Download What is Behavior Therapy? Behavior therapy is based on the

What is Behavior Therapy?
Behavior therapy is based on the premise that you learn all behavior through interaction
and experience, and therefore, you can solve some of life's problems by unlearning specific
behaviors. For instance, clients with anger management problems may have learned angry and
aggressive responses by observing such behavior in their parents or other care givers. The aim of
behavior therapy is to help such clients unlearn these dysfunctional violent behaviors.
According to the behavioral school of thought, behavior is neutral until the environment
affects it. A person is not intrinsically good or bad but develops patterns of behavior by
interacting with the environment and its components, whether they are parents, friends, peer
groups, or role models.
The origins of behavior therapy can be attributed to three learning theories: classical
conditioning, operant conditioning, and social learning (Nystul, 2003). Let's explore the basic
elements of each of these theories.
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Classical Conditioning
Classical conditioning is a theory evolved from Ivan Pavlov's experiments with dogs.
Pavlov found that the dogs would salivate in response to a conditioned stimulus, such as a bell or
a light, paired with an unconditioned stimulus, such as food. This salivation was an
unconditioned response. After some time, the dogs started salivating when they heard the bell
even if no food was present. This salivation was a conditioned response. Pavlov concluded that
this theory could be applied to human beings as well.
For instance, at a New Year's Eve party two years ago, Sheila found out that her
boyfriend was married and had hidden this fact from her. Sheila was devastated. Ever since,
Sheila feels anxious around the time of the New Year.
Classical conditioning theory was later
applied to counseling in the work of Joseph Wolpe (1958, 1973) through his theory of systematic
desensitization, a process to treat phobias. You will learn about systematic desensitization later
this week.
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Operant Conditioning
B. F. Skinner postulated that learning occurs only with reinforcement. In other words,
individuals learn and modify behaviors by interacting actively in their environment. Those
behaviors that are reinforced are more likely to occur, while those that are not reinforced stop
occurring.
Skinner experimented with rats, teaching them to press a lever for food. These
experiments gave birth to his theory. Use the online library link to find articles and research
reviews of his work.
Operant conditioning is a more active theory than classical conditioning and more easily
applied to everyday situations. Some principles of operant conditioning are (Nystul, 2003):
•
Positive Reinforcement: This occurs when a positive outcome follows an action and
increases the probability of that action occurring again.
•
Negative Reinforcement: This occurs when, in response to an action, a negative outcome
ends and increases the probability of the action occurring again.
•
Punishment: This occurs when an undesired consequence follows an action and decreases
the likelihood of the action occurring again.
•
Negative Punishment: This occurs when a rewarding consequence is removed in response
to an action and decreases the likelihood of that action occurring again.
•Extinction: This occurs when a previously reinforced action is no longer followed by the
same reinforcement. Therefore, the likelihood of that action occurring again is reduced.
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The principles of reinforcement are crucial to the understanding of operant conditioning
theory because they help you understand how you can apply operant conditioning to behavior
modification.
Behavior modification is used to describe a program that relies on rewarding positive
behavior in order to increase the frequency of such behavior. It also uses extinction and
punishment to reduce undesirable behavior. Operant conditioning principles are used to facilitate
behavior modification.
Let's move on to the social learning theory.
Social Learning Theory
This theory was postulated by Albert Bandura and states that learning occurs from the
interaction of a person with the environment through observation, modeling, and imitation
(Nystul, 2003). For example, being a strong parent is important. The reason is that if you are
afraid of water and show your fear, then your child may observe your fear and also be afraid of
water. However, if you bravely face your fear and step into the swimming pool, then your child
will observe you and do the same. Therefore, watching others model behavior is also important
in learning. Social learning theory is relevant to all ages of people.
You learned about the three theories of learning. What are the key elements common to
each theory and its corresponding therapy? (Nystul, 2003)
•
Behavior therapy focuses on obvious, observable behavior, and cognitions.
•
Behavior therapy focuses on current problems. The past is important only to define how
it affects the present.
•
Behavior therapy is based on the fact that dysfunctional behavior occurs because of
inappropriate learning.
•
Behavior therapy uses well-defined, concrete goals.
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Techniques of Behavior Therapy
Behavior therapy is meant to be short term in duration. However, it can encompass as
many as 25 to 50 sessions. Some of the techniques of behavior therapy include self management,
self efficacy, token economy, assertiveness training, and systematic desensitization. Let's explore
them.
