CHAPTER 7
THE PRINCIPLES OF COGNITIVE AND BEHAVIORAL
CHANGE STRATEGIES
Table of Contents
CHAPTER 7
THE PRINCIPLES OF COGNITIVE AND BEHAVIORAL
CHANGE STRATEGIES
 | note that the exercise is essentially a behavioral change
 | process goals: participation for fun |
| outcome goals: weight reduction, better
cardiovascular function |
|
| very important to note the three components of attitude
(cognitive, affective and behavioral) and to have some
familiarity with cognitive-behavioral strategies |
| major approaches:
| classical conditioning |
| Operant conditioning |
| cognitive-behavioral approaches |
| social cognitive theory |
|
| useful in stopping undesirable behaviors and in
encouraging adaptive behaviors
| note that the two behaviors must be incompatible
with each other |
|
| Pavlov, 1920's: conditioned reflex (specific unlearned
reaction mediated by the ANS and elicited by a stimulus)
| probably involved in development of fear and
anxiety associated with exercise (e.g. dog bite
while running) |
| to reduce fear, the exercise behavior should be
paired with (e.g. no dog bite) |
| best used with unlearned innate reflexes...modern
examples:
 | systematic desensitization |
| progressive relaxation |
|
|
| Wolpe, 1950's: use of relaxation to suppress anxiety
| counterconditioning: substitute relaxation in
place of the anxiety response (cannot be both
anxious and relaxed at the same time) |
|
| steps:
| relaxation training |
| creation of an anxiety hierarchy |
| actual desensitization |
|
| Jacobson, 1938: progressive muscle relaxation through
systematic tightening and then relaxing of about 14
different muscle groups |
| see Table 7.1 (pg. 114) |
Creating an Anxiety Hierarchy
list things which cause anxiety (SUDS - subjective units of
distress scale)
approximately 20-25
items should be on a relatively equally graduated scale
| relaxation therapy and then reintroduction of each
successively worse anxiety item
| scene presented 3-4 X for 5-10 sec |
| 3-4 scenes/session, session 30 min - 1 hr. |
| later useful to put the client into a real life
situation |
|
| Carnwath & Miller, 1986: when not to use systematic
desensitization:
| when suppressed emotions could become
uncontrolled |
| when muscular relaxation could cause pain or
interfere with recent surgery |
| when there is some type of personality disorder |
| when medical conditions require (e.g. epilepsy) |
|
| focus on behavior and its consequences
| secondary reinforcers most commonly used in
everyday behavior (e.g. money vs food) |
|
| model assumes that antecedent conditions result in some
target behavior which has consequences affecting whether
or not the behavior will continue |
| discriminative stimuli or prompts:
| e.g. driving on the right side of the road at
night |
| e.g. stopping at a stop light when there is
nobody else there |
|
| both of the above contain a warning that something might
be there (e.g. another car coming) |
| antecedent cues warn of the possibility of a potentially
forthcoming consequence
| antecedent cues are not reinforcers |
|
| examples of antecedent cues in exercise (i.e. they
facilitate the occurrence of exercise:
| facilities and equipment |
| dressing for exercise |
| making plans with a friend to go to a class |
|
| note that some antecedent cues facilitate behaviors which
compete with exercise
| in addition, some cues built into a class
situation, do not transfer to the individual
situation (cannot exercise by oneself) |
|
| a method of attempting to "scoop" antecedent
conditions...or to substitute some other set of
antecedent conditions for a set which is causing trouble |
| stimulus control can be used either to reduce undesirable
behaviors or encourage desirable ones
| e.g. person missing a noon exercise class because
(s)he wants to socialize with colleagues...let
her/him miss the class, but eat alone...more fun
to go to class |
|
| Karoly and Harris, 1986: how to apply stimulus control:
| identify the anticipatory links between
antecedent cues and the desirable behavior |
| identify antecedent cues for undesirable behavior |
| remove (via fading or negative reinforcement) the
cues for inappropriate behavior |
| strengthen cues for appropriate behavior |
| teach client to recognize cues which have strong
associations with undesirable behaviors |
|
| can be either reinforcement or punishment
| event that increases behavior is a reinforcement |
| event that decreases behavior is a punishment |
|
| note figure 7.2 pg. 117 (Instructor's note: substitute
diagram presented separately) |
| e.g. praise and encouragement, documentation of
improvements, self-observation of positive changes |
| note that a reinforcer for one person may not be a
