Dr.

Abdelaziz Elfaki University of Dammam

Outlines:
Definition

The Basic Model

The Role of Neurobiological

Processes Development of Behavior Disorders The Mechanics of Change with Couples and Families Assessment Therapy Techniques Treatment of Sexual Dysfunction

Definition
Cognitive-behavioral marriage and family therapy

(CBFT) is a therapeutic approach intended to help couples and families experiencing difficulties with their relationships. CBFT looks at individual behaviors, thought patterns, emotions, beliefs and perceptions and the effect that these have on the functioning of the couple or family as a whole. CBFT is concerned with current interactions between the members of the couple or family system, and the meaning that is derived from these interactions.

Background
When they first working with

families, behavior therapists applied learning theory to train parents in behavior modification and teach couples communication skills

 Pavolve: Classical Conditioning Watson: used classical conditioning to experimentally

induce a phobia in "Little Albert

Systematic Desensitization Anxiety is response of the autonomic nervous system acquired through classical conditioning. Systematic desensitization deconditions anxiety through reciprocal inhibition by pairing responses Skinner: incompatible with anxiety Operant Conditioning Responses that are positively reinforcement will repeat more frequently; those that punished or ignored will be extinguished. Richard Stuart (1969):Contingence Contracting Focused on how the exchange of positive behavior could be maximized using
Wolpe:

 During '70s, behavioral family therapy

evolved into 3 major packages :

Parent Training Therapy Couples Therapy Sex

By the end of '70s, there has been a

rapprochement between behavioral models and cognitive theories.

The Basic Model

The central premise of behavior therapy is :
o Behavior is maintained by its consequences.

Consequences that increase behavior are called reinforcers; those that decrease behavior are known as punishers. o Extinction occurs when no reinforcement follow a response.

The Basic Model

The central premise of cognitive therapy is: o Our interpretation of other people's behavior affects the way we respond to them. o Among the most troublesome of automatic thoughts are those based on arbitrary inference ,distorted conclusions shaped by a person`s schemas ,or core belief about the world and how it functions. o What makes these underlying beliefs problematic is that although they are generally not conscious ,they bias how we respond to everything and everyone.

The Basic Model

Theory of Social Exchange (Thibaut and Kelley's ):

People strive to maximize rewards and minimize

costs in relationships. In a successful relationship, partners work to maximize mutual rewards. By contrast, in unsuccessful relationship, the partners are too busy trying to protect themselves from getting hurt to consider ways to make each other happy. Behavior exchanges follow a norm of reciprocity, that means aversive or positive stimulation from one person tends to produce reciprocal behavior from the others. Kindness begets kindness, and the opposite is also true.

The Role of Neurobiological Processes

Recently, increasing attention has been paid to the effects of genetics and neurobiology on interpersonal relationships. The emerging field of neuropsychobiology provides us with new insights into how emotional and behavioral patterns develop in intimate relationships.

The Role of Neurobiological Processes

Louann Brizendine (2006) cites research showing that women use both hemispheres of their brains to respond to emotional experiences, whereas men use only one hemisphere (Wagner & Phan, 2003).

The Role of Neurobiological Processes

It was also determined that the connections between the emotional centers of the brain are more active and extensive in women (Cahill, 2003). This likely explains why women typically remember emotional events, such as arguments, more vividly and retain them longer than

The Role of the Amygdala

Such subcortical structures as the amygdala are believed to operate quickly and automatically, so that certain triggered features, such as when the whites of our eyes widen in a fearful expression, are relatively unfiltered and always evoke responses, such as flight, that may be important for

Normal Family Development

According to behavior exchange theory (Thibaut and Kelley's,1959) ,a good

relationship is one in which giving and getting are balanced. Wills , Weiss, and Patterson (1978) found that
unpleasant behavior reduced marital satisfaction more than pleasant behavior increased it .
Healthy families arent problems free, but they

have ability to cope with problems when they arise

Gottman & Krokoff,1989

Development of Behavior Disorders

Behaviorists view symptoms as learned responses. The don`t look for underlying motives. At first glance it would seem puzzling that family members reinforce undesirable behavior. Parents usually respond to misbehavior in their children by scolding and lecturing .These reactions may seem like punishment ,but they may in fact be reinforcing ,because attention even from a critical parent-is a powerful social reinforcer.

Development of Behavior Disorders

The use of aversive control ,nagging ,crying ,withdrawing is often sited as a major determinant of marital unhappiness. People in distressed relationships also show poor problemsolving skills .

