Behavior Theory
Whether or not a person performs a behavior AGAIN depends most on these types of consequences.
What is short-term consequences.
Includes any activity that creates unpleasant internal sensations.
Interoceptive Exposure.
[What are the other types of exposure? What are some examples of each type, say, for a person with a spider phobia?]
In Cognitive Theory, behaviors are considered part of this.
What are Consequences?
[Why do behaviorists and cognitivists disagree about where behaviors and beliefs belong in the ABCs? Even with this disagreement, why does it make sense that behavioral and cognitive ABC models (and techniques) can be used together in the treatment of a single patient?]
We use this technique in order to identify core beliefs.
The Downward Arrow
[How does the Downward Arrow work?]
Any of the following: The patient is not aware of all the antecedents that are triggering the maladaptive behavior. The maladaptive behavior is too strongly reinforced. The adaptive behavior is not reinforced enough. The adaptive behavior is punishing. The patient does not encounter enough antecedents that would allow for the adaptive behavior to occur.
Explain how Activity Planning works.
Activity Planning asks the patient to engage in a series of small steps toward their ultimate, more complex target behavior that they want to be engaging in. For example, in the first week, the person might be asked to add 2 items to a list of gardening needs/ideas each day during the first week. During the second week, they spend 5 minutes each day online looking at where they could buy these needs. And so on...
[Can you create a 3-4 week activity plan for a patient who wants to start knitting?]
These are the "comparisons" that contribute to an attributional style.
What are (1) internal vs. external, (2) global vs. specific, (3) and stable vs. unstable.
[Can you identify examples? What makes an attributional style pathological?]
When we help a patient engage in restructuring they come up with an alternative thought (i.e. something different than their original automatic thought). What's the most important thing about their new, alternative thought?
It needs to be realistic -- based on objective evidence.
[What do we call this more realistic thought after restructuring?]
These are actually useless and not naturally reinforcing, even after conditioning. Yet somehow, everyone would want them because our society has made them useful.
What are generalized reinforcers?
[What is a primary reinforcer? What is a conditioned reinforcer? What is a token economy? What is a functional class?]
When developing an Exposure Hierarchy, options for exposure are arranged (from lowest to highest) based on these.
What are Subjective Units of Distress (SUDs)?
[Can you create an Exposure Hierarchy for, say, a patient with a spider phobia? Make sure you use your SUDs!]
A person just came in 3rd at a recent track meet. Give an example of a core belief, and then an example of an automatic thought that may be connected with that core belief.
Many possible answers. For example: Automatic Thought - "I should have come in first place." Core Belief - "I'm a failure."
[What's the difference between an automatic thought and a core belief?]
A patient worries a lot about her job. On her Probabilities and Costs homework for this week, she listed 10 worries. Before they *could* have happened, this is how likely she thought they were: 80, 75, 50, 95, 100, 60, 60, 45, 85, 80. Only 2 of the worries came true. Calculate this patient's probability estimate and actual probability.
Probability Estimate = 73%; Actual Probability = 20%
[How do we examine Costs?]
Explain within-session habituation.
Within-session habituation means that we want the patient to experience a decrease in distress during an exposure exercise BEFORE they discontinue the exercise. In other words, they habituate to that triggering event during that specific practice.
[What is our guideline for when enough within-session habituation has occurred? What is between-session habituation?]
Why would a CBT therapist provide a patient with training in PMR?
Getting early "success" increases patient buy-in/belief in the effectiveness of the therapist and treatment; because many patients in CBT experience muscle tension (due to emotions like anxiety or anger); because patients tend to enjoy it and can experience increases in self-efficacy due to the sense of progress.
What are the 3 elements in the cognitive triad? Provide an example of a core belief for each of the 3.
Self, Other, and the World. Examples might be: "I'm a good person." "Other people do their best to be kind." and "The world is a safe place."
Identify 2 cognitive distortions in the following stream of thoughts. Explain what these distortions are. "I am so stupid. How could I have gotten so many questions wrong on the test? Oh wait. Because I'm STUPID! No wonder my girlfriend left me. Why would anyone want to be with someone stupid, who's never going to get a job and going to have a terrible time making it through life. I'm so mad at myself. I should be able to do better."
Many possible answers. For example: "...who's never going to get a job..." is Jumping to Conclusions.
Based on Operant Conditioning, why would a person learn to count to 7 repeatedly in order to reduce feelings of anxiety?
The counting (behavior) must be reinforced if we assume that the person continues or increases engaging in it. We might hypothesize that counting removes a sense of threat. The subtraction of threat makes the situation "better" for the person, so we likely have Negative Reinforcement here.
[Can you come up with other examples of reinforcement and punishment affecting a person's behavior?]
Build an Exposure Hierarchy for a patient with a fear of circles/dots. Specifically, give two examples of exposure exercises -- but they have to be different types of exposures.
Many possible answers.
"It's my fault that my patient attempted suicide last week. I was supposed to have helped her feel better, at least enough to not want to kill herself. What good am I as a therapist -- I'm probably not helping any of my patients right now. It's just that I'm so distracted at home at the moment. At least those distractions will be over soon."
Identify the 3 attributions in this stream of thoughts. Explain how you know.
Attributions are internal, global, and unstable.
[Can you try using the Downward Arrow method and think through what some of the core beliefs might be?]
Restructure the following thought. Name and explain the method you choose to use. "My mom's dementia is getting so much worse, and I know that I'm not being helpful enough. I really need to be around more. Going over a few times a week just isn't enough. She was always there for me when I was a kid. I need to always be there for her now."
Many possible answers. For example: Thinking in Shades of Grey could help the person realize that they are doing something. A more realistic thought might be - "I am doing my best and getting over to visit her a few times a week. At the same time, I wish I could visit her more."
[What are all the different methods for cognitive restructuring? Can you explain how each would work? What do we know about the effectiveness of CBT overall?]