Clarification And The Transference

Nonetheless, confrontation along with clarification may have an important role to play, especially early in the course of the therapy. Interpretation is not possible or useful until the patient has developed some degree of at least a working alliance. As long as the therapist's interpretations are caught up in the vicissitudes of the patient's projective distortions and negative transference reactions, they will be heard as either threatening or destructive, or if reflecting a more idealized...

Aubrey H Fine

California State Polytechnic University I. Description of Treatment II. Theoretical Bases III. Empirical Studies IV Suggestions for Clinical Application animal-assisted activities Therapy that involves animals visiting people for motivational and recreational benefits to enhance quality of life. The same activity can be repeated by the facilitator with the same or different people, unlike the therapeutic intervention that is tailored to the specific person. animal-assisted therapy A...

Attention Deficit Disorders All Types

There are multiple studies that have shown QEEG biofeedback to be a successful treatment for attentional problems. These studies are based on the rationale that individuals with attentional problems generally have more slow waves in their EEG than individuals who do not have attentional problems. Therefore, the protocol requires the reduction of slow waves, either theta or alpha, while increasing faster waves, such as SMR or beta. The protocol for EEG biofeedback treatment of ADD ADHD will be...

Progressive Relaxation

Before starting PR training, patients should be given a rationale for the PR. It should be noted that PR is easily learned and does not require any special abilities. The method involves learning to relax by first tensing and then relaxing different muscle groups in the body. Briefly tensing muscles makes it easier to experience the contrast between a tensed and a relaxed muscle, and to notice tension in various muscles during daily activities. The different muscle groups that are included can...

Irritable Bowel Syndrome IBS

IBS is manifested in about 8 to 19 of the population and is associated with symptoms of abdominal pain, constipation and or diarrhea, and gas. About 85 of those with IBS have an increase in symptoms when experiencing stress. Therefore, the treatment of choice is relaxation therapy and research has shown that relaxation therapy combined with finger temperature biofeedback is the most effective. Although more direct forms of feedback have been tried, such as colonic motil-ity sounds, rectal...

Differential Relaxation 1 Introduction to Differential Relaxation

In order for AR to be an effective coping skill it must be portable, The patient should be able to use it in practically any situation and not be constricted to a comfortable armchair in the home or in the therapist's office. The primary purpose of differential relaxation (DR) is to teach the patient to relax in other situations besides in the comfortable armchair. The secondary purpose of DR is to learn not to be tense in the muscle groups not being used for the activity at hand.

Sweat Gland Activity

There are two types of sweat glands located in the human skin, the apocrine and eccrine glands. The apocrine sweat glands primarily respond to thermal regulation and the eccrine sweat glands tend to respond to emotionality or arousal level. Therefore, the eccrine glands are of interest in most psychophysiology and biofeedback applications. Eccrine glands have the greatest density in the palm of the hands, the volar sur face of the fingers, the bottoms of the feet and toes, under the arms, the...

Case Illustrations

Robert Gould and his colleagues compared the use of bibliotherapy involving minimal counselor contact in the treatment of panic with guided imaginal coping and a wait-list group. Changes assessed included frequency and severity of panic attacks, perception of ability to deal with panic attacks, and level of depression and avoidance. Participants in the bibliotherapy group (n 12) were requested to read Coping with Panic A Drug-Free Approach to Dealing with Anxiety Attacks over a 4-week period at...

Releaseonly Relaxation

The introduction provided before the start of the release-only phase of PR is that this step is intended to reduce the time it takes for the patient to become relaxed from 15-20 minutes with the PR to about 5-7 minutes, and to help them learn to relax without having to tense muscle groups. Patients are told they will be instructed to focus on the different parts of the body and are asked to relax as much as possible. If, after having tried to relax they still feel tension in a muscle, they...

Theoretical Basis

AMT was developed in 1971 as a solution to the in-appropriateness of desensitization for dealing with what is now called generalized anxiety disorder (GAD). Desensitization is effective for phobias but requires the identification of the stimuli precipitating the anxiety response. In GAD, clients experience a more chronic, generalized state of anxiety, and the external cues eliciting anxiety cannot be identified so precisely. Desensiti-zation was, therefore, not applicable, and alternative...

Instruction of Rapid Relaxation

When the patient is relaxing in natural situations during this phase of AR the relaxation has largely been reduced. The patient is instructed and the therapist models the following sequence 1. Take a deep breath and slowly let the air out 2. Think relax quietly each time you breathe out 3. Scan your body for any signs of tension and relax as much as possible in the situation 4. Stay in the relaxed state for 30-60 seconds. If, after doing all the above, the patient still feels that they haven't...

Introduction to Application Training

The only rationale you give the patient at this stage is that it is now time to start practicing in reality what they have learned in theory. Before starting this phase it is very important to give the patient an instruction that sets their expectations at the right level. You remind the patient that applied relaxation is a skill and as with any other skill it takes practice to refine it. This means that the patient should not expect that AR functions at 100 the first time it is applied, such...