Development of Behavior Disorders

According to cognitive behaviorists ,the schema that plague relationships are learned in the process of growing up. These schemas are the underlying basis of the shoulds ,selffulfilling prophesies ,mind reading ,jealousy ,and bad faith that poison relationships by distorting family members` responses to each other`s actual behavior.

The Mechanics of Change with Couples and Families

Cognitive Processes : Expectations and Standards : Cognitive processes are the backbone of the cognitive -behavioral approach to relationship dysfunction. Baucom, Epstein, Sayers, and Sher (1989) developed a typology of cognitions that frequently surface during the course of relationship distress. These processes include:

The Mechanics of Change with Couples and Expectations and Families-Standards

1. Selective attention. The individuals tendency to notice only certain aspects of the events occurring in relationships and to overlook others (e.g., focusing on the partners words and ignoring his or her actions). 2. Attributions. Inferences about the factors that have influenced a partners actions (e.g., concluding that a partner failed to respond to a question because he or she wants to control the relationship).

The Mechanics of Change with Couples and Families-Expectations and Standards

3. Expectancies. Predictions about the likelihood that particular events will occur in the relationship (e.g., that expressing feelings to ones partner will result in the partners getting angry). 4. Assumptions. Beliefs about the general characteristics of people and relationships (e.g., a wifes assumption that men dont need emotional attachment). 5. Standards. Beliefs about the characteristics that people and relationships "should have (e.g., that partners should have no boundaries between them, sharing all of their thoughts and emotions

Common Cognitive Distortions with Couples and Families

1. Arbitrary inference. Conclusions are made in the absence of substantiating evidence, for example, parents whose teenager arrives home a half hour beyond her curfew conclude, Shes up to no good again. 2. Selective abstractions. Information is taken out of context, and certain details are highlighted while other important

Common Cognitive Distortions with Couples and Families

3. Overgeneralization. An isolated incident or two is allowed to serve as a representation of all similar situations, related or unrelated. For example, when a parent declines a childs request to go out with his friends, the child concludes, You never let me do anything. 4. Magnification and minimization. A situation is perceived as more or less significant than is appropriate. For example, an angry husband blows his top upon discovering that the checkbook isnt balanced and says to his wife, Were in big trouble.

Common Cognitive Distortions with Couples and Families

5. Personalization. External events are attributed to oneself when insufficient evidence exists to render a conclusion. For example, a woman who finds her husband adding more salt to her meal assumes, He hates my cooking. 6. Dichotomous thinking. Experiences are codified as either black or white, a complete success or a total failure. This is otherwise known as polarized thinking. For example, when a husband is reorganizing a closet and his wife questions the positioning of one of the items, the husband thinks to himself, Shes never happy

Common Cognitive Distortions with Couples and Families

7. Labeling and mislabeling. Ones identity is portrayed on the basis of imperfections and mistakes made in the past, and these are allowed to define oneself. For example, subsequent to continual mistakes in meal preparation, a wife thinks, 1 am worthless, as opposed to recognizing her error as being minor. 8. Tunnel vision. Sometimes mates see only what they want to see or what fits their current state of mind. A man who believes that his wife does whatever she wants anyway may accuse her of making a choice based purely on selfish reasons.

Common Cognitive Distortions with Couples and Families

9. Biased explanations. This is a type of thinking that partners develop during times of distress, automatically assuming that a spouse has a negative alternative motive behind his or her intent. For example, a woman tells herself, Hes acting real lovey-dovey because he wants a favor from me. Hes setting me up. 10. Mind reading. Some spouses end up ascribing unworthy intentions to each other. For example, a man thinks to himself, I know what is going through her mind; she thinks that I am naive about what shes doing.

Attachment and Affect

Models of Attachment and the Secure Emotional Connection : Bowlby (1979) believed that human attachment patterns noted in infantcaregiver interactions went on to play a vital role in human development from the cradle to the grave Research has supported a positive correlation between adult attachment and relationship satisfaction (Mikulincer et al., 2002). When both partners in a

Attachment Styles
Bartholomew and Horowitz (1991) further expanded this concept into four styles of attachment: 1. Securethe view of oneself as worthy and others as trustworthy, allowing one to be comfortable with intimacy and autonomy. 2. Preoccupiedmaintaining a negative view of oneself, yet a positive view of others, causing one to become overinvolved in close relationships and depending on others for a sense of self-

Attachment Styles
3. Fearfulavoidanta negative view of both oneself and others, causing one to be fearful of intimacy and avoiding relationships with other people. 4. Dismissingmaintaining a positive view of oneself, but a negative view of others, causing one to avoid relationships with others, preferring to remain independent and shying

Assessment
1-Initial Joint Interviews : Joint interviews with a couple or a family are an important source of information about past and current functioning. Not only are they a source of information about the members memories and opinions concerning characteristics and events in their relationships, conjoint interviews also give the therapist an opportunity to observe the family

Assessment
Cognitive-behavioral therapists approach assessment in an empirical manner, using initial impressions to form hypotheses that must be tested by gathering additional information in subsequent sessions.