reinforcer for another
| ask the client |
|
| e.g. elimination of lack of energy, relief from tension,
reduction in self-consciousness |
| negative reinforcement increases the frequency of
occurrence of a behavior |
| stress and tension from noncompliance, weight gain,
difficulty exercising because of muscle pain |
| punishment is not particularly advised for fitness
programs...creates negative feelings
| if used, should only be used to stop undesirable
behaviors |
|
| e.g. loss of social contact when not at exercise class,
falling behind in place in goal-setting charts |
| removal of consequences if a behavior continues...results
in the reduction of that behavior (e.g. leaving weights
lying around in a weight room) |
Social Reinforcement
| a social consequence which affects future behaviors
| can be positive or negative |
|
| probably best to minimize criticism and maximize praise |
| Presbie & Brown, 1977: re how to make verbal praise
more effective:
| keep a record of how many verbal praises are
given to a person...go for 15X in 30 min. |
| praise students equally |
| praise behaviors as well as students |
| ignore inappropriate behavior unless dangerous or
really disruptive |
| try for 5X more positive statements than negative
ones |
|
Operant Techniques Applied to
Exercise Settings
| making oneself or others do undesirable things before
getting desirable ones (e.g. I can't go out until I
finish my studying.) |
| written statements of behaviors which will be done and
the rewards which will be given |
| Kirschenbaum & Flanery, 1983: have to include
expectations, responsibilities and contingencies for
behavioral change |
| Kanfer & Gaelic, 1986:
| clear description of target behavior |
| time criterion for completion |
| specific positive reinforcements and punishments
identified |
| bonus clause for over-achievement (i.e. the
reward) |
| a means for measuring progress |
| time criterion for administration of
reinforcement contingencies |
|
| Dunber et al, 1979: Why are contracts effective?
| involves the client in the process |
| written contract cannot be forgotten, cheated
upon, etc. |
| public commitment > private commitment |
| goal attainment can establish an incentive
situation |
|
| everyone contributes, winner takes all
| e.g. Wing et al, 1980: lottery group subjects
exercised better than non-lottery subjects even
though the exercise regimen only allowed them the
chance to win the lottery |
|
| Karoly & Harris, 1986: re use of Operant techniques:
| consequences soon after behavior |
| tangible reinforcements used only early |
| over time, reduce the desired exercise frequency
and duration |
| written contracts |
| public posting of goals and goal achievement |
| incentives from exercise behavior outcomes - not
attendance |
| group contracts > individual contracts |
| personal feedback > group feedback |
|
Developing and Implementing an
Operant Program
| from Snyder, 1989: |
| describe problem |
| identify target behavior |
| identify antecedent cues |
| identify environmental cues |
| identify consequences |
Program Development and Implementation
| identify antecedent cues & environmental stimuli
incompatible with undesirable ones |
| construct a set of consequences (positive reinforcement,
contingency management, negative reinforcement) |
| monitor target behavior |
| help client identify other contingencies |
| evaluate effectiveness |
| do 3 month, 6 month and 1 year follow-ups |
| main idea is that while behaviorism is a good approach to
changing behavior, it should be modified to include
thinking |
| assumes:
| cognitive activity affects behavior |
| cognitive activity can be altered |
| cognitive change can cause behavioral change |
| furthermore:
| all behavior involves cognition |
| cognition affects how people perceive the
world |
| therapy which does not involve how people
see the world (i.e. cognition) will not
work |
|
|
| from Meichenbaum, 1974, 1986: importance of covert speech
and internal dialogue
| cognitive-behavioral modification model (CBM)
| teaches people to modify self-statements
which are negative |
|
|
| concepts:
| cognitive events happen when we make a decision,
anticipate some emotional experience or learn a
new skill |
| cognitive process is how people process
information
| automatic and unique to the individual |
|
| cognitive structures are beliefs and assumptions
which influence how an individual sees the world |
|
Phase I. Conceptualization of the Problem
| leader helps client to explore and defines all aspects of
the problem |
| leader helps client to use situational analysis to
identify:
| precedent events to the problem |
