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Lecture Overview. Nature and history of the behavior therapies Early developments Conceptual approaches Common myths Common features Current status Empirically-supported treatments Definition and criteria Discussion of empirically-supported treatments

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Lecture Overview

  • Nature and history of the behavior therapies

    • Early developments

    • Conceptual approaches

    • Common myths

    • Common features

    • Current status

  • Empirically-supported treatments

    • Definition and criteria

    • Discussion of empirically-supported treatments

  • Discussion of science-based clinical practice

Behavior Therapy


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Historical Developments

  • Early developments (low impact)

    • Pavlov

    • Watson

    • Thorndike

  • Modern origins (high impact)

    • Wolpe

    • Eysenck

    • Skinner

    • Bandura

Behavior Therapy


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Conceptual Approaches Within the Behavior Therapies

  • Applied behavior analyses

  • Classical conditioning approach

  • Cognitive behavior modification

  • Social learning theory

Behavior Therapy


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Major Features of Social Learning Theory

  • Reciprocal determinism (triadic reciprocity)

Behavior Therapy


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Triadic Reciprocity

Behavior

Environment

Person Factors

Behavior Therapy


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Major Features of Social Learning Theory

  • Reciprocal determinism (triadic reciprocity)

  • Emphasis on cognitive mediation

Behavior Therapy


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Major Features of Social Learning Theory

  • Reciprocal determinism (triadic reciprocity)

  • Emphasis on cognitive mediation

  • Emphasis on capacity for self-directed change

Behavior Therapy


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Major Features of Social Learning Theory

  • Reciprocal determinism (triadic reciprocity)

  • Emphasis on cognitive mediation

  • Emphasis on capacity for self-directed change

  • Emphasis on the role of observational learning

Behavior Therapy


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Major Features of Social Learning Theory

  • Reciprocal determinism (triadic reciprocity)

  • Emphasis on cognitive mediation

  • Emphasis on capacity for self-directed change

  • Emphasis on the role of observational learning

  • Self-efficacy mechanism of change

Behavior Therapy


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Things to Know about Self-Efficacy

  • Integrative theory of psychological change

  • Emphasizes importance of domain-specific perceptions of coping

  • Four major sources of self-efficacy influence

    • Enactive

    • Vicarious

    • Physiological

    • Persuasive

  • Emphasizes the role of cognitive appraisal of self-efficacy information

Behavior Therapy


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Self-Efficacy Determination

Enactive

Vicarious

Cognitive Appraisal

Physiological

Persuasion

Self-Efficacy

Behavior Therapy


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Commonly Held Myths About Behavior Therapy

  • Behavior therapy is mechanistic and de-emphasizes the therapist-client relationship

  • Behavior therapy ignores subjective experience

  • Behavior therapy is a superficial form of treatment

  • Behavior therapy results in symptom substitution

  • Behavior therapy is suited for only a limited number of problems

Behavior Therapy


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Common Characteristics of the Behavior Therapies

  • Adoption of science as the major vehicle for advancing knowledge about psychological dysfunction and its treatment

  • Emphasis on learning processes in both the acquisition and modification of most forms of abnormal behavior

  • Focuses on the current determinants of psychological dysfunction

  • Client’s presenting problem(s) are given serious attention and focus

  • Employs an action-oriented educational approach(e. g., skills)

Behavior Therapy


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Common Characteristics of the Behavior Therapies Cont.

  • Specificity in defining, treating, and measuring target problems

  • Treatment outcome is evaluated in terms of the initial induction of change, its generalization to real life settings, and its maintenance over time

  • Close linkage between assessment and treatment

  • Provides a closer match between the goals of the client and the intervention and assessment practices of the clinician (directness)

Behavior Therapy


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Common Characteristics of the Behavior Therapies Cont.

  • Extensive use of psychological assistants (e.g., parents, teachers, spouses)

  • Is broadly applicable to a full range of psychological disorders, medical, educational, and community problems

  • Has a self-corrective feature imposed by the scientific method

Behavior Therapy


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Current Trends in Behavior Therapy Research

  • Development, testing, and dissemination of disorder-specific manualized treatments

  • Assessment of the clinical significance of treatments

  • Identification of treatment moderators

  • Study of continuation and maintenance strategies

  • Integration of therapy approaches

  • Study of change mechanisms

  • Greater emphasis on effectiveness research

Behavior Therapy


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Discussion of Empirically-supported Treatments

  • What does it mean to to say that a treatment is empirically-supported?

Behavior Therapy


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Criteria for an Empirically-Supported Treatment (Chambless & Hollon, 1998)

  • Comparisons with a no-treatment control group, alternative treatment group, or placebo (a) in a RCT, controlled single-case experiment, or equivalent time series design and (b) in which the EST is significantly superior to no treatment, placebo, or alternative treatment or the EST is equivalent in efficacy to an established EST in a study with sufficient power to detect moderate differences.