Assessment
2 -Gathering Background Information : During the initial joint interview, the therapist asks each member of the family about: His or her reasons for seeking assistance, Each persons perspective on those concerns, Any changes that each member thinks would make family life more satisfying.

Assessment
3 - Inventories and Questionnaires : A therapist often asks couples and family members to complete questionnaires before the intake interviews, so that he or she can ask for additional information about the questionnaire responses during the initial interviews. Naturally, individuals reports on questionnaires are subject to bias, such as blaming others for family problems and presenting themselves in a socially desirable way.

Assessment
A variety of measures have been developed to provide an overview of key areas of couple and family functioning, such as overall satisfaction, cohesion, communication quality, decision making, values, and level of conflict .

Inventories and Questionnaires

Dyadic Adjustment Scale (Spanier, 1976), Marital Satisfaction InventoryRevised (Snyder & Aikman, 1999), Family Environment Scale (Moos & Moos, 1986), Family Assessment Device (Epstein, Baldwin, & Bishop, 1983), Self-Report Family Inventory (Beavers, Hampson, & Hulgus, 1985).

Additional Psychological Testing and Appraisals

Occasionally, the need may arise for more specific assessment, especially if serious psychopathology is suspected in spouses or family members. The Minnesota Multiphasic Personality Inventory 2 (MMPI2) and the Millon Clinical Multiaxial Inventory (MCMI) are two of the more popular instruments for determining levels

Cognitive-Behavioral Techniques
1- Educating and Socializing Couples and Family Members about the Cognitive-Behavioral Model . 2-Identifying Automatic Thoughts and Associated Emotions and Behavior. 3- Addressing Schemas and Schema Restructuring.

Behavioral Techniques
1- Communication Training : Strategies for the Speaker 1. Speak attentively 2. Ask meaningful questions. 3. Do not overspeak. 4. Accept silence. 5. Avoid cross-examining.

Behavioral Techniques
Strategies for the Listener 1. Listen attentively 2. Do not interrupt. 3. Clarify what you hear. 4. Reflect on what you hear. 5. Summarize Conveying Empathy Validation.

Behavioral Techniques
Techniques for Modifying and Reducing Interruptions in Communication The Pad-and-Pencil Technique.

Behavioral Techniques
Problem-Solving Strategies: Define the problem in specific behavioral terms. Compare perceptions and arrive at an agreeable description of the problem. Generate a possible set of solutions. Evaluate the advantages and disadvantages of each solution. Select a feasible solution. Implement the chosen solution and evaluate its effectiveness

Behavioral Techniques
Behavioral Exchange Agreements Contingency Contracts : Stuart outlined a four-step process of employing this strategy: 1. Identify a rationale for mutual change. 2. Have each spouse or family member initiate changes in his or her own behavior first. 3. Record the frequency of the targeted behavior on a chart. 4. Have each spouse or family member sign a written contract for a series of exchanges of desired behaviors.

Behavioral Techniques
Assertiveness Training Deescalation and Time Out Behavioral Rehearsal Role Reversal Acquiring Relationship Skills Homework Assignments Bibliotherapy Assignments Audiotaping or Videotaping Interactions at Home

Behavioral Techniques
Activity Scheduling Self-Monitoring Testing Predictions with Behavioral Experiments Behavioral Techniques and Parental Control

Cognitive-Behavioral Techniques
Addressing the Potential for Relapse
Partners Negativity and Hopelessness about Change Negative schemas about the characteristics of the relationship need to be addressed by having the clients test the validity of their fixed views and consider information that suggests that such views can be changed Differences in Agendas Anxiety about Changing Existing Patterns in the Relationship

Roadblocks
Therapist Roadblocks Unrealistic Expectations Cultural Obstacles Racial Issues Environmental Forces Psychopathology Low Intellectual and Cognitive Functioning Effects of Previous Treatment Inoculation against Backsliding