

• babysitting nephews at their house before 7am (verified via caller ID phone call)

• exercise < 8 am (verified by photo emailed by 8:30am)

Daily fees (for 7 mornings prior to session)• $50 if no babysitting and no work before 8 am.• $20 when begin babysitting or work 7 am - 8 am.• $0 when begin babysitting or work before 7 am• fee reduction of $60 per mile (< 8 am) on cardio

exercise machine

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Contingency Management

UAs: 3 days/wk, 2 days/wk, 1 day/wk

Voucher Method• $1 each time abstinent, increase $1.50 each time• reset to $1 if positive, refusal, or missed• 2 weeks of negatives reinstates highest reward• $10/wk bonusLottery Prize Method (variable ratio schedule)• 50% chance of money or “Good job, try again”• usually $1 or $20, and 1/500 chance for $100• each time abstinent one extra draw

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Contingency Management

Cost per patient for six weeks outpatient treatment

$175 - Standard $375 - Voucher Method ($100 paid to patient)$350 - Lottery Prize Method ($80 paid to patient)

12 weeks of intervention in research studies

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Escape Conditioning:Punishment & Neg. Reinforcement

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Negative Reinforcement

Escape = Negative reinforcement

• escape from punishment and UCS/CS

• punishment for not escaping

• no opportunity for extinction when there is no longer any UCS

Avoidance of punishment = reinforcement

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Two-Factor Fear Theory

The Avoidance Paradox:

• How could an absence of a stimulus reinforce a response?

Solution:

• escape from fear CR is negative reinforcer

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Evidence for Two-Factor Theory

• Escape from CS decreases fear CR

• Increasing fear (CR) increases avoidance– adding conditioned fear stimuli

• Decreasing fear decreases avoidance– adding conditioned inhibitors (safety signals)

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Problems with Two-Factor Theory

• Not all fears begin with classical conditioning

• Fear extinction should occur after CS repeated without UCS*– extinction only to brief CS exposure if escape

• Fear decreases as avoidance (of UCS) becomes stronger/quicker over time– avoidance without noticeable fear– increasing sense of control and predictability

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Two-Factor Fear Theory

The Avoidance Paradox:• How could an absence of a stimulus

reinforce a response?

Solutions:• CS are conditioned/secondary punishers• escape from CS is negative reinforcer• CS is an SD• safety signals are conditioned positive

reinforcers

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One-Factor TheoryAvoidance responses can be learned without

respondent conditioning (CS or CR)• Sidman non-signaled avoidance task

– no obvious CS to avoid– pressing a bar delays a shock for 30 sec– 10% vs. 30% probability of shock every 2 sec

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Pratice midterm examYour examplesReading “quiz”Review FA instructions and examplesSuperNanny videosYour projectsNew videos

Agenda – class #4

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Behavioral Conceptualization of Hypothetical Constructs

Non-behavioral “explanations”

• internalize and externalize

• “need”

• projection

• catharsis (emotional “release”)

• “rejection sensitivity” is the reason why some people are exceptionally distressed by rejection

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Behavioral Conceptualization of Hypothetical Constructs

Report the times of day the behavior occurs

Give specific examples of thoughts

Focus on consequences that actually explain why the behavior occurs. Do not list hypothetical long-term consequences

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1. “stressed”

2. “tardiness”

3. “procrastination”

4. biting nails "is not that strong"

5. driving "well above" the speed limit

6. “unexpectedly heavy traffic is cause of arriving late (target should be time at leaving the house)

Review the “Target” sections of previous students’ functional analyses

Behavioral Problem Definition

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Estimate the probabilities of the response (e.g., every time?) when the various "triggers" occur

Conditional probabilities:

P(A|B) vs. P(B|A)

Behavioral Analyses

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Therapeutic Exposure

Learned emotional responses will be eliminated when……there is repeated/prolonged exposure to all triggers (and variations thereof)…in all contexts…as long as the person does not escape…and nothing bad happens.

Is it feasible?

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Therapeutic Exposure

(prolonged non-reinforced exposure and response prevention)

Expose

• repeated avoided behaviors

• enter avoided situations

• present avoided stimuli– actual stimuli (in vivo)– imagery (simulation)

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Emotional Processing Theory

• Activate the emotion schema– e.g., “danger”– therefore, arousal should be high

• Introduce incompatible information– e.g., “safety” (disconfirm danger)

(active cognitive processing)

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Extinction

• Reversal (decrease) of learned responses– reverse classical conditioning– reverse operant responses

• Extinction is new learning not “un-learning”– does not erase previous learning– decrease in response depends on context– original conditioning often overrides extinction

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Respondent Extinction

• Conditioned stimuli occur

• Emotionally-evocative stimuli no longer follow– UCS– 1st-order CS (to extinguish 2nd-order CS)

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Reinforced Fear

Reacquisition – re-pairing of CS and UCS

Reinstatement – recurrence of UCS reactivates the CR, even if no additional pairing

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Reacquisition of Fear

CS1 = light

CS1 => shock (10 times, 100 amps)

