Introduction to Cognitive Behavioral Therapies
Lecture 1:
Book: Behavioral Interventions in Cognitive Behavior Therapy;
Practical guidance for putting theory into action
Chapter 1: Overview
Aaron Beck and his daughter Judith Beck: a primary assumption of their model is that distorted and
dysfunctional thinking influences behavior and mood and that such biased forms of thinking are
common in all psychological disorders. Each specific form of a psychological disorder is defined by a
unique set of thought distortions. Therapeutic activities should be geared toward promotion of
realistic, balanced and accurate thinking and that the modification of thinking will produce changes
in mood and behavior. Modification of underlying schema’s, beliefs is required to bring about lasting
changes.
Behavioral views on abnormality; individuals who have psychological disorders are often regarded to
have maladaptive schemas. Internal anomaly must be changed, removed or altered in some way if
the person is to no longer be disordered or deviant.
Behavior theory Search for internal causes of behaviors is avoided. Primarily concerned
with what one does and the contexts in which behavior occurs. Notions
of what constitutes normality/abnormality are found in cultural
norms/values/practices that can change over time. Behavioral
perceptive assumes that there is nothing inherently defective/deviant
about individuals who report emotional/behavioral problems.
Behavioral interventions within CBT; description and application;
A focus on behavior and its context:
Three-term contingency 1. Antecedents= conditions/stimuli that set the occasion for
behavior to occur. Can include specific persons/
places/objects/events.
2. Behavior; anything a person does. Overt behavior (observable
by other people) and covert behavior (behavior within the
person such as thoughts, emotions and physical sensations).
Consequences; effect that behavior produces. Behavior is
reinforced if the consequences that follow behavior increase
the likelihood of the behavior occurring again in future
occasions. Behavior is punished if consequences decrease the
likelihood of the behavior occurring again.
A focus on why people act the way they do:
Functionalism Based on Darwinian evolutionary principles. The physical structure of
a particular species is determined by its associated function natural
selection involves selection of most adaptive physical structures on
the basis of functional properties associated with that structure.
Environmental Overarching process associated with selection of variations in
determinism individual’s behavior during his/her lifetime and in cultural practices
, over successive generations.
Contextualism Emphasizes how events and behavior are organized and linked
together in meaningful ways. Primarily concerned with the context
within behavior is embedded or the contextual flow in which behavior
occurs.
Common features among behavioral assessment;
- Interpersonal therapies= focus on social behavior and relations with others
- Cognitive therapies= focus on automatic thoughts, underlying assumptions and schemas
- Humanistic therapies= emphasize immediate emotions, experiences, and provision of
validation by the therapist for these emotions and experiences
- Psychodynamic therapies= emphasize historical material, mental representations of self and
others and the use of defense mechanisms
- Biological therapies= emphasize neurochemical functions and neurocircuit activity
Contemporary behavior Concerned with the contexts within a client’s problematic behaviors
therapies occurs. Emphasizes on potentially modifiable antecedents and
consequences associated with maintenance of problematic behavior.
Some clients display problematic behaviors because they have not yet
learned alternatives/more adaptive forms. Motivation is modifiable; it
can be increased/decreased as a result of environmental
manipulations.
- Antecedents of problematic behavior
- Consequences
- Client’s learning history as it relates to current problematic
behavior
- Client’s current behavioral repertoire; overt behaviors,
thoughts and mental images, emotions, and physiological
sensations/responses
- Client’s motivation for change
Common features among behavioral interventions;
- Empirical orientation= use of empirically supported intervention strategies.
- Therapist-client collaboration= client is an active participant. Client and therapist work
together.
- Active orientation= clients are actively encouraged to do something about their problems
areas.
- Flexible approach= hypotheses concerning client’s problem areas undergo continuous testing
and evaluation.
- Emphasis on environment-behavior relations= clients are described in terms of what they do
(actions, thoughts, emotions, physical sensations).
- Time-limited and present focus= time allotted for therapy varies with the nature and severity
of the problem areas. Emphasis is placed on the current situation rather than the past.
- Problem and learning focus= solutions are sought, these solutions are geared toward
teaching new/adaptive behaviors.
History of behavior therapy and behavioral interventions within CBT:
- Pavlov;
Classical conditioning= stimuli (unconditioned stimulus =UCS) will yield a
reflexive/innate/unlearned response (unconditioned response= UCR). A neutral
, object/event (conditioned stimulus= CS), when repeatedly paired/associated with UCS,
will elicit a response (conditioned response= CR). Stimulus (S) elicits response (R) (thus
SR)
Extinction= if the CS is repeatedly presented without the UCS, the CR will eventually
disappear.
