General Principles and Empirically Supported Techniques of Cognitive Behavior Therapy E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Proven and effective, cognitive-behavior therapy is the most widely taught psychotherapeutic technique. General Principles and Empirically Supported Techniques of Cognitive Behavior Therapy provides students with a complete introduction to CBT. It includes over 60 chapters on individual therapies for a wide range of presenting problems, such as smoking cessation, stress management, and classroom management. Each chapter contains a table clearly explaining the steps of implementing each therapy. Written for graduate psychology students, it includes new chapters on imaginal exposure and techniques for treating the seriously mentally ill.
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Seitenzahl: 2072
Veröffentlichungsjahr: 2009
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Table of Contents
Title Page
Copyright Page
PREFACE
Acknowledgements
CONTRIBUTORS
Chapter 1 - A BRIEF HISTORY OF COGNITIVE BEHAVIOR THERAPY: ARE THERE TROUBLES AHEAD?
FIRST-GENERATION BEHAVIOR THERAPY
SECOND-GENERATION BEHAVIOR THERAPY
THE RISE OF COGNITIVE BEHAVIOR THERAPY
TOWARD THIRD-GENERATION BEHAVIOR THERAPY
Chapter 2 - ASSESSMENT AND COGNITIVE BEHAVIOR THERAPY: FUNCTIONAL ANALYSIS AS ...
WHAT IS A “FUNCTIONAL ANALYSIS”?
BEHAVIORAL PRINCIPLES
STEPS TOWARD A FUNCTIONAL ANALYSIS
OPERANT CONTINGENCIES AND THIRD-WAVE THERAPIES
ISSUES AND CHALLENGES
CONCLUSION
Chapter 3 - COGNITIVE BEHAVIOR THERAPY: A CURRENT APPRAISAL
REVIEW OF COGNITIVE THEORY
ALTERNATIVE THEORIES OF DEPRESSION
TRADITIONAL COGNITIVE BEHAVIOR THERAPY
GENERIC COGNITIVE BEHAVIORAL THEORY FOR PSYCHOLOGICAL DISORDERS
MEDIATIONAL THEORIES OF CT
CURRENT PERSPECTIVES IN CBT
SHOW ME THE DATA: EVIDENCE OF EFFECTIVENESS OF CBT
SUMMARY OF META-ANALYSES
EVIDENCE OF MEDIATION BY POSITED MECHANISMS
MEDIATORS IN DEPRESSION
MEDIATORS IN ANXIETY
STATE OF MEDITATIONAL DATA
EVIDENCE FROM COMPONENT ANALYSES
Anxiety Disorders
STATE OF THE DATA
Chapter 4 - CULTURAL AWARENESS AND CULTURALLY COMPETENT PRACTICE
DEFINITIONS OF CULTURE AND RELATED TERMS
SHIFTING SOCIODEMOGRAPHIC TRENDS AND EXISTING DISPARITIES IN HEALTH CARE DELIVERY
INCREASING CULTURAL AWARENESS AND KNOWLEDGE
STRATEGIES FOR INCREASING CULTURAL COMPETENCE IN MENTAL HEALTH CARE DELIVERY
THE PRACTICE OF CULTURALLY COMPETENT MENTAL HEALTH CARE
THE PRACTICE OF CULTURALLY COMPETENT COGNITIVE BEHAVIOR THERAPY
CONCLUSION
Chapter 5 - NEW DIRECTIONS IN COGNITIVE BEHAVIOR THERAPY: ACCEPTANCE-BASED THERAPIES
HISTORY OF THE BEHAVIOR THERAPY MOVEMENT
COGNITIVE BEHAVIOR THERAPIES
ACCEPTANCE-BASED THERAPIES
SPECIFIC APPLICATIONS OF ACCEPTANCE-BASED APPROACHES
COMPARISON OF TWO REPRESENTATIVE APPROACHES
Comparison of Clinical Strategies
CONCLUSIONS
Chapter 6 - PSYCHOLOGICAL ACCEPTANCE
THE GROWTH OF PSYCHOLOGICAL ACCEPTANCE IN CBT
CONCEPTUALIZATIONS OF ACCEPTANCE
CLINICAL INTERVENTIONS TO PROMOTE PSYCHOLOGICAL ACCEPTANCE
WHEN IS ACCEPTANCE RECOMMENDED, AND WHEN IS IT LIKELY TO BE LESS EFFECTIVE?
UNRESOLVED ISSUES AND DIRECTIONS FOR FUTURE RESEARCH
CONCLUSION
Chapter 7 - ANGER (NEGATIVE IMPULSE) CONTROL
RESPONSIVE POPULATIONS AND CONTRAINDICATIONS
ANGER MEASUREMENT
THOUGHT STOPPING
RELAXATION TRAINING
PROBLEM-SOLVING SKILLS TRAINING
SELF-REINFORCEMENT
URGE CONTROL
EVIDENCE-BASED APPLICATIONS
RESOURCES
CONCLUSIONS
Chapter 8 - ASSERTIVENESS SKILLS AND THE MANAGEMENT OF RELATED FACTORS
BEHAVIORAL, COGNITIVE-AFFECTIVE, AND SOCIAL FACTORS INFLUENCING ASSERTIVENESS
ASSESSMENT
PRECONDITIONS FOR ASSERTIVENESS
ASSESSMENT OF ASSERTIVENESS SKILLS AND PERFORMANCE ABILITIES
BEHAVIORAL OBSERVATION
ASSERTIVENESS TRAINING
ASSERTIVENESS IN SPECIFIC CONTEXTS
CONCLUSION
Chapter 9 - ATTRIBUTION CHANGE
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS
HOW TO APPLY ATTRIBUTION CHANGE TECHNIQUES: OVERVIEW
STEP-BY-STEP PROCEDURES
Chapter 10 - BEHAVIORAL ACTIVATION TREATMENT FOR DEPRESSION
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS OF THE TREATMENT
OTHER DECISIONS IN DECIDING WHETHER TO USE BEHAVIORAL ACTIVATION
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
FINAL CONSIDERATIONS
Chapter 11 - RESPONSE CHAINING
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
HOW DOES THIS TECHNIQUE WORK?
COMPLETING AND VALIDATING A TASK ANALYSIS
DETERMINE WHAT CHAINING PROCEDURE TO USE
Chapter 12 - BEHAVIORAL CONTRACTING
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
ASSOCIATED CHALLENGES
STEP-BY-STEP PROCEDURES
Chapter 13 - BIBLIOTHERAPY UTILIZING COGNITIVE BEHAVIOR THERAPY
EVIDENCE-BASED APPLICATION
LIMITS OF BIBLIOTHERAPY
FACTORS TO CONSIDER WHEN RECOMMENDING BIBLIOTHERAPY
PRACTICE RECOMMENDATIONS
CONCLUSION
Chapter 14 - BREATHING RETRAINING AND DIAPHRAGMATIC BREATHING TECHNIQUES
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
EVIDENCE-BASED APPLICATIONS
CONTRAINDICATIONS OF THE TECHNIQUE
OTHER DECISION FACTORS WHEN DECIDING TO USE THE TECHNIQUE
HOW DOES BREATHING RETRAINING WORK?
STEP-BY-STEP PROCEDURES
Chapter 15 - CLASSROOM MANAGEMENT
CLASSROOM RULES
ENHANCING CLASSROOM ENVIRONMENT
REINFORCEMENT STRATEGIES
Giving Effective Commands
Chapter 16 - COGNITIVE DEFUSION
EVIDENCE FOR THE EFFECTIVENESS OF COGNITIVE DEFUSION
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS OF THE TECHNIQUE
OTHER DECISIONS IN DECIDING WHETHER TO USE COGNITIVE DEFUSION
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
THINKING VERSUS EXPERIENCE
OBJECTIFYING THOUGHT
A THOUGHT IS A THOUGHT IS A THOUGHT
FOCUS ON THE FUNCTIONAL UTILITY OF THOUGHTS
CONCLUSION
Chapter 17 - COGNITIVE RESTRUCTURING OF THE DISPUTING OF IRRATIONAL BELIEFS
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE THIS TECHNIQUE
HOW DOES THIS TREATMENT WORK?