| typical problem situation |
| people involved |
| stressors |
| reinforcements |
| general consequences of the event |
| client makes notes recalling all thoughts,
feelings, anxieties and self-statements |
|
Phase II. "Trying On" the
Conceptualization
| leader and client identify the relationship between
self-talk and problem |
| leader shows how self-talk is causing negative effects |
| leader and client reconceptualize the situation |
Phase III. Modifying Cognitions and
Producing New Behaviors
| whole idea is to develop constructive (as opposed to
destructive) cognitions |
| new dialogues should be:
| realistic |
| interventions made at cognitive event (e.g. I'll
never be able to do this), cognitive process
(e.g. If I can't do this I'm a failure) and/or
cognitive structure (I can't do anything right) |
|
| Ellis, 1962: assumption that psychological problems arise
from irrational thinking |
| ABCDE paradigm:
| A: events do not cause emotional disturbances |
| B: beliefs about what an event means cause
emotional problems |
| C: leader should determine what event triggered
the reaction, what the person's belief is and |
| D: dispute the irrational belief(s) |
| E: this leads to a positive effect |
|
| Haaga & Davison, 1986: four categories of irrational
beliefs:
| awfulizing: making the situation worse than it
really is |
| shoulds, oughts and musts: believing that we
"deserve" what everyone else has |
| comparative evaluation: equating personal worth
with behavior |
| need statements: elevation of wishes to needs |
|
Beck's Cognitive Therapy
| Beck, 1976: concept of cognitive distortions:
| personalization - blaming oneself for external
events |
| polarized thinking - thinking in absolutes |
| selective abstraction - focusing only on a
negative |
| arbitrary inference - drawing negative inference
from no data |
| overgeneralization - sweeping conclusions from
minimum data |
| magnification - perceiving minor things to be
important |
| minimizing - discounting positive accomplishments |
|
| same general therapeutic procedure as Meichenbaum, except
| in conceptualization phase, try some reality test
in which the truth of various thoughts can be
established |
| establish why one has underlying beliefs which
maintain automatic thoughts |
|
| leader should be able to recognize situations in which
automatic thinking could be involved |
| client is primarily responsible for the change process
| ...therefore client must have a strong motivation
for change |
| instructor is only a motivator or advisor |
|
| Kanfer, 1970 re stages in self-management: |
| focus on behavior |
| establishment of criteria by which to evaluate behavior
(criteria from self and significant others) |
| self-evaluation of what behavior is against what it
should be |
| if OK, no action; if incongruence, client develops
strategies for changing behavior |
| instructor very important in providing motivational
support |
| Snyder, 1989: forgoing a short-term reinforcement in
order to avoid negative long-term consequences
| e.g. avoiding high-cholesterol foods |
|
| long-term positive consequences > short-term positive
consequences |
| pay attention to frequency, intensity and duration of
behaviors
| e.g. Schacter, 1971: overweight Ss who reported
eating a certain amount of food and who were
subsequently fed exactly that much food, all lost
weight (...therefore underestimation of food
eaten) |
|
| record-keeping of antecedent, concurrent and
consequential factors |
| Snyder, 1989 re steps which facilitate self-observation:
| emphasize the importance of this phase |
| be specific about behavior to be logged |
| help client to identify a workable way to log
behavior |
| role-playing/rehearsal of behavior observation
process |
| start with simple behaviors, complex later |
| help client determine time/setting in which to
record behavior |
| keep in touch initially |
| meet with client to identify antecedents and
consequences |
| start the treatment (short- and long-term goals) |
|
| Tomarken & Kirschenbaum, 1982 re factors aiding in
successful self-regulation:
| record problem behavior, not successful behavior |
|
| process by which individuals design and administer their
own reinforcement program |
| Kanfer, 1975 re steps for designing a self-reinforcement
program:
| identify positive reinforcers |
| define the specific target behavior,
reinforcement contingencies and
self-reinforcement plan |
| instructor and client rehearse the
self-reinforcement procedure (e.g. steps,
possible obstacles) |
| instructor helps client to modify reinforcement
contingencies as situation changes |
|
| point that all people formulate explanations for the
