Cognitive behavioral theory and therapy

Fall 2002

 

Lizabeth Roemer, Ph.D.

Office: M-4-212

Phone: 287-6358

Office Hours: Tues, Thurs  1:00 – 2:30

 

Course Objectives and Format:  This course is designed to enhance students’ theoretical, empirical and practical understanding of cognitive-behavior therapy.  Readings and lectures will address behavioral theory, assessment (as it relates to treatment), and behavioral therapies.  Topics will include classic behavioral principles and therapies, information-processing, cognitive approaches to psychopathology, and more recent, integrative approaches in the behavioral tradition. In-class activities will include lectures, discussions, video and audiotape presentations as well as therapy simulations.  Although this course will in no way provide a comprehensive review of the behavioral tradition, it is intended to provide a comprehensive introduction to this area of psychotherapy which will prepare students to further explore behavioral therapies on their own and in subsequent supervised practica.

 

Books:  

Goldfried, M.R., & Davison, G.C. (1994). Clinical behavior therapy - 2nd Edition. New York: John Wiley & Sons.

 

Barlow, D.H. (Ed.) (2001). Clinical handbook of psychological disorders: A step-by-step treatment manual – 3rd Edition. New York: Guilford.

 

Linehan, M. (1993). Skills Training Manual for cognitive behavioral treatment of borderline personality disorder. New York: Guilford.

 

Additional readings will be included in a course packet.

 

Requirements:

 

1.  Case conceptualization 20%

            Early in the course, we will discuss basic principles of behavioral conceptualization. Using Goldfried & Davison chapter 3 as a model, you will be asked to conceptualize a case you are currently seeing or have seen in the past according to behavioral principles.  Students who haven’t begun to see cases yet should either choose a fictional character (from a book, TV show, or movie), make up a case, or see me for a case description to use. This is an exercise designed to give you practice thinking in behavioral terms; use it as an opportunity to try out functional analysis and to think about stimuli and consequences for an individual’s behavior.

Due: Feb 17th  

 

2.      Treatment plan   20%

            I will provide feedback on your conceptualization. Later in the semester, you will be asked to develop a cognitive-behavioral treatment plan for this individual. This should be a brief 2-3 page write-up in which you clearly define target behaviors and explain the rationale for the interventions you have chosen. Do not use the kitchen-sink approach. You should demonstrate your ability to make clinical decisions based on the client’s presentation and your conceptualization of the case.  You do not have to recommend traditional behavioral techniques (e.g., relaxation, exposure); you do have to provide behavioral explanations for the interventions you propose. You may also want to include a discussion of alternative approaches if the ones you suggest are not effective (and how you would know if they weren’t effective).

Due: April 20th  

 

3.      Basic research chapter presentation     10%

 

Throughout the course packet, there are chapters from a book (Learning and behavior therapy) in which learning researchers in the field summarize findings from basic research that relates to clinical behavior therapy.  Each of you will be assigned one chapter. On the day that chapter is due, students will be asked to do a brief presentation of key points of interest from the chapter. Presentations should be 10-20 minutes and very informal. I just want you to familiarize the rest of the class with the things you learned from the chapter.  Submit a list of the 5 topics you would most like to present on by February 20th  and I will email you all your assignments shortly after that.

 

The topics are:

 

Extinction: A review of theory and the evidence suggesting that memories are not erased with non-reinforcement

Observational and nonconscious learning

Learned helplessness

Drug conditioning and drug seeking behavior    

Learning and eating

Self-control

Choice and momentum

Rule-governed behavior

 

4.      Skills training        10%

            Students will choose one module of Linehan’s DBT Skills training and take responsibility for presenting it to the class and leading discussion during the week of  Dec 12th . Students will be expected to conduct the skills module using the class as a group in a role-play exercise. Students who choose the same topic will operate as co-therapists. Students need to submit a list of their top 3 choices for modules by April 20th  so assignments can be made.

 

5.   Final take-home exam         30%

 

On May 4th, a take-home exam will be distributed. Questions will be designed to promote the integration of course material and application of principles to real-life situations.  Exams will be due on May 18th.

 

6. Class participation      10%

 

I expect you to come to class each week having read and thought about the assigned reading. I would like you to share your reactions to the readings and to course material in class. Class is more enriching for everyone when you each bring your unique perspectives and experiences to class discussion.

 

 

Course outline

 

January 27   Introduction, review of syllabus, review of behavioral theory

 

Feb 3    Basic principles of cognitive-behavioral therapy

Goldfried & Davison Chapter 1-3

 

Excerpts from “Learning Theory and the Behavioral and Cognitive-Behavioral therapies.” From the Massachusetts Licensing Exam study materials (review if needed)

 

O’Donahue, W. (1998) Conditioning and third generation behavior therapy.  In W. O’Donahue (Ed.) Learning and behavior therapy (pp 1-14).  Boston: Allyn and Bacon.

 

Feb 10 The therapeutic relationship / functional analysis /early detection

 

Raue, P.J., Goldfried, M.R., Barkham, M.  (1997). The therapeutic alliance in psychodynamic-interpersonal and cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 65, 582-7.

