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Chapter 14

Clinical Psychology Chapter 14.docx

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John Stephens

Chapter 14- Psychotherapy: Behavioural and Cognitive-Behavioural Perspectives Origins of the Behavioural Approach • Definition – Clinical work that aligns itself with the study of human behaviour – Highly diversified field – Scientific emphasis – De-emphasis of inferred variables • Origins – Classical conditioning – Learning theory – Systemic desensitization • Excellent efficacy and effectiveness – Operant tradition • Classrooms, prisons, mental institutions • Better for group processes B.F. Skinner – Would not be happy with cognitive behavior therapy because he believed everything was observable Techniques of Behaviour Therapy • Important Factors – Relationship between therapist and client • The bond, relationship and atmosphere is key – Use of multiple techniques • Broad spectrum behavioural therapy – Detailed analysis • SORC model • Needs to be replicable • Very big on articulating with the use of psychometrics Systematic Desensitization • Wolpe (1958) Psychotherapy by reciprocal inhibition • Reciprocal Inhibition “If a response antagonistic to anxiety can be made to occur in the presence of anxiety-provoking stimuli so that it is accompanied by a complete or partial suppression of the anxiety responses, the bond between the stimuli and the anxiety response will be weakened” (Wolpe, 1958, p.71). • If you practice being relaxed in an anxiety provoking situation, eventually it will not make you anxious anymore • Create another response to an anxiety-provoking stimuli • Procedures • History of problem • After an intake, become more specific about elements around their phobia • Determining treatment • Assessing appropriateness • Briefing the patient • Relaxation training • Key piece is breathing • Development of anxiety hierarchy • Relaxation techniques • Muscle tensing then release • Possible use of hypnosis • Breathing exercises • Anxiety hierarchy • Difficulties identified • Ordered by anxiety level • Low to moderate to extreme • Relaxation practiced at each level of hierarchy • Rationale • Counterconditioning: the substitution of relaxation for anxiety • Extinction of behaviours: when the patient repeatedly visualizes anxiety-generating situations but without ensuing bad experiences, the anxiety responses are eventually extinguished • Habituation • Positive reinforcement Exposure Therapy • In-vivo or in imagination • Graded or maximal (flooding) – Flooding would be someone who is afraid of snakes putting them in a bin with snakes • Characteristics of effective exposure – Longer duration better than shorter – Repeat until anxiety subsides – Graduated • Graduation isn’t as subtle, you don’t move back – Client must attend to feared stimulus – Client must experience anxiety Exposure Therapy for Panic Disorder • Client placed into anxiety causing situation • External cues • Interoceptive cues for panic • Start to look at internal cues and exemplify them or exaggerate • Same symptoms as a heart attack Behaviour Therapy for OCD: Exposure plus Ritual Prevention • 15 sessions over three weeks • Each session – 2 hours • High intensity, an hour and a half is common • In-vivo exposure with response prevention (e.g., contaminate hands without washing) • Imaginal exposure (e.g., prolonged imagination of worst-case) • Homework – practice exposure between sessions • Maintenance – planned booster sessions Exposure Therapy: Evaluation • Highly effective for anxiety-based problems where avoidance is prominent • Treatment of choice – Agoraphobia (70% - significant improvement) – OCD (75% - significant improvement) • Important component of treatment for panic disorder Behavioural Rehearsal • A technique to expand a patient’s repertoire of coping behaviours • Practice the behaviour for eventual integration into real life • Origins in psychodrama • Fixed role playing – Therapeutic emotional release – Altering cognitive structures • Stages – Prepare the patient – Target specific situations – Actual rehearsal – Patient’s utilization of skills in real-life situation • Assertiveness training – One application of behavioural rehearsal – Stems from anxiety due to timid coping – Sexual issues, depression, marital conflicts – Cognitive self statements enhance effects of training • You need to review what you have just done in your head in a positive way – Aim is not to teach aggression, but rather how to express one’s feelings without trampling on the rights of others Contingency Management • Positive reinforcement • Negative reinforcement • Punishment • Response Cost • What is the impact on me if I do this? Effect on Behaviour Stimulus Presented + Positive Reinforcement = Behaviour Increases Stimulus Withdrawn + Negative Reinforcement = Behaviour Increases Stimulus Presented + Punishment (Response-Contingent Aversive Stimulation) = Behaviour Decreases Stimulus Withdrawn = Response Cost (Punishment) = Behaviour Decreases • Changing behaviour by manipulating consequence • Common with children and adolescents • Forms – Shaping/ successive approximation: attempts at a desired behaviour are rewarded until it is achieved – Time out: removal of patient from environment in which unwanted behaviour is reinforced – Contingency contracting: agreement between patient and therapist specifying consequences of beha
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