CS1 => fear (9/10)

CS1 => no shock (100 times)

CS1 => no fear (2/10)

CS1 => shock (1 time , 50 amps)

CS1 => fear (8/10)

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• Habituation is a decrease in CR and UCR due to simple repetition of CS and UCS– person “gets used to” the stimulus– satiation is habituation to positive stimuli

• Extinction only explains reduction in CR– lack of stimuli that could reinforce CR

Respondent Habituationvs. Extinction

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No longer bothered by Sushi after many Sushi meals

Less excitement after many years in a relationship

Child becomes less afraid of water by staying in

Water seems less cold after staying in a while

Repeatedly petting a dog reduces fear

Praise becomes less effective if it is used too much

Criticism becomes less effective if it is used too much

Whipping becomes less effective punishment

Habituation or Extinction?

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PTSD Fear Schema

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What do PTSD Patients Avoid?

• Conditioned stimuli (fear schema)– classically conditioning– higher order conditioning– semantic conditioning

• Fear and other emotions

• Symbolic and verbal stimuli

• Mental images of catastrophes

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Extinction Depends on Context

Extinguished responses return when the extinction context differs from the new context (conditioning is more general)

• time• previous events• physical setting or other stimuli• biological states• emotional states

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Extinguished responses (respondent and operant) return when the extinction context differs from the new context

• spontaneous recovery (AAA)

• renewal (ABA, ABC, AAB)

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Extinction Depends on Memory

We never forgot our past harm

We easily forget our past safety

Memory enhancers

• D-cycloserine

• Extinction reminders

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Renewal Types

1 2 3

Conditioning A A A

Extinction B A B

Re-exposure A B C

to CS/SD

There are three settings or contexts: A, B, C

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Renewal Examples

extinction context renewal context

jumping barrier added barrier removed

no drug lever removed drug lever added

SuperNanny present SuperNanny gone

male therapist in office at client’s home

greyhound did not bite bulldog

Black friendly in suburb in ghetto

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Conditioned Inhibition:Safety Signals

J.P. Segundo:• cats were given painful electric current • a sound (CS) occurred when electricity

was turned off (-UCS)• UCR: relaxation• CR: sound elicited relaxation even when

current was not turned off

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Renewal of Avoidance Extinction

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ABA Renewal

CS1 (light) => UCS (shock) => CS2 (sound)

CS1 => fear

CS2 => relaxation

CS1 + CS2 => no shock (extinction)

CS1 + CS2 => no fear

CS1 => fear

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Renewal (Internal Context)CS1 (light) => UCS (shock)

CS1 => fear

CS1 + CS2 (caffeine) => no shock

CS1 + CS2 => no fear (extinction)

CS1 => fear

CS1 => no shock (extinction)

CS1 + CS2 (caffeine) => fear

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ABA Renewal

CS1 (outside) => UCS (vomit)

CS1 (outside) => fear => pills => less fear

pills => relaxation

CS1 + pills => extinction (no fear)

CS1 => fear

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Safety Signals:Explanations for Safety

Safety is attributed to the safety signal, not the CS

Therefore, the perceived danger of the CS is not disconfirmed

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Reinstatement of Fear

CS1 = light, CS2 = sound


CS1 => fear (9/10)


CS1 => no fear (2/10)


CS1 => fear (5/10)

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• mutual coercion (negative reinforcement)

• stimulus control (structure)

• non-contingent reinforcers (estab. oper.)

• extinction (no pay off for bad behavior and not getting out of demands)

• negative reinforcement (time out)

• extinction (for getting off time out)

• extinction for leaving bed

SuperNanny

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ABA Bird Feeding Renewal

MOVE OPERANT RENEWAL SLIDES TO A MUCH EARLIER LECTURE

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ABA Child Tantrum Renewal

1 Parents extend bed time (before SuperNanny)

2 With help from SuperNanny, parents do not extend bedtime

3 After SuperNanny leaves, parents ask for bed time and child tantrums

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AAB Child Tantrum Renewal

1 Parents extend bed time

2 Parents do extinction

3 Babysitter ask for bed time and child tantrums

1 Parents extend bed time at home

2 Parents do extinction at home

3 Parents ask for bed time on vacation and child tantrums

Distraction and Safety Behaviors

1. Safety behaviors and distraction can impede emotional processing

2. Safety behaviors and distraction can enhance emotional processing

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• Is flexible for different cases

• Encourages examination of many causes

• More opportunities for intervention

• Considerable empirical support

• Guides effective interventions

Advantages of Modern Integrative CBT Theory

116

Current stimuli can control current responses

• bell => salivation

• white rat => fear

• “close” => contraction of pupils

• bedroom => alertness + anxiety+worry

• being in any car => sleepiness + sleep

• size of plate => amount of food eaten

• darkness (outside) => TV (no chores)

Stimulus Control

117

Problems with Reinforcement

Therapist’s lack of awareness of mutual influence or of behaviors needing to be reinforced

