Behavioral and CBT PowerPoint presentation

Psychotherapies
Behavioral Therapy and CBT

Behavior Therapy
 A set of clinical procedures relying on experimental
findings of psychological research
 Based on principles of learning that are
systematically applied
 Treatment goals are specific and measurable
 Focusing on the client’s current problems
 To help people change maladaptive to adaptive
behaviors
 The therapy is largely educational - teaching
clients skills of self-management

Four Aspects of Behavior
Therapy
1. Classical Conditioning
 In classical conditioning certain respondent behaviors, such
as knee jerks and salivation, are elicited from a passive
organism
2.Operant Conditioning
 Focuses on actions that operate on the environment to
produce consequences
 If the environmental change brought about by the behavior
is reinforcing, the chances are strengthened that the
behavior will occur again.
 If the environmental changes produce no reinforcement,
the chances are lessened that the behavior will recur

Four Aspects of Behavior
Therapy
 3. Social Learning Approach
 Gives prominence to the reciprocal
interactions between an individual’s behavior
and the environment
 4. Cognitive Behavior Therapy
 Emphasizes cognitive processes and private
events (such as client’s self-talk) as mediators
of behavior change

Process (Brackham & Silberman,1971)
Therapy involves the following steps;
 Defining the problem
 Developmental history
 Establishment of Specific goals
 Determining the best methods for change.

Focus of behavioural techniques
 Changing and controlling the antecedents of
behaviour.
 Changing and controlling the reinforcement of
behaviour.
 Learning social skills.
 Using models to recognize unwanted behaviour and
to learn desirable behaviour.
 Using imagery to extinguish and/or practice
behaviour.

Therapeutic Techniques
 Relaxation Training ~ to cope with stress.
 The client helped focus on the muscles of the body
while breathing in and out.
 Systematic Desensitization ~ for anxiety and
avoidance reactions.
 The anxious person is helped to relax in the face of the
anxiety producing stimulus. The person is systematically
desensitized to the fearful object or situation through a
gradual exposure to it, while in a relaxed state.

Techniques …
 Modeling ~ observational learning
 Live modeling is combined with gradual client practice
 Assertion Training ~ social-skills training
 Teach clients how to stand up for their rights and
cope with life’s challenges.
 Multimodal Therapy ~ a technical eclecticism

Techniques …
 Flooding
 a client is made to stay in the feared situation to
experience the anxiety which it evokes .
Prolonged & intensive in vivo or imaginal
exposure to highly anxiety-evoking
stimuli without the opportunity to avoid them
 Self-Management Programs ~ “giving
psychology away”

Self management (Coon, 2013 )
 Covert Sensitization: Aversive imagery is used
to reduce occurrence of an undesired response
 Thought Stopping: Aversive stimuli are used to
interrupt or prevent upsetting thoughts
 Covert Reinforcement: Using positive imagery to
reinforce desired behavior
 Tension Release Method: Procedure of deep
relaxation

Techniques …
 Eye Movement Desensitization and
Reprocessing (EMDR)
 An exposure-based therapy that involves
imaginal flooding, cognitive restructuring, and
the use of rhythmic eye movements and other
bilateral stimulation to treat traumatic stress
disorders and fearful memories of clients
 Reduces fear and anxiety by holding
upsetting thoughts in your mind while rapidly
moving your eyes from side to side

Reinforcement and token
economies
 Tokens: Symbolic rewards like poker chips, gold stars,
or stamps that can be exchanged for real rewards
 Can be used to reinforce positive responses
immediately
 Effective in psychiatric hospitals and sheltered care
facilities
 Target Behaviors: Actions or other behaviors a therapist
seeks to change
 Token Economy: Patients get tokens for many socially
desirable or productive behaviors; they can pay tokens
for tangible rewards and for undesirable behaviors

Cognitive Therapy: Introduction
 Therapy that helps clients change thinking
patterns that lead to problematic behaviors
or emotions
 Based on the premise that irrational
thought processes are a cause of
maladaptive behaviors
 Cognitive therapy is VERY effective in
treating depression, shyness, and stress

Cognitive Behavioral Therapy
(CBT)
 "Cognitive" refers to our thoughts.
 "Behavioral" refers to our actions.
 Depression has most to do with our
feelings.

