Download Behavior Therapy

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Jenna Nowak
Professor Robert Woolfolk
Systems of Psychotherapy
13004831
Behavior Therapy
Behavior Therapy has been an expanding approach to psychotherapy since the 1950s. It
has advanced and thrived since its beginnings, and contains a wide range of strategies. The focus
of behavior therapy is to change factors in the environment that influence an individual’s
behavior as well as the ways in which individuals respond to their environment (Antony, 193).
As one of the most extensively researched forms of psychotherapy, many studies provide
evidence for the effectiveness of behavior therapy. From its beginnings, behavior therapy has
evolved, but has always emphasized the role of empiricism in the process.
Learning is an integral part of behavior therapy. A change in harmful behaviors to
beneficial behaviors is the way in which learning occurs. Behaviors of individuals in different
situations have a function. Certain situations create different behaviors. Based on those
behaviors, a scientific approach is taken to change them. Behavior therapists focus on the way in
which clients can learn skills to benefit them in times of need. Because behavior therapy focuses
on the client’s change in behavior, the client takes an active role in therapy. Data that is
collected through the course of therapy is used as a reference to patterns of behavior that the
client experiences. This collected data is readily shared with the client and both the client and
therapist set goals for treatment. The therapist suggests certain strategies and the client uses the
strategies both in session and for homework in between sessions. Behavior therapy views
maladaptive behaviors as acquired the same way adaptive behaviors are acquired. The behaviors
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are not viewed as a problem, just developed through reinforcement and punishment. Behavior
therapy is concerned with repeated behaviors rather than the root cause of the behaviors, such as
early forms of psychotherapy.
The beginning of behavior therapy can be traced back to events from the 1920s and
1930s. One of the first events was the first of the classical conditioning experiments with the
Russian physiologist, Ivan Pavlov. Pavlov was the first to show the process with dogs. Two
stimuli are paired in classical conditioning. The first stimulus is a stimulus that is introduced that
causes no response in an individual. This is called the conditioned stimulus. The second
stimulus is an unconditioned stimulus that elicits a response based on the nature of the
individual. The response that the unconditioned stimulus elicits is called an unconditioned
response. After pairing the conditioned stimulus with the unconditioned stimulus many times,
the conditioned stimulus comes to elicit the same response as the unconditioned stimulus. After
the conditioned stimulus starts eliciting the unconditioned response, without the unconditioned
stimulus, it is then called a conditioned response. When dogs were shown food, the dogs would
start salivating. Pavlov would set off a neutral light or tone (the conditioned stimulus) and would
pair it with food (the unconditioned stimulus). The dogs would salivate from the food (the
unconditioned response). After pairing the light or tone with the food, the dogs would salivate at
the neutral light or tone without the food. The salivation from the light or tone was the dogs’
conditioned response.
After classical conditioning has occurred, the repeated presentation of the conditioned
stimulus without the unconditioned stimulus can lead to the extinction of the conditioned
response. A dog will stop salivating if the food is repeatedly not presented after the light or tone.
However, even after extinction has occurred, reinstatement can take place. Reinstatement can
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occur when the same conditioned stimulus and unconditioned stimulus are paired together again,
eliciting the same response as before. Reinstatement usually returns quickly and can suggest that
previous learning is not fully erased from extinction.
Another occurrence that set the rise of behavior therapy was with the work of John B.
Watson. Watson was the first to study classical conditioning in humans. Through classical
conditioning, Watson and Rayner had an infant, Albert, learn to become afraid of a white rat
when its presence was paired with a loud noise. Watson is commonly known as the father of
behaviorism. Watson believed that only observable behaviors can be studied, and did not believe
that emotions and thoughts should be studied.
Modern behavior strategies were introduced in the 1920s and 1930s because of classical
conditioning. A student of Watson, Mary Cover Jones, treated a young boy for his fear of
rabbits. Another treatment, by Mowrer and Mowrer, helped children that had a problem with
urinating the bed. Their treatment was named the bell and pad and is still used for children
today.
Operant conditioning had a great impact on the rise of behaviorism as well. Edward
Thorndike and B.F. Skinner are credited as the founders of operant conditioning. Operant
conditioning focuses on behavior as it is affected by the contingencies in the environment. It is a
form of learning in which the frequency, form, or strength of a behavior is influenced by its
consequences (Antony, 201). Two methods involved in operant conditioning are reinforcement
and punishment. Reinforcement causes a behavior to increase, while punishment causes a
behavior to decrease. Behavior can increase or decrease in the frequency or intensity. Positive
reinforcement occurs when something desired is awarded to an individual after a certain
behavior. Negative reinforcement occurs when something not desired is taken away after a
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behavior, causing a sense of relief. Punishment comes in the form of positive and negative as
well. Positive punishment happens when an individual is punished after a certain behavior; such
as getting yelled at when uttering a curse word. Negative punishment occurs when something
desired is taken away after a given behavior. An example of negative punishment would be if a
child received no dinner after getting into a fight at school that day. Changing the patterns of
reinforcement and behavior can result in changing an individual’s behavior.
The 1949 Boulder Conference on Graduate Education in Clinical Psychology had a
significant impact on the field of psychology when it started to abandon the most influential
psychotherapy at the time, psychoanalysis. The discipline of psychology started to embrace the
scientist-practitioner model. This model emphasized a scientific, hypothesis driven approach to
the work of therapists. As this more empirically based model started to emerge, many
psychologists started to abandon psychoanalysis for more scientific approaches to therapy.
Psychoanalysis and other related psychodynamic approaches differ the most in
psychotherapy from behavior therapy. Psychoanalysis believes that observable behaviors are the
result of unconscious conflicts and inner desires. Behavior therapy typically takes behaviors at
face value. Watson did not believe in unobservable behaviors, but contemporary behavior
therapists accept that humans are not always conscious of their behaviors and information can be
processed outside of their awareness. Unlike psychoanalysis, behavior therapy also does not
accept the role of psychosexual conflicts and the interpretations of dreams. Behavior therapy is
more directive than psychoanalysis, with the patient being active throughout the course of
treatment. As an active part in therapy, the client is less reliant on the interpretation of the
therapist than in psychoanalysis. Psychoanalysis is more concerned with the root of the problem
behavior than the actual behavior itself. Behavior therapy focuses on the maintaining behaviors,
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not focusing on the root cause. Because traditional psychoanalysis focuses more on the root of
the problem, it cannot predict or explain the successful results of behavior therapy. Not being
able to explain the results of behavior therapy can lead to a contradiction in psychoanalytic
theory. Although psychoanalysis was the most prominent and influential form of psychotherapy
at the time, the need for a more scientific approach lead to the rise of behavior therapy.
As behavior therapy started to rise, research groups in South Africa, the United Kingdom,
and North America began to apply the techniques of classical conditioning and operant
conditioning to problems of behavior.
In South Africa, a physician named Joseph Wolpe started studying the process of
classical conditioning as a medical student. After taking an interest in the area, he developed
systematic desensitization. Systematic desensitization involves gradually confronting feared
situations in imagination while simultaneously practicing progressive relaxation to relax the
muscles of the body (Antony, 197). The treatment is one of the first to be formally researched,
and has results that support the effectiveness of it. However, it is not formally used today.
Rather than exposure in the imagination, exposure to real life situations is used. Although
contemporary behavior therapists use the real life exposure, they rarely use relaxation in the
process. It seems that the relaxation paired with the exposure is not effective.
In 1965, Wolpe moved to Temple University and began to train a team of psychologists
including Arnold Lazarus and Stanley Rachman. They began to direct a form of therapy that
they referred to as conditioning therapy. Although they were using conditioning therapy as the
name, Lazarus was the first person to use behavior therapy in a published article.