• Inadvertent reinforcement of problems

• Inadvertent failure to reinforce progress

118

Generalization Gradient

119

Reinforcement Example

cues (SDs):

• same physical position

• I repeat word/number when she reaches toward the wrong one

• she looks at my facial expression

• she looks at where I am looking

120

Newer Theories ofRespondent Conditioning

Conditioning does not simply result from repeated temporal pairing of stimuli

• high base-rate occurrence of UCS (without CS) reduces strength of CR

• high base-rate occurrence of CS (without UCS) reduces strength of CR

• depends on other stimuli and context• some stimuli are harder to condition• CS can be paired with absence of UCS

Ways to Change Learned Emotional Responses

• Cognitive restructuring

• Therapeutic exposure to emotion triggers

• Counter-conditioning (reciprocal inhibition)– problematic stimuli/responses paired with other

competing/opposite stimuli/responses• emotion regulation behaviors• opposite actions (e.g., approach, confidence)

• Cognitive dissonance induction

122

• Habituation

• Emotional processing– role of safety signals

• Self-efficacy (confidence and control)

• Generalization (prevent renewal)

• Opposite action

Orienting to Exposure

123

• Brain tricks us into believing overly fearful– protects us by overgeneralizing perceived danger– reminders, memories, and images seen as dangerous– emotion brain areas different than logical areas

• Desensitize or “get used to” triggers– give examples

• Practice tolerating or coping with triggers• Get brain to realize that many situations,

reminders, memories, images are not dangerous– needs convincing information from a new experience– needs enough time for safety info to “sink in” to the gut– we must “talk to” the emotional part of the brain

• We can “act into” new emotions

Exposure Rationale

Resistance to Exposure Therapy

Client Questions:

Why should it help when I already get triggered all the time?

Why should I repeat negative thoughts when I will just end up believing them more and get more upset?

Systematic Desensitization

Relaxation does improves outcomeswhen added to intermittent imaginal exposure

1 > 2


• Imaginal exposure can reduce fear without any relaxation training

• Relaxation sometimes does reduce fear more than graded imagery alone– when therapist controls progress up the

hierarchy– when there are few treatment sessions– when there is short duration of exposure trials

• Most studies have shown that the timing of relaxation does not influence outcomes


In animal studies:

• exposure to CS is necessary and sufficient for fear reduction

• graded exposure vs flooding has comparable outcomes

• offering food during exposure can help OR impede fear reduction– helpful if the food helps the animal get more

exposure

Exposure + RelaxationFor fear reduction:

• prolonged exposure is most effective

• adding relaxation does not help

1 = 2 > 3

Exposure + Relaxation

It is possible that relaxation:

• increases collaboration and willingness

• gets more exposure

• makes desensitization occur more quickly

Exposure +Cog.Restructuring

For fear reduction:

• adding cognitive restructuring does not help

1 = 2 > 3

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What is the most effective way to change a negative schema?

How to solve the head vs. gut problem?

Is cognitive processing necessary?– rational disputation or experiential/emotional?

Are passive learning experiences sufficient if the person gets important new info?– Is active coping necessary?– Are new actions necessary?

Unified Protocolfor Treating Emotion Disorders• Psychoeducation (attitude toward emotion)• Antecedent cognitive reappraisal

– cognitive restructuring during episodes can be form of avoidance

– encourage cognitive flexibility– get clients into avoided situations

• Prevention of emotional avoidance– increase emotion awareness and tolerance

• Changing emotion-driven behaviors

Opposite Action for Unjustified Emotions

to Trigger

Maladaptive Actions

Elicit and Reinforce Responses

Opposite Action• Not avoiding

– prolonged exposure and response prevention

• Actively approach (and choose)– behavioral activation & mastery experiences

• Opposite associations (counter-conditioning)

• Opposite emotions (reciprocal inhibition)• Opposite verbal behavior• Opposite nonverbal behavior

– confidence– voice– face

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New Behavior Changes Cognition

“On the one hand, explanations of change processes are becoming more cognitive.

On the other hand, it is performance-based treatments that are proving most powerful in effecting psychological changes. Regardless of the method involved, the treatments implemented through actual performance achieve results consistently superior to those in which fears are eliminated to cognitive representations of threat (Bandura, 1977, p. 78)

136

Modern CBT Theory

137

Modern Behavioral Theory

138

New thinking prompts new behaviors that lead to more reinforcers and fewer punishers, which

changes depressive affect

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New behaviors lead to more reinforcers and fewer punishers, which changes belief, which changes

depressive affect

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Counter-Conditioning

• Activate the conditioned responses

• Present stimuli that elicit different responses– candy => pleasure

• Engage in behaviors that elicit opposite responses (reciprocal inhibition)– relaxation is incompatible with fear– approach is opposite to fear, shame

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Counterconditioning

CS UCS UCR CR .

T1 rat => orienting

T2 noise => startle/fear

T3 rat + noise => startle/fear

T4 rat => fear/crying

CS UCS+ UCR CR .

