*Behaviour Therapies

Maladaptive behaviours are learned and can be unlearned using conditioning principles.
Behaviour therapy rejects the influence of unconscious forces and "inner dynamics."

Purpose: To reduce (decondition) anxiety and to condition new reactions to stimuli (e.g., reactions to alcohol, sexual objects).
Common forms include:
- Exposure Therapy
- Systematic desensitization
- Aversion therapy

Definition: Presenting the conditioned stimulus (CS), which is the feared stimulus, without the unconditioned stimulus (UCS) to extinguish the anxiety response.
Process of Fear Formation:
- A neutral stimulus (e.g., car) paired with an aversive UCS (e.g., accident) creates a conditioned stimulus (CS) which produces a conditioned response (CR) of anxiety.
- Avoidance of the feared stimulus becomes reinforced through operant conditioning: anxiety is negatively reinforced.

Therapeutic Application

Clients are exposed to the CS without any means of escape (avoidance is not allowed).
Flooding/Implosion Therapy Definition: Directly exposes clients to intense anxiety-provoking stimuli (real or imagined) until the anxiety is extinguished.
Response Prevention Definition: A technique that blocks avoidant behaviours to allow extinction to occur.

Focus: Exposure to feared environments (e.g., crowds, driving, checkout lines).
Method: Measured real-life performance tasks before and after therapy.
Results: Significant improvement with long-lasting gains; many months to years.
Note: Patients who could not benefit from typical talk therapies often show improvement through exposure methods.

Definition: Immersive computer-generated environments that simulate real experiences (360° visuals, sound, head/hand tracking).
Advantages:
- Allows clients to experience presence within the feared situation.
- Flexible and programmable (therapist can change scene intensity during sessions).
- Therapists can accompany clients within the VR environment.
Applications: Effective for phobias (e.g., elevators, heights, spiders), PTSD, eating disorders, social anxiety, gambling disorders.
Outcomes:
- VR exposure is often as effective as in-person exposure therapy.
- Some studies indicate better success rates than cognitive-behavioral therapy (CBT) or waiting list controls.
- Augmented reality (AR) is emerging as a more affordable and accessible option.

Introduced by Joseph Wolpe in 1958.
Goal: To pair relaxation techniques with anxiety-inducing stimuli; anxiety becomes incompatible with relaxation.
Counterconditioning Definition: Process of replacing an anxiety response with a new, incompatible response (relaxation).

Train clients in muscle relaxation skills.
Construct a stimulus hierarchy (Definition): A list of anxiety-inducing scenes arranged from least to most anxiety-provoking (typically 10-15 scenes).
Clients visualize the scenes while in a deeply relaxed state, leading to reduced anxiety as they progress up the hierarchy.
- Example: A hierarchy for test anxiety might progress from hearing about an exam, walking into the test room, to seeing an unanswerable question.

Goal: Not to reduce anxiety but to create a negative reaction to a harmful stimulus.

Involves pairing an attractive conditioned stimulus (CS), such as alcohol or sexual images, with a noxious unconditioned stimulus (UCS) like electric shocks or nausea-inducing injections.

Use of nausea-inducing drugs like disulfiram (Alcoholism) with alcohol consumption.
Application in treatment of pedophilia using electric shocks combined with sexual images of children (measured via penile response).

Typically demonstrates good short-term outcomes but has weak generalization to real-world scenarios.
Best results are obtained when combined with skills for preventing relapse in patients.