Behavior Therapy

History

  • arose in 1950s, although idea of evidence based research on behavior is ancient

  • initially based on learning theory

  • in general, approach was a break from psychoanalysis

  • not a single method, a set of clinical procedures

  • focuses on behavior

    • some include emotions, cognitions, images, etc.

    • depends on operational definition

Initial Theorists

  • Ivan Pavlov

    • classical conditioning

  • Joseph Wolpe

    • South Africa wing

  • B.F. Skinner

    • United States wing

    • operant conditioning

  • Hans Eysenck

    • United Kingdom wing

    • focus on interaction of personality, environment, behavior

  • Arnold Lazarus

    • multimodal therapy

Basic Principles

  • present focus

    • to help people change maladaptive behaviors

    • what does this look like in practice?

  • self-management

    • educational approach to teach clients to care for themselves

    • in-session, client is active, engaged

  • reinforcement

    • rewards and punishments

  • shaping

    • focus on small, incremental changes

  • actions, not insight

    • focus on behaviors over internal workings

    • change can and does happen without understanding of origins

    • knowing that one has a problem and knowing how to change it are two different things

      • Martell (2007)

  • research base

    • relying on experimental findings of psychological research

  • measurable assessments

    • treatment goals are specific and measurable

    • therapist is constantly assessing behaviors

      • over time, client should be as well

  • classical conditioning

    • in classical conditioning certain respondent behaviors, such as knee jerks and salivation are elicited from a passive organism

  • operant conditioning

    • focuses on actions that operate on the environment to produce consequences

      • if the environmental change brought about by the behavior is reinforcing, the chances are strengthened that the behavior will occur again. If the environmental changes produces consequences

    • social-learning approach

      • gives prominence to the reciprocal interactions between an individual’s behavior and the environment

    • functional assessment

      • more on this…

Basic Behavior Techniques

  • all counseling approaches will focus on behaviors at some time, depending on the circumstances

  • a focus on behavior is the most immediate option to establish client change

    • if a client is unsafe we immediately assess risk and focus on behaviors to increase safety

  • clients don’t always recognize that they are agents in their own lives, and that they have the means to live (and behave) differently

    • identifying how they are behaving in ways that create or maintain presenting issues is pertinent

  • a key element of all modern behavioral approaches is being very specific in language, as generalities make it much harder for individual to take specific actions

    • helping clients develop operational definitions of behaviors can be a pertinent step before they’re able to change them

  • to help clients work directly on behaviors we might…

    • reflect to them how behaviors impact thoughts and feelings (and other behaviors)

    • help them recognize how past conditioning (operant or classical) has led clients to behave in particular ways

    • assess frequency of behaviors, particularly those related to presenting issues

    • make realistic goals to adjust those frequencies

      • have them consider possible outcomes and consequences, and assess the level of motivation and investment the client has

  • highlight (again and again) the above to help increase awareness

    • this is more conditioning

Larger Behavior Therapeutic Approaches

  • relaxation training

    • to cope with stress

  • systematic desensitization

    • for anxiety and avoidance reactions

  • modeling

    • observational learning

  • assertation training

    • learning to express oneself

  • social skills training

    • learning to correct deficits in interpersonal skills

  • self-management programs

    • “giving psychology away”

  • aversion therapy

  • exposure therapy

Exposure Therapy

  • in vivo desensitization

    • brief and graduated exposure to an actual fear situation or event

  • flooding

    • prolonged and intensive in vivo or imaginal exposure to stimuli that evoke high levels of anxiety, without the opportunity to avoid them

  • eye movement desensitization and reprocessing (EMDR)

    • an exposure-based therapy that involves imaginal flooding, cognitive restructuring, and the use of rhythmic eye movements and other bilateral stimulation to treat traumatic stress disorders and fearful memories of clients

Functional Assessment of Behavior

  • not to be confused with a functional behavior assessment, an educational process

  • focus is on a behavior that the client wants to increase (reinforce) or decrease (distinguish)

    • specify a well-defined target behavior

  • ABC Model

    • antecedent

    • behavior

    • consequence

  • antecedent leads to behavior, which leads to consequences

Modern Disciplines

  • cognitive behavior therapy (CBT)

    • combined with either rational emotive behavior therapy (REBT) and/or cognitive therapy (CT)

    • save this for next class

  • social learning approach    

    • Albert Bandura

    • now known as “social cognitive theory”

  • multimodal therapy

    • a technical eclecticism

  • applied behavior analysis

    • training new behaviors

    • particularly effective in working with developmentally delayed individuals

  • dialectical behavior therapy

    • learning emotional regulation and mindfulness

    • designed for the treatment of borderline personality disorder

  • mindfulness-based stress reduction therapy

    • meditation and yoga

  • acceptance and commitment therapy

    • learning acceptance and non-judgment of thoughts and feelings as they occur

Applied Behavior Analysis (ABA)

  • therapeutic relationship

    • counselor shows high levels of empathy, self-congruence

    • relationship is collaborative

  • operationalization of behavior

    • focus on the concrete, specific behaviors

    • vague/general ideas become objective, observable actions

  • reinforcement

    • punishments and rewards guide behavior

  • goals

    • designed to make specific behavioral changes

    • concrete, specific, observable and measurable

Acceptance and Commitment Therapy (ACT)

  • acceptance

    • of what is in your personal control

  • commitment

    • to taking action that enriches the client’s life

  • goal is to create a full and meaningful life, and accepting the pain that such a life inevitably entails

  • mindfulness as a stance, not a practice

  • being with “creative helplessness”

  • 6 core processes

    • the present moment

    • acceptance

    • defusion

      • techniques that let us separate from our thoughts

    • self-as-cintext

      • “pure awareness”, the observing self

    • committed action

      • workability

    • values

      • knowing what matters

ACT Techniques

  • techniques

    • experiential exercises

      • leaves on a stream

    • metaphors

      • pendulum metaphor

  • worksheets

    • values

    • defusion

    • e.g.

      • values assessment rating form

      • the costs of avoidance worksheet

      • the willingness and action plan

      • overcoming F.E.A.R.

Limitations

  • pathologizes questionable behaviors as in need of extinction

  • major focus on behaviors as opposed to other aspects of mind, emotions, and cognitions

  • deemphasizes therapeutic relationship, human connection, by viewing therapist as teacher

  • no emphasis on insight

  • focus on symptoms rather than underlying causes

  • approach allows for inadvertent or deliberate manipulation of client

  • may be overly directive, imposing, mechanized