PSY340

Week Two
Chapters One and Two
(graphics from Spiegler & Guevremont, 2003):
General Overview of Behaviour Therapy
Clinical Assessment and Diagnosis
Unit Coordinator/Lecturer:
Dr. Mary Morris
Brief History of Treating Psychological
Disorders
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 the
community.
Effective antipsychotic medication.
General mood of optimism in country.

In 1961 community mental health centres were
established.
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 than
high 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 developing
awareness and changing problem behaviour,
thoughts and/or feelings.

Commonalities among all types of
psychotherapists:
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 ones ideal self differs from their
real self.
Goal = create an environment so client can help self.
Premises: Humans are innately good and can cure themselves
given the right environment.

Therapy consists of:
Giving unconditional positive regard.
Showing empathy.
Actively listening.
Reflecting the clients thoughts/feelings.
Cognitive Therapy
Focuses on changing negative thoughts and
beliefs in order to eliminate maladaptive
behaviours.
Cognitive Therapy
Variant = Rational Emotive Therapy (RET)
Problems arise because we hold irrational beliefs that
interfere with our ability to perceive clearly.
They lead to negative thoughts.
Goal = detect unrealistic, self-defeating and
irrational thoughts, and to develop alternative
rational beliefs.
Family System Therapy
Most problems develop in a family setting.

Goal = improve family
relationship/communication:
Not an alternative to other therapies.
The big difference is family system therapists prefer
to talk with family members together.
Behaviour Therapy
Focuses on applying conditioning principles to
change maladaptive behaviours.

1. Systematic desensitisation (Wolpe, 1958):
a. Used to treat phobias.
b. Based on classical conditioning principles.
c. Pair relaxed states with increasingly fearful stimuli.
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).
Therapy Types Conclusion
Most therapists practice eclectic therapy.

The types of therapy appear to be equally effective.

Three common factors at work in all types of
psychotherapy:
1. A supportive relationship.
2. An opportunity to open up.
3. A reason for hope.

For some disorders, certain types of therapy tend to
be more successful.
But, there is no universal best type of therapy.
Insight-Oriented vs. Action-Oriented
Approaches
Insight-Oriented:
Emphasis: Self-awareness
and understanding.
Primary medium: Verbal
interventions.
More attention to the
therapeutic relationship
and to process,
interpretation and insight.
Counsellor: Nondirective.
Action-Oriented:
Emphasis: Relief of
symptoms.
Primary medium: Action
with verbal processing.
More attention to
objective, scientific
behavioural interventions
and outcome measures.
Counsellor: Active and
directive.
History of Behaviour Therapy
When did humans begin attempting to alter their
own and others problem behaviour?
Any training of humans or animals often involves
Behaviour Therapy (BT).
BT has a long past, but a short history (Frank &
Wilson, 1973).
History of Behaviour Therapy
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) (Watsons student) (Behaviour Therapy
Extinction):
Fear of rabbit in a child via modelling and in vivo exposure.
History of Behaviour Therapy
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.
History of Behaviour Therapy
Post-war demand for psychological treatment:
Poor fit with psychoanalysis.

1952 Eysencks reviews insight therapy
outcomes:
No difference between treatment and no treatment.
Post-war Expansion of Behaviour
Therapy
1950s to 70s highlights USA:
Skinner elaborates operant conditioning:
Animal learning: Reinforcement schedules, shaping.

Ayllon (& Azrin) (1961) apply BT to psychiatric
hospitals:
Token economies shaping adaptive behaviours.
Post-war Expansion of Behaviour
Therapy
1950s to 70s highlights South Africa:
Wolpe the founder of BT:
Systematic desensitisation for anxiety problems.

