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N. J. Smelser and Paul B. Baltes (editors) 2001 International Encyclopedia of the Social & Behavioral Sciences. Pergamon, Oxford. Gelder M G, Marks I M, Wolff H H 1967 Des- sitization and psychotherapy in the treatment of phobic . tcs: a controlled enquiry. British Journal of Psychiatry 1 .: 53-73 Ghosh A, Marks I M, Carr A C 1988 herapist contact and outcome of self-exposure treatme,nisr phobias: a controll -. 152: 234-8 study. British Journal of Psychi Hand 1, Lamontagne Y, Ma /I M 1974 Group e osure (flooding) in vivo for ago .' hobia. British Journ of Psychiatry 124: 588-602 , Kirk J, Clark D M 89 Cognitive Hawton K, Salkovskis Behaviour Therap or psychiatric proble . In: A Practical K Guide. Oxford t versify Press, Oxford , Janet P 1903 Le • bsessions et la Psych henie. Bailliere, Paris Jones M C 1 • 4 Elimination of ch rcn's fears. Journal o. Experin tad Psychology 7: 328 Keane Fairhank J A, Ca ell J M. Zimering R T 89 .D. in l m. live (flooding) therap educes symptoms of P. tnam combat veteran Behavior Therapy 20: 2• -60 gdon D, Turkington , John C 1994 Cogniti Behaviour Therapy of Schizop enia: The amenability . delusions and hallucinations to asoning. British Journa •f Psychiatry 164: 581-7 1971 New technique to behaviour therap Levy R, Mey Ritual pr ention in obsessional p tents. Proceedings of iety of Medicine 64: 1 Royal ry and Mark M 1981 Cure and ca of neurosis. In: otherapy. Wiley, N York P ctice of Behavioural Ps rks I M 1986 Behavi ral psychotherapy. Maudsley Bristol, UK Pocket Book of Clinic Management. Wri Marks I M, Gray S, ohen D, Hill R, M son D, Ramm amine and brief th pist-aided expos Stern R 1983 I in agoraphobi having self-exposur omework. Arch' General Ps iatry 40: 153-62 1975 Treatment • chronic Marks I M odgson R, Rachma y in vivo expos . Two-year obsess e-compulsive neuros foil -up and issues in tre ent. British Jour of Psychiatry : 349-64 soglu M, Noshir i H, Monteiro rks I M, Lelliot P, ne, self-exposur' and Cohen D, Kasviki 1988 Clomipr posure for obs ve-compulsive tuals. therapist-aided 2-34 British Journ of Psychiatry 52: Johnson V E 1 Human Sex Response. Masters W Church' / London Masters H, Johnson Ch chill, London ews A M, Gelder G, Johnston 1981 Agora nt. Guilford P s, New York ature and Trea Mathews A M, Jo ston D W, La ashire M, Mu y M, Shaw P M, Gelder G.1976 lma al flooding a exposure to ent outcome tth agoropho real phobi ttuations - tre patients ritish Journal Psychiatry 1 . 362-71 McDon d R, Sartory G rey S J, Cob , Stern R, Ma Effects of se exposure inst ctions on ag tpatients. Beh our Research d Therapy 17: iaviour Thera Meyer V. Ches E S 1970 Psychiatry. nguin, Lond 59 Toward pirical behavi laws: 1. Posit' Premack D reinfor ment. Psycho gical Review 66- 19-33 Rachn S J, Cobb , Grey S, Mc nald R, Maw R 1979 The havioural trea ory G, Ste Isive disorders th and withou sessive-co mine. Beha or Research and erapy 17: 462-7 Rachman odgson R, Mar I M 1971 Treat obses e-compulsive ne osis. Behavior Re 237 St p11 T J, Levis D G 19. Essentials of impl.. ve therapy: a earning theory base' psychodynamic b avior therap Journal of Abnornta sychology 72: 496- 13 Stravynski A, Mar M, Yule W 1982 S. cal skills probl- sin neurotic outp eats. Archives of 'eneral Psychi ry 39: 1378-85 Stern R S, P ummond L M 199 he Practice o Behavioural and Co. itive Psychotherap . Cambridge U 'versa), Pres Ca dgc, UK Brief and pr caged flood - g: A Ster. S, Marks I M 1 • mparison in agor hobic patien Archives of eneral Psychiatry 28: 271 6 Tarrier N, Beck- R, Harwood ., Baker A, usupoff L, two cogni - •e-behavioural Ugarteburu 1993 A trial methods o treating drug-r-. stant residua •sychotic symptoms in izophrenic pat nts: I. Outcou British Journal of Psyc try 162: 524-53 War ' k H M C, Clar P M, Cobb A , Salkovskis P M 1996 controlled tai. of cognitive •chavioural treatment of ypochondriasi . British Journ of Psychiatry 69: 189-95 atson J P, M ks I M 1971 ' elevant and irrelevant fear in flooding crossover st y of phobic patients. Behavior Therapy 275-93 Rayner P •20 Conditioned emotional reactions. Watson Jot al of Experim tal Psychology 3: 1 W..e J 1958 Psyc . therapy by Reciprocal Inhibition. Stanford niversity Pre , Stanford, CA L. M. Drummond Behavior Therapy: Psychological Perspectives A new way of treating psychopathology, called behavior therapy, emerged in the 1950s. In its initial form this therapy was restricted to procedures based on classical and operant conditioning. Therapists who employ operant conditioning as means of treatment often prefer the term `behavior modification.' Over the years many writers have broadened the scope of behavior therapy beyond conditioning to include any attempt to change abnormal behavior, thoughts, and feelings by applying the research methods used and the discoveries made by experimental psychologists in their study of both normal and abnormal behavior. Over a number of years people in the clinical field —among them Joseph Wolpe and Arnold Lazarus in South Africa, H. J. Eysenck in Great Britain and B. F. Skinner, Albert Bandura, Albert Ellis, and Aaron T. Beck in the United States—began to formulate a new set of assumptions about dealing with clinical problems. Although there are areas of overlap, it is helpful to distinguish four theoretical approaches in behavior therapy- -counterconditioning and exposure, operant conditioning, modeling, and cognitive behavior therapy. 1081 Behavior Therapy: Psychological Perspectives 1. Counterconditioning and Exposure Counterconditioning is relearning achieved by eliciting a new response in the presence of a particular stimulus. A response (R,) to a given stimulus (S) can be eliminated by eliciting a new response (R 2) in the presence of that stimulus. For example, in an early and now famous demonstration in 1924, Mary Cover Jones successfully treated a young boy's fear of rabbits by feeding him in the presence of a rabbit. The animal was at first kept several feet away and then gradually moved closer on successive occasions. In this way the fear (R,) produced by the rabbit (S) was replaced by the stronger positive feelings evoked by eating (R 2 ). The counterconditioning principle, deriving from earlier work by Pavlov and Guthrie, forms the foundation of an important behavior therapy technique, systematic desensitization, developed by Joseph Wolpe (1958). A person who suffers from anxiety works with the therapist to compile a list of feared situations, starting with those that arouse minimal anxiety and progressing to those that are the most frightening. Over a number of sessions and sometimes with the help of taped at-home practice, the person is also taught to relax deeply. Step-by-step, while relaxed, the person imagines the graded series of anxietyprovoking situations. The relaxation tends to inhibit any anxiety that might otherwise be elicited by the imagined scenes. The fearful person becomes able to tolerate increasingly more difficult imagined situations as he or she climbs the hierarchy over a number of therapy sessions. Reduction of fears in real life usually follows. Wolpe hypothesized that counterconditioning underlies the efficacy of desensitization: a state or response antagonistic to anxiety is substituted for anxiety as the person is exposed gradually to stronger and stronger doses of what he or she fears. Some experiments (Davison 1968) suggest that counterconditioning accounts for the efficacy of the technique, but a number of other explanations are possible (see Social Cognitive Theory and Clinical Psychology). Most contemporary theorists attach importance to exposure per se to what the person fears; relaxation is then considered a useful strategy to encourage a frightened individual to confront what he or she fears, rather than a response that is substituted for the maladaptive anxiety. Whatever its mechanism of action, systematic desensitization and other exposure techniques have been shown to be effective in reducing a wide variety of fears, from specific phobias like fear of snakes and closed spaces to more complex fears such as social anxiety and agoraphobia (see Psychological Treatments, Empirically Supported). Another type of counterconditioning, aversive conditioning, also played an important historical role in the development of behavior therapy. In aversive conditioning, a stimulus attractive to the patient is paired with an unpleasant event, such as a drug that 1082 produces nausea, in the hope of endowing it with negative properties. For example, a problem drinker who wishes to stop drinking might be asked to smell alcohol while he or she is being made nauseous by a drug. Aversive techniques have been employed to reduce smoking and drug use, and the socially inappropriate attraction that objects have for some people, such as the sexual arousal that children produce in pedophiles. Aversion therapy has been controversial for ethical reasons. A great outcry has been raised about inflicting pain and discomfort on people, even when they ask for it. For example, in its early days, aversion therapy was used to try to change the sexual orientation of homosexuals. But in the late 1960s, gay liberation organizations began to accuse behavior therapists of i mpeding the acceptance of homosexuality as a legitimate lifestyle. Currently, aversion therapy is rarely used as the only treatment for a particular problem. 