CONCLUSION
Chapter 18 - COGNITIVE RESTRUCTURING: BEHAVIORAL TESTS OF NEGATIVE COGNITIONS
HOW TO USE BEHAVIORAL TESTS TO COUNTER NEGATIVE THINKING
EXAMPLES OF BEHAVIORAL TESTS TO COUNTER NEGATIVE THINKING
SUMMARY AND CONCLUSIONS
Chapter 19 - COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING
PROPOSED MECHANISMS OF EFFECT
COMMUNICATION SKILLS TRAINING PROCEDURES
FUNCTION OF SPEAKER/LISTENER SKILLS
STEP-BY-STEP PROCEDURES FOR SPEAKER/LISTENER SKILLS
FUNCTION OF PROBLEM-SOLVING SKILLS
STEP-BY-STEP PROCEDURES FOR PROBLEM-SOLVING SKILLS FOR COUPLES
GENERALIZABILITY
EVIDENCE-BASED APPLICATIONS
SUMMARY
Chapter 20 - COMPLIANCE WITH MEDICAL REGIMENS
MAJOR THEORIES OF COMPLIANCE
GUIDELINES FOR COMPLIANCE ENHANCEMENT
AN EXAMPLE OF COMPLIANCE ENHANCEMENT
Chapter 21 - CONTINGENCY MANAGEMENT INTERVENTIONS
GENERAL PRINCIPLES OF CONTINGENCY MANAGEMENT
APPLICATIONS OF CONTINGENCY MANAGEMENT
DESIGNING AN EFFECTIVE CONTINGENCY MANAGEMENT INTERVENTION
BARRIERS TO IMPLEMENTATION
Chapter 22 - DAILY BEHAVIOR REPORT CARDS: HOME-SCHOOL CONTINGENCY MANAGEMENT PROCEDURES
TREATMENT ACCEPTABILITY
FOR WHOM IS THE INTERVENTION APPROPRIATE?
HOW DOES THE INTERVENTION WORK?
STEPS TO DEVELOPING AND USING A SCHOOL-HOME NOTE
Chapter 23 - DIALECTICS IN COGNITIVE AND BEHAVIOR THERAPY
DIALECTICS IN COGNITIVE AND BEHAVIOR THERAPY
WHO MIGHT BENEFIT FROM DIALECTICAL STRATEGIES
THEORY OR MECHANISM BY WHICH DIALECTICS IS HYPOTHESIZED TO WORK
SPECIFIC DIALECTICAL TREATMENT STRATEGIES
CONCLUSIONS
Chapter 24 - DIFFERENTIAL REINFORCEMENT OF LOW-RATE BEHAVIOR
OVERVIEW
EXAMPLES OF DRL
USING DRL SCHEDULES
LIMITATIONS OF DRL
FUTURE WORK
Chapter 25 - DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIOR AND DIFFERENTIAL ...
CONSIDERATIONS PRIOR TO IMPLEMENTING A DRO/DRA PROCEDURE
DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIOR (DRO)
DIFFERENTIAL REINFORCEMENT OF ALTERNATIVE BEHAVIOR (DRA)
SUMMARY
Chapter 26 - DIRECTED MASTURBATION: A TREATMENT OF FEMALE ORGASMIC DISORDER
INTRODUCTION
EVIDENCE-BASED APPLICATIONS
WHO MIGHT BENEFIT FROM THIS TREATMENT
CONTRAINDICATIONS FOR TREATMENT
THE INITIAL INTERVIEW
STEP-BY-STEP PROCEDURES
KEY ELEMENTS OF THE DIRECTED MASTURBATION PROGRAM
PROBLEMS TO DEAL WITH DURING THE TREATMENT PROGRAM
DISCUSSION
Chapter 27 - DISTRESS TOLERANCE
EMPIRICAL EVIDENCE SUPPORTING THE USE OF DISTRESS TOLERANCE
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRADICTIONS
DECIDING TO USE DISTRESS TOLERANCE
DISTRESS TOLERANCE TECHNOLOGY
PROCEDURES
CONCLUSION
Chapter 28 - EMOTION REGULATION
UNDERSTANDING EMOTION REGULATION AND DYSREGULATION
EMOTION REGULATION STRATEGIES AND INTERVENTIONS
Chapter 29 - ENCOPRESIS: BIOBEHAVIORAL TREATMENT
INTRODUCTION
UNDERLYING PROCESSES
EVALUATION
CONTRAINDICATIONS
TREATMENT OF FE
PREVENTION
CONCLUSION
Chapter 30 - EXPRESSIVE WRITING
HOW TO DO EXPRESSIVE WRITING
WHO BENEFITS FROM EXPRESSIVE WRITING?
CONTRAINDICATIONS
WHY DOES EXPRESSIVE WRITING WORK?
SUGGESTED USES
Chapter 31 - FLOODING
WHEN ARE FLOODING PROCEDURES USED?
ARE FLOODING PROCEDURES EFFECTIVE IN REDUCING FEAR?
WHY DOES FLOODING WORK?
HOW TO CONDUCT FLOODING IN VIVO
HOW TO CONDUCT FLOODING IN IMAGINATION
CONCLUSION: HELPING THE CLIENT HANDLE DISTRESS
FUTURE DIRECTIONS
EVIDENCE-BASED APPLICATIONS
Chapter 32 - EXPERIMENTAL FUNCTIONAL ANALYSIS OF PROBLEM BEHAVIOR
BACKGROUND
WHO MIGHT BENEFIT FROM THE FUNCTIONAL ANALYSIS
POSSIBLE CONTRAINDICATIONS
ADDITIONAL CONSIDERATIONS
HOW DOES THE FUNCTIONAL ANALYSIS WORK?
EMPIRICAL SUPPORT FOR THE FUNCTIONAL ANALYSIS
STEP-BY-STEP INSTRUCTIONS
LINKING THE FUNCTIONAL ANALYSIS TO TREATMENT
Chapter 33 - FUNCTIONAL COMMUNICATION TRAINING TO TREAT CHALLENGING BEHAVIOR
WHO MIGHT BENEFIT FROM THIS TREATMENT
CONTRAINDICATIONS OF THE TREATMENT
HOW DOES THE TREATMENT WORK?
EVIDENCE FOR THE EFFECTIVENESS OF FCT
STEP-BY-STEP PROCEDURES
PREDICTING SUCCESSFUL OUTCOMES
Chapter 34 - FUNCTIONAL SELF-INSTRUCTION TRAINING TO PROMOTE GENERALIZED LEARNING
STEP 1: SELECT AN ARRAY OF EXAMPLES
STEP 2: CLASSIFY RESPONSES INTO TEACHING SETS
STEP 3: DIVIDE MEMBERS OF THE TEACHING SET INTO TRAINING EXAMPLES THAT WILL ...
STEP 4: TEACH SELF-INSTRUCTION
STEP 5: EVALUATE THE EFFECTS OF TRAINING
STEP 6: WITHDRAW TRAINING BASED ON STUDENT PERFORMANCE
CONCLUSION
Chapter 35 - GROUP INTERVENTIONS
INTRODUCTION
WHO MIGHT BENEFIT FROM GROUP INTERVENTIONS?
CONTRAINDICATIONS
PRACTICAL CONSIDERATIONS
STEP-BY-STEP PROCEDURES
Chapter 36 - HABIT REVERSAL TRAINING
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS OF THE TREATMENT
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
Assessment and Data Collection
Implementing HRT Components
Chapter 37 - HARM REDUCTION
EVIDENCE-BASED APPLICATIONS OF HARM REDUCTION
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS OF THIS THERAPY
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
CONCLUSION
Chapter 38 - PUTTING IT ON THE STREET: HOMEWORK IN COGNITIVE BEHAVIORAL THERAPY
THERAPIST USE OF HOMEWORK
EVIDENCE-BASED APPLICATIONS OF HOMEWORK
WHAT IS THE PROCESS BY WHICH HOMEWORK PRODUCES ITS EFFECTS IN THERAPY?
USE OF HOMEWORK WITH SPECIFIC POPULATIONS
HOW DOES HOMEWORK WORK?
WHO MIGHT BENEFIT FROM HOMEWORK ASSIGNMENTS
CONTRAINDICATIONS FOR HOMEWORK ASSIGNMENTS
OTHER FACTORS IN DECIDING WHETHER TO USE HOMEWORK
STEP-BY-STEP PROCEDURES FOR USING HOMEWORK
Chapter 39 - THE PROLONGED CS EXPOSURE TECHNIQUES OF IMPLOSIVE (FLOODING) THERAPY
IMPLOSIVE THEORY
OVERVIEW OF THE THERAPEUTIC EXTENSION OF IMPLOSIVE THEORY
CONTRAINDICATION OF THE TREATMENT
OTHER ISSUES IN DECIDING WHETHER TO USE AN EXPOSURE BEHAVIORAL APPROACH
HOW DOES THE TECHNIQUE WORK?
A STEP-BY-STEP PROCEDURAL OUTLINE OF IMPLOSION THERAPY
DEALING WITH RESISTANCE AND DEFENSES
SESSION SPACING AND TREATMENT DURATION
EVIDENCE-BASED APPLICATIONS
ADDENDUM
Chapter 40 - COGNITIVE BEHAVIORAL TREATMENT OF INSOMNIA
INTRODUCTION AND BACKGROUND
THE COGNITIVE BEHAVIORAL MODEL OF INSOMNIA
DIAGNOSIS AND ASSESSMENT OF INSOMNIA
THE COGNITIVE BEHAVIORAL TREATMENT OF INSOMNIA
CONCLUSION
Chapter 41 - INTEROCEPTIVE EXPOSURE FOR PANIC DISORDER
WHO MIGHT BENEFIT FROM THIS TREATMENT?
CONTRAINDICATIONS OF THE TREATMENT
OTHER CONSIDERATIONS IN DECIDING WHETHER TO USE INTEROCEPTIVE EXPOSURE
HOW DOES INTEROCEPTIVE EXPOSURE WORK?
