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PSY343 LECTURE notes.docx

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Neil Rector

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th December 14 9:30 AM TEXTBOOK NOTES 9: Behavior Therapies SKETCH Learning theory  abnormal behavior – mostly acq. & maintained w/ same principles as normal behavior  assessment – continuous, focuses on CURRENT determinants of behavior  people = what they think, feel & do in specific situations  treatment – derived from theory & experimental findings of scientific psychology o methods: precisely specified, replicable, RIGOROUSLY TESTED. o individually tailored to different problems & different people. o Goals & methods: mutually contracted w/ client  Research – evaluates effects of specific techniques on specific problems  Outcome – initial induction of behavior change, its generalization to real-life settings, & its maintenance over time. Radical: symptom = problem Behaviorists disagree w/ one another: are self-reports of subjective units of distress acceptable? Small-n rigorous or large group w/ placebo & no-treatment? 3 C’s of behavior therapy: counterconditioning, contingency mgmt, c-b modification. * Most therapists work with techniques from all 3 viewpoints. COUNTERCONDITIONING “Reciprocal Inhibition” – systematic desensitization: Based on Respondent Conditioning: JOSEPH WOLPE Wrote Psychotherapy By Reciprocal Inhibition (1958) Conditioned fear of buzzer (paired w/ shock)– wouldn’t eat w. buzzer on. Thought maybe he could use eating to inhibit anxiety – fed cats in cages increasingly similar to the cage where the shocks originally happened  extinguished anxiety. Use of deep relaxation or sexual arousal to inhibit anxiety, assertive responses to inhibit social anxiety. Reported >90% success w/ his counterconditioning method THEORY OF PSYCHOPATHOLOGY Anxiety causes most behavior disorders (pattern of responses from sympathetic nervous system. - phys changes: blood pressure & rate increase, decreased circulation to stomach & genitals, more to voluntary muscles, pupil dilation, dry mouth. - can be learned: a response evoked in temporal contiguity w/ a given stimulus & subsequently the stimulus can evoke the response (but couldn’t before.) classical respondent conditioning: Pavlovian generalization: stimuli physically similar to original conditioned stimulus evoke same response.  generalization gradient / anxiety hierarchy. What about generalized / free-floating anxiety? – Conditioned to fear omnipresent stimuli, like your body Anxiety can lead to secondary symptoms like disturbed sleep, impaired memory, tremors, gastrointestinal stuff And then THESE can ELICIT anxiety as well!  vicious cycle Also often  AVOIDANCE. So cuzza these stuffs “Anxiety” is often not the primary complaint. Also you can have more than 1 anxiety, so fixing your elevator phobia might not cure your insomnia Symptom substitution: myth of ppl who see all behavior as interconnected by 1 underlying dynamic conflict. Successful elimination of a specific anxiety & specific secondary sx will NOT  new sxs THERAPEUTIC PROCESSES Systematic Desensitization In vivo desensitization Assertiveness Training Graduated homework assignments Sexual Arousal Sensate focusing Behavior Activation Stimulus Control CONTINGENCY MANAGEMENT – “Behavior Modification” - Behavior Analysis Based on Operant conditioning THEORY OF PSYCHOPATHOLOGY Reinforcements & Punishments Prompt THERAPEUTIC PROCESSES 1. Operationalize Target Behavior 2. Identify Behavioral Objectives 3. Measures (behavioral, baseline) 4. Naturalistic Observation 5. Monitor Results Categories of Contingency Management Procedures:  institutional control  self-control  mutual control / contracting  therapist control  aversive control COGNITIVE-BEHAVIOR MODIFICATION THEORY OF PSYCHOPATHOLOGY THERAPEUTIC PROCESSES Biofeedback Neurobiofeedback: EEG feedback Attribution theory: Learned optimism: MEICHENBAUM: Self-instructional training: Stress inoculation Problem-Solving Therapy: DIALECTICAL BEHAVIOR THERAPY MARSHA LINEHAN Skills training & Crisis intervention – behavior therapy + Mindfulness – meditation pracices PROCESS OF CHANGE: behavioral & cog methods – exposure, skills training, contingency management, problem solving, Radical acceptance: accept dysfxnal behavior AND change it Dialectic: apparent contradiction between opposing forces. In this case, of accepting AND changing behavior THERAPEUTIC RELATIONSHIP Validation: empathy for DBT Modeling PRACTICALITIES OF BEHAVIOR THERAPY EFFECTIVENESS OF BEHAVIOR THERAPY Small-N Designs Effectiveness w/ Children - Effectiveness w/ Adults - Effectiveness w/ Couples & Families - Effectiveness of Specific Behavioral Methods  Relaxation Training o Autogenic training  Social Skills Training  Stress Inoculation  Biofeedback  Behavioral Activation  Self-Statement Modification  Contingency Management  Behavioral PARENT Training  Problem Solving Effectiveness for Specific Disorders  OCD  Panic Disorder  Personality Disorders  Mental Retardation  Eating Disorders  ADHD  Schizophrenia  Anger Disorders  Cigarette Smoking  Nocturnal Enuresis  Migraine Headache  Insomnia  Irritable Bowel Syndrome CRITICISMS PSYCHOANALYTIC HUMANISTIC CULTURAL INTEGRATIVE FUTURE DIRECTIONS 10: Cognitive Therapies MAIN GOAL: THEORY OF PERSONALITY THEORY OF PSYCHOPATHOLOGY THERAPEUTIC RELATIONSHIP THERAPEUTIC PROCESS 11: Systemic (Family) Therapies MAIN GOAL: THEORY OF PERSONALITY THEORY OF PSYCHOPATHOLOGY THERAPEUTIC RELATIONSHIP THERAPEUTIC PROCESS EFFECTIVENESS 65% treatment success rate in couple/fam ther …. Approximately 2 / 3 benefit significantly work as well & sometimes better than other forms of therapy CRITICISMS