Relaxation Therapies

Since the late 1950s a host of formal relaxation therapies including progressive muscle relaxation training, autogenic training, imagery training, biofeedback, and hypnosis have all been used to treat insomnia. Common to these approaches is their focus on such factors as performance anxiety and bedtime arousal, which often perpetuate sleep difficulties. Regardless of the specific relaxation strategy employed, treatment entails teaching the insomnia sufferer a formal exercise or set of exercises...

Electroencephalogram

EEG biofeedback is the fastest growing area in biofeedback today Part of this interest is due to the fact that changes in instrumentation hardware and software have provided the means to quickly perform mathematical analysis of brain waves so that feedback about the EEG characteristics can be provided within fractions of a second after they are detected. However, recording the EEG is of great technical difficulty because the electrodes must be placed in the correct location while maintaining...

Anxiety Disorders

The biofeedback techniques primarily used in the treatment of anxiety disorders are frontal EMG, finger temperature, SCA, and heart rate feedback. These modalities are used to train a deep state of relaxation. The clinician can then use the deep state of relaxation as an incompatible response to the anxiety state. Although specific biofeedback such as heart rate might be used for a cardiac phobic, the most widely used technique is to train on the most active modality, based on the individual's...

Diabetes Mellitus

Diabetes mellitus is caused by the disregulation of insulin produced by a malfunctioning of the pancreas. Because insulin regulates the amount of glucose available to cells, this disorder has serious consequences for life expectancy. The traditional management of diabetes is lifestyle changes through education, diet, and physical exercise along with hypoglycemic medication. The role biofeedback plays in the management of diabetes is through stress reduction techniques with...

Introduction to Rapid Relaxation

The purposes of rapid relaxation (RR) are to teach the patient to relax in natural but not anxiety-arousing situations, and to further reduce the time it takes to become relaxed. The goal for this is 20-30 seconds. In order to reach these goals the patient should use rapid relaxation 15-20 times a day in natural situations. At this stage it is very important that the therapist spends some time to thoroughly go over the goals with the patient and to write down suitable situations that function...

Clinical Case Formulation

Ultimately, behavioral assessment must inform treatment planning and increase the probability that maximally efficacious treatments are implemented. The importance of developing a clinical case formulation based on assessment results has been recognized by workers endorsing diverse models of psychopathology. However, integration of assessment tools from diverse, and sometimes incompatible, theoretical models has not been successful. Increasingly, clinical case formulation is being viewed by...

Outmoded Public Policy and Psychotherapy

While access to medicine and surgery was changing rapidly, making physical health care available to most employed persons, mental health remained mired in an outmoded public policy that believed psychotherapy was not feasible under third-party payment. The development of the Blues had made available hospital care for acute mental conditions, but outpatient care continued to be excluded. For the most part mental conditions were treated in the ever-burgeoning state mental hospitals from which...

The History of Capitation

A method of reimbursement for large populations that is based on a set amount of payment per member (enrollee) per month (known in the industry as pm pm) also had its beginnings in the 1930s. The Ross-Loos Group in Los Angeles and Doctor Callan and Staff in the San Francisco Bay Area solicited subscribers from the general public, as employer-sponsored health insurance was still almost a decade away. This fact, with ready access to health care in spite of an inability to pay, made prepaid health...

Schizophrenia

Schizophrenia is another costly illness for which psychotherapy can be cost-effective. The cost of schizophrenia in the United States in 1991 was 65 billion dollars, including treatment costs (19 billion dollars) and productivity lost due to illness (46 billion dollars). Psychotherapy, especially family therapy, given in combination with medication, has been shown to be cost-effective in the treatment of schizophrenia by decreasing the rate of relapse and the number of days spent in the...

The Rise of Employer Sponsored Health Insurance

Once the United States plunged into World War II, a hidden enemy was inflation resulting from the overheated economy of total mobilization. The Congress quickly passed wage and price controls, inadvertently hampering the recruitment of workers from the farms to the war economy. Moving literally millions of rural workers to the large cities required incentives, and since higher wages were not permitted, offering complete health care was an acceptable alternative. Emerging from the Great...

Neuropsychology and Attention Remediation

Neuropsychology, and the related field of cognitive psychology, have made major contributions to our understanding of the attentional system, at the levels of both cognitive operations and neuronal activity. The attention system is believed to be composed of subsystems that perform different but interrelated cognitive functions. These different subsystems are mediated by different anatomic areas that together work as a network. Neuropsychology has emphasized the importance of studying the...

Case Example

Richard Eisler and his colleagues Michel Hersen and Peter Miller in 1974 used assertion training with a 28-year-old house painter admitted to a hospital after he had fired a shotgun into the ceiling of his home. His history revealed periodic rages following a consistent failure to express anger in social situations. His behavior was assessed by asking him to role-play in social situations in which he was unable to express anger. These included being criticized by a fellow employee at work,...

Doing FAP

Functional analytic psychotherapy employs several therapeutic strategies. The three primary ones are (a) watch for CRBs, (b) evoke CRBs, and (c) reinforce CRB2s. Strategy 1 Watch for CRBs. This strategy is the most important one because it alone will lead to more intense and effective treatment. A therapist who is skilled at observing instances of clinically relevant behavior also is more likely to naturally encourage clients to give up self-defeating patterns in the here and now, and foster...

