Module 5.5b Treatment of Psychological Disorders: Behavioral, Cognitive, and Group Therapies

Learning Targets

• 5. 5-4: Describe the basic assumptions of behavior therapy and how it differs from psychodynamic and humanistic therapies; also, describe classical conditioning techniques, including exposure therapies and aversive conditioning.

• 5. 5-5: Describe the premise of behavior therapy based on operant conditioning principles and contrast the views of its proponents and critics.

• 5. 5-6: Describe the goals and techniques of cognitive therapies and cognitive-behavioral therapy.

• 5. 5-7: Explain the goals and benefits of group and family therapies.

Behavior Therapies

• Basic Assumption: Behavior therapy differs from insight therapies (psychodynamic and humanistic) by focusing on the problem behaviors themselves rather than underlying causes.

• Insight therapies assume self-awareness and psychological well-being go hand in hand.

  • Psychodynamic therapists expect problems to lessen as people gain insight into their unresolved and unconscious tensions.

  • Humanistic therapists expect problems to diminish as people get in touch with their feelings.

• Behavior therapists, influenced by the behavioral perspective, doubt the healing power of self-awareness.

• Behavior therapists assume that problem behaviors are the problems.

• Instead of delving deeply to find inner causes, behavior therapists use learning principles to offer strategies for reducing unwanted behaviors.

• They view issues like phobias as learned responses and aim to replace unwanted behaviors with constructive ones.

• Classical Conditioning Techniques:

  • Based on Ivan Pavlov's experiments, these therapies use classical conditioning principles.

  • Classical conditioning explains how we learn behaviors and emotions.

  • Example: A dog attack can lead to a conditioned fear response to dogs.

  • O.H. Mowrer developed a conditioning therapy for chronic bed-wetting using a liquid-sensitive pad connected to an alarm.

    • Moisture triggers the alarm, waking the child.

    • After trials, the child associates bladder relaxation with waking.

    • Effective in three out of four cases and boosts self-esteem.

  • Counterconditioning pairs a trigger stimulus with a new response incompatible with fear.

    • Example: Exposure therapy for elevator fear pairs the enclosed space with relaxation.

Exposure Therapies

• Mary Cover Jones worked with a 3-year-old, Peter, who was petrified of rabbits and other furry objects. To rid Peter of his fear, Jones planned to associate the fear-evoking rabbit with the pleasurable, relaxed response associated with eating.

• Jones associated a rabbit with a pleasurable, relaxed response (eating) to counter Peter's fear.

  • She introduced a caged rabbit while Peter had a snack.

  • Gradually moved the rabbit closer.

  • Within two months, Peter held and stroked the rabbit while eating, and his fear of other furry objects also subsided.

• Joseph Wolpe refined Jones's technique into exposure therapies.

• Exposure therapies use applied behavior analysis to address disordered behaviors by repeatedly exposing individuals to stimuli that trigger unwanted reactions.

• Repeated exposure can lead to adaptation, reducing fear reactions.

• Helpful for conditions like PTSD.

• Systematic Desensitization:

  • An exposure therapy used to treat specific phobias.

  • It's based on the principle, "You cannot simultaneously be anxious and relaxed."

  • Involves creating a fear hierarchy (a ladder of speaking situations that trigger increasing levels of fear).

  • Training in progressive relaxation to release tension in muscle groups.

  • Imagining mildly anxiety-arousing situations while practicing relaxation.

    • Therapist instructs to switch off mental image and go back to deep relaxation if anxiety is felt.

  • Moving to actual situations and practicing what was imagined, starting with easy tasks and gradually moving to more anxiety-filled ones.

  • Conquering anxiety in real situations increases self-confidence.

• Sometimes fear is not just of a situation but also of being incapacitated by the fear response. As fear subsides, so does the fear of the fear.

• Virtual Reality Exposure Therapy:

  • Used when anxiety-arousing situations are too expensive, difficult, or embarrassing to recreate.

  • Uses a head-mounted display unit to project a lifelike three-dimensional virtual world tailored to a particular fear.

  • Examples: Simulated plane flights for fear of flying, simulated social interactions for social anxiety.

  • Studies show relief from real-life fear and social anxiety.

Aversive Conditioning

• Exposure therapy helps you learn what you should do; it enables a more relaxed, positive response to an upsetting harmless stimulus.

• Aversive conditioning helps you learn what you should not do; it creates a negative (aversive) response to a harmful stimulus (such as alcohol).

• Associates unwanted behavior with unpleasant feelings.

  • Examples:

    • Painting fingernails with a nasty-tasting nail polish to treat compulsive nail biting.

    • Lacing appealing drinks with a drug that produces severe nausea to treat alcohol use disorder.

• Taste aversion learning in animal protection programs: wolves avoid sheep after being sickened by eating a tainted sheep.

• In therapy, cognition influences conditioning. People know that outside the therapist's office they can drink without fear of nausea.

• Therapists often combine aversive conditioning with other treatments.

Operant Conditioning Techniques

• Based on B.F. Skinner's principles: consequences influence voluntary behaviors.

• Behavior Modification: Reinforces desirable behaviors and fails to reinforce or punishes undesirable behaviors.

• Applied Behavior Analysis (ABA): Uses learning theory to increase positive behavior and decrease unwanted behavior.

  • Examples:

    • Helping socially withdrawn children with autism spectrum disorder learn to interact.

    • Helping people with schizophrenia behave more rationally.

  • Uses positive reinforcers to shape behavior in a step-by-step manner.

• Token Economy:

  • Used in institutional settings.

  • People earn tokens for displaying desired behaviors, which can be exchanged for rewards.

  • Examples of desired behaviors:

    • Getting out of bed, washing, dressing, eating, talking meaningfully, cleaning their rooms, or playing cooperatively.

  • Examples of rewards:

    • Candy, TV time, day trips, or better living quarters.

  • Used successfully in homes, classrooms, correctional institutions, and among people with various disabilities.

• Criticisms of Behavior Modification:

  • Durability of behaviors: Will behaviors stop when reinforcers stop?

  • Critics believe that people may become too dependent on extrinsic rewards.

  • Control: Is it right for one human to control another's behavior?

  • Critics feel it's authoritarian to deprive people of something they desire and decide which behaviors to reinforce.

• Proponents' Arguments:

  • Behaviors will endure if therapists wean people from tokens by shifting them toward real-life rewards like social approval.

  • Using positive rewards is more humane than institutionalizing or punishing people.

  • The right to effective treatment and an improved life justifies temporary deprivation.

Cognitive Therapies

• The cognitive therapies assume that our thinking colors our feelings.

• Anxiety can arise from an "attention bias to threat."

• Self-blaming and overgeneralized explanations of bad events feed depression.

• Cognitive therapies help people change their mind with new, more constructive ways of perceiving and interpreting events.

• Cognitive restructuring echoes Marcus Aurelius' saying "You have power over your mind."

• Rational-Emotive Behavior Therapy (REBT):

  • Developed by Albert Ellis.

  • Many problems arise from irrational thinking.

  • Challenges illogical, self-defeating assumptions.

  • Aims to change feelings and enable healthier behaviors by exposing the "absurdity" of self-defeating ideas.

  • Challenges illogical, self-defeating assumptions.

• Beck's Cognitive Therapy:

  • Developed by Aaron Beck.

  • Challenges people's automatic negative thoughts.

  • People with depression view life through dark glasses.

  • Gentle questioning seeks to reveal irrational thinking, and then to persuade people to reduce the negative bias that colors their thoughts and perceptions

    • As shown in one of Beck's session with a client.

  • Getting people to change what they say to themselves is an effective way to change their thinking.

  • Cognitive therapists have offered stress inoculation training to change negative self-talk.

    • Which teaches people to restructure their thinking in stressful situations

  • Saying more positive things to yourself is enough.

    • "Relax. The test may be hard, but it will be hard for everyone else, too. I studied really hard. Besides, I don't need a perfect score to get a good grade."

Cognitive-Behavioral Therapy

• Cognitive-behavioral therapy (CBT) takes a combined approach to treating depressive and other disorders.

• Cognitive-Behavioral Therapy (CBT):

  • Combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior).

  • Aims to alter both the way people think and the way they act.

  • Seeks to make people aware of their irrational negative thinking and to replace it with new ways of thinking.

  • Trains people to practice the more positive approach in everyday settings.

  • Addresses unhealthy emotion regulation common in anxiety, depressive, and bipolar disorders.

  • Trains people to replace catastrophizing thinking with more realistic appraisals.

  • Encourages practicing behaviors incompatible with their problem as homework.

  • Uses:

    • Keeping a log of daily situations associated with negative and positive emotions, and engaging more in activities that lead to feeling good.

    • Those who fear social situations might learn to restrain the negative thoughts surrounding their social anxiety and practice approaching people.

• CBT has been used to effectively treat people with obsessive-compulsive and related disorders.

• Dialectical Behavior Therapy (DBT):

  • Helps change harmful and even suicidal behavior patterns.

  • Dialectical means "opposing," and this therapy attempts to make peace between two opposing forces-acceptance and change.

  • Therapists create an accepting and encouraging environment, helping clients feel they have an ally who will offer them constructive feedback and guidance.

  • Clients learn new ways of thinking that help them tolerate distress and regulate their emotions.

  • May also receive training in social skills and in mindfulness meditation, which helps alleviate depression.

  • Group training sessions offer additional opportunities to practice new skills in a social context, with further practice as homework.

• Acceptance and Commitment Therapy (ACT):

  • Helps clients learn to accept their feelings and commit to actions that are more consistent with their life values.

  • ACT effectively treats depression and anxiety, and even chronic pain.

Group and Family Therapies

• Group Therapy:

  • People share and interact with others.

  • It saves therapists' time and clients' money and often is no less effective than individual therapy.

  • It offers a social laboratory for exploring social behaviors and developing social skills.

  • It enables people to see that others share their problems and can be a relief to discover that others have experienced similar stressors, troublesome feelings, and behaviors.

  • It provides feedback as clients try out new ways of behaving. Hearing that you look or sound poised, even though you feel anxious and self-conscious, can be very reassuring and the presence of others can promote accountability.

• Family Therapy:

  • Assumes that no person is an island and our social and cultural environments form us.

  • Views families as systems, in which each person's actions trigger reactions from others.

  • Therapists are often successful in helping family members identify their roles within the family's social system, improve communication, and discover new ways of preventing or resolving conflicts.

• Self-Help Groups:

  • Often provide support to people who struggle to find it elsewhere.

  • Most focus on stigmatized, hard-to-discuss problems.

  • Many use a 12-step program modeled on that of Alcoholics Anonymous (AA).

  • Studies of 12-step programs such as AA have found that they help reduce alcohol use disorder at rates comparable to other treatment interventions.

Comparing Modern Psychotherapies