Psychotherapy and Therapeutic Skills
Summary
Week 1
Lecture 1
The biggest misconception about behaviour therapy is that it only focuses on behaviour, which is
not true. The focus is on behavioural change, but this is done through cognitions, emotions etc.
Each behavioural therapy can be seen as an experiment since there are experimental methods and
outcome evaluation done both on group and individual levels. Not every treatment is completely
different, but the best fitting treatment is selected for the unique individual. Usually, manuals can
be used on individuals and they work fine, but if they turn out to not work, you can try different
options. Manualized treatments are often used for treating DSM-5 diagnoses. BT focuses on
expanding behavioural repertoire and response options (rather than just changing behaviour). It
focuses on empiricism (supported by science) and hypothesis testing. Behaviour is not blamed on
the individual but rather said to be affected by the environment. There is a focus on offering
insight to the patient about the problem. It is a very homework intensive therapy (practicing
in-between sessions). Treatment is active, structured, directive, creative, transparent and
collaborative.
Misconceptions on BT include denial of deeper thoughts (not true), BT being superficial (focus
on symptoms rather than causes, not true), exclusive focus on the present (not true, the past too),
ignores therapeutic relationship (not true, openness and transparency, trust and confidence are
vital). There have been three waves of BT: (Behavioural) - (behavioural + cognitive) -
(Behavioural + cognitive + acceptance). Nowadays, neurology, technology etc are incorporated
into the system as well. Mindfulness has also become popular as incorporation into CBT. the
foundation of BT is learning theory (operant/classical conditioning, observational/instructional
learning, remember from the past block).
In criteria for treatment planning we consider:
, - Probability
- Problematic value
- Treatability
- Centrality (vs. end problem)
- Patients reason for therapy
In functional analysis, the stimulus (stress at home) generates a response (getting drunk), the
positive consequence is the maintaining factor (relieve from stress), but there is also a negative
consequence (housemate angrier), which is the reason for therapy.
The meaning analysis: the schema of how a stimulus becomes so aversive (beating causing fear).
An argument with the father (CS) could precede beating (US), so fear (CR and UR) gets
associated with arguing. Extinction causes unlearning, inhibition creates new learning (the new
learning overrules the old aversive learning). Techniques include:
- Exposure
- In vivo
- Imaginal
- Interoceptive
- VR
- Response prevention (think of OCD)
- Operant conditioning (reinforcement/punishment)
- Stimulus-control (keeping stimulus away)
- Modelling
- Behavioural activation (stimulating and motivating patients)
- Social skills training (more in social phobia)
These techniques can be on many levels
- Individual, group etc
- Therapist (also friends and teachers)
- Session length can vary
- Treatment length can vary
- Therapy setting can be creative
Reinforcement and punishment:
- PR: rewarding stimulus added, behaviour increases
, - NR: aversive stimulus removed, behaviour increases
- PP: aversive stimulus added, behaviour decreases
- NP: rewarding stimulus removed, behaviour decreases
The therapeutic relationship is vital. Empathy, positive regard, genuineness etc is displayed for:
- Social reinforcement for desired behaviours
- Modelling desired skills
- Correct problematic cognitions (cognitive)
Literature Week 1 - Wedding Chapter 6 - Behaviour Therapy
Overview
Behaviour therapy aims to change factors in the environment that influence an individual’s
behaviour as well as the ways in which individuals respond to their environment. Behaviour
therapy focuses on changing behaviour, is rooted in empiricism, is active, transparent, and
behaviours are assumed to have a function. CBT borrows strategies from a variety of techniques.
Psychoanalysis differs the most from behaviourism. Psychoanalysis assumes that observable
behavioural symptoms are a manifestation of unconscious conflicts and motivations, whereas
behaviour therapy takes behaviours at face value for the most part. Psychoanalysis is more
non-directive (unlike CBT) less evidence-based and transparent, doesn’t include homework and
relies more on interpretation. Adlerian and gestalt therapy is relatively similar to CBT.