In clinical contexts; traumatic event can become a UCS at the time of the original trauma,
which elicits a number of reflexive/unlearned responses (UCR) such as fear. An individual
with PTSD which has strong emotional reactions (CRs) to events/objects (CSs) related/
similar to the original situation.
- Thorndike; if a response results in reward, the action will be strengthened. Actions that don’t
result in reward, will become weakened over time.
Law of effect= learning process and associated behaviors are influenced by the
consequences that follow the behavior.
- Skinner; RC (consequence)
Operant; a unit of behavior that operates on environment by producing consequences.
Much of the behavior that people display is selected/shaped over the course of a lifetime
by consequences that such behavior produces. (ontogenetic selection, phylogenetic
selection processes and cultural selection processes)
The emergence of behavior therapy;
- Joseph Wolpe; first manualized treatment protocol based on the principle of reciprocal
inhibition. Anxiety could be reduced/eliminated by pairing the experience of anxiety with an
incompatible feeling state (relaxation).
- Hans Eysenck; behavior therapy (desensitization, negative practice and aversion therapy).
The emergence of CBT;
- Bandura; social learning theory/social cognitive theory. Behavior, cognitive factors and
environmental influences reciprocally and continuously interact and influence each other.
Self-efficacy; individual’s beliefs about his/her personal efficacy/ability to successfully
perform coping behavior. These are determinants whether such behavior will be
performed.
- Beck; Cognitive Therapy of Depression
Chapter 2: Principles, goals and structure of initial assessment sessions
Behavioral assessment Identification of potentially modifiable contextual features that are
associated with the maintenance of problematic behavior. The
emphasis lies on the person, clinically relevant behaviors that
he/she displays, the environmental variables that select/influence/
maintain these behaviors.
Goals of behavioral assessment;
1. Classification of nature of client’s problems and identification of associated target behaviors.
2. Evaluation of extent to which client’s problems impair his/her functioning.
3. Identification of factors that support and maintain problem areas.
4. Collaborative development of formulation of the client’s problems and development of
therapeutic intervention plan.
5. Ongoing evaluation of effectiveness of treatment.
, Features of behavioral assessment and therapy;
- Focus is on context; the person in interaction with the environment.
- Recognition that each person lives in a unique context and has unique learning histories and
genetic endowment. Behavioral assessment and treatment should be tailored to the
individual’s needs.
- Behavior is viewed as situationally specific rather than cross-situationally.
- Limited inference is used.
- Development of effective behavior and competencies.
Establishing rapport with client; therapist should demonstrate genuineness, respect, warmth,
acceptance, validation and accurate empathy. This sets the foundation for development of a trusting
relationship.
Behavioral assessment can involve questionnaires, checklists, rating scale assessments.
Case formulation Hypothesis about causes, precipitants and maintaining influences of
a person’s psychological, interpersonal and behavioral problems.
Problem behaviors can be categorized into two categories;
1. Behavioral excess= apparent when a individual displays particular forms of behavior that are
excessive in terms of frequency/intensity/duration. Can be maintained by positive and
negative reinforcement.
2. Behavioral deficits= apparent when an individual does not demonstrate an adequate range
of behavior in a variety of contexts or does not display adequate flexibility when adjusting
behaviors in accordance with shifting circumstances. Can develop because past
environments did not adequately model/shape/reinforce such behaviors. Another possibility
could be that absent behaviors have never been learned at one time and are not part of a
person’s repertoire.
Coping behaviors; CBT tries to develop and strengthen alternative and adaptive coping skills.
- Problem-solving skills= find effective solutions to problems that arise.
- Social skills= develop and maintain social and intimate relationships and obtain
reinforcement from others.
- Self-regulation skills= ability to alter inner states or responses.
- Mindfulness skills= foster a full awareness in the present moment (attention, awareness,
observation, discrimination, non-judgmental and maintenance of present moment).
Domains of impairments;
- Personal functioning
- Family and social relations
- Occupational and school functioning
- Legal difficulties or proceedings
- Health and medical status
- Current life situation and quality of life
- Suicide risk and other risk areas
Behavioral interview Often conducted within the first few sessions. Used to gather
information relevant to the development of a behavioral case
formulation. Focus is on designation of the client’s problem areas,
identification of specific behavioral patterns relates to the problem
