L18 Behavioral Approaches?

參考文獻(xiàn)/圖片來(lái)源：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.

18.1 Conditioning

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Pavlov’s Laboratory

? Ivan Pavlov (1849 – 1936)

Russian physiologist who researched?digestion

? Pavlov’s digestion research

- Collected and analyzed gastric secretions

- Studied salivary responses to food

- After several trials, dogs began salivating before the food arrived

- “Psychic” secretions

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Classical Conditioning

Operant Conditioning

? Focuses on behavior occurs (or does not occur) based on?environmental consequences

? Focus on consequences of behavior

? Focus on voluntary behaviors and contingencies

- Reinforcement increases a target behavior

? Positive Reinforcement = Add something good

? Negative Reinforcement = Take away something?unpleasant/bad

- Punishment decreases a target behavior

? Positive Punishment = Add something unpleasant/bad

? Negative Punishment = Take away something good

18.2 Behaviorism & Behavior Therapy

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Principles of Behaviorism

? Started as reaction against psychoanalytic theory and?psychodynamic psychotherapy

? Focused on a science of behavior

- Based on key ideas in conditioning

- Complex human behavior?and humane emotions?could be understood in stimulus-response?terms

“Psychology as the behaviorist views it is?a purely objective experimental branch?of natural science. Its theoretical goal is?the prediction and control of behavior.”?- John B. Watson, 1913

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Behavior Therapy

? Primary goal: Observable behavior change

? Psychotherapy should be grounded in science with:

- Observable behaviors

? eg Number of cigarettes smoked per day

- Testable hypotheses

??eg?If a client is given money for smoking 0 cigarettes each day,?they are less likely to smoke

? Can be conceptualized as an application of the scientific?method

18.3 Behavioral Treatments

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18.3.1 Techniques in the Treatments

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Techniques Based on?Classical Conditioning

Exposure Therapy

? Used commonly with?anxiety disorders

? Interacting with the?feared stimulus

Systematic Desensitization

? Combination of?relaxation training plus?exposure therapy

? Also common for anxiety

Assertiveness Training

? Includes exposure in the form of facing?interpersonal fears

? Direct instructions, modeling, and?practice used

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Techniques Based on?Operant Conditioning

Contingency Management

? Change the if-then?statements that influence?behavior

Token Economies

? Clients earn tokens for?engaging in certain?behaviors

Shaping

? Used to with complex?behaviors

? Successive?approximations of the?behavior are rewarded

Behavioral Activation

? Increase the frequency of?behaviors that are?positively reinforcing for?the client

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18.3.2 Exposure Therapy

? Mainly based on Classical Conditioning

- Theory is that fear is a conditioned response

? To stop association, present the conditioned stimulus repeatedly

? Fear decreases in the absence of a negative outcome

? Very effective in the treatment of anxiety disorders

? Exposure activities

- Graded exposure: Develop a fear hierarchy; start with easier fears,?work your way up to more challenging fears

- Flooding/implosion: “Worst first”

- In-vivo: Confronting the feared stimulus “in real life”

- Imaginal: Vividly visualizing feared stimulus

? Fear hierarchy: Specific phobic objects/situations are?identified and given a fear rating?- Start with the least feared

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18.3.3 Obsessive-Compulsive Disorder (OCD)

? Obsessions

- Intrusive, recurrent, and persistent thoughts,?impulses, or images that cause anxiety or distress

- Not simply excessive worries about real-life problems

- Attempts to ignore, suppress, or neutralize?obsessions

- Common examples: contamination; doubting if?something has been done; aggressive impulses

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? Compulsions

- Repetitive behaviors or mental acts that a person?feels driven to perform in response to obsession

- Aimed at preventing a dreaded event but are not?realistically connected to that event (or are excessive)

- Common examples: hand-washing; checking;?counting

18.3.4 Exposure & Response Prevention (EX/RP)

? Prolonged exposure to obsessional cues without access to?rituals/compulsions

- Time-limited treatment

- Session length can vary: eg?Intensive: 15 two-hour sessions over?3 weeks

? In-vivo exposure often used; imaginal used when in-vivo is not?safe or feasible

? Effective for over 80% of patients with?good long-term outcomes

? Goals of exposures:

- Tolerate negative thoughts and uncertainty

- Habituate to anxiety and experience a decrease in distress

- Feared (catastrophic) events do not happen

? Subjective Units of Discomfort or Distress (SUDS)

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? Case Example (from Foa et al., 2012)

- Mike feared harming strangers while driving or harming his?family by failing to check locks and the stove at home. He?also worried that he would drop his 4-year-old daughter?while carrying her over hard flooring, leading to serious?injury.

? Example rear hierarchy for Mike included:

- Turning stove off without checking (50 SUDs)

-?Locking door without checking (60 SUDs)

-?Carrying daughter while walking on hard surfaces (75 SUDs)

- Driving on highway without retracing his route (100 SUDs)