Why Focus on Theory?

1. Why Focus on Theory? • Guide your interventions to be maximally effective/efficient for unique clients and situations • Empirical studies (and ESTs) are never sufficient • can never be enough studies • research findings always require interpretation • there are always exceptions (moderators) • Very often therapists need to improvise • if fewer sessions than recommended • if client does not respond to standard procedures • if client does not cooperate (e.g., culture, world-view) • if client has a problem not in DSM, “atypical”, or “NOS” • Allows for technical eclecticism • Orient clients (expectancies and collaboration)

2. Becoming a Good Therapist • Learn principles of behavior and behavior change • Learn techniques, observe therapy • Practice, practice, practice! • Have CBT supervisors view your videotapes and give you feedback • Incorporate new research (PSY6023)

3. Specific things to learn • How to do a thorough person-specific analysis of proximal causes • Understand effective ways to change problematic thinking and emotions • Understand treatment failures • failures to generalize to real world • return of problem behaviors/emotions

4. What is Behaviorism? 1. Principles of learning derived from science 2. Does not acknowledge internal “diseases” 3. Leads to superficial change (symptom substitution) 4. A set of technical language that alienates others 5. It is coercive/controlling, limits free will 6. It oversimplifies human complexities 7. Is too deterministic, claiming that responses are only determined by immediate stimuli (S-R) 8. It feels dehumanizing, ignoring most thinking and feeling and the uniqueness of each person

5. Behaviorism Myths 3. Little evidence for symptom substitution 5. It is generally not coercive/controlling 5. It does not limit free will 6. Behavioral theory is complex in considering a variety of causes including thinking 7. No longer a stimulus-response theory 8. It does not have to feel dehumanizing, if so it is based on your thinking and/or conditioning 8. It does not ignore thinking and feeling and very much considers uniqueness of each person

6. Which Therapy Orientation? 1. Free association 2. Free responses to ambiguous auditory stimuli 3. Analysis of patients feelings toward therapist and how they resemble feelings toward others

7. The Functions of CBT 1. Increase abilities for effective behavior to live a valued life 2. Improve motivation and salience of true goals 3. Decrease thoughts/emotions that interfere with effective behaviors or quality of life 4. Increase distress tolerance and acceptance 5. Restructure the environment to promote effective behaviors (antecedents and consequences) 6. Ensure generalization to natural environment

8. What is CBT? Interventions guided by CBT theories • Functional analysis • Problem solving 1. Skills training 2. Cognitive modification 3. Exposure strategies 4. Mindfulness/meditation 5. Contingency management 6. Homework

9. The Therapist’s Influence • Verbal teaching (didactic/instruction) • Modeling (intentional and inadvertent) • Reinforcement and punishment • verbal • nonverbal (intentional and inadvertent) • careful observation: the counting horse • natural versus arbitrary

10. The Therapist’s Influence • Modeling • Negative judgment of others (validation) • Positive judgment (praise) • Failure model (validation) • Reinforcement • of judgment (by laughing) • of self-criticism (by reassuring or praise) • of suicidality (by providing more help)

11. The Teacher’s Influence • Verbal teaching (didactic/instruction) • Modeling (intentional and inadvertent) • Reinforcement and punishment • Verbal • Nonverbal (intentional and inadvertent)

12. What are Effects of These Consequences? • Praise • Being yelled at and criticized • Food • Physical pain • Fear • Gaining weight (obesity) • Time-out from recess (child) • Beep (stacked squares) SEraser

13. Function Varies Considerably Function (causal relations) depends on • the disorder • the person (genetics + learning history) • external context (physical or interpersonal) • recent external events/stimuli • internal context • biological changes (e.g., hunger) • emotions • mental perspective or thinking • drug intoxication

14. What is CBT? Interventions based on a commitment to the scientific analysis of: • causes of psychopathology • change strategies • efficacy/effectiveness • mechanisms of change • operational definitions of causes, behaviors, and change processes

15. What is CBT? • CBT is driven by science • CBT is diverse and evolving • CBT is active and collaborative • self-monitoring • learning new coping skills and behaviors • practice in and out of sessions

16. What is CBT? What is behavior therapy? What is radical behaviorism? What is (applied) behavior analysis? What is cognitive therapy? What is cognitive-behavior therapy? What’s the difference??

17. History of CBT:The Pendulum Swings • Introspection psychology – problematic • 1st wave of CBT • Watson – extreme behavioral • Skinner – “radical” behavioral, less extreme • 2nd wave of CBT: Cognitive revolution • 3rd wave of CBT: • contextual approaches • integrative approaches

18. History of CBT:Your Mentorship Lineage • William James • Albert Bandura (Stanford) • Gerald Davison (USC) • Marsha Linehan • Milton Brown • you

19. Early Behavioral Theory Behavior is controlled by its Antecedents and Consequences

20. To a Behaviorist:All forms of “behavior” can cause other “behaviors”“Cognitions are not causes”

21. Current stimuli can control current responses bell => salivation white rat => fear “close” => contraction of pupils bedroom => alertness + anxiety+worry being in any car => sleepiness + sleep size of plate => amount of food eaten darkness (outside) => TV (no chores) Stimulus Control 21

22. Stimulus Control Control responses by controlling antecedents: • remove conditioned stimuli • remove discriminative stimuli • remove opportunities to behave • prevent problematic conditioning Examples: • remove binge foods (cigarettes) from home • rearrange the space in which eating occurs • rearrange the space in which person sleeps • do not read or watch TV in bed

23. Why the Cognitive Revolution? Evidence against behavioral theories: • lack of S-R consistencies between people • individuals respond differently to same stimuli • intermittent reinforcement effects • observational learning • cognitions/awareness correlate with learning • cognitive dissonance effects • overjustification effects (rewards)

24. A Activating Event B Belief C Consequence (emotion/behavior) ABC’s of Cognitive Therapy Thoughts and beliefs determine emotions and behavior.

