Behavior Therapy

Basics of Behavior Therapy

Behaviorism is the second force of psychotherapy. Behavior Therapy is the first wave of behaviorism and was developed in part as an alternative to pscyhoanlysis in the 1950's and 60's. B.F Skinner (pictured right) is a strict behaviorist who built on the foundations of Pavlov and Watson. He believed that everything we do is built on punishment and reward. The second wave of Behavior Therapy focused on integrating cognitive principles with behavior therapy (CBT). The third wave focused on integrating mindfulness concepts into more traditional behavior/cognitive principles (DBT).

Key Concepts:
- People are both producers and products of their environment
- Individual difference are derived primary from differences in experience, but genetics might play a role
- Behavior is learned through modeling, conditioning, and reinforcement
- All behavior has a purpose or function
- Behavior must be viewed and understood in the context it occurs
- A client's environment can be manipulated to increase appropriate behavior and decrease dysfunctional behavior
- Clients need to take an active role in their counseling experience to achieve new and changed behavior
- Classical Conditioning*
- Operant Conditioning*
- Social Learning Theory*

Therapeutic Process & Goals
- The therapeutic process is a very structured and scientific process that involves the following steps

Assessment & evaluation of defined behaviors
Identification of target behaviors (often the initial focus/motive of counseling)
Identification of why a behavior occurs, the consequence, and how a client responds to those consequences
Selection of interventions specific to each behavior that removes desirability and replaces it with more adaptive behavior
Ongoing assessment and monitoring of behavior to determine effectiveness of selected interventions
Follow up assessments after completion of goals to determine overall effectiveness of counseling

The main goals of Behavior Therapy is to replace maladaptive behaviors with adaptive ones that increase overall wellbeing of a client.

Classical Conditioning Concepts

Repeated presentation of a stimulus that causes a given response over time when paired with something else. The stimulus and response become paired so when the stimulus is present the response occurs.

Pavlov's Dog Experiment

Extinction involves the conditioned response decreasing over time after the stimulus is removed

When the bell rang but there was no food, the dogs still salivated for a period of time until it became unpaired

Stimulus generalization: responding the same way to a similar stimulus
Behaviorism is the theory that behavior can be explained by conditioning and that behavioral problems are best addressed by changing behaviors without consideration of thoughts or feelings
Reciprocal inhibition: eliciting a novel response brings a decrease in the strength of a concurrent habitual response

A parent making a silly face at their child who just fell. The silly face elicits amusement which automatically decreased sadness of the fall

Systematic desensitization: pairs relaxation with controlled exposure to a feared stimulus. Widely used in treatment of specific phobias. Based on reciprocal inhibition
When behavior is overgeneralization and becomes unhealthy people then need to learn how to distinguish between similar cues called stimulus discrimination

Operant Conditioning Concepts

Learning based on consequences
Stimulus-response (S-R) the more frequently a stimulus and response coincide, with the response being rewarded, the stronger the tendency to engage in that response when the stimulus occurs

A child learning that the only way to get their parents love and attention is to be sick and grows up with that attitude

Counterconditioning reverses habits by pairing a behavior with a strong incompatible response to the same cue to change the behavior

The child eventually changed her behavior when her partner complained about how annoying her frequent complaints of being sick were

Social Learning Theory Concepts

Not an approach to therapy, but the principles are foundational to Behavior Therapy
Differs from above concepts because it includes additional focus on people's worldview, beliefs, and cognitive processes
Emphasizes how individuals learn by observing and modeling others

Modeling is learning by imitating behavior both positive and negative

Another part of SLC is self-efficacy which is our belief in our ability to accomplish something. Modeling can change our cognitions and abilities to improve self-efficacy

Self-efficacy theory states that people will be able to perform a task based on their belief about how well they will perform and the consequences that come from doing it

Therapeutic Techniques & Procedures

Behavior Therapists are generally interested in 3 questions

What does the problem look like in concrete, specific, behavioral terms?
What happens before the problem occurs?
What happens after the problem occurs?

Operant Conditioning Techniques
- Positive Reinforcement: addition of a positive stimulus to increase behavior
- Negative Reinforcement: removal of a negative stimulus to increase behavior
- Positive Punishment: additional of an aversive stimulus to decrease behavior
- Negative Punishment (response cost): removal of a favorable stimulus
- Extinction: behavior stops due to a lack of reinforcement
- Prompting: verbal, visual, or physical cue is used to cause a behavior
- Shaping: gradually increasing similar behaviors until the target behavior is learned
- Chaining: reinforcing step by step behaviors that lead to a more complex behavior

Classical Conditioning Techniques
- Exposure Based Interventions:
  - Exposure helps people learn to identify their fear response and sit with uncomfortable feelings without fleeing. The goal is to increase control over the feelings of distress in a given situation. Repeated contact with feared stimulus will result in adaptation
  - Virtual Reality Therapy: uses VR technology to imitate a specific experience
  - Pacing of exposure is important
    - Flooding; intensive exposure from 30 minutes to 8 hours. Can be overwhelming and therefore not effective for treating phobias
    - Implosion: prolonged, intense exposure therapy where clients imagine an anxiety producing situation to help develop a more appropriate response
    - Graduate exposure: have clients face fear for a short time, then increase exposure time in small increments over time.
      - Systematic Desensitization
    - Interoceptive exposure: encourages people to experience feared bodily sensations in a safe environment without engaging in avoidance or escape strategies
      - Spinning in a chair to achieve dizziness
      - Most often used to treat panic disorder
- Relaxation techniques
  - Progressive muscle relaxation
  - Diaphragmatic breathing

Application of Behavior Therapy

Used to treat Autism spectrum, depressive/bipolar, anxiety, trauma stress, personality eating, and SUD
Particularly effective with those experiencing depression because behavior change can reduce severity of depression
Exposure therapies have shown value in treating specific phobia, PTSD, acute trauma, and panic disorder

Multicultural Groups

Focus on behaviors over feelings might land well with certain populations such as men, elders, those in Asian cultures as these individuals tend to be less comfortable and open about their feelings
The use of punishment can raise ethical concerns and result in unintended outcomes. Counselors should use culturally and ethically informed decision making when employing operat conditioning techniques especially.

Limitations

Behavior Therapy focuses on changes in behavior but is not concerned with underlying feelings, thoughts, or cognitions. Clients might not develop understanding of their behavior depsite it changing.
Behavior Therapy uses techniques focus on reducing behaviors rather than deeper processing which might just lead to a supression of symptoms and not true change or healing.

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