Theoretical Bases

BGT is based on contemporary conditioning and cognitive theories of emotional disturbance. Current conditioning models assume that emotional reactions can be learned in multiple ways, including classical conditioning, transmission of information from one person to another, and observing other people react emotionally to stimuli. Classical conditioning, as conceived in contemporary models, is a process of learning to associate a stimulus with a particular outcome. In other words, it is a process...

Programming of Change

Specific goals are established for each session. Perhaps only one or two behaviors will be focused on in a session, or the initial repertoire might be such that all needed verbal and nonverbal behaviors can be practiced. Assessment of the client's behavior in relation to given situations will reveal available behaviors and training should build on available repertoires. Hierarchies ranked in terms of the degree of anxiety or anger that different social situations create can be used to gradually...

Characteristics of Manualized Interventions

A wide range of psychological conditions has come to the attention of researchers wishing to develop empirically supported intervention packages. The range of disorders varies, from depression to simple phobia, headache to childhood enuresis, sexual dysfunction to sex offenses. A detailed list of empirically supported treatment is provided by Hayes, Barlow, & Nelson-Gray in their 1999 book. Criteria have been developed for three levels of empirically supported interventions well-established...

Applications And Exclusions

Assertion training requires a careful descriptive analysis of relevant interpersonal relationships. If this analysis indicates that assertion would have unavoidable negative effects, as it may for example in abusive relationships, this would not be recommended. Other methods must be explored. Clients must be willing to act differently in real-life situations and have the self-management skills to do so (e.g., remind themselves to act differently). Cultural differences regarding what behaviors...

Psychotherapy

Pacific University, Forest Grove, Oregon Michel Hersen, Ph.D., ABPP, is Professor and Dean, School of Professional Psychology, Pacific University, Forest Grove, Oregon. Dr. Hersen is a graduate of State University of New York at Buffalo, and completed his post-doctoral training at the West Haven VA (Yale University School of Medicine Program). Dr. Hersen is past president of the Association for Advancement of Behavior Therapy. He has co-authored and co-edited 133 books, and has published 223...

Cognitive Restructuring Changing What Clients Say to Themselves

Thoughts relevant to assertive behavior include helpful attributions (casual accounts or behavior), realistic expectations (I may not succeed no one succeeds all the time), helpful rules (when in doubt think the best), self-reinforcement for efforts to improve and positive consequences, problem-solving skills, and accurate perception and translation of social cues (e.g., noting and accurately interpreting a smile as friendly). In addition, cognitive skills (e.g., distraction) are involved in...

Description Of Treatment

Assertion training usually consists of a variety of components, including instruction, model presentation, behavior rehearsal, feedback, programming of change, and homework assignments. Other procedures that may also be used, depending on what is found during assessment, include self-instruction training, relaxation training, cognitive restructuring (e.g., decreasing unrealistic expectations or beliefs), and interpersonal problem-solving training (helping clients to effectively handle...

Cognitive Change Models

In 1993 Jack Rachman explained the success of exposure in vivo by the acquisition of fresh, disconfirma-tory evidence (e.g. no heart attack, did not lose control), which weaknes the catastrophic cognitions. From this perspective, exposure is viewed as a critical intervention through which catastrophic cognitions may be tested. This is in line with the cognitive-behavioral therapy (CBT) based on the perceived danger theory according to Aaron Beck and colleagues. Within this model exposure (i.e.,...

Case Illustrations A Mr A

A man in his late 40s in his seventh psychotherapy session, Mr. A. paused and then asked his psychiatrist if everything he said was truly confidential. The psychiatrist replied that within the limits of the law, and with the exception of any emergency involving threat to life and limb, confidentiality would be maintained. The psychiatrist added that she would actively use all legal means to resist any efforts to intrude in any case. Mr. A. then haltingly revealed, with great shame, that he had...

Pelvic Floor Disorders

The primary biofeedback applications in pelvic floor disorders are the treatment of urinary and fecal incontinence through the use of EMG biofeedback and specially designed sensors. This section will briefly cover biofeedback for urinary and then fecal incontinence. Urinary incontinence is the inability to maintain control over urinary functions. The goal of biofeedback treatment is to alter both smooth and striated muscle activities related to bladder control. The following methods are...

Michael J Lambert and David A Vermeersch

Effectiveness of Psychotherapy II. Factors Important to Psychotherapy Outcome III. Negative Effects of Psychotherapy IV Summary common factors Active ingredients that are common to all forms of psychotherapy and contribute to positive patient outcome. patient variables Characteristics of patients related to psychotherapy outcome. psychotherapy outcome The effects of psychotherapy on patient status. specific intervention variables Therapeutic techniques or interventions unique to a specific...

Differential Reinforcement of Other or Incompatible Behavior

Differential reinforcement of other behavior (DRO) refers to rewarding behavior other than a specified undesirable behavior. A child with autism, for example, may be given a reward during any 5-minute interval during which he or she plays with no aggressive behavior. In related fashion, an adult may be rewarded for interacting with others and not avoiding an anxiety-provoking situation. Differential reinforcement of incompatible behavior is similar to DRO, but involves rewarding a behavior that...