cause of events and behaviors...however if some people
consistently attribute the cause of behavior to a certain
source, it is an attribution theory approach |
| Ross, 1977: people have consistent distortion tendencies:
| tendency to believe that behavior of others is
under control of personality factors
(dispositional factors) |
| tendency to believe that behavior of oneself is
under the control of situational factors |
|
| Weiner, 1979, 1986: three-dimensional attribution theory:
| internality vs externality:
| internal = physical ability; external =
exercise setting |
|
| stability vs instability:
| stability = personality; instability =
mood, fatigue |
|
| controllability vs uncontrollability:
| controllability = effort, commitment;
uncontrollability = fatigue, aptitude |
|
|
| point is that if someone uses words/concepts like mood,
fatigue, luck and chance to explain his/her behavior,
(s)he is attributing things to be outside of personal
control |
| another point is that sometimes it is useful for the
leader to help change the attribution...e.g. Forsterling,
1980:
| someone who feels that lack of progress is due to
lack of physical ability...instructor notes that
not enough effort was given (internal-stable
-> internal-unstable) |
| someone who will not join a class because of past
sport/exercise failures...instructor advises that
earlier experience was the exception to the rule
(internal stable -> external-stable) |
| someone pushes him/herself too hard because of
fear that stopping will result in
failure...instructor points out how far (s)he has
already gone (internal-unstable ->
internal-stable) |
| someone is overly confident that weight loss is
simply a matter of proper dieting...instructor
reminds him/her that weight loss is not 100%
predictable (internal-unstable ->
external-unstable) |
|
| from Bandura & Walters, 1963: principles of social
learning
| personal, environmental and behavioral factors
mutually influence one another |
| observation of a model can greatly assist
learning |
|
| Bandura, 1977: more learning is done from watching others
that from getting reinforcement ourselves
| can't possibly get all experience ourselves |
| watching others is easy...no cost |
|
| application in fitness is that it is "almost"
good enough to just be a good model...people will figure
out for themselves that it pays to be "just like
you"
| in addition, watching classmates helps to learn
what, when, where and how to exercise |
|
Basic Processes of Observational Learning
| since we don't learn all we see, there must be some
principles which regulate our ability to use social
learning |
| things which can affect our attention to copy a model
include:
| selective attention (we only see what we want to
see) |
| cognitive skills (if we do not understand
something, it does not exist) |
| behavior which does not mean anything to us is
not perceived |
| ugly behavior (or ugly models) is/are not copied |
| no model = no modeling |
|
| we have to be able to remember things after the model is
gone, so use some type of symbolic representation to do
so |
| sometimes mistakes are made (e.g. copying someone's dress
code instead of their actions) |
| we practice what we believe we have seen...this is often
difficult so we need feedback as to how well we are
doing...instructor is important here |
| principles of reward govern in large part, whether the
behavior acquired through modeling will be exhibited |
Enhancement of Acquisition of New
Behaviors and Performance
| how can an instructor best use social learning theory in
a fitness setting (a la Perry & Furukawa, 1986)? |
| similar to observer (sex, age, race, attitudes) |
| having a little higher prestige than observer |
| having a little more competence (e.g. vs highly
competent) |
| having ability to exude warmth and nurturance |
| a friend > a stranger |
| personal characteristics (e.g. dependency, self-esteem,
SES, gender) |
Characteristics of the Observer
| (ideally) having the ability to process and retain
information |
| having a little uncertainty (creates higher attention
level) |
| having moderate (as opposed to high) anxiety |
Characteristics of the Modeling
Presentation
| live models are best |
| tape, film, audio and scripts = symbolic models...but the
presentation has to be edited well |
| multiple models can show variability |
| might be a good strategy to show the model overcoming
obstacles and increasing his/her ability to cope |
| some motor skills can be broken into parts...therefore
model the parts in isolation |
Factors That Enhance Performance
| use incentives:
| vicarious reinforcement: let the observer see the
model being rewarded |
| direct reinforcement: reward the observer
reproducing the model's behavior |
|
| how to improve performance:
| active rehearsal: watch and reproduce |
| feedback: cannot learn easily without some type
of feedback |
| participant modeling: model interacts directly
with observer |
|
| Bandura, 1977: belief that one is capable of doing
something
| self-efficacy hypothesized to be fundamental to
lifestyle change |
| behavioral change dependent upon self-efficacy
expectations and outcome expectations |
|
| Bandura, 1986: four sources of information which affect
self-efficacy:
| enactive experience: behaviors successfully done
in the past |
| vicarious experience: observing someone else do
the behavior |
| verbal persuasion: ability to talk oneself into
doing something |
| physiological states: e.g. high arousal decreases
ability to convince oneself that something is
possible |
|
| how to determine one's self-efficacy level (from Bandura,
1977):
| ask him/her if (s)he thinks that a behavior can
be done (by anyone)
| ask him/her if (s)he thinks (s)he can do
it |
|
|
| note that behaviors which one thinks he/she can do, may
nonetheless be not done if one believes the behaviors
have no possibility of achieving some desired outcome
(e.g. weight loss) |
| Kaplan et al, 1984 found that being able to walk for
exercise increased participants self-determined
capability of doing future walking |
| from Marlatt & Gordon, 1980, 1985: relapse prevention
model
| originally concerned with addictive behaviors
(NOTE: In addiction the goal is to reduce
frequent undesirable behaviors while the goal in
adherence is to increase infrequent desirable
behaviors.) |
|
| note that a lapse may or may not lead to relapse
| first: high-risk situation |
| then: maybe coping or non-coping |
| coping = increase in self-efficacy |
| non-coping = lower self-efficacy + short-term
reinforcement from substance use |
|
| abstinence violation effect: belief that abstinence, once
broken, always leads to relapse
| creation of "all-or-none" requirement
(loss of feeling of control) |
| any "failure" results in guilt,
self-blame and lowered self-esteem |
|
Predictors of Lapse and Relapse
| Cummings et al, 1980: stress, depression and anxiety =
30% of relapses |
| could be that as in partial-reinforcement effect (i.e.
partially rewarding a behavior results in slower
acquisition of the behavior) early compliance leads to
more likelihood of problems after a slip |
| e.g. spouses, self-help groups (Alcoholics Anonymous) |
| ...but environmental cues are also involved in relapse
(e.g. social pressure, social cues)...pick your friends! |
| some things are more physiologically addictive than
others (e.g. smoking vs eating) |
Stage 1: Motivation and Commitment
| find out who is committed and who is not (e.g.
deposit-refund system) |
| instructor should attempt to help improve motivation:
| contracts |
| goal setting (distal and proximal) |
| planned leisure activities (social reinforcers) |
|
Stage 2: Initial Behavior Change
| learn to understand what is involved in the lapse/relapse
process |
| skill improvement techniques:
| decision making skills (e.g. decision balance
sheet) |
| coping skills (e.g. reminder cards on what to do
when something bad happens) |
| cognitive restructuring (e.g. attributing the
mistake to the situation instead of oneself) |
|
| teach client how to monitor their own behavior and to
self-administer an intervention |
| encourage social support |
| rather than stopping an undesirable behavior (e.g.
overeating) encourage a desirable one (e.g. exercising) |
Relapse Prevention Applied to
Exercise Settings
| Martin & Dubbert, 1984 re findings specifically
applied to exercise settings:
| lots of chances for lapses...teach people to
expect them |
| teach people to watch out for the abstinence
violation effect...use the new Participaction
theme (anything is better than nothing!) |
| teach people to avoid high-risk situations (over
commitment of time) |
| teach people to deliberately take some time off
and then restart...relapse training |
|
APPLICATION OF
BEHAVIORAL CHANGE STRATEGIES TO SPECIFIC HEALTH CONCERNS
| smoking is a major health problem and it's difficult to
stop once one has started
| stage 1: preparation
| modeling, attitudes toward smoking |
|
| stage 2: initiation
| peer pressure, reinforcement, curiosity,
rebelliousness, "adult" |
|
| stage 3: habitual
| nicotine, emotions, environmental cues |
|
| stage 4: stopping
| health concerns, expense, aesthetics,
responsibility to others, social support,
self-mastery |
|
| stage 5: resuming
| withdrawal symptoms, stress, social
pressure, abstinence violation effect |
|
|
| so what maintains smoking?
| physiological (nicotine dependence, withdrawal
symptoms) |
| psychological (anxiety, craving,
rationalizations) |
| social/cultural (peer/adult models, peer
pressure, norms/laws) |
| environmental (commercials, situations) |
| behavioral (multiple behavioral cues) |
|
| aversive strategies most frequently used, but not
particularly effective |
| Lichtenstein & Penner, 1977: rapid smoking...often
works but not advised for people with physical problems |
| Snyder, 1989: focused smoking technique - concentration
on negative sensory perceptions during smoking...good in
a few cases |
| Gatchel & Baum, 1983: tension-reduction strategies -
systematic desensitization and relaxation -> reduce
antecedent stimuli and use fading |
| probably a good idea to use many (as opposed to few)
stimulus control techniques |
| multicomponent programs: combination of self-monitoring
skills, behavioral management, aversive techniques,
skills training, etc. |
| cognitive-behavioral techniques found to be a good choice
for treatment |
| psychological/physiological differences between obese and
non-obese:
| Schacter et al, 1968: not as able to identify
internal hunger cues |
| Nisbett, 1968: more sensitive to environmental
stimuli |
| Rodin et al, 1974: more reactive to emotionally
arousing events |
| Schacter, 1971: hypothalamus function differences |
|
Cognitive-Behavioral Treatment
| Snyder, 1989; Carnwath & Miller, 1986:
| self-control techniques (depositing money to be
returned when goals are met) |
| self-monitoring (daily caloric intake records) |
| stimulus control (altering antecedent cues and
consequences) |
| reinforcement (of desirable and undesirable
behaviors) |
| coping skills (re urges to eat) |
|
| can focus on the environmental aspects of stress, the
individual's appraisal of the environment and/or the
coping skills of the individual |
| Snyder (1989) - how to alter the environmental demands:
| provide info (e.g. tell people what to expect
from a program) |
| create social support systems (e.g. family,
friends) |
| planning for a treatment environment (e.g. assess
where people are going to attempt to use coping
skills...try to make that environment better) |
|
| Meichenbaum, 1977 re coping skills training:
| teach how to understand how cognition is involved |
| teach how to observe one's self-statements and
maladaptive behavior |
| teach how to problem-solve |
| teach how to model "good"
self-statements |
| rehearse |
| teach how to relax |
| let them try it out in a real life situation |
|
| big question whether the "disease" model or the
"learned behavior" model is correct in
understanding addictive behavior
| disease: biological forces overpower an
individual...best to achieve abstinence
(...therefore social support groups, etc.) |
| learned behavior: addictive behavior from
maladaptive habits (...therefore Operant,
cognitive-behavioral and social-learning
approaches) |
|
| most widely-used approaches have involved stimulus
control, self-reinforcement, coping skills training and
relapse management |
| Marlatt & Gordon, 1978 re relapse problems:
| negative emotional states |
| inability to resist social pressure |
| interpersonal conflict |
|
| psychobiological risk factors:
| high cholesterol |
| high blood pressure |
| smoking |
| high fat diet |
| sedentary lifestyle |
|
| psychosocial risk factors:
| poor social relationships, absence of
social/familial network |
|
| socioeconomic risk factors:
| little education |
| low occupational status |
| low income |
| substandard housing |
|
| coping style training (e.g. modification of Type A
behavioral pattern - time urgency, competitiveness,
hostility) |
Behavioral Treatment
| Type A behavior modification:
| reduce physiological arousal |
| reevaluating the environment |
| restructuring perceptions |
|
| Friedman & Rosenman, 1974: behavioral counseling >
cardiac counseling in reducing Type A behavior and in
reducing incidence of heart attacks |
| Gruen, 1975: coping skills rehearsal, problem solving and
information-seeking helped cardiac patients recover
faster |
| Bandura, 1986: self-efficacy helps people to increase
their level of physical activity |
| practitioners need to understand how and why behavioral
change occurs in order to make it happen
|
| function of learning:
| classical learning:
| good for modifying existing behaviors |
| not so good at initiating new behaviors
|
|
| Operant conditioning:
| good for using reinforcements to modify
consequences of behavior
|
|
| cognitive-behavioral approaches:
| more oriented to internal as opposed to
external events
|
|
| social cognitive theory:
| looks at reciprocal effects of
environment, behavior and internal
processes |
| focus on observational learning ...
therefore we can learn from watching
another person |
|
|
Back to Table of Contents
Ch 7 Exam Review Questions
Back to PHED 4226 Class Notes Page
Back to Dr. D's Home Page
Last Revised:
January 5, 2011 11:07 AM
|