2. Operant Conditioning Several behavioral procedures derive from operant conditioning, an analysis of overt behavior in terms of the conditions under which it occurs and the consequences that it elicits from the environment (see Autonomic Classical and Operant Conditioning; Behavior Analysis, Applied). Much of this work has been done with children, perhaps because a great deal of their behavior is subject to the oversight and control of others. Treatment typically consists of altering the consequences of problem behavior. For example, if it was established that the problem was motivated by attention seeking, the treatment might be to ignore it. Alternatively, the undesired behavior could be followed by time-out, a procedure wherein the person is banished for a period of time to a dreary location where positive reinforcers are not available. Making positive reinforcers contingent on behavior is used to increase the frequency of desirable behavior. For example, a socially withdrawn child could be reinforced for playing with others. Similarly, positive reinforcement has been used to help children with autistic disorder develop language, to remediate learning disabilities, and to help children with mental retardation develop necessary living skills. Other problems treated with these methods include bedwetting, aggression, hyperactivity, disruptive classroom behavior, and tantrums (Kazdin and Weisz 1998). 2.1 The Token Economy An early example of work within the operant tradition is the token economy, a system in which tokens (such as poker chips or stickers) are given for desired Behavior Therapy: Psychological Perspectives behavior and can later be exchanged for pleasing items and activities. Ayllon and Azrin (1968) set aside an entire ward of a mental hospital for a series of experiments in which rewards were provided for activities such as making beds and combing hair, and were not given when behavior was withdrawn or bizarre. The patients, who averaged 16 years of hospitalization, were systematically rewarded for their ward work and self-care with plastic tokens that could later be exchanged for special privileges, such as listening to records, going to the movies, renting a private room, or enjoying extra visits to the canteen. The life of each patient was as much as possible controlled by this regime. The rules of a token economy—the medium of exchange, the chores and self-care rewarded and by what number of tokens, the items and privileges that tokens—ar can be purchased and for how many carefully established and usually posted so that the patients can understand what the payoff is for behaving in a particular way. These regimes have demonstrated how even markedly regressed adult hospital patients can he significantly helped to achieve more normal functioning by systematic manipulation of reinforcement contingencies. The role of cognitive factors, discussed below, was not formally acknowledged in the early operant conditioning work. Token economy work demonstrates the positive i mpact of directing staff attention to rewarding selfcare and recreational behaviors, and on the acquisition of social skills, in contrast to the more typical situation in which patients get attention more when they are acting maladaptively and sometimes dangerously. The beneficial effects of carefully constructed token economies have been shown to be markedly superior to routine hospital management, including antipsychotic drugs (Paul et al. 1997). 3. Modeling Modeling has also been used in behavior therapy (see Social Cognitive Theory and Clinical Psychology). For example, people can reduce their unrealistic fears by watching both live and filmed encounters in which others gradually approach and successfully confront the things they are afraid of. Modeling is also part of the treatment for children with autistic disorder, helping them develop complex skills. Films depicting actors having pleasurable sex have been used to help sexually inhibited people overcome their discomfort with sexuality and learn sexual techniques (see Sex Therapy, Clinical Psychology of). In an analogous fashion, some behavior therapists use role-playing in the consulting room. Particularly with patients who lack social skills, therapists demonstrate patterns of behaving that might prove more effective than those in which the patients usually engage and then have the patients practice them. In his behavior rehearsal procedures, Lazarus (2000) demonstrates exemplary ways of handling a situation and then encourages patients to imitate them during the therapy session. For example, a student who does not know how to ask a professor for an extension on a term paper might watch the therapist portray a potentially effective way of making the request. The clinician would then help the student practice the new skill. Similar procedures have helped patients with schizophrenia acquire social skills to allow them to deal more effectively with others, and with nonpsychotic patients to encourage greater assertiveness. 