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Lecture 6

LIT 20600 Lecture 6: Behavior Therapy

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LIT 20600

Ch 9. BEHAVIOR THERAPY this chapter illustrate how operate conditioning applied in Introduction: settings can be beneficial in developing prosocial and Behavior therapy therapists focus on observable behavior, current adaptive behaviors. determinants of behavior, learning experiences that promote change, 3. Social Learning Approach – It was developed by Albert tailoring treatment strategies to individual clients, and rigorous Bandura and Richard Walters. It is interactional, assessment and evaluation. Behavioral procedure are used in the fields interdisciplinary, and multi modal among the of developmental disabilities, mental illness, education as well as environment. Social learning and cognitive theory involves special education, community psychology, clinical psychology, a triadic reciprocal interaction among the environment, rehabilitation, business, self-management, sports psychology, health personal factors, and individual behavior. In the social related behaviors and gerontology. cognitive approach the environmental events on behavior are mainly determined by cognitive processes governing Historical Background: how environmental influences are perceived by an Traditional behavior therapy arose simultaneously in the US, South individual and how these events are interpreted. A basic Africa and Great Britain in the 1950’s. In spite of harsh criticism and assumption is that people are capable of self-directed resistance from psychoanalytic psychotherapists, the approach behavior change. survived. Its focus was on demonstrating that behavioral conditioning 4. Cognitive Behavior and social learning theory -now techniques were effective and were a viable alternative to represent the mainstream of contemporary behavior psychoanalytic therapy. Contemporary behavioral therapy emerged as therapy. Since the 1970’s the behavioral movement has a major force in psychology in the 1970’s. Known as the “first wave” in conceded legitimate place to thinking, even to the extent the behavioral field, behavior therapy techniques were viewed as the of giving cognitive behavioral problems. By the mid 1970’s treatment of choice for many psychological problems. The 1980’s were cognitive behavior therapy has replaced behavior therapy characterized by a search for new horizons in concepts and methods as the accepted designation and the field began that went beyond traditional learning theory. Behavior therapists emphasizing the interaction among affective, behavioral, continued to subject their methods to empirical scrutiny and to and cognitive dimensions. A good example of this more consider the impact of the practice of therapy on both clients and the integrated approach is multimodal therapy, which is larger society. Increased attention was given to the role of emotions in discussed later in this chapter therapeutic change as well as biological factors in psychological disorders. Two of the most significant developments in the field were: The former distinction between behavior therapy and cognitive 1. The continued emergence of Cognitive Behavior Therapy behavior therapy is far less of one now than it used to be, and in as a major force reality, is much more blended in theory practice, and research. 2. The application of behavioral techniques to the prevention and treatment of health related disorders. Key Concepts- View of Human Nature: By the late 1990’s the Association fir Behavioral and Cognitive Modern behavior therapy is grounded on a scientific view of human Therapists (ABCT) formerly known as the Association for Advancement behavior that implies a systematic and structured approach to of Behavior Therapy, claimed membership of 4,300. The current counseling. This view does not rest on a deterministic assumption that description of ABCT is “ A membership organization of about 4,500 humans are a mere product of their sociocultural conditioning. Rather mental health professionals and students who are interested in the current view is that the person is the producer and the product of empirically based behavior therapy or cognitive behavior therapy. “This their environment. name change and description reveals the current thinking of The current trend in behavior therapy is toward developing integrating behavioral and cognitive therapies. Cognitive therapy is procedures that actually give control to clients and thus increase their considered to be the “second wave” of the behavioral tradition. By the range of freedom. Behavior therapy aims to increase people’s skills so early 2000’s the “third wave” of the behavioral tradition emerged that they can increase their range of freedom in responding and have enlarging the scope of research and practice. This newest less restrictive choices that were not available earlier. development includes dialectical behavioral therapy, mindfulness- based stress reduction, and acceptance and commitment therapy. Basic Characteristics and Assumptions: Four areas of Development: 1. Behavior therapy is based on the principles and Contemporary behavior therapy can be understood by considering procedures of the scientific method. Behavior therapists four major areas of development: classical conditioning, operant state treatment goals in concrete objective terms to make conditioning, social learning theory, and cognitive behavioral therapy. replication of their interventions possible. Treatment 1. Classical conditioning – (respondent conditioning) refers goals are agreed upon by the client and therapist. to what happens prior to learning that creates a response Throughout the course of therapy, the therapist assesses through paring. A key figure is Ivan Pavlov. An example of problem behaviors and the conditions that are maintaining this procedure is based on the classical conditioning model them. Research methods are used to evaluate the of Joseph Wolpe’s systematic desensitization. effectiveness of both assessment and treatment 2. Operant Conditioning- Involves a type of learning in which procedures. In short, behavioral concepts and procedures behaviors are influenced mainly by the consequences that are stated explicitly , and revised continually. follow them. If the environment changes brought about the behavior are reinforcing - that is they provide a reward 2. Behavior therapy deals with the clients current problems brought about the behavior are reinforcing- the chances and the factors influencing them as opposed to an are increased that behavior will occur again. If the analysis of possible historical determinants. Emphasis is environment changes and produce no reinforcement or on specific factors that influence present functioning and produce positive stimuli the changes are that the behavior what factors can be sued to modify performance. At times will not occur again. Positive and negative reinforcement, understanding of the past may offer useful information punishment, and extinction techniques described later in about environmental events related to present behavior. Behavior therapists look to the current environmental suggests that behavior (B) is influenced by some particular events that events that maintain problem behaviors and help clients precede it called antecedents (A) and certain behaviors that follow it produce behavior change by changing environmental called consequences (C) factors through a functional assessment. Antecedent events are ones that cue or elicit a certain behavior. 3. Clients involved in behavior therapy are expected to Consequences are events that maintain a behavior in some way assume an active role by engaging in specific actions to either by increasing or decreasing it. deal with their problems. Rather than simply talking In doing an assessment interview the therapists’ task is to identify the about their condition, they are required to do something events that influence or functionally related to the behavior. to bring about change. Clients monitor their behavior both Behavior related therapists tend to be active and directive and to during and outside of therapy. They practice coping skills function as consultants and problem solvers. They pay close attention and role play new behavior. Therapeutic tasks that clients to the cues given by clients, and are willing to follow their clinical carryout in daily life are a part of this approach. This is an hunches. They must possess skills, sensitivity, and clinical acumen. They action oriented and an educational approach, and learning use some techniques common to other approaches such as is viewed as being at the core of therapy. Clients learn new summarizing, reflection, clarification, and open ended questioning. and adaptive behaviors to replace old and maladaptive • Based on a comprehensive functional assessment, the behaviors. therapist formulates initial treatment goals and designs 4. This approach assumes that change can take place and implements a treatment plan to accomplish these without insight into underlying dynamics. These goals. therapists operate on the premise that changes in • The behavioral clinician uses strategies that have research behavior can occur prior to or simultaneously with an support for use with a particular kind of problem. These understanding of oneself, and that behavioral change may strategies are used to promote with a particular kind of lead to an increased level of self understanding. While it is problem. These strategies are used to promote true that insight and understanding about contingencies generalization and maintenance of behavior change. A that exacerbate one’s problems can supply motivation to number of these strategies are described later in this change, knowing one has a problem and knowing how to chapter. change it are two different things. • The