25. ABC’s of Cognitive Therapy Examples: • student getting bigger belly • person hunched over at Home Depot saying “Don’t kill yourself…” • letter from Board of Psychology • at Target, I turned around and my daughter was gone

26. The Big Debate The Role of Cognition (B) in Dysfunctional Emotions and Behaviors (C)

27. Cognitive Mediation of Emotions and Behaviors

28. John Watson’s Behaviorism

29. Disadvantages of Early Models Insisting always cognitive mediation: • impedes search for other causes • external antecedents/context • cognitive learning in context • role of mental context vs. cognitive content • consequences for problem and target behaviors • clients fabricate plausible thoughts

30. Modern CBT Theory

31. The Failure of Catharsis

32. A Reformulation of Differences Pure “Behavior” Therapy • John Watson (pure externalism) Behavioral-Cognitive Therapy • B.F. Skinner (the least cognitive) • Steven Hayes (contextual Skinnerian) • Albert Bandura (50-50) • Arthur Staats (50-50) Cognitive-Behavioral Therapy (the most cognitive) • Aaron T. Beck • Albert Ellis (more behavioral than Beck)

33. Three Ways to Reduce Suffering and Stop Problem Behaviors 1. Change problematic thoughts 2. Reduce negative emotions 3. Change the way you relate to your thoughts and emotions (internal context)

34. 3rd Wave of CBT • Acceptance and Commitment Therapy • Dialectical Behavior Therapy • Mindfulness-based Cognitive Therapy • Mindfulness-based Stress Reduction • Mindfulness-based Relapse Prevention • Mindfulness-based Therapy for GAD

35. Two Primary Forms of Learning 1. Classical (respondent) conditioning 2. Operant (instrumental) conditioning …to help us effectively navigate our world • make use of signals effectively prepare us for important events and opportunities

36. Two Primary Forms of Learning 1. Classical (respondent) conditioning 2. Operant (instrumental) conditioning Both usually co-occur and interact Both signals and responses: • can occur outside of awareness • can be inside or outside the person

37. Respondent Conditioning UCS = important evocative stimuli, usually not learned (e.g., injury or food) UCR = “natural” response to a UCS CS = stimuli (usually neutral) that acquire potential to elicit a new response CR = the learned response

38. Respondent Conditioning Original Theory: stimulus substitution • A previously neutral stimulus functions as the evocative stimulus with which it has been paired • The response transfers to the neutral stimulus such that it is no loner neutral • The number temporal pairing of CS-UCS determines the CR strength

39. Pavlovian Experimental Apparatus

40. Little Albert Experiment

41. Respondent Conditioning

42. Respondent Conditioning CS UCS UCR CR . T1 bell => orienting T2 food => salivation T3 bell+food => salivation T4 bell => salivation T1 rat => orienting T2 noise => startle/fear T3 rat + noise => startle/fear T4 rat => fear/crying

43. Generalization Gradient

44. Salivation can be conditioned to almost any neutral stimulus—buzzers, lights, touches One dog was conditioned to salivate when it received an electric shock. At first the shock was very weak so as to be barely perceptible. As the shock was increased in strength it was found that a very strong shock produced no sign of pain or displeasure. There was no quickening of the heartbeat or breathing which usually accompanies an unpleasant event. Instead the shock was followed by mouth-watering and tail wagging. Respondent Conditioning 44

45. Respondent Conditioning CS UCS UCR CR . T1 bell => orienting T2 light => pupils contract T3 bell+light => pupils contract T4 bell => contraction CS can also be the spoken word “contract,” which can cause the pupils to contract

46. Learning principles apply to both overt behaviors and private behaviors Internal/private stimuli can become CS thinking emotions heart beat reinforcement and punishment can alter: internal responses thinking emoting involuntary or reflexive behaviors cough bruxism 46

47. Verbal Conditioning Command your pupils to “contract” Command your temperature to drop 47

48. Interoceptive Conditioning Exteroceptive conditioning Ex: overtly spoken words: “CONTRACT” Interoceptive conditioning Ex: sub-vocal speech: “CONTRACT” 48

49. Rescorla-Wagner Theory Our brains are not stupid!! Conditioning is not simplistic. Conditioning effects depend on many factors …based on what is useful

50. Rescorla-Wagner Theory Conditioning is not a stupid process by which the organism willy-nilly forms associations between any two stimuli that happen to co-occur. Rather, the organism is better seen as a strategic information seeker striving to predict its world to increase good outcomes and avoid harm. If one thinks of classical conditioning as developing between CS and US under just those circumstances that would lead a scientist to conclude that the CS causes the US, one has a surprisingly successful heuristic for remembering the facts of what it takes to produce associative learning.