Cognitive-Behavior Modification An Integrative Approach THE PLENUM BEHAVIOR THERAPY SERIES Series Editor: Nathan H. Azrin

THE TOKEN ECONOMY: A Review and Evaluation By Alan E. Kazdin

COGNITIVE-BEHAVIOR MODIFICATION: An Integrative Approach By Donald H. Meichenbaum

BEHAVIORAL TREATMENT OF ALCOHOL PROBLEMS Individualized Therapy and Controlled Drinking By Mark B. Sob ell and Linda C. Sobell Cognitive-Behavior Modification An Integrative Approach

By Donald Meichenbaum University of Waterloo, Waterloo, Ontan'o, Canada

Springer Science+Business Media, LLC Library of Congress Cataloging in Publication Data

Meichenbaum, Donald. Cognitive-behavior modification.

(Plenum behavior therapy series) Bibliography: p. Includes index. 1. Behavior modification. 2. Cognition. I. Title. BF637.B4M43 616.8'914 77-5847

First Printing-June 1977 Second Printing—May 1979

ISBN 978-1-4757-9741-1 ISBN 978-1-4757-9739-8 (eBook) DOI 10.1007/978-1-4757-9739-8

© Springer Science+Business Media New York 1977 Originally published by Plenum Press, New York in 1977 Softcover reprint of the hardcover 1st edition 1977

All rights reserved

No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Preface

This book is an account of a personal journey through a research program. A number of people have helped guide my way. To them I am deeply grateful. Special thanks are offered to my students, whose constant stimulation and provocation were incentives to write this book. Moreover, in the belief that they would never show the initiative to put together a festschrift for me (Le., a book dedicated to someone for his contributions), I decided to do it myself. Several people cared enough to offer editorial criticisms, namely, Myles Genest, Barney Gilmore, Roy Cameron, Sherryl Goodman, and Dennis Turk. The reader benefits from their perspicacity. Finally, to my parents, who taught me to talk to myself, and to my family, without whose constant input this book would have been completed much sooner, but would have been much less fun, I dedicate this book.

D.M.

5 Contents

Prologue 11

Chapter 1 Self-Instructional Training 17 Hyperactive, Impulsive Children: An Illustration of a Search for a Deficit 23 Luria's Model (24), Private Speech and Mediational Skills (27) Self-Instructional Treatment of Hyperactive, Impulsive Children: A Beginning 31 Empirical Studies of Self-Instructional Training 34 Combining Self-Instructions and Operant Procedures (44), Reasoning Rediscovered (47), Importance of Attributional Style (48), Taking Stock (54)

Chapter 2 The Clinical Application of Self-Instructional Training to Other Clinical Populations: Three Illustrations 55 Social Isolates 56 Creative Problem-Solving 58 Adult Schizophrenics 68 What Shall We Say to Ourselves When We Obtain Negative Results? 77 7 8 Contents

Chapter 3 Clinical Observations on Conducting Self-Instructional Training 83 Use of Play 84 Importance of Affect 88 Flexibility of Format 89 Use of Imagery 93 The Child as Collaborator 95 In the Classroom 99 Summary 103

Chapter 4 Cognitive Factors in Behavior Therapy Techniques 107 Beginning from Learning Theory 109 Anxiety-Relief Conditioning III Systematic Desensitization 118 Relaxation Component (119), Imaginal Component (120) Modeling 125 Assertion (129), Obesity (133) Aversive Conditioning 135 Value of Mental Rehearsal (137)

Chapter 5 Stress-Inoculation Training 143 Coping Skills Techniques 145 Procedures of Stress Inoculation 150 I: Educational Phase (150), II: Rehearsal Phase (153), III: Application Training (156), Positive Thinking (159) Application of Stress-Inoculation Training to the Control of Anger 162 Application of Stress-Inoculation Training to Pain Tolerance 169 An Overview of Pain Treatment Literature (169), Experimentally Induced Pain (173), Clinical Applications (180) Contents 9

Chapter 6 Cognitive Restructuring Techniques 183 Cognitions as Instances of Irrational Belief Systems 187 Cognitions as Instances of Faulty Thinking Styles 191 Cognitions as Instances of Problem-Solving Ability and Coping Skills 194 Cognitive Restructuring Therapies-Some Differences 195

Chapter 7

The Nature of Internal Dialogue-Foundations of a Theory of Behavior Change 201 Function of Internal Dialogue 203 Interpersonal Instructions (203), Cognitive Factors in Stress (204), Instructional Sets and Physiological Effects (207), Further Characteristics of the Internal Dialogue (209) Structure of Internal Dialogue 211

Chapter 8 A Cognitive Theory of Behavior Change 215 A Clinical Example 216 Phase 1: Self-Observation 219 Phase 2: Incompatible Thoughts and Behaviors 223 Phase 3: Cognitions Concerning Change 224

Chapter 9 A Cognitive-Behavior Modification Approach to Assessment 229 The Comparative Groups Approach 231 10 Contents

The Specific Deficits Approach 233 A Cognitive-Functional Approach 235 A Cognitive-Functional Sampler (237) Clinical Applications of a Cognitive-Behavior Assessment Approach 248 A TAT-like Approach (255), Other Psychometric Tests (256), The Role of the Group in Assessing Cognitions (257) Epilogue 261 References 263 Author Index 295 Subject Index 303