T4 rat + candy => fear reduction

T4 rat => pleasure

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Reciprocal Inhibition Theory:Fear Reduction

• Activate the conditioned fear responses

• Elicit incompatible responses to fear– relaxation– humor– curiousity– sexual pleasure– HRV– anger?– (choose to) approach (with confidence)


Relaxation does improves outcomeswhen added to intermittent imaginal exposure

1 > 2

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Reciprocal Inhibition Theory:Anger Reduction

• Activate the conditioned anger responses

• Elicit incompatible responses to anger– empathy– kindness

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Opposite Action

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Opposite ActionExamples:

• slow breathing

• nodding (head phone study)

• smiling (facial feedback)

• eat fried grasshoppers

• opposite political speech

• self-esteem

• snake exposure therapy commitment

• obesity study – gains maintained 2 years

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Cognitive DissonanceCognitive Theory

• When we do act contrary to our beliefs and there are insufficient reasons for doing so we are uncomfortable (for lying, time, effort)

• To reduce the discomfort we change our beliefs so that we convince ourselves that there really was no discrepancyEx: self-attribution (personal explanation):– “I did it because I wanted to” (intrinsic interest)– “I said it because it’s true”

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Cognitive Dissonance Induction

• Counter-attitudinal role-playing– elicit opposite public behaviors

• speech• nonverbal behavior• attitude: “act as if”

– elicit discomfort and maximize effort– low pressure; high choice– encourage internal attributions

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Cognitive Dissonance Induction

• Reduce avoidance– increase emotional processing– increase mastery and confidence– solve problems and increase reinforcers

• Facial feedback

• Cognitive dissonance– operant conditioning of consistency

• Classical conditioning– smile (nodding) is CS for liking/agreement

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Cognitive DissonanceBehavioral Theory

• We reinforce each other for consistency– we want others to be predictable

• We get punished for:– lying or breaking promises– hypocrisy– “flip-flopping” (John Kerry)

• Only if observed by others and if no observable external control or “valid reasons”

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Albert Bandura

Observational learning (modeling)

• Attention

• Retention

• Reproduction

• Motivation– past consequences– promised consequences– vicarious consequences

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Albert Bandura

Self-regulation (self-control)

• Self-observation

• Standards of performance

• Self-administered consequences

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Cognitive-Affective Personality System

• Encoding-interpretation

• Expectancies

• Values and Goals

• Self-regulation

• Competencies and Skills

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The Functions of CBT

1. Increase abilities for effective behavior to live a valued life

2. Improve motivation and salience of true goals

3. Decrease thoughts/emotions that interfere with effective behaviors or quality of life

4. Increase distress tolerance and acceptance5. Restructure the environment to promote

effective behaviors (antecedents and consequences)

6. Ensure generalization to natural environment

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Skills

1. Behavioral control– self-talk

– self-management (e.g., stimulus control)

2. Emotion regulation

3. Distress tolerance

4. Interpersonal effectiveness

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Obstacles to New Learning and Emotion Extinction

• Failure to change the emotion schema– failure to access schema

• new beliefs in the head but not the gut

– safety signals– safety behaviors

• Other problems with generalization– new learning occurred in limited internal or

external contexts

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Maximizing New Learning and Emotion Extinction

• Change the emotion schema– access schema by eliciting emotion– prevent safety signals– block safety behaviors (avoidance)

• Promote generalization– new learning in all relevant contexts

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Generalizing New Learning:State-Dependent Learning

1) Goal to increase a new effective behavior or coping response.

People will be more able/likely to engage in new behaviors and coping responses in new contexts are similar to the contexts in which the responses were learned.

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Intellectual Emotional

Verbal Nonverbal

Explicit Implicit / Tacit

Conscious Unconscious

Semantic Procedural

Propositional Implicational

Processing Modes

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Generalizing New Learning and Emotion Extinction

Practice in all relevant contexts:

• bring therapy into real life– (cued) homework practice– extinction reminder (safety signal?)– in vivo coaching via telephone

• bring real life into therapy– activate relevant emotions (schemas)– have a genuine relationship– work on real problems that emerge in sessions

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First:• approach evocative stimulus (in vivo)

– elicit fear, sadness, shame, depression, anger– hold, smell, and taste alcohol

• hear negative statements• imagine (or talk about) upsetting scenarios

– describe traumatic event in detailThen practice:• adaptive thinking• regulating emotions (e.g., relax)**• acting assertive• inhibiting impulsive action or acting opposite


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Rehearse thoughts during relevant emotion

• Devil’s advocate– therapist voices negative thinking

• Systematic Rational Restructuring– patient imagines upsetting situation

• Stress Inoculation Therapy


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There once was a man who hated his own footprints. In order to get away from the footprints, the man ran faster and faster. But the faster he ran, the more footprints he made. And finally, he ran himself to death.

