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Cognitive Behavior Interventions (CBI) - Full Compact Course Summary (Lecture & Literature)

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Very compact (yet complete) notes for the course exam of Cognitive Behavior Interventions (CBI). Includes all the material from the literature and 4 lectures (specified on the left margin). It also includes essential tables and figures of models to help visualizing them! To help reading speed, ...

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  • 1, 2, 4, 6, 8, 9, 13, 14
  • June 19, 2024
  • 23
  • 2023/2024
  • Summary

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‭MSc Clinical Psychology - Leiden University‬
‭2024‬
‭ ognitive Behavioral Interventions - Notes‬
C
‭Main Topics‬ ‭Notes: Lec & Exam‬

‭ h 4. Exposure therapy:‬
C -‭ exposure therapy is not a mechanism, it's a procedure; used in CBT to reduce pathological fear and related‬
‭promoting emotional‬ ‭emotions‬
‭processing of‬ ‭- anxiety disorders = when safe stimuli acquires a meaning of danger and elicits irrational fear and‬
‭pathological anxiety‬ ‭avoidance‬
‭Basic Foundations‬ ‭- learning principles as used to understand pathological anxiety‬
‭classical conditioning‬ ‭- previously neutral CS (dog) acquires meaning through association with US (bite) → evokes automatic UR‬
‭(fear); forms CS → UR‬
‭- is‬‭pathological‬‭when CS is not in itself dangerous‬‭→ treated with extinction (repeat CS without US) or‬
‭counter conditioning (repeat CS with pleasant US)‬
‭- avoidance is reinforced via drop in physiological arousal; prevents the individual from learning that CS‬
‭does not entirely predict harm (CS-no US), impedes extinction!‬
‭- fear is originally learned through classical conditioning and maintained through‬‭operant conditioning‬
‭- therapy = a) extinction through confrontation with CS + b) elimination of avoidance‬
‭emotional processing‬ ‭- there is a‬‭fear network‬‭= structure for escaping‬‭or avoiding danger; representation of feared stimuli,‬
‭theory‬ ‭responses, and meaning of stimuli and responses → activated by input matching the info stored‬
‭- fear structure becomes‬‭pathological‬‭= associations‬‭among stimulus, response, and meaning do not reflect‬
‭reality (stimulus is not actually dangerous)‬
‭-‬‭emotional processing‬‭=‬‭correcting*‬‭the structure,‬‭which leads to fear reduction‬
‭- emotional processing occurs under 2 conditions: (1) the fear structure must be activated; (2) new‬
‭incompatible info must be incorporated into the pathological memory structure/ form a new one)‬
‭- *NOTE: actually, pathological structure cannot be modified, exposure therapy only forms‬‭a new competing‬
‭structure‬‭(see inhibitory learning theory)‬
‭- overlap with CBT = changes in erroneous cognitions is also a primary therapy goal‬
‭Empirical Evidence‬ ‭- phobias: fear structure has erroneous info about feared object/ situation, e.g., exaggerated estimation of‬
‭probability of harm → disconfirm negative expectations; no apparent advantage in adding cognitive therapy‬
‭- panic disorder: when physical sensations, panic, and anxiety are considered dangerous (indicators of‬
‭catastrophes e.g., heart attack, going crazy) → goal is to confront feared bodily sensations, in vivo;‬
‭medication may interfere (prevent inhibitory learning)‬
‭- SAD: worry about being judged and criticized, perceived as incompetent because of apparent anxiety →‬
‭role-plays, in vivo; make specific predictions for objective evaluation; exposure is critical in CBT for SAD‬
‭- GAD: exaggerations in a sense of harm, due to low tolerance for uncertainty, perceiving worry as positive‬
‭coping; worry is negatively reinforced (decrease in emotional distress) but prevents emotional processing in‬
‭the long-term; avoidance of situations associated with exaggerated sense of danger (e.g., new uncertain‬
‭experiences); no clear phobic target, limited success‬
‭- OCD: exaggerated or unrealistic estimates of threat and belief that compulsions are the needed to reduce‬
‭anxiety → exposure to feared stimuli and abstinence from rituals →‬‭disconfirmation‬‭of the expected harm‬
→
‭ ‬‭emotional processing‬‭; large effectiveness‬
‭- PTSD: avoidance of trauma-related thoughts, situations → prolonged exposure therapy (PE) has most‬
‭evidence → emotional processing‬
‭- PE = expose to trauma reminders and memories (avoidance maintains the beliefs about themselves and the‬
‭world); imaginal exposure (because even remembering is perceived as dangerous; but not under- or‬
‭over-engaged!) → processing immediately after, encourage explicit insights to facilitate emotional processing‬
‭Research and Unresolved‬ ‭- fear response to CS may return when: US is presented without CS (‬‭reinstatement‬‭); CS is presented‬
‭Issues‬ ‭outside the place of extinction (‬‭renewal‬‭); spontaneously‬‭(‬‭spontaneous recovery‬‭)‬
‭- avoid relapse: booster sessions; encourage to continue self-exposure on their own‬
‭- complicated grief: erroneous beliefs about death →‬‭avoidance preventing integration of loss‬
‭- also may be used in treating depression targeting‬‭experiential avoidance‬
‭- exposure may be effective beyond reduction of pathological fear, i.e., whenever pathological emotions‬
‭arising from erroneous beliefs are maintained through cognitive/ beh avoidances‬

