Behavior Therapy

Contemporary therapy can be understood by considering four

 Classical conditioning—involuntary; on what happens prior to learning
 Operant conditioning—voluntary; on what happens after learning
 Social-cognitive theory—triadic reciprocal interaction among environment, personal factors
(beliefs, preferences, expectations, perceptions, interpretatio), and indiv behavior
 Cognitive behavior therapy—based on the idea that belief influences how they act and feel
Basic assumptions
 Based on the scientific method, and thus behavior is operationally defined
 assumes that change can take place without insight into origins and underlying dynamics
 treatment interventions are individually tailored to specific problems
Therapeutic process
Goal—increase personal choice; create new conditions for learning
 Clients have an active role in formulating specific measurable goals that are clear,
concrete,understood, and agreed upon by client and counselor
T’s Function—conduct a functional assessment (or behavior analysis) using the ABC model
 Antecedents, dimensions of the problem Behavior, and the Consequences of behavior
 In behavioral assessment interview, the therapist identifies particular antecedent events
C’s experience
 The therapist teaches concrete skills (instructions, modeling, feedback), while the client engages
in behavior rehearsal, and receives active homework between sessions
 Warmth, empathy, and acceptance are necessary but not sufficient for change to occur
Techniques
 Operant conditioning—positive & reinforcement, positive & negative punishment
 Progressive muscle relaxation—regular breathing is associated with producing relaxation
 Systemic desensitization—imagining more anxiety-inducing situations while engaging in behavior
that competes with anxiety
o Prog muscle relaxation, then anxiety hierarchy, then desensitization, then homework
 In vivo exposure--in vivo means actual exposure. In vivo tends to reduce anxiety rapidly
 Flooding—intense and prolonged exposure to actual anxiety-producing stimuli without engaging
in any anxiety-reducing behaviors
 Eye movement desensitization and reprocessing (EMDR)—assessment and preparation, imaginal
flooding, and cognitive restructuring in treating individuals with trauma
o The ethical use of the procedure demands training and supervision, as is true of
exposure therapies in general
 Social skills training—helps clients develop skills in interpersonal competence
 Self management programs and self-directed behavior—include teaching clients how to select
realistic goals, translate these into target behaviors, how to create an action plan for change.
o Select goals, translate it to behaviors, self-monitoring (diary), working on plan, evaluating
 Clinical behavior therapy—assessment is multimodal (based on other therapy systems), though
treatment is cognitive behavioral
 Mindfulness and acceptance-based approaches—based on (1) an expanded view of psych health,
(2) a broad view of acceptable outcomes, (3) acceptance, (4) mindfulness, and (5) creating a life
worth living
o Dialectical behavioral therapy (DBT)—blends behavioral and psychoanalytic techniques
for treating BPD, teaching clients to recognize and accept simultaneous opposing forces.
 o Mindfulness-based stress reduction (MBSR)—assists people in learning how to live more
fully in the present, since distress results from continuously wanting things to be
different from what they actuallya re
o Mindfulness-based cognitive therapy (MBCT)—an 8-week group treatment. Mindfulness
develops self-compassion, and when we acknowledge our own shortcomings without
critical judgment, we begin to treat ourselves with kindness. It emphasizes experiential
learning, in-session practice, learning from feedback, completing homeworkassignments,
and applying what is learned.
o Acceptance and commitment therapy (ACT)—uses acceptance and mindfulness
strategies, together with commitment and behavior change strategies, to increase
psychological flexibility. Fully acceptance of present experience and mindful letting go of
 Weaknesses—does not target the underlying stuff, tend to focus on specific behavioral problems
COGNITIVE BEHAVIORAL THERAPY
 Both CT and CBT are based on the assumption that beliefs, behaviors, emotions, and physical
reactions are all reciprocally linked.
 All of the cognitive behavioral approaches stress the importance of links between cognitive
processes, emotions, and behavior
Albert Ellis’ Rational Emotive Behavior Therapy (REBT)
 Based on the notion that people contribute to their psychological problems by the rigid and
extreme beliefs they have about events and situations; cognitions, emotions, and behaviors
interact significantly and have a reciprocal cause-and-effect relationship.
 Basic concepts—emotional disturbance lies on blaming oneself, and actively reinforcing our self-
defeating beliefs through autosuggestion and self-repetition.
 “I must do well and be loved and approved by others”
 “Other people must treat me fairly, kindly, and well”
 “the world and my living conditions must be comfortable, gratifying, and just”
o ABC Framework—an Activating event leads to inference (Belief), which creates the
emotional Consequence.
 After C comes Disputing, which include methods that challenge irrational beliefs
 Goal—therapist aims to help clients differentiate between realistic and unrealistic goals, as well
as self-defeating and life-enhancing goals. Another goal is to assist the clients in USA, UOA, ULA
 Client’s experiences—emphasizes here-and now experience, and highlights their ability to
change the patterns of thinking and emoting that they constructed earlier. Also homework.
o Warm relationships are not necessary
Aaron and Judith Beck’s Cognitive Therapy (CT)
 did not assert that negative thoughts were the sole cause of depression. Beck’s research
indicated that depression could result from negative thinking, but it could also be precipitated by
genetic, neurobiological, or environmental changes
o once people became depressed, their thinking reflected what Beck referred to as the
negative cognitive triad: negative views of the self (self-criticism),the world (pessimism),
and the future (hopelessness).
o CT is based on the theoretical rationale that the way people feel and behave is
influenced by how they perceive and place meaning on their experience
o Three theoretical assumptions of CT are (1) that people’s thought processes are
accessible to introspection, (2) that people’s beliefs have highly personal meanings, and
(3) that people can discover these meanings themselves rather than being taught or
having them interpreted by the therapist
 o CT has specific treatment protocols for anxiety, depression, and anger while REBT
teaches a similar philosophical principles to curb these problems
 Generic cognitive model—perceptions of situations, rather than the situation itself, influence
emotion, physiology, and behavior
o Psychological distress is an exaggeration of normal adaptive functioning
o Faulty information processing is a prime cause of exaggerations (arbitrary inferences,
selective abstraction, overgeneralization, magnification and minimization,
personalization, labeling and mislabeling, dichotomus thinking)
o Our beliefs play a major role in determining psych distress we experience
o Changes in beliefs lead to changes in behaviors and emotions
o If beliefs are not modified, clinical conditions are likely to reoccur
 Differences between CT and REBT
o REBT is highly directive, persuasive, and the teaching role of the therapist is emphasized
o CT uses the Socratic dialogue, the clients themselves reflect and arrive on conclusions
o REBT aims to persuade clients that their beliefs are irrational and nonfunctional, while CT
views distorted beliefs as results of cognitive errors rather than just irrational beliefs
 C-T Relationship—combine empathy and sensitivity with technical competence. Therapists are
continuously active and deliberately interactive with clients, helping them frame conclusions in
the form of testable hypothesis.
o CT identify specific, measurable goals, and move directly into areas that cause the most
difficulty for clients. Homework is also included
 Applications of CT cognitive techniques—cog methods focus on identifying and examining
beliefs, exploring the origins of these beliefs, and modifying them if evidence does not support
these beliefs
 Treatment approaches—thought records helps identify negative automatic thoughtsaction plans.
Strengths-based Cognitive Behavioral Therapy
 Active incorporation of client strengths encourages clients to engage more fully in therapy, and
provides avenues for change that would otherwise be missed
 Four-step model of resilience—search for strength, construct a personal model of resilience
(PMR), apply it to a real-life problem, and practice.
Cognitive Behavior Modification
 Focuses on changing a client’s self-talk.
o They must first notice how they think, feel, and behave, and the impact they have on
others. Then they must modify the scripted nature of their behavior
 Similarities with REVT—REBT is more direct and confrontational in uncovering and disputing
irrational thoughts, whereas Meichenbaum’s self-instructional training focuses more on helping
clients become aware of their self-talk and the stories they tell about themselves. It is easier to
change our behavior rather than our thinking first.
o Self-observation, starting new internal dialogue, learning new skills,
 Stress inoculation training—conceptual-educational phase (therapeutic alliance, where C and T
rethink stress concerns that clients bring), skills-acquisition and consolidation phase (variety of
behavioral and cognitive-coping skills), application and follow-through phase
FAMILY SYSTEMS THERAPY
 Individuals are best understood through assessing the interactions between and among family
members. In this case, problematic behavior may:
o Serve as a function or purpose for the family
o Be unintentionally maintained by family processes
 o Be a function of the family’s inability to operate productively
o Be a symptom of dysfunctional patterns handed down across generations

