cognitive-behavioral therapies, part i psyc 4500: introduction to clinical psychology brett deacon,...
TRANSCRIPT
Cognitive-Behavioral Therapies,
Part I
PSYC 4500: Introduction to Clinical Psychology
Brett Deacon, Ph.D.
November 27, 2012
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
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