,‭ h 2. Clinical‬
C -‭ to empirically identify the controllable variables maintaining a behavior (functionally related)‬
‭Functional Analysis:‬ ‭- to personalize the intervention‬
‭Understanding the‬ ‭- to complement the current diagnostic system when the diagnostic doesn't entirely fit, treatment failed or‬
‭Contingencies of‬ ‭doesn't exist; an alternative to the "diagnose and treat" paradigm‬
‭Reinforcement‬ ‭-‬‭structuralism‬‭= focuses on‬‭unobservable‬‭internal‬‭events, via introspection‬
‭-‬‭functionalism‬‭= emphasis on the‬‭observable‬‭behavior;‬‭answer "why" by specifying contextual relationships‬
‭and how they influence the beh; assumes all beh to be adaptive and useful in some way‬
‭-‬‭behaviorism‬‭= primary goals is the prediction and‬‭control of beh‬
‭- applied predominantly to treat observable beh in developmentally disabled, mood, SUD, eating, psychotic‬
‭- private/ internal events (e.g., emotions and thoughts) come under the same control as overt beh → also‬
‭apply to functional analysis‬
‭Distinguishing features‬ ‭-‬‭focus on the function/ purpose of beh rather than‬‭its topography‬‭: through an analysis of the controlling‬
‭variables → can hypothesize how to change it!‬
‭- topography = descriptive features independent of the consequences; fail to explain‬‭why‬‭the beh is‬
‭occurring‬
‭-‬‭the unit of analysis is the whole person‬‭interacting‬‭in and with a particular environment (beh cannot be‬
‭understood in isolation!, to also understand the‬‭function‬‭of the beh)‬
‭-‬‭idiographic approach‬‭: examines beh on an individual‬‭basis → identify targets relevant for the specific‬
‭client and contexts‬
‭-‬‭enhanced treatment utility of the assessment‬‭(how‬‭it helps with treatment outcomes) → FA is inherently‬
‭perspective!: indicates a specific and empirically supported course of action/ intervention!‬
‭-‬‭dynamic and iterative‬‭: FA is iterative and self-correcting‬‭in nature; ongoing processes of adapting the‬
‭prescribed intervention to new data from the beh and context‬
‭Basic behavioral principles‬ ‭-‬‭assumption‬‭: individual occurs within an environmental‬‭context that interacts with the beh → this‬
‭interaction =‬‭"‬‭contingencies of behavior‬‭"‬
‭-‬‭one contingency = antecedents: behavior → consequences‬‭(it is three-term: A:B → C)‬
‭- A, B, C relate in a probabilistic manner (not mechanistic cause!);‬‭A increases the probability of B‬‭(set the‬
‭occasion for it),‬‭B produces C‬
‭-‬‭antecedents‬‭= environmental stimuli consistently‬‭present in the context in which the beh occurs; grouped‬
‭into‬‭stimulus classes‬‭(= same effect on beh)‬
‭- emotions, thoughts (covert beh) are not considered as solitary antecedents (not in a vacuum)‬
‭-‬‭beh‬‭= anything an individual does (also private‬‭e.g., emotions and thoughts); produce similar consequences‬
‭(=‬‭response classes‬‭of beh)‬
‭-‬‭consequences‬‭= changes in the environment after‬‭the beh that alter the probability of future occurrences‬
‭of the beh‬
‭-‬‭positive/ negative‬‭contingencies = added/ removed‬‭stimulus from environment‬
‭-‬‭reinforcing/ punishing‬‭contingencies = increase/‬‭decrease occurrence of beh‬
‭- use FA to know how a stimulus/ event affect future beh‬
‭Functioning relations‬ ‭-‬‭reinforcement‬‭: increase in the frequency of behavior‬‭as a function of the beh consequences; negatively‬
‭reinforced = stimulus taken away was a‬‭punisher‬
‭-‬‭punishment‬‭: decrease in the frequency of behavior‬‭as a function of the beh consequences; positively‬
‭punished =‬‭punisher‬
‭-‬‭extinction‬‭: a process that‬‭breaks the contingency‬‭between beh and its consequence; when beh no longer‬
‭produces a consequence; often precipitated by an extinction burst (= rapid increase in the frequency of the‬
‭beh before it decreases)‬
‭Guidelines for conducting‬ ‭- collaborate with the client to clearly formulate the concerns and to develop achievable goals‬
‭an FA‬ ‭Step 1: identify characteristics of the client through a broad assessment‬
‭-‬ ‭strengths e.g., personal resources; social support, financial…‬
‭-‬ ‭weaknesses e.g., diminished perspective taking, poor physical health…‬
‭-‬ ‭FA is a next step in assessment (after diagnosis) to investigate the function of the topographical beh‬
‭Step 2: develop preliminary analysis in terms of behavioral principles‬
‭-‬ ‭to determine the function of the beh‬
‭-‬ ‭assessment is limited to the controllable variables, identifying relationships that can be altered‬
‭-‬ ‭goal of FA‬‭= create an effective intervention linked‬‭directly to the analysis of the beh‬