4. Cognitive Behavior Therapy There is nothing either good or bad, but thinking makes it so. (Hamlet, Act II, Scene 2) The mind is its own place, and in itself Can make a Heav'n of Hell, a Hell of Heav'n. (Paradise Lost, line 247) Behavior therapy initially eschewed any appeal to cognitive processes (Wolpe 1958), perhaps as part of efforts to distinguish it from insight-oriented therapies like psychoanalysis and its many variations, as well as humanistic and existential approaches. But it became increasingly apparent in the mid to late 1960s that an empirically-based understanding of therapeutic change would be inadequate without formal inclusion of cognitive variables (Bandura 1969, Davison 1966, London 1964) (see Social Cognitive Theory and Clinical Psychology). One of the ways cognition entered into behavior therapy was via research on modeling. The question was how the observation of a model is translated into changes in overt behavior. In his original writings on modeling, Bandura asserted that an observer could somehow learn new behavior by watching others. Given the emphasis that much of experimental psychology places on learning through doing, this attention to learning without doing was important. But it did not delineate the processes that could be operating. A moment's reflection on the typical modeling experiment suggests the direction that theory and research have taken. The observer, a child, sits in a chair and watches a film of another child making a number of movements, such as hitting a large, inflated plastic doll in a highly stereotyped manner, and hears the child in the film uttering peculiar sounds. An hour later the youngster is given the opportunity to imitate what was earlier seen and heard. The child is able to do so, as common sense and folk wisdom would predict. How can we understand what happened? Since the child did not do anything of interest in any motoric way while watching the film, except perhaps fidget in the chair, it would not 1083 Behavior Therapy: Psychological Perspectives be fruitful to look at overt behavior for a clue. Obviously, the child's cognitive processes were engaged, including the ability to remember later on what had happened. Data such as these led some behavioral researchers and clinicians to include cognitive variables in their analyses of psychopathology and therapy. 4.1 Approaches to Cognitive Behavior Therapy Cognitive behavior therapy (CBT) applies theory and research on cognitive processes to alter cognition in the interests of effecting favorable change in emotions and behavior (see Cognitive Theory: ACT). CBT has become a blend of the cognitive and behavioral perspectives. Cognitive behavior therapists pay attention to private events—thoughts, perceptions, judgments, self-statements, and even tacit (unconscious) assumptions—and have studied and manipulated these processes in their attempts to understand and modify overt and covert disturbed behavior. But they do not neglect the behavioral factors reviewed above that influence emotion, cognition, and overt behavior (Bandura 1969). 4.1.1 Beck's cognitive therapy. The psychiatrist Aaron Beck is one of the leading cognitive behavior therapists. He developed a cognitive therapy for depression based on the idea that depressed mood is caused by distortions in the way people perceive life experiences (Beck 1976). For example, a depressed person may focus exclusively on negative happenings and ignore positive ones. Beck's therapy aims to persuade patients to change their opinions of themselves and the way in which they interpret life events. For example, when a depressed patient expresses feelings that nothing ever goes right, the therapist uses Socratic strategies to help the person identify counter-examples. The general goal of Beck's therapy is to provide patients with experiences, both inside and outside the consulting room, that will alter their negative schemas, their general beliefs about themselves and their environment. This therapy has shown its value, particularly in alleviating depression (DeRubeis et al. 1999), but elements of Beck's approach can be found as well in effective cognitive– behavioral interventions for such problems as bulimia nervosa, panic disorder (see especially Barlow et al. 2000), social phobia, and generalized anxiety disorder (see Clinical Psychology: Manual-based Treatment; Cognitive Therapy; Psychological Treatments, Empirically Supported). 