In the UK, Hans Eysenck was studying behavioral treatments at the Institute of
Psychiatry in London. Eysenck was the first to found a behavior therapy journal in 1963,
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Behaviour Research and Therapy. Rachman, both a student of Wolpe and Eysenck, worked on
successful behavioral treatments for different disorders, such as agoraphobia, obsessivecompulsive disorder, and other anxiety based problems. Another one of Eysenck’s students,
Cyril Franks, founded the Association for the Advancement of the Behavioral Therapies in 1966.
The name was changed in 2005 to the Association for Behavioral and Cognitive and Cognitive
Therapies. The name change reflected the changing scope of behavior therapy as recognizing
the importance of cognitive approaches.
Behavior therapy in North America was focused more on operant conditioning than
classical conditioning. One of Skinner’s students, Nathan Azrin helped establish the field of
applied behavior analysis. He also started developing treatments based on operant conditioning.
He developed reinforcement-based programs that were used to help substance-use disorders.
Azrin also started developing behavioral treatments for having unwanted habits reversed. Token
economy was another one of Azrin’s contributions to the field of behavior psychology. In token
economy, behavioral problems were managed through reinforcement of desirable behaviors by
providing tokens that could later by exchanged for rewards (Ayllon & Azrin, 1968). The method
of token economy was widely used for managing disruptive behavior, until more contemporary
methods, such as medication, were available.
All of the contributions from the past have led to the expansion of behavior therapy
today. Most therapists practicing behavior therapy today refer to their work as cognitivebehavior therapy. Early forms of behavior therapy did not pay much attention to unobservable
experiences, and as behavior therapy advances, cognitive methods are recognized as an
important role in how an individual responds to the environment.
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Behavior therapy is most closely aligned with cognitive therapy and rational emotive
behavior therapy. Cognitive-behavioral therapists make use of strategies from not only behavior
therapy, but also cognitive approaches to therapy, paying more attention to thoughts and
emotions. In 1955, Albert Ellis was the first to start practicing rational psychotherapy. It was
then renamed to rational emotive behavior therapy in 1993. Therapists such as Rachman and
Lazarus began integrating cognitive strategies into their therapy. Learning had also been noted
by observing others, which Albert Bandura discovered. This type of learning could have both
the same desirable and undesirable outcomes as classical conditioning and operant conditionings
both had. Behavioral treatments today make use of observing others and modeling after their
behavior.
An advancement in behavior therapy has taken place in the past ten years. The “third
wave” of behavior therapy refers to the development of the acceptance-based behavioral
therapies, which emphasize the importance of accepting unwanted thoughts, feelings, and
emotions rather than trying to control of directly change them (Antony, 199). These therapies
encourage clients to seek out and realize what they want in life and begin to make changes and
live in a way that is more harmonious with their values. Because of how new acceptance-based
behavioral therapies are, it is hard to determine what kind of impact they will have on the role of
psychotherapy.
One approach of acceptance-based behavioral therapies is the use of mindfulness.
Mindfulness is about being present in the moment and listening with no judgments. Mindfulness
training includes thoughts, sensations, and emotions being recognized as they occur. No matter
what feelings may come about, they are to be accepted as they are. Mindfulness practices may
include meditation, mindful breathing exercises, mindful scanning of the body, mindful eating
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and others (Antony, 216). Although meditation can date back to early forms of Buddhism, the
new concept is studying the effectiveness it has in behavioral treatment.
Another strategy for facilitating acceptance is acceptance and commitment therapy. This
is a form of psychotherapy that was introduced by Stephan Hayes. The first component of
acceptance and commitment therapy is the promotion of acceptance. When unwelcome thoughts
or feelings come a client’s way, they are encouraged to first notice them and then accept them
instead of trying to change or control them. Clients are encouraged to take note of their thoughts
as if they were not their own and view them as an outsider. Putting a different perspective on
their thoughts and feelings leads the client to not hold the thoughts and feelings with such value.
