Cognitive Behavioral Interventions Important Definitions/Concepts

Cognitive Behavioral Interventions

Professor Susan Dowd Stone, MSW, LCSW
Behavior Therapy The process and procedures that change the consequences of
behaviors and the stimulus conditions that illicit them.
Cognitive Behavior Therapy Treatments that alter/change cognitions which are
influencing psychological problems. (Goal is to reduce distress and increase
attainment of goals).
Four Principles of CBT
Scientific involves precise empirical evaluation
Active not just talking, but actively engaged in changing and doing
something about problems
Present Focus Focus on current conditions/symptoms in the here and now
Learning Focus Behaviors develop and are maintained and are changed
primarily through learning, CBT provides clients with learning experiences
and learning these principles are the backbone of CBT experiences.
Aaron Beck The Father of Cognitive Behavior Therapy, founder of the Beck
Institute at UPENN
Individualized therapy one or more therapeutic approaches to cater to clients
specific needs
Stepwise Progression Behavior therapy often proceeds in a stepwise progression
moving from simply to more complex (i.e. behavioral hierarchy, target behaviors
toward goals).
Treatment Packages Treatment consisting of two or more therapy
procedures/techniques
Brevity associated with CBT in terms of fewer sessions. CBT among therapies
considered short term.
Positive Reinforcement when a pleasant or Undesirable stimulus is presented
added as a consequence of a person performing a specific behavior. (If something is
ADDED it is considered POSITIVE reinforcement think of a math PLUS sign as
opposed to adjective)
Negative Reinforcement When a pleasant or undesirable event is REMOVED, i.e.
taken away as a consequence of a person performing a certain behavior.
Reinforcement - POSITIVE OR NEGATIVE ALWAYS increases the likelihood
that the behavior will be repeated!!!!
Modeling Demonstrating a behavior for another person. Modeling therapy used for
fear/anxiety/skills training.

Behavioral Rehearsal Therapy procedure in which a client practices performing a

target or other behavior.
Response Cost Punishment technique in which a clients access to a valued item or
privilege is removed as a consequence of performing a maladaptive or unwanted
behavior.
Cognitive Restructuring Identifying and recognizing maladaptive or unwanted
cognitions and substituting or modifying them with more adaptive and less
distressful truths.
Stress Inoculation Training Meichenbaum: Learning to cope with stress evoking
events by acquiring coping skills and then practicing them while exposed to the
stressor.
Systematic Desensitization Client imagines successively more anxiety arousing
situations while engaging in a behavior that competes with anxiety, such as muscle
relaxation.
Extinction Withholding reinforcement of a behavior with the goal of eradicating it.
Token Economy System for motivating clients to perform desirables
functions/behaviors by giving a token or points/chips toward something desirable to
the client. Clients can then exchange the tokens for backup reinforcers i.e.
good/services/ they would like.
Shaping Components of target behavior are reinforced, rather than the entire
behavior. Incremental reward of successively closer approximations of the full
behavior desired are reinforced until the entire behavioral goal is achieved.
Socratic Questioning/Dialogue Guided discovery Asking the client a series of
easily answerable questions that lead client to recognize distortions in beliefs or
cognitions.
Behavioral Medicine - The application of behavior therapy procedures to physical
health and illness.
Overt Behaviors Actions that the public can see or hear (eating, walking, talking,
stealing)
Covert Behaviors Private behaviors of which the individual is typically aware, but
which are not observable to others.
3 categories:
Cognitions i.e. thinking, expecting, attributing
Emotions feelings, fear, sadness, shame
Physiological responses heart and respiration, blood pressure

ABC Model antecedents, behaviors, consequences

Target Behavior a narrow, discreet aspect of the problem or desired behavior that
can be clearly defined and easily measured - can be overt or covert behavior.
Exposure Therapy (brief) exposes client to a threatening event for a short period
incrementally beginning with aspects that provoke minimal anxiety and
progressing to more anxiety provoking aspects. (prolonged) higher intensity
exposure to feared thing or event from the onset.
Automatic thoughts maladaptive cognitions that appear to arise reflexively,
without prior deliberation or reasoning.
John Watson Founder of Behaviorism which emphasized the importance of
objectively studying behaviors through directly observable stimuli and responses.
He was influenced by Pavlov.
Ivan Pavlov Founder of Classical Conditioning, major contributions to behavior
therapy (think dog and bell experiment).
B.F. Skinner he investigated operant conditioning w/ pigeons and rats (cats in a
cage trying to escape learned which routes were more likely to result in freedom;
therefore used those behaviors more often).
Joseph Wolpe Developed several behavior therapies, the most notable Systematic
Desensitization. Sometimes referred to as the father of behaviorism.
Albert Bandura Developed Social Learning Theory that included principles of
classical and operant conditioning as well as observational learning. Called his
approach Social Cognitive Theory turned the tide away from pure behaviorism
toward internal process of learning (i.e. thoughts).
Donald Meichenbaum developed CBT treatment packages such as selfinstructional training and stress inoculation training that are used to treat a wide
range of psychiatric problems.
Albert Ellis in conjunction with Beck, Ellis developed Rational Emotive Therapy
which he renamed Rational Emotive Behavior Therapy. Both were used to modify
the negative or illogical thinking patterns associated with many psychological
disorders such as anxiety and depression.
AABT Association for the Advancement of Behavior Therapy now ABCT
Association for Behavioral and Cognitive Therapies www.ABCT.org
Maintaining Conditions antecedents and consequences of a behavior that cause it
to be performed.
8 Steps of Behavior Therapy
1.
2.
3.
4.
5.

Clarifying the clients problem

Formulating initial goals for therapy
Identifying maintaining conditions
Selecting target behaviors to help alter maintaining conditions.
Designing a treatment plan (selecting specific techniques to enhance
target behaviors or other treatment goals)

6. Implementing the treatment plan

7. Evaluating the success of the treatment plan
8. Changing the treatment plan or conducting follow up assessments.

Case Study research method that provides a detailed description of what

transpires during the treatment of an individual client
Hypothesis the automatic thoughts/behaviors clients have which are subject to
empirical verification rather than being accepted as the way things are or
established facts.

Four CBT Evaluation Outcome Measures:

1.
2.
3.
4.

Meaningfulness of change
Transfer and generalization of change
Durability of change
Acceptability of the therapy

Multimodal Assessment Obtaining information about more than one mode of

behavior in a behavioral assessment.
Multimethod Use of 2 or more methods to gather information about a target
behavior
Behavioral Checklist List of potential problem behaviors, can be developed by
client or person who knows client well.
Naturalistic Observation - Observing and recording a clients specific, overt, target
behaviors as the client naturally engages in them.
Simulated Observation Conditions are set up to resemble the natural environment
in which the clients problem is occurring.
Four goals in initial CBT interview:
1.
2.
3.
4.

Establish rapport with client

Gather information about the clients problem
Obtain data about maintaining conditions
Educate the client about CBT approach

Irrational Beliefs and Distortions - Distressing, often negative beliefs/assumptions

about the world, self and others that are based on distorted views and which have
been accepted as truths without empirical validation.

Skills Training treatment packages including modeling, behavioral rehearsal,

psycho education and reinforcement to teach client interpersonal skills and coping
methods.