 Multigenerational family therapy (by Bowen)

o Differentiate self within a system and understand one’s family of origin
o Emphasizes a multigenerational perspective, where problems manifested in one’s
current family will not significantly change until relationship patterns are understood
o Key generator of anxiety in families is perception of too much closeness or distance
o Emotional fusion and differentiation
o Triangles—smallest stable relationship unit to preserve stability
 May become problematic when a third party’s involvement distracts members
from resolving problems; tend to repeat across generations
o Nuclear family emotional system—describes how and where and in which family
members or which relationships symptoms come to reside in the nuclear family.
 Couple conflict—conflict may be functional for fused relationships
 Spouse—both undifferentiated that they define themselves to the other
 Symptoms in a child—family fusionchild develops psych problems
 Child with least emotional separation is said to be the most vulnerable
to developing symptoms
o Techniques include—differentiated stance, actively directing conversation,
detriangulation, multigenerational genogram
 Detriangulation—helps recognize both subtle and more obvious ways that we
are triangled by others, help plan ways of communicating a neutral position (I
statements)
 Genogram—draw family tree, DTR, reflect
 Human validation process model (by Satir)
o Emphasizes communication and emotional experiencing, especially on the personal
relationship between therapist and family to achieve change.
o Focuses on communication patterns, self-esteem, and self-worth for each member
o Tools—model for congruence, sculpting (psychodrama), family life chronology, touch
communication
 Structural-Strategic Family therapy (Minuchin)
 o Structural changes must occur within a family before an individual’s symptoms can be
reduced or eliminated.
 Structural-strategic approaches—included joining, boundary setting,
unbalancing, reframing, ordeals, interventions, enactments
 Parental subsystem, spousal subsystem, sibling subsystem, etc
 Boundaries—defines who is in and out of the relationship
 Alignment—who is with or against whom
 Power—who is most and least influential
o Tools—joining and accommodating, boundary making, enactments
 Multilayered process of family therapy
o Families are multilayered systems that are affected by the larger systems they embed on.
o Members and the system can be assessed based on power, alignment, organization,
structure, development, culture, and gender.
 Importance of relationships in family therapy
o Therapists must show respect, caring, empathy, and genuine interest in others
 Conducting an assessment
o Most formal assessment procedures present the situation in a clearer manner
o In the assessment process, it is important to inquire on family perspectives on issues
 Hypothesizing and sharing meaning
 Facilitating change—occurs when family therapy is viewed as a joint or collaborative process
 These tend to be brief since families who seek professional help tend to want resolution of some
problematic symptom.
o Specific goals are determined by the practitioner’s orientation or through a collaborative
process between family and therapist.
 The Filipino family
o Collective, close-knit, intergenerational, extended
o “tagasalo”—may be non-compulsive or compulsive

MINDFULNESS THERAPY