COUN A221F Lecture 7 CBTII Behavioral therapy_Done.pdf

LECTURE 7: COGNITIVE BEHAVIORAL THERAPY II: BEHAVIORAL THERAPY COUN A221F Theories and Practice in Counselling and Mental Health Hong Kong Metropolitan University LEARNING OUTCOMES ▪ Understand the assumption of behavioral therapy on problematic behaviors ▪ Recognize the concepts of classical con...

LECTURE 7: COGNITIVE BEHAVIORAL THERAPY II: BEHAVIORAL THERAPY COUN A221F Theories and Practice in Counselling and Mental Health Hong Kong Metropolitan University LEARNING OUTCOMES ▪ Understand the assumption of behavioral therapy on problematic behaviors ▪ Recognize the concepts of classical conditioning, operant conditioning, and social cognitive therapy, including extinction and spontaneous recovery ▪ Apply the procedure of systematic desensitization and schedule of reinforcement in daily lives ASSUMPTION OF BEHAVIOURAL THERAPY ▪ Both adaptive and maladaptive behaviors are acquired, maintained, and changed in the same way. ▪ This means that behavioral case conceptualization involves an assessment of context within which a behavior occurs: ▪ Hypothesis about the causes, maintaining factors, and treatment interventions (Truax, 2002). ▪ Psychopathology may be a function of inadequate learning or skill deficits. BEHAVIOUR CHANGE ELEMENTS ▪ Increase knowledge, skills, and change-enhancing. ▪ Decrease behaviors. ▪ Reduced avoidance and self-defeating or problematic activity usually provides short-term relief, but this behavioral reduction creates many more problems include further reduction of mood, loss of self-worth, increased avoidant behavior, increased anxiety about avoided situation, feelings of isolation, and loss of productivity. PART A: CLASSICAL CONDITIONING ▪ Stimulus is any event that can potentially influence behavior, whereas a response is a particular instance of a behavior ▪ Rate of response is the frequency with which a response occurs in a certain period of time ▪ Elicited Behavior is behavior that occurs automatically in response to a stimulus HABITUATION AND SENSITIZATION ▪ Habituation: Reduced responsiveness to a relatively meaningless stimulus when the stimulus is repeatedly presented, such as clock sound, sounds on the street, football players ignore the audience. ▪ Sensitization: persistence of a response or increased responding to a stimulus. ▪ Dishabituation: occurs when a novel stimulus (such as tone) is presented with the eliciting stimulus. The organism begins responding to the previous stimulus again. (not the tone). WHAT DO YOU THINK OF? BASIC CONDITIONING PHENOMENA ▪ Acquisition is the process of developing and strengthening a conditioned response through repeated pairings of an NS and a UCS. For example, association between the tone and shock. ▪ The maximum amount of conditioning that can take place in a particular situation is called asymptote of conditioning. ▪ Extinction: a conditioned response can be weakened or eliminated when the CS is repeatedly presented without the UCS. ▪ Spontaneous recovery: the reappearance of the CR following a rest period after extinction. In general, each time the response recovers it is somewhat weaker and extinguishes more quickly than before. COUNTER-CONDITIONING ▪ Counter-conditioning: two stimuli can become associated with each other even though both elicit strong responses initially. The response to a CS is reversed by pairing this stimulus with a UCS that promotes the opposite type of reaction. ▪ Systematic desensitization TREATMENT OF CLASSICAL CONDITIONING: RELAXATION TRAINING ▪ Progressive muscle relaxation (PMR): By pairing muscle-tension conditioned stimulus with pleasurable relaxation, muscle tension as a stimulus or trigger for anxiety is extinguished. ▪ Breathing retraining ▪ Stretching ▪ Meditation ▪ Imagery ▪ Hypnosis SYSTEMATIC DESENSITIZATION ▪ Training techniques in PMR ▪ Build fear hierarchy ▪ Pairing the PMR techniques with the fear hierarchy TYPES OF SYSTEMATIC DESENSITIZATION ▪ Imaginal or In Vivo exposure (real life situation) desensitization ▪ Research suggests that in vivo exposure desensitization are more effective than imaginal procedures (Emmelkamp, 1994). ▪ Massed (intensive) or spaced (graduated) exposure sessions ▪ Research suggests that massed and spaced exposure desensitization yield no significant differences (Ost, Alm, Brandberg, & Breitholz, 2001). TYPES OF SYSTEMATIC DESENSITIZATION ▪ Interoceptive exposure ▪ Identical to other exposure techniques except the target exposure stimuli are internal physical