Behavioral therapy

Behavioral therapy is also known as behavioral modification. It is a psychological method based on the principle that one can change the badly adjusted, maladaptive, observable, specific and self destructive behavior, through learning new and more suitable behaviors (Skinner, p 194). The origin of this theory can be traced back to the school of behaviorism which indicates that one can scientifically study psychological matters through observation of overt behavior without necessarily involving interior psychological states.Skinners theory of behaviorism accepted and supported that internal state could be part of a certain kind of behavior without necessarily being the main cause; however, he declared that through environmental manipulation, one could improve on them. The behavioral theorists include Hans Eysenck, Joseph Wolpe, Harry Solomon, Ogden Lindsley and B. F Skinner and they all had different ways of looking at behavioral problems. Eysenck’s perspective saw behavioral p roblem as connection between one’s behavior, the environment and personality characteristics. For the sake of this study, I will focus on B.F skinner’s behavioral theory (Skinner, p 198). Origin of behavioral therapy Edward Thorndike did experiments to discover the ability of dogs and cats to solve problems. He constructed wooden crates and he would cage the animals each in their own crate. The animals would escape from the crates. Though initially he just wanted to show that dogs and cats’ achievement could be controlled, he realized that he could measure the intelligence of these animals using his tools (Lindsley, p 34). He would set the animals for the same kind of task and observe how long it took to complete the given task.He learnt that there was no difference in performance between the animals that started an assignment and the ones that first observed the others performing (Skinner, p 89). He also learnt that when an animal did something that made it to successfully get out of the box; the animal was likely to repeat that action when faced by the same kind of problem. He concluded that reward reinforces the relationship between stimulus and action. He later formalized it to be called the law of effect (Skinner, p 199). Classical conditioning theory then came to explain that there is an association between reflex and the neutral stimulus.Watson used rats in his experiments to improve on the law of effect and apply it in behaviorism. He made a maze which the rats were supposed to follow. Once they had mastered the routes, he started putting blocks at different points of the maze (Skinner, p 94). If a route was blocked, the rats would then follow another route indicating that they had memory. Once the second route was blocked they would follow the other available route. He observed that when the reward for an action done was less, then the rats performed the task more slowly (Lindsley, p76). B.F Skinner came to improve on Thorndike an d Watson’s work by studying objectively behavior sequences over a prolonged period of time. He came up with the concept of operant conditioning which related the operant response and the reinforcement. This theory is based on the proposal that learning could help in change of overt behavior. People change their behavior as a result response to the occurrences in their surroundings. A given response leads to a certain outcome. When one reinforces a certain pattern of Stimulus-Response, a person’s response becomes conditioned (Skinner, p 97).The key element in this theory is reinforcement; this is anything that supports the response that is desired. Reinforcement could be positive or negative. Positive reinforcement makes one be encouraged to do more of the action that led to positive results. It includes attaining satisfaction after doing something, being recognized, being praised for work well done among others. Negative reinforcement on the other hand involves the act ions that make one increase the frequency of responses once a certain stimulus is withdrawn. Aversive stimulus results to the reduction of responses (Skinner, p 200). Behavioral Therapy This is a report about Paula a client who was referred to therapy by the general practitioner of the hospital. Following a thorough physical checkup performed on Paula the GP feels that Paula’s heart is sound enough and her condition is psychological. (Getzfeld, 2004). Paula’s case is not an isolated case of psychological dysfunction and in fact a sizeable number of people suffer these attacks in silence. (Beck, Rush, Shaw, & Emery, 1979). This is perhaps due to the feelings of embarrassment and stupidity that they feel they might be accused of.Additionally, panic attacks are not well known to many and hence the stigma. Nonetheless, panic attacks are not insignificant and can have a crippling effect in someone’s life. They are a symptom of underlying stressing and traumatic events in the patient’s life. (Feather & Ronan, 2006). This report gives a diagnosis of Paula’s case. It gives a comprehensive analysis of what is the onset of Paula’s con dition, the triggers and the effects of her attack. At the end of the report it will give the findings and recommendations on the way forward for Paula in getting treatment for her condition.Diagnosis Paula has been experiencing an array of symptoms that occur frequently at the workplace and outside home. These symptoms include dizzy spells, shortness of breath, dizziness and lightheadedness as well as chest pains and fast heartbeats. Paula feels that there is cause for alarm because these symptoms may be an indication of a heart attack. For this reason she has sought medical help from her general practitioners, and she has even visited a cardiologist for a sonogram and echocardiogram. Both these tests showed no defects or indication of heart attack.Nothing is wrong with Paula’s heart and apparently the symptoms may be a psychological related. The doctors at the company clinic where Paula works suggested that she try to relax more and steer away from caffeine, nonetheless the attacks still persevere despite Paula’s attempts to relax. She sought a second opinion from another physician who also gave similar diagnosis i. e. her attacks are a psychological problem hence she needs to sign up for therapy. With that Paula came to the clinic. Brief history of PaulaIn order to clearly diagnose Paula’s condition information from her life experiences both in the present and from the past had to be sought. Paula is 27 years old, single and lives at home with her parents. She has a good job at a securities and bond trading company which she has worked for loyally since she graduated from university with a BA in economics seemingly her life was be smooth and no developmental milestones have been experienced on her part. Prior to her recently persistent attacks she was ready to enroll for MBA.Her father died soon after she graduated from University after a brave fight with cancer, emphysema and the killer heart attack. Her mother has some health problems although nothing too serious. Her grandparents died of cancer; her grandma of breast cancer and her grandpa of colon cancer, she feels that cancer runs in the family and is afraid of it too. This is the reason why she stopped smoking and does not drink alcohol. She says matter of factly â€Å"I have enough bad seeds in me†. Paula is the only child not by plan but out of natural misfortune.She had a little brother who died at the age of three out of heart defects that developed with age. He also had other birth defects that Paula was unwilling to disclose. This memory made her teary. Obviously, the death of the little boy had deep-seated effects in all the family members. (Feather & Ronan, 2006). According to Paula, her parents did not try to get pregnant again and the option of adoption was too devastating to consider. Paula’s mother and friend at work feel greatly concerned over her condition and Paula feels that as well. Paula feels that it is time she had greater c ontrol over her problem.The medication she has been taking i. e. Xanax and Contac zonk her out and she refers to herself as a ‘walking dead’ when she is on this medications. The persistent attacks seem to be triggered by anything major to Paula and given the nature of her job she reports frequent dizzy spells, faints and attacks at work. She remembers a case whereby a client fell through and all the blame was pinned on her. At the same time a coworker at the workplace had shown particular interest on Paula as a woman. All these major events occurring concurrently in her somewhat laid back lifestyle triggered an attack.In the moment of it all, the other workers got wind of her weak point and she is afraid that they might think of her as ‘chicken’ or incompetent of handling such a demanding job. Frequency of attacks Paula’s attacks have been with her for a long while. She points out that ever since she entered university she started experiencing them. The stress levels were high what with the huge load of work, pressure from men in campus and the need to fit in since the university was small and everyone knew everyone else. In her high school it was easy to be an invisible wall paper and stay unnoticed when necessary.Unfortunately in university this was not the case and she lacked the necessary support systems or good outlets to channel the stress she was feeling. She also recalls her father’s death which affected her greatly. It was overwhelming for her although she had suspected it would happen soon. This reminded her of her brother’s death. For this reason Paula feels ‘life is very unfair’. The death of loved ones caused her to withdraw from life completely. At school she would get sweaty and the dizzy spells prior to presentation and even before she lost her virginity she had a panic attack.Paula’s case now involves her mothers, her co-workers the doctors and now psychiatrist. Before, it was her personal problem and she felt she could deal with it. Now her life is significantly affected and people around her are worried. Doctors feel that it is time she saw a therapist to uncover the real cause of the problem. Her mother feels strongly about the same as also the people at work. Assessment and investigation plan It seems that Paula is suffering from severe depression which manifests itself in panic attacks.(Alpert & Fava, 2004) She has not developed the expression skills and seems to bottle up feelings of anxiety, frustration, hurt and stress. She has managed to deactivate her social life and is highly dependant on her mother for comfort although she does not disclose her inner feelings to her mother as well. Notably, at 27 and with a good job she is still unattached to anyone and does not go out with friends. Throughout the sessions she makes no mention of significant persons other than her mother. Even at university she frequently went home to be babied.Her family back ground is a troubled one with a history of heart diseases and cancers. Her loved ones seem to be consumed by these diseases and she feels afraid of being the next. Panic attacks manifest either as ‘a way of getting through tough situations’ as she puts it or as a reaction to overpowering feelings of loss, excitement or expectations. After reviewing Paula’s case in detail it is recommended she have behavioral therapy as a start treatment program since it is the best therapy linked to activating the client from depression, a condition that is the underlying cause of Paula’s panic attacks.BATD (Behavioral Activation treatment for Depression) overview, foundation and Assumptions. This treatment option bases its foundations from cognitive therapy. It basically involves activating the client from depression by encouraging them to make connection between powerful experiences both in the present and in the past with the symptoms that they may be having. In Paulaâ €™s case it is panic attacks. The basic assumption of this therapy is that depression and subsequent symptoms of depression arise from life expenses of the patient and not the genetic predisposition. (Cooper, Smith & Upton, 1994).Vulnerability is severed by traumatic life events. This therapy encompasses assessment and treatment of cognitive, emotional and behavioral aspects of the clients. This means that its efforts are channeled toward sharpening social skills of the client through training and reinforcements, imparting relaxation techniques as well as therapy to help relax the client, increasing pleasurable activities in the clients life say situations with more laughter and easiness, training clients on assertness and emotional expressions and restructurings the clients patterns of thoughts and cognitive perceptions.(Gortner & Jacobson, 2000, Martell, Addis & Jacobson, 2001) These areas are greatly emphasized because they alter the client’s beliefs of the world aroun d them and eventually how they choose to resolve their inner problems or conflicts which are evident in behaviour. According to Beck, Rush, Shaw and Emery (1979 p. 118) mentioned in Jacobson, Mortell and Dimidjian 2007, p. 257 ‘the aim of this therapy to bring about change in the clients negative outlook in life’. The beliefs and expectations of a person indecent in his cognitive make up ultimately affect behaviour.The behavioral activation therapy recognizes that some depressions and subsequently panic attack may be or a result of genetic predisposition, it greatly emphases environmental factors as a great a preventative measure for depression maintenance. Course of treatment Paula’s treatment will commence with the establishment of therapeutic rapport with the therapist while they discuss the objectives and goals for the therapy and the sessions. This will be achieved by encouraging Paula to ask questions and be as comfortable as possible during the sessions.Pa ula and the therapist will explore the implications that her depression has had on Paula’s life for instance she lacks a social life, she cannot do her daily tasks any more, she will lose her job and so on. Under this treatment the therapist will be performing some functional analysis on Paula to gauge how well Paula is responding to treatment. For example, she should be able to start driving her car to work and performing her duties at work. The use of home works will be helpful to both Paula and the therapist in finding areas that the therapy should concentrate on.The therapy sessions will also explore the strategies that Paula should use to avoid a relapse. Paula intervention plan The first step in her treatment plan is to get her to talk more about her unpleasant life experiences. So far she has registered commendable progress into talking about her father and her young brother. When she first came in she was fidgety and kept checking her pulse over her neck. She had a pa nic stricken look but now she has relaxed a little.It is impossible to accurately state the duration that Paula might take to show full recovery since depression can be hard to overcome with the lack of proper support systems and the troubling environment at her workplace. Nonetheless, Paula sounds really determined to get over this problem and regain full control of her life. A two hour session with the psychiatrist thrice a week for a month and once a week for the following two months is recommended. This will be flexible enough for Paula to manage work and treatment. The significant people in Paula life i. e.family and coworkers need to give Paula all the support she needs to overcome this milestone. This is because her depression is not just an inner problem but the environment also triggers her attacks. The boss could encourage Paula to take some early days off and maybe some days be allowed to work from home until she is ready to work full time. The mother needs to continue be ing there for her daughter but on the other hand encourage her to be more independent. This will ensure that she is strong enough to handle life situations on her own and avoid a relapse in case she dies.The coworkers may be a bit more supportive when she experiences panic attacks and let her know it is nothing to be ashamed of. Again, Paula should expand her social networks and support system and this will a particular area where she will be trained during therapy sessions. Paula seems to over think her situations and the events in her life. A case in point is where she is quick to say that her coworkers will recommend she be transferred to the mail room because of the panic attacks. She feels that she should ‘never’ have an attack at the office again.She says ‘everyone will laugh and say look at the retard at it again. ’ She also seems to have planned out her suicide and thought of the consequences i. e. she would go to hell, it would be painless if she o verdosed on Aspirin, she would play some sad music, the suicide letter and other details fully planned. This seems to be Paula’s pattern of thinking and it is detrimental. In therapy, I will be interested in activating Paula’s spontaneity and her ability to accept her vulnerabilities and limitations towards having a fuller life. Measuring progressIn order to gauge progress on Paula’s treatment the therapist should be able to find improvements in Paula’s frequency of panic attacks. Ideally, they should reduce in the first month of treatment significantly. Additionally, her patterns of avoidance will be evaluated to see how well she is able to confront her fears. (Carr, 2001). For example, she avoids getting close to any man who might show interest in her hence stays away from social scenes like movies theatres and social gatherings. She also marks all the exit points to a place just incase she suffers another panic attack.Driving is also a problem to her a nd she has to be driven by her mother. She also avoids going out doors and stays in mostly where treatment will be effective, Paula should be able to take on her daily activities and develop healthy relationships with new people. The therapist will also make use of homework whereby Paula can try to engage in a task she feels prohibitive or unable to handle and see how well or not she manages the situation. This homework will allow her to self monitor her own progress and in therapy session discuss the feelings of accomplishment and pleasure derived from engaging in that activity.Results of the actions So far Paula has impressively shed light on her life. She has made the first big step towards treatment and that is the resolution to seek professional help. The diagnosis is that Paula is suffering from panic disorder which overlaps severe depression. She has had traumatic life experiences and suppressed them sufficiently. However she has reached a point where the emotions and negativ e psychological beliefs can no longer be bottled up hence the frequent panic attacks.The panic attacks have greatly eroded her self-esteem to a point that she planned a suicide although did not execute it. After evaluating her case I recommend psychiatric assessment just to ascertain this diagnosis so that the next level of therapy i. e. relaxation therapy and psychoanalysis can commerce. Although Paula is not actively keen on attempting another suicide, the risk is inherent and she needs close monitoring by her family and friends before and during therapy until she is strong enough to stand on her own.Paula should enroll in an activity that will enable her to think outside herself and her problems as well as boost her self-esteem. Yoga and social gatherings will particularly do her a lot of good. (Gortner & Jacobson, 2000). Lastly but importantly, Paula’s GP and cardiologist input would also be necessary in affirming this diagnosis so that Paula is well convinced that her pa nic attacks are purely psychological and not heart attack related. This will encourage her to continue the treatment. ConclusionPanic attacks are surmountable behavior activation therapy is a good way of assisting clients who suffer these attacks. The collaborative relationship between the client and the therapist should be useful in uncovering the depression in clients who suffer depression. The patterns of avoidance that Paula has developed such as avoiding relationships and friendships with others, avoiding social places staying away from work among others are crippling to Paula’s life and need to be confronted. Paula has to find a way of dealing with her problems in healthy ways. Behavioral therapy Behavioral therapy is also known as behavioral modification. It is a psychological method based on the principle that one can change the badly adjusted, maladaptive, observable, specific and self destructive behavior, through learning new and more suitable behaviors (Skinner, p 194). The origin of this theory can be traced back to the school of behaviorism which indicates that one can scientifically study psychological matters through observation of overt behavior without necessarily involving interior psychological states.Skinners theory of behaviorism accepted and supported that internal state could be part of a certain kind of behavior without necessarily being the main cause; however, he declared that through environmental manipulation, one could improve on them. The behavioral theorists include Hans Eysenck, Joseph Wolpe, Harry Solomon, Ogden Lindsley and B. F Skinner and they all had different ways of looking at behavioral problems. Eysenck’s perspective saw behavioral p roblem as connection between one’s behavior, the environment and personality characteristics. For the sake of this study, I will focus on B.F skinner’s behavioral theory (Skinner, p 198). Origin of behavioral therapy Edward Thorndike did experiments to discover the ability of dogs and cats to solve problems. He constructed wooden crates and he would cage the animals each in their own crate. The animals would escape from the crates. Though initially he just wanted to show that dogs and cats’ achievement could be controlled, he realized that he could measure the intelligence of these animals using his tools (Lindsley, p 34). He would set the animals for the same kind of task and observe how long it took to complete the given task.He learnt that there was no difference in performance between the animals that started an assignment and the ones that first observed the others performing (Skinner, p 89). He also learnt that when an animal did something that made it to successfully get out of the box; the animal was likely to repeat that action when faced by the same kind of problem. He concluded that reward reinforces the relationship between stimulus and action. He later formalized it to be called the law of effect (Skinner, p 199). Classical conditioning theory then came to explain that there is an association between reflex and the neutral stimulus.Watson used rats in his experiments to improve on the law of effect and apply it in behaviorism. He made a maze which the rats were supposed to follow. Once they had mastered the routes, he started putting blocks at different points of the maze (Skinner, p 94). If a route was blocked, the rats would then follow another route indicating that they had memory. Once the second route was blocked they would follow the other available route. He observed that when the reward for an action done was less, then the rats performed the task more slowly (Lindsley, p76). B.F Skinner came to improve on Thorndike an d Watson’s work by studying objectively behavior sequences over a prolonged period of time. He came up with the concept of operant conditioning which related the