6. Clinical psychologies
• Why does a person suffer?
• How does a person ought to live life?
• How can you predict and control it?
Dynamic Humanistic Behavioral
Systemic
Family therapy
7. Behavior therapy vs. CBT
1800 1920s 1950s 1960s 1970s 1980s 1990s 2000s
1895 1920 1958 1969 1971 1982 1991
Angst
Neurosis
Freud S.
Logotherapy
(paradoxical intention,
end persistent self-
observation) Frankle V.
Systematic
desensitization
Wolpe J.
Exposure
Marks IM
Stress Inoculation Training
Michenbaum D.
Mindfulness
stress reduction
Kabat-Zinn J.
Meta-CT
Wells A.
1926 1959 1971 1983 1991
神経衰弱及び強迫観念
の根治法 森田正馬
Behavior therapy
Eysenck H.J.
Problem solving therapy
D'Zurilla, Goldfried
Motivational
Interviewing
Miller MR.
Functional Analytic
Psychotherapy
Kohlenberg, R. J. &
Tsai, M
1930 1956 1971 1993
Behaviorism Watson JB Applied behavior
analysis for chronic
psychotic patients
Skinner BF
Anxiety Management training
Suinn, Richardson
DBT
Linehan MM
1962 1971 1999
REBT
Ellis A.
Covert conditioning
Cautela JR
Acceptance &
Commitment
Therapy Hayes SC
1963 1977
CT
Beck AT
CBT
Michenbaum D.
1976
Multimodal behavior therapy
Lazarus A.
1st generation BT
2nd
gener
ation
3rd generation
8. Progress of ABA
B FSkinner Richard Herrnstein David Premack
Robert Rescorla Daniel Kahnemann
Steve Hayes
Ai
9.
10. Something Lost, Something Gained
• BT has evolved (and in some ways devolved)
• Less “deep knowledge” of learning, behaviorism
• Less understanding of process variables, i.e., mechanisms of
change
• More risk averse
• On positive note, wider range of ideas in Third Wave BT
11. Who were the Major Founders?
1) B.F. Skinner, Ph.D. Harvard (operant conditioning)
2) Joseph Wolpe, M.D. South Africa, Pepperdine (systematic
desensitization/reciprocal inhibition)
3) Albert Ellis, Private Practice NYC (cognitive restructuring)
1) Critique—not based on cognitive psychology
13. Other Very Important Founders
• Hans Eysenck
• Ogden Lindsley
• Arnold Lazarus
• Isaac Marks (English)
• Leonard Krasner/Leonard Ullmann
• Walter Mischel
• Gordon Paul
• Stewart Agras
• Nathan Azrin/Donald Baer/Todd Risley/Montrose Wolf
• David Barlow
14. Key Universities of Founders
• Harvard (Skinner)
• Columbia (Nate Schoenfeld)
• Iowa (Hullian/Spence)
• Stanford (Bandura)
15. Second Wave Universities
(key examples)
• Illinois
• Kansas
• Washington
• Indiana
• SUNY Stony Brook
• West Virginia
• Georgia
• Western Michigan
• Rutgers
• Penn State
16. Key Characteristics of Founders
1) Iconoclastic and not risk
averse
• Taking on psychoanalysis
2) Committed to Science
• Although diverse views of
science
• Particularly CT v. ABA
3) Committed to
Behaviorisms
--Variety of behaviorisms
4) Knew Learning Theory
and Research
5) Committed to a Social
Mission
Deplorable state of care of
“mentally ill”
6) They had fun doing this
17. Differences from Contemporary BT
• Properties 3 & 4 much less frequently found
• 1) is also less found
• 2) is found less; less commitment to process research
• Third Wave BT uses different set of ideas
• Mindfulness
• Validation
• Acceptance and Commitment not from learning or cognitive
psychology
18. Major Concern: Less “Deep Knowledge”
• Particularly about learning principles/research
• Distance between learning research and BT
• Relative disuse of Behavior Economics, Matching Law, Deprivation
Analysis, Recent advance of comparative cognitive science
20. What is CBT?
Popular CBT
Cognition
Behavior
Environment
Behavior Therapy
Cognition
Behavior
Environment
21. What is Behavior Therapy
• Application of learning theory to problem behaviors in general
• Applied not only to human but to other animals.
• Behavior Therapy is a general term
• Applied Behavior Analysis
• Behavior Modification
• Behavior Therapy
• Cognitive Therapy
• Cognitive Behavior Therapy
• 3rd generation (wave) Behavior Therapy
23. 1st generation
• 50s
•Respondent Behavior Therapy：
• Emotion, Anxiety, Feeling, Drive
•Operant Behavior Therapy：
• Community Reinforcement Approach for
alcoholism
• Autistic children
•Integration of two theories
24. HJ Eysenck
• Rebuttal against psychoanalysis
• Is it ok to assume some unconsciousness mind as a basic reason of
problem behavior?