•
Self-Management and Self-Control: These techniques assist clients to become advocates
and spokespersons for their own change. Therapists provide only expertise in management of the
clients' behavior. Kanfer and Goldstein (1986) identify the following skills involved in this
method. Let's understand these skills with the example of Jim, who has anger management
difficulties:
◦
Monitor their responses. For example, the therapist would ask Jim to monitor whether a
response Jim made in anger was appropriate in that situation.
◦
Make contracts with clients about changes expected from them. The therapist would
write up the changes that the clients should implement. For example, the next time Jim is angry,
he could walk into another room for some time to control his anger.
◦
Rope in people in the clients' lives to support their attempts to change. For example, the
therapist would have Jim talk to the people in Jim's life about what they could do to ensure that
he fulfills his contract.
◦
Have clients evaluate their progress. For example, the therapist would ask Jim what he
did well that worked and what he can do better to progress more.
◦Help clients come up with a list of reinforcements for the consequences of those
behaviors that promote growth. For example, Jim may like a wide range of reinforcements to
continue behavior change. These could range from a cup of coffee in the morning to a trip abroad
to reward him.
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•
Self-Efficacy: One aspect of Bandura's theory refers to people's faith in their ability to
complete what is expected of them. Therefore, one of the techniques of behavior therapy is to
establish self-efficacy in clients. Bandura, Reese, and Adam (1982) believed that clients can
strengthen their confidence in their ability by performing tasks, watching someone else perform
tasks, or by believing that they can perform tasks.
Let's understand this with the help of an example. Consider that Jack suffers from an
inability to use elevators. Jack may watch people use an elevator and realize that no harm comes
to them. His therapist may try to make Jack believe that he is strong enough to face his fear of
elevators and may also recommend accompanying Jack to support him while using one.
Why is self-efficacy important? If clients do not believe that they are capable of doing
things well, they may never try new behaviors. This would further strengthen their belief that
they are incapable of doing anything. It is a vicious circle. However, when clients think that they
can try something new successfully, they are more likely to try their best and succeed.
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•
Assertiveness Training: This technique is necessary for clients who have difficulty
standing up for their rights or expressing their feelings without losing control. The steps in
assertive training are (Rimm and Cunningham, 1985):
1.
Therapists and clients have to agree that there is a need for assertiveness training. For
example, clients admit to having difficulty saying "no" to anyone.
2.
Therapists inform clients of the benefits of assertiveness. For example, by learning to be
more assertive, clients feel less overwhelmed by responsibility.
3.
Therapists provide examples of how clients can be assertive in different situations in the
clients' lives after which the clients practice those behaviors.
4.
Therapists give feedback and reinforcement to clients for successful rehearsal and
implementing assertive behavior in the real world.
•
Token Economy: Ayllon and Azrin (1968) invented this reinforcement technique in
which clients are given tokens for desired behaviors, and the clients can trade those tokens for
goods or privileges that they want. This may be particularly convenient in institutions and among
children.
For instance, every time clients with schizophrenia perform simple tasks that they
normally would not, such as making their beds or brushing their teeth, therapists give the clients
tokens. When the clients collect a specific number of tokens, they may be allowed to watch a
movie or go out for a meal. The aim of this technique is to give clients an incentive to perform
activities that should be a part of their everyday repertoire. This technique is based on the model
of operant conditioning you learned about earlier this week.
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•Systematic Desensitization: This is a technique developed by Wolpe (1958, 1973) to
work with clients who suffer from phobias or excessive fears about death, injury, or sex (Nystul,
2003). This technique is based on the classical conditioning model you learned about earlier this
week.
Systematic desensitization consists of certain steps. Let's understand these steps with an
example of Gina, who has a phobia of flying:
1.
Therapists should use the principle of counter conditioning to teach clients to relax by
introducing a relaxation response instead of an adverse response. If clients feel anxious, teaching
them to relax their muscles during stress is the first step. Relaxation exercises involve tensing
muscles of the arms, legs, abdomen, and face and then relaxing them. For example, first, the
therapist should teach Gina relaxation exercises.
2.
Therapists should help clients build a hierarchy of situations that make the clients fearful.