CBT PSYCHOANALYTIC HUMANISTIC CULTURAL INTEGRATIVE FUTURE DIRECTIONS 15: Integrative & Eclectic Therapies MAIN GOAL: POPULARITY: Occam’s Razor Multimodal: Comprehensive coverage of all modalities – eclectic. Arnold Lazarus THEORY OF PERSONALITY & PSYCHOPATHOLOGY BASIC ID: a multimodal assessment template to figure out how best to treat a specific client Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal relationships, Drugs / Biology * incest tends to occur most frequently in families with overly loose or non-existent boundaries ???? THERAPEUTIC RELATIONSHIP THERAPEUTIC PROCESS Mechanisms of Change:  B – pos / neg reinforcement, counterconditioning, extinction, stimulus control  A – acknowledge, clarify & recognize FEELINGS, abreaction:  S – tension release, sensory pleasuring  I – coping images, change self-image  C – cog. Restructuring, heighten awareness, EDUCATION  I – modeling, develop soc. Skills like assertiveness, disperse unhealthy collusions, nonjudgmental acceptance  D – identify medical illness, stop subst. abuse, eat & exercise better, psychotropic meds when needed Client’s Role: important, his presenting problem & goals direct treatment. – Mutually select goals. Therapist’s Role: create a modality profile EFFECTIVENESS Integrative: THEORY OF PERSONALITY & PSYCHOPATHOLOGY THERAPEUTIC RELATIONSHIP THERAPEUTIC PROCESS EFFECTIVENESS CRITICISMS CBT PSYCHOANALYTIC HUMANISTIC CULTURAL INTEGRATIVE FUTURE DIRECTIONS 16: Conclusions & Current Debates TRANSTHEORETICAL APPROACH STAGES OF CHANGE  Precontemplation  Contemplation  Preparation  Action  Maintenance  Recycling  Termination LECTURE NOTES DIALECTICAL BEHAVIOR THERAPY october 28 st nd rd 1 Wave – traditional behavior therapy 2 Wave - CBT 3 Wave – DBT, Acceptance & Commitment Therapy DBT Acceptance and commitment therapy act :here pat gets a lot of attention BT uses specific strategies for specific disorders – this is seen even more clearly in the case of DBT Introduced specially for BPD  unstable sense of self   affect instability, emotional dysregulation (intense mood swings, very reactive)  imagined or real fear of relationships ending  intense and unstable relationships  impulsivity in spending, Subst abuse, sexual behavior  suicidal and self mutilating behv/  report feelings of emptiness/ difficulty managing & expressing emotions like anger  sometimes dissociative symptoms ( psychotic) DBT DBT ASSUMPTIONS OF BPD o Lack key emotional regulation, interpersonal & intrapersonal skills o Environmental factors might inhibit these skills or prevent them from being used  reinforcement of pathological behaviors  DBT designed to facilitate the learning, integration & generalization of these skills BASED on the idea that Behavior is increased or maintained when reinforced, reduced when punished, extinguished when reinforcements are removed DBT looks for specific triggers of dysfxnal behavior, & try to manipulate contingencies to modify behaviors Ex: Avoidance as internal contingency of pathological behavio “feeling of relief”  use praise or attention as external factor to increase desired behavior Contingencies in environment are complex, but will continue in the presence of int or ext reinforcement DBT emphasizes the relationship between the individual and the context - which reinforces his behaviors 5 MAJOR AREAS TARGETED BY DBT 1) Affective Dysregulation: issue of reactive mood states: heightened emotional response. inappropriate and/or excessive anger 2) Behavioral Dysregulation: impulsivity, self-mutilation, suicidal gestures or attempts 3) Interpersonal aspects: real or imagined fear of abandonment 4) Self- Dysregulation: identity disturbance, unstable self-image, chronic feelings of emptiness 5) Cognitive Dysregulation: Transient stress-related paranoid ideation or severe dissociative symptoms Heightened emotional response system – could have genetic and/or neurobiological causes - (5htt gene / short allele of 5ht  genetic vulnerability) Or vulnerability cud derive from childhood experiences that have affected the brain structures that deal with emotional regulation Emotional dysregulation Might lead to both behavioral and cognitive dysfunctions   inability to access problem-solving tools & previous problem-solving experiences   tendency to act impulsively, w/o considering consequences  which may  guilt & shame for acts, reinforcing the initial problems with emotional arousal! Impulsive behaviors: (including suicidal attempts & substance use) potentially consequences of high emotional dysregulation &/OR coping mechanisms – like self-medication THERAPEUTIC IDEAS OF DBT GOAL = Identify and modify INVALIDATING ENVIRONMENTS: caregiver / environment respond insensitively, inappropriately, erratically to the at-risk individual’s emotional reactions  invalidating environment is probably a cause of fear of abandonment  hyper-vigilance for signs of rejection  invalidating environment can  personal invalidation “I shouldn’t feel x, I’m bad, I make trouble” Dialectics:  EDUCATE young adolescents, so they understand their emotional experiences  teach ACCEPTANCE The heart of problem = family failed to teach the child to self regulate emo (by avoiding or blaming the ind) .’. dbt want to und how these has happened (2/3 or ¾ of BPD patients have a history of some form of childhood abuse) nd A 2 key goal is to identify & modify self-invalidating cognitions and resulting emot.& behav. consequences Notion of Dialectic: Grounded in philosophy and science, related to the interconnectedness between a person in their totality of existence - how patient acts affects therapist and how therap act = affect client o Ex. Dealing with pain
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