Assignments

Wolpe used SUD’s rating as a mechanism of communication between therapist and client regarding unpleasant emotional states, typically anxiety but sometimes other private internal experiences (anger, disgust, loathing, arousal).

For anxiety the scale was anchored at 0 (no anxiety or tension at all, completely relaxed and comfortable) and 100 (anxiety, terror, panic as intense as imaginable). The client was invited to use this as a vehicle for sharing with the therapist their internal experience. It could also be used as a metric for scaling hierarchies and measuring change. Homework assignments involving relaxation training often include having the client write down their SUD rating immediate before beginning relaxation and immediate afterwards. This helps monitor client progress toward effective relaxation (and provides a measure of the number of practices the client engaged in.

Other practitioners have used different scale (e.g., 1-10; 1-7); there is no clear advantage of one vs. the other but you might want to note in your client record what scale you are having them use.

SUD’s ratings can be made retrospectively for various experiences or times of a day, can be made “in the moment” to report on immediate experience, and can be used in self-monitoring assignments. The validity of retrospective ratings are probably more problematical than current ratings, but there is not real external criteria to judge validity against.

Assignment 1: Self-monitor your subjective anxiety on an hourly basis (for waking hours) between now and your next class. Record you SUD ratings in your journal.

After completing the ratings: Do you notice anything interesting in the pattern of results? Did you have any difficulties in carrying out this assignment? What problems might a client have in carrying out such an assignment and how might you minimize these?

Choose something you have an excessive, unreasonable fear of–The literature suggests that most of us have 5 to 7 of these, so cough up and self-disclose. Use this fear to construct a hierarchy of 7 to 10 steps ranging from the mildest noticeable anxiety to fear as extreme as you could experience it. Assign each hierarchy scene a SUD rating and try to adjust the scenes to get a spread of anxiety from low to high. Record your hierarchy of scenes in your journal.

Construct an image which is maximally relaxing for you. Be sure to include details regarding as many sensory modalities as possible, and construct the scene in maximum detail. Note your SUD experience before and after focusing on the image as a clue toward refinement of the image. Record your Personally Relaxing Image in your journal.

1. Think about a stop sign.
2. Take a deep breath and relax as you exhale.
3. Think about a pleasant place you would enjoy being right now.

Practice Cautella’s Self-Control Triad 10 (minimum) to 20 times a day between now and our next class (note that for a client this instruction would usually be for a week—until the next session). Record your practices (approximately 30 seconds each) in your journal—date, time, place, any particular qualitative impression. Note in your journal any changes in your experience—is it getting easier, harder, more effective, boring, etc? At the end, write down what you have learned about what it would be like for a client to be carrying out such an assignment. How might you use this in considering how you want to give behavioral assignments?

For the next two weeks made your best effort at meditating for 10 minutes each day. In your journal immediately afterwards write a brief note regarding your experience. You may use either focused (chose a mantra) or mindfulness (open awareness of environment/self/breath) meditation. You can experiment with both but should shortly choose one for at least a 10 days trial. One does not really learn to meditate in two weeks, if it is even the sort of thing one can speak of learning at all, but it will give you a taste of the experience. Meditation does seem to be the sort of thing that is more about the journey than the destination. Don’t be concerned about whether you are achieving the correct results–just see what it is like.

Using the fear hierarchy you have constructed, try a session of self-desensitization:

1. Select the lower image in your hierarchy which still causes you some anxiety (The desensitization practice in class may have affected some of the lower items.). Consider this item and assign it a current SUD value–how much anxiety do you believe it would cause you at this point in time (This may have changed since your initial hierarchy construction.).
2. Write down your current SUD’s rating: how much anxiety to you fell now for whatever or no reason at all–your current state.
3. Work on relaxing as deeply as possible. You may use any behavioral technique you wish (PMR, imagery, breathing, meditation, etc.). Try to get your SUD rating as low as possible.
4. Visualize as vividly as possible the hierarchy scene you have selected. Try to imagine it actually occurring, work at making the experience as real as possible.
5. If you begin to experience an increase in anxiety, “erase” the image from you mind and focus on your relaxation again. Reduce you anxiety to zero again.
6. Repeat the imaginal experience of your hierarchy item, and again terminate if you begin to experience anxiety. Repeat 4, 5, 6 as needed.
7. If you can visualize your image for approximately 30 seconds without experiencing any anxiety, terminate the image and work on relaxing further.
8. If you reach 7, try the next image up in your hierarchy, Repeat 4, 5, 6.
9. If you reach 7 and have tried a higher scene:
   • If you desensitize this scene (2 30″ trials without anxiety), terminate your session by relaxing again for a minute or two and closing. Record your experience in your journal.
   • If you do not desensitize you second scene by the time you are ready to end, return to your original scene and repeat this twice, close and relax for a minute or two. Record your experiences in your journal.