STEP-BY-STEP GUIDE ON HOW TO IMPLEMENT INTEROCEPTIVE EXPOSURE
CONDUCTING AN IDIOGRAPHIC ASSESSMENT AND FUNCTIONAL ANALYSIS
PROVIDING CLIENTS WITH AN ADEQUATE RATIONALE FOR INTEROCEPTIVE EXPOSURE
STRUCTURE AND SELECTION OF INTEROCEPTIVE EXPOSURE EXERCISES
TYPES OF INTEROCEPTIVE EXPOSURE EXERCISES
IMPLEMENTATION OF INTEROCEPTIVE EXPOSURE
EXPOSURE HOMEWORK
PROMOTING GENERALIZATION USING NATURALISTIC EXPOSURE
STRATEGIES TO UNDERMINE AVOIDANCE AND SAFETY-SEEKING BEHAVIORS
Chapter 42 - LIVE (IN VIVO) EXPOSURE
WHO MIGHT BENEFIT FROM IN VIVO EXPOSURE
EVIDENCE-BASED APPLICATIONS
CONTRAINDICATIONS
ANY OTHER DECISION FACTORS IN DECIDING WHETHER TO USE THE TECHNIQUE
HOW DOES IN VIVO EXPOSURE WORK?
STEP-BY-STEP PROCEDURES
Chapter 43 - APPLICATIONS OF THE MATCHING LAW
APPLICATIONS
CONSIDERATIONS
STEP-BY-STEP PROCDURES
FOCUS ON APPLIED IMPLICATIONS
SUMMARY
Chapter 44 - MINDFULNESS PRACTICE
PRIMARY MINDFULNESS STRATEGIES AND THEIR EMPIRICAL STATUS
WHO MIGHT BENEFIT FROM MINDFULNESS STRATEGIES AND CONTRAINDICATIONS OF THE TREATMENT
OTHER FACTORS TO CONSIDER IN DECIDING WHETHER TO USE MINDFULNESS STRATEGIES
HOW DOES MINDFULNESS PRACTICE WORK?
STEP-BY-STEP GUIDELINES FOR THE CLINICAL USE OF MINDFULNESS PRACTICE
Chapter 45 - MODERATE DRINKING TRAINING FOR PROBLEM DRINKERS
MODERATION TRAINING APPROACHES
KEY ELEMENTS OF MODERATION TRAINING
WHO IS LIKELY TO BENEFIT FROM MODERATION TRAINING?
THE RISKS OF MODERATION
CONCLUSION
Chapter 46 - MULTIMODAL BEHAVIOR THERAPY
CONTEXT
ENTER COGNITIVE RESTRUCTURING AND MORE
WHO MIGHT BENEFIT FROM THIS APPROACH
CONTRAINDICATIONS
THEORY AND MECHANISM
TWO SPECIFIC MULTIMODAL PROCEDURES
ILLUSTRATIVE CASE
A STEP-BY-STEP INQUIRY
Chapter 47 - POSITIVE PSYCHOLOGY: A BEHAVIORAL CONCEPTUALIZATION AND ...
THE HISTORICAL ROOTS OF POSITIVE PSYCHOLOGY
CURRENT PERSPECTIVES IN THE POSITIVE PSYCHOLOGY MOVEMENT
BEHAVIORISM AND POSITIVE PSYCHOLOGY: COMMON FACTORS
CONTEMPORARY BEHAVIORAL THERAPIES AND POSITIVE PSYCHOLOGY
CRITICISMS OF POSITIVE PSYCHOLOGY
CONCLUSION
Chapter 48 - MOTIVATIONAL INTERVIEWING
RESEARCH ON THE EFFICACY OF MI
WHO MIGHT BENEFIT FROM MI?
THEORETICAL UNDERPINNINGS OF MI
THE PRACTICE OF MOTIVATIONAL INTERVIEWING
CONCLUSION
Chapter 49 - NONCONTINGENT REINFORCEMENT AS A TREATMENT FOR PROBLEM BEHAVIOR
CONTRAINDICATIONS OF THE TECHNIQUE
CONSIDERATIONS
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
WHEN NCR DOES NOT DECREASE PROBLEM BEHAVIOR
Chapter 50 - PAIN MANAGEMENT
KEY CONCEPTUAL FACTORS
COGNITIVE BEHAVIORAL THERAPY FOR CHRONIC PAIN
A SESSION-BY-SESSION GUIDE TO A TYPICAL COURSE OF TREATMENT
EVIDENCE-BASED APPLICATIONS
CONCLUSION
Chapter 51 - PARENT TRAINING
THEORY
INTERVENTION
PARENT TRAINING PROCEDURES
CAVEAT
Chapter 52 - SELF-EFFICACY INTERVENTIONS: GUIDED MASTERY THERAPY
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS OF THE TREATMENT
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
Chapter 53 - POSITIVE ATTENTION
ADVANTAGES OF THE TECHNIQUE
LIMITATIONS OF THE TECHNIQUE
WHO MIGHT BENEFIT FROM POSITIVE ATTENTION?
HOW DOES POSITIVE ATTENTION WORK?
POSITIVE ATTENTION IN PARENT-CHILD INTERACTION THERAPY
FUNCTIONAL ANALYSIS IN PCIT
STEP-BY-STEP PROCEDURES
Chapter 54 - PROBLEM-SOLVING THERAPY
SOCIAL PROBLEM SOLVING
EVIDENCED-BASED APPLICATIONS
CONTRAINDICATIONS
EVIDENCE FOR THE EFFICACY OF PST
STEP-BY-STEP GUIDE
Chapter 55 - PUNISHMENT
THE OPERATION OF PUNISHMENT
THE FUNCTION OF PROBLEM BEHAVIOR
EFFECTIVENESS OF PUNISHMENT
IDENTIFYING FUNCTIONAL TREATMENTS
CASE EXAMPLES
SUMMARY
Chapter 56 - RAPID SMOKING
WHO MIGHT BENEFIT FROM THIS TECHNIQUE
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE RAPID SMOKING
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
CONCLUSION
EVIDENCE-BASED APPLICATIONS
Chapter 57 - RELAPSE PREVENTION
WHO MIGHT BENEFIT
INDICATIONS/CONTRAINDICATIONS
OTHER FACTORS TO CONSIDER
THEORETICAL BASES
TREATMENT COMPONENTS
PROCEDURES
FINAL COMMENTS
Chapter 58 - RELAXATION
KEY DEVELOPMENTS IN RELAXATION TRAINING
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS OF THE TREATMENT
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
FURTHER CONSIDERATIONS
Chapter 59 - RESPONSE PREVENTION
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS OF THE TREATMENT
OTHER FACTORS IN DECIDING WHETHER TO USE RESPONSE PREVENTION
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
Chapter 60 - SATIATION THERAPY
LIMITS OF SATIATION THERAPY
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS
HOW DOES SATIATION THERAPY WORK?
STEP-BY-STEP TECHNIQUE
Chapter 61 - IDENTIFYING AND MODIFYING MALADAPTIVE SCHEMAS
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS
EVIDENCE-BASED APPLICATIONS
Chapter 62 - SELF-MANAGEMENT
HOW DOES IT WORK?
EVIDENCE FOR THE EFFECTIVENESS OF SELF-MANAGEMENT THERAPY
INDICATIONS AND CONTRAINDICATIONS
TOPIC-BY-TOPIC PROCEDURES
Chapter 63 - SAFETY TRAINING/VIOLENCE PREVENTION USING THE SAFECARE PARENT ...
OVERVIEW
WHO MIGHT BENEFIT FROM SAFECARE?
CONTRAINDICATIONS FOR SAFECARE
HOW DOES SAFECARE WORK?
STEP-BY-STEP PROCEDURES FOR SAFECARE
IMPLEMENTATION OF SAFECARE
Chapter 64 - SELF-MONITORING AS A TREATMENT VEHICLE
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
VARIABLES RELATED TO THE EFFECTIVENESS OF SELF-MONITORING
FACTORS TO CONSIDER IN DECIDING WHETHER TO USE SELF-MONITORING
STEP-BY-STEP PROCEDURES
Chapter 65 - SENSATE FOCUS
INTRODUCTION
WHO MIGHT BENEFIT FROM SENSATE FOCUS?
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE SENSATE FOCUS
HOW DOES SENSATE FOCUS WORK?
EVIDENCE FOR THE EFFECTIVENESS OF SENSATE FOCUS
STEP-BY-STEP PROCEDURES
HOW TO AVOID COMMON PROBLEMS
Chapter 66 - SHAPING
DEFINITION OF SHAPING
CASE EXAMPLES
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS
OTHER FACTORS TO CONSIDER WHEN DECIDING WHETHER TO USE THIS TECHNIQUE
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
CONCLUSION
Chapter 67 - SOCIAL SKILLS TRAINING
WHO WILL BENEFIT FROM SOCIAL SKILLS TRAINING?
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE SOCIAL SKILLS TRAINING
HOW DOES SOCIAL SKILLS TRAINING WORK?
