Boek 1: BEHAVIORAL INTERVENTIONS IN CBT
Chapter 1: Overview
1970’s the term cognitive-behavioural therapy (CBT) began to take hold. CBT
got scientific evaluation and refinement.
CBT is a broad concept, with a variety of approaches. Emphasizes on cognitive,
behavioural and environmental factors. There are 10 different schools under the
umbrella term CBT. The cognitive approach (Beck) is one of them.
Assumptions:
1. Distorted & dysfunctional thinking influences mood and behaviour. These
thought distortions are unique for every disorder.
2. Inaccurate and biased forms of thinking are common to all psychological
disorders.
3. modification of underlying beliefs and schemas is required to bring change.
Implication of these assumptions modification of thinking will change mood &
behaviour.
Variations in cognitive perspectives depend on the level in which the environment
is considerate a determinant of thinking, emotion and action.
Behavioural approach: avoids describing mental concepts and instead
focusses on the physical environment. Thinking and emotions are seen as
examples of behaviour.
Deviant or defect models of abnormality are predominant in psychology:
In cognitive therapy, disorders are seen as maladaptive schemas,
underlying behavioural and emotional disorders.
Medical approach: underlying diseases or biological processes are
presumed to underlie psychological disorders.
Psychodynamic approach: quality, integration & differentiation of self &
maturity of comping mechanisms are etiologically relevant for
psychological disorders.
Therapy will focus on removing or altering these internal anomalies.
Behavioural theory & therapy: search for internal causes is avoided, but it
does acknowledge possible internal causes. But instead, this approach is
concerned with what one does & the context in which this behaviour
occurs.
What is normal/abnormal from the behavioural perspective?
This depends on cultural norms, values and practices. Culture is the
context for referencing which behaviours are acceptable and unacceptable.
This means that these understandings can shift over time. (example:
homosexuality, drapetomania (slaves seeking freedom by running away
from their masters).
The behavioural perspective assumes that there is nothing inherently
deviant or defective about persons who report psychological problems
Cognitive & behavioural approach have often conflicting theories, regarding the
determinants of behaviour. CBT incorporates views that can be contradictory.
Behavioural interventions within CBT assumptions:
1. psychological disorders are defined by overt (within the person) and covert
(observable by others) behaviour.
2. Between person, behaviour and environment exists a functional relationship.
, The three-term contingency is often the basic unit for analysing these
relationships specific for an individual:
1. Antecedents occasions within which behaviour occurs (places,
persons, objects)
2. Behaviour anything the person does, overt & covert
3. Consequences the effect the behaviour produces
Behaviour = reinforced when these consequences increase the likelihood that
the behaviour will occur again.
Behaviour = punished when the consequences decrease the likelihood that the
behaviour will occur again.
Function of behaviour:
Functionalism based on Darwin’s evolution theory. The behaviour that is
functional in a particular context is selected, not selected (not functional)
behaviour becomes extinguished.
Environmental determinism the process of selection of variations in an
individuals behaviour during his or her lifetime and cultural practices over
successive generations.
Contextualism is concerned with the context within which behaviour takes
place, or the ‘contextual flow’ in which behaviour occurs. How events and
behaviours are linked in meaningful ways.
Behavioural assessment
In behavioural therapy, motivation is seen differently than in other orientations.
Motivation is not seen as an inner drive, but rather as a state or condition,
resulting from (external) environmental events. In this way, motivation is
modifiable by using the environment.
In the assessment of behaviour, the functional context of the behaviour is
assessed and evaluated, by determining the antecedents, the behaviour, the
consequences, the learning history and its relation with the current behaviour,
the overt behaviours (coping skills etc), thoughts, emotions, physiological
sensations, the client’s motivation to change and the client’s current behavioural
repertoire. This repertoire can be divided into four response domains:
1. Over and motor behaviours
2. Thoughts (also mental images)
3. Emotions
4. Physiological sensations
The outcomes of the assessment determine which interventions are appropriate
for the individual tailor made. This, because the same consequences (the
disorder) can have different underlying causes and maintenance processes.
Characteristics over behavioural interventions:
- Empirical orientation
- Therapist- client collaboration
- An active orientation (not only talking)
- Flexible approach (continuously evaluating and adjusting hypotheses and
therapy)
- Emphasis on environment-behaviour relations
- Time-limited and present-focused
- Problem and learning focus (of new, adaptive behaviours)
- Emphasis on both change and acceptance
History of behavioural therapy & interventions
Basic theories of learning:
Chapter 1: Overview
1970’s the term cognitive-behavioural therapy (CBT) began to take hold. CBT
got scientific evaluation and refinement.