4.1.2 Ellis's rational–emotive behavior therapy. Albert Ellis is another leading cognitive behavior 1084 therapist (see Behavior Psychotherapy: Rational and Emotive). His principal thesis is that sustained emotional reactions are caused by internal sentences that people repeat to themselves and that these selfstatements reflect sometimes unspoken assumptions— irrational beliefs—about what is necessary to lead a meaningful life. In Ellis's rational emotive behavior therapy (REBT) (Ellis 1962), the aim is to eliminate self-defeating beliefs through a rational examination of them. Anxious persons, for example, may create their own problems by making unrealistic demands on themselves or others, such as, '1 must win love from everyone.' Ellis proposed that people interpret what is happening around them, that sometimes these interpretations can cause emotional turmoil, and that a therapist's attention should be focused on these beliefs rather than on historical causes or, indeed, on overt behavior. Ellis used to list a number of irrational beliefs that people can harbor, such as the assumption that they must be thoroughly competent in everything they do. More recently, he has shifted from a cataloguing of specific beliefs to the more general concept of `demandingness,' that is, the musts or shoulds that people impose on themselves and on others. Thus, instead of wanting something to be a certain way, feeling disappointed, and then perhaps engaging in some behavior that might bring about the desired outcome, the person demands that it be so. It is this unrealistic, unproductive demand, Ellis hypothesizes, that creates the kind of emotional distress and behavioral dysfunction that bring people to therapists, and that should be altered in order to create a more realistic, less absolutistic approach to life's demands. Research supports the value of REBT in alleviating a wide range of anxiety-related problems, including interpersonal performance anxiety, test anxiety, anger, and depression; and it may also be of use in a preventive way by teaching children that their self-worth is not utterly dependent on their endeavors. 4.1.3 Behavioral medicine. A wide range of cognitive–behavioral strategies have been applied with success in a field called `behavioral medicine,' defined as the study and application of empirically supported techniques for the prevention and amelioration of physical problems (see Behavioral Medicine). For example, relaxation training has been found effective in reducing blood pressure in borderline hypertension, possibly by lessening the anger that patients experience when frustrated or provoked (see Hypertension: Psychosocial Aspects). Cognitive and behavioral interventions are useful also in encouraging people, even older adults, to alter their lifestyle in ways that contribute to better health and even to help cancer patients cope with their illnesses and with the pain associated with the treatment of them. There is ever-increasing appreciation of the importance of Behavior Therapy. Psychological Perspectives psychological factors in encouraging people to adopt healthier lifestyles, adhere to sometimes difficult treatment regimens, and to cope with negative emotions that, if unchecked, can exacerbate the course of a physical illness as well as affect the success of a medical intervention (see Self-efficacy and Health). 4.2 Conceptual Issues in Cognitive Behavior Therapy Some criticisms of CBT should be noted. The concepts on which it is based (e.g., schema) are somewhat slippery and not always well-defined. Furthermore, cognitive explanations of psychopathology do not always explain much. For example, that a depressed person has a negative schema tells us that the person has a pessimistic outlook on things. But such a pattern of thinking is actually part of the diagnosis of depression. What is distinctive in the cognitive paradigm is that the thoughts are given casual status; that is, the thoughts are regarded as causing the other features of the disorder, such as profound sadness. Left unanswered is the question of where the negative schema came from in the first place, and to what extent it creates negative emotion and maladaptive behavior rather than being only a correlate of them. Is the cognitive point of view basically different and separate from the behavioral paradigm? Much of the preceding discussion suggests that it is. But the growing field of cognitive behavior therapy gives one pause, for its workers study the complex interplay of