STEP-BY-STEP PROCEDURES
EXAMPLES OF EVIDENCE-BASED APPLICATIONS
Chapter 68 - SQUEEZE TECHNIQUE FOR THE TREATMENT OF PREMATURE EJACULATION
WHO MIGHT BENEFIT FROM THIS TREATMENT?
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE THE SQUEEZE TECHNIQUE
CLINICAL APPLICATION OF THE SQUEEZE TECHNIQUE
CURRENT APPLICATIONS OF THIS TREATMENT
Chapter 69 - STIMULUS CONTROL
STIMULUS CONTROL AND CLASSICAL CONDITIONING
STIMULUS CONTROL AND OPERANT CONDITIONING
RULES AND STIMULUS CONTROL
STIMULUS CONTROL BY THE CONSEQUENCES OF BEHAVIOR
TREATING INSOMNIA THROUGH STIMULUS CONTROL
HOW TO IMPLEMENT STIMULUS CONTROL PROCEDURES
Chapter 70 - STIMULUS PREFERENCE ASSESSMENT
ADVANTAGES OF THE TECHNIQUE
WHO MIGHT BENEFIT FROM STIMULUS PREFERENCE ASSESSMENT?
HOW DOES THE TECHNIQUE WORK?
EVIDENCE FOR THE EFFECTIVENESS OF STIMULUS PREFERENCE ASSESSMENT
WHEN TO CHOOSE ONE PROCEDURE OVER ANOTHER
Chapter 71 - STRESS INOCULATION TRAINING
WHO MIGHT BENEFIT FROM SIT?
CONTRAINDICATIONS
HOW DOES SIT WORK?
STEP-BY-STEP PROCEDURES
A PROCEDURAL FLOW CHART OF STRESS INOCULATION TRAINING
Chapter 72 - STRESS MANAGEMENT INTERVENTION
WHO MIGHT BENEFIT FROM THIS TECHNIQUE?
CONTRAINDICATIONS
OTHER FACTORS IN DECIDING WHETHER TO USE STRESS MANAGEMENT
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES
EVIDENCED-BASED APPLICATIONS
CONCLUSION
Chapter 73 - SYSTEMATIC DESENSITIZATION
TYPES OF SYSTEMATIC DESENSITIZATION
EVIDENCED-BASED APPLICATIONS
CONTRAINDICATIONS
HOW DOES THE TECHNIQUE WORK?
STEP-BY-STEP PROCEDURES: TRADITIONAL SYSTEMATIC DESENSITIZATION
KEY ELEMENTS OF SYSTEMATIC DESENSITIZATION
Chapter 74 - THINK-ALOUD TECHNIQUES
THINK-ALOUD METHODS OF COGNITIVE ASSESSMENT
THE “ARTICULATED THOUGHTS IN SIMULATED SITUATIONS” THINK-ALOUD COGNITIVE ...
CONCLUSION
Chapter 75 - TIME-OUT, TIME-IN, AND TASK-BASED GROUNDING
INTRODUCTION
UNDERLYING PROCESSES
EVIDENCE OF EFFECTIVENESS
CONTRAINDICATIONS
THE ROLE OF TIME-IN
USING TO
TASK-BASED GROUNDING: A RECENT EXTENSION OF TO
CONCLUSION
Chapter 76 - GUIDELINES FOR DEVELOPING AND MANAGING A TOKEN ECONOMY
WHO MIGHT BENEFIT FROM A TOKEN ECONOMY?
FACTORS IN DECIDING WHETHER TO USE A TOKEN ECONOMY
GUIDELINES
Chapter 77 - URGE SURFING
CLINICAL POPULATIONS
URGE SURFING STEP-BY-STEP
Chapter 78 - VALIDATION PRINCIPLES AND STRATEGIES
WHO MIGHT BENEFIT FROM VALIDATION?
WHAT TO VALIDATE
CONTRAINDICATIONS
HOW DOES THE TECHNIQUE WORK?
EVIDENCE FOR THE EFFECTIVENESS OF VALIDATION
STEP-BY-STEP PROCEDURES
Chapter 79 - VALUES CLARIFICATION
WHO MIGHT BENEFIT FROM VALUES CLARIFICATION?
CONTRAINDICATIONS
HOW DOES VALUES CLARIFICATION WORK?
STEP-BY-STEP PROCEDURES
EVIDENCE-BASED APPLICATIONS
SUMMARY
AUTHOR INDEX
SUBJECT INDEX
This book is printed on acid-free paper.
Copyright © 2009 by John Wiley & Sons, Inc. All rights reserved.
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Library of Congress Cataloging-in-Publication Data:
General principles and empirically supported techniques of cognitive behavior therapy / edited by William O’Donohue, Jane E. Fisher. p. ; cm. Includes bibliographical references and index.
eISBN : 978-0-470-48500-2
1. Cognitive therapy. I. O’Donohue, William T. II. Fisher, Jane E. (Jane Ellen), 1957 [DNLM: 1. Cognitive Therapy-methods. WM 425.5.C6 G326 2009] RC489.C63G46 2009 616.89’142-dc22 2008036138
PREFACE
This book includes introductory material (the first five chapters) so that the reader can gain both a general overview of CBT as well as gain a general understanding of some of the basics of cognitive behavior therapy. The first chapter provides a brief history of cognitive behavior therapy and presents some of its current and future challenges. A key problem is that cognitive behavior therapy was based on learning research and other research in experimental psychology, but now the ties to this research are much looser and indirect. This might have certain costs that are not properly realized. The second chapter covers assessment issues in cognitive behavior therapy, focusing on functional analysis. This chapter introduces and explains much of the basic terminology that the student needs to understand to properly understand CBT, such as contingency, schedule of reinforcement, functional relationship, and so forth. The third chapter provides an overview of some of the evidence base for CBT. CBT is different than many other forms of psychotherapy in that its appeal is not based solely on its conceptual attractiveness but upon scientific studies of its outcomes. This puts CBT in the camp of “evidenced based practice,” an important quality improvement development in healthcare. This is not to say CBT is a “done deal”; there is always more evidence to collect regarding outcomes and processes involved in CBT. We are at the beginnings of our research agenda, not at the end. The next chapter covers cultural issues in the implementation of CBT. CBT attempts to develop regularities but countenances the fact that each client has a unique history and present circumstance and thus it is part of the clinician’s job to understand the relevance of this and make appropriate adaptations to assessment and treatment plans. Finally, the last chapter in this section covers some of the new developments in CBT. Dialectical Behavior Therapy, Mindfulness, and Acceptance and Commitment Therapy have been gaining a lot of attention in the last few decades and the promise and problems of these are discussed.
Over the last three decades there has been a significant increase in interest in cognitive behavior therapy. This has occurred for several reasons: 1) Mounting experimental evidence supports the effectiveness of cognitive behavioral therapy for certain psychological problems induding high incidence problems such as depression and the anxiety disorders. The well-known Chambless report, for example, identifies many cognitive behavioral therapies as being empirically supported. In fact, cognitive behavioral techniques comprise most of the list. 2) Cognitive behavior therapy tends to be relatively brief and often can be delivered in groups. Therefore it can be more cost-effective than some alternatives and be seen to offer good value. These qualities have become particularly important in the era of managed care with its emphasis upon cost containment. 3) Cognitive behavior therapy has been applied with varying success to a wide variety of problems (see Fisher and O’Donohue, 2006 for over 70 behavioral health problems in which CBT can be considered an evidence based treatment. Thus, it has considerable scope and utility for the practitioner in general practice or the professional involved in the training of therapists. 4) Cognitive behavior therapy is a relatively straight forward and clearly operationalized approach to psychotherapy. This does not mean that case formulation or implementing these techniques is easy. However, CBT is more learnable that techniques such as psychoanalysis or Gestalt therapy. 5) Cognitive behavioral therapy is a therapy system comprised of many individual techniques, with researchers and practitioners constantly adding to this inventory. A given behavior therapist, because of his or her specialty, may know or use only a small subset of these. A clinician or clinical researcher may want to creatively combine individual techniques to treat some intransigent problem or an unfamiliar or complicated clinical presentation.
This volume attempts to bring together all of the specific techniques of cognitive behavior therapy. It does this in an ecumenical fashion. Historically, and currently, there are divisions inside behavior therapy that this book attempts to ignore. For example, cognitive and more traditionally behavioral techniques are included. This offended some prospective authors who were clearly warriors in the cognitive-behavioral battle. We wanted to be inclusive, particularly because pragmatically the outcome research favors both sides of this particular battle.
Our major interest in compiling this book was twofold: First we noted the lack of a volume that provides detailed descriptions of the techniques of cognitive behavioral therapy. Many books mentioned these but few described the techniques in detail. The absence of a comprehensive collection of the methods of cognitive-behavior therapy creates a gap in the training of students and in the faithful practice of cognitive behavior therapy. Second, with the increased interest in cognitive behavior therapy, particularly by the payers in managed care, there has been an increasing bastardization of behavior therapy. Some therapists are claiming they are administering some technique (e.g., relapse prevention or contingency management) when they clearly are not. This phenomenon, in our experience, rarely involves intentional deception but instead reflects an ignorance of the complexities of faith-fully implementing these techniques. This book is aimed at reducing this problem.
There is an important question regarding the extent to which a clinician can faithfully implement these techniques without a deeper understanding of behavior therapy. The evidence is not clear and of course the question is actually more complicated. Perhaps a generically skilled therapist with certain kinds of clients and certain kinds of techniques can implement the techniques well. On the other hand, a less skilled therapist dealing with a complicated clinical presentation utilizing a more subtle technique might not do so well. There is certainly a Gordon Paul type ultimate question lurking here. Something like: “What kind of therapist, with what type of problem, using what kind of cognitive behavior therapy technique, with what kind of training, can have what kinds of effects. . .” With the risk of being seen as self-promoting, the reader can learn about the learning and conditioning underpinnings of many of thes techniques in O’Donohue (1998); and more of the theories associated with these techniques in O’Donohue and Krasner (1995). Fisher and O’Donohue (2006) provide a description of particular problems that these techniques can be used with.
References
Fisher, J.E.,& O’Donohue, W.T. (2006) Practitioner’s guide to evidence based psychotherapy. New York: Springer O’Donohue, W., & Krasner, L. (Eds.). (1995). Theories of behavior therapy. Washington: APA Books O’Donohue, W. (Ed.). (1998). Learning and behavior therapy. Boston: Allyn & Bacon.
ACKNOWLEDGMENTS
We wish to thank all the chapter authors. They uniformly wrote excellent chapters and completed these quickly.
We’d also like to thank our editor at John Wiley & Sons, Patricia Rossi. She shared our vision for this book, gave us some excellent suggestions for improvement, and has been wonderful to work with.
We’d also like to thank Linda Goddard for all her secretarial skills and expert assistance in all aspects of the manuscript preparation; she was invaluable.
Finally, we’d like to thank our families for their support, and especially our children, Katie and Annie, for their enthusiasm and delightfulness.
CONTRIBUTORS
Jonathan S. AbramowitzUniversity of North Carolina Chapel Hill, NC
Dean T. AchesonUniversity at Albany, SUNY Albany, NY
Jennifer H. AdamsUniversity of Colorado at Denver Denver, CO
Mark A. Adams, Ph.D., B.C.B.ABest Consulting, Inc. Fresno, CA
K. Angeleque Akin-LittleMassey University Auckland, NZ
Mark Alavosius, Ph.D. University of Nevada, Reno Reno, NV
Claudia Avina, Ph.D. University of Nevada, Reno Reno, NV
Jenna L. Baddeley, M.A. The University of Texas at Austin Austin, TX
Anjali Barretto, Ph.D. Gonzaga University Spokane, WA
Wendy K. Berg, M.A. University of Iowa Iowa City, IA
Jennifer L. Best, Ph.D. University of North Carolina Charlotte, NC
Arthur W. Blume, Ph.D. University of North Carolina Charlotte, NC
Stephen R. Boggs, Ph.D. University of Florida Gainesville, FL
Jordan T. BonowUniversity of Nevada, Reno Reno, NV
John C. Borrero, Ph.D. University of Maryland Baltimore, MD
Carrie S. W. Borrero, Ph.D. Kennedy-Krieger Institute Baltimore, MD
Stephanie Both, Ph. D. Leiden University Medical Center Leiden, Netherlands
J. Annette Brooks, Ph. D. New Mexico VA Healthcare System Albuquerque, NM
Jeffery A. BuchananMinnesota State University Mankato, MN
Eric BurkholderDublin Unified School District Department of Special Education Dublin, CA
James E. Carr, Ph.D. Western Michigan University Kalamazoo, MI
Lavina L. CavasosNew Mexico VA Healthcare System Albuquerque, NM
Daniel Cervone, Ph.D. University of Illinois at Chicago Chicago, IL
Stacey M. CherupUniversity of Nevada, Reno Reno, NV
Kim ChristiansenCarson City, NV
Linda J. Cooper-Brown, Ph.D. University of Iowa Children’s Hospital Iowa City, IA
Michelle G. Craske, Ph.D. UCLA Los Angeles, CA
Dan Crimmins, Ph.D. The Marcus Institute Atlanta, GA
Wendy CrookUniversity of Nevada, Reno Reno, NV
Jesse M. CrosbyUtah State University Logan, UT
Joseph DagenUniversity of Nevada, Reno Reno, NV
Sabrina M. DarrowUniversity of Nevada, Reno Reno, NV
Gerald C. Davison, Ph.D. UCLA Los Angeles, CA
Kim DeRuyk, Ph.D. Boys’ Town Boys’ Town, NE
Sona Dimidjian, Ph.D. University of Colorado Boulder, CO
Keith S. Dobson, Ph.D. University of Calgary Calgary, Canada
Brad Donohue, Ph.D. University of Nevada, Las Vegas Las Vegas, NV
Crissa DraperUniversity of Nevada, Reno Reno, NV
Claudia Drossel, Ph.D. University of Nevada, Reno Reno, NV
Melanie P. Duckworth, Ph.D. University of Nevada, Reno Reno, NV
V. Mark DurandUniversity of South Florida St. Petersburg, FL
Anna Edwards, Ph.D. The Marcus Institute Atlanta, GA
Albert Ellis, Ph.D. Deceased
Erica L. EnglandDrexel University Philadelphia, PA
Sheila M. Eyberg, Ph.D. University of Florida Gainesville, FL
Kyle E. Ferguson, M.A. Riverview Hospital Coquitlam, BC, Canada
Jane E. Fisher, Ph.D. University of Nevada, Reno Reno, NV
Edna B. Foa, Ph.D. University of Pennsylvania Philadelphia, PA
William C. Follette. University of Nevada, Reno Reno, NV
Evan M. FormanDrexel University Philadelphia, PA
John P. Forsyth, Ph.D. University at Albany (SUNY) Albany, NY
Maxwell R. FrankUniversity of Hawaii at Manoa Honolulu, HI
Michelle A. FrankKennedy-Krieger Institute Baltimore, MD
Martin E. Franklin, Ph.D. University of Pennsylvania Philadelphia, PA
Patrick C. Friman, Ph.D. Father Flanagan’s Boys’ Home Boys’ Town, NE
Armida R. FruzzettiUniversity of Nevada, Reno Reno, NV
Alan E. Fruzzetti, Ph.D. University of Nevada, Reno Reno, NV
Tiffany Fuse, Ph.D. National Center for PTSD Jamaica Plain, MA
Christina G. Garrison-DiehnUniversity of Nevada, Reno Reno, NV
Robert J. Gatchel, Ph.D. University of Texas at Arlington Arlington, TX
Scott Gaynor, Ph.D. Western Michigan University Kalamazoo, MI
Patrick M. Ghezzi, Ph.D. University of Nevada, Reno Reno, NV
Elizabeth V. Gifford, Ph.D. Palo Alto Veterans Administration Palo Alto, CA
Alan M. GrossUniversity of Mississippi University, MI
Kate E. HamiltonPeter Lougheed Centre Calgary, Canada
Jay Harding, Ed.S.University of Iowa Iowa City, IA
Cathi D. Harris, M.A. Washington Special Commitment Center Steilacoom, WA
Nicole L. HausmanKennedy-Krieger Institute Baltimore, MD
Steven C. HayesUniversity of Nevada, Reno Reno, NV
Holly Hazlett-StevensUniversity of Nevada, Reno Reno, NV
Lara S. Head, Ph.D. University of Wisconsin Madison, WI
Elaine M. HeibyUniversity of Hawaii at Manoa Honolulu, HI
James D. Herbert, Ph.D. Drexel University Philadelphia, PA
Ramona Houmanfar, Ph.D. University of Nevada, Reno Reno, NV
Kathryn L. Humphreys, Ph.D. National Center for PTSD, VA Boston Healthcare System Boston, MA
Nicole N. Jacobs, Ph.D. University of Nevada, Reno School of Medicine Reno, NV
Alyssa H. Kalata, M.A. Western Michigan University Kalamazoo, MI
Mary Lou Kelley, Ph.D. Louisiana State University Baton Rouge, LA
Brian C. Kersh, Ph.D. New Mexico VA Healthcare System Albuquerque, NM
Kelly KoernerEBP Seattle, WA
Douglas Kostewicz, Ph.D. University of Pittsburgh Pittsburgh, PA
Ellen Laan, Ph.D. University of Amsterdam Amsterdam, Netherlands
Arnold A. Lazarus, Ph.D. Rutgers, The State University of New Jersey Piscataway, NJ
Linda A. LeBlanc, Ph.D. Western Michigan University Kalamazoo, MI
Deborah A. Ledley, Ph.D. University of Pennsylvania Penn Valley, PA
Jung Eun LeeUniversity of Nevada, Reno Reno, NV
Eric R. Levensky, Ph.D. New Mexico VA Healthcare System Albuquerque, NM
Donald J. Levis, Ph.D. Binghamton University Binghamton, NY
Jennifer M. Lexington, Ph.D. University of Massachusetts Amherst Amherst, MA
Marsha M. Linehan, Ph.D. University of Washington Seattle, WA
Steven G. Little, Ph.D. Massey University Auckland, New Zealand
Andy Lloyd, Ph.D.U.S. Army
Jessa R. LoveWestern Michigan University Kalamazoo, MI
Tamara M. Loverich, Ph.D.Eastern Michigan University Ypsilanti, MI
Jason B. Luoma, Ph.D. Portland Psychotherapy Clinic Portland, OR
John R. Lutzker, Ph.D. The Marcus Institute Atlanta, GA
Kenneth R. MacAleese, M.A., B.C.B.A.Reno, NV
Kristen A. MaglieriTrinity College Dublin, Ireland
Christine Maguth Nezu, Ph.D. Drexel University Philadelphia, PA
Gayla Margolin, Ph.D. UCLA Los Angeles, CA
G. Alan Marlatt, Ph.D. University of Washington Seattle, WA
Christopher MartellPrivate Practice Seattle, WA
Brian P. Marx, Ph.D. National Center for PTSD, VA Boston Healthcare System Boston, MA
Mary McMurranUniversity of Nottingham Nottingham, United Kingdom
Donald Meichenbaum, Ph.D. University of Waterloo Waterloo, Ontario, Canada
Victoria E. MercerUniversity of Nevada, Reno Reno, NV
Eileen MergesSt. John Fisher College Rochester, NY
Gerald I. Metalsky, Ph.D. Lawrence University Appleton, WI
Raymond G. Miltenberger, Ph.D., B.C.B.A. University of South Florida Tampa, FL
Sally A. MooreUniversity of Washington Seattle, WA
Kevin J. MooreOregon Social Learning Center, Community Programs Eugene, OR
Karen MurphyUniversity of Nevada, Reno Reno, NV
Adel C. NajdowskiCenter for Autism and Related Disorders, Inc. Tarzana, CA
Amy E. Naugle, Ph.D. Western Michigan University Kalamazoo, MI
Cory F. Newman, Ph.D. University of Pennsylvania Philadelphia, PA
Kirk A. B. Newring, Ph.D. Nebraska Dept. of Correctional Services Lincoln, NE
William D. NewsomeUniversity of Nevada, Reno Reno, NV
Arthur M. Nezu, Ph.D. Drexel University Philadelphia, PA
Amanda Nicholson-Adams, Ph.D., B.C.B.A. California State University at Fresno Fresno, CA
William T. O’Donohue, Ph.D. University of Nevada, Reno Reno, NV
Pamella H. Oliver, Ph.D. California State University, Fullerton Fullerton, CA
Jennette L. PalcicLouisiana State University Baton Rouge, LA
Gerald R. Patterson, Ph.D. Oregon Social Learning Center Eugene, OR
James W. PennebakerThe University of Texas at Austin Austin, TX
Michael L. Perlis, Ph.D. University of Rochester Rochester, NY
Katherine A. PetersonUtah State University Logan, UT
Wilfred R. Pigeon, Ph.D. University of Rochester Medical Center Rochester, NY
Alan Poling, Ph.D. Western Michigan University Kalamazoo, MI
Lisa Regev, Ph.D. University of Nevada, Reno Reno, NV
Lynn P. Rehm, Ph.D. University of Houston Houston, TX
Jennifer Resetar, Ph.D. Boys’ Town Boys’ Town, NE
Patricia Robinson, Ph.D. Mountainview Consulting Group, Inc. Zillah, WA
Richard C. Robertson, Ph.D. Baylor University Medical Center Dallas, TX
Frederick Rotgers, Psy.D., ABPPPhiladelphia College of Osteopathic Medicine Philadelphia, PA
Clair RummelUniversity of Nevada, Reno Reno, NV
Frank R. Rush, Ph.D. Pennsylvania State University University Park, PA
Joel Schmidt, Ph.D. VA Northern California Healthcare System Oakland, CA
Walter D. Scott, Ph.D. University of Wyoming Laramie, WY
Christine SegrinUniversity of Arizona Tucson, AZ
Rachel E. SgambatiCarson City, NV
Deacon ShoenbergerUniversity of Nevada, Reno Reno, NV
David M. SlagleUniversity of Washington Seattle, WA
Rachel S. F. TarboxThe Chicago School of Professional Psychology at Los Angeles Los Angeles, CA
Kendra TracyUniversity of Nevada, Las Vegas Las Vegas, NV
Michael P. Twohig, Ph.D. Utah State University Logan, UT
Timothy R. Vollmer, Ph.D. University of Florida Gainesville, FL
David P. Wacker, Ph.D. University of Iowa Children’s Hospital Iowa City, IA
Michelle D. Wallace, Ph.D. California State University, Los Angeles Los Angeles, CA
Todd A. WardUniversity of Wellington Wellington, New Zealand
Jennifer Wheeler, Ph.D. Private Practice Seattle, WA
Daniel J. Whitaker, Ph.D. The Marcus Institute Atlanta, GA
Larry W. Williams, Ph.D. University of Nevada, Reno Reno, NV
Ginger R. Wilson, Ph.D. The ABRITE Organization Santa Cruz, CA
J. M. WorrallUniversity of Nevada, Reno Reno, NV
Marat ZanovUniversity of Southern California Los Angeles, CA
Lori A. Zoellner, Ph.D. University of Washington Seattle, WA
1
A BRIEF HISTORY OF COGNITIVE BEHAVIOR THERAPY: ARE THERE TROUBLES AHEAD?
William O’Donohue
In its beginnings, behavior therapy was linked to learning research in an inextricable and unique manner. I will refer to this period in the history of behavior therapy as “first-generation behavior therapy.” First-generation behavior therapy was a scientific paradigm that resulted in important solutions to a number of clinical problems (Task Force on Promotion and Dissemination of Psychological Procedures, 1995). For various reasons, however, many behavior therapists and researchers lost touch with developments in conditioning research and theory. Over the last three decades, behavior therapists turned their attention to topics such as therapies based on “clinical experience” (e.g., Goldfried & Davison, 1976), techniques seen independently from underlying behavioral principles (Hayes, Rincover, & Solnick, 1980), cognitive experimental psychology, cognitive accounts not based on experimental cognitive psychology (e.g., Ellis & Harper, 1975), and integrating or borrowing from other therapeutic approaches (Lazarus, 1969; but see O’Donohue & McKelvie, 1993). I will collectively refer to these developments as “second-generation behavior therapy.”
Often, the argument in second-generation behavior therapy for this widening of influences was that “some clinical problem has not yielded to a conditioning analysis; therefore, other domains need to be explored for solutions.” This is a reasonable argument, as it is imprudent to restrict behavior therapy to conditioning if there are important resources in other domains. However, there are grounds for concern because second-generation behavior therapists may have relied too heavily on these other domains to the extent that contemporary learning research extends older research, contradicts older research, or has discovered completely new relationships and principles. Clinical problems may be refractory to behavioral treatment simply because the behavior therapist is not using the more powerful regularities uncovered by recent learning research. It is possible that one of the core ideas—extrapolating results from learning research—of first-generation behavior therapy still remains a useful animating principle for contemporary therapy.
However, many contemporary behavior therapists still look to conditioning principles and theory developed in the 1950s and 1960s for solutions to clinical problems. In this chapter, third-generation behavior therapy is called for. Third-generation behavior therapists should extrapolate contemporary learning research to understand and treat clinical problems. Third-generation behavior therapy should rely on regularities found in modern accounts of classical conditioning, latent inhibition, two-factor theory, response-deprivation analysis of reinforcement, behavioral regulation, matching law, other models of choice behavior, behavioral momentum, behavioral economics, optimization, adjunctive behavior, rule-governed behavior, stimulus equivalence, and modern accounts of concept learning and causal attribution.
FIRST-GENERATION BEHAVIOR THERAPY
Prior to the 1960s, the founders of behavior therapy extrapolated laboratory learning results to clinical problems. For example, John Watson and Rosalie Rayner (1920) attempted to demonstrate that a child’s phobia could be produced by classical conditioning. Mary Cover Jones (1924a, b) showed that a child’s fear of an animal could be counterconditioned by the pairing of the feared stimulus with a positive stimulus. O. Hobart Mowrer and Willie Mowrer (1938) developed a bell and pad treatment for enuresis that conditioned stimulus for sphincter control and the inhibition of urination.