How did your experiences at self-desensitization compare with your experience of desensitization in class? How might this inform your clinical practice?

Using your hierarchy, go through another session of self-desensitation on whatever is your current bottom scene (the lowest one which still elicits some level of anxiety). This time, instead of terminating the scene whenever you begin to notice some anxiety, continue with the image and visualize yourself using some coping responses in that situation to deal with the anxiety and continue to face the situation. Follow the discussion in Goldfried and Davison. Terminate a scene when 1) it is successfully resolved (in your imagination), or 2) it not longer elicits any anxiety at all, or 3) if your experience of anxiety rises dramatically and you find the experience very distressing. Following termination of the scene, for any reason, spend a few minutes relaxing, close, and record your experience in your journal.

How did your experience of traditional versus coping desensitization compare? Which of the two would you find more preferable if your wanted to work on reducing your excessive anxieties? How might this inform your clinical practice? [A caution here–your experience (i.e., that of a normal person with anxiety responses which, though real, are probably probably subclinical in severity and functional impairment) are not necessarily a good model for understanding the response of an individual with a phobia or other clinical anxiety disorder.]

Using your hierarchy and the results of the desensitization sessions, both in class and self-directed, try to arrange a confrontation with one of the situations that your worked on desensitizing. Do your best to set up an actual encounter with a situation from your hierarch that you dealt with.

Before you go into the situation: What is your expectation? Are you confident that your will have less fear? Are you skeptical that you will have any less fear? Do you notice an anticipatory anxiety? Consider how a client might respond and process these experiences.

As you are in the situation: What is our experience? Do you notice any anxiety? Is the anxiety as strong/great/uncontrollable/horrible as your imagined it would be? Do you find yourself making use of any coping responses (breathing control, conditioned relaxation, passive attitude, etc.?)? How doe the coping responses change your experience of the encounter?

Afterwards: How do you feel? (pleased, disappointed, powerful,frustrated, proud, exhausted, etc.) Record your experiences in your journal and consider what this might suggest to you about clinical practice.

A key role in many behavioral formulations of depression and treatment for depression is played by low frequencies of reinforcing experiences in a person’s life. While some therapists focus primarily on pleasant activities (Lewinsohn’s Pleasant Events Schedule looks at the rated pleasantness and frequency of occurrence of 320 potential reinforcers over the past 30 days), Beck also drew attention to another class of potentially important stimulus events–activities associated not so much with a sense of pleasure, but of mastery over environmental needs and situations. Here is the example I often use with clients: I don’t particularly enjoy mowing my yard (It’s not really a “Yippee, I get to mow the yard today!” kind of thing for me.), but I do like the sense of satisfaction from know the job is completed and attended to for the next week (“That’s done, great, now I can focus on fun stuff like persecuting graduate students.”).

Over the next week, in your journal rate your mood at then end of each day on a 0 to 10 scale:

0: dark, miserable, awful, crummy days; gloom and doom; you’re a failure, the world sticks, nothing ever changes

10: great, happy, successful days; the sun is shinning; you’re doing well, opportunities are endless, everything is looks good

and

Keep track each day, in your journal, of large and small positive events. For each event your record note whether it involves feelings of pleasure, or mastery, or both.

then

At the end of the week look back at your ratings and your records of positive events, is there any obvious relationship? What do you think are the natural regulators of mood in your life? Some literature suggests that frequency of positive experiences, mild physical exercise, and social contact are the primary stimuli associated with a prevailing positive mood in humans.

