Cognitive Behavioral Therapy is based on the observation that cognition, emotion, and behavior are reciprocally related.. Emotion. James-Lange Theory of EmotionAction or response precedes emotionI run, therefore I must be afraid.Canon-Bard Theory of EmotionEmotion precedes action.I am afraid, therefore I run..
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Differential Reinforcement of Other Behavior (DRO)
Avoidance learning (E.g., electric shock to reduce arousal in presence of child pornography)
A behavior that is rewarded every time is acquired or learned quickly.
Fading the reward schedule to intermittent makes the behavior less vulnerable to instances of non-reward. The behavior persists for a relatively long period of time, even if not rewarded.
Effectiveness of consequences depends on:
Consistency (reinforcement schedule)
Potency (cost-benefit ratio)
Satiation (felt need for the stimulus or response)
The Premack Principle
A desirable or often-engaged in behavior or situation can serve as a reinforcer for another (new) behavior.
Example: If you always brush your teeth and need to develop a habit of taking medicine, pair the medicine routine with the teeth-brushing routine.
Complex social behavior increases and decreases in frequency in response to social reinforcement and social “response cost” or punishment.
Example: A pat on the back or a thank you from the boss reinforces excellent work habits better than an increase in salary.
Lack of skill (lack of “know-how”)
Restricted range of coping strategies (“know-what”)
Behavioral inconsistency (“know-when”)
Insufficient stimulus control (difficulty with initiating or maintaining behavior)
Insufficient contingency control (failure to reward self)
Behavioral Difficulties #2
Disorders of Executive Control
Delay of Gratification / Poor Impulse Control (inhibition of behavior)
Goal Directedness (initiation of behavior)
Human cognition tends to be categorical and hierarchical. (We sort and categorize.) This is biologically determined – it’s how the brain works.
Sorting and categorizing makes learning possible, through a process of assimilation and accommodation.
Categorizing and comparing allows us to arrive at efficient rules for sorting the vast amount of information that confronts us every waking moment.
Early-acquired cognitive rules form basic schema that tell us what information is important for survival:
what data to actively seek,
what data is relevant and noteworthy, and
what can be safely ignored
Early acquired schema (probably prior to age 8 or so) form our basic assumptions about ourselves and the world and the relationship between those two. They form our Core Beliefs or Basic Beliefs.
Schema tend to be partial constructs, usually operating outside our awareness. They tend to be fragmentary, visceral, iconic vs. verbal. They are presumed true, unquestioned.
Characteristics of Basic Schema
They are absolutes.
They are unquestioningly taken as Truths.
They are consistent across time and situation.
They function below the level of awareness.
They tend to be non-verbal, visceral & iconic.
They tend to be partial constructs.
They are highly resistant to change.
They are evident only indirectly in patterns of cognition, emotion, & behavior.
Cognitive Schema may be…
Beliefs about Self are acquired from:
Stories told about the child within his/her hearing
Stories told directly to the child about themselves
Reflections of and reactions to the child’s behavior by significant others
Stories erroneously adopted (false memories)
Events that happened to others
Events in books or on television
Interpretations of early life events
Experiences of success and failure
Self-Schema ExamplesThe Self may be experienced as…
Schema about the World - general
The nature of God
Is vengeful, just, merciful;
Takes an active part/observes but does not interfere;
Has a personal relationship with us/is available only through the mediation of a shaman or intermediary
Schema about the World – general - 2
The nature of Man
Man is savage, noble, erring, divine;
Is innocent/sinful; villainous/heroic;
Has agency and free will/has a predestined fate.
Schema about the World – general - 3
The nature of the World
The world is mysterious/knowable;
Schema about the World – 4
Birth order & role within the family
Relative value of boys and girls
Role of father, mother, children, boundary diffusion
Rules about family membership, diffuseness of boundary around the family
Nature of success
Schema about the World – 5
Definition of family;
Nature of respect;
Achievement & striving
Goal of development
Relationship with dominant culture
Relationship with authority
Schema about the World – 6
Country/Region - examples
The South shall rise again.
The “show me” state
The Second City, a city of farmers
More nuts per square inch…
Sophisticated; Big Apple
Schema about the Future
The future is…
Likely to be worse, better, the same
Schema result in behavioral imperatives:
The world is…
Therefore I must…
Schema provide us with a cognitive map that
Explains the past (where we’ve been)
Makes sense of the present (where we are)
Predicts the future (where we are likely to go next)
They tell us what signposts to look out for and what to do along the way.