Bulimia Nervosa

Jill was a 23-year-old administrative assistant who had been binge eating and purging since the age of 16. Although her mother was slim and even glamorous, her father's side of the family tended to be obese and Jill seemed to have inherited those tendencies. Throughout Jill's teen years her mother constantly urged her to watch her weight, to avoid getting too chubby, so that she would be socially popular. Jill did everything she could to diet, and she exercised rigorously. However, all of her...

Empirical Evidence

The empirical evidence in support of DBT is promising. In the original randomized clinical trial of DBT conducted by Linehan and colleagues during the treatment development phase, participants were chronically suicidal women diagnosed with BPD who had a recent history of parasuicide. Participants were randomly assigned to one year of either DBT or treatment-as-usual (TAU), a naturalistic control group in which participants receive psychotherapy as it is usually offered in the community. As...

Empirical Studies A Posttraumatic Stress Disorder

Because of its claims of rapid effective treatment, EMDR has been subjected to many empirical tests and to much scientific scrutiny. It has been extensively researched in the treatment of PTSD. All but one of the research studies that used civilian participants found EMDR to be efficacious in the treatment of PTSD, and the one combat veteran study that provided a full course of treatment also revealed EMDR to be efficacious. Generally, these studies found substantial clinical effectiveness,...

Empirical Support

Flooding was introduced to the psychological literature via animal studies. In one early study, rats were conditioned to avoid electric shock in one half of a cage by moving to the other side of the cage when a buzzer sounded. After conditioning, the buzzer was continually sounded while the rats were prevented from emitting the avoidance response by the presence of a barrier in the middle of the cage. After several long trials of continuous stimulus presentation along with response prevention,...

Assessment

BMT has a fairly distinct tradition of beginning the couple evaluation process by employing three or four different methods of gathering information to understand the problems and strengths of a given relationship and to plan various interventions to accomplish the therapeutic goals. First, there are a series of semi-structured clinical interviews, typically 2 to 3 sessions, which often include separate meetings with each partner as well as meeting the couple in a conjoint format. In general,...

Lars Gran st

Description of Applied Tension II. Theoretical Basis for Applied Tension III. Applications and Exclusions V Case Illustration VI. Summary application training The application of the tension technique when experiencing the early signs of a blood pressure drop while being exposed to blood stimuli. blood-injury-injection phobia The fear and avoidance of seeing blood, injuries or receiving an injection or other invasive medical procedures. diphasic pattern The initial increase followed by a...

Case Illustration

The following case example will illustrate the treatment process and application of the theoretical concepts that have been presented. The therapist in this case was Stephen Zahm. Kim, a 44-year-old successful professional woman was referred by her physician due to recurrent periods of depression. She had been depressed off and on for much of her life. The bouts of depression had worsened recently in both duration and severity. She had not been able to tolerate antidepressant medications, and...

Client Populations

Research demonstrates that backward chaining has been successfully used with diverse populations ranging from children to elderly adults. Although some research has demonstrated the effectiveness of this procedure with persons who are typically developing the majority of studies have focused on individuals with developmental disabilities. Within this latter population, backward chaining has been extensively used and found to be particularly effective in teaching skills to children and adults...

Carolyn Zerbe Enns

Summary consciousness-raising Activities that increase awareness about how oppressions such as sexism, racism, heterosex-ism, and ageism influence the lives of individuals. feminist analysis and gender role analysis Techniques used to examine how inequality, injustice, and power imbalances may limit individual potential. Gender analysis involves examining restrictive gender role beliefs and behaviors, weighing their costs and benefits, and constructing alternatives to...

Theoretical Integration

In an effort to provide a conciliatory note on this argument, Reitman and Drabman, and Dougher point out the similarities between radical cognitivists and radical behaviorists by indicating both are interested in achieving behavior change, with fundamental differences in method to achieving that change. On the one hand, it appears that the addition of cognitive to behavior therapy has led to improvement in the delivery of treatment and may even enhance treatment adherence in some cases (as in...

Empirical Studies

Empirical outcome studies have proved that exposure in vivo is an effective treatment in reducing phobic complaints in specific phobias, in social phobias, in agoraphobia with or without panic disorder, and in hypochondriasis. Studies have shown that exposure to anxiety-provoking situations also has a positive effect on frequency and intensity of panic attacks in agoraphobics. Obsessive-compulsive disorder patients benefit from exposure in vivo treatment with the addition of response prevention...

Dialectical Behavior Therapy

Linehan I. Introduction and Overview II. Theoretical Foundation III. Description of Treatment borderline personality disorder A psychiatric disorder characterized primarily by intense negative emotions (including depression, anger, self-loathing, and despair), disturbed interpersonal relationships, and self-damaging impulsive behaviors such as substance abuse and para-suicide. dialectics A philosophical world-view that reality reflects an ever-changing...

Supervised Clinical Work With Patients

Very early on in psychotherapy education, supervised clinical experiences with patients are necessary to transform concepts learned from books or classrooms into actual human encounters. At least some of the aforementioned experiential learning activities in a situation without clinical responsibility should precede attempts at psychotherapeutic relationships with patients. Psychiatry residency programs take as a fundamental aspect of physician behavior the dictum prima non nocere, or first do...