Behavior Therapy


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Criteria for an Empirically-Supported Treatment (Chambless & Hollon, 1998)

  • These studies must have been conducted with (a) treatment manual or its logical equivalent; (b) a population, treated for specified problems, for whom inclusion criteria have been delineated in a reliable and valid manner; and (c) reliable and valid outcome assessments tapping the problems targeted for change; and (d) appropriate data analysis.

Behavior Therapy


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Criteria for an Empirically-Supported Treatment (Chambless & Hollon, 1998)

  • For a designation of efficacious, the superiority of the EST must have been shown in at least two independent research settings (sample size of 3 or more at each site in the case of single case experiments). If there is conflicting evidence, the preponderance of the well-controlled data must support the EST’s efficacy.

Behavior Therapy


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Criteria for an Empirically-Supported Treatment (Chambless & Hollon, 1998)

  • For a designation of possibly efficacious, one study (sample size of 3 or more at each site in the case of single case experiments) suffices in the absence of conflicting evidence.

Behavior Therapy


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Criteria for an Empirically-Supported Treatment (Chambless & Hollon, 1998)

  • For a designation of efficacious and specific,the EST must have been shown to be significantly superior to pill or psychological placebo or an alternative bona fide treatment in at least two independent research settings. If there is conflicting evidence, the preponderance of the well-controlled data must support the EST’s efficacy and specificity.

Behavior Therapy


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Discussion of Empirically-supported Treatments Hollon, 1998)

  • What does it mean to to say that a treatment is empirically-supported?

  • What are the socio-political forces contributing to the push for empirically supported treatments?

Behavior Therapy


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Socio-political Factors in the Push for Empirically-Supported Treatments

  • Debate about national health care coverage of psychological services

  • Adoption of non-empirical criteria by MHC’s

  • Legislation related to malpractice and psychotherapy

    • Standard Care Principle – i.e., treatments that are commonly used are assumed to be valid

    • Respectable Minority Principle – i.e., a treatment is considered valid if a minority of the field (as few as six individuals) believe it to be so

Behavior Therapy


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Discussion of Empirically-supported Treatments Empirically-Supported Treatments

  • What does it mean to to say that a treatment is empirically-supported?

  • What are the socio-political forces contributing to the push for empirically supported treatments?

  • What are the major objections to empirically-supported treatment?

Behavior Therapy


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Objections/Limitations to Empirically-Supported Treatments Empirically-Supported Treatments

  • The randomized clinical trial (RCT) is limited in its ability to inform clinicians about the effectiveness of therapy administered in the real world because of:

    • Stringent inclusion/exclusion criteria

    • Fixed number of sessions

    • Use of highly trained therapists

    • Use of treatment manuals

  • Downplays the importance of client and therapist factors in determining psychotherapy outcome;

  • Presents problems for our graduate training programs;

Behavior Therapy


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Objections/limitations to Empirically-supported Treatments Empirically-Supported Treatments

  • Creates further tension between scientists and practitioners

Behavior Therapy


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Discussion of Empirically-supported Treatments Empirically-Supported Treatments

  • What does it mean to to say that a treatment is empirically-supported?

  • What are the socio-political forces contributing to the push for empirically supported treatments?

  • What are the major objections to empirically-supported treatment?

  • What steps might be taken to move therapy research forward?

Behavior Therapy


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Moving Therapy Research Forward Empirically-Supported Treatments

  • Increase clinical relevance

    • Relaxing patient selection criteria

    • Increase length of treatment trials

    • Flexible dosing of treatment

  • Improved designs that inform the field on treatment moderators and mediators

  • Study treatments in their natural environment

Behavior Therapy


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Characteristics of Science-based Clinical Practice Empirically-Supported Treatments

  • Therapist Attitude: Operating with the belief that science is the major vehicle for advancing knowledge about psychological dysfunction and its treatment.

  • Case formulation (factors currently maintaining the patient’s difficulties) is based on a series of testable hypothesis that are subjected to ongoing testing and possible disconfirmation.

  • Treatment Focus:Treatment is designed to address one or more factors presumed to maintain the patient’s difficulties (i.e., conceptual linkage between case formulation and treatment).

Behavior Therapy


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Behavior Therapy Empirically-Supported Treatments


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Characteristics of Science-Based Clinical Practice Empirically-Supported Treatments

  • Treatment procedures are described with sufficient specificity so as to allow replication by others.

  • Treatment outcome is evaluated using assessment methods with adequate reliability and validity.

  • Clinician acknowledges possible threats which might cloud inferences concerning the effects of treatment on clinical outcome and strives to control these threats through various strategies (e.g., use of single-case designs, replication, etc).

Behavior Therapy


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Bridging the Gap Between Science and Practice Empirically-Supported Treatments

  • Need for better communication between scientists and practitioners

  • Need to develop dissemination outlets other than scientific journals

  • Scientists need to work directly with practitioners in settings where the treatment is to be adopted

  • Scientists must design treatments that address the clinical priorities, time constraints and limited resources that face the practicing clinician

  • Need to apply scientific knowledge of the dissemination process to our field.

Behavior Therapy


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