History
Precursors
Pliny the Elder: earliest documented behavioural treatment (aversion therapy)
Treatment of Victor of Aveyron by Jean-Marc-Gaspard Itard: no human contact until adolescence
(modeling, shaping, reinforcement)
Ivan Pavlov: classical conditioning (in animal)
John B. Watson: classical conditioning in humans, founder of behaviourism (Little Albert)
Mary Cover Jones (student of Watson): modeling and exposure
Mowrer and Mowrer: classical conditioning
, Edward Thorndike and B.F. Skinner: operant/instrumental conditioning
After Boulder Conference on Graduate Education in Clinical Psychology, many psychologists
abandoned psychoanalysis for BT.
Beginnings
Behaviour therapy emerged in the 1950s as research groups in South Africa.
Joseph Wolpe: found systematic desensitization (gradually confronting feared situations in
imagination while simultaneously practising progressive relaxation to relax the muscles of the
body), this results in reciprocal inhibition. His technique is not widely used nowadays despite
scientific support. (students: Lazarus and Rachman)
Arnold Lazarus: student of Wolpe, changed conditioning therapy (of Wolpe) into behavioural
therapy.
Hans Eysenck: studied behavioural treatments in London. He recruited Rachman, who developed
treatments for agoraphobia, OCD etc.
Nathan Azrin: student of Skinner. Established applied behaviour analysis, developed
reinforcement-based programs for treating substance-use disorders and behavioral treatments for
reversing unwanted habits. He also developed token economy (behavioural problems were
managed through reinforcement of desirable behaviours by providing tokens that could be
exchanged for rewards later).
Current status
Behaviourism expanded to cognitive techniques (Ellis, Beck, Lazarus, Rachman). Cyril Franks
found the term CBT.
Albert Bandura: emphasized the importance of observation along with classical and operant
conditioning.
The third-wave of behaviour therapy refers to the incorporating of acceptance-based techniques
(accepting the unwanted rather than exerting control or change). ACT, MBCT, DBT are
examples.
Summary
Week 1
Lecture 1
The biggest misconception about behaviour therapy is that it only focuses on behaviour, which is
not true. The focus is on behavioural change, but this is done through cognitions, emotions etc.
Each behavioural therapy can be seen as an experiment since there are experimental methods and
outcome evaluation done both on group and individual levels. Not every treatment is completely
different, but the best fitting treatment is selected for the unique individual. Usually, manuals can
be used on individuals and they work fine, but if they turn out to not work, you can try different
options. Manualized treatments are often used for treating DSM-5 diagnoses. BT focuses on
expanding behavioural repertoire and response options (rather than just changing behaviour). It
focuses on empiricism (supported by science) and hypothesis testing. Behaviour is not blamed on
the individual but rather said to be affected by the environment. There is a focus on offering
insight to the patient about the problem. It is a very homework intensive therapy (practicing
in-between sessions). Treatment is active, structured, directive, creative, transparent and
collaborative.
Misconceptions on BT include denial of deeper thoughts (not true), BT being superficial (focus
on symptoms rather than causes, not true), exclusive focus on the present (not true, the past too),
ignores therapeutic relationship (not true, openness and transparency, trust and confidence are
vital). There have been three waves of BT: (Behavioural) - (behavioural + cognitive) -
(Behavioural + cognitive + acceptance). Nowadays, neurology, technology etc are incorporated
into the system as well. Mindfulness has also become popular as incorporation into CBT. the
foundation of BT is learning theory (operant/classical conditioning, observational/instructional
learning, remember from the past block).
In criteria for treatment planning we consider:
, - Probability
- Problematic value
- Treatability
- Centrality (vs. end problem)
- Patients reason for therapy
In functional analysis, the stimulus (stress at home) generates a response (getting drunk), the
positive consequence is the maintaining factor (relieve from stress), but there is also a negative
consequence (housemate angrier), which is the reason for therapy.
The meaning analysis: the schema of how a stimulus becomes so aversive (beating causing fear).
An argument with the father (CS) could precede beating (US), so fear (CR and UR) gets
associated with arguing. Extinction causes unlearning, inhibition creates new learning (the new
learning overrules the old aversive learning). Techniques include:
- Exposure
- In vivo
- Imaginal
- Interoceptive
- VR
- Response prevention (think of OCD)
- Operant conditioning (reinforcement/punishment)
- Stimulus-control (keeping stimulus away)
- Modelling
- Behavioural activation (stimulating and motivating patients)
- Social skills training (more in social phobia)
These techniques can be on many levels
- Individual, group etc
- Therapist (also friends and teachers)
- Session length can vary
- Treatment length can vary
- Therapy setting can be creative
Reinforcement and punishment:
- PR: rewarding stimulus added, behaviour increases
, - NR: aversive stimulus removed, behaviour increases
- PP: aversive stimulus added, behaviour decreases
- NP: rewarding stimulus removed, behaviour decreases
The therapeutic relationship is vital. Empathy, positive regard, genuineness etc is displayed for:
- Social reinforcement for desired behaviours
- Modelling desired skills
- Correct problematic cognitions (cognitive)
Literature Week 1 - Wedding Chapter 6 - Behaviour Therapy
Overview
Behaviour therapy aims to change factors in the environment that influence an individual’s
behaviour as well as the ways in which individuals respond to their environment. Behaviour
therapy focuses on changing behaviour, is rooted in empiricism, is active, transparent, and
behaviours are assumed to have a function. CBT borrows strategies from a variety of techniques.
Psychoanalysis differs the most from behaviourism. Psychoanalysis assumes that observable
behavioural symptoms are a manifestation of unconscious conflicts and motivations, whereas
behaviour therapy takes behaviours at face value for the most part. Psychoanalysis is more
non-directive (unlike CBT) less evidence-based and transparent, doesn’t include homework and
relies more on interpretation. Adlerian and gestalt therapy is relatively similar to CBT.
History
Precursors
Pliny the Elder: earliest documented behavioural treatment (aversion therapy)
Treatment of Victor of Aveyron by Jean-Marc-Gaspard Itard: no human contact until adolescence
(modeling, shaping, reinforcement)
Ivan Pavlov: classical conditioning (in animal)
John B. Watson: classical conditioning in humans, founder of behaviourism (Little Albert)
Mary Cover Jones (student of Watson): modeling and exposure
Mowrer and Mowrer: classical conditioning
, Edward Thorndike and B.F. Skinner: operant/instrumental conditioning
After Boulder Conference on Graduate Education in Clinical Psychology, many psychologists
abandoned psychoanalysis for BT.
Beginnings
Behaviour therapy emerged in the 1950s as research groups in South Africa.
Joseph Wolpe: found systematic desensitization (gradually confronting feared situations in
imagination while simultaneously practising progressive relaxation to relax the muscles of the
body), this results in reciprocal inhibition. His technique is not widely used nowadays despite
scientific support. (students: Lazarus and Rachman)
Arnold Lazarus: student of Wolpe, changed conditioning therapy (of Wolpe) into behavioural
therapy.
Hans Eysenck: studied behavioural treatments in London. He recruited Rachman, who developed
treatments for agoraphobia, OCD etc.
Nathan Azrin: student of Skinner. Established applied behaviour analysis, developed
reinforcement-based programs for treating substance-use disorders and behavioral treatments for
reversing unwanted habits. He also developed token economy (behavioural problems were
managed through reinforcement of desirable behaviours by providing tokens that could be
exchanged for rewards later).
Current status
Behaviourism expanded to cognitive techniques (Ellis, Beck, Lazarus, Rachman). Cyril Franks
found the term CBT.
Albert Bandura: emphasized the importance of observation along with classical and operant
conditioning.
The third-wave of behaviour therapy refers to the incorporating of acceptance-based techniques
(accepting the unwanted rather than exerting control or change). ACT, MBCT, DBT are
examples.
