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Summary Introduction to cognitive behavioural therapies
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Introduction to cognitive behavioral therapiesFarmer, R.F. & Chapman (2016). Behavioral
interventions in cognitive behavior therapy: Practical
guidance for putting theory into action.
Chapter 1. overview
- CBT is a broad and heterogeneous concept that represents a variety of therapeutic
approaches that emphasize, to varying degrees, cognitive, behavioral, emotional,
physiological, and environmental factors in relation to psychological disorders.
- There are at least 10 schools that can be identified under the umbrella of CBT. One of these
is represented by the influential cognitive approach to understanding and treating
psychological disorders advanced by Aaron T. Beck and his daughter, Judith S. Beck.
- A primary assumption of their model is that distorted and dysfunctional thinking influences
mood and behavior and that such biased forms of thinking are common to all psychological
disorders.
- Cognitive perspectives that have informed developments in CBT vary in the degree to which
the environment is viewed as a determinant of thinking, emotion, and action. Some cognitive
theories, for example, emphasize cognitively constructed environment over the physical
environment as the primary determinant of emotion and behavior
- In contrast to models that emphasize the predisposing or causal properties of cognitive
constructs, behavior theory and therapy generally avoid ascribing mental concepts a causal
role in behavior and instead place primary emphasis on the physical environment. From a
behavioral perspective, thinking and emotional responding are examples of bvehavior and
are subject to many of the same influences as more observable behavior
- Indeed, the term cognitive behavior therapy incorporates several points of view that can, at
times, be contradictory or even incompatible.
- Many excellent resources describe cognitive-oriented therapeutic interventions geared
toward the modification of evaluations, attitudes, underlying beliefs, and schemas.
- Even though cognitive and behavioral interventions can occasionally be at odds in relation to
therapeutic assumptions and goals, we strive to highlight areas of compatibility and instances
in which integration is desirable or possible.
Behavioral interventions in CBT; underlying assumptions and common
features
- In this section, we provide an overview of behavioral perspectives on abnormality and
psychological disorders. We also briefly review several of the core underlying assumptions
associated with behavior therapy and behavioral interventions. We then discuss some of the
primary features that differentiate behavior therapies from other approaches.
Behavioral views on abnormality
- In each instance, the presumed internal defect that the person has (e.g. maladaptive
schemas, aberrant neurochemistry, malevolent internalized self and object relations) is
targeted for therapy; it is assumed that this internal anomaly must be changed, removed, or
altered in some way if the person is to no longer be deviant or disordered.
- Behavior theory and therapy have a different view. Within behavioral traditions, the search
for internal causes of behavior is largely avoided.
, - From the behavioral perspective, notions of what constitutes normality and abnormality are
found in cultural norms, values, and practices.
- From a behavioral perspective, the determinants of what might be regarded as abnormal
behavior are no different from the determinants that shape and maintain normal behavior.
What is regarded as “psychopathology” in some quarters is often viewed from a behavioral
perspective as a “problem in living”, or a justifiable response to dysfunctional or stressful
environments, which may be further exacerbated by inadequate behavioral repertoires for
responding to or coping with life’s problems
- The behavioral perspective assumes that there is nothing inherently defective or deviant
about persons who report emotional or behavioral problems.
Behavioral interventions within CBT: description and application
- Some people have unpleasant reactions to terms such as behavior therapy, behavior
modification, or behaviorism.
A focus on behavior and its context
- Behavioral perspectives are associated with a number of assumptions about the individual,
the context within which he or she lives, and the factors that influence his or her behavior.
- Covert behavior = occurring within the individual
- Overt behavior = overt actions that can be observed by others
- Three-term contingency = when applied to behavior therapy, the three-term contingency
concept refers to the interaction of the person with his or her environment and includes
three elements: The occasion within which behavior occurs, the behavior itself, and the
consequences of that follow behavior. When behavior therapists attempt to develop
hypotheses about behavior, this framework is often used
- Antecedents of behavior = includes conditions or stimuli that set the occasion for behavior to
occur. Antecedent stimuli can include specific persons, places, objects, or events
- Behavior = refers to anything a person does. This includes not only behavior that other
people can potentially observe another person do, such as speak or perform some other
physical movement, but also covert behaviors
- Consequences = refers to the effect that behavior produces. Technically speaking, behavior is
reinforced if the consequences that follow behavior increase the likelihood of that behavior
again occurring on future occasions. Conversely, a behavior is punished if the consequences
that follow decrease the likelihood of that behavior again occurring in similar future
situations.
A focus on why people act the way they do
- When behaviorally oriented clinicians talk about the function of behavior, they are basically
talking about why people behave the way they do.
- Functionalism = based on Darwinian evolutionary principles. In Darwinian evolutionary
theory, the physical structure of a particular species is determined by its associated function.
- In behavior theory, the behavior of an individual that is functional in particular
environmental contexts (i.e. produces reinforcing consequences) is selected or made more
likely, whereas behavior that is not functional (i.e. does not produce reinforcing
consequences) is not selected or, over time, becomes extinguished.