For example, in Gina's case, the hierarchy may be packing a suitcase, taking a cab to the airport,
checking in, waiting to board the airplane, stepping toward the airplane, stowing the suitcase,
sitting down and fastening the seatbelt, taking off, and landing.
3.
Therapists should make clients relax, and then introduce the first situation that is scary to
them. In Gina's case, the first situation in the hierarchy is packing a suitcase. The relaxation helps
desensitize clients to the fearful response. Repeat this process at each step of the hierarchy.
4.
Therapists should expose clients to real-life situations that they fear. For example, the
therapist should ask Gina to make a trip on an airplane.
5.
Finally, therapists should have the clients assess how much progress they made across a
variety of situations.
Effectiveness of Behavior Therapy (Nystul, 2003)
Behavior therapy works well for anxiety disorders such as phobias, post-traumatic stress
disorder (PTSD), generalized anxiety, and obsessive-compulsive disorder; depression, especially
when used with cognitive therapy; alcoholism; and sexual disorders.
You are now familiar with the theories and treatment methods of behavior therapy. Now,
let's explore another model of counseling and psychotherapy, known as CBT.
Cognitive Behavior Therapy (1 of 5)
Behavior therapy focuses on modifying behaviors to change clients' present situation.
However, this does not take into consideration clients' thoughts and feelings. CBT aims to
change behavior while paying attention to clients' thoughts and feelings.
The aim of CBT is to help clients identify their own maladaptive or ineffective thoughts
and behaviors and to make interventions that foster growth in the clients. Words that are
associated with CBT are logic, behavior, observation.
CBT is based on certain theories such as cognitive behavior modification, rational
emotive behavior therapy (REBT), and the ABC model. Let's discuss each of these theories now:
•
Cognitive Behavior Modification: Donald Meichenbaum's CBT theory propagates the use
of self-instructional therapy and stress inoculation training. Self-instructional therapy involves
self-control exercised through an internal dialog that mediates clients' thoughts and their
behavior. Stress inoculation is another useful approach that consists of many sub-stages assisting
clients to rethink their disabling thoughts, solve problems, use relaxation strategy, rehearse
required behavior, monitor their own progress, and provide positive reinforcement for
improvements made (Nystul, 2003).
•
REBT: This theory proposes that therapists can best understand clients by the way they
talk and the way the things they say influence their emotions. Humans have a tendency to be
rational with thoughts that help create contentment and survival or irrational with thoughts that
curtail contentment and survival. In order to prevent dysfunctional behavior in clients, it is
important to understand the interrelationship between thinking, feeling, and behavior and the fact
that thoughts affect behavior. Most people operate under "should," "ought," and "must" - for
example, "Everybody should like me" or "I must get that job." Often, irrational thoughts are
translated into self-defeating statements - for example, a self-damnation statement such as "I am
worthless and I do not deserve the good things in life." (Nystul, 2003)
•
The ABC Theory: The ABC theory of personality is central to REBT. The task of a
therapist is to work through the stages of the ABC theory in order to modify clients' selfdefeating cognitions. These stages are:
1.
The activating event that clients react to. For instance, Jennifer has a fight with her
boyfriend.
2.
Clients' belief system or cognitive reaction to the event. Jennifer may feel, "Oh my God!
This is the end of the relationship. He does not love me anymore."
3.
The emotional consequences of clients' experiences. For instance, Jennifer experiences
sadness, anger, and depression.
4.
Clients disputing their self-defeating thought processes. Jennifer may dispute her
thoughts by thinking that all couples disagree. She may feel, "Is it more important to be right or
for me to find contentment within the relationship?"
5.
The effect of the disputing process. A result of Jennifer disputing her thoughts may be the
following statement: "I can call him and try to make things better. This is the only thing that is in
my control. If he does not respond to my attempts to make this better, then maybe he is not worth
my time."
Cognitive Behavior Therapy (3 of 5)
Techniques in REBT
The following techniques are used in REBT:
•
Cognitive Techniques: These techniques overcome clients' self-defeating cognitions and
include:
◦
Redefining and getting a different perspective on a situation. For example, telling a client
that the car accident the client was involved in was not the client's fault but the other driver's
fault.
◦
Helping clients understand their problems in terms of the big picture. For example, when
a client's mother is being hurtful, it is more because of her past and her own issues and less about
the client.
