psy340 wveek two (overview of bt & clinical assessment and diagnosis)(1)

8/11/2019 PSY340 Wveek Two (Overview of BT & Clinical Assessment and Diagnosis)(1)

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PSY340 Week Two

Chapters One and Two (graphics from Spiegler & Guevremont, 2003):

General Overview of Behaviour TherapyClinical Assessment and Diagnosis

Unit Coordinator/Lecturer:Dr. Mary Morris



Brief History of Treating PsychologicalDisorders

What to do with the severely disturbed?Middle Ages to the 17th Century:

Madness = in league with the devil. Torture, hanging, burning and sent to sea.

18th Century:Mentally disordered people = degenerates.

Keep them away from society.



Mental Health Care Reform

Philippe Pinel (1745-1826):Reform in Paris mental hospitals.Some patients got better enough to leave hospital.

Dorothea Dix (1802-1887):Reform United States system.Moral-treatment movement.Kindly care.Led to large, state-supported public asylums:

Overcrowding, loss of public attention.



The 20th Century

Deinstitutionalisation (mid 1950s):Get people out of asylums and back into thecommunity.Effective antipsychotic medication.General mood of optimism in country.

In 1961 community mental health centres wereestablished.



Today

Today we have psychotherapists.

LOTS of them……



Types of Psychotherapists

Clinical Psychologist.

Counselling Psychologist.

Marriage and Family Therapist.

Psychiatrists.

Psychiatric Nurse. g

Psychoanalyst.



Orientations of Psychotherapists



Recipients of Treatment

Women seek more treatment than men.

University educated people seek more treatment thanhigh school educated.

White people seek more treatment than non-white

people.

Higher income seek more treatment than lower income.



What is Psychotherapy

When a therapist aids a client in developingawareness and changing problem behaviour,thoughts and/or feelings.

Commonalities among all types ofpsychotherapists:

1. Interpersonal learning is important.2. Self-knowledge is sought.3. Therapy is gradual.



Psychotherapy

We will review/discuss three main categories of psychotherapy.

Insight Therapies:1. Psychoanalysis.2. Client-Centred Therapy (Humanistic).3. Cognitive Therapy.4. Family System Therapy.

Behaviour Therapies:1. Systematic Desensitisation (changing overt behaviour).2. Aversion Therapy (changing overt behaviour).

Biomedical Therapies:Biological functioning interventions.



Psychoanalytic Therapy

Problems arise from unconscious feelings and conflicts.

Goal = catharsis (the uncovering and resolving of

unconscious conflicts).

Therapy may consist of:Free Association.Resistance.

Transference.Dream Analysis.



Client-Centred Therapy

Problems arise when one’s ‘ideal self’ differs from their‘real self’.

Goal = create an environment so client can help self.Premises: Humans are innately good and can cure themselvesgiven the right environment.

Therapy consists of:Giving unconditional positive regard.Showing empathy.

Actively listening.Reflecting the client’s thoughts/feelings.



Cognitive Therapy

Focuses on changing negative thoughts andbeliefs in order to eliminate maladaptivebehaviours.



Cognitive Therapy

Variant = Rational Emotive Therapy (RET)Problems arise because we hold irrational beliefs thatinterfere with our ability to perceive clearly.

They lead to negative thoughts.Goal = detect unrealistic, self-defeating andirrational thoughts, and to develop alternative

rational beliefs.



Family System Therapy

Most problems develop in a family setting.

Goal = improve familyrelationship/communication:Not an alternative to other therapies.

The big difference is family system therapists preferto talk with family members together.



Behaviour Therapy

2. Social skills training:a. Modelling.b. Behavioural rehearsal.

3. Token economies.

4. Aversion therapy:a. Repeatedly pair the problematic behaviour with an

aversive stimuli (e.g., a drug that causes nausea).



Insight-Oriented vs. Action-Oriented Approaches

Insight-Oriented:Emphasis: Self-awarenessand understanding.