, ‭Step 3: gather additional info and finalize the conceptual analysis‬
‭-‬ ‭describe the analysis as a working hypothesis that the clinician and client will test together‬
‭-‬ ‭evaluate the components of the analysis: interview relatives, conduct home-based assessments…‬
‭Step 4: devise an intervention based on step 3‬
‭-‬ ‭goal of intervention = modify the existing beh through (a) behavioral skills training, (b) alteration of‬
‭the environment, (c) modification of flawed rule statements affecting the beh‬
‭-‬ ‭Establishing alternative ways to engage with life via contingencies that support the new beh‬
‭Step 5: implement intervention and assess change‬‭(incorporate‬‭the new data in the FA as it is collected)‬
‭Step 6: if outcome is unacceptable, recycle back to step 2 and 3‬
‭Limitations of FA‬ ‭- validity and reliability of FA has not been extensively evaluated‬
‭- requires time and resources → may be most cost effective when standardized interventions do not‬
‭effectively address all the causal variables, or when there is no evidence-based treatment available (often‬
‭with complex cases, i.e., multiple problems, variables)‬

‭ h 9. Behavioral‬
C -‭ "‬‭if there is one certainty in behavioral science,‬‭it is that positive reinforcement, when applied well, can generate,‬
‭activation (BA)‬ ‭change, and maintain behavior‬‭" → a scientific law‬
‭- positive reinforcement (R+) is fundamental to human experience‬
‭- to the behaviorist: contingencies indicate the meaning of the behavior‬
‭the‬‭principle‬‭of BA‬ ‭=‬‭therapeutic scheduling of specific activities for‬‭the client to complete in daily life that function to increase contact‬
‭with diverse, stable, and personally meaningful sources of positive reinforcement‬
‭- scheduling of specific activities is primary component; also secondary techniques (see below)‬
‭- increase R+ is the ultimate goal; other techniques e.g., reducing escape and avoidance behaviors (negatively‬
‭reinforced) → increase R+ (it's a constructive therapy!, to create rich, meaningful lives)‬
‭- positive reinforcement as diverse, stable, and personally meaningful → not a hedonistic search for‬
‭pleasure! (the goal = the client's behavioral repertoire to be diverse, stable, and meaningful for the client!)‬
‭BA's model of‬
‭psychopathology‬




-‭ depression begins with environments characterized by losses of, reductions in, or chronically low levels of‬
‭positive reinforcement (R+); e.g., loss of a loved one, loss of a job, chronic deprivation of R+ (abuse, neglect),‬
‭inability to obtain and maintain contact with R+ (e.g., social skills);‬
‭- depression can also begin with increased negative reinforcers (R-) → restricts the chance to experience R+‬
‭for fulfilling beh, e.g., financial stress, routine of "to-do's"; in a life dedicated to avoiding aversives (increased‬
‭R-), it is difficult to contact R+ (decreases R+ for positive behavior)‬
‭- many forms of psychopathology (depression, suicidal beh) are functions of unhealthy efforts to avoid‬
‭negative emotions, thoughts, memories, and social interactions → avoidance contributes to reductions in R+‬
‭- R+ of depressed behavior, e.g., family that gives room and covers for inactivity, appreciates being more at‬
‭home → healthy beh is not prompted, R+ is low‬
‭- reinforcement and mood covary together (anhedonia, negative mood, depression)‬
‭- reinforcement maintains behavior → lost R+ leads to reduction in the frequency or even extinction of‬
‭previous behavior/ activity‬
‭- increased R- and R+ for depressed behavior → increase in avoidance and depressed behavior → beh‬
‭changes the environment (reinforcement)‬
‭- clinical depression as a result of a self-perpetuating cycle of reinforcer, mood, and behavior changes‬


‭BA's theory of treatment‬
‭mechanism‬




‭- contingency management techniques alter the environment directly => target behavior to increase R+‬

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