Outcome Research

Since 1975, when the first controlled research of such therapy appeared, there have been at least 23 empirically based outcome studies of grief therapy. A significant caveat must be underscored before a The experience of loss, particularly through death, is usually a confusing experience that triggers a search for meaning in the majority of bereaved persons. Grief therapy, especially in a group context, can provide grievers with a scheme of mourning and recovery such as the one provided by...

Mechanisms of Action

Although it is apparent that EMDR expedites information processing, the exact mechanisms by which this occurs are unknown. Speculation about the role of eye movements abounds. A wide variety of primary research studies dating from the 1960s through the present have indicated a correlation between eye movements and shifts in cognitive content and attribution. Several hypotheses attempt to explain how they may contribute to information processing within the EMDR procedures (1) eye movements...

Applications

Perhaps one of the most striking features of applied behavior analysis is the scope of applications. Table 6 samples some of the applications to illustrate the breadth of the approach. Interventions have been carried out in diverse settings such as the home, at school, institutions (hospitals, rehabilitation centers, nursing homes), business and industry, and the community. Indeed, it is safe to say no other psychological intervention or approach has been applied as widely to human behavior....

Clinical Ethics Analysis of Case

The developmental history given by Crystal's mother revealed that from about age 1 Crystal would behave normally and then have apparently unprovoked several-week-long periods of depression, oppositional behavior, irritability, and difficulty with relationships. These episodes occurred about every 2 months. Whether other family problems might have been occurring at that time was not yet fully explored. When not in the abnormal moods, Crystal seemed to be a...

Diverse Clinical Applications

In large-scale studies of EMDR treatment with trauma populations, direct internal comparisons were made for those with and without PTSD diagnosis. The equivalent findings on numerous affective and cognitive measures lend credence to the notion that EMDR can be effectively used to process disturbing experiences that may contribute to a variety of clinical complaints. Although positive reports have been published on the application of EMDR to the treatment of (1) personality disorders, (2)...

Values Inherent in Health Economics Output versus Input

Health care can be viewed as an output of the health care industry, or it can be seen as an input to health. This is an important distinction that will determine much of public policy, but the resulting debate with its questioning of theoretical assumptions often stems from the fact that these two views are not mutually exclusive. The first of these sees health care as the output produced by physicians, hospitals, and all other providers in the industry. It is therefore important to measure how...

Efficacy

Andrew Butler and Judith Beck conducted an analysis of fourteen meta-analyses of cognitive therapy outcome studies in 2000. They found substantial support for the efficacy of cognitive therapy in 325 studies, comprising 9,000 patients. Cognitive therapy was found to be somewhat superior to antidepressant medications in the treatment of adult unipolar depression. A significant finding was that depressed patients treated with cognitive therapy had half the relapse rate (30 ) of those who had...

Anorexia Nervosa

Few controlled trials of psychotherapy for anorexia nervosa have been published, in part due to the tremendous difficulties of conducting such trials with this population, especially during phases when the patients are seriously underweight. Consequently, recommendations regarding the role of psychotherapy in early phases of treatment rely strongly on consensus opinions of experienced clinicians and clinical researchers. Investigators increasingly appreciate just how much malnutrition in...

Didactic Learning

Most educational systems for psychotherapy begin with didactic learning situations in which basic concepts of psychotherapy are presented. The main mental health disciplines in which psychotherapy is practiced are psychiatry, psychology, and social work. Each of these core disciplines has a wide variety of subspecial-ties. Each provides subspecialty training in different conceptual models for psychotherapy, such as psychoanalysis, cognitive therapy, interpersonal therapy, and behavioral...

Urine Alarm Plus Medications

Doleys, which was referred to earlier, several medications including dex-amphetamine sulfate (Dexadrine), methamphetamine hydrochloride (Methadrine), and imipramine (Tofranil) were used in the treatment of nocturnal enuresis. When dexamphetamine, methamphetamine, or imipramine was combined with the standard urine alarm protocol the duration of treatment was shorter although sometimes by a very small number of nights. However, the relapse rate was higher. In an...

Treatment Progress

At the outset both Bob and Cindy seemed motivated to improve their marriage. While admitting to some emotional ambivalence about being with wife versus lover, Bob indicated that he wanted to stay with the family and make the marriage more rewarding. He had terminated contacts with his lover. Bob and Cindy made very good early progress. In fact, with only an average amount of direction, encouragement, repeated assignments, and reinforcement by the therapists, they did quite well through the...

Cancer Patients Psychotherapy

Stanford University School of Medicine I. Description of Treatment II. Theoretical Bases III. Outcome IV Summary active coping Finding some aspect of a stressor that one can do something about and formulating a plan of action to respond to it. affective expression The direct ventilation of emotion. hypnosis A state of relaxed, attentive, focused concentration with a reduction in peripheral awareness. personalization Bringing discussion of problems into the here and now by discussing problems as...

The Information Processing System

The physiologically based information processing system can be compared to other body systems such as digestion in which the body extracts nutrients for health and survival. The information processing system sorts perceptions of experience and stores memories in an accessible and useful form. Information processing is essential for learning and involves the forging of associations with experiences previously stored in memory. The strong negative affect or dissociation induced by a traumatic...

