7 Behavioral Cognitive Continuum

From Cole, M. From Cole, M. Applied theories in occupational therapy: a practical approach instructor’sApplied theories in occupational therapy: a practical approach instructor’s manualmanual. Online document, . Online document, http://www.efacultylounge.com, based on Cole, M. (2008). http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approachApplied theories in occupational therapy: a practical approach. Thorofare, . Thorofare,

NJ: SLACK Incorporated.NJ: SLACK Incorporated.

Behavioral Cognitive Behavioral Cognitive ContinuumContinuum

Reference: Cole & Tufano, Reference: Cole & Tufano, Chapter 12Chapter 12



Roots of BehaviorismRoots of Behaviorism

Pavlov – classical conditioningPavlov – classical conditioning Skinner – operant conditioningSkinner – operant conditioning Applied scientific method to Applied scientific method to

human behaviorhuman behavior Foundation for learning theoryFoundation for learning theory Began 1930s & 1940sBegan 1930s & 1940s



FocusFocus

Behavior that can be observed Behavior that can be observed and measuredand measured

Rules out unconscious Rules out unconscious motivationmotivation

Directly opposed to Directly opposed to psychoanalytic theorypsychoanalytic theory

Learning and behavior Learning and behavior modificationmodification

Includes perception & cognitionIncludes perception & cognition



Continuum: Behavioral to Continuum: Behavioral to Cognitive Theories & TheoristsCognitive Theories & Theorists Behavior modification: Skinner, Behavior modification: Skinner,

Pavlov, LazarusPavlov, Lazarus Biomechanical, Rehabilitative: Biomechanical, Rehabilitative:

Trombly, Denton, Mosey, FidlerTrombly, Denton, Mosey, Fidler Cognitive Perceptual: Toglia & Cognitive Perceptual: Toglia &

AbreuAbreu Cognitive Disabilities: AllenCognitive Disabilities: Allen Cognitive Behavioral: Bandura, Cognitive Behavioral: Bandura,

Beck, Ellis, LinehanBeck, Ellis, Linehan



Behavioral Cognitive Continuum, Behavioral Cognitive Continuum, Client ApplicationsClient Applications

Behavior Modification: allBehavior Modification: all Biomechanical, Rehabilitative: Biomechanical, Rehabilitative:

physical disabilitiesphysical disabilities Cognitive Perceptual: brain injury Cognitive Perceptual: brain injury

(TBI), Stroke (CVA), mental illness, (TBI), Stroke (CVA), mental illness, drug/alcohol rehab.drug/alcohol rehab.

Cognitive Disabilities (Allen)Cognitive Disabilities (Allen) Cognitive Behavioral: all mental Cognitive Behavioral: all mental

illness except psychosis, emotional illness except psychosis, emotional aspects of any disorder, preventionaspects of any disorder, prevention



Behavior Modification, Behavior Modification, Concepts & TechniquesConcepts & Techniques Includes: goals & objectives, training, Includes: goals & objectives, training,

shaping, chaining, modeling, external shaping, chaining, modeling, external reinforcement, rehearsal & practice, reinforcement, rehearsal & practice, role playing, systematic role playing, systematic desensitization, biofeedbackdesensitization, biofeedback

OT examples: assertiveness training, OT examples: assertiveness training, social skills training, graded tasks, social skills training, graded tasks, relaxation, time management, stress relaxation, time management, stress managementmanagement



Biomechanical Concepts & Biomechanical Concepts & TechniquesTechniques Strength, ROM, endurance, Strength, ROM, endurance,

positioning, prevention, restoration, positioning, prevention, restoration, compensation, adaptation, skill compensation, adaptation, skill training, biofeedback, context of ADLtraining, biofeedback, context of ADL

OT Examples: group exercise, group OT Examples: group exercise, group games involving graded movements, games involving graded movements, learning prevention strategies, learning prevention strategies, ergonomics in the workplace, work ergonomics in the workplace, work hardening, training in use of adaptive hardening, training in use of adaptive equipment, energy conservationequipment, energy conservation



Cognitive Perceptual Cognitive Perceptual Concepts & TechniquesConcepts & Techniques Skill training (remediation) for Skill training (remediation) for

orientation, attention, visual orientation, attention, visual processing, motor planning, memory, processing, motor planning, memory, cognition, problem solving. cognition, problem solving. Multicontextual use of strategies, Multicontextual use of strategies, metacognition. Functional approach. metacognition. Functional approach. Quadraphonic approach (Abreu)Quadraphonic approach (Abreu)

OT Examples: group orientation, OT Examples: group orientation, labels & reminders, cancellation labels & reminders, cancellation sheets, computer programs, group sheets, computer programs, group multicontextual strategy practicemulticontextual strategy practice



Cognitive Disabilities, AllenCognitive Disabilities, Allen

Assessment & management: Assessment & management: ongoing evaluation through crafts or ongoing evaluation through crafts or ADL tasks, cuing, assistance through ADL tasks, cuing, assistance through facilitation & probing, home safety facilitation & probing, home safety screenings, care giver education, screenings, care giver education, modification of task environmentsmodification of task environments

OT examples: use of cognitive OT examples: use of cognitive performance modes to accurately performance modes to accurately plan future placement, determine plan future placement, determine competence, predict need for competence, predict need for assistance, and adapt environment assistance, and adapt environment to produce best ability to function.to produce best ability to function.



Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, Concepts & StrategiesConcepts & Strategies Social learning, modeling, self-Social learning, modeling, self-

regulation, disputing irrational regulation, disputing irrational beliefs, thought stopping, beliefs, thought stopping, interruption, cognitive reframing or interruption, cognitive reframing or restructuring, dialectical strategiesrestructuring, dialectical strategies

OT Examples: psycoeducational OT Examples: psycoeducational modules, group learning, role modules, group learning, role playing, worksheets for self playing, worksheets for self awareness & understanding, awareness & understanding, interpersonal effectiveness, emotion interpersonal effectiveness, emotion regulation, distress tolerance, regulation, distress tolerance, mindfulness mindfulness



Behavioral Strategies: Goals Behavioral Strategies: Goals & Objectives & Objectives (Cole, 2005 p.142)(Cole, 2005 p.142)

Writing Long term goals: these Writing Long term goals: these are not always measurableare not always measurable

In your notebook write one In your notebook write one lifetime goal for yourself in each lifetime goal for yourself in each of the following categories:of the following categories: ProfessionalProfessional FamilyFamily FinancialFinancial SpiritualSpiritual



Behavioral ObjectivesBehavioral Objectives

In contrast to long-term goals, In contrast to long-term goals, these have specific time limits.these have specific time limits.

Short steps toward a longer Short steps toward a longer term goalterm goal

Should be observableShould be observable Should imply way to measureShould imply way to measure Based on similar principles to Based on similar principles to

Allen & Toglia, observe behavior Allen & Toglia, observe behavior to infer thoughts & perceptionsto infer thoughts & perceptions



Practice: Recognizing Practice: Recognizing Measurable Goals Measurable Goals (Cole, 2005, (Cole, 2005, p. 141)p. 141) Worksheets: circle measurable Worksheets: circle measurable

goals.goals. Correct answers: 2,4,9,10,12, Correct answers: 2,4,9,10,12,

14,15,17,1814,15,17,18 Discuss why these are Discuss why these are

measurable.measurable. Homework: write one behavioral Homework: write one behavioral

objective for each lifetime goal.objective for each lifetime goal.



Conditioning & HabitsConditioning & Habits

Pavlov: classical conditioning. Pavlov: classical conditioning. What happens when you are What happens when you are hungry and you see a picture of hungry and you see a picture of a delicious pizza on TV? a delicious pizza on TV?

Stimulus is associated with Stimulus is associated with visual image, eventually visual visual image, eventually visual image replaces stimulus.image replaces stimulus.

Much of today’s advertising is Much of today’s advertising is based on this principle.based on this principle.



Conditioning, cont.Conditioning, cont.

Skinner, operant conditioningSkinner, operant conditioning Behavior that is reinforced in the Behavior that is reinforced in the

environment tends to be repeatedenvironment tends to be repeated Behavior that is ignored tends to Behavior that is ignored tends to

diminishdiminish Many random reinforcements exist in Many random reinforcements exist in

the environmentthe environment Learning can be both positive and Learning can be both positive and

negative, depending on what is negative, depending on what is reinforcedreinforced



Conditioning & Habits, cont.Conditioning & Habits, cont.

External reinforcement External reinforcement What are some examples?What are some examples?

Reinforcement can also be Reinforcement can also be internalized.internalized. What are some examples?What are some examples?

Once a behavior becomes Once a behavior becomes habitual, reinforcement is no habitual, reinforcement is no longer necessary.longer necessary.



HabitsHabits

Habit diminishes the conscious Habit diminishes the conscious attention with which our acts are attention with which our acts are performed. (James, 1985)performed. (James, 1985)

Familiar objects in the Familiar objects in the environment serve as stimuli for environment serve as stimuli for the habitual performance of the habitual performance of tasks.tasks.

Example: morning routinesExample: morning routines



Shaping & ChainingShaping & Chaining

Uses principle of operant Uses principle of operant conditioning to learn new behaviorsconditioning to learn new behaviors

Breaks down task/activity into Breaks down task/activity into sequence of stepssequence of steps

Reinforces each step as it is Reinforces each step as it is performed successfully (shaping)performed successfully (shaping)

Each step serves as stimulus for Each step serves as stimulus for next step (chaining).next step (chaining).



Rehearsal & PracticeRehearsal & Practice

Basis of all learningBasis of all learning Used in approaches on the Used in approaches on the

continuumcontinuum Reinforcement needed when Reinforcement needed when

motivation is lackingmotivation is lacking How is this principle used in the How is this principle used in the

biomechanical frame of biomechanical frame of reference?reference?



The EndThe End

Skinner FilmSkinner Film

A Phillip P. Blake Production in association A Phillip P. Blake Production in association with Research Press Company. Written by with Research Press Company. Written by David Seltzer. David Seltzer.

Additional Resource:Additional Resource:

Cole, M. (2005). Group Dynamics in Cole, M. (2005). Group Dynamics in Occupational Therapy: The Theoretical Occupational Therapy: The Theoretical Basis and Practice Application of Group Basis and Practice Application of Group Intervention. 3rd ed. Thorofare, NJ: SLACK Intervention. 3rd ed. Thorofare, NJ: SLACK Incorporated.Incorporated.

7 Behavioral Cognitive Continuum

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