Lazzarus extending BT with groups and kids.
Post-war Expansion of Behaviour
Therapy
1950s to 70s highlights USA:
Bandura expansion of classical and operant
conditioning:
Social learning theory: Observation and cognition.
Integration of cognition into BT.
Post-war Expansion of Behaviour
Therapy
1950s to 70s highlights USA:
1962-63 Cognitive Behaviour Therapy (CBT) is
born; with two distinct approaches:
Ellis: Rational Emotive (Behaviour) Therapy.
Becks: Cognitive Therapy.
Both focus on the modification of maladaptive cognitions
as important therapeutic goals.
Post-war Expansion of Behaviour
Therapy
1950s to 70s highlights USA:
1970s Meichenbaum elaborated CBT:
Self-Instructional Training.
Stress-Inoculation.
Standardised treatment packages for disorders.
Combinations of BT elements for different symptoms.

1970s to Now:
CBT is the dominant clinical approach.
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 (behavioural
indicator).
Physiological measurements.
Behaviour Therapy Concept of the
Person
Trait verses State determine behaviour:
Attributional errors regarding behaviours.
Behavioural descriptions remove implied motivation.
Precise and individualistic.
Behaviour Therapy Concept of the
Person
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 influence
behaviour:
Behaviour change through altering maintaining
factors.

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 for
Psychologists:
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 and
testing interventions.

Principles of learning can account for the development and
treatment 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 principles
of 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 to
specify treatment goals:
a. Goals must be specific and measurable.
Classical Conditioning Techniques
Relation Techniques:
Many different kinds.
Used in combination with other behavioural
techniques.
Progressive Muscle Relaxation (Jacobsen, 1938):
Person learns how to tense and relax muscle groups.
Therefore, can identify tension before it becomes a
problem and reduce it independently.
Classical Conditioning Techniques
Systematic Desensitisation:
1. Teach client relaxation strategy.
2. Create a hierarchy of anxiety.
3. Present anxiety provoking stimuli paired with
relaxation.
Classical Conditioning Techniques
In Vivo Desensitisation:
Similar to systematic desensitisation, but is always in
real 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 Operant
Conditioning (i.e., behaviour change):
1. Antecedent.
2. Behaviour.
3. Consequence.
Operant Conditioning
Reinforcement:
Positive reinforcement.
Negative reinforcement.

Punishment:
Positive punishment.
Negative punishment.
Operant Conditioning: Notes About
Punishment
Punished behaviour is not forgotten.

Causes increased aggression.

Creates fear that can generalise to undesirable
behaviours.

Does not necessarily guide towards desired behaviour.

Punishment teaches how to avoid it.
Operant Conditioning
Operant Conditioning Techniques
Functional Assessment:
Understand the behaviour in terms of the function it
serves.
Identify the A, B and C.
Implement functional treatments.
Operant Conditioning Techniques
Contingency Contracts:
Formal written agreement.

Shaping:
The process in which complex terminal behaviours
are reinforced in approximate successive stages.
Token economy.
Social Learning Approach
Gives prominence to the reciprocal interactions
between an individuals behaviour and the
environment.
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 peoples behaviours being rewarded
or punished leads to reinforcement of those
behaviours in an observer.
Therapists Role
Serves as a consultant, problem solver, coach and
educator.

Directive and active.

Models desirable behaviour.

Collaborative relationship, but therapist is expert.
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 minutes
total):

In the workgroup (15-20 minutes):
Consider some important issues regarding the approach to
clinical work likely to exist as a function of your particular
organisations 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).
Week Two: Simulation Exercise
Exercise Two:
Consider and reflect on impressions of
character:
How they might behave, think and feel in different
situations.
What might go on in their head?
How might this be shown in their behaviour?

All impressions are valuable.


Client Empathy
Think of how else to make it more realistic. This
is a good site albeit on YouTube to
demonstrate a variety of skills.
http://www.youtube.com/watch?v=NH8sEpc_
A9I
End of Lecture Two

See You Next Week
Week Three
Chapters Three and Four
(Spiegler & Guevremont, 2003)
Overview/Discussion of Psychological Report