Approaches of Cognitive therapy
 Rational Emotive Behavioral Therapy
(Albert Ellis)
 Cognitive Therapy (Aaron Beck)
 Cognitive Behavioral Modification
(Donald Meichenbaum)

A. Rational Emotive Behavioral
Therapy (REBT)
 Stresses thinking, judging, deciding, analyzing, and doing.
 Assumes that cognitions, emotions, and behaviors
interact and have a reciprocal cause-and-effect
relationship.
 Is highly didactic, very directive, and concerned as much
with thinking as with feeling.
 Teaches that our emotions stem mainly from our beliefs,
evaluations, interpretations, and reactions to life situations
 Attempts to change irrational beliefs that cause emotional
problems

The Therapeutic Process
 Therapy is seen as an educational
process
 Clients learn:
 To identify and dispute irrational beliefs that
are maintained by self-indoctrination
 To replace ineffective ways of thinking with
effective and rational cognitions
 To stop absolutistic thinking, blaming, and
repeating false beliefs

1. View of Human Nature
 We are born with a potential for both rational
and irrational thinking
 We have the biological and cultural tendency to
think crookedly and to needlessly disturb
ourselves
 We learn and invent disturbing beliefs and keep
ourselves disturbed through our self-talk
 We have the capacity to change our cognitive,
emotive, and behavioral processes

3. Irrational Ideas
 Irrational ideas lead to self-defeating
behavior
 Some examples:
 “I must have love or approval from all the
significant people in my life.”
 “I must perform important tasks competently
and perfectly.”
 “If I don’t get what I want, it’s terrible, and I
can’t stand it.”

B. Aaron Beck’s Cognitive
Therapy (CT)
 Insight-focused therapy
 Emphasizes changing negative thoughts and
maladaptive beliefs
 Theoretical Assumptions
 People’s internal communication is accessible to
introspection
 Clients’ beliefs have highly personal meanings
 These meanings can be discovered by the client
rather than being taught or interpreted by the
therapist

Theory, Goals & Principles of CT
 Basic theory:
 To understand the nature of an emotional episode or disturbance
it is essential to focus on the cognitive content of an individual’s
reaction to the upsetting event or stream of thoughts
 Goals:
 To change the way clients think by using their automatic thoughts
to reach the core schemata and begin to introduce the idea of
schema restructuring
 Principles:
 Negative Automatic Thoughts (NATs): personalized notions that
are triggered by particular stimuli that lead to emotional
responses

More on principles…
 The cognitive principle: it is interpretations of events, not
events themselves.
 The behavioural principle: what we do has a powerful influence on our
thoughts and emotions.
 The continuum principle: mental-health problems are best conceptualised
as exaggerations of normal processes.
 The here-and-now principle: it is usually more fruitful to focus on current
processes rather than the past.
 The interacting-systems principle: it is helpful to look at problems as
interactions between thoughts, emotions, behaviour and physiology and the
environment.
 The empirical principle: it is important to evaluate both our theories and our
therapy empirically.

CT’s Cognitive Distortions
 Overgeneralization: taking a single incident or point
in time and using it as the sole piece of evidence for a
broad conclusion.
 Filtering: Interpreting events based on what has
happened in the past. “I can’t trust men, they only let you
down.” A person ignores all of the good things in life and
focuses solely on the negative. You see everything
as going wrong.
 Mind reading: This is when you assume what
someone is thinking without really knowing.

Cognitive Distortions …
 Magnification and minimization: exaggerating
the importance of shortcomings and
problems while minimizing the importance of
desirable qualities.
 Catastrophising: Exaggerating the impact of
events. Imagining the worst case scenario.
“I am never going to be able to find somewhere
to live. I am going to become homeless and starve
to death.”

Cognitive Distortions …
 Personalizing: an individual believes that
everything they do has an impact on external
events or other people. People frequently blame
the self for any unpleasant event and taking
responsibility for others feelings and behaviours.
“It’s alnl my fault, I must have done something
wrong.”
 Labeling and mislabeling: making a judgment
about yourself or someone else as a person.