cues. ▪ For example, hyperventilation, running in place, holding one’s breath to produce dizziness and increased heart rate. ▪ Virtual reality exposure VIDEO SHARING ▪ Role Play: Behaviour Therapy ▪ https://www.youtube.com/watch?v=zdsaW_TSzHU ▪ Therapists Are Using VR Headsets To Cure Phobias ▪ https://www.youtube.com/watch?v=GMttQHMjbJo ▪ newlife330 靜觀呼吸練習 ▪ https://www.youtube.com/watch?v=MoS-CXf1Vh8&t=1s ▪ Overcoming A Dog Phobia (Cynophobia) ▪ https://www.youtube.com/watch?v=LIafk4RAjAA PART B: OPERANT CONDITIONING ▪ He was a firm believer of the idea that human free will was an illusion and any human action was the result of the consequences of that same action. ▪ The process by which a response becomes more or less likely to occur depending on its consequences: reinforcement or punishment. CONSEQUENCES OF BEHAVIOR ▪ A neutral consequence neither increases or decreases the probability that the response will recur. ▪ Reinforcement strengthens the response or makes it more likely to recur. ▪ Punishment weakens a response or makes it less likely to recur. ▪ While reinforcer promotes behavioral repetition, the responses do not have to be performed the same way. TYPES OF REINFORCEMENT ▪ Positive reinforcement ▪ When a pleasant consequence follows a making the response more likely to occur again. response, TYPES OF REINFORCEMENT ▪ Negative reinforcement ▪ When a response is followed by the removal of something unpleasant, making the response more likely to occur again. TYPES OF PUNISHMENT ▪ Positive punishment ▪ When something unpleasant occurs after a behavior. ▪ Negative punishment ▪ When something pleasant is removed after a behavior. EXERCISE Situation A child gets a candy when he makes eye contact with the teacher in greeting. A child yells in class loses a token from the token board (collection of tokens to exchange for a prize). A child breaks a toy is forbidden to play with the toys A child eats more vegetable to stop his mother’s talking. A child being scolded by the teacher for making noise in class. A child eats expired food and got stomachache. A child studies hard so that he does not get bad grades. A 6-year-old girl with autism screamed when working on English exercises in class. The teacher gave her “time-out” by asking her to stand outside the classroom for 5 minutes. Positive/ Negative? Reinforcement/ Punishment? SCHEDULES OF REINFORCEMENT FACTORS INFLUENCING ACQUISITION Interval Intensity Prior experience with conditional and unconditional stimulus (behaviour and reinforcement/ punishment) Number of CS-US (behaviour and reinforcement/punishment) pairings SIDE EFFECT OF EXTINCTION ▪ Extinction burst: a temporary increase in the frequency and intensity of responding when extinction is first implemented. ▪ For example, when we plug money into a candy machine and receive nothing in return. We do not just give up and walk away, we instead press the button several times and often with increasing amount of force. ▪ Increase in variability: For example, if candy machine stolen our money, we will likely vary the way we push the button, such as holding it down for a second before releasing it. SIDE EFFECT OF EXTINCTION SIDE EFFECT OF EXTINCTION ▪ Emotional behavior: The emotional reaction induced by withdrawal of an expected reinforcer is called frustration. Frustration maybe sufficiently severe to include aggressive reactions. ▪ Aggression: For example, pigeon whose key pecking is placed on extinction will reliably attack another pigeon. People often become angry with those who block them from obtaining an important goal. OPERANT CONDITIONING IN TREATMENT Token economy Social Skills Training TOKEN ECONOMY ▪ Provide with points or chips for engaging in desirable behaviors, to obtain goods or privileges. ▪ Operationalize the target behaviors and identify behavioral objectives. ▪ Develop a system for measuring the target behaviors. ▪ Identify contingencies that maintain undesirable behaviors and desirable behaviors. ▪ Nearly 100 studies have shown that tangible positive reinforcement may undermine intrinsic motivation (cameron & Pierce, 1994). SOCIAL SKILLS TRAINING ▪ Assertive individual speaks up, expresses feelings, and let need be known without dominating others. ▪ Includes: introducing oneself to strangers, giving and receiving compliments, saying no to requests from others, making requests of others, speaking up or voicing an opinion, and maintaining social conversations. display of negative feelings, involving standing up for oneself and engaging in conflict COMPONENTS OF ASSERTIVENESS expression of and dealing with personal limitations, involving a readiness to admit mistakes and deficits initiating assertiveness, involving making one's opinion known praising others and accepting praise Psychoeducation Verbal feedback with concrete examples STRATEGIES FOR SOCIAL SKILLS TRAINING Point out the consequences of problematic behaviors (e.g., “I find myself tuning out of the conversation when you avoid eye contact with me.”) Providing specific suggestion (e.g., “Could you try starting three sentences with the words I feel… or I think…?) Video feedback Modelling Role play PART C: SOCIAL COGNITIVE THEORY ▪ Social cognitive theories emphasize how behavior is learned and maintained: ▪ through observation and imitation of others, ▪ positive consequences, ▪ cognitive processed such as plans, expectations, and beliefs. SELF EFFICACY ▪ The belief in your ability to perform a particular behavior to achieve a certain outcome (Bandura, 1989; 1994) ▪ A = the behavior’s antecedents (everything that happens just before the maladaptive behavior is observed) ▪B = behavior (concrete behavioral terms; measurable) ▪C = the behavior’s consequences (everything that happens just after the maladaptive behavior occurs) PART D: BEHAVIOURAL ABCS (SOMMERS-FLANAGAN, 2003) BEHAVIOUR CHANGE ELEMENTS ▪ Increase the quantity and quality of positively reinforced behavior, as well as improve coping behaviors to deal more adaptively with negative life situations. ▪ Record activities until they become more habitual. ▪ Try to encourage client to make an internal attribution for the completion of behavioral assignments. BEHAVIOUR IDENTIFICATION BEHAVIOUR IDENTIFICATION ANTECEDENT (TRIGGERS) IDENTIFICATION ANTECEDENT (TRIGGERS) IDENTIFICATION ANTECEDENT (TRIGGERS) IDENTIFICATION CONSEQUENCE IDENTIFICATION CONSEQUENCE IDENTIFICATION SUMMARY GOAL SETTING EXERCISE: ASSESS WHETHER THE GOAL IS GENERAL OR SPECIFIC Goals Talk to my boss about getting paid for working overtime Be less demanding of my friends Stop smoking by the end of the month Take better care of my health Get along better with my parents Do a pleasant activity with my partner on a weekly basis Learn better parent management skills for when my eight-year-old son has emotional distress General or Specific? IN-CLASS EXERCISE (1) ▪ A client with whom I am working has a fear of dirt. She remarks that her parents would always yell and scream at her when she was younger, playing in the dirt. In terms of behavioral principles, which approach most likely accounts for the client’s fear? ▪ Modeling ▪ Classical conditioning ▪ Operant conditioning ▪ Flooding IN-CLASS EXERCISE (2) ▪ Associated mostly with the mentally retarded and serve mental disorders, this technique uses something symbolic (e.g., a coin, coupon) that is later exchanged for a “backup reinforcer.” ▪ Response cost ▪ Stimulus control ▪ Token economy ▪ Stimulus economy ▪ Response economy IN-CLASS EXERCISE (3) ▪ Which of the following factor is NOT a part of Bandura's triadic reciprocal interaction system? ▪ awareness ▪ behavior ▪ beliefs ▪ environment IN-CLASS EXERCISE (4) ▪ If a client, who is afraid of snakes, is asked to come closer to a snake and then gradually touch a snake, this procedure is most likely: ▪ desensitization ▪ imaginal flooding ▪ in vivo exposure ▪ virtual reality therapy REFERENCES ▪ Archer, J., & McCarthy, C. J. (2007). Theories of Counseling and Psychotherapy: Contemporary Applications.Upper Saddle River,NJ: Merrill Prentice Hall. ▪ Corey , G (2008). Theory and Practice of Counseling and Psychotherapy,Thomson Learning ▪ Deborah, D., & Keith, S. D. (2009). Evidence-based Practice of Cognitive Behavioral Therapy. US: Guilford Press. ▪ Gerald, C. (2013). Theory and Practice of Counseling and Psychotherapy with Course Mate. (9th ed.). US: Cengage. ▪ Mcleod, J. (2003) An Introduction to Counselling. (3rd ed.). Open University Press. ▪ Raymond, J. C., & Danny, W. (2005). Current Psychotherapies. (7th ed.). Thomson Brooks / Cole. ANSWER Goals Talk to my boss about getting paid for working overtime Be less demanding of my friends Stop smoking by the end of the month General or Specific? Specific and measurable General Specific and measurable Take better care of my health General Get along better with my parents General Do a pleasant activity with my partner on a weekly basis Learn better parent management skills for when my eight-year-old son has emotional distress Specific and measurable Specific