- Zhuangzi, 300 BC

Three Ways to Reduce Suffering and Stop Problem Behaviors

1. Change problematic thoughts

2. Reduce negative emotions

3. Change the way you relate to your thoughts and emotions (internal context)

3rd Wave of CBT

• Acceptance and Commitment Therapy

• Dialectical Behavior Therapy

• Mindfulness-based Cognitive Therapy

• Mindfulness-based Stress Reduction

• Mindfulness-based Relapse Prevention

• Mindfulness-based Therapy for GAD

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Modern Behavioral Theory

Mindfulness

“Keeping one’s consciousness alive to the present reality” – Hanh

“Bringing one’s complete attention to the present experience on a moment-to-moment basis” – Marlatt

“Paying attention in a particular way…on purpose, in the present moment, and nonjudgmentally” – Kabat-Zinn

Meditation is OnlyOne Form of Mindfulness

Forms of mindfulness practice:

• Internal vs. external focus

• Focused vs. open awareness

• Isolated/sitting vs. integrated into life

Mindfulness is NOT

• Buddhism

• Meditation

• Relaxation

• Thinking about what you notice

• Stopping thoughts

Acceptance

“Experiencing events fully and without defense” – Hayes

Acceptance

Non-acceptance + Pain = Suffering

Acceptance is NOT approval

“Acceptance is too hard!”– imagine accepting– act as if you accept– fully accept for even a moment

Accept what is not true?

Why Mindfulness?

• Differentiate facts vs. thoughts and judgments– notice judgments and interpretations– describe facts rather than judge or interpret

• Get unstuck from thoughts/memories– pain with less suffering– reduce rumination– effective action despite contrary thoughts,

feelings, or urges (slow down!)

• Exposure to primary emotions• Effective distraction

What is Your Brain Thinking?

The thought ____ just popped into my mind– “I just felt like saying…”– Don’t take it personal!

I just noticed ____ feeling arise within me

Therapists should model this distancing

Mindfulness-Based CT

• Kabat-Zinn MBSR applied to depression

• Works for depression relapse

• Works for depression in which thinking plays a prominent role

• Does not work for reactive depression

Mindfulness-Based CT

Study 1

# epis. MBCT TAU

1-2 54% 31%

>2 37% 66%

Study 2

MBCT TAU

1-2 50% 20%

>2 36% 78%

Acceptance andCommitment Therapy

“Get out of your head and into your life”

Acceptance via Metaphors

• Quicksand

• Chinese finger traps

• The unruly child

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Question

What is the relevance of ironic process theory for understanding and

treating disorders of emotion?

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Ironic Process Theory

• Operating process– Intentionally create distracting mental content– Is difficult because negative content is much

more accessible than positive– very effortful, requires a lot of cognitive

resources

• Monitoring process– automatic search for failure

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Harmful Effects of Rewards

When the reward is

• tangible / arbitrary / excessive

• promised in advance or expected

• contingent upon task involvement or effort

When the behavior is

• already occurring at a high rate

Handout 14

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Effective Reinforcement

• Contingent on completion of a behavior• Provides specific useful feedback• Not coercive, judgmental, or tied to punishment• Minimal reinforcement• Intermittent reinforcement• Natural reinforcement

– pay attention to what the client does– be responsive (reinforce behavior that is useful)– use your natural reactions (SISD)– generalizable (available in many contexts)

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Natural Reinforcement

• Putting on a jacket keeps you warm

• Using a toilet keeps you clean and dry

• Complying with a request (not praise)

• Excitement (not praise)

• Dismay or demoralization

• Flow of a conversation/relationship

• Bored listener when a client rambles

• SISD – positive or negative

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Natural Reinforcement

Amber

• Reading games

• Reading lyrics

• Reading gets compliance from us

Opponent process – shivered awake right after dreaming about hot shower

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Behavior & Self-Interpretation

We make conclusions about ourselves based on our behaviors and relevant explanations for our behaviors given the environmental context

Behavior-schema discrepancy is uncomfortable (dissonant) without external explanations

We seek to reduce dissonance either by finding reasonable external explanations or by changing our view of ourselves.

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The Cognitive Revolution

• Aaron T. Beck

• Albert Ellis

• Julian Rotter– locus of control

• Albert Bandura– Social Learning Theory– Social-Cognitive Theory

• Walter Mischel (Cervone & Shoda)

– Cognitive and Affective Personality System

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Levels of Cognition

• Schemas (e.g., inferred or latent content)

– core beliefs– cognitive-affective neural networks

• Cognitive processing– schema activation (inferred)– distortions (e.g., negative bias)– attributional style

• Cognitive products (content in awareness)

– automatic thoughts– attributional conclusions

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Schemas

Many inter-related components:

• stimulus elements

• meaning elements

• (core) beliefs

• emotion elements

• action tendencies (scripts)

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Fear Schema

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Activation of Schemas

Ambiguous situations similar to aspects of schema:

• similar stimuli (visual, touch, smell, etc.)• similar behaviors of others (comments,

visual appearance)• similar emotions• similar meaning

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Count the F’s

FINISHED FILES ARE THE RE-

SULT OF YEARS OF SCIENTIF-

IC STUDY COMBINED WITH

THE EXPERIENCE OF YEARS.