operant response and the reinforcement. This theory is based on the proposal that learning could help in change of overt behavior. People change their behavior as a result response to the occurrences in their surroundings. A given response leads to a certain outcome. When one reinforces a certain pattern of Stimulus-Response, a person’s response becomes conditioned (Skinner, p 97).The key element in this theory is reinforcement; this is anything that supports the response that is desired. Reinforcement could be positive or negative. Positive reinforcement makes one be encouraged to do more of the action that led to positive results. It includes attaining satisfaction after doing something, being recognized, being praised for work well done among others. Negative reinforcement on the other hand involves the act ions that make one increase the frequency of responses once a certain stimulus is withdrawn. Aversive stimulus results to the reduction of responses (Skinner, p 200).When considering this theory, schedules of reinforcement are considered to be very important. Principles under this theory are that positively reinforced behavior is very likely to reoccur. Shaping is also a principle that states that in order to reinforce behavior, information should be provided in small amounts. Stimulus generalization principles talks of reinforcement being generalized across stimuli that are similar to the original one (Lindsley, p 56). Behavior modification using B. F Skinner’s theory Behavior modification refers to a straight forward therapy technique that bases its arguments on skinner’s theory.It indicates that one can extinguish the unwanted behavior through the removal of the reiforcer and at the same time, behavior that is desired can be obtained and maintained via reinforcement . This argument has been used in solving many psychological problems. It is the preferred method when dealing with children. Other disorders which can be corrected using this therapy are anxiety disorders, phobias, eating disorders, anger management, aggressive behavior and substance use. All these are eliminated through changing the activities and behavior that may have contributed to such disorders (Skinner, p 96).Token economy is a derivative of behavior modification and it is used in institutions like prisons, juveniles, and psychiatric hospitals. This involves giving tokens to these people whenever they behave in a certain required way. When they revert to poor habits, the tokens are withdrawn. This is one way of behavior modifications that these institutions have used in order to keep order within the institutions. At times, Behavioral therapy methods are brought together with additional psychological involvements like medication (Skinner, p 197).This technique uses the follow ing approaches when using behavioral therapy to change a negative behavior to a positive one; systematic desensitization, flooding, behavior modification, prevention of exposure and response, operant conditioning, observational learning, contingency management, matching law, habit reversal training and covert conditioning (Lindsley, p72). Best fit patients for behavior therapy Behavioral therapy can be used as a tool to treat various problems like mental illnesses and their symptoms especially those that have maladaptive behavior.These conditions include phobias, eating disorders, anger management, aggressive behavior and substance use. Organic disorders like insomnia and incontinence could also be handled using the behavioral techniques (Skinner, p 205). This technique works very well in the treatment process of obesity. This process starts with the analysis of the activity and eating patterns in addition to other habits like dieting methods. After all this information is collected , the therapist uses it to come up with positive methods that can be used to promote weight loss, a positive self image and get healthier eating practices.The therapist does an analysis to the behavioral cause of stress in a patient. An appropriate method of treatment is then established. Cognitive therapy This therapy focuses in altering the bad behavior through changing the patterns of thinking behind them. It involves the emotions and the thoughts of the individual and the way they can be changed so that this person starts behaving more appropriately. This therapy can be used to correct many disorders like schizophrenia, autism, shyness, neurosis, stress disorders, attention deficit disorders, social phobias, mental disorders and addictions (McCullough, Para 24).It involves helping patients to triumph over difficult situations and modifying dysfunctional emotional, behavior and thinking responses. Treatment is all about bringing together the beliefs of the client and those of the therapist and testing them. It may also include testing the kind of assumptions an individual makes in life and also identifying the extent of distortion of thoughts that renders them unhelpful and unrealistic (Kohlenberg, p 234). Once the therapist challenges the way an individual thinks about something, that person is likely to change the way of thinking.Initially, this therapy was used to treat people suffering from depression. Beck came up with a list which contained ‘errors’ in thinking. He suggested that the errors maintained depression. They included selective abstraction, minimizing positives and magnifying negatives, over generalization and arbitrary inference (Kohlenberg, p 234). Historical development of cognitive therapy The theory of cognitive therapy came to be more than 50 years ago and it suggested that thoughts act as a go-between to stimuli like emotions and external events.A stimulus brings out a thought which can be a weighed up judgement of a kind and this further leads to a certain emotion. People’s evaluation of thought about a certain stimulus is what results to an emotional