◦
Reading certain books that would help with the process of change (Nystul, 2003).
•
Emotive Techniques: These techniques help with self-acceptance (Corey, 2001). Some of
these strategies are humor, imagery of a happy emotional responses, and shame-attacking
exercises. An example of a shame-attacking exercise is to encourage clients who are afraid of
public ridicule to do something ridiculous in public (Nystul, 2003).
•Behavioral Techniques: These techniques are behavior modification techniques of
reinforcement and punishment, assertiveness training, systematic desensitization, and relaxation
therapy (Nystul, 2003).
Goals of REBT
The goals of REBT are as follows:
•
Helping clients become aware of their irrational and unhelpful thoughts. The therapists'
role is educational and confrontational. Therapists confront clients about these unhelpful
thoughts and ways to modify them. When the clients are aware of how often their thoughts are
negative and self-defeating, they can make a more conscious effort to think in ways that are
helpful (Nystul, 2003). In addition, the clients confront their thoughts and make them more
productive.
•Helping clients reformulate their thoughts and build a logical approach to their issues.
Cognitive Behavior Therapy (4 of 5)
Beck's Cognitive Therapy
In the mid-1950s, Aaron Beck proposed a theory of CBT primarily to treat anxiety and
depression. Beck's cognitive therapy works from the premise that many disorders occur because
of mistaking environmental cues. For example, a person you are conversing with may have
Attention-Deficit/Hyperactivity Disorder (ADHD), but you think that the person finds you
uninteresting. Cognitive therapy also contends that people have the capacity to determine their
own course by choosing cognitions that work for them (Nystul, 2003).
Key Concepts of Beck's Cognitive Therapy (Nystul, 2003)
The following are the key concepts of Beck's Cognitive Therapy:
•
The Significance of Cognition: The way a person perceives, interprets, and assigns
meanings to events determines how the person feels and what the person does.
•
Thought Vulnerability: People operate under certain schemas which are fundamental
beliefs and assumptions about themselves, the world, and others. These assumptions can be
healthy or unhealthy. These beliefs influence illogical thinking and the way people misinterpret
neutral events in their lives as negative events.
•
Cognitive Distortions: These are systematic and illogical thoughts. Beck and Weishaar
(2000) list the following distortions:
◦
Arbitrary Inference: Holding on to an opinion when there is no evidence to support it or
when contradictions exist.
◦
Selective Abstraction: Taking information out of context or ignoring other information.
◦
Overgeneralization: Making a general rule on the foundation of only isolated events and
then applying it to unrelated situations.
◦
Magnification and Minimization: Viewing events as too important or not important at all.
◦
Personalization: Holding yourself responsible for events that you do not have any control
over.
◦Dichotomous Thinking: Seeing yourself or your experiences as "good" or "bad."
Cognitive Behavior Therapy (5 of 5)
Techniques of Beck's Cognitive Therapy
The techniques in cognitive therapy are as follows (Nystul, 2003):
•
Decatastrophizing: Therapists ask "what-if" questions to make clients face and imagine
their worst fears. For example, "What is the worst that can happen if you fail your exam?"
•
Reattribution Technique: In this technique, therapists help clients find other possible
causes of events. For example, asking a client to think of other reasons that her mother yelled at
her, instead of assuming it was because her mother wanted to embarrass the client.
•
Decentering: Therapists ask clients to list observations that would assist in finding more
realistic perceptions of others' reactions. This reduces the clients' anxiety because they recognize
that others' lives do not center around theirs. For example, Jack may take out his anger on his
spouse because of a huge phone bill he just received.
•
Behavioral Techniques: Therapists teach clients to relax — for example, deep breathing
exercises; prepare for difficult situations — for example, rehearse for a speech; and face their
fears — for example, be in the presence of a dog without panicking.
Critiquing Behavior Therapy and CBT
Some of the advantages of behavioral and cognitive behavioral therapies are that they are
easy to understand and implement with clients. However, the major disadvantage of these
therapies is that more importance is given to the role of thoughts and behavior and less to the
cause and history of the disorder and the secondary role of emotions in the lives of clients. In
addition, changing cognitions may not be possible with certain populations — for example,
clients who have a below-average intelligence quotient (IQ). However, these therapies are timebound and may be useful in today's world of third party favor mandates for brief therapy.
