Current Medical Diagnosis & Treatment in Psychiatry

Behavioral & Cognitive-Behavioral Interventions

Conclusion

Modern behavioral and cognitive-behavioral interventions emphasize the role of learning and adaptation to the environment both in shaping and maintaining normal life functions and in the emergence of maladaptive symptomatology. In essence, these approaches focus on behavior as important in its own right and often seek to change instances of disordered behavior via the application of clearly articulated basic principles of learning. Three basic, interrelated perspectives exist: classical conditioning, which emphasizes the learning of associations between classes of stimuli; operant conditioning, which emphasizes the learning of relations between behaviors and their consequences; and the cognitive perspective, which emphasizes the role of idiosyncratic beliefs and misconceptions in coloring each of the two earlier perspectives. There can be little doubt that the learning-based approaches have sparked a major revolution in the treatment of psychiatric disorders and that each perspective can point to a series of notable gains. These approaches can often be combined with medications for beneficial effect and should be part of the armamentarium of any well-trained clinician.

- Full Story - »»»    

Combined Interventions in Developmental Disabilities

Behavioral interventions can be highly effective in improving the quality of life for people who have developmental disabilities and display serious behavior problems. Sometimes behavioral methods are insufficient by themselves. Psychopharmacologic treatments can control psychopathologic symptoms and behavior in some people with mental retardation and related disabilities, much as they are effective in treating disorders (eg, major depression, bipolar disorder, anxiety disorder, schizophrenia) in non–developmentally delayed individuals.

- Full Story - »»»    

Combinations with Medications

Many of the disorders treated with behavioral or cognitive-behavioral therapy can also be treated pharmacologically, although some cannot. In some disorders, a combination of drugs and behavioral (or cognitive-behavioral) therapy is more effective than either modality alone. Despite the theoretically based concerns of advocates for each approach, one modality rarely interferes with the other, although such interference sometimes occurs. For many disorders, there are simply not adequate data to guide clinical practice; we often know that both modalities are effective in their own right but do not know whether their combination enhances treatment response.

- Full Story - »»»    

Fundamental Assumptions of Learning Theory-Based Therapies

Several basic assumptions are common to most learning-based interventions. Perhaps most basic is that the behavior of the individual who has been referred for psychiatric treatment is of concern in its own right. Behavior is not necessarily an indication of pathology at some other level of analysis (eg, brain chemical or psychic). Moreover, pathologic behavior is often seen as the result of the demands of the environment in which the person is living, working, or going to school (or, in the case of the cognitive approaches, the person’s perception of the environment). What appears to be pathologic behavior may be a best-effort adaptation to an impossible situation given the person’s cognitive or personality limitations (eg, living with alcoholic parents, residing in an abusive institutional or community residential setting, interacting with people who don’t use the same communication system).

- Full Story - »»»    

Modern Approaches

Modern cognitive and cognitive-behavioral approaches to psychotherapy got their impetus from two converging lines of development. One branch was developed by theorists originally trained in dynamic psychotherapy. Theorists such as Albert Ellis, the founder of rational-emotive therapy, and Aaron Beck, the founder of cognitive therapy, began their careers adhering to dynamic principles in theory and therapy but soon became disillusioned with that approach and came, over time, to focus on their patients’ conscious beliefs. Both ascribe to an antecedent events, a person’s beliefs, affective and behavioral consequences (ABC) model, which states that it is not just what happens to someone at point A (the antecedent events) that determines how the person feels and what he or she does at point C (the affective and behavioral consequences) but that it also matters how the person interprets those events at point B (the person’s beliefs). For example, someone who loses a relationship and is convinced that he or she was left because he or she is unlovable is more likely to feel depressed and fail to pursue further relationships than is someone who considers his or her loss a consequence of bad luck or the product of mistakes that he or she will not repeat the next time around. Both theorists work with patients to actively examine their beliefs to be sure that they are not making situations worse than they necessarily are. Ellis typically adopts a more philosophical approach based on reason and persuasion, whereas Beck operates more like a scientist, treating his patients’ beliefs as hypotheses that can be tested and encouraging his patients to use their own behaviors to test the accuracy of their beliefs.

- Full Story - »»»    

Cognitive & Cognitive-Behavioral Interventions

Cognitive & Cognitive-Behavioral Interventions
One of the major changes in behavioral approaches in the past several decades has been the emergence of the cognitive and cognitive-behavioral interventions. Based largely on social learning theory, these approaches posit that organisms are not just the passive recipients of stimuli that impinge on them but instead interpret and try to make sense out of their worlds. These approaches don’t reject more traditional classical and operant perspectives on learning; rather, they suggest that cognitive mediation plays a role in coloring the way those processes work in humans and other higher vertebrates.