response and not necessarily the stimulus itself. Beck also came up with the etiological theory of depression under cognitive therapy. The theory indicated that people think negatively because their thinking is inclined to negative interpretations. People suffering from depression acquire negative schemas which are important ways through which information about the future; the world and the self are processed.These schemas are adopted early in life maybe during childhood or puberty as a result of going through stressful events in life. When such people come across situations that are similar to the ones in which the negative schemata was established, it becomes activated in the current situation (Kohlenberg, p 235). Beck also explained about the negative cognitive triad which constitutes negative biases and negative schemata. He proposed that pe ople who are depressed are very likely to make unconstructive evaluations of their future, world and selves.Depressed people are impossibility thinkers according to Beck. The cognitive triad indicates that a negative schema results to cognitive bias which fuels negative schema (Kohlenberg, p 237). Researchers suggested that depression could occur as a result of responding to perceived or imaginary loss. It could also be caused by self critical characteristics of the ego. Many psychologists wrote about cognitive features of depression trying to identify the cognitive components that caused depression. They also tried to develop many cognitive intercessions that could be used to treat depression.Since then, there have been many successful cases of patients suffering from depression getting well through cognitive therapy. His theory was opposed by behaviorists who claimed that mental causes of problem was unmeaningful and non scientific. With time, it was merged with the behavioral the rapy so as to deal with the problems that it could not have dealt with on its own (Kohlenberg, p 240). Strategies under cognitive therapy Cognitive therapy uses two strategies i. e. emotional focused and problem focused strategies.The problem focused strategy aim at directing the client in the process of identifying the problem. The therapist then helps the client to identify the responses that are utilized in the process of reducing distress in a situation. They are also evaluated to check how effective they are. The therapist and the client then develop and examine alternative responses to see how beneficial they can be to a client. When faced with a stressful situation, the client feels empowered to make mindful alternatives and chose among them the best way in which to respond.This gives the patient a kind of control over situations as they try different methods of getting out of distressful situations (McCullough, Para 32). Emotional focused strategies also aim to get the same outcomes as the other strategy. This perspective aims to alter the perception of the client on the distressing event. It therefore helps in changing the level of perceived suffering. The client is helped to redefine the problem which aids in the transformation of a disaster into a challenge or even an opportunity.The process of restructuring the event can be achieved through various ways like selective attention, distancing, minimization, and looking for constructive value from any given bad situation. When all these happen, the patients get the feeling that he is in control of the situation and this contributes to reduce the levels of stress (Kohlenberg, p 245). Best fit patients for cognitive therapy Since this technique was discovered, the most common condition that it has treated is depression.Patients who have depression are allowed to undergo self evaluation to check whether they act, say and do things the way they are supposed to do and how the patient views all these. Skills deficits are also established so that the therapist can know the source of the problem. Life experiences in terms of how satisfied the patient has been by the kind of life that he has lived (McCullough, p 24). The expectations of the patient are also evaluated in order to know how realistic they are. The therapist checks on the kind of self talk that the patient usually has.If it is negative, then it could be a source of depression since the patient seems not to believe in his capabilities and this could lead to negative repercussions like being fired (Kohlenberg, p 254). The process goes on to evaluate the kind of automatic thought that the patient has. In most cases, there is consistency in that a person who usually has positive automatic thought is likely to have them, in most situations and the same case applies to negative automatic thoughts. Irrationality or rationality of ideas is evaluated because irrational ideas could cause depression.Depressed patients tend to generalize in most cases. The therapist works to find out the extent of generalization in his depressed patients. Cognitive distortion is also checked so that the therapist can be in a position to tell the extent of depression. Optimism versus pessimism is evaluated given different situations. All these are ways through which therapists can know the causes of depression and get ways of tackling it (McCullough, p 25). Comparison and contrast between behavioral and cognitive therapyBehavioral therapy focuses on how one can change from bad behavior through strategies like reinforcement. On the other hand, cognitive therapy focuses on how there can be a change of behavior due to a change in how a person thinks about a certain situation. While cognitive therapies deal with emotions and thoughts that direct a person towards behaving in a particular way, behavioral therapy on the pother hand focuses on how to change and eliminate the bad behavior (Kohlenberg, p 263). While behavioral therapy deals w ith observation of behavior, cognitive therapy deals with the cognitive elements.