 

Safran, J. & Segal, Z. (1990). Interpersonal Processes in Cognitive Therapy. New York: Basic Books.  Pp. 18-29.

 

Follette, W.C., Naugle, A. E., & Callaghan, G. M. (1996). A radical behavioral understanding of the therapeutic relationship in effecting change. Behavior Therapy, 27, 623-641.

 

Traux, P. (2002). Behavioral case conceptualization for adults. In M. Hersen (Ed.) Clinical behavior therapy (pp 3 –36). New York: Wiley & Sons.

 

Tanaka-Matsumi, J., Seiden, D.Y., Lam, K.N. (1996). The culturally informed functional assessment (CIFA) Interview: A strategy for cross-cultural behavioral practice. Cognitive and Behavioral Practice, 3, 215-233.

 

Feb 17 Relaxation, systematic desensitization

 

Wolpe, J.  (1995) Reciprocal Inhibition: Major agent of behavior change. In W. O'Donohue & L. Krasner (Eds.), Theories of behavior therapy,  (pp.23-58). Washington: American Psychological Association.

 

Borkovec, T. D. & Roemer, L. (1994). Generalized anxiety disorder.  In R. T. Ammerman & M.

Hersen (Eds.)  Handbook of prescriptive treatments for adults (pp. 261-281).  New York: Plenum.

 

Goldfried & Davison  Chapter 5 & 6

 

Feb 24 Learning theories of fear  - exposure based treatments

 

****Falls, W.A. (1998) Extinction: A review of theory and the evidence suggesting that memories are not erased with non-reinforcement. In W. O’Donahue (Ed.) Learning and behavior therapy. (pp205-229) Boston: Allyn and Bacon.

 

****Mineka, S. & Hamida, S. (1998) Observational and nonconscious learning. In W. O’Donahue (Ed.) Learning and behavior therapy. (pp 421-439)  Boston: Allyn and Bacon.

 

Kihlstrom, J.F. (1987). The cognitive unconscious. Science, 237, 1445-1452.  (optional)

 

Craske, M.G. & Barlow, D.H. (2001).  Panic disorder and agoraphobia.  In D.H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual  (3rd ed., pp. 1-59). New York: Guilford.

 

Foa, E. B., & Franklin, M. E. (2001).  Obsessive compulsive disorder. In D.H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual  (3rd ed., pp. 209-263). New York: Guilford.

 

March 2 Emotional-processing/cognitive approaches to treating anxiety disorders

 

Foa, E. B. & Kozak, M. J. (1986).  Emotional processing of fear: Exposure to corrective information.  Psychological Bulletin, 99, 20-35.

 

Jaycox, L. & Foa E.B. (1996). Obstacles in implementing exposure therapy for PTSD: Case discussions and practical solutions Clinical Psychology and Psychotherapy: An International Journal of Theory and Practice, 3, 176-184.

 

Meichenbaum, D. (1993) Changing conceptions of cognitive behavior modification: Retrospect and prospect. Journal of Consulting and Clinical Psychology, 61, 202-204.

 

Chambless, D. L, & Gills, M. M. (1993).  Cognitive therapy for anxiety disorders.  Journal of Consulting and Clinical Psychology, 61, 248-260.

 

Goldfried & Davison, Chapter 8

 

Roemer, L., Riggs, D.S., & Harrington, N.T. (In press). Behavioral/cognitive approaches to post-traumatic stress: Theory-driven, empirically based treatment. In C. Figley (Ed.), Brief treatments for the traumatized. Westport, CT: Greenwood.

 

March 9   Cognitive-behavioral approaches to depression

           

****Overmeier, J.B. & LoLordo, V. M. (1998). Learned helplessness. In W. O’Donahue (Ed.) Learning and behavior therapy. (pp 352-367)  Boston: Allyn and Bacon.

 

Jacobson, N. S., Dobson, K. S. Truax, P. A., Addis, M.E., Koerner, K., Gollan, J.K., Gortner, E., & Prince, S.E. (1996). A component analysis of cognitive-behavioral treatment for depression, Journal of Consulting and Clinical Psychology, 64, 295-304.

 

Hollon, S. D., Shelton, R. C., & Davis, D. D. (1993).  Cognitive therapy for depression:  Conceptual issues and clinical efficacy.  Journal of Consulting and Clinical Psychology, 61, 270-275.

 

Jacobson, N. S., Martell, C. R., Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8, 255-270.

 

Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Journal of Consulting and Clinical Psychology, 70, 275- 287.

 

Young, J.E., & Weinberger, A. D., Beck, A.T. (2001).  Cognitive therapy for depression. In D.H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual  (3rd  ed., pp. 264-308). New York: Guilford.

 

 

March 23           Eating behavior/ Behavioral rehearsal, operant procedures

 

****Davidson, T.L., & Benoit, S.C. (1998) Learning and eating. In W. O’Donahue (Ed.) Learning and behavior therapy. (pp 498-517)  Boston: Allyn and Bacon.

 

****Logue, A.W. (1998). Self-control. In W. O’Donahue (Ed.) Learning and behavior therapy. (pp 252-273)  Boston: Allyn and Bacon.

