LECTURE SUMMARY
COGNITIVE BEHAVIORAL
INTERVENTIONS
2020/2021
, Table of contents
Lecture 1 Page 2
Lecture 2 Page 10
Lecture 3 Page 17
Lecture 4 Page 21
1
,Lecture 1 Exposure and cognitive restructuring
_____________________________________
Chapters: 4 and 6
Exposure therapy
Theoretical background
Exposure therapy is related to Pavlov’s
classical conditioning. In classical
conditioning, a conditioned stimulus
elicits a conditioned response after
conditioning. In this sample:
Unconditioned reflex ->
salivation if the dog eats food
Unconditioned stimulus (US) ->
food
Unconditioned response (UR)->
salivation
Conditioned stimulus (CS) -> bell
Conditioned response (CR) -> salivation
Classical Conditioning is a type of learning in which a stimulus acquires the
capacity to evoke a reflexive response that was originally evoked by a different
stimulus. The example with the dog showed that learning can influence behavior
in animals. John Watson replicated this research in humans. He conditioned a
baby to be scared of ‘fluffy’ things. Classical conditioning can lead to the onset of
(pathological) fear. The process of operant conditioning is needed to explain
the maintenance of fear (Skinner.)
Two factor model Mowrer
Mowrer placed classical and operant
conditioning in the same ‘learning-
model.’ Things are learned by paring
a stimulus with an action (e.g. dog
and dog bite.) This elicits a
conditioned response (e.g. fear) and
is called contiguous paring. The
neutral stimulus (dog) becomes a
conditioned stimulus and the
response is now a conditioned
response (fear.) This new fear
response becomes a new conditioned stimulus to certain behavior, here
avoidance. This
maintains the fear (avoidance learning.) All above
mentioned models are so-called ‘black box models.’
Certain stimuli evoke behaviours. What happens in between is unknown.
Emotional processing theory
These early learning accounts were expanded by integrating Lang’s concept of
2
, the ‘fear structure’ to create a comprehensive model for understanding
pathological anxiety. The fear structure is an anxiety memory in which
representations of stimuli, responses and meanings are stored. In anxiety
disorders, stimulus representations are linked to danger and/or other strong
responses. The emotional processing theory states that for this fear to
diminish, the person has to be confronted by the fear (form of exposure therapy.)
In effective therapy the fear-structure needs to be corrected. This is done in
several steps;
1. Fear-structure has to be activated (the patient must experience anxiety
during therapy)
2. New information, incompatible with the old information, must be
introduced in the fear structure.
Intervention
Exposure therapy
Exposure therapy purposefully
generates anxiety by exposing an
individual repeatedly to fear provoking
stimuli. When this stimuli is presented, it is
important that there are no aversive
outcomes (so a clown does not attack and
kill you when you see one.) This leads to
extinction through inhibitory learning. Both
the fair memory and the new memory
compete for retrieval in the work memory.
This is called retrieval competition. With
anxiety, a lot of people tend to avoid their fear inducing stimuli. This provides
short-term relieve of the anxiety, but the anxiety is maintained on the long term.
This is because the person does not learn that there is no negative outcome
related to the stimuli. The idea of exposure therapy is to learn that the stimuli is
not threatening. There are three types of exposure therapy;
1. In vivo exposure; exposure to the external feared stimuli
2. In vitro/imaginal exposure; exposure to the imaginal stimuli
3. Interoceptive exposure; exposure to physical (internal) stimuli
Effectiveness
Exposure therapy is effective for;
1. Specific phobia
2. Panic disorders; mostly interoceptive exposure
3. Social anxiety disorder; mostly combined with cognitive interventions
4. Generalized anxiety disorder
5. Obsessive compulsive disorder
6. Trauma (PTSD); exposure therapy in trauma related cases is debatable,
mostly focusses on diminishing the fear of related stimuli (e.g. all men with
beards, because you were attacked by a man with a beard.)
Variations in exposure therapy
1. Massed exposure vs spaced exposure
-> Maybe multiple hours a day for five days a week, or one hour only on
3
COGNITIVE BEHAVIORAL
INTERVENTIONS
2020/2021
, Table of contents
Lecture 1 Page 2
Lecture 2 Page 10
Lecture 3 Page 17
Lecture 4 Page 21
1
,Lecture 1 Exposure and cognitive restructuring
_____________________________________
Chapters: 4 and 6
Exposure therapy
Theoretical background
Exposure therapy is related to Pavlov’s
classical conditioning. In classical
conditioning, a conditioned stimulus
elicits a conditioned response after
conditioning. In this sample:
Unconditioned reflex ->
salivation if the dog eats food
Unconditioned stimulus (US) ->
food
Unconditioned response (UR)->
salivation
Conditioned stimulus (CS) -> bell
Conditioned response (CR) -> salivation
Classical Conditioning is a type of learning in which a stimulus acquires the
capacity to evoke a reflexive response that was originally evoked by a different
stimulus. The example with the dog showed that learning can influence behavior
in animals. John Watson replicated this research in humans. He conditioned a
baby to be scared of ‘fluffy’ things. Classical conditioning can lead to the onset of
(pathological) fear. The process of operant conditioning is needed to explain
the maintenance of fear (Skinner.)
Two factor model Mowrer
Mowrer placed classical and operant
conditioning in the same ‘learning-
model.’ Things are learned by paring
a stimulus with an action (e.g. dog
and dog bite.) This elicits a
conditioned response (e.g. fear) and
is called contiguous paring. The
neutral stimulus (dog) becomes a
conditioned stimulus and the
response is now a conditioned
response (fear.) This new fear
response becomes a new conditioned stimulus to certain behavior, here
avoidance. This
maintains the fear (avoidance learning.) All above
mentioned models are so-called ‘black box models.’
Certain stimuli evoke behaviours. What happens in between is unknown.
Emotional processing theory
These early learning accounts were expanded by integrating Lang’s concept of
2
, the ‘fear structure’ to create a comprehensive model for understanding
pathological anxiety. The fear structure is an anxiety memory in which
representations of stimuli, responses and meanings are stored. In anxiety
disorders, stimulus representations are linked to danger and/or other strong
responses. The emotional processing theory states that for this fear to
diminish, the person has to be confronted by the fear (form of exposure therapy.)
In effective therapy the fear-structure needs to be corrected. This is done in
several steps;
1. Fear-structure has to be activated (the patient must experience anxiety
during therapy)
2. New information, incompatible with the old information, must be
introduced in the fear structure.
Intervention
Exposure therapy
Exposure therapy purposefully
generates anxiety by exposing an
individual repeatedly to fear provoking
stimuli. When this stimuli is presented, it is
important that there are no aversive
outcomes (so a clown does not attack and
kill you when you see one.) This leads to
extinction through inhibitory learning. Both
the fair memory and the new memory
compete for retrieval in the work memory.
This is called retrieval competition. With
anxiety, a lot of people tend to avoid their fear inducing stimuli. This provides
short-term relieve of the anxiety, but the anxiety is maintained on the long term.
This is because the person does not learn that there is no negative outcome
related to the stimuli. The idea of exposure therapy is to learn that the stimuli is
not threatening. There are three types of exposure therapy;
1. In vivo exposure; exposure to the external feared stimuli
2. In vitro/imaginal exposure; exposure to the imaginal stimuli
3. Interoceptive exposure; exposure to physical (internal) stimuli
Effectiveness
Exposure therapy is effective for;
1. Specific phobia
2. Panic disorders; mostly interoceptive exposure
3. Social anxiety disorder; mostly combined with cognitive interventions
4. Generalized anxiety disorder
5. Obsessive compulsive disorder
6. Trauma (PTSD); exposure therapy in trauma related cases is debatable,
mostly focusses on diminishing the fear of related stimuli (e.g. all men with
beards, because you were attacked by a man with a beard.)
Variations in exposure therapy
1. Massed exposure vs spaced exposure
-> Maybe multiple hours a day for five days a week, or one hour only on
3