Making Use of Found Time

The client may have some difficulty filling the time once taken up with heavy, prolonged drinking and its aftermath. To avoid boredom, and to help support a moderate drinking habit, the client can be encouraged to take up new (and increase existing) recreational activities to take the place of drinking. The therapist can guide the client as he or she considers a wide range of athletic, intellectual, social, political, religious, musical, and other activities he or she might want to sample. The...

Outcome Research On Cbgt

The research tends to provide support of the effectiveness of CBGT in the treatment of social phobias. For example, Heimberg in 1990 conducted a study comparing CBGT with a credible placebo control in the treatment for social phobias of 49 participants. Groups met weekly for twelve 2-hour sessions. The CBGT condition (n 25) consisted of exposure to simulated phobic events, cognitive restructuring of maladaptive thoughts, and homework for self-directed exposure and cognitive restructuring...

Cognitive Behavior Group Therapy

The Relevance of the Group in CBGT III. The Structure of the CBGT Group VI. Some Closing Remarks Further Reading cognitive behavior group therapy (CGBT) Therapy that occurs within the context of a group and that incorporates a variety of cognitive strategies, modeling techniques, and other behavioral techniques. generalization phase In this phase clients are prepared to transfer what they have learned in group to the natural environment. Extra-therapeutic assignments are designed to be...

Types Of Consequences

Consequences that follow a particular behavior can often be categorized as positive or negative. In addition, such consequences may be given or taken away. A positive consequence that is given refers to positive reinforcement and generally serves to increase the frequency of a behavior. Examples include providing bonus incentives for workers or rewarding a child for extra chores via a new privilege. A positive consequence that is taken away is a form of extinction and generally serves to...

Empirical Bases For Behavioral Case Formulation

Behavior therapy and its constituent methodologies have been extensively studied, and are, at present, a favored child among therapies. One reason for this is that behavioral case formulation requires specificity, the utilization of hypothesis formation, and systematic hypothesis testing. Behavioral methodologies are the clinical equivalent to scientific methodologies and, as such, lend themselves to empirical study. It is said that behavioral methods are studied more than any other therapies....

Essential Hypertension

There is substantial research on the treatment of essential hypertension with biofeedback. Studies show that frontal EMG, finger temperature, SCA, and direct blood pressure feedback have all been used successfully. Most of the research supports combining the biofeedback with some relaxation strategy such as progressive muscle relaxation, or autogenic training. Although direct blood pressure feedback might seem superior because it is straightforward, the research does not support it as a...

Therapy Method

By attending to observable behaviors that indicate blocked awareness and interruptions to acting on needs, desires, or interests, Gestalt therapy captures the essence of a person's existential position in the world, which impacts all aspects of self-experience and relationships. For example, the patient speaks softly, apologizes frequently, becomes slightly tearful but cannot cry, changes the subject, or shuts down if strong feelings threaten to emerge. Can she become aware of how she clamps...

Companion Animals and Children

Brenda Bryant reports that animal companions have been found to provide important social support for children. She also reports that animals within a home may assist children in developing a greater sense of empathy for others, and may enhance a child's self-esteem and social skills. Bryant surveyed 213 children and identified four potential psychological benefits of animals for children. In 1990 she utilized the My Pet Inventory to assess the subjects' interests. A factor analysis of Furman's...

Catherine Miller

Conditioned response Response to conditioned stimulus similar to response to unconditioned stimulus. conditioned stimulus Stimulus that elicits similar response as unconditioned stimulus after repeated pairings. exposure General term for many therapeutic techniques in which clients are presented with feared stimuli or situations in order to reduce anxiety symptoms. neutral stimulus Stimulus that produces no response prior to repeated pairings with unconditioned stimulus becomes conditioned...

William M Klykylo

Wright State University School of Medicine I. Definition and History of Concept II. Comorbidity and Substance Abuse III. Comorbidity in Childhood Disorders V. Applications of Concept Further Reading comorbidity The co-occurence of more than one disorder in the same individual. endocrinopathy A disorder caused by or affecting the endocrine system of the body. epidemiologic Relating to the study of epidemiology or to the characteristics of a disease or physiologic phenomenon in a population as a...

Dysfunctional Beliefs

Theories of fear have become increasingly complex in recent years. Classical conditioning and many other factors are thought to be involved. Consistent with the neo-conditioning and emotional processing models, some theorists have proposed that exaggerated beliefs about the probability and severity of danger may play an important role in motivating fear and avoidance. Such dysfunctional beliefs play a prominent role in contemporary theories of agoraphobia and social phobia, and may play a more...

Emotional Processing

Emotional processing is defined as the modification of memory structures that underlie emotions. This model of anxiety reduction is partly based on Peter Lang's model of bioinformational processing and Jack Rach-man's work on the concept of emotional processing. According to Lang emotion is represented in memory structures as action tendencies that contain (1) information about the feared stimulus situation (2) information about verbal, physiological, and overt behavioral responses and (3)...