• Treatment effects? Randomized Placebo controlled trials
• TX should be;
• Based on sound evidences, scientific skepticism
• Human behaviors;
• Are mostly learned behaviors
25. 1st generation：respondent Behavior Therapy
• Why does a person suffer from “mental illness”？
• Because he/she has unbearable “negative feelings.”
• Where do “negative feelings” come from？
• Something makes him/her feel negative
Stimulus（S）→Response（R）
26. 1st generation：respondent Behavior Therapy
•Respondent theory、S-R theory
•Stimulus（S）→Behavior（R）
• A news of epidemics → Fear
• In the public → Anxiety, Physical response
• Poop → Disgust、Contamination
• “Context effects on conditioning, extinction, and
reinstatement”?
27. 1st generation：respondent Behavior Therapy
• Then, that something should be stopped making him/her feel
negative！
• Goals of treatment
• Stopping or reducing Response（R）to Stimulus（S）
• Essence：Magnitude of emotion changes over time（Rule
of emotion）
• Tx
• Exposure, Flooding, Implosion
• Systematic Desensitization
• Reciprocal Inhibition
• Eating, Sexual arousal, Assertion, Muscle relaxation, Humor
28. 1st generation：operant Behavior Therapy
• Why does a person suffer from “mental illness”？
• Because he/she shows problem behavior（Or, does
not show adaptive behavior）
• Why does problem behavior occur？
• Because “environment” supports the behavior（B）！
• Environment？
• Antecedent of the behavior (A）and the consequence
of the behavior（C）
A→B→C
Context（Preceding Stimulus）→Behavior→ Consequence Stimulus
Philosophy：Living creatures(human)are actively trying to
change their environment. They are not passive.
29. 1st generation：operant Behavior Therapy
•Problem behavior
• Context → Avoidance → Consequence
Party gathering → Leave early → Silent environment
（Anxiety） （Release of anxiety）
30. 1st generation：operant Behavior Therapy
•Tx
• Then, how can you resolve problem behavior？
• Behavior is supported by its environment. So if you
change the environment, the problem behavior will be
changed.
• In detail, identify the context and antecedent (A)of the
problem behavior, and change the consequence(C).
This will make the behavior (B）modified and by
repeating the process, this will make a new behavior
shaped (shaping.)
Consequence changes the cause: reversal idea
Modern learning theory is “Behavioral Selection”
similar to modern Darwinism
31. 1st generation：operant Behavior Therapy
• Tx technique
• Change Anteceding Stimulus：Stimulus control
• Change consequence：Contingency management，
Reinforcement schedule
• Shaping, prompting, Chaining
• As a package
• Behavioral Activation (Pleasant Event Schedule)
• Community Reinforcement Approach
• Token Economy, Behavioral Contracts
• Social skills training
32. Behavioral contingency
• Difference from folk psychology
• Similar to Evolution Theory
• Naïve evolution theory, Survival of the fittest, evolution = progress
• Neo-Darwinism, Survival of the luckiest, Natural selection
33. Four behavioral contingency
Basic behavioral contingency
Appearance Disappearance
Reinfo
rcer
Reinforcement by
appearance of reinforcer
↑
Extinction by disappearance
of reinfocer
↓
Punish
er
Punishment by appearance of
punisher
↓
Reinforcement by
disappearance of punisher
↑
34. Criticism against 1st generation
• Respondent and operant theories are too simple
• Human behavior is not limited only to physical reaction,
emotion, covert behavior
• Pascal said “Man is a thinking reed.”
• We should focus on Cognition, thinking, and mind
• Controlling human by consequence like food (Token, points,
or money)is challenging the human dignity.
37. 2nd generation：Cognitive Behavior Therapy
• Mid ６０ s
• Focus on human Cognition（Mind and thinking）
• Pathological theories (Causal model)
• The reason of mental suffering, such as anxiety or problem
behaviors is the existence of “negative Cognition”
• “Negative Cognition” is the fundamental reason of suffering
• Tx
• Great, Easy to understand! Then, you should eliminate bad
Cognition, and get well！
• Right on！If you control ”How I think,” you will get better.
