1. Cognitive-Behavioral Therapies, Part I PSYC 4500: Introduction to Clinical Psychology Brett 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: http://www.abct.org/dPublic/?m=mPublic&fa=WhatIsCBTpublic http://www.abct.org/dPublic/?m=mPublic&fa=WhatIsCBTpublic 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) http://www.youtube.com/watch?v=KZag1zlecGI

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 http://www.youtube.com/watch?v=2cOLJBPQZRA