Differential Attention

Marcus, and Ashvind N. Singh Virginia Commonwealth University and Central State Hospital I. Description of Treatment II. Theoretical Bases III. Empirical Studies IV Summary attention The description of a procedure involving certain therapist behaviors that either precede or follow an individual's behavior. Attention is not a priori a reinforcer. Although it can be a powerful reinforcer for some individuals, for others, it can be a punishing stimulus or even a...

Iiiempirical Studies

Covert reinforcer sampling has been evaluated in two case studies and one study in which it was compared with the traditional method of overt or direct reinforcer sampling. In the first case study, reported in 1976 by Patricia Wisocki, the procedure was employed along with several other behavioral techniques to help a client overcome a fear of social rejection. Covert reinforcer sampling was successfully used to help the client explore potentially reinforcing new social activities in order to...

Theoretical Bases A The Psychology Behavior Therapy

Many people are skeptical of behavior therapies of all types because they equate them with B.F Skinner's behaviorism. Those who are concerned about the fact that behavior can be conditioned often consider behaviorism a type of mind control, rather than a tool to promote positive behavior change. In part, because of such fears, modern behavior therapy tends to focus more on social learning and cognitive techniques than on conditioning behavior. However, the basic foundation of behavior therapy...

Behavioral Analysis

A behavioral analysis of nocturnal enuresis focuses on the role of environmental conditions and appropriate learning experiences or conditioning. Treatment emphasizes the development of bladder fullness as a discriminative cue enabling the child to inhibit voiding until the appropriate stimulus (bathroom) is present. Additionally, bladder fullness would come to be an adequate stimulus for arousal from sleep. This approach highlights the learned nature of the desired response (nighttime...

Cue Controlled Relaxation

The purpose of cue-controlled relaxation (CR) is for the patient to learn to associate the self-instruction relax with a relaxed state, and further reduce the time it takes to become relaxed. Cue-controlled relaxation may be introduced to patients as follows Most of us have probably been in situations where we or an acquaintance have been very nervous. In that situation we often get the advice to 'take it easy and relax.' This advice very seldom works since it is given when we are already...

Conditioning of Anxiety Relief

In his monograph Psychotherapy by Reciprocal Inhibition published in 1958, which stimulated the widespread introduction of behavioral modification procedures to psychiatry and psychology, Wolpe suggested that anxiety-relief responses might be directly conditioned to convenient stimuli and subsequently used to counter anxiety. He based the suggestion on the observation that if a stimulus was repeatedly presented to an eating animal just before withdrawing its food, that stimulus acquired the...

Intake Session and Inventory Assessments

A friend referred Cindy and Bob to the clinic. They were in their early thirties, had been married for 6 years, and had two daughters, aged 2 and 4. It was the second marriage for Bob, a boiler repairman and mechanical engineer, and the first for Cindy, who was occupied as a housewife and mother. During the initial clinical interview the co-therapist team asked about presenting complaints and the precipitating event leading to the initiation of therapy. When asked, Why are you seeking help now...

Schema Focused Cognitive Therapy

As an extension of Beck's cognitive therapy for personality disorders, Jeffrey Young and his colleagues formulated the concept of an early maladaptive schema, defined as a long-standing and pervasive theme that originates in childhood defines the individual's behaviors, thoughts, feelings, and relationships with other people and leads to maladaptive consequences. Applied specifically to characterological issues, the goal of schema-focused therapy is to help patients to identify cognitive...

Parameters of Exposure in Vivo

Wolpe explained the relative effectiveness of systematic desensitization by the fact that it would be impossible to feel anxious and relaxed at the same time he called this reciprocal inhibition. Research, however, has demonstrated that the addition of relaxation to the exposure element is not essential for improvement. In the eighties, Lars Goran Ost introduced applied relax ation. The purpose of applied relaxation is to teach the patients to monitor and recognize the early signs of tension...

Instruction of Differential Relaxation

The session starts with the patient sitting in the armchair relaxing on their own with the help of CR. When the patient has signaled that they are relaxed, they then follow the instruction to perform certain movements with different parts of the body while at the same time concentrating on being as relaxed as possible in the rest of the body. During the performance of these movements the patient should scan the body often (i.e., think through the different muscle groups) in order to discover...

Didactic Teaching

Behavior therapy relies on didactic teaching to explain behavioral concepts and to instruct clients in how to complete exercises. Individuals are often presented with psychoeducational materials in both verbal and written formats, with the aim of informing them of the various factors that are maintaining maladaptive behaviors. For instance, in presenting information regarding diaphragmatic breathing to individuals with a history of panic attacks, behavior therapists may provide a description of...

Types Of Covert Rehearsal

In general, as the word implies, covert rehearsal involves repetition, or thinking about the material over and over again. However, in a less strict sense, any mental processing engaged in after as well as any extra mental processing engaged in during the occurrence of an event or the presentation of a stimulus item can be considered as covert rehearsal. In those cases, continual repetition per se is not necessary, although the concept of repetition is still there because any further thinking...

Graduated versus Intensive Stimuli Presentation

Clients may be exposed to stimuli in a graduated fashion, beginning with a stimulus that induces little anxiety, or in an intensive fashion, beginning with a stimulus that is maximally anxiety-provoking. The decision on which format to follow should be based on prior research and practical concerns. Research has demonstrated that either format is effective in reducing overall anxiety symptoms, both immediately following treatment and after a short interval. However, one study found that...

