Behavior Therapy

What is psychotherapy?

An emotionally charged confiding interaction Between a trained therapist and someone suffers from psychological probemsUsing psychological techniquesAims: • change behaviour• Decrease distress• Increase joy, aspiration, and hope• Improve resilience

Aim: To answer these questions

• Behavior (Action) Vs Insight Therapy• Elements of behavioral approaches • Behavior therapy & learning • Goals of BT• Various techniques• Role of behavior therapist • Strengths & Weaknesses

Insight- vs. Action-OrientedApproaches

Approach Insight Action-orientedEmphasis self-awareness and

understandingrelief of symptoms

Primary medium

verbal intervention & processing

action with verbal processing

Attention therapeutic relationship, process, interpretation, insight

objective, scientific behavioral interventions and outcome measures

Therapist nondirective active & directive

Common elements of behavioral approaches 1. Emphasizes on the present (not past)2. Gives attention – to change specific

dysfunctional behaviors3. Rely on research - in developing and testing

interventions4. Consider principles of learning – to develop

and treat dysfunctional behaviors5. Treatment outcomes – carefully measured6. Matches specific treatments to particular

presenting problems

How do psychological problems arise?• All behaviors are the result of learning

Behavior is a product of learningNo matter how pathological client’s behavior may be, it is

the result of past learning and conditioning

What has been learned can be unlearnedSame learning principles that apply to learning

maladaptive behavior can be used to get rid of it

Behavioral Therapy and Learning

Three primary types of behavior problems:

Behavioral Excess- behavior that occur too often

Behavioral Deficits – too little or non-existent

Inappropriate/maladaptive behavior-Minor (less impairment-nail biting ) to severe(more impairment-sexual behaviors) interference in ADL

Goals of Behavioural Therapy 1. Aims to change behavior in order to change emotion and

mood.2. Directed exclusively towards symptomatic improvement,

without addressing psychodynamic causation.

Behavioural Therapy Techniques

Before this…what is counterconditioning?◦Behavioural therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviour.

◦ Systematic desensitization◦ Aversion therapy

Systematic DesensitizationEg. Used to treat phobias

Systematic Desensitization◦Developed by Wolpe (1950)◦Aim: remove feared response of a phobia, and substitute a relaxation response to the conditional stimulus gradually using counterconditioning.◦3 phases treatment: 1. Relaxation training2. Hierarchy construction3. Desensitization of stimulus

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Systematic Desensitization: 1. relaxation training◦Patient is taught a deep muscle relaxation technique and breathing exercises. E.g. control over breathing, muscle detensioning or meditation. ◦reciprocal inhibition: one response is inhibited because it is incompatible with another. ◦In the case of phobias, fears involves tension and tension is incompatible with relaxation.

Systematic Desensitization: 2. Hierarchy construction

Systematic Desensitization: 3. Desensitization of stimulus

Start from least unpleasant stimuli

Move on next stage when no longer afraid

Return to earlier stage if become upset

Systematic Desensitization◦The therapy is complete once the agreed therapeutic goals are met (not necessarily when the person’s fears have been completely removed).

◦Exposure can be done in two ways:

◦· In vitro – the client imagines exposure to the phobic stimulus.

◦· In vivo – the client is actually exposed to the phobic stimulus. (also called graded exposure)

Aversion Therapy: Eg. Used to treat substance abuse

Aversion Therapy◦Repeated coupling of an unpleasant or painful stimulus (or imagining something unpleasant), with an undesirable behaviour.◦Eg. alcohol-dependent patient is made to vomit (by adding emetic to the alcohol) every time a drink is ingested.◦Disulfiram (antabuse) is given when alcohol-free, patient is warned of severe physiological consequences (nausea, vomiting, hypotension, collapse) if drinking.

Flooding

Flooding◦Patient is exposed immediately to most anxiety-provoking stimulus.◦If carried out in imagination is called implosion.◦Effective to treat phobias.◦Experimental work is being done with computer-generated virtual reality (beneficial effect reported): eg. height phobia, fear of flying, arachnophobia, claustrophobia

Video

Token Economy:

Eg. used to treat

Schizophrenia

A form of positive reinforcementIn hospital settings, tokens are awarded for desirable behaviour (such as following instructions during occupational therapy) and can be exchanged for a variety of positive reinforcers such as food, television time or a weekend pass.

Extinction◦Commonly used in autistic or Down syndrome children.◦ reinforcement that is provided for problem behavior (often unintentionally)

is discontinued in order to decrease or eliminate occurrences of these types of negative (or problem) behaviors.

◦Eg:  Dannie tries to get mom's attention by dropping her toy on the floor. Her mom smiles at Dannie, picks up the toy and hands it back to her. This series of actions reinforces Dannie's negative behavior because she is getting the attention that she is seeking. As a result, she will continue to engage in this type of behavior in order to receive the positive reinforcement that her mom provides. To address this problem, Dannie’s mom should ignore Dannie when she drops the toy; if she consistently ignores this problem behavior, it is highly likely that Dannie will reduce engaging in this behavior as her actions no longer produce the effect that she is seeking.

Punishment ◦Positive punishment works by presenting a negative consequence after an

undesired behavior is exhibited, making the behavior less likely to happen in the future.

◦Eg. During a meeting or while in class, your cell phone starts ringing, you are lectured on why it is not okay to have your phone on.

◦Negative punishment happens when a certain desired stimulus/item is removed after a particular undesired behavior is exhibited, resulting in the behavior happening less often in the future.

◦Eg. Siblings get in a fight over who gets to go first in a game or who gets to play with a new toy, the parent takes the game/toy away.

Paraphilias (abnormal sexual behaviour) can be punished using electric shock.

Social Skills TrainingAims: Improve interpersonal skills

Treat depression, anxiety, antisocial, delinquent behaviour, schizophrenia, social

withdrawal and isolation.

Modeling Client encouraged to watch socially skilled friends (eye contact, active listening)

Behavioral Rehearsal Client tries to practice social techniques in structured, role-playing exercises

Shaping Clients are gradually asked to handle more complicated and delicate social situations

Assertiveness training- To become a person to have confidence in his judgement and

sufficient self-esteem to express his opinions.

Also deals with real-life task such as food shopping, looking for work, interacting with

other ppl, overcoming shyness

Behavior Therapist Roles Serves as a consultant, problem solver, coach, and educatorDirective and activeEncourages patients to develop positive feelings to help

maintain therapeutic allianceTherapist helps client to develop insight into problems as

needed to improve adaptive responses.

Behavior TherapyStrength Weakness

Strong empirical tradition & evidence Does not address broader human problems

Specific problems are identified & attacked

Does not integrate past

Forces client to be explicit about goals Therapist can manipulate

Can be used with a variety of populations

Not suitable for people with more complex mental health needs or learning difficulties

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