They form a basis for our personalities, making our cognition, emotion, and behavior consistent across time and situation.
Schema contribute to cognitive error.
Schema are generalizations. They do not reflect differences between first learning experiences and the present situation. They resist influence by new data.
Schema filter out some information, while over-valuing other information.
Schema are highly resistant to change. They are over-valued ideas that operate outside of awareness and are unquestioned under normal circumstances.
We resist, ignore, fail to notice, or disbelieve data that runs counter to our basic beliefs.
We differentially note data that confirms basic beliefs.
Fundamental attribution error:
The tendency to overemphasize dispositional or personality-based explanations for others’ behavior while dismissing situational explanations.
The opposite typically occurs when explaining one’s own (negative) behaviors.
Availability heuristic – the most salient (aggravating, desired) examples are most easily brought to mind, and are then taken as typical or representative.
Cognitive Error is inevitable. It occurs simply because of the way the brain works. It is desirable – if we did not sort and categorize, we could not learn.It is beatable under certain circumstances – we can learn to notice, catch, interrupt, and do something else with our tendency toward error.
Types of Cognitive Error
Disqualifying the Positive
“Shoulds” and “Musts”
Basic or Conditional (if-then) Beliefs
Usually operate outside of awareness, but can be brought to awareness with much more ease than basic schema.
Immediate, unpremeditated, “knee jerk” cognitive interpretations of events.
Directly shape emotion and strongly influence behavior.
Exaggerated, distorted, mistaken, or unrealistic ATs play a role in psychological distress.
Vaihinger – “as if”
Phenomenology – Immanual Kant & Husserl – the construction of knowledge as a rule-bound, creative act
Karen Horney – Tyranny of the Shoulds
Kelly – the Psychology of Personal Constructs & fixed role therapy
Social Learning Theory – observation of models
Assumptions of CBT
Beck, then most
CT highlights the role of philosophy and self-persuasion in personal change.
Supposes that we have a choice how to think and feel about things, as well as how we act.
Cognition, Emotion, and Behavior mutually influence each other
Disorders are characterized by(not caused by) dysfunctional thinking.
Disorders are characterized by insufficient range of coping responses.
So CBT assesses and seeks to intervene in three areas:
Cognitive, emotional and behavioral patterns may cause, contribute to, maintain, contribute to resistance in changing, or cause relapses in symptoms.
SITUATIONAL VARIABLES can also cause, contribute to, maintain, resist changes in, or cause relapses in symptoms.
It is always important to understand the physical, biological, developmental, and social-emotional context in which the problem occurs.
Goals of CBT/CT
Interrupt self-perpetuating cycles of cognitive error, disturbed mood, and ineffective behavior.
The client becomes less disturbed. Symptoms recede. First-order change.
Modify beliefs and assumptions that predispose the client to the problems.
The client becomes less disturbable. Ellis’s “elegant solution” or “second-order change”.
Provide the client with more effective ways to manage the situations that provoke their distress or difficulties.
The client is able to manage similar and dissimilar stressors more effectively; the client is more skilled.
Assessment ala CBT
Nature of the problem
Onset (learning history, but later), duration, course
Consequences (reinforcers and costs)
The client’s explanation & understanding of the problem
Previous attempts to solve the problem and relative success of these
Assessment ala CBT/CT
Daily Thought Record
Critical Incidents - history
Cognition, emotion, behavior
Situational variables – who, what, when, where
Thought Record – part 1
Assessment ala CBT/CT cont’d.
Formal Assessment Tools
Beck Depression Inventory
Beck Anxiety Scale
Beck Hopelessness Scale
Burns Anxiety Inventory
Dysfunctional Attitudes Scale
Fear Survey Schedule
And MANY more…
Use appropriately; use sparingly; use repeatedly.
Assessment ala DSM-IV-TR
Symptoms from DSM
Collaborative Goal Setting:
Client’s goals – realistically and objectively defined
Therapist’s goals based on practicality, theory, conceptualization
Mutually agreed upon
Goals should be empirical:
Objective – verifiable by other than subjective methods
Observable – outside of “the black box”
Measurable – able to be counted, recorded, scored, scaled,