Economic Pressures on the Political System

The political system has experienced concerted efforts by providers and other constituencies to more stringently regulate HMOs and managed care. Among the legislation under serious consideration have been parity laws, a Patients' Bill of Rights, and laws to inhibit incentives to providers for cost containment. All of these and others are under active consideration by the Congress and state legislatures, and although some laws have been passed, advocates are expressing disappointment in the...

Interventions

From its inception, the traditional interventions associated with BMT have included communication and problem-solving skills training and behavioral exchange techniques. Over the years, in many empirical studies, both interventions have been shown to be highly correlated with marital satisfaction. Although communication problem is probably the number one complaint of couples seeking therapy and most therapy approaches work on improving communication between partners in some manner, the hallmark...

The Eight Phases of Treatment

During EMDR, the unprocessed dysfunctionally stored material is linked to more adaptive material, and new associations are made. The client attends to emotionally disturbing material in multiple brief doses while simultaneously focusing on an external stimulus (e.g., therapist-directed eye movements, hand-tapping, bilateral tones). EMDR's three-pronged protocol ensures that all past, present, and future aspects of the problem are thoroughly addressed. Current conditions that elicit distress are...

Empirical Studies A Efficacy of Exposure

Decades of research have established that exposure therapies, particularly graded in vivo exposure and flooding, are the treatments of choice for specific phobias and play an important role in treating other anxiety disorders. These treatments produce clinically significant reductions in fear in about 60 to 80 of cases. Systematic de-sensitization is the least effective of the exposure therapies. Although it is not often used as a stand-alone treatment, this mild, undemanding intervention is a...

Model Presentation

Instruction, model presentation, rehearsal, and coaching can be used when clients lack requisite behaviors in certain situations or when there is a need to refine behaviors. The need to use modeling will be influenced by the complexity of the skill to be acquired and nature of the entering repertoires (available skills) of clients. The greater the complexity of the skill and the more lacking the initial repertoire, the greater the value of model presentation is likely to be. An advantage of...

Using FAP to Improve Cognitive Therapy for Depression

Cognitive-behavior therapy (CBT) for depression, developed in 1979 by Dr. Aaron Beck and his colleagues, has been shown to be an effective treatment for major depression. As with any treatment for depression, however, there is room for improvement. In particular, some clients are resistant to the methods and rationale of cognitive therapy, and outcome is endangered by what is known as a rationale-client mismatch. Examples of mismatches include clients who experience that their feelings rule no...

Presentation Formats 1 Visual Imagery

In implementing CPR, clients are instructed to imagine a scene in which they are performing the behaviors to be increased. The reinforcing scene should be clearly visualized within 5 seconds after imagining this scene. One pair of target and reinforcing scenes is referred to as a single trial. In 1986, Joseph Cautela and Albert Kearney stated that an intertrial interval of at least 1 minute is recommended in order to avoid inhibition of reinforcement and too rapid a growth of inhibitory...

The Match Mismatch Model

Rachman and colleagues have suggested that anxiety expectancies might play a mediating role in exposure therapy. They found that phobics typically overpredict the amount of fear they expect to experience in a threatening situation. A number of researchers investigated the overpre-diction of fear in a series of laboratory studies, in which they asked the subjects to rate their predicted fear before they were exposed to a threatening situation, and to indicate their reported fear just after the...

Awareness Training

The goal of awareness training is to teach the client to identify each occurrence of the habit and to identify the antecedents or warning signs that the habit behavior is about to occur. A number of procedures are used to achieve this goal. First, in the response description procedure, the client is asked to describe the habit behavior. The client describes all the behavioral movements involved in the habit behavior and all of the different ways in which the habit behavior may occur. Next, in...

Assessment Phase

Overlapping with cohesion building and orientation is the assessment phase. This actually begins with the client selecting a given group with a general theme in which she or he is interested or has major concerns (e.g., anxiety management, anger control, dealing with HIV infection). In the group and even in an intake interview, the particulars of the problem begin to be spelled out. Many practitioners make use of such paper and pencil tests as Beck's 1976 depression inventory, the fear survey...

Bearable Electrical Aversion in Treatment of Homosexuality

Throughout the 1960s the assumption persisted that the milder form of electrical aversion was a conditioning procedure resulting in an aversion to the stimulus or behavior that preceded administration of the electric shock. This assumption was first questioned in 1969 in relation to its use in the modification of homosexual interest or behaviors. As pointed out in a 1977 review by McConaghy, it was this use that was most subjected to empirical investigation, both in relation to its efficacy and...

Henry T Stein and Martha E Edwards

Alfred Adler Institute of San Francisco and Ackerman Institute for the Family III. Applications and Exclusions V Case Illustration VI. Summary antithetical scheme of apperception The sharply divided way of interpreting people and situations with an either or, black and white restriction of qualities no grey area is acknowledged. compensation A tendency to make up for underdevelopment of physical or mental functioning through interest and training, usually within a relatively normal range of...