Complete the Rathus questionnaire you received in class and calculate your score. How do you compare with other college students? How useful is it to know how generally assertive you are? Assertiveness can be conceptualized as either a trait like attribute or as a set of behavioral competencies. Behavior therapist usually focus on the more situationally specific perspective regarding assertiveness. Alternatively, we can realize that even a generally assertive person may have some situations which give her/him more than usual difficulty.

RAS reversed items: 1, 2, 4, 5, 9, 11, 12, 13, 14, 15, 16, 17, 19, 23, 26, 30

national norms for college and university students (these are are old and may well be out of date):

mean score for males: 12
standard deviation: 22

mean score for females: 7
standard deviation: 22

For the unit on social skill training you will need a personal problem to work on. Most helpful would be a real (it’s less fun to make something up and you may have to put too much energy into your deception to gain much from the experience), minor (you will need to discuss this in front of your classmates), and would actually be worth working on (get something out of the project). Think small–some recurrent, little aggravation in your life that you wish you could handle better. Consider the characteristics Liberman looks for in target behaviors for social skills training:

Selecting target behaviors
Guidelines for setting interpersonal goals in social skill training (Liberman, DeRisi, & Mueser, 1989, pp. 40-41)
1. Attainable
2. Positive and constructive behaviors
3. Specific
4. Functional behaviors
5. Consistent with the patient’s rights and responsibilities
6. Chosen by the patient
7. High-frequency behaviors
8. Likely to occur in the near future or having occurred in the recent past

Come up with a goal for yourself and write it in your journal. Your therapist will help you with any needed clarification prior to your day-run.

Here is your next task: for the next week, when you are on campus, smile at and nod or greet everyone you pass. Do not slow down, do not engage in conversation, make no behavior that might raise concerns you are selling magazines, religion, etc. Just try and make eye contact, smile, and say: “Hello” or “Good morning” or “Nice day” or simply nod; and keep on moving. I want you to record the number of greetings you make each day, and the number of positive responses you receive (e.g., a smile or nod back, a positive greeting, etc.). That’s it–just keep track of the number of people you make positive overtures to each day you are on campus (which should be everybody you pass), and the number of positive responses you get back. Keep track of your daily results in your journal.

Before beginning this assignment, in your journal, I want you to predict the % of positive responses you will receive. Write down your ballpark estimate of what percentage of people on the ISU campus will respond positively to a nonthreatening social stimulus.

Afterwards you might consider these questions:

What purposes might be served by such an assignment? How generalize do you imagine the results would be to other situations? How is the structuring of the assignment (that you are clearly not trying to engage the stranger in prolonged or purposeful interaction)? Beck liked to make use of this assignment for various purposes in his cognitive therapy of depression. What would his emphasis be on?

A key role in many behavioral formulations of depression and treatment for depression is played by low frequencies of reinforcing experiences in a person’s life. While some therapists focus primarily on pleasant activities (Lewinsohn’s Pleasant Events Schedule looks at the rated pleasantness and frequency of occurrence of 320 potential reinforcers over the past 30 days), Beck also drew attention to another class of potentially important stimulus events–activities associated not so much with a sense of pleasure, but of mastery over environmental needs and situations. Here is the example I often use with clients: I don’t particularly enjoy mowing my yard (It’s not really a “Yippee, I get to mow the yard today!” kind of thing for me.), but I do like the sense of satisfaction from know the job is completed and attended to for the next week (“That’s done, great, now I can focus on fun stuff like persecuting graduate students.”).

Over the next week, in your journal rate your mood at then end of each day on a 0 to 10 scale:

0: dark, miserable, awful, crummy days; gloom and doom; you’re a failure, the world sticks, nothing ever changes

10: great, happy, successful days; the sun is shinning; you’re doing well, opportunities are endless, everything is looks good

and

Keep track each day, in your journal, of large and small positive events. For each event your record note whether it involves feelings of pleasure, or mastery, or both.

then

At the end of the week look back at your ratings and your records of positive events, is there any obvious relationship? What do you think are the natural regulators of mood in your life? Some literature suggests that frequency of positive experiences, mild physical exercise, and social contact are the primary stimuli associated with a prevailing positive mood in humans.