Solution-Focused Therapy
Solution-focused therapy has its roots in both behavior and cognitive behavior treatment.
This form of therapy helps people set concrete goals and achieve them. Treatment is focused on
the present and future rather than the past. In fact, solution-focused therapists do very little
probing for a history of the problem. They are not interested in digging out why a particular
behavior has existed or been chronically present in the person’s life. Instead, the therapist helps a
person imagine what a changed behavioral response might look like and then work to implement
that vision. Therapy is designed to create an optimistic view about the possibilities for change.
Therapists using a solution-focused approach assume that a person’s problematic
behavior stems from their perspective of themselves and the world. To change that behavior,
they must change their perspective. As the person becomes aware of the possibilities for change,
they inevitably create motivation that leads to efforts to respond to the same life situations in
different ways. Even slight changes are viewed as movement in the right direction. The
establishment of concrete and specific goals is central to progress.
Seligman (2006) identifies seven principles of treatment that typically guide solutionfocused therapy:
1.Identify a problem that is solvable. Solution-focused therapy doesn’t view people’s
problems as a sign of pathology but rather a normal part of life that people routinely experience.
It can be changed with the right attitude and approach to finding a solution.
2.Establish goals that are specific, observable, measurable, and concrete.
3.Encourage change in the client, regardless of how small it may seem.
4.Create and write down strategic tasks that promote change and help achieve goals.
5.Identify and encourage positive attempts at change.
6.Consolidate progress to help client sustain optimism and change their perspective that
brought about the problematic behavior.
7.Terminate treatment when goals have been accomplished.
Solution-focused therapy tends to be very brief in duration compared to insight-oriented
therapies such as Psychoanalytic therapy or Adlerian therapy. Solution-focused therapy typically
lasts for 5-10 sessions, with the average length of treatment being about 5 sessions.
Multicultural Issues
Are behavior therapy and CBT suited to all clients with difficulties? Or are they more
suited to some clients from specific cultural backgrounds? Let's understand the importance of
cultural differences in the application of behavior therapy and CBT.
Consider people from Asian countries. Studies show that they are told what they should
do from early childhood. They look to experts for all the answers and for advice on how to
correctly solve problems. Such clients may not be insightful and articulate. Chances are that
ambiguity and insight may make them anxious. For clients who are used to this way of living,
behavior and CBT may be well suited. Their behavior — which is concrete and they can accept it
as "real" — is the focus of change. Experts tell them what they should do differently, and this
may be good because the clients transfer the responsibility for their well-being onto others. The
rules are simple: You do this, and you get punished; but you do that, and you get rewarded.
However, for clients who have more existential dilemmas and are discontent but do not
know why, behavior and CBT may not be a good fit. These clients may be well functioning, have
no significant phobias or psychosis, and may not provide enough data for therapists to work on.
Examples of such clients are those who wonder about the meaning of life and try to figure out
what they can do to find it. These clients may "have everything" in their lives but know that
something is "missing."
Therefore, before selecting the treatment methods appropriate for clients, it is important
that counselors and therapists have an accurate understanding of the clients' culture.
Goals of Therapy
Behavior therapy and CBT emphasize goals. These goals are constructed as observable
and concrete. For therapy to be effective, goals should be clear and the criteria for meeting they
well defined. For example, some poor goals for Jim are:
•Jim wants to be a better student.
•Jim wants to be happy.
These can be modified to be more achievable and easy to relate to:
•In three months, Jim's grades should be in the seventieth percentile of his class.
•Jim should spend one hour pursuing his interests every Friday evening.
What makes the second set of goals "better"?
These might be the following reasons why the second set of goals is better.
•Measurable: The goals can be measured in terms of either percentile ranks or time spent.
•Realistic: Both goals appear to be possible and doable, given Jim's schedule and
responsibilities.
•For Self: Both goals involve Jim alone and not others in his life. No one can control
another person. Goals should be what clients want for themselves and not what parents or friends
expect of the clients.
•Time-Bound: Goals should be achievable by a realistic end date. If there is no end date,
clients would be unable to firmly establish the subtasks to reach the goals.
•Short Term: If the goals are long term such as for two years or longer, then the clients
may be disheartened because they would not see the results for a long time. Therefore, goals
should be short-term.
•Achievable: The goals should be reasonable given the clients' abilities and potential.
Unrealistic goals may result in disappointment.