Introduction to Behaviorism & Cognitive Behavior TherapiesAnne Farrell, Ph.D.New York Medical College

Introduction and goals Background Knowledge and experience Goals

– Familiarize participants with tenets of behaviorism and basis for cognitive behavior therapies

– Background and interrelationships– Common adult and pediatric

applications– References and resources

Behavior Therapy Commonly used to treat

– anxiety, mood, eating disorders, parasuicidality

– impulse, anger control disorders, disruptive behavior

– sexual dysfunction, substance abuse– behavioral medicine and compliance

Two models of conditioning– Classical (Pavlovian) conditioning model– Operant (Skinnerian) conditioning model

Classical conditioning “Pavlovian” conditioning model

– unconditioned reflexes (UCR)• salivation, eye blink

– Contingency: pair with neutral stimulus (UCS)• bell, tone, bang, ash

– Conditioning (CS)• Previously neutral stimulus becomes

conditioned stimulus

– Conditioned response (CR)• Reflex now occurs in response to CS

Common examples?

Classical conditioning Relation to specific disorders

– Post-traumatic stress– Specific phobias (Little Albert)

• Panic disorder with agoraphobia

Related principles– Contingency, extinction,

generalization, discrimination– Schedules of reinforcement and

resistance Background

– First applied as BT by Wolpe, Lazarus

Skinnerian conditioning (“B-mod”) consequences of a behavior change

future probability of occurrence key influence

– association between response and consequences

Thorndike’s Law of Effect– positive outcomes strengthen

behaviors– negative outcomes weaken them

Operant Conditioning

Positive reinforcement Probability of response when it is

followed by a rewarding stimulus examplesNegative reinforcement Probability of response when it is

followed by removal of an unpleasant stimulus

examplesPunishment frequency of response due to

consequence

Operant Conditioning (Skinner)

Operant Conditioning Principles timing

– learning is more efficient under immediate rather than delayed circumstances

shaping– reward successive approximations of

desired behavior primary reinforcement

– reinforcer is innately satisfying secondary reinforcement

– reinforcer acquires its value through experience

Schedules of Reinforcement Continuous reinforcement– response is reinforced every time it

occurs. Partial reinforcement

– a response is reinforced only part of the time.

Schedules: rules for partial reinforcement– fixed ratio: after set # target responses– variable ratio*: after average

(unpredictable) # of responses– fixed interval: after a fixed amount of time– variable interval: after an unpredictable

amount of time

Resistance to extinction

Operant Conditioning

extinction a response is not reinforced and it

decreasesspontaneous recovery occurs in operant conditioning (and CC)discrimination learning to repeat only reinforced responsesgeneralization giving the learned response to similar

stimuliApplied behavioral analysis (ABA): operant conditioning principles to change

behavior

BT and disorders Assumptions about etiology? Anxiety disorders

– Acquired – classical conditioning– Maintained – operant conditioning

Role of avoidance– Highly reinforcing

Manualized treatments– Barlow: panic disorder, GAD

• Stress innoculation, panic induction, biological challenge

– Foa: OCD, PTSD• Exposure with response prevention• Relaxation strategies and retelling

– Frequently combined with meds, cog therapies

Basics of CBTs Assessment and intervention Empirical support for practice Characteristics of treatment

– Active, structured, focused– Past v. present v. future– Brief therapies– Change is achieved by

• Altering connections between troublesome situations and habitual reactions to them

• Challenging and changing distorted beliefs and thoughts that relate to dysfunction

Applications Operant conditioning

– Applied behavior analysis (ABA)• Single case designs• Children with autism, challenging

behavior

– Educational interventions• Functional behavioral assessment (FBA)

and behavior intervention plans (BIP)– Mandated under IDEA

– Generic parenting strategies• Reinforcement and punishment

ABCs– Antecedent – behavior - consequence

Single case design (ABA)

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Cognitive therapies Emerge from behavioral models

– Use BT techniques– Assume interrelationship among

cognition, affect, behavior Beck, Ellis, Young Situation, thoughts, feelings,

behavior Common elements:

– Ellis (RET): core irrational ideas– Beck (CT): maladaptive beliefs– Young: Early maladaptive schemas

CBT techniques Relaxation and imagery Self monitoring (mood monitoring,

impulse control, self-mutilation) Exposure Response prevention Flooding Behavioral rehearsal Thought stopping Coping statements Cognitive disputation

Outcomes Empirical support evidenced via

– Single case design (A-B-A-B)– Controlled studies

• Comparison to no treatment, wait-list, placebo-controls; comparison to other therapies and combinations of therapies

– Meta-analyses• Group differences expressed in sds

Resources Association for the Advancement

of Behavior Therapy (AABT.org) American Institute for Cognitive

Therapy (AICT.com) Ellis Institute, Beck Institute National Institutes of Mental Health

–– Web site – Facts about…