Professional Documents
Culture Documents
have been integrated into cognitive-behavioral therapy (CBT). In a nutshell, CBT aims to replace
maladaptive emotional, behavioral and cognitive responseoften adopted through experience
and learningwith responses that are adaptive to improve the quality of life of the cleint. The
goals of CBT include 1) teaching new ways of responding and fostering novel experiences for
the formation of adaptive behavioral, emotional and cognitive patterns 2) maintaining positive
changes through repetition for long-lasting effects, and 3) using functional analysis for ongoing
evaluation to flexibly guide intervention and gauge client progress. According to Craske (2010),
the following three major theories are the primary sources from which the clients condition can
be viewed: learning theory, social learning theory, and cognitive appraisal theory. Each theory
has its own unique contribution to CBT and is explored by Craske (2010) separately and in
combination when an overlap occurs.
Learning theory is based on both classical and instrumental conditioning. Craske (2010)
explains that classical conditioning occurs when an evocative stimulus (US) producing an
involuntary response (UR) is paired with a neutral stimulus multiple times, and upon removal of
this evocative stimulus, the once neutral stimulus (CS) produces the involuntary response (CR).
This phenomenon plays a critical role in the formation of psychopathology, especially anxiety
disorders and phobias. For example, an irrational fear of dogs may ensue following a frightening
situation involving a barking, snapping, and vicious dog; hence, all dogs have been associated
with the fear response. The process by which all four legged animals are fear is called
generalization, where a stimulus similar to the conditioned stimuli evokes an involuntary
response. One major criticism of classical conditioning is that not all individuals who undergo
such experience develop phobias. Craske (2010) offers the following three additional factors that
influence whether or not one develops such pathology: constitutional factors (e.g., temperament,
personal history), contextual factors (e.g., high intensity and less control over events), and
postevent processes (rumination following the adverse event). Explanatory power of classical
conditioning for substance abuse is also discussed by Craske (2010), except the association is to
a pleasurable response.
Treatment from this perspective typically involves disrupting the associations between
the conditioned response and the outcome response through a process called extinction (Craske,
2010). For example, an individual with social anxiety would be exposed to an anxiety provoking
situation without a traumatizing effect; thus, the association loses its strength though mechanisms
such as habituation (decrease of anxiety through repeated exposure) and inhibitory learning
(expectancy change). For changes to sustain over time after exposure therapy, exposures must be
conducted in multiple contexts and should free from any safety signals (e.g., medication, food,
presence of the therapist). Though initially absent, cognitive interpretation of classical
conditioning is inclusive of not only mechanistic/automatic expectancies but also higher-order
cognitive processes. The mechanistic view posits that classical conditioning can occur without
conscience awareness, while the alternative dictates that expectancies are often influenced by
maladaptive beliefs (i.e., overestimation, catastrophizing, and over-attention to the negative).
Such beliefs mediate stronger conditioning (Craske, 2010).