Distortions …
 Should statements: Living in the world of the
“shoulds”, “oughts” and “musts” is one of the most
common thinking errors. Thinking this way results in
feelings of guilt, shame and failure.
“I must give up heroin.” “I should be nicer to him.”
 Polarized thinking: all-or-nothing thinking;
everything’s either black or white, never shades of
grey in between.
“If I fail one test means I am a total failure”

C. Donald Meichenbaum’s Cognitive
Behavior Modification (CBM)
 Focus:
 Client’s self-verbalizations or self-statements
 Premise:
 As a prerequisite to behavior change, clients
must notice how they think,
 feel, and behave, and what impact they
have on others
 Basic assumption:
 Distressing emotions are typically the result of
maladaptive thoughts

Meichenbaum’s CBM
 Self-instructional therapy focus:
 Trains clients to modify the instructions they give to
themselves so that they can cope
 Emphasis is on acquiring practical coping skills
 Cognitive structure:
 The organizing aspect of thinking, which seems to
monitor and direct the choice of thoughts
 The “executive processor,” which “holds the
blueprints of thinking” that determine when to
continue, interrupt, or change thinking

Behavior Change & Coping
(CBM)
 3 Phases of Behavior Change
 1. Self-observation
 2. Starting a new internal dialogue
 3. Learning new skills
 Coping skills programs – Stress inoculation
training (3 phase model)
 1. The conceptual phase
 2. Skills acquisition and rehearsal phase
 3. Application and follow-through phase

Introduction
 Modern CBT is derived from BT (emphasis
behaviour change to overcome mental health
problems), and cognitive therapy CT (to
understand and change meaning of events).
 Problems described in terms of the
interactions between four ‘systems’:
 The cognitive system – what a person thinks,
imagines, believes.
 The behavioural system – what they do ort
observed by others.
 The affective system – their emotions.

 The physiological system – what happens to
their body, such as autonomic arousal or
changes in appetite.
 We distinguish three ‘levels’ of cognition:
 Negative automatic thoughts (NATs) –
specific thoughts that arise spontaneously in
various situations- negatively effect on mood.
 Dysfunctional assumptions – ‘rules for living’
that guide behaviour and expectations, and
are often in conditional (if … then …) form.

 Core beliefs – general beliefs about oneself,
other people etc operate across a wide range
of situations (unconscious).
 Psychological problems have varying
cognitions, in content, style or both – e.g.
in anxiety there is a preoccupation with
threat, and associated biases towards
perceiving threat.

CT’s Cognitive Triad
 Pattern that triggers depression:
 1. Client holds negative view of themselves
 2. Selective abstraction: Client has tendency
to interpret experiences in a negative manner
 3. Client has a gloomy vision and projections
about the future

Other examples …
 oneself (guilt, blame, self-criticism) – ‘I’m
useless, inadequate, lazy …’;
 the world, and current and past experience
(selective attention to the negative,
anhedonia, etc.) – ‘Nothing is worthwhile,
everything works out badly, no one cares
about me …’;
 the future (pessimism, hopelessness) – ‘It
will always be like this, I’ll never get better,
there’s nothing I can do …’.

Primary symptoms of depression
 Loss of energy and interest lead to
thoughts such as ‘It’s not worth it, I’ll wait
until I feel better’.
 Poor memory, concentration, etc., may
lead the client to think ‘I’m stupid’ or ‘I
must be going senile’.
 Loss of sexual interest and irritability may
be interpreted as indicating ‘My marriage
has major problems’.

Goals of CBT for Depression
 helping the client to counteract any negative
cognitive biases and develop a more balanced
view of himself, the world and the future;
 restoring activity levels, especially activities
that bring a sense of pleasure or achievement;
 increasing active engagement and problem-
solving.

Treatment components
 Behavioural strategies, including activity
scheduling and graded task assignments.
 Early cognitive strategies, including distraction
and counting thoughts.
 The main cognitive behavioural work of
monitoring and testing Negative Automatic
Thoughts.
 Relapse prevention, including working with
dysfunctional assumptions and/or core beliefs,
and revising earlier strategies

Treatment Strategies
 Dealing with Negative Automatic Thoughts
 Medication; anti-depressants
 Dealing with Suicidal Thoughts
 Exploring and working with reasons for suicide
 Structured problem solving
 Identify problem
 Generate a list of possible solutions
 Gauge the best solution/alternative
 Breakdown into achievable steps

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