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Cognitive Distortions• Overgeneralization

– Labeling– All-or-nothing thinking (rigidity)

• Mental filter• Ignoring/discounting the positives• Jumping to conclusions

– Mind Reading– Fortune Telling

• Exaggeration/Minimization• Emotional reasoning• "Should" statements (rigid rules)

• Personalizing/Blame

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Depressive Thinking

Beck’s Cognitive Triad

Distorted negative thinking about:• Self (low self-esteem)

• World– “nothing is meaningful or worthwhile”

• Future– hopelessness– helplessness (low self-efficacy)

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Schema Activation

Schema: “I am unlovable”

Situation: boss gives corrective feedback

Cog. processing Cog. Productsjumping to conclusions“He is criticizing me”

neg. attribution / label “(…because) I am a loser”

mind-reading “(…because) he hates me”

fortune telling “I will get fired”

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Schema Activation


Situation: Partner ends romantic relationship to move away for graduate school. Relationship was very strong, but not long

Cog. processing Cog. Productsneg. attribution “(…because) I am fat / ugly”

judgmental label / filter “I am fat / ugly”

should “I should lose more weight”

fortune telling “I will never find another”

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Schemas

Danger Schemas: PhobiasInterpersonal Schemas:• Racial prejudice• Gender rolesSelf-Schemas:• Unlovability/Rejection

– Abandonment/Mistrust– Defectiveness/Shame

• Helplessness/Dependence• Subjugation/Self-sacrifice

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SchemasCBT primarily works by changing schemas:

• (Outdated?) remnants of previous learning

• Elaborate well-organized cognitive-affective structures, or neural networks

Function

• Make sense of situations with incomplete or ambiguous information

• Generate useful responses to situations

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Schema Activation

Schema: “Black people are criminals”

Situation: see person taking food from a store without paying

Verbal response: ??

Schema: “Black people are dangerous”

Situation: police officer sees person standing up from behind an object in an alley

Motor response: ??

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Schema Activation

Schema: “Old people are slow and sickly”

Priming: see “old” words

Motor response: slower walking down hall

Schema: “Interrupting is rude, helping is nice”

Situation: describing a nice friend

Motor response: offer help to someone else

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Three CBT Approaches to Treating Depression

• Cognitive restructuring (“inside out” approach)– change the content of thoughts

• Behavioral activation (“outside in” approach)– activity scheduling– problem solving– change the function/context of thinking

• function of avoidance• context of literality (ACT defusion, mindfulness)

– make behavior depend less on thinking/mood

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Activity Scheduling in Cognitive Therapy

Pleasurable activities

• “Nothing is meaningful or worthwhile”

Mastery activities (self-efficacy)

• “I am incapable of doing anything”

Behavioral experiments

• “I am incapable of that”

• “It won’t work out”

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Evidence for Cognitive Theories

• Many correlational clinical studies• Some analog experimental studies

– repeating negative statements (Velten)– delay of gratification (cognitive transformations)– self-efficacy manipulations

• Clinical experiments on misattribution– insomnia– social fears

• Cognitive therapy is effective

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Cognitive Therapy Mediation Studies

1) CT is based on cognitive theory– thinking causes emotions and behavior

2) Change in CT is associated with cognitive change as hypothesized– concurrent change correlations

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Component Analysis Study

Cognitive therapy for depression is comprised of cognitive restructuring (CR) and behavioral activation (BA)

• Removing CR does not reduce its effectiveness

• BA is as effective as BA+CR

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5 interpretations of change process

• BA works better because– thinking is irrelevant– BA is better at changing thinking– it improves environment and thinking

• CR and BA are both effective and redundant – both change thinking– both change environment (reinf + punish)

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Assume we have baked delicious deserts sweetened with sugar and honey

If replacing all of the sugar with honey does the sugar not improve the flavor?

Three groups are needed

• Could CR be as effective as CR+BA?

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Cognitive Distortions• Overgeneralization

– Labeling– All-or-nothing thinking (rigidity)

• Mental filter• Ignoring/discounting the positives• Jumping to conclusions

– Mind Reading– Fortune Telling

• Exaggeration/Minimization• Emotional reasoning• "Should" statements (rigid rules)

• Personalizing/Blame

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Schema Activation


Situation: boss gives corrective feedback

Cog. processing Cog. Productsjumping to conclusions“He is criticizing me”

neg. attribution / label “(…because) I am a loser”

mind-reading “(…because) he hates me”

fortune telling “I will get fired”

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Schema Activation


Situation: Partner ends romantic relationship to move away for graduate school. Relationship was very strong, but not long

Cog. processing Cog. Productsneg. attribution “(…because) I am fat / ugly”

judgmental label / filter “I am fat / ugly”

should “I should lose more weight”

fortune telling “I will never find another”

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Question

What are the three components of Beck’s cognitive triad of depression?

Be specific.