Part 1: keep a thought record for a few days. You can use your journal, a 3×5 card, one of the record forms from class–whatever is easiest for you to manage. Think about how you would want a client to do this. It’s probably not practical to record every thought and image you have (plus the embarrassment factor if all that stuff ever came to light). How would you want your client to do this: sample based on time of day (first 5′ of every waking hour, etc.), sample based on regular, external events (when first arrive at class, etc.), sample based on identified mood state (when you notice yourself depressed, anxious, whatever)? These are a few of the strategies that have been used. Try something for a couple of days.

As you review your thought records, assign each item a qualitative rating (neg, pos.), if a thought has no emotion/energy attached to it, consider it neutral (but be careful, irrational negative beliefs often mask themselves as “neutral” thoughts). What does your balance of positive and negative look like?

Part 2. This is easier in some ways, but usually needs to be preceded by something like Part 1, just keep track of positive and negative thoughts. Again, use your journal, 3×5 card, back of you hand (but transfer to permanent record before your once a week bath), whatever and just keep a running tally of positive and negative thoughts or images you are having during the week. Try for several days worth at least. As you are keeping track of this, also give each day an overall mood rating ([bad] 1 to 10 [good]). When you are having clients make global mood ratings it is important to have them make the rating at approximately the same time each day (some will be experiencing diurnal mood fluctuations). I usually suggest that clients make their rating at bedtime, look back over the day, and give their experience an overall rating

Again, What does your balance of positive and negative tallies look like? Is there any association between your tally for a given day and the evaluative ratings you gave that day? [Did you tell you client to consider her/his tally when making his global rating; or to make the rating without considering the frequency counts?] What would it be like for a client to be carrying out activities like this? How could you make it easier for them? How could you enhance compliance with these types of assignments (which are almost universal in cognitive behavior therapy)?

Identifying Automatic Thoughts Powerpoint

Judith Beck has her clients use this basic question:

“What was going through your mind just then?”

to help catch automatic thoughts. She has clients use their awareness of a shift or intensification
in affect to cue their questioning what they are thinking about (In session,
she will inquire if she notices evidence of shifts/changes/intensifications
of emotion.).

Other techniques are shown in the handout from class.

Monitor your automatic thoughts and record in your journal.
Try using shifts of affect (emotion) as cues to prompt yourself with Beck’s
question, record results.

[Many automatic thoughts are negative/dysfunctional/irrational/neurotic/embarrasing:
if you need to, edit the contents of your class journal–you might want to
keep “two sets of books” like good organized crime activities: write
down all the automatic thoughts you can identify on a separate sheet of paper
and transfer the ones for public consumption to your journal

Consider a recent situation in which you felt upset (unhappy, sad, irritated, nervous, scared). Describe the situation or event that was going on:

How did you feel? Rate the intensity of your feeling (0-10)

What did you do?

What were you thinking (thoughts, images, belief)? Rate the degree of conviction you have in each thought/strength of each image 0-10. Do any of these thoughts/images seem non constructive (do they make you feel bad?, are they irrational?, do they seem unlikely or exaggerated?): put a star by the nonproductive thoughts/images

What responses could you make to the nonproductive thoughts/images? Rate the degree of conviction you have in each alternative self-talk (0-10)

How do you feel after substituting more productive thoughts/images? Rate intensity of feeling (0-10)

Consider the Rumple family: in your journal develop your formulation of the family’s difficulties, create a problem list for all family members, create also a list of how each family member is disadvantaged/hurt by the current state of affairs (useful in your efforts to “sell” change to each member of the system).

Rate your beliefs regarding the follow 10 statements on a 1 (agree) to 7 (disagree) scale. Bring your ratings to class on July 6th for discussion.

a) Reinforcement is bribery.
b) Individuals become dependent upon extrinsic reinforcements.
c) Behavior therapy is coercive.
d) Behavior therapy is nothing new–everyone does it all the time.
e) Behavior therapy is mechanistic.
f) Behavior therapy is to simplistic to adequately understand human beings.
g) Behavior therapy is authoritarian and paternalistic in attitude.
h) Behavior therapy is dehumanizing and degrading.
i) Behavior therapy is too dangerous a threat to individual freedom and should be restricted.
j) Behavior therapy is manipulative.

Adapted by Kazdin (1980). Behavior Modification In Applied Settings. Homewood, Ill. : Dorsey Press.