临床与咨询心理学导论 18 - Behavioral Approaches
L18 Behavioral Approaches
参考文献/图片来源：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.
18.1 Conditioning
Pavlov’s Laboratory
• Ivan Pavlov (1849 – 1936)
Russian physiologist who researched digestion
• Pavlov’s digestion research
- Collected and analyzed gastric secretions
- Studied salivary responses to food
- After several trials, dogs began salivating before the food arrived
- “Psychic” secretions
Classical Conditioning
Operant Conditioning
• Focuses on behavior occurs (or does not occur) based on environmental consequences
• Focus on consequences of behavior
• Focus on voluntary behaviors and contingencies
- Reinforcement increases a target behavior
• Positive Reinforcement = Add something good
• Negative Reinforcement = Take away something unpleasant/bad
- Punishment decreases a target behavior
• Positive Punishment = Add something unpleasant/bad
• Negative Punishment = Take away something good
18.2 Behaviorism & Behavior Therapy
Principles of Behaviorism
• Started as reaction against psychoanalytic theory and psychodynamic psychotherapy
• Focused on a science of behavior
- Based on key ideas in conditioning
- Complex human behavior and humane emotions could be understood in stimulus-response terms
“Psychology as the behaviorist views it is a purely objective experimental branch of natural science. Its theoretical goal is the prediction and control of behavior.” - John B. Watson, 1913
Behavior Therapy
• Primary goal: Observable behavior change
• Psychotherapy should be grounded in science with:
- Observable behaviors
• eg Number of cigarettes smoked per day
- Testable hypotheses
• eg If a client is given money for smoking 0 cigarettes each day, they are less likely to smoke
• Can be conceptualized as an application of the scientific method
18.3 Behavioral Treatments
18.3.1 Techniques in the Treatments
Techniques Based on Classical Conditioning
Exposure Therapy
• Used commonly with anxiety disorders
• Interacting with the feared stimulus
Systematic Desensitization
• Combination of relaxation training plus exposure therapy
• Also common for anxiety
Assertiveness Training
• Includes exposure in the form of facing interpersonal fears
• Direct instructions, modeling, and practice used
Techniques Based on Operant Conditioning
Contingency Management
• Change the if-then statements that influence behavior
Token Economies
• Clients earn tokens for engaging in certain behaviors
Shaping
• Used to with complex behaviors
• Successive approximations of the behavior are rewarded
Behavioral Activation
• Increase the frequency of behaviors that are positively reinforcing for the client
18.3.2 Exposure Therapy
• Mainly based on Classical Conditioning
- Theory is that fear is a conditioned response
• To stop association, present the conditioned stimulus repeatedly
• Fear decreases in the absence of a negative outcome
• Very effective in the treatment of anxiety disorders
• Exposure activities
- Graded exposure: Develop a fear hierarchy; start with easier fears, work your way up to more challenging fears
- Flooding/implosion: “Worst first”
- In-vivo: Confronting the feared stimulus “in real life”
- Imaginal: Vividly visualizing feared stimulus
• Fear hierarchy: Specific phobic objects/situations are identified and given a fear rating - Start with the least feared
18.3.3 Obsessive-Compulsive Disorder (OCD)
• Obsessions
- Intrusive, recurrent, and persistent thoughts, impulses, or images that cause anxiety or distress
- Not simply excessive worries about real-life problems
- Attempts to ignore, suppress, or neutralize obsessions
- Common examples: contamination; doubting if something has been done; aggressive impulses
• Compulsions
- Repetitive behaviors or mental acts that a person feels driven to perform in response to obsession
- Aimed at preventing a dreaded event but are not realistically connected to that event (or are excessive)
- Common examples: hand-washing; checking; counting
18.3.4 Exposure & Response Prevention (EX/RP)
• Prolonged exposure to obsessional cues without access to rituals/compulsions
- Time-limited treatment
- Session length can vary: eg Intensive: 15 two-hour sessions over 3 weeks
• In-vivo exposure often used; imaginal used when in-vivo is not safe or feasible
• Effective for over 80% of patients with good long-term outcomes
• Goals of exposures:
- Tolerate negative thoughts and uncertainty
- Habituate to anxiety and experience a decrease in distress
- Feared (catastrophic) events do not happen
• Subjective Units of Discomfort or Distress (SUDS)
• Case Example (from Foa et al., 2012)
- Mike feared harming strangers while driving or harming his family by failing to check locks and the stove at home. He also worried that he would drop his 4-year-old daughter while carrying her over hard flooring, leading to serious injury.
• Example rear hierarchy for Mike included:
- Turning stove off without checking (50 SUDs)
- Locking door without checking (60 SUDs)
- Carrying daughter while walking on hard surfaces (75 SUDs)
- Driving on highway without retracing his route (100 SUDs)