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Depressive Thinking

Beck’s Cognitive Triad

Distorted negative thinking about:• Self (low self-esteem)

• World– “nothing is meaningful or worthwhile”

• Future– hopelessness– helplessness (low self-efficacy)

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Question

According to behavioral activation theory, what are the operant

conditioning principles that explain depression?

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Behavioral Theory

Depression episodes start from:• Excessive punishment

– severe stressors => learned helplessness– mild stressors => conditioned depressive affect

• Lack of positive reinforcement

Depression increases/persists due to:• Avoidance of stressors

– avoidance is negatively reinforced– prolongs/worsens problems– results in fewer opportunities for reinforcement

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Question

What primary psychosocial processes underlie the maintenance

and persistence of depression?

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Interpersonal Theories

Interpersonal Behaviors of Depressives• self-denigrating and helpless• reassurance seeking• negative feedback seeking

Consequences Provided by Others• positive reinforcement (e.g., reassurance)

• confirmation of negative self-views• conflict and rejection (punishment)

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Stress Generation HypothesisReciprocal Causation

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Stress Generation

• Passive problem solving, giving up, and avoidance

• Depressive interpersonal behaviors

Two related explanations:

• punishment for (unskillfull) effort

• low self-efficacy

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Models of Substance Abuse

• Positive reinforcement– classically conditioned drug-like responses

• Negative reinforcement (two-process theory)

– classically conditioned drug-opposite responses– escape from withdrawal in high risk situations– tension reduction (self-medication)

• Ineffective coping skills

• Negative thinking

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Models of Substance Abuse

Conditioned responses:• depend on where in the NS the drug acts• depend on the response system (e.g., heart)

• depend on the CS (e.g., holding vs. drinking)– when drug behavior is blocked

• same direction physiology• opposite subjective experience

– when drug behavior is consummated• opposite physiology• same direction subjective experience

• depend on the context

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Relapse Prevention

Goals:

• Prevent lapses

• Prevent escalating to full relapse

• Improve self-efficacy and coping with high risk situations

• Reduce urges

• Accept urges

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Question

Assuming that the patient has a lapse, what three processes could

lead the patient to fully resume their addictive behaviors?

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Relapse Consequences

• Reacquisition – after extinction of CS, minimal repairing of UCS and CS fully reactivates CR

• Reinstatement – after extinction of CS, CS/CR becomes reactivated by recurrence of UCS in a different context

• Abstinence violation effect – the belief that once one has relapsed they should “throw in the towel” (12-step program)

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Reacquisition of Drug CR

CS1 = friend’s garage


CS1 => fear (9/10)


CS1 => no fear (2/10)


CS1 => fear (8/10)

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Reinstatement of Drug CR

CS1 = friend’s garage, CS2 = beach vacation


CS1 => fear (9/10)


CS1 => no fear (2/10)


CS1 => fear (5/10)

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Negative Thinking Patterns

• Positive expectancies of use

• Catastrophic expectancies for not using• Low perceived self-efficacy (helplessness)

– AA belief of powerless over alcohol?

• Negative labeling (“addict” or “alcoholic”)

• Abstinence violation effect

• Emotion-distorted thinking– negative emotion high risk situations

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Automatic Activation of Alcohol Expectancies

Reaction time study:

He was less stressed when he was…drunk

They said they were …drunk

He was more outgoing after he had thebeer

They said it was the… beer

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Question

How is the two-factor theory relevant to understanding and treating

substance abuse?

How is it connected to opponent process theory?

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Two-Factor Theory

CS => UCS => UR

bedroom => heroin => euphoria

bedroom => dysphoria

SD => behavior =>consequence

injection => injection => less dysphoria

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Two-Factor Theory

Stage 1:SD => behavior => consequencelever => press lever => opiate

Stage 2:CS => UCS => UR (assumed)light => opiate => euphoria

Stage 3:SD+CS => more lever pressing

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Opponent Process Theory

Drug-opposite responses function to counteract the drug in advance

• goal is to maintain equilibrium (homeostasis)

• conditioned tolerance is a consequence

• context switching can lead to overdose

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Question

Assuming the patient does not resume addictive behavior, what should be the effect of repeated and prolonged exposure to drug cues?

How does this treatment approach really seem to work in contrast to how it is supposed to work?

What four enhancement methods should help maximize the effectiveness of cue exposure therapy for addictive behaviors?

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Cue Exposure TherapyMethods• In vivo exposure, spaced in multiple contexts

• www.vrworlds2.com/demo.cfm

• Imaginal (interoceptive/emotional) exposure• Extinction reminder• Coping skills rehearsalMechanisms• Respondent (habituation) vs. operant extinction• State-dependent learning of coping skills• Improved self-efficacy• Acceptance of emotions and urges (no “fix”)

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Renewal (Internal Context)CS1 (light) => UCS (shock)

CS1 => fear

CS1 + CS2 (caffeine) => no shock

CS1 + CS2 => no fear (extinction)

CS1 => fear

CS1 => no shock (extinction)

CS1 + CS2 (caffeine) => fear

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Alcohol Exposure Therapy

6 sessions of• in vivo exposure to alcohol• imaginal exposure to trigger events• coping skills (e.g., urge surfing, self-talk)Four conditions• CET + coping skills• CET + psychoeducation• Relaxation + coping skills• Relaxation + psychoeducation

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Extinction of Alcohol Urges

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Extinction of Alcohol Urges

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Cue Exposure Therapy

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Cognitive Restructuring

3 question technique

• What is the evidence for that thought?