- Within functional or selectionist accounts of human behavior, behavior is largely, if not
exclusively, determined.
, - Environmental determinism = the overarching process associated with the selection of
variations in an individual’s behavior during his or her lifetime and in cultural practices over
successive generations.
- Behavioral accounts are also often associated with the concept of contextualism = contextual
approaches to the study of behavior emphasize how events and behavior are organized and
linked together in meaningful ways (i.e. “the act in context”). Contextualism, then, is
primarily concerned with the context within which behavior is embedded or the contextual
flow in which behavior occurs.
Common features among behavioral assessments
- The focus of contemporary therapies varies in accordance with underlying theory and
presumed mechanisms of behavior change.
- Each form of therapy targets what is understood through associated theory to be the most
central determinant or cause of problematic behavior. Consequently, the types of
interventions used and the means through which they are delivered vary considerably across
these general classes of therapies.
- Contemporary behavior therapies are primarily concerned about the contexts within which a
client’s problematic behavior occurs. This is because behavior therapists place emphasis on
potentially modifiable antecedents and consequences associated with the maintenance of
problematic behavior.
- When viewed in the behavioral approach, motivation is modifiable, something that can be
increased or decreased as a result of environmental manipulations
- In the behavioral assessment of clients, several features associated with the functional
context of behavior are assessed and evaluated
- Among these are the following areas:
- The antecedents of problematic behavior
- The consequences of problematic behavior
- The client’s learning history as it relates to current problematic behaviors
- The client’s current behavioral repertoire; cover four response domains;
1. Overt behaviors
2. Thoughts
3. Emotions
4. Physiological sensations or response
5. The client’s motivation for change
- Decisions as to which behavioral interventions are appropriate are decided individually for
each client given the outcomes associated with assessment of these areas. That is, behavior
theory and therapy suggest that the factors that influence behavior vary across individuals.
- Whereas the form of problematic behavior might appear to be the same among members of
both groups (e.g. excessive drinking), the hypothesized maintaining factors associated with
each subtype suggest different functional properties associated with the same behavior
across individuals.
Common features among behavioral interventions
- There are a number of general characteristics of behavioral interventions, some of which
other schools of therapy share, including the following:
- An empirical orientation = as reflected in its grounding in the basic behavioral sciences, use
of empirically supported intervention strategies, and use of ongoing assessments of the
client’s behaviors targeted for therapeutic change
, - Therapist-client collaboration = in which the client is an active participant in the therapeutic
process and the client and therapist work together to develop a formulation of the client’s
problem areas and a plan for therapy based on this formulation
- An active orientation = in which clients are actively encouraged to do something about their
problem areas rather than only talk about them
- A flexible approach = in which hypotheses concerning the client’s problem areas undergo
continuous testing and evaluation, with the overall client formulation and corresponding
therapeutic activities modified and adjusted as warranted by new information or
observations
- An emphasis on environment-behavior relations = with clients described in terms of what
they do; that is, the actions they perform and the thoughts, emotions, and physical
sensations they experience. These actions are further conceptualized with reference to the
situational contexts within which they occur
- A time-limited and present focus = in which the time allotted for therapy varies in accordance
with the nature and severity of the problem areas addressed in therapy, with emphasis
placed on one’s current situation rather than the past
- A problem and learning focus = in which solutions to problematic behaviors are sought, with
these solutions often geared toward teaching new or adaptive behaviors, changing aspects of
dysfunctional environments, or providing relevant information about behaviors of interest
- An emphasis on both change and acceptance processes = in which interventions that
promote therapeutic change are undertaken in a context that conveys valuation of the client
and encourages the development of client self-validation and the adoption of a
nonjudgmental approach to the experience of thoughts, feelings, and bodily sensations as
they occur
An overview of the history of behavior therapy and behavioral interventions
within CBT
- A review of the history of the behavior therapy movement establishes a context for
understanding the foundational role of behavioral interventions in CBT.
Basic theories of learning
- The theoretical roots of contemporary behavioral interventions are found in the foundations
of modern learning theories.
- Respondent or classical conditioning = the basic idea behind classical conditioning is that
some environmental stimuli, when presented in a particular way, yield a reflexive, innate (or
unlearned) response. For example, when a rubber hammer is struck right below the kneecap
(UCS), a reflexive kneejerk response follows (UCR). The knee-jerk is an unlearned, innate
response to the type of stimulation that a rubber hammer strike against the knee produces
- In the case of classical conditioning, Pavlov and colleagues demonstrated that a neutral
object or event, when repeatedly paired or associated with the UCS, will come to acquire
certain stimulus properties over time (i.e. this previously neutral stimulus will become a CS).
This CS, in turn, will come to elicit a response (CR) under some circumstances that appears
quite similar to the UCR produced by the UCS.
- Generalization = CRs often occurred in the presence of stimuli that resembled or were similar
to the CS in some way
- Extinction = if the CS was repeatedly presented without the UCS, the CR would eventually
disappear.
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