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  1. Cognitive-Behavioral Therapies, Part IPSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D. November 27, 2012

  2. Reminder • Please complete course evaluations!

  3. Questions for Herbert et al. (2000) response paper, due Tuesday 12/3 • 1. Why do think EMDR has become so popular among therapists? • 2. What can be concluded about EMDR from the observation that component studies generally find that imagery without eye movements is as effective as standard EMDR? • 3. Which one of the FiLCHeRS (essential features of science) do you find most troublesome about EMDR?

  4. Cognitive-Behavioral Therapy • Encompasses variety of related therapies • Behavior modification techniques • Cognitive modification techniques • Combinations of these • Gradual evolution toward emphasis on cognitive factors (AABT  ABCT)

  5. Characteristics of CBT • Brief and time-limited (M = 16 sessions) • A good therapeutic relationship is important, but not the focus (i.e., necessary but not sufficient) • Rooted in science and philosophy • Direct relationship between psychopathological processes and treatment strategies • Emphasis on outcome research

  6. Characteristics of CBT • From ABCT website: • The therapist and client work together with a mutual understanding that the therapist has theoretical and technical expertise, but the client is the expert on him- or herself. • The therapist seeks to help the client discover that he/she is powerful and capable of choosing positive thoughts and behaviors. • Treatment is often short-term. Clients actively participate in treatment in and out of session. Homework assignments often are included in therapy. The skills that are taught in these therapies require practice. • Treatment is goal-oriented to resolve present-day problems. Therapy involves working step-by-step to achieve goals. • The therapist and client develop goals for therapy together, and track progress toward goals throughout the course of treatment.

  7. Behavior Therapy • Based on behavioral principles of learning and behavior change • Classical conditioning • Operant conditioning • Vicarious conditioning • Direct relationship between learning principles that caused the problem and those used to treat it

  8. Basic Operant Techniques • Reinforcement – increase the likelihood of a specific behavior • Positive reinforcement – rewarding positive behavior with a desirable stimulus (e.g., behavioral activation, therapist encouragement) • Negative reinforcement – removing undesirable stimulus (e.g., avoidance, nagging)

  9. Basic Operant Techniques • Punishment – decrease the likelihood of a specific behavior • Positive punishment (aka “response-contingent aversive stimulation,”) • Negative Punishment – remove desirable stimulus to extinguish undesirable behavior (e.g., Ignoring)

  10. Applying the Behavioral Model • Token economy • Shaping/successive approximations • Time out • Modeling • Aversion therapy (e.g., alcohol) •

  11. Cognitive Modification Procedures • One example: Rational Emotive Behavior Therapy (REBT) • Developed by Albert Ellis in 1950s • Basic idea: we are not disturbed by events, but by how we view them

  12. REBT • The REBT philosophy: • Preference vs. demand is the dividing line between emotional health and disturbance • Dissatisfaction is different from and does not lead to disturbance • Feelings are not externally caused • Irrational beliefs cause unhealthy emotions

  13. REBT • Healthy vs. unhealthy emotions • Sadness vs. depression • Annoyance vs. anger • Apprehension vs. fear • Regret vs. shame

  14. Typical Way of Thinking A → C Activating Consequence Event (Emotion)

  15. REBT Model A → B → C Activating Belief Consequence Event (Emotion)

  16. REBT Model A → B → C Fail an exam “I am stupid. I’ll never graduate. Despair I should just drop out.” Fail an exam “This stinks, but it’s not the end of the Disappointment world. I’ll study harder next time.”

  17. REBT • Clients usually present with problems with C • They usually blame A for their problems • REBT focuses on B • Dispute irrational Bs and replace with rational Bs

  18. Beck’s Cognitive Therapy • Independently developed by Aaron Beck in 1950s • Similarities with REBT • Cognitive schemas – global, absolute beliefs • Cognitive distortions – in-situation errors in thinking • All or nothing thinking • Mind reading

  19. Basics of “Cognitive Restructuring” • Disputing inaccurate thoughts • 1. Identify the specific, inaccurate thought • 2. Examine the evidence for and against that thought • 3. Generate a more accurate and adaptive way of thinking

  20. Integrating Cognitive and Behavioral Strategies • How can we combine cognitive and behavioral strategies so we can best modify a problem? • Behavioral experiments – testing the accuracy of negative beliefs in the real-world

  21. Behavioral Experiments • Devise an experiment to test the following beliefs: • The embarrassment of appearing foolish will be intolerable • I won’t have anything to say if I talk to other people • I will run out of air if I stay in an enclosed space for too long • If I don’t check the stove the house will burn down • I can’t tolerate not knowing for sure if I have cancer • I will pass out if I hyperventilate for too long • If I think about something bad happening, it will happen

  22. REBT • Video of Albert Ellis with Gloria • Pay attention to A-B-C model, identifying, and disputing beliefs • What’s it like to be a patient in REBT? • What’s it like to be a therapist in REBT? • A disclaimer about Albert Ellis

  23. Albert Ellis Video Clips •