WEEK 1. EXPOSURE AND BEHAVIORAL ACTIVATION
CBT: TWO CENTRAL BELIEFS Ourcognitionshave a controlling influence on ouremotions and behavior
How weact or behavecan strongly affect ouremotionsand thought patterns
THERAPY METHODS Individualized conceptualization, Problem-oriented focus, Collaborative therapeutic relationship, Socratic question, Cognitive restructuring
AARON T. BECK
o F irst person to develop theories/methods for usingcognitive & behavioral interventions
o Ideas from: psychoanalytic concepts + post-Freudian analysts
o Negative cognitive triad: cognitive conceptualization of depression (negative thinking style: self, world, and future)
FIRST WAVE:
o eaction to psychoanalysis: focus onobservableandmeasurablebehaviors (ignore internal states)
R
WAVES OF BEHAVIOR BEHAVIORISM o Based onconditioning paradigms: classical (Pavlo)and operant (Skinner) conditioning
THERAPY o Led to dissatisfaction => important to include cognitive processes
o ognitiverevolution: bring back cognitive processesto understand how people learn & behave
C
SECOND WAVE: o Acknowledging the role of behavioral processes
CBT o Influential figures:Aaron T. Beck + Albert Ellis
o Not a rejection from the first wave => combination of both
COGNITIVE BEHAVIOR
o F amily of psychological interventions that are based oncognitive and behavioral principles
THERAPY o Identify and increase adaptive schemas+modify andreduce the influence of maladaptive schemas
o Reduce emotional problems by focusing on thinking and behaviors
o Psychological problems are based on => unhelpful ways of thinking + learned patterns of unhelpful behaviors
EXPOSURE THERAPY
o ( purposefully)Exposurepatientrepeatedly to fear-provokingstimuli =>extinction of fear, no more avoidance
o Goal: promote emotional processing through theactivationof the fear structureand the integration of informationthat is inconsistent with the
pathological elements of the fear structure
o Types: in vivo, in vitro (imaginal), interoceptiveexposure, systematic desensitization (gradual), flooding techniques
, Passive way of learning - Pavlov =>ONSETof pathologicalfear
Neutral stimulipaired with aCSrepeatedly triggeraUCR =>NS becomes a CS =>triggering a CR similarto the original UCR
o S = problematic situation/thought that elicits emotional response
C
LASSICAL
C o UCS/ UCR = theme/event that enables to explain why the CS leads to the UCR (didn’t learn it)
CONDITIONING
o CR = negative emotion (learned it)
Fear conditioning
o eneralization: stimuli that are similar to the CSalso elicit fear =>pathological=> stopped throughextinction
G
o Fear extinction: CS repeatedly presentedwithout theUCSor withpleasant stimuli
Examples CS (bully) => UCR (fear)
U UCS (dog bite) => UCR (frightened)
CS (people) => UCS (bully) => UCR (fear) CS (sight of dog) => UCS (dog bite) => UCR (frightened)
CS (people) => CR (fear) CS (sight of dog) => UR (frightened)
Active way of learning - Skinner =>MAINTENANCEofpathological fear
L earning through the consequences of our behaviors => changes in voluntary behavior
Reinforced behavior => repeated vs punishment behavior => weakened
OPERANT
CONDITIONING
Positivereinforcement Behaviorstrengthened=>addingsomethingdesirable
Negativereinforcement Behaviorstrengthened=removingsomethingundesirable
Positivepunishment Behaviorweakened=addingsomethingundesirable
Negativepunishment Behaviorweakened=removingsomethingdesirable
L earning
MOWRER’S TWO o AcquiredfromClassical conditioning
FACTOR MODEL o MaintainedbyOperant conditioning
, Program for escape or avoiding danger (model to understand anxiety)
types of
3 . F eared stimuli
1
information 2. Fear responses
FEAR STRUCTURE 3. Meaning of the stimulus and response
(Lang)
o ecomes pathological: associations among stimulus,response, and meaning representationsdon’t reflectreality
B
- Themeaningyou add to a certain stimulus => whichdetermines how you will react
o Shows that fear is both cognitive and behavioral
o Anxiety disorder: harmless stimuli + responses are viewed as erroneously dangerous
Effective exposure therapy =>Correct fear structure(expanded from Lang's fear structure)
E MOTIONAL
PROCESSING Modifying old associations =>new associations arecreated=> forming competing structures (not includepathological associations)
THEORY
T HEORIES OF (Kozak & Foa) Demands
o F ear structure needs to be activated
EXTINCTION OF o New information must be introduced in the fear structure(not compatible with old)
FEAR
Correction of fear structure is indicated byhabituation=>not predictive of therapy outcomes(follow up:not less anxiety or avoidance)
Effective exposure therapy =>Form new, competingnon-FS (FS stays intact)=> focused on strengtheningCS
INHIBITORY uided ET (explains why some people after ET might experience fallbacks =>fear comes back bc the oldfear structure is still intact)
G
LEARNING THEORY Fear structure + Non-threat structurecompete forretrieval
Demands
o ew information must be introduced to form a new representation
N
o Enhancing the accessibility + retrievability of non-threat association
S trategies to
o E xpectancy violation: design exposure to violate specificexpectations
enhance IL o Remove safety behaviors: decrease the use of them
o Variability: vary stimuli and contexts
o Deepenedextinction: present 2 cures during the sameexposure after conducting extinction with 1 of them
o Attentionalfocus: maintain attention on the CS targetduring exposure
o Mental reinstatement/ retrieval cues: use cue presentduring extinction to reinstate previous exposure
CBT: TWO CENTRAL BELIEFS Ourcognitionshave a controlling influence on ouremotions and behavior
How weact or behavecan strongly affect ouremotionsand thought patterns
THERAPY METHODS Individualized conceptualization, Problem-oriented focus, Collaborative therapeutic relationship, Socratic question, Cognitive restructuring
AARON T. BECK
o F irst person to develop theories/methods for usingcognitive & behavioral interventions
o Ideas from: psychoanalytic concepts + post-Freudian analysts
o Negative cognitive triad: cognitive conceptualization of depression (negative thinking style: self, world, and future)
FIRST WAVE:
o eaction to psychoanalysis: focus onobservableandmeasurablebehaviors (ignore internal states)
R
WAVES OF BEHAVIOR BEHAVIORISM o Based onconditioning paradigms: classical (Pavlo)and operant (Skinner) conditioning
THERAPY o Led to dissatisfaction => important to include cognitive processes
o ognitiverevolution: bring back cognitive processesto understand how people learn & behave
C
SECOND WAVE: o Acknowledging the role of behavioral processes
CBT o Influential figures:Aaron T. Beck + Albert Ellis
o Not a rejection from the first wave => combination of both
COGNITIVE BEHAVIOR
o F amily of psychological interventions that are based oncognitive and behavioral principles
THERAPY o Identify and increase adaptive schemas+modify andreduce the influence of maladaptive schemas
o Reduce emotional problems by focusing on thinking and behaviors
o Psychological problems are based on => unhelpful ways of thinking + learned patterns of unhelpful behaviors
EXPOSURE THERAPY
o ( purposefully)Exposurepatientrepeatedly to fear-provokingstimuli =>extinction of fear, no more avoidance
o Goal: promote emotional processing through theactivationof the fear structureand the integration of informationthat is inconsistent with the
pathological elements of the fear structure
o Types: in vivo, in vitro (imaginal), interoceptiveexposure, systematic desensitization (gradual), flooding techniques
, Passive way of learning - Pavlov =>ONSETof pathologicalfear
Neutral stimulipaired with aCSrepeatedly triggeraUCR =>NS becomes a CS =>triggering a CR similarto the original UCR
o S = problematic situation/thought that elicits emotional response
C
LASSICAL
C o UCS/ UCR = theme/event that enables to explain why the CS leads to the UCR (didn’t learn it)
CONDITIONING
o CR = negative emotion (learned it)
Fear conditioning
o eneralization: stimuli that are similar to the CSalso elicit fear =>pathological=> stopped throughextinction
G
o Fear extinction: CS repeatedly presentedwithout theUCSor withpleasant stimuli
Examples CS (bully) => UCR (fear)
U UCS (dog bite) => UCR (frightened)
CS (people) => UCS (bully) => UCR (fear) CS (sight of dog) => UCS (dog bite) => UCR (frightened)
CS (people) => CR (fear) CS (sight of dog) => UR (frightened)
Active way of learning - Skinner =>MAINTENANCEofpathological fear
L earning through the consequences of our behaviors => changes in voluntary behavior
Reinforced behavior => repeated vs punishment behavior => weakened
OPERANT
CONDITIONING
Positivereinforcement Behaviorstrengthened=>addingsomethingdesirable
Negativereinforcement Behaviorstrengthened=removingsomethingundesirable
Positivepunishment Behaviorweakened=addingsomethingundesirable
Negativepunishment Behaviorweakened=removingsomethingdesirable
L earning
MOWRER’S TWO o AcquiredfromClassical conditioning
FACTOR MODEL o MaintainedbyOperant conditioning
, Program for escape or avoiding danger (model to understand anxiety)
types of
3 . F eared stimuli
1
information 2. Fear responses
FEAR STRUCTURE 3. Meaning of the stimulus and response
(Lang)
o ecomes pathological: associations among stimulus,response, and meaning representationsdon’t reflectreality
B
- Themeaningyou add to a certain stimulus => whichdetermines how you will react
o Shows that fear is both cognitive and behavioral
o Anxiety disorder: harmless stimuli + responses are viewed as erroneously dangerous
Effective exposure therapy =>Correct fear structure(expanded from Lang's fear structure)
E MOTIONAL
PROCESSING Modifying old associations =>new associations arecreated=> forming competing structures (not includepathological associations)
THEORY
T HEORIES OF (Kozak & Foa) Demands
o F ear structure needs to be activated
EXTINCTION OF o New information must be introduced in the fear structure(not compatible with old)
FEAR
Correction of fear structure is indicated byhabituation=>not predictive of therapy outcomes(follow up:not less anxiety or avoidance)
Effective exposure therapy =>Form new, competingnon-FS (FS stays intact)=> focused on strengtheningCS
INHIBITORY uided ET (explains why some people after ET might experience fallbacks =>fear comes back bc the oldfear structure is still intact)
G
LEARNING THEORY Fear structure + Non-threat structurecompete forretrieval
Demands
o ew information must be introduced to form a new representation
N
o Enhancing the accessibility + retrievability of non-threat association
S trategies to
o E xpectancy violation: design exposure to violate specificexpectations
enhance IL o Remove safety behaviors: decrease the use of them
o Variability: vary stimuli and contexts
o Deepenedextinction: present 2 cures during the sameexposure after conducting extinction with 1 of them
o Attentionalfocus: maintain attention on the CS targetduring exposure
o Mental reinstatement/ retrieval cues: use cue presentduring extinction to reinstate previous exposure