 

Wilson, G.T.,, & Pike, K.M. (2001). Eating disorders. In D.H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual  (3rd ed., pp. 332-375). New York: Guilford

 

**** Nevin, J.A. (1998). Choice and momentum. In W. O’Donahue (Ed.) Learning and behavior therapy. (pp 230-251)  Boston: Allyn and Bacon.

 

Goldfried & Davison     Chapters 7 & 10

 

Turk, C. L.,  Heimberg, R.G., & Hope, D. A. (2001).  Social anxiety disorder. In D.H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (2nd ed., pp. 99-136). New York: Guilford

 

March 30    Cognitive-behavioral approaches to treating addiction

 

Laws, D.R. (1995). A theory of relapse-prevention. In W. O'Donohue & L. Krasner (Eds.),  Theories of behavior therapy,  (pp.23-58). Washington: American Psychological Association.

 

Najavits, L. M. (in press). Seeking safety: A new psychotherapy for posttraumatic stress disorder and substance use disorder. In P. Ouimette & P. Brown (Eds.) Trauma and substance abuse: Causes, consequences and treatment of comorbid disorders. Washington DC: American Psychological Association Press.

           

McCrady, B. S. (1993). Alcoholism. In D.H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual  (2nd ed., pp. 362-396). New York: Guilford.

 

 

April 6         Interpersonal cognitive-behavioral approaches

 

Goldfried & Davison Chapter 14

 

Safran, J. & Segal, Z. (1990). Interpersonal Processes in Cognitive Therapy. New York: Basic Books.  Pp. 42-76.

 

Kohlenberg, R.J. & Tsai, M. (1995).  Functional analytic psychotherapy: A behavioral approach to intensive treatment. In W. O’Donohue & L. Krasner (Eds.),  Theories of behavior therapy  (pp. 637-658). Washington: American Psychological Association.

 

Newman, M. G., Castonguay, L. G., Borkovec, T. D., & Molnar, C. (in press). Integrative therapy for generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.) Generalized anxiety disorder: Advances in research and practice. New York: Guilford.

 

April 13 Integrating acceptance into cognitive-behavioral approaches

 

****Hayes, S. & Ju, W. (1998) Rule-governed behavior. In W. O’Donahue (Ed.) Learning and behavior therapy. (pp 374-391).  Boston: Allyn and Bacon.

 

Hayes, S. C., Strosahl, K. D., & Wilson, K. G.  (1999). Acceptance and commitment therapy: An experiential approach to behavior change (Chapter 3). New York: Guilford.

 

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness and the prevention of depression: A guide to the theory and practice of mindfulness-based cognitive therapy (Chapters 2 and 4). New York: Guilford.

 

Roemer, L., & Orsillo, S.M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 9, 54-68.

 

 

April 20  Acceptance and Mindfulness-based Cognitive –Behavioral Therapies

 

Hayes, S. C., Strosahl, K. D., & Wilson, K. G.  (1999). Acceptance and commitment therapy: An experiential approach to behavior change (Chapters5 and 8). New York: Guilford.

 

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness and the prevention of depression: A guide to the theory and practice of mindfulness-based cognitive therapy (Chapter 5). New York: Guilford.

 

Linehan, M.S., Cochran, B. N., & Kehrer, C.A. (2001).  Dialectical behavior therapy for borderline personality disorder. In D.H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual  (3rd  ed., pp. 470-522). New York: Guilford.

 

Wheeler, J. G., Christensen, A., & Jacobson, N.S. (2001).  Couple distress. In D.H. Barlow (Ed.),  Clinical handbook of psychological disorders: A step-by-step treatment manual  (3rd ed., pp. 470-522). New York: Guilford.

 

 

 

 

April 27 Cultural considerations in cognitive and behavior therapy

 

Review Tanaka-Matsumi et al. (above)

 

Hays, P. A. (1995). Multicultural applications of cognitive-behavior therapy. Professional Psychology: Research and Practice, 26, 309-315.

 

Renfrey, G. S. (1992). Cognitive behavior therapy and the Native American client. Behavior Therapy, 23, 321-341.

 

Organista, K. C., & Munoz, R. (1996). Cognitive behavioral therapy with Latinos. Cognitive and Behavioral Practice, 3, 255-270.

 

Teru Toyokawa, T., & Nedate, K. (1996). Application of cognitive behavior therapy to interpersonal problems: A case study of a Japanese female client. Cognitive and Behavioral Practice, 3, 289-302.

 

McNair, L. D. (1996). African American women and behavior therapy: Integrating theory, culture, and clinical practice. Cognitive and Behavioral Practice, 3, 337-350.

 

Fink, C. M., Turner, S. M., & Beidel, D. C. (1996). Culturally relevant factors in the behavioral treatment of social phobia: A case study. Journal of Anxiety Disorders, 10, 201-209.

 

 

 

May 4 & 11 Emotion and Interpersonal Skills Training 

 

Linehan, M. (1993). Skills Training Manual for cognitive behavioral treatment of borderline personality disorder. New York: Guilford.Pp. 38-58; 63-103.         

 

Cloitre, M., Koenen, K. C., Cohen, L., & Han, H. (in press). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology.