CURRENT PSYCHOTHERAPIES

Corsini/Wedding

Chapters 7, 8 & 9

SW 607 Group III: Wolfe Kaleiwahea Makekau

CHAPTER 7 BEHAVIOR THERAPY

Significant Figures Associated With Behavior Therapy
Ivan Pavlov (1849-1936) B. F. Skinner (1904-1990)

Joseph Wolpe (1915-1997)

Albert Bandura

OVERVIEW OF BEHAVIOR THERAPY

o o Relative newcomer on the psychotherapy scene. Early definition: Behavior therapy was defined as the application of modern learning theory to the treatment of clinical problems. Modern learning theory referred to principles and procedures of classical and operant conditioning. 1950s emerged as a systematic approach to the assessment and treatment of psychological disorders. Undergone significant changes in nature and scope Responsive to advances in experimental psychology and innovations in clinical practice.

o o o

CORE CONCEPTS
Behaviorism is focused on the capacity of human beings to learn about their environments and bring about desired consequences. The primary argument is that there is an unspoken benefit to the actions of each individual, drawn into being by hidden connections between the action. This promotes the feeling of benefit, known as conditioning. In this way, synaptic connections can draw together feelings and behaviors over time.

THREE MAIN TRADITIONAL APPROACHES

Second Wave of Behavior Therapy
o Applied Behavior Analysis o The Neobehavioristic mediational StimulusResponse (S-R) Model o Social-Cognitive Theory

APPLIED BEHAVIOR ANALYSIS

o Direct extension of Skinners (1953) radical behaviorism. o Relies of operant conditioning Behavior is a function of its consequences. o Treatment procedures are based on altering relationships between overt behaviors and their consequences. o Makes use of reinforcement, punishment, extinction, stimulus control, and other procedures derived from laboratory research.

THE NEOBEHAVIORISTIC MEDIATIONAL STIMULUS-RESPONSE (S-R) MODEL

o Features the application of the principles of classical conditioning. o Derives from the learning theories of Pavlov, Guthrie, Hull, Mowrer, and Miller. o S-R model is mediational, with intervening variables and hypothetical constructs prominently featured. o S-R theorists have been interested in the study of anxiety. o the techniques of systematic desensitization and flooding are closely associated to this model, both are directed toward the extinction of the underlying anxiety assumed to maintain phobic disorders.

SOCIAL-COGNITIVE THEORY
o The social-cognitive approach depends on the theory that behavior is based on three interacting regulatory systems. 1. External stimulus events 2. External reinforcement 3. Cognitive mediational processes o In the social-cognitive approach, the influence of environmental events on behavior is determined by cognitive processes, individuals perception and interpretation. o Psychological functioning involves a reciprocal interaction among three interlocking sets of influences. 1. Behavior 2. Cognitive processes 3. Environmental factors o In social-cognitive theory, the person is the agent of change. o The theory emphasizes the human capacity for self-directed behavioral change.

SOCIAL-COGNITIVE THEORY
o A primary focus of both cognitive and behavioral techniques is to change the cognitive processes viewed as essential to therapeutic success.

o The basic assumption is that it is not so much experience itself but rather the persons interpretation of that experience that produces psychological disturbance.
o Both cognitive and behavioral methods are used to modify faulty perceptions and interpretations of important life events.

o For these reasons, it is now common to refer to behavior therapy as cognitive -behavioral therapy (CBT).
o As pointed out by Jacobson (1987), incorporation of cognitive theory and therapy into behavior therapy has been so total that it is difficult to find pure behavior therapists working with outpatients. o Behavior therapy, in a broad sense, refers to practice based primarily on social-cognitive theory and encompassing a range of cognitive principles and procedures.

COMMON CHARACTERISTICS BETWEEN THE THREE MODELS

o Behavioral therapist subscribe to a common core of basic concepts. o The two foundations of behavioral therapy: 1. A psychological model of human behavior that differs fundamentally from the traditional psychodynamic model. 2. A commitment to the scientific method.

COMMON CHARACTERISTICS
o The emphasis on a psychological model of abnormal behavior and the commitment to the scientific method have the following consequences.

1. Many types of abnormal behaviors formerly regarded as signs and symptoms of illness are better construed as nonpathological problems of living.
2. Abnormal behavior is assumed to be acquired and maintained in the same manner as normal behavior. 3. Behavioral assessment focuses on current determinants of behavior. The person is best understood and described by what the person does in a particular situation. 4. Treatment requires a prior analysis of the problem into components or subparts. Procedures are then targeted at specific components. Treatment strategies are individually tailored to different problems in different individuals. 5. Understanding the origins of a psychological problem is not essential for producing behavioral change. 6. Commitment to the scientific method. This includes an explicit, testable conceptual framework.

THE THIRD WAVE OF BEHAVIOR THERAPY

o First wave focused on modifying overt behavior.

o Second wave focused on cognitive factors, resulting in cognitive-behavioral therapy (CBT).

o Third wave comprises a group of therapeutic approaches with overlapping conceptual and technical foundations. o The two most prominent forms of these developments are:
1. Dialectical Behavior Therapy (DBT)
2. Acceptance and Commitment Therapy (ACT)

THIRD WAVE
o Dialectical Behavior Therapy (DBT)
o Defining feature is the focus on balancing the traditional emphasis on behavior change with the value of acceptance and the importance of the relationship between the two.
1. Acceptance and Change: Acceptance can be viewed as a willingness to choose to experience negative thoughts or feelings without defense. 2. Mindfulness Training: 5 core skills 1. Observe or attend to emotions without trying to terminate them when painful. 2. Describe a thought or emotion. 3. Be nonjudgmental. 4. Stay in the present. 5. Focus on one thing at a time (one-mindfully).

THIRD WAVE
o Acceptance and Commitment Therapy (ACT)
o Core therapeutic principles. 1. Experiential Avoidance: the process of trying of avoid negative or distressing private experiences (e.g. thoughts, feelings, memories, sensations). 2. Acceptance: Accept thoughts an feelings. 3. Cognitive Defusion: Separating thoughts from their referents and differentiating the thinker from the thoughts. 4. Commitment: ACT focuses on action. Commitment refers to making mindful decisions about what is important in your life and what you are going to do in order to live a valued life.

THEORY OF PSYCHOTHERAPY
o Behavior therapy emphasizes corrective learning experiences in which clients acquire new coping skills, improve communication, or learn to break maladaptive habits and overcome self-defeating emotional conflicts. o Learning: The high degree to which behavior therapist emphasize the clients activities in the real world between sessions is one of the distinctive features of the behavioral approach. o The Therapeutic Relationship: Strong therapeutic alliance is essential. Directive and concerned, a problem solver and a coping model.

PROCESS OF PSYCHOTHERAPY
o Problem identification and assessment: Identify and understand presenting problems.

o Assessment Methods: : Therapist relies heavily on clients self reports, in assessing thoughts, fantasies, and feelings.
o Guided Imagery: Symbolically recreate a problematic life situation. o Role Playing: This method lends itself to the assessment of interpersonal problems, with the therapist adopting the role of the person with whom the client reports problems. o Physiological Recording: Examples are monitoring a clients sexual arousal in response to specific stimuli that cause changes in penile or vaginal blood flow.

PROCESS OF PSYCHOTHERAPY
o Self Monitoring: Detailed, daily records of particular events or psychological reactions.

o Behavioral Observation: Assessment of overt problem behavior, ideally, is based on actual observation of the clients behavior in the natural environment.
o Psychological Tests and Questionnaires: Behavior therapists do not use standardized psycho-diagnostic tests. Assessment devices are not sufficient for carrying out a functional analysis of the determinants of a problem, but are useful in establishing the initial severity of the problem and charting therapeutic efficacy over the course of treatment.

PROCESS OF PSYCHOTHERAPY
o Treatment Techniques 1. Imagery-Based Techniques 2. Cognitive Restructuring 3. Assertiveness and Social Skills Training 4. Self-Control Procedures 5. Real-life Performance-Based Techniques

o Length of Treatment: No established guidelines. Length of therapy and the scheduling of the treatment sessions are contingent upon the patients progress. Often short -term treatment but therapy lasing 25 to 50 sessions is commonplace.
o Manual-Based Treatments: A treatment manual describes a limited and set number of techniques for treating a specific clinical disorder. Behavioral therapists have been at the forefront of this development.

MECHANISMS OF PSYCHOTHERAPY
o Learning Processes o Cognitive Mechanisms

APPLICATIONS
Behavior therapy can be used to treat a full range of psychological disorders in different populations, as well as problems in education, medicine, and community living. o Anxiety Disorders 1. Panic Disorder 2. Obsessive-Compulsive Disorders 3. Posttraumatic Stress Disorder (PTSD) o Depression o Eating and Weight Disorders o Schizophrenia o Childhood Disorders o Behavioral Medicine o Prevention and Treatment of Cardiovascular Disease

ROLE OF THERAPIST
The aim is for both, therapist and client to work together, seeking out negative behaviors and thoughts, assessing their realism, and correcting the habit or thought where it is found to be unrealistic or unhealthy for the client.

ROLE OF CLIENT
The clients role is to work on the mental and physical elimination of habits and practices, as well as ease of addiction or obsessions through conditioning practices.

KEY INTERVENTIONS
Interventions may include the client journaling their feelings, beliefs and reactions during important events; practicing thought-questioning; practicing anti-avoidance behaviors; and, practicing new ways to relax and behave.

GOALS OF TREATMENT
Full consciousness of behavioral patterns means that one is completely aware of and in control of how one acts and reacts. This is the overarching goal. Deeply-rooted beliefs are usually developed uncontrollably as a reaction to life experiences, and these are to be addressed in treatment. This can effectively teach the patient behavioral techniques relating to mental health in addition to relieving symptoms.

COGNITIVE THERAPY
Aaron Temkin Beck was born on July 18, 1921 (age 91) in Rhode Island. Aaron Beck conducted research in the 1960s, which served as the foundation of cognitive therapy.

Aaron was investigating the anger turned

inward psychoanalytic concept regarding depression and negative cognitions.

What is cognitive Therapy?

Cognitive therapy is a kind of psychotherapy and generally a short-term treatment.

The difference between cognitive therapy and other talk therapys is that cognitive therapy has extensive research or scientific evidence to prove effectiveness.

Research studies show CB to be effective for a whole range of problems: depression, anxiety, substance abuse, eating disorders, and so forth.

It is also proven to work for older adults as well as children in adolescence.

The Cognitive Model

Behaviors

Situation

Auto
Thoughts

Em otions

Underlying Beliefs

Physiological Response

Cognitive Model
Automatic thoughts influence ones behavioral, motivational, and physiological responses. We all have cognitive vulnerabilities (i.e., core beliefs) which predispose us to interpret information a certain way. These vulnerabilities are developed early When these beliefs are rigid, negative, and ingrained we are predisposed to pathology As we mature these core beliefs give us rules for living or conditional assumptions

Seven Basic Assumptions that underlie Becks theory

o Perception and experiencing in general are active processes which involve both inspective and introspective data. o The patient's cognitions represent a synthesis of internal and external stimuli. o How a person appraises a situation is generally evident in his cognitions (thoughts and visual images). o These cognitions constitute the person's stream of consciousness or phenomenal field, which reflects the person's configuration of himself, his world, his past and future. o Alterations in the content of the person's underlying cognitive structures affect his or her affective state and behavioral pattern. o Patient can become aware of his cognitive distortions. o Correction of these faulty dysfunctional constructs can lead to clinical improvement.

GENERAL PRINCIPLES OF CT
Relationship between patient and therapist is collaborative Goal is to correct dysfunctional thinking and help patients modify erroneous assumptions Patient is taught to be a scientist who generate and tests hypotheses

KEY INTERVENTIONS
Allows client to become aware that cognitions(actual or perceived) are having a negative effect.

Therapist helps client to understand that thought patterns are not always based upon reality.

Therapist shows client how cognitions affect their feelings, internal beliefs and assumptions.

Client made to understand that their internal beliefs are formed in childhood, which Beck calls schemas.

GOALS OF TREATMENT
Disrupting dysfunctional core belief cycle. Changing cognitive patterns.
THUS putting a STOP to:

Depression,
Anxiety Fear Loneliness

Chapter 9 Existential Psychotherapy

Irvin D. Yalom Rollo May 1909-1994

Introduction
Existential psychotherapy is not a specific technique or set of techniques. It is more philosophical in nature Existential psychotherapy is a philosophy about human nature Proponents of existential psychotherapy have not advocated specific training institutes because its presupposition can underlie any form of therapy

Proponents of existential psychotherapy have not advocated specific training institutes because its presupposition can underlie any form of therapy In existential terms, the conflicts individuals experience are regarding the givens of existence From the existential perspective "deep" conflict means the most fundamental concern at that moment

Historical Background
1958 Existential Psychotherapy first introduced to the U.S. with the publication of Existence: A New Dimension in Psychiatry and Psychology, by Rollo May, Ernest Angel, and Henri Ellenberger. 1980 The first comprehensive textbook in Existential Psychotherapy was written by Irvin Yalom. Yalom attempted to detail what an existential psychotherapist actually does in a therapeutic session. Another key figure in existential psychotherapy was Victor Frankl, whose approach to existential psychotherapy, was called logotherapy, which focused on will, freedom, meaning, and responsibility.

