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Cognitive-behavior Interventions Lecture Notes
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Notes Lecture CBISuzanne Derksen Health and Medical Psychology
Lecture 1: Exposure and Cognitive Restructuring
Exposure Classical conditioning = A type of learning in which a stimulus
Therapy: acquires the capacity to evoke a r eflexive response that was
Theoretical
originally evoked by a different stimulus.
background
Pavlov: a previously neutral stimulus (conditioned stimulus, CS)
acquires meaning through association with a significant stimulus
(unconditioned stimulus, US), which invokes an innate behavioral
response (unconditioned response, UR). With repeated pairing of
the CS and the US, the two stimuli become affiliated and the CS
begins to produce the behavioral response in the absence of the
US (conditioned response, CR).
Watson & Little Albert: instilled a fear of a white rat toy in a
9-month-old child by pairing the toy with a loud noise. The fear of
rats then generalized to a range of white fuzzy objects.
→ CS: Rat (other similar stimuli)
→ US: Loud noise
→ UR: Distress
→ CR: Distress when seeing rat
After conditioning, the sight of the rat made Albert scream – after
a while Albert began to show similar terrified behaviors to
Watson’s face. The fear evoked by the white, furry, rat, had
generalized to other white, furry things, like Watson's beard.
Maintenance of fear: Classical conditioning can lead to the onset
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, of (pathological) fear. The process of operant conditioning is
needed to explain the maintenance of fear.
Two-factor model Operant conditioning: method of learning that employs rewards
of Mowrer and punishments for behavior. Through operant conditioning, an
association is made between a behavior and a consequence
(whether negative or positive) for that behavior.
Two coping strategies for dealing with anxiety symptoms:
Avoidance and Escape.
Avoidance → behaviors that attempt to prevent exposure to a
fear-provoking stimulus.
Escape → quickly exit a fear-provoking situation.
These coping strategies are considered maladaptive because they
ultimately serve to maintain the disorder and decrease
functioning. Both coping strategies are highly reinforcing because
they remove or diminish the unpleasant symptoms.
1947 → Mowrer two-factor model (classical and operant
conditioning): the avoidance of (or escape from)
anxiety-provoking stimuli resulted in the removal of unpleasant
emotions. Thus, avoidance becomes a reward and reinforces
(increases) the behavior of avoidance.
Avoidance and escape are called negative reinforcement. The
removal of unpleasant symptoms (negative) leads to an increase
in that behavior (reinforcement).
Black box models Behaviorists, being concerned with observable behavior, treat the
mind almost as the proverbial "black box." Input enters and
output exits, but the processes that relate the input to the output
are not examined. The "black box" idea is convenient for
behaviorism because mental processes are unobservable and
therefore very difficult to explain according to behavioral theory.
2
, Instead of motivation, the e
nvironment is the key factor
influencing behavior. Skinner's basic strategy for studying
behavior involves functional analysis; the link between behavior
and exact determining conditions is sought. He maintains that
most of human behavior is the result of freely-given response
patterns, also called operants.
Emotional Early learning accounts were expanded by integrating Lang’s
processing theory concept of the ‘fear structure’ to create a comprehensive model
(EPT) for understanding pathological anxiety.
→ Fear structure: anxiety memory in which representations of
stimuli, responses, and meanings are stored.
In anxiety disorders, stimulus representations are linked to
danger and strong responses.
Important for therapy: effective therapy = fear-structure needs to
be corrected.
→ Demands: Fear structure has to be activated (the patient must
experience anxiety during therapy) and new information,
incompatible with old info, must be introduced in fear structure.
What is Exposure Therapy?
Exposure therapy purposefully generates anxiety by exposing an
individual repeatedly to fear provoking stimuli.
In the absence of repeated aversive outcomes.
→ Which leads to e
xtinction through inhibitory learning.
Extinction refers to the gradual weakening of a conditioned
response that results in the behavior decreasing or disappearing.
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, Expectancy of anxiety and avoidance → A high level of anxiety is
expected. This expectancy leads to avoidance. The avoidance
provides short term relief. However, the anxiety is maintained on
the long term.
Anxiety-curve: The more you practise, the more anxiety levels will
decrease over time.
Three types of - In vivo exposure: Exposure to external feared stimuli.
exposure - In vitro/imaginal exposure: Exposure to imaginal stimuli.
- Interoceptive exposure: Exposure to physical (internal
stimuli).
When? Specific phobias, panic disorder, social anxiety disorder,
generalized anxiety disorder (GAD), obsessive-compulsive
disorder (OCD), trauma (PTSD).
Thus → DSM-5:
- Anxiety disorders
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