As congruent to folk psychology, every body jumped in
Bad Cognition(reason)→bad illness
Removal of the reason→cure
This made Behavior Therapy disseminate into Psychiatry
40. Cognitive Behavior Therapy
• Tx technique
• Concurrent use of 1st generation Behavior Therapy techniques
• So this is not “Cognitive therapy” but “Cognitive Behavior Therapy”
• Technique unique to Cognitive modification (1st generation BT
did not have）
• Cognitive Restructuring, Four columns
• Challenging Cognition Collaborative empiricism
• Realistic？Theoretical? Evidence？Counter-evidence？Adaptive？
• Problem solution training, coping skills training
• If you experience negative cognition, you can stop or modify it
• Thought Stopping, Self Instruction, Decisional Balancing, Graph method
(responsibility), Distraction of attention
41. 2nd generation
• Cognitive Behavior Therapy tries to control not only emotion
and behavior, but “Cognition” too.
• Thus Cognitive Behavior Therapy works better than 1st
generation and has broader applications including Mood
disorder, Anxiety disorder, Psychotic disorders etc.
Depending on the diagnostic categories, CBT postulates proprietary bad Cognitions
(Cognitive models of specific diseases)
In the case of OCD：
TAF(Thought Action Fusion), Intrusive Thoughts, Overestimates of responsibility
42. Challenge against 2nd generation
• Hmm, yes, but？
• Can you eliminate bad Cognition（Mind, thinking) entirely？
• Is bad Cognition always bad？
• E.g. “I am a bad boy” may make you feel miserable, but sometimes not.
• Even if you think “I have touched a dirty staff,” you may not wash your hands.
• And paradoxically, if you try to think like “No, I don’t think about that” “As
this is bad cognition, I should never think this,” you think them more often.
• Can we really control our Cognition?
• Negative cognition, pathological Cognition (TAF found in OCD) are not
unique to people suffering from mental illness. Normal healthy people
have some of them too.
• Why does Cognitive Behavior Therapy work？
• Cognitive Theory are just one of the hypothesis of pathogenesis. Just like
decades old monoamine hypothesis of major depression.
43. 3rd Generation：Acceptance
• Late 80s
• Focus on human Cognition, and mind
• But does not try to eliminate “bad” cognition, but modify the
function (consequence) of the cognition.
Behavior analysis of language
Rule governed behavior
Moment to moment behavior analysis
Functional Analysis
44. 3rd generation：Acceptance
• Review of 2nd generation behavior theories
1. Bad Cognition、Emotion → problem behavior
2. Eliminate or modify Bad Cognition
3. No more Bad Cognition → no problem
45. 3rd generation：
• Honestly, it is impossible to eliminate “causal or bad Cognition.”
• And controlling intentionally one’s own emotion is also impossible
• Thus, let’s abandon the thought or intention to eliminate or control bad
cognitions of emotions
• We don’t need to eliminate Band or negative Cognition
• Cognition is originally neutral. It is neither bad or good.
• We, human, arbitrary attach a label on the cognition.
• Bad Cognition is not intrinsically bad.
• break the magic spell of “bad Cognition” of the “bad”, and stop
obsessing about Cognition
• “Not obsessed "is, even if you think or feel something bad, you just
accept them as it is, and don’t try to change them (problem behavior,
avoidance, rituals)
46. 3rd generation：
The reason of psychopathology
• Feeling bad or thinking bad are not pathological
• The real pathology is being obsessed with something looks
like pathological, and trying to eliminate or control them
Behavioral Flexibility
• Trying to eliminate or control it makes your behavior
repertoire narrow. You cannot engage more positive /
productive behaviors.
• Narrowing behavioral repertoire is pathological.
48. 3rd generation：
• In detail
• ACT is
• Accepting suffering（Acceptance)
• Engaging to positive activities（Commitment)
• This can be explained by simple A-B-C
contingency
A－B－C
49. 3rd generation：Acceptance based
Cognitive Behavior Therapy
• Intervention to help accepting suffering
• Intervention to the obsessed view（Decrease the function of the unconstructive
rules）：
• Cognitive Defusion（Modifying the function of the Cognition）
• Intervention to the avoidance (experiential avoidance)
• Experience the paradox of experiential avoidance
• Reinforce experiencing thoughts and emotions as they are（Acceptance）
• New self experience
• Self as a context where private events occur
• Intervention to make life more valuable
• Discover and reinstate values, （Reinforce productive rule governed behavior）
• Facilitate behaviors congruent with his/her values （Behavioral Activation）
51. Shaping game
• Preparation
• Choose one animal from the audience
• The animal is put out of the room. Remaining are trainers
• Decide the specific behaviors to shape
• Writing one’s name on the white board, Standing on the chair, Standing in front of the room
• Jumping, Push up, Raise both one’s arms.
• After the decision is made, the animal is allowed to enter the room
• Trainers role
• If the animal acts behaviors which is close to the target behavior, reinforce with
clap.
• If clapping did not work for several times, the animal returns to the entrance of
the room
• Please don’t do these
• Make any vocal sign, chuckle, wink, discussing between trainers