• What are alternative interpretations?

• What’s really the worst thing that could happen? How could you deal with it?

Definite short-term effects on emotion.

Little evidence of direct long-term effects.

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Short-Term Effects of Thinking

• Repeating the primes elicits moderately depressed mood among normal participants.

• Unscrambling contextual questions led to less depressed affect (and less corrugator EMG)

Prime: “I feel very sad”• Have all my past feelings changed with time?Prime: “Many things I do turn out wrong”• Don’t I have both good and bad times?• What will I think about this 20 yrs from now?

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Cognitive Restructuring

How can it work even better for long-term change?

• What is the evidence for that thought?

• What are alternative interpretations?

• What’s really the worst thing that could happen? How could you deal with it?

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Learning Theory of Panic

• Interoceptive conditioning

• False alarms

• Catastrophic misinterpretations

• Upward spiral of anxiety/fear

• Vicarious learning

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What do Panic Patients Avoid?

• Driving

• Crowds

• Physical exercise• Intense emotions (sex, rides, movies)

• Humid areas (e.g., hot showers)

• Being alone

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• Medications

• Distraction

• Relaxation

• (easy access to) other people

• Planning ways to escape

Safety Behaviors in Panic Disorder

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Model of Worry in GAD

• Avoidance of harmless situations that are seen as threatening

• Threatening thoughts and images that are– uncontrollable– frequent and intense– varied in content

• Distressing vivid catastrophe images and associated somatic sensations

• Low autonomic arousal (e.g., heart rate)

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Safety Behaviors in GAD

• Excessive information gathering– reassurance seeking– checking on loved ones (e.g., jealousy)

• Ignoring threatening information– e.g., refusal to read obituaries

• Excessive preparation

• Quick shifting between different worries

• Thinking is excessively logical/superficial– suppression of vivid images and sensations

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Avoided Stimuli and Behaviors

Social phobia• threatening social stimuli (faces)

• full participation in social events

• making mistakes

OCD

• distressing situations: toilet seats

• thoughts: thoughts of harming others

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Avoided Stimuli and Behaviors2-factor threat beliefsavoidance prob. severity

PTSD reminders/talk assault never recover

Panic arousal/relax panic death

GAD* image/worry bad things catastrophe

GAD check/reassure infidelity end of relationship

OCD checking fire* death/destitute

OCD filth/clean sick* death

OCD thoughts transgress. death/hell

Social avoid/isolate rejection alone foreveravoid/isolate teasing ostracism

preparation mistakes* rejection

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Orienting Clients to CBT

1. What are the therapy strategies?

2. What is the evidence for the treatment?

3. What is the evidence for the processes of change?

4. What are the causes of their problem and how linked to the change strategies?

5. Identify causes to reduce shame/blame.

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Observational LearningBehavioral Theory

• Children are reinforced for imitating and punished for non-conformity– infant facial mimicry– etiquette– cultural customs

• “When in Rome do as the Romans Do”– Solomon Asch “perception” study

• Seeing others get reinforced is an +SD

• Seeing others get punished is an -SD

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Overjustification Effects Cognitive Theory

• When we situational cues provide external reasons for doing something (e.g., bribes) then it reduces our internal motivation

• External attributions (explanations) reduce internal attributions

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Overjustification Effects Behavioral Theory

• Current bribe offer is an +SD for “do more”– doing more results in more rewards

• Recent received bribe is an +SD for “do less”– doing less results in more bribe offers, which

results in more bribe rewards

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Stopping Overt Behaviors

• Stop reinforcement of problem behaviors

• Provide more reinforcers for alternative or incompatible behaviors

• Punish problem behaviors

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Operant Extinction

Change what happens after the operant response

• Reverse positive reinforcement– withhold reinforcing stimuli– prevent usual increase in reinforcers

• non-contingent reinforcers before response

• Reverse negative reinforcement– maintain punishing stimuli (no escape)

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SuperNanny Extinction

1 Child misbehaves and keeps getting off the naughty spot (and tantrums)

2 Parent keeps returning kid to spot

3 Child stays on naughty spot

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Habituation is:

• a decrease in a response because reinforcers become less potent due to repetition of reinforcers– satiation

• an increase in a response because punishers become less potent due to repetition of punishers

Operant Habituation

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Decrease in an operant response because…

• Habituation

…reinforcers become less potent due to excessive repetition of reinforcers

• Extinction

…reinforcers do longer follow the response

Operant Habituationvs. Extinction

Why Focus on Theory?

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