Behavior Change

Midterm Review of Theory-Based Interventions

In small groups, read the case study below and answer some of the questions provided. You will only have time to

discuss a few of them, but the ones that you don't answer in groups can be a helpful study tool for the exam!

You are working with a 20 year-old, Black, cisgender, female client named Angela who experienced a traumatic car

accident a few months ago where she was seriously injured. Since then, her physical injuries have healed, but she has

been having panic attacks and other anxiety symptoms, such as feeling "edgy." She tells you the car accident was her

fault and since then, she has doubted her driving abilities and worries she will get into another car accident and could

possibly die or kill someone. As a result, she has been avoiding driving.

Angela works 20 miles away from her home and needs to continue working in order to help her family pay bills.

Unfortunately, there is not any public transportation between her home and workplace, so she has been relying on her

brother to drive her. Sometimes he is unable to do so, or is late, so her supervisor has been getting upset and she has

given Angela two written warnings. Angela tells you that she is upset and disappointed in her work performance, but

doesn't think she'll ever drive again because "the risk is too high."

When asked to describe her mood, Angela reports feeling "low" and "sad." She has been avoiding spending time with

friends because she does not feel she would be "fun to be around" and is spending most of her free time alone in her

apartment. She tells you that she has been having trouble sleeping, feels she is overeating, and is very upset that she has

gained 15 pounds in the past two months. Angela tells you that her health and her appearance is important to her and

she has been considering downloading the Noom app to help her lose weight. She has also been investigating the cost to

join the local Anytime Fitness.

Her diagnosis is:

 F43.23 Adjustment Disorder with Mixed Anxiety and Depressed Mood

Her goals on her treatment plan are to:

 Learn skills for managing anxiety and panic attacks

 Improve mood

 Engage in healthy eating behaviors

There are many interventions that you could use to accomplish the goals in Angela's treatment plan! Please choose

some of the questions to answer in groups, and feel free to add any information to Angela's case that would be helpful

for you!

There are no right/wrong answers to these questions. They are here for you to reflect on the concepts and how they

may fit with a clinical setting.

Developmental and Cultural Interventions

 Even though she is 20, Angela may still be experiencing the personal fable or imaginary audience. How might

those things impact her driving ability or feelings about her driving skills?

 You feel that Bronfenbrenner's Bioecological Systems Theory provides a helpful framework to understand the

forces that are impacting Angela and decide to explain it to her. Role-play how you might explain each part of

the theory to Angela and work with her to decide together how her microsystem, mesosystem, etc. are

impacting her. (One person in your group can play Angela and one person can play the therapist. The others can

provide feedback and suggestions after the role-play!)

Classical Conditioning Interventions

 You decide that exposure therapy would help Angela resume driving. Would you use imaginal exposure or in-

vivo exposure? Why? What factors would you consider in making this determination?

 How could you use counterconditioning instead of simple exposure therapy? What is the difference between

counterconditioning and exposure therapy?

Operant Conditioning Interventions

 How might you incorporate reinforcement to help Angela resume spending time with her friends and improve

her mood? What specifically would you use as the reinforcer? What type of reinforcer would that be? What

schedule of reinforcement would you use?

 Role-play creating a token economy to help Angela meet one of the goals on her treatment plan. Have one

group member play "Angela" and have one member play the therapist. Work with Angela to determine a set of

"rules," what she will use as "tokens" (stickers on a worksheet, checkmarks in a planner, etc.), and determine a

variety of backup reinforcers she can choose from (see pg. 104 in your textbook).

Social Cognitive Interventions

 Which self-regulation strategies do you think Angela would benefit from using to achieve one of the goals on

her treatment plan? How would you recommend that she implement them?

 What could you do to help increase Angela's self-efficacy surrounding healthy eating?

 You decide to teach Angela some breathing techniques that she can use when she feels anxious. Role play how

you would use modeling and guided mastery to help her learn the techniques. One person in your group can

play Angela and one can play the therapist. The others can observe and provide feedback and suggestions after

the role play! (If no one in your group knows how to do any breathing techniques, you can substitute a

mindfulness or meditation skill or other relaxation/anxiety management technique.)

Motivational Interviewing/ Stages of Change Interventions

 What stage of change do you think that Angela is currently in regarding changing her eating behavior? What

stage do you think she is in regarding changing her driving behavior?

 What processes of change may you want to use based on her current stage(s) of change?

 Role play using the motivational interviewing "OARS" with Angela. One person in your group can play Angela

and one can play the therapist. The others can observe and provide feedback and suggestions after the role

play! The therapist should ask 'Angela' to talk about her problem and her feelings about making changes and use he OARS skills during the discussion.

MIDTERM STUDY GUIDE

This study guide is intended to help you focus your studying. Please keep in mind that the material that was

presented in class which also appears in the Ormrod 'Human Learning' text or other assigned readings has the

highest probability of appearing on the exam. However, there is always some material that is only in the book

that will be on the exam, as well as material that we only covered in class.

The exam will be a combination of multiple choice and short answer/brief essay questions. There will be

approximately 20 multiple choice questions (20 points) and you will choose approximately 5 of 8 short answer

questions to answer for four points each (20 points).

STUDY TIPS

Because I want you to be able to apply what you learn to your future career, I want you to know about the

topics on this study guide in depth. In other words, try to do more than simply memorize the definition –

understand why it is important, be able to discuss an example, know how you would use the material in

clinical practice, etc. Some ways to help you do this are:

 Create a detailed outline for all the information below. Include the definition (in your own words), an

example, and also extra information to help you understand the concept in depth. For example, why is

it important? How does it apply to clinical practice?

 If two terms seem similar, write down the difference between those terms.