- Full Story - »»»    

Applications to Clinical Treatment

The practical utility of the operant apparatus and measurement approach was adopted quickly in ex-perimental psychology, physiology, neurochemistry, pharmacology, and toxicology laboratories throughout the world. The methodology provided the springboard for the field of behavioral pharmacology, the study of subcortical self-stimulation, animal models of addictive behavior, and the study of psychophysics and complex human social behavior in enclosed experimental spaces. Skinner’s pragmatic theory struck a popular chord with many young psychologists, special educators, and practitioners in training. In 1948, Sidney Bijou began an applied research program and experimental nursery school for children with mental retardation at the Rainier School in Washington, applying operant principles. Bijou was joined by Donald Baer, a recent graduate of the University of Chicago, and they conducted seminal research on early child operant behavior. In 1953, Ogden Lindsley and Skinner began applying operant methods to study the behavior of patients with schizophrenia at Metropolitan State Hospital in Waltham, Massachusetts.

- Full Story - »»»    

Emergence of Instrumental & Operant Learning Theory

Summary
Strategies based on classical conditioning have also been used in the treatment of depression, somatoform disorders, dissociative disorders, substance abuse, sexual difficulties, medical problems, and a variety of other disorders. In general, these approaches represent some of the most effective of the therapeutic interventions. As is the case with other types of behavioral strategies, they rest on a solid foundation of basic empirical work, much of it with nonhuman animals, and on the creative adaptation of those basic principles to human populations.

- Full Story - »»»    

Extinction & Exposure Therapy

Despite its evident clinical utility, systematic desensitization is based on an essential misperception of the laws of classical conditioning. Classical conditioning is essentially ephemeral. Organisms stop responding to the conditioned stimulus when it is no longer paired with the unconditioned stimulus. Pavlov’s dogs may have learned to salivate to the ringing of the bell, but if Pavlov kept ringing the bell after it was no longer paired with the meat powder, the dogs soon stopped salivating to its ring. This is referred to as the process of extinction, in which conditioned stimuli lose their capacity to elicit a response when they are presented too many times in the absence of the unconditioned stimulus.

- Full Story - »»»    

Applications to Clinical Treatment

Applications to Clinical Treatment

Joseph Wolpe provided the first coherent set of clinical procedures, based on principles of classical conditioning, that had a major impact on the field. Wolpe had studied experimental neuroses in cats. In the course of his studies, which involved shocking animals when they tried to feed and observing the results of the conflict this produced, Wolpe replicated the essential features of Jones’s earlier attempt to reduce a learned fear via the process of counterconditioning. He soon extended his work to people with phobic disorders and was able to reduce his patients’ distress by pairing the object of their fear with an activity that reliably produced an incompatible response. Like Salter, he experimented with the induction of anger and sexual arousal before finally settling on a set of isometric exercises developed to help reduce stress in patients with heart conditions. This procedure, called progressive relaxation, consists of having patients alternately tense and relax different muscle groups in a systematic fashion and can lead to a state of profound relaxation. The isometric exercises could be paired with the presumably conditioned stimulus (whatever the patient feared) in order to have the new conditioned response (relaxation) override the existing arousal and distress that patients experienced in the presence of the phobic stimulus.

- Full Story - »»»    

Early Demonstrations in Humans

Early Demonstrations in Humans

J. B. Watson, one of the leading figures in American psychology, recognized the potential utility of classical conditioning as an explanation for the development of symptoms of psychopathology. Watson and a graduate student conducted a classic demonstration of how the principles of classical conditioning explicated by Pavlov could be extended to humans. In this study, Watson first showed that a 3-year-old boy called Little Albert had no particular aversion to a small white laboratory rat: He would reach for it and try to pet it, as young children are inclined to do. Watson and his assistant then placed a large gong out of sight behind Little Albert and sounded it loudly every time they brought the rat into the room. Although Little Albert had shown no initial aversion to the rat, he showed a typical startle response to the sounding of the gong (again, like most young children would). Before long, he began to become upset and burst into tears at the sight of the rat alone and would try to withdraw whenever it was brought into the room.

- Full Story - »»»    

Roots of Behavioral & Cognitive-Behavioral Interventions

Although their roots can be found at the beginning of the 20th century, modern behavioral and cognitive-behavioral therapies arose during the 1950s and early 1960s when the scientific study of behavior emerged as a subject with validity in its own right. Disordered behavior was no longer taken to be purely a symptom or indicator of something else going on in the mind. Of inherent concern was its relation to past and current environmental events thought to be causally related to that behavior. Methods developed in animal laboratories began to be tested—in laboratory, institutional, clinical, and school settings—with people who had chronic mental illness or mental retardation and with predelinquent adolescents. Improvements in patient behavior and functioning were often striking. These changes took place against a backdrop of growing dissatisfaction with the prevailing notion that psychopathology typically arose from unobservable psychic causes that were assessed and treated using techniques that seemed to be based more on art than science. In addition, an accumulating literature of outcome studies revealed that much of the psychotherapy as it had been practiced until the early 1960s engendered very modest and largely unpredictable results. Thus contemporary behavior therapies emerged from three distinct psychological traditions: classical or Pavlovian conditioning, instrumental or operant conditioning, and cognitive-behavioral and rational-emotive therapies.

- Full Story - »»»    

<< Back to main


Copyright © 2004-2005 Psychiatry.HealthSE.com. All Rights Reserved.