Despite the initial promise of these early extrapolations, these efforts were generally ignored in clinical practice. Psychotherapists of the period were largely interested in psychoanalysis, a paradigm with a much different focus. Behavior therapists had to compete with the many offshoots of psychoanalysis. Andrew Salter (1949) shows some of the antipathy that many behavior therapists had toward psychoanalysis:
It is high time that psychoanalysis, like the elephant of fable, dragged itself off to some distant jungle graveyard and died. Psychoanalysis has outlived its usefulness. Its methods are vague, its treatment is long drawn out, and more often than not, its results are insipid and unimpressive. Every literate non-Freudian in our day knows these accusations to be true. But we may ask ourselves, might it not be that psychotherapy, by its very nature, must always be difficult, time-consuming, and inefficient? I do not think so. I say flatly that psychotherapy can be quite rapid and extremely efficacious. I know so because I have done so. And if the reader will bear with me, I will show him how by building our therapeutic methods on the firm scientific bed rock of Pavlov, we can keep out of the Freudian metaphysical quicksands and help ten persons in the time that the Freudians are getting ready to “help” one. (p. 1)
In the 1950s, Joseph Wolpe (1958) attempted to countercondition anxiety responses by pairing relaxation with the stimuli that usually elicited anxiety. Wolpe’s work represents the real beginnings of modern behavior therapy, as his work comprised a sustained research program that affected subsequent clinical practice. The earlier work of Watson, Jones, and others was not as programmatic and for whatever reasons did not disseminate well. Wolpe’s desensitization techniques and his learning account of fears generated dozens of research studies and clinical applications over the following decade. The reader is referred to Kazdin’s (1978) excellent history of behavior therapy for additional examples of early learning-based therapies.
First-generation behavior therapists not only utilized learning principles to formulate interventions, but also used learning principles to develop accounts of the origins and maintenance of problems in living. Abnormal behavior was judged to develop and be maintained by the same learning principles as normal behavior (e.g., Ullmann & Krasner, 1969). Problems in learning or problems in maintaining conditions resulted in a variety of behavior problems. Ullmann and Krasner’s (1969) textbook on abnormal behavior is a useful compendium of first-generation learning-based accounts of the development and maintenance of changeworthy behavior.
Most of the initial behavioral studies were influenced by Pavlovian principles, particularly simultaneous and forward classical conditioning. This is not surprising, as some of these predated Skinner’s work on operant conditioning. However, in the 1950s, another stream of behavior therapy emerged: applied behavior analysis or behavior modification. These interventions relied on operant principles. In one of the first studies to explicitly use operant principles, Lindsley, Skinner, and Solomon (1953) initiated this stream when they operantly conditioned responses in schizophrenics, demonstrating that psychotic disorders did not obviate basic conditioning processes. Another important early operant researcher, Sidney Bijou (e.g., Bijou, 1959) investigated the behavior of both normal and developmentally delayed children through the use of functional analyses and schedules of reinforcement. Baer, Wolf, and Risley (1968) in the first issue of the Journal of Applied Behavior Analysis highlighted the importance of the systematic and direct application of learning principles for the future of applied behavior analysis:
The field of applied behavior analysis will probably advance best if the published descriptions of its procedures are not only precise technologically but also strive for relevance to principle.... This can have the effect of making a body of technology into a discipline rather than a collection of tricks. Collections of tricks historically have been difficult to expand systematically, and when they were extensive, difficult to learn and teach. (p. 96)
These cases of first-generation behavior therapy exhibit several important commonalities:
• The clinical scientists had extensive backgrounds in basic learning research. They could reasonably be described as learning researchers seeking to understand the generalizability of laboratory research as well as examining the practical value of this research by helping to solve problems involving human suffering.
• They were applying what was then current learning research to clinical problems.
• The results of their clinical research were by and large positive, although the methodological adequacy is problematic by today’s standards.
• They saw their particular research as illustrating a much wider program of research and therapy. That is, their research did not exhaust the potential for the applicability of learning principles to clinical problems, but merely illustrated a small part of a much wider program.
During this period, behavior therapy was often defined by a direct and explicit reference to learning principles. For example, Ullmann and Krasner (1965) defined behavior modification as “includ[ing] many different techniques, all broadly related to the field of learning, but learning with a particular intent, namely clinical treatment and change” (p. 1; italics in the original). Wolpe (1969) stated, “Behavior therapy, or conditioning therapy, is the use of experimentally established principles of learning for the purpose of changing maladaptive behavior” (p. vii). Eysenck (1964) defined behavior therapy as “the attempt to alter human behavior and emotion in a beneficial manner according to the laws of modern learning theory” (p. 1). Franks (1964) stated, “Behavior therapy may be defined as the systematic application of principles derived from behavior or learning theory and the experimental work in these areas to the rational modification of abnormal or undesirable behavior” (p. 12). Furthermore, Franks (1964) wrote that essential to behavior therapy is a “profound awareness of learning theory” (p. 12).
Although by and large these early behavior therapists agreed that learning principles should serve as the foundation of behavior therapy, the behavior therapy they advocated was not homogeneous. There was a significant heterogeneity in this early research. These researchers did not draw upon the same learning principles, nor did they subscribe to the same theory of learning. Skinner and his students emphasized operant conditioning principles; Watson, Rayner, and Jones, Pavlovian principles; and Wolpe and others, Hullian and Pavlovian. Moreover, within these broad traditions, different regularities were used: Some used extinction procedures, others excitatory classical conditioning; some differential reinforcement of successive approximations, others counterconditioning. However, each of these is a canonical illustration of behavior therapy of this period because each shares a critical family resemblance: an extrapolation of learning principles to clinical problems.
A related but separate movement occurred during this period. This movement did not gather much momentum and has largely died out. It is best represented by the work of Dollard and Miller (1950). In their classic book, Personality and Psychotherapy, these authors attempted to provide an explanation of psychoanalytic therapy techniques and principles based on learning principles. Dollard and Miller attempted to explain psychoanalytic techniques by an appeal to Milian learning principles. This movement should be regarded as separate from the first movement described earlier because the connection between conditioning and a therapy technique in this movement is post hoc. That is, first, therapeutic principles are described with no direct connection to learning principles, and this is followed by an attempt to understand these by learning principles. In the first movement, initially learning principles are discovered, and this is followed by the development of treatment procedures.
Today, there is little work that follows the second paradigm. Few are attempting to uncover the learning mechanisms underlying Rogerian and Gestalt techniques, object-relations therapy, and the like. This is probably because today, unlike the 1950s, there is more doubt regarding whether there is anything to explain. This movement attempted to explain, for example, how psychoanalysis worked (the conditioning processes involved). However, if there is little reason to believe that these other therapies are effective, then there is little reason to explain how they work. Moreover, this movement failed to produce any novel treatment techniques. In its emphasis on attempting to understand existing therapy techniques, it produced no useful innovations.
However, the model of moving from the learning laboratory to the clinic proved to be an extraordinarily rich paradigm. In the 1960s, numerous learning principles were shown to be relevant to clinical problems. Learning research quickly proved to be a productive source of ideas for developing treatments or etiological accounts of many problems in living. The development of psychotherapy had been a quasi-mysterious process before this point. Psychotherapies were usually developed by the unique clinical observations of the person who would become the leader of the school. Psychotherapists were no longer dependent on the “revelations” of insightful and creative seers who founded their schools. For the first time, psychotherapists could do Kuhnian (Kuhn, 1970) normal science because it is considerably more straightforward to extrapolate extant learning principles to clinical phenomena than it is to understand how, say, Freud formed and revised his assertions. “Extrapolate learning principles” is a clear and useful heuristic for the context of discovery.
Six books were critically important in extending the learning-based therapy paradigm. Wolpe’s (1958) Psychotherapy by Reciprocal Inhibition; Eysenck’s (1960) Behavior Therapy and the Neuroses; Franks’s (1964) Conditioning Techniques in Clinical Practice and Research; Eysenck’s Experiments in Behavior Therapy (1964); and Krasner and Ullmann’s two volumes, Case Studies in Behavior Modification (1965) and Research in Behavior Modification (1965). All contained an extensive set of case studies, research, and conceptual analyses that greatly extended the paradigm. Conditioned reinforcement, modeling, generalization and discrimination, satiation techniques, punishment, the effects of schedules of reinforcement, and token economies were investigated. Moreover, these principles were applied to a greater number and variety of clinical problems. Eating, compulsive behavior, elective mutism, cooperative responses, disruptive behavior, anorexia, hysterical blindness, posttraumatic anxiety, fetishism, sexual dysfunction, stuttering, tics, school phobia, tantrums, toilet training, social isolation, teaching skills to people with mental retardation, and hyperactive behavior were all addressed by learning-based treatments in these books. The matrix involving the crossing of learning principles by kinds of problematic behavior resulted in a rich research and therapy program.
Due to the initial successes in applying learning principles to clinical problems, another trend emerged. First-generation behavior therapists started working in the other direction: they began with a clinical problem and then attempted see to what extent it yielded to an analysis based on learning principles. Thus, a reciprocal relationship between the clinic and the learning lab emerged. This movement was important because behavior therapists can also be interested in uncovering basic learning processes in humans and can have a useful vantage point for generating and testing hypotheses concerning basic processes.
However, there is some danger with this approach. Unfortunately, it could be quite attractive to the behavior therapist who knew much more about clinical presentation than about learning research. This may have been the beginnings of the reliance of behavior therapists on something other than a thorough and faithful knowledge of current learning theory and research. With the success of behavior therapy came a new kind of professional: one who was first trained to be a clinical behavior therapist rather than a learning researcher.
