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Craske (2010) begins her third chapter outlining underling principles and theories that

have been integrated into cognitive-behavioral therapy (CBT). In a nutshell, CBT aims to replace
maladaptive emotional, behavioral and cognitive responseoften adopted through experience
and learningwith responses that are adaptive to improve the quality of life of the cleint. The
goals of CBT include 1) teaching new ways of responding and fostering novel experiences for
the formation of adaptive behavioral, emotional and cognitive patterns 2) maintaining positive
changes through repetition for long-lasting effects, and 3) using functional analysis for ongoing
evaluation to flexibly guide intervention and gauge client progress. According to Craske (2010),
the following three major theories are the primary sources from which the clients condition can
be viewed: learning theory, social learning theory, and cognitive appraisal theory. Each theory
has its own unique contribution to CBT and is explored by Craske (2010) separately and in
combination when an overlap occurs.
Learning theory is based on both classical and instrumental conditioning. Craske (2010)
explains that classical conditioning occurs when an evocative stimulus (US) producing an
involuntary response (UR) is paired with a neutral stimulus multiple times, and upon removal of
this evocative stimulus, the once neutral stimulus (CS) produces the involuntary response (CR).
This phenomenon plays a critical role in the formation of psychopathology, especially anxiety
disorders and phobias. For example, an irrational fear of dogs may ensue following a frightening
situation involving a barking, snapping, and vicious dog; hence, all dogs have been associated
with the fear response. The process by which all four legged animals are fear is called
generalization, where a stimulus similar to the conditioned stimuli evokes an involuntary
response. One major criticism of classical conditioning is that not all individuals who undergo
such experience develop phobias. Craske (2010) offers the following three additional factors that
influence whether or not one develops such pathology: constitutional factors (e.g., temperament,
personal history), contextual factors (e.g., high intensity and less control over events), and
postevent processes (rumination following the adverse event). Explanatory power of classical
conditioning for substance abuse is also discussed by Craske (2010), except the association is to
a pleasurable response.
Treatment from this perspective typically involves disrupting the associations between
the conditioned response and the outcome response through a process called extinction (Craske,
2010). For example, an individual with social anxiety would be exposed to an anxiety provoking
situation without a traumatizing effect; thus, the association loses its strength though mechanisms
such as habituation (decrease of anxiety through repeated exposure) and inhibitory learning
(expectancy change). For changes to sustain over time after exposure therapy, exposures must be
conducted in multiple contexts and should free from any safety signals (e.g., medication, food,
presence of the therapist). Though initially absent, cognitive interpretation of classical
conditioning is inclusive of not only mechanistic/automatic expectancies but also higher-order
cognitive processes. The mechanistic view posits that classical conditioning can occur without
conscience awareness, while the alternative dictates that expectancies are often influenced by
maladaptive beliefs (i.e., overestimation, catastrophizing, and over-attention to the negative).
Such beliefs mediate stronger conditioning (Craske, 2010).

Instrumental conditioning is presented by Craske (2010) as the second critical piece of

learning theory, and is based on the principle that consequences of a response dictate future
probability of that response. Consequences are categorized into two typesreinforcers and
punishers where reinforces increase the likelihood of a particular response while punishers
decrease its frequency. Following a specific behavior, a positive reinforcer is a usually
pleasurable event that is presented following a behavior (i.e., reward), and a negative reinforcer
is a withdrawal of an adverse event (i.e., medication for a headache). Positive punisher is
typically a negative event that follows a behavior (i.e., unpleasant odor) while a negative
punisher is the removal of a something positive (i.e., time out). Extinction is also an important
concept in instrumental theory where the lack of consequence (pleasurable or adverse) decreases
the frequencies of a behavior. Factors that are thought to influence reinforces and punishers
include: satiation (i.e., hunger or lack thereof), immediacy (how quickly a consequence follows a
behavior), contingency (reliability of the consequence), and size of consequence (Craske, 2010).
Treatment from the instrumental view consists of identifying causal relationships
between antecedents and consequences of behaviors, and then managing behavioral contingency
(Craske, 2010). Causal relationships or behavioral contingences are identified through a
functional analysis. The management of these contingences may involve removal or avoidance of
antecedents, dicriminant training, changing the value of reinforcers and altering the
consequences of behavior. Craske (2010) warns that for contingency management to be effective,
reinforcers for adaptive behavior must be stronger than for maladaptive behavior. Craske (2010)
also warns that for rule-governed behavior and for deficits in particular skills, contingency
management are not as effective. Similar to conditioned learning, instrumental learning also
incorporates expectancies but views thoughts in terms of function and not content (Craske,
2010). This openness to thoughts allowed for a smoother integration between instrumental
learning and cognitive theory.
Social learning theory or Self-Efficacy Theory expanded expectancy based leaning to
include the concept of self-efficacy (Craske, 2010). Self-efficacy is defined as a belief that one
can direct a behavior to produce an outcome. Low self-efficacy is assumed to contribute the
development of deficiencies, decreasing performance and contributing to pathology. As such,
treatment from this view aims to strengthen the clients perception of self-efficacy.
Cognitive Appraisal Theory posits that the driving force of behavior is distorted and
dysfunctional thinking and that environmental impact is mediated by the individuals
interpretation. Craske (2010) discusses two key individuals who pioneered this theoryEllis and
Beck. Rational-Emotive Behavioral Therapy, conceived by Ellis, claims that emotional states (C)
are brought upon by internal beliefs, thoughts, and sentences (B) and not necessarily by the
activating event (A). Irrational internal beliefs are characterized by rigidity and excessiveness
that do not withstand empirical scrutiny of the environment. Cognitive Therapy, coined by Beck,
similarly posits that emotional distress is the result of inflexible thought patterns and beliefs
(schemes and core beliefs) preventing clients to benefit from positive reinforcement.