Primary medium: Verbalinterventions.More attention to thetherapeutic relationshipand to process,interpretation and insight.Counsellor: Nondirective.

Action-Oriented:Emphasis: Relief ofsymptoms.Primary medium: Action

with verbal processing.More attention toobjective, scientificbehavioural interventionsand outcome measures.Counsellor: Active anddirective.



History of Behaviour Therapy

When did humans begin attempting to alter theirown and others ‘problem’ behaviour?

Any ‘training’ of humans or animals often involvesBehaviour Therapy (BT).BT has a long past, but a short history (Frank &

Wilson, 1973).




Systemic work:Pavlov (Classical Conditioning):

(UCS + CS) x X trials = CR..

Watson (1914) (Behaviourism – Human Application):Observable stimuli and responses.Rejection of consciousness thought and imagery:

Reaction to Psychoanalysis.

Mary Jones (1924) (Watson’s student) (Behaviour TherapyExtinction):

Fear of rabbit in a child via modelling and in vivo exposure.




1933 Thorndike extending the paradigm:Behaviours systematically changed by their consequences(operant conditioning).

1934 Jacobson physiologist technique acquired:Progressive relaxation.

1935 Willie and Hobart Mowrer (classical conditioning

based technique):‘Bell and pad’ method for nocturnal enuresis.




Post-war demand for psychological treatment:‘Poor fit’ with psychoanalysis.

1952 Eysenck’s reviews ‘insight’ therapyoutcomes:

No difference between treatment and no treatment.



Post-war Expansion of Behaviour Therapy

1950’s to 70’s highlights USA: Bandura expansion of classical and operantconditioning:

Social learning theory: Observation and cognition.Integration of cognition into BT.



Post-war Expansion of Behaviour Therapy

1950’s to 70’s highlights USA: 1962-63 Cognitive Behaviour Therapy (CBT) isborn; with two distinct approaches:

Ellis’: Rational Emotive (Behaviour) Therapy. Beck’s: Cognitive Therapy.

Both focus on the modification of maladaptive cognitions

as important therapeutic goals.



The Behavioural Model

4 modes of Behaviour that BT is applied:

1. Overt: Observable (e.g., walking, speech, writing).

Covert: Not directly observable.

2. Cognitive (e.g., thinking, remembering, imagining).

3. Feeling (e.g., emotion)

4. Physiological Responses (e.g., heart rate, muscle

tension, galvanic skin response).



The Behavioural Model

Assessment of ‘covert’ behaviours: Inclusion has been historically controversial.Self-report.Observation of behaviour ‘anchors’ (behaviouralindicator).Physiological measurements.



Behaviour Therapy Concept of thePerson

Trait verses State determine behaviour: Attributional errors regarding behaviours.Behavioural descriptions remove implied motivation.Precise and individualistic.



Behaviour Therapy Concept of thePerson

We are what we do (and think): What influences what we do?

What has gone before and what is happening now?

Reciprocal determinism (interaction between):Covert behaviours (e.g., beliefs, expectancies).Overt behaviours.Environmental conditions.



Model of Behaviour Therapy

Events occurring before and after influencebehaviour:

Behaviour change through altering maintainingfactors.



Model of Behaviour Therapy

A B C model (antecedents & consequences[maintaining factors]):

Antecedents: Prerequisites, prompts, setting events:

Will the behaviour occur?Consequences: Appraised value to self and significant others: Will the behaviour continue.

Maintaining vs. Originating conditions:

Past influences present through present cognitions:Indirect and subject to change.Heredity factors place broad limits of capacity.

1st step to identifying maintaining conditions:

E.g., Figure 3.2 in the text.



Psychologists ‘Maintaining Conditions’

Counsellors and Therapists are generic titles:Professional registration is required forPsychologists:

Prerequisites:State and Territory 4 years + 2 years supervision (accept WA).National (APS policy) 6 years + 2 years supervision.

Ongoing:Professional development.

Adherence with ethical guidelines and codes of conduct.



