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Behavior Modification
Published in Eli Ilana, Oral Psychophysiology, 2020
The process of counterconditioning involves the same principles, but attempts to condition a more adaptive response to the unpleasant situation rather than simply eliminating the maladaptive response. The principle of counter-conditioning is widely applied in systematic desensitization, whereby the anxiety-evoking stimulus is shown in the presence of a pleasant experience, which gradually replaces the fear.1
Food Addiction
Published in Hanna Pickard, Serge H. Ahmed, The Routledge Handbook of Philosophy and Science of Addiction, 2019
Ashley Gearhardt, Michelle Joyner, Erica Schulte
Contingency management (CM) techniques may be adapted to emphasize abstinence, and this approach is of growing interest for the treatment of substance-related addictions. Contingency management is based on operant conditioning principles and provides individuals with rewards (e.g., gift cards) for treatment participation or achieving goals (e.g., abstaining from use) (Prendergast et al., 2006). Contingency management aims to reduce the rewarding value of addictive substances by reinforcing behavior inconsistent with drug use. Previous studies have observed that adding CM to standard treatment (e.g., psychoeducation, coping skills), relative to standard treatment alone, resulted in greater likelihood and longer duration of abstinence, reduced drop-out rates, and increased attendance of treatment sessions (for a review, see Zajacet al. in this volume). Relatedly, Kong and colleagues (2016) observed that alternative reinforcers may be useful in reducing the reinforcing effects of food. Thus, CM may also be effective in helping some individuals abstain or reduce their consumption of potentially addictive foods. For example, individuals with addictive-like eating behavior may be rewarded with incentives for abstaining from highly triggering foods. Overall, future research is needed to evaluate whether applying these addiction-related intervention approaches would improve clinical outcomes related to obesity and binge eating.
The History of CBT
Published in Marcia L. Rosal, Cognitive-Behavioral Art Therapy, 2018
G. Wilson (1978) labeled the second type of behavior therapy the Neobehavioristic Mediational Stimulus–Response Model, which uses the principles of conditioning and counterconditioning to mitigate abnormal behavior (i.e., usually fears and anxieties). S–R treatments were based on learning theories such as those conceived by Pavlov (1927) and others familiar to art therapists. Included in this type of behavior therapy are the techniques associated with systematic desensitization and flooding, the goal of which is to decrease or extinguish the fears and anxieties relating to phobias. Clients are instructed to imagine the frightful situation or object, identify their response, and finally, visualize the consequences of engaging with the problematic condition. Imaginal or symbolic representations produce an arousal response not unlike exposure to the real object or in situ conditions. The introduction of mental imagery, a higher cognitive process, is a step towards hypothesizing that cognitive mediators, as part of behavior therapy (or what G. Wilson labeled “neobehavioristic” methods), are useful in treatment (p. 10). What follows in this form of behavior therapy, through incremental exposures in a hierarchical manner to the feared event, is that an individual learns to effectively cope with their anxieties. Today, systematic desensitization is still used, but often in conjunction with anti-anxiety medications, cognitive-behavioral therapy, and/or relaxation treatments.
Emerging therapeutic targets for anorexia nervosa
Published in Expert Opinion on Therapeutic Targets, 2023
Psychotherapy is the first-line treatment for patients with anorexia nervosa. Recently, several encouraging developments in the field of psychotherapy have been made which mainly rely on mechanism-oriented research and use different evidence-based treatment targets which are supposed to underpin anorexia nervosa’s core psychopathology. These suggested psychotherapeutic interventions target broadly defined treatment targets which are supposedly closely intertwined, including neurocognitive profiles associated with cognitive overcontrol, habit formation processes and reward processing, as well as fear conditioning. Most of these more recent psychotherapy treatment targets draw back on neurobiological findings and models suggesting a fundamental imbalance between (pre)frontal brain pathways and reward/somatosensory pathways in anorexia nervosa. Moreover, the dlPFC might play a central role in exerting excessive cognitive control. This imbalance might contribute to aversive food valuation, shifts in reward processing and maladaptive habit formation in anorexia nervosa.
Applying the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents to Misophonia: A Case Example
Published in Evidence-Based Practice in Child and Adolescent Mental Health, 2023
Niza A. Tonarely-Busto, Dominique A. Phillips, Estefany Saez-Clarke, Ashley Karlovich, Kelly Kudryk, Adam B. Lewin, Jill Ehrenreich-May
The literature-base for treatments for misophonia is sparse with most evidence presented via case examples and case reports and mostly utilizing adult samples. Psychotherapy models found useful in adults include cognitive behavioral therapy (CBT; Bernstein et al., 2013; Jastreboff & Jastreboff, 2002, 2006, 2014; McGuire et al., 2015; Reid et al., 2016; Schneider & Arch, 2017; Schröder et al., 2017) and counter conditioning (Dozier, 2015). Frank and McKay (2019) further examined exposure therapy for misophonia, using an inhibitory learning framework. This approach emphasizes the readjustment of emotional responses to aversive sounds instead of habituation to the sounds. Frank and McKay (2019) posit that the inhibitory learning model is most beneficial in contexts or with conditions in which exposures do not produce habituation within the client – an attribute of misophonia. It is unlikely that a client with misophonia will ever habituate to their sound triggers due to the automatic activation of brain systems, including AIC, and atypical functional connectivity between the AIC and other brain areas responsible for emotion regulation and processing (Kumar et al., 2017). Within their work, inhibitory learning-focused exposure strategies were found to improve clients’ perceived control over their emotional reactions and their generalization of skills to produce functional improvements (Frank & McKay, 2019).
Rewarding recovery: the time is now for contingency management for opioid use disorder
Published in Annals of Medicine, 2022
A leading barrier to greater adoption of contingency management in clinical practice is presumably the relative lack of innovation. The origins of contingency management date back to the 1960s and operant conditioning principles, which was followed by a surge of rigorous, high-quality clinical trials in the 1990s. Traditional contingency management protocols (e.g. requirement for in-person appointments, use of a “prize bowl” filled with slips of paper) have since become rudimentary, outdated, and onerous in the current digital era, necessitating novel, technology-enabled solutions to facilitate widespread adoption. Other limitations include that many accepted contingency management procedures reward drug-free urinalysis screens exclusively, and there is only a low chance that the desired behaviour will actually be reinforced. In the commonly used probabilistic “prize-based” procedure, patients earn draws from a prize bowl containing slips of paper when the target behaviour is exhibited, but slips often have either no monetary value or a low-value prize. This raises the common complaint that contingency management is a “game of chance” due to the lack of immediate and consistent meaningful reinforcement that is required for lasting change.