KEY POINTS
Existential psychotherapy is more philosophical in nature Existential psychotherapy is not a specific technique Focuses on issues central to human existence Existential therapy is basically an experiential approach to therapy It is based on a personal relationship between client and therapist. It stresses personal freedom in deciding one's fate. It places primary value on self-awareness.

BASIC CONCEPTS
Holds a different view of inner conflictConflict is between the individual and the givens of existence. Yalom defines four categories of ultimate concerns that encompass these fundamental challenges of the human condition: 1. 2. 3. 4. Freedom and Responsibility Isolation Meaning Death

FREEDOM AND RESPONSIBILITY The central issue in existential psychotherapy is freedom and responsibility. A concept ultimately associated with freedom is assuming responsibility. The existential concept of freedom refers to the fact that we are the authors of our own world. It can be conceived as one in which the actively increases and embraces his/her freedom (i.e. freedom from destructive habits, self-imposed paralysis of the will, or from self-limiting beliefs).

ISOLATION Intrapersonal isolation the fact that we are isolated from parts of ourselves. Interpersonal isolation the fact that we are isolated from others. Existential isolation pertains to our aloneness in the universe, dividing between self and others. Isolation is the primary source of anxiety.

MEANING
Meaninglessness in life leads to emptiness and hollowness (existential vacuum). Existentialists believe that the major solution to meaninglessness is engagement.

Finding meaning in life is a by-product of engagement, which is a commitment to creating, loving, working, and building.
Tells us how to live not why to live.

DEATH According to the existential viewpoint, death gives significance to living. Death provides the motivation for us to live our lives fully and take advantage of each opportunity to do something meaningful. Emphasizes the importance of living mindfully and purposefully, aware of ones possibilities and limits in a context of absolute freedom and choice.

ANXIETY
Existential psychotherapy accepts anxiety as a normal condition of living. An outcome of being confronted with the four givens of existence: freedom and responsibility, isolation, meaning, and death. Anxiety can be a stimulus for growth as we become aware of and accept our freedom.

Key Interventions: By isolating the thoughts from harmful practices or actions, individuals can monitor their feelings or, in the case of an addict, cravings, independent of taking action on those feelings. If there is no definition of whom one ought to be, then the patient can concentrate on what is happening to them in the present. Past actions and self-definitions are irrelevant, and the future is yet unknown. Goals of Treatment: The goal of existential therapy is for each person to realize and surpass their potential, to live in a somewhat existential manner within the moment, to fulfill self-definition, and to create social change as a result of their own personal evolution.

The Existential Therapist:

The existential therapist places central prominence on the person-toperson relationship. It assumes that client growth occurs through this genuine encounter.

It is not the techniques a therapist uses that make a therapeutic difference, but rather, it is the quality of the client-therapist relationship that heals. Although existential therapists may apply techniques from other orientations, their interventions are guided by a philosophical framework about what it means to be human.
It provides a new view of death as a positive force, not a morbid prospect to fear, for death gives life meaning. Existentialists have also contributed a new dimension to the understanding of anxiety, frustration, loneliness, and alienation. The aim of existential work is to assist people in developing their talents in their own personal way, helping them in being true to what they value.

THERAPEUTIC GOALS:
To expand self-awareness To increase potential choices To help the client accept responsibility for their choices To help the client experience authentic existence The existential emphasis is based on the philosophical concerns of what it means to be fully human.

Clients Experience in Therapy: Challenged to take responsibility Major themes are anxiety, freedom and responsibility, isolation, death, and the search for meaning Assist client in facing life with courage, hope, and a willingness to find meaning in life. The final decisions and choices rest with the client Clients learn that making choices can create anxiety

Rollo May Existential Therapy Interview Clip http://youtu.be/Cay743y-Sak

Rollo May: The Human Dilemma

http://youtu.be/cT6qBtYJ-90

Summary
As humans, according to the existential view, we are capable of selfawareness, which is the distinctive capacity that allows us to reflect and to decide. With this awareness we become free beings who are responsible for choosing the way we live and how we influence our own destiny. This awareness of freedom and responsibility gives rise to existential anxiety, which is another basic human characteristic. Whether we like it or not, we are free, even though we may seek to avoid reflecting on this freedom. The knowledge we must choose, even though the outcome is not certain, leads to anxiety. This anxiety is heightened when we reflect on the reality that we are mortal. Facing the inevitable prospect of eventual death gives the present moment significance, for we become aware that we do not have forever to accomplish our projects. The task is to create a life that has meaning and purpose. As humans we are unique in that we strive toward fashioning purposes and values that give meaning to living. Whatever meaning our life has is developed through freedom and a commitment to make choices in the face of uncertainty.