Psychologists ‘Maintaining Conditions’

Additional environmental factors:Relevant State and Federal government decisions.Public services regulations, policies and procedures.Business regulations, policies and procedures.

Workplace policies, procedures and politics.



Common Elements of Behavioural Approaches

An emphasis on the present rather than on the past.

Attention to changing specific dysfunctional behaviours.

Reliance on research as an integral partner for developing andtesting interventions.

Principles of learning can account for the development andtreatment of maladaptive behaviours.

A preference for carefully measuring treatment outcomes.

Matching specific treatments to particular presenting problems.



How do Psychological Problems Arise?

All behaviours are the result of learning.

Three primary types of problems:Behavioural excess.Behavioural deficits.Inappropriate/maladaptive behaviour.



How Does Change Occur?

Learning new responses by using the principlesof four types of conditioning to alter behaviour.

What are the four types of conditioning?



Goals of Behaviour Therapy

1. To create new conditions of learning.

2. Client and therapist work collaboratively tospecify treatment goals:a. Goals must be specific and measurable.



Classical Conditioning Techniques

Relation Techniques:Many different kinds.Used in combination with other behaviouraltechniques.Progressive Muscle Relaxation (Jacobsen, 1938):

Person learns how to tense and relax muscle groups.

Therefore, can identify tension before it becomes aproblem and reduce it independently.




Systematic Desensitisation:1. Teach client relaxation strategy.2. Create a hierarchy of anxiety.3. Present anxiety provoking stimuli paired with

relaxation.




In Vivo Desensitisation:Similar to systematic desensitisation, but is always inreal situation.

Flooding:Prolonged and intensive exposure to feared stimuli.

Implosion:

Type of flooding done in the imagination.Involves exaggeration rather than reality.



Operant Conditioning

Three things necessary for OperantConditioning (i.e., behaviour change):

1. A ntecedent.2. B ehaviour.3. C onsequence.




Reinforcement:Positive reinforcement.Negative reinforcement.

Punishment:Positive punishment.Negative punishment.



Operant Conditioning Techniques

Functional Assessment:Understand the behaviour in terms of the function itserves.

Identify the A, B and C.Implement functional treatments.



Operant Conditioning Techniques

Contingency Contracts:Formal written agreement.

Shaping: The process in which complex terminal behavioursare reinforced in approximate successive stages.

Token economy.



Social Learning Approach

Gives prominence to the reciprocal interactionsbetween an individual’s behaviour and theenvironment.



Social Learning Techniques

Modelling: Learning by observing others.Serves two purposes:

Person can learn new behaviour.

Behaviour that is inhibited becomes less frequent.

Participant modelling.

Coping model.



Social Learning Techniques

Vicarious Learning:Observing other people’s behaviours being rewardedor punished leads to reinforcement of those

behaviours in an observer.



Strengths

Strong empirical tradition and evidence.

Specific problems are identified and attacked.

Forces client to be explicit about goals.

Can be used with a variety of populations.



Weaknesses

Does not address broader human problems.

Does not integrate past.

Therapists can manipulate.

Difficult with certain groups.

May not emphasise the role of feelings enough.



Week Two: Simulation Exercise

Exercise One: Workplace Considerations (30 minutestotal):

In the workgroup (15-20 minutes):Consider some important issues regarding the approach toclinical work likely to exist as a function of your particularorganisation’s focus. Some ideas to consider:

Who pays? Who is the client?

Where are the boundaries of service provision?For each character, how might the organisation approach each case?

Class discussion (10-15 minutes).



Client Empathy

Think of how else to make it more realistic. Thisis a good site – albeit on YouTube todemonstrate a variety of skills.http://www.youtube.com/watch?v=NH8sEpc_

A9I

http://www.youtube.com/watch?v=NH8sEpc_A9I






End of Lecture TwoSee You Next Week

Week ThreeChapters Three and Four

(Spiegler & Guevremont, 2003)Overview/Discussion of Psychological Report

psy340 wveek two (overview of bt & clinical assessment and diagnosis)(1)

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