beliefs, expectations, perceptions, and attitudes on the one hand, and overt behavior on the other. For example, Albert Bandura (1977), a leading advocate of the cognitive viewpoint, argues that different therapies produce improvement by increasing people's sense of self-efficacy, a belief that they can achieve desired goals. But, at the same time, he argues that changing behavior through behavioral techniques is the most powerful way to enhance self-efficacy. Therapists such as Ellis and Beck emphasize direct alteration of cognitions through argument, persuasion, Socratic dialogue, and the like to bring about i mprovements in emotion and behavior. Complicating matters still further, Ellis, Beck, and their followers also place considerable importance on homework assignments that require clients to behave in ways in which they have been unable to behave because they are hindered by negative thoughts (see Cognitive Therapy). Indeed, one study failed to find added benefit from the cognitive components of Beck's cognitive therapy (CT) as compared with the behavioral components alone (Jacobson et al. 1996). Ellis even changed the label for his approach from rational-emotive therapy to rational-emotive behavior therapy in order to highlight the importance of overt behavior. Therapists identified with cognitive behavior therapy work at both the cognitive and behavioral levels, and most of those who use cognitive concepts and try to change beliefs with verbal means also use behavioral procedures to alter behavior directly. This issue is reflected in the terminology used to refer to people such as Beck and Ellis. Are they cognitive therapists or cognitive behavior therapists? The latter term is preferred by behavior therapists because it denotes both that the therapist regards cognitions as major determinants of emotion and behavior and that he or she maintains the focus on overt behavior that has always characterized behavior therapy. Nonetheless, Beck, even though he assigns many behavioral tasks as part of his therapy, is usually referred to as the founder of cognitive therapy (CT), and Ellis's rational-emotive therapy (RET) used to be spoken of as something separate from behavior therapy. 5. Concluding Comment Towards the end of the twentieth century, the increasing role of managed care in the United States— entering the picture much later than in other Western countries—made mental health professionals more aware of the need to employ the best-validated and most efficient interventions available. This greater level of accountability is having a revolutionary effect on who gets treated, for how long, and at what cost. Not all patients are helped with behavioral and cognitive-behavioral procedures, and the data are not fully available as to what kinds of problems respond better to such approaches than to others (such as psychoanalytically oriented, humanistic/existential, or drug and other somatic therapies). An advantage of the approaches reviewed in this article is that they possess a high degree of accountability: procedures are clearly spelled out, links to the science of behavior change are a defining characteristic, and evaluations of outcome are routine. These features of behavioral and cognitive therapies would seem to bode well for the continuing development of more and better interventions, to the benefit both of the science and the profession as well as the communities that are served. See also: Behavior Therapy: Psychiatric Aspects; Behavior Therapy with Children; Cognitive and Interpersonal Therapy: Psychiatric Aspects; Cognitive Therapy; Operant Conditioning and Clinical Psychology Bibliography Ayllon T, Azrin N H 1968 The Token Economy: A Motivational System for Therapy and Rehabilitation. Appleton-CenturyCrofts, New York Bandura A 1969 Principles of Behavior Modification. Holt, Rinehart & Winston, New York 1085 Behavior Therapy: Psychological Perspectives Bandura A 1977 Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review 84: 191-215 Barlow D H, Gorman J M, Shear M K, Woods S W 2000 Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. Journal of the American Medical Association 283: 2529-74 s Beck A T 1976 Cognitive Therapy and the Emotional Di orders. International Universities Press, New York Davison G C 1966 Differential relaxation and cognitive restructuring in therapy with a 'paranoid schizophrenic' or 'paranoid sound and empirically validated, and (3) application of such principles and procedures to adjustment Olendick problems of children and adolescents' ( 1986). Presented here is an overview of the historical roots of child behavior therapy, an explication of key concepts underlying the approach, and examples of classic and contemporary uses of behavior therapy with children. state.' Proceedings of the 74th Annual Convention of the American Psychological Association, Washington DC Davison G C 1968 Systematic desensitization as a counterconditioning process. Journal of Abnormal Psychology 73: American Psychological Association. 