 Give a "mini lecture" (aloud or in your head) explaining what you learned about each concept. If you

feel like you could teach it to someone, you'll do well on the exam!

 Make a study group. Have each member be the "expert" on one chapter and teach it to the others in

the group.

Week 1 / INTRODUCTION TO LEARNING AND BEHAVIOR CHANGE (Ch. 1; Hays article)

 Defining learning and how we know a client has 'learned'

 Advantages and drawbacks of theories

 Plasticity, neurogenesis, and consolidation

 ADDRESSING framework and culturally responsive CBT (from Hays article)

Week 2 / CULTURAL CONTEXTS OF LEARNING AND BEHAVIOR CHANGE INTERVENTIONS (Ch. 9 page 284-

301; Ch. 10 page 312-325; selected article about culture/interventions)

 Constructivism, schemes (and accommodation and assimilation), equilibration

 Piaget's stages

 Imaginary audience and personal fable

 Types of thinking in post-formal thought

 Erikson's stages and focus of each stage

 Self-talk/private speech and inner speech

 Internalization

 Zone of proximal development and scaffolding

 Mediated learning experiences

 Bronfenbrenner's theory

 How the above concepts could apply to the therapy environment

 Be able to discuss one of the articles related to adapting interventions to a specific population

Week 3 / CLASSICAL CONDITIONING (Ch. 3; Ch. 4 page 87-101; Supplemental Article)

 Orienting reflex and habituation

 Be able to label the terms in an example about classical conditioning

 The 'Little Albert' classical conditioning study

 Contiguity vs. contingency

 Generalization and discrimination

 Counterconditioning

 Extinction

 Self-monitoring (from assigned article)

 Be able to discuss how classical conditioning could lead to the development of a mental health disorder

and how classical conditioning techniques could help treat a mental health condition

Week 4 / OPERANT CONDITIONING (Ch. 3; Ch. 4 page 87-101; Supplemental Article)

 Be able to identify the differences between classical and operant conditioning

 Law of effect

 Positive/negative reinforcement and positive/negative punishment (be able to label examples)

 Schedules of reinforcement and types of reinforcement

 Shaping vs. chaining

 Premack principle

 Generalization and discrimination

 Active and passive avoidance learning

 Be able to discuss how operant conditioning could lead to the development of a mental health disorder

and how operant conditioning techniques could help treat a mental health condition

Week 5 / SOCIAL COGNITIVE THEORY (Ch. 5)

 Vicarious reinforcement and punishment

 Outcome and efficacy expectations

 Reciprocal determinism/ causation

 Modeling and the facilitation, inhibition, and disinhibition effect

 Self efficacy

 Guided mastery

 Self-regulation and strategies to improve it

 How the above concepts could apply to the therapy environment

Week 6 / TRANSTHEORETICAL MODEL OF CHANGE & MOTIVATIONAL INTERVIEWING (Two supplemental

articles)

 Stages of change

 Processes of change

 Four principles of motivational interviewing and OARS of motivational interviewing

 Be able to identify examples of the above terms and how they could relate to the clinical environment

Week 7 / LEARNING AND BEHAVIOR CHANGE TOOLS FOR CLINICAL PRACTICE

 There were no readings for this week.

NOTE: You are not expected to read all of the additional articles on Canvas that your group members

presented to you. Just know a basic description of the interventions (flooding, behavioral activation, and assertiveness skills).

********************************SAMPLE MIDTERM EXAM. *************

The following are examples of multiple choice and short answer/brief essay questions related to

material from the first half of the semester. None of these are actual exam questions but will give you

an idea of the types of questions that may be asked.

1) In Pavlov's study of classical conditioning, salivation to meat was the ______________ and

salivation to a buzzer/bell was the ________________.

A. Unconditioned response; conditioned response

B. Conditioned stimulus; conditioned response

C. Unconditioned response; unconditioned stimulus

D. Unconditioned stimulus; unconditioned response

2) After being attacked by a dog, Marcus begins to fear dogs. His therapist is concerned about this,

so the therapist repeatedly shows Marcus dogs in the neighborhood without allowing him to get

attacked. In other words, the therapist is repeatedly presenting the CS without the UCS. Marcus's

therapist is using which principle?

A. Relativistic thinking

B. Mediated learning experience

C. Spontaneous recovery

D. Extinction

3) You are working with a young child, Pa, who is displaying many disruptive behaviors, including

cursing. You and Pa's parents decide that the next time she curses, her parents will take away Pa's

videogame time for one week. By taking away videogame time, Pa's parents are using:

A. Negative punishment

B. Positive punishment

C. Negative reinforcement

D. Positive reinforcement

4) You are working with a client who has a diagnosis of Gambling Disorder. You know that reducing

gambling behavior can be a challenge because slot machines, scratch-off lottery tickets, and most

other forms of gambling pay off based on what schedule of reinforcement?

A. Fixed ratio

B. Variable ratio

C. Fixed interval

D. Variable interval

5) When an older sibling models the behavior of 'appropriate dinnertime behavior' to their younger

sibling, it increases the frequency of appropriate dinnertime behavior in the younger sibling. This is

referred to as:

A. Disinhibition effect

B. Facilitation effect

C. Inhibition effect

D. Modeling effect

6) According to Bronfenbrenner, society's norms and culture are a part of our:

A. Microsystem

B. Mesosystem

C. Chronosystem

D. Macrosystem

Answers for 1-6: A, D, A, B, B, D

8) Define positive reinforcement and negative reinforcement in your own words. Describe an example

of how they could each be used to increase the frequency that a therapy client would complete

'homework' assignments.

9) How might you implement self-monitoring with a client to help them improve their social skills?

10) According to Erikson's 'Industry vs. Inferiority' stage of development, what are some challenges

you may see in a client who is 10 years old?