Care must be taken not to lose sight of another important dimension of first-generation behavior therapy: its commitment to science and research. This scientific commitment, although not unprecedented in the history of psychotherapy, was more thoroughgoing. In 1952, after more than a half-century of the dominance of psychotherapy by psychoanalysis, Eysenck correctly pointed out that there was little properly controlled research that demonstrated it was more effective than a placebo treatment. Part of Eysenck’s thesis was that it may be the case that effective therapies had yet to be discovered. However, another part was that existing therapies had not been adequately evaluated with properly controlled designs. Psychotherapists were doing an inadequate job as clinical researchers by not evaluating the efficacy of their therapies.
Admittedly, many of the early reports of behavior therapy were largely uncontrolled case studies that merely demonstrated its potential utility. Behavior therapists, however, quickly began to conduct unprecedentedly well-controlled research. Paul’s (1966) study of the effectiveness of systematic desensitization can properly be regarded as the first research in history that was sufficiently well controlled to demonstrate that a form of psychotherapy was more effective than placebo and no treatment.
The research orientation of behavior therapists may have emanated from the school’s roots in conditioning theory and research. Many then-extant forms of therapy had a much different heritage: the founder of the particular school made what were taken by some as astute clinical observations (witness Freud, Perls, Rogers; see O’Donohue & Halsey, 1997) and somehow formed this clinical experience into a more or less systematic school of therapy. It is easier to be “looser” when one is not extrapolating from a basic science. In contrast, the learning researchers/behavior therapists who composed the first wave of behavior therapy did not give up their experimental orientation when turning their attention to clinical problems. Behavior therapy from its beginnings valued science. The epistemological principles from their backgrounds in experimental psychology remained with them and became an important part of the metascience of behavior therapy. Behavior therapists were interested in process research because they had a strong prior set of expectations (i.e., learning principles) of what these process variables might look like.
First-generation behavior therapy resulted in unprecedented progress in psychotherapy. If we somewhat arbitrarily say that the modern era of psychotherapy began in roughly 1900 with Freud, then we can agree with Eysenck (1952) in that the first 50 years of psychotherapy resulted in little progress. No treatments were developed that effectively resolved the problems they attempted to address. In contrast, during the early years of behavior therapy, significant progress was made with enuresis, phobias, other anxiety problems, child management problems, skill deficits of developmentally disabled individuals, self-injurious behavior and stereotypic behavior of autistic and schizophrenic individuals, and social and verbal problems of schizophrenia. These all were no longer completely refractory to ameliorative attempts. Moreover, as Salter (1949) described, behavioral treatment was also much quicker and less costly. In the span of a little over a decade, psychotherapy made progress that it failed to make in the preceding five decades. Surely, any reasonable observer could see that there was something special about this new movement. Today, if one looks at the Task Force on Promotion and Dissemination of Psychological Procedures (1995), this first-generation behavior therapy still accounts for a significant percentage of what are now considered “validated treatments.”
The success of early behavior therapy should not have come as a complete surprise. Psychotherapists for the first time began using a strategy that had proved successful in other domains. For nearly a century, physicians had relied on experimental physiology and microbiology, and by extrapolating from the results of the basic biological sciences they had made significant clinical progress. Engineers relied on the basic sciences of physics and chemistry and made remarkable progress solving many applied problems. The strategy used by these groups was enticing: Extrapolate antecedently validated principles from basic research to applied problems.
For the first time in the 1950s and 1960s, psychotherapy began to use the same strategy: first nomothetics were discovered through basic research, and then these were applied to practical problems. In the learning laboratory, learning researchers derived principles applicable to human behavior. The animals used in their research were largely chosen for convenience rather than because of any strong interest in understanding the behavior of that particular species. Evolutionary theory supported some behavioral continuity across species, which further justified the study of infrahuman animals. The laboratory and the animal preparation allow control that is not possible in naturalistic studies of humans. Variables can be controlled and isolated, and thus false hypotheses can more easily be refuted. Regularities emerging from the learning laboratory have relatively good epistemic credentials and a reasonable potential for revealing clinically useful regularities. The epistemic credentials of the laboratory-derived first-generation behavior therapy were far superior to the epistemic credentials of principles or regularities alleged by the clinical observers who initiated competing schools of therapy. The number of possible therapy techniques is, of course, indefinitely large, and therefore it is useful to have antecedent evidence on which to judge which are worthy of investigation (Erwin, 1978).
An additional, somewhat more subtle, factor may also have contributed to the success of first-generation, learning-based therapies. This paradigm may have met with such unprecedented success because of felicitous correspondences between the core objects of both programs. Learning researchers attempt to uncover how experience changes behavior. In fact, a common definition of learning is that learning is experience that results in relatively enduring changes in behavior. This focus precisely addresses the general question involved in the enterprise of psychotherapy: How can therapists structure experience so that relatively enduring changes occur in the client’s behavior? Thus, this paradigm might have been successful because of the confluence of the aims of these two pursuits.
Two further confluences might have accounted for the success of operant approaches. Skinner criticized research utilizing group designs. He argued that group averages are a confused and confusing scientific variable. Instead of group comparisons, Skinner argued for the intensive experimental analysis of the behavior of an individual organism. The goal was to find the controlling variables of the individual’s behavior by manipulating environmental conditions to see if these were functionally related to subsequent behavior. Again, this emphasis is highly consistent with the clinician’s problem situation. The clinician is rarely concerned with group averages, but rather is concerned with the behavior of an individual client. Moreover, clinicians aim to find manipulable conditions to bring about desirable changes in the client’s behavior.
A final confluence was that in conducting these single-subject designs, Skinnerians eschewed statistical analysis. They wanted to show that they had identified controlling variables due to the reliable, high-magnitude changes produced in the dependent variable. Although some learning researchers statistically analyzed group designs in order to find “statistically significant” differences, operant researchers wanted to demonstrate differences that would be readily apparent in any graphical display. This is fortuitous because clinicians generally want or need dependent variables to undergo large changes. The work coming out of the operant lab showed that these large changes were possible. Work coming out of group designs showed that with large enough sample sizes, small differences (that were statistically significant but often not clinically significant) were possible.
Despite the considerable advantages provided by this basic science/applied science model, it has one serious disadvantage. The limits of the basic science place limits on the applied science. Learning research was (and still is) unsettled. Pavlovians, Ruffians, and Skinnerians, among others, engaged in debates concerning fundamental issues. Much of the behavior of the organism remained unaccounted for. There was a clear need for further basic research to fill the many lacunae in the learning account. At times, behavior therapists were stymied because they relied on incorrect information, incomplete information, regularities that were weak, and regularities whose initial conditions or boundary conditions were poorly understood.
SECOND-GENERATION BEHAVIOR THERAPY
In the 1970s, behavior therapy’s heterogeneity increased. Systematic desensitization, implosion therapy, and two-factor accounts of anxiety disorders were examples of the continuing influence of Pavlov, Hull, and Mowrer, respectively. Those influenced by Skinner sometimes tried to distinguish themselves from those influenced by non-operant principles and particularly from those influenced by nonconditioning factors. Operantly inclined behavior therapists sometimes called what they did applied behavior analysis or behavior modification. These terminological distinctions have not always been clear, but at times they function as code words for background allegiances regarding favored learning principles. The increasing diversity of behavior therapy should not be surprising, as the seeds for the growth of a heterogeneous discipline were present from its beginning. For example, Ullmann and Krasner (1965) described behavior therapy as “treatment deducible from the sociopsychological model that aims to alter a person’s behavior directly through the application of general psychological principles (p. 244, italics added). These prominent, early behavior therapists viewed behavior therapy as also relying on many social-psychological domains such as role theory, small-group research, demand characteristics, labeling, and conformity. Ullmann and Krasner attempted to set a learning-influenced behavior therapy in the larger context of a psychology of behavior influence.
Gerald Patterson (1969), another prominent early behavior therapist, agreed with the emphasis on social-psychological principles:
It seems to me that future trends will of necessity involve a greater reliance upon principles available from social learning. The term social learning as used here refers to the loosely organized body of literature dealing with changes in learning, or performance, which occur as a function of contingencies which characterize social interaction. ... Many of the mechanisms which have been described as bringing about these changes have been based upon principles from social psychology rather than learning theory: these would include such processes as persuasion, conformity, and modeling. (p. 342)
Arnold Lazarus, a student of Wolpe’s, was probably one of the earliest and most significant forces for turning behavior therapists’ attention to areas other than learning. Lazarus argued that learning principles were helpful but insufficient. Lazarus (1968) stated:
Why should behavior therapists limit themselves only to “experimentally established principles of learning against the background of physiology” and ignore other areas of experimental psychology such as studies on perception, emotion, cognition, and so forth? And why should behavior therapists avoid using such techniques as self-disclosure, dyadic interactions, and other methods, as long as they can be reconciled with reinforcement principles? Finally, one might inquire to what extent Wolpe’s reference to a “stimulus-response model” is a vague and meaningless abstraction. If the current upsurge of interest in behavior therapy is to expand and mature, we must beware of oversimplified notions, limited procedures, and extravagant claims which would conceivably undermine our efforts. (p. 2)