91-9 DeRubeis R J, Helfand L A, Tang T Z, Simons A D 1999 Medications vs. cognitive behavioral therapy for several depressed outpatients: A mega-analysis of four randomized comparisons. American Journal of Psychiatry 15: 1007-13 Ellis A 1962 Reason and Emotion in Psychotherapy. Lyle Stuart, New York Jacobson N S, Dobson K S, Truax P. Addis M, Koerner K, Pollan J, Gortner E, Prince S 1996 A component analysis of cognitive behavioral treatment for depression. Journal of Consulting and Clinical Psychology 64: 295-304 Kazdin A E, Weisz J R 1998 Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology 66: 19-36 Lazarus A A 2000 Multimodal therapy. In: Dumont F, Corsini R J (eds.) Six Therapists and One Client. Springer, New York, pp. 145-66 London P 1964 The Modes and Morals of Psychotherapy. Holt, Rinehart & Winston, New York Paul G L, Stuve P, Cross J V 1997 Real-world inpatient programs: Shedding some light: A critique. Applied and Preventive Psychology: Current Scientific Perspectives 6: 193204 Wolpe J 1958 Psychotherapy by Reciprocal Inhibition. Stanford University Press, Stanford, CA G. C. Davison Behavior Therapy with Children Child behavior therapy, including behavior modification and cognitive therapy, consists of a group of diverse but related scientifically-based approaches to the assessment and treatment of children experiencing behavioral and emotional difficulties. Although contemporary behavior therapy with children is characterized by a plurality of viewpoints, techniques, and theoretical rationales, a distillation of these differing perspectives reveals several common features that define the essence of child behavior therapy. These features include `(1) principles of behavioral psychology, most notably principles of learning, (2) use of strategies or procedures that are methodologically 1. Historical Roots The historical roots of child behavior therapy can be traced to the work of John B. Watson, a key figure in the rise of behaviorism in America during the early 1900s. Watson, who rejected the trends of the time emphasizing mentalistic causes of behavior, maintained that learning processes were the basis of all human behavior. In perhaps the first historical antecedent to modern behavior therapy, one of Watson's students, Mary Cover Jones, applied classical conditioning principles to alleviate a young boy's intense fear of rabbits, by rewarding an incompatible response to fear, and using successive approximations to introduce the rabbit (Jones 1924) (see Classical Conditioning and Clinical Psychology). With the exception of a few isolated examples, such as the classic `bell and pad' method of treating nocturnal enuresis (bedwetting) (Mowrer and Mowrer 1938), there was a lag of some 30 years before interest in behavioral approaches in the treatment of children re-emerged in psychology. This resurgence was precipitated in large part by discontent with psychoanalysis, the prevailing therapeutic model of the day. Institutional settings in which developmentally delayed children often resided provided the ideal, tightly controlled environments in which to evaluate emergent behavioral treatments. In most cases, early behavioral techniques were developed in animal laboratories by experimental psychologists with the objective of demonstrating the utility of applying specific learning principles to rather circumscribed child behavioral symptoms (Mash 1998). During the 1960s, behavior therapy relied primarily upon operant conditioning procedures, the principles of which had been pioneered by B. F. Skinner in the 1940s (see Operant Conditioning and Clinical Psychology. These approaches were used successfully with developmentally delayed children in institutional settings. Lovaas and Simmons (1969), for example, were able dramatically to improve the behavior of autistic children by applying operant learning principles to manipulate the environmental antecedents and consequences of behavior. In the 1960s and 1970s, behavior therapy was extended to school settings where it was applied to classroom misbehavior. Through this work it was found that ignoring disruptive behavior, while reinforcing positive behavior through praise (or atten- 1086 Copyright © 2001 Elsevier Science Ltd. All rights reserved. International Encyclopedia of the Social & Behavioral Sciences ISBN: 0-08-043076-7