The second component encourages the clients to explore and recognize what they find important
and start taking action to align their behaviors with it. This helps the client start leading a richer
life, as their actions follow their beliefs.
There are many other strategies that behavior therapy includes. Because behavioral
therapy also aligns with cognitive strategies, it covers a wide range.
One strategy of behavioral therapy is behavioral assessment. Behavioral assessment
starts before the treatment even begins. The client is first evaluated to determine what course the
treatment should take. Behavioral assessment distinguishes the behaviors that are to be changed
throughout the course of treatment. Many methods are determined to be of help to the client
based on the target behaviors from the assessment. And because behaviors can come about from
different contexts or because of different people, multiple methods are necessary to see what
helps. The target behaviors are determined by both the client and the therapist because the client
takes an active role during behavior therapy. Behavioral assessment relies on functional analysis
to determine the variables that result in the patterns of target behaviors. Identifying the variables
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includes switching things around in the environment and observing the behaviors that emerge.
Most therapists also concentrate on internal variables.
An assessment can include a behavioral interview. This includes getting a background
on the behavior. The therapist can also observe the client and take note of any other subtle
things about the client that the client themselves do not notice. Hearing from the client directly
what it is that sets off the given behavior and why it is a problem for them is another way the
therapist can deduce a treatment plan.
The client can also be observed in an environment that evokes the behavioral response
through behavioral observation. This assessment determines the antecedents and consequences
of a behavior in the given context it arises in. There are two different types of behavioral
observation. The first is a naturalistic observation, where the client is in the natural environment
where the behavior occurs. The second is analog observation, where the client is observed in a
manipulated environment. A problem with behavioral observation can be if the client’s behavior
is affected because it is a known assessment. This is called reactivity. Reactivity can be reduced
if the therapist can act as an unobserved observer, allowing the clients to act in a natural way.
Another way of reducing reactivity is allowing the client to become acclimated to the situation
before taking notes on the behavior patterns.
Exposure-based strategies are one of the most effective forms of behavioral techniques.
Exposure primarily treats anxiety disorders and fear. Exposure involves confronting feared
stimuli directly instead of avoiding them (Antony, 210). There are different forms of exposure.
One form of exposure is in vivo exposure; this is where clients are exposed to feared situations in
real life. In vivo exposure may occur in session or between sessions for homework. Another
type of exposure is imaginal exposure. This type of exposure involves imagining a feared
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situation. Imaginal exposure usually is used for clients that block out or fear their own thoughts,
not for external situations. A third type of exposure strategy is interoceptive exposure.
Interoceptive exposure involves purposely experiencing frightening physical sensations until
they are no longer frightening (Antony, 210).
There are many guidelines that make sure exposure will be positive. Predictability, and
control of the client are important in exposure-based strategies. Frequent cases of exposure work
better than cases spaced far apart. Longer sessions of exposure are better than short sessions.
Also modeling, by either the therapist or another trusted individual can lead to better results.
From its beginnings, behavioral therapy has expanded and has shown to be an effective
form of psychotherapy. Although behavior therapy covers a wide range of strategies, it is
focused on learning. A change in behavior through learning is what makes these strategies
effective. The abandonment of psychoanalysis for behavior therapy was the result of the newly
accepted scientific based approach to psychology. Because behavior therapy was so deeply
rooted in empiricism helped shift the focus of psychology at the time. Behavior therapy has
continued to expand and adopt new beliefs in comparison to early models. The focus for the
future of behavior therapy is to improve effectiveness of treatments as they develop over time.
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Bibliography
Antony, M. M., & Roemer, L. (2011). Behavior therapy. Washington, DC: American
Psychological Association.
Ayllon, T., & Azrin, N. H. (1968). The Token economy: A motivational system for therapy and
rehabilitation. New York: Appleton-Century-Crofts.
Wedding, Danny, and Raymond J. Corsini. Current Psychotherapies. 10th ed. 193-229. Print.