CBT is a broad concept, with a variety of approaches. Emphasizes on cognitive,
behavioural and environmental factors. There are 10 different schools under the
umbrella term CBT. The cognitive approach (Beck) is one of them.
Assumptions:
1. Distorted & dysfunctional thinking influences mood and behaviour. These
thought distortions are unique for every disorder.
2. Inaccurate and biased forms of thinking are common to all psychological
disorders.
3. modification of underlying beliefs and schemas is required to bring change.
Implication of these assumptions modification of thinking will change mood &
behaviour.
Variations in cognitive perspectives depend on the level in which the environment
is considerate a determinant of thinking, emotion and action.
Behavioural approach: avoids describing mental concepts and instead
focusses on the physical environment. Thinking and emotions are seen as
examples of behaviour.
Deviant or defect models of abnormality are predominant in psychology:
In cognitive therapy, disorders are seen as maladaptive schemas,
underlying behavioural and emotional disorders.
Medical approach: underlying diseases or biological processes are
presumed to underlie psychological disorders.
Psychodynamic approach: quality, integration & differentiation of self &
maturity of comping mechanisms are etiologically relevant for
psychological disorders.
Therapy will focus on removing or altering these internal anomalies.
Behavioural theory & therapy: search for internal causes is avoided, but it
does acknowledge possible internal causes. But instead, this approach is
concerned with what one does & the context in which this behaviour
occurs.
What is normal/abnormal from the behavioural perspective?
This depends on cultural norms, values and practices. Culture is the
context for referencing which behaviours are acceptable and unacceptable.
This means that these understandings can shift over time. (example:
homosexuality, drapetomania (slaves seeking freedom by running away
from their masters).
The behavioural perspective assumes that there is nothing inherently
deviant or defective about persons who report psychological problems
Cognitive & behavioural approach have often conflicting theories, regarding the
determinants of behaviour. CBT incorporates views that can be contradictory.
Behavioural interventions within CBT assumptions:
1. psychological disorders are defined by overt (within the person) and covert
(observable by others) behaviour.
2. Between person, behaviour and environment exists a functional relationship.
, The three-term contingency is often the basic unit for analysing these
relationships specific for an individual:
1. Antecedents occasions within which behaviour occurs (places,
persons, objects)
2. Behaviour anything the person does, overt & covert
3. Consequences the effect the behaviour produces
Behaviour = reinforced when these consequences increase the likelihood that
the behaviour will occur again.
Behaviour = punished when the consequences decrease the likelihood that the
behaviour will occur again.
Function of behaviour:
Functionalism based on Darwin’s evolution theory. The behaviour that is
functional in a particular context is selected, not selected (not functional)
behaviour becomes extinguished.
Environmental determinism the process of selection of variations in an
individuals behaviour during his or her lifetime and cultural practices over
successive generations.
Contextualism is concerned with the context within which behaviour takes
place, or the ‘contextual flow’ in which behaviour occurs. How events and
behaviours are linked in meaningful ways.
Behavioural assessment
In behavioural therapy, motivation is seen differently than in other orientations.
Motivation is not seen as an inner drive, but rather as a state or condition,
resulting from (external) environmental events. In this way, motivation is
modifiable by using the environment.
In the assessment of behaviour, the functional context of the behaviour is
assessed and evaluated, by determining the antecedents, the behaviour, the
consequences, the learning history and its relation with the current behaviour,
the overt behaviours (coping skills etc), thoughts, emotions, physiological
sensations, the client’s motivation to change and the client’s current behavioural
repertoire. This repertoire can be divided into four response domains:
1. Over and motor behaviours
2. Thoughts (also mental images)
3. Emotions
4. Physiological sensations
The outcomes of the assessment determine which interventions are appropriate
for the individual tailor made. This, because the same consequences (the
disorder) can have different underlying causes and maintenance processes.
Characteristics over behavioural interventions:
- Empirical orientation
- Therapist- client collaboration
- An active orientation (not only talking)
- Flexible approach (continuously evaluating and adjusting hypotheses and
therapy)
- Emphasis on environment-behaviour relations
- Time-limited and present-focused
- Problem and learning focus (of new, adaptive behaviours)
- Emphasis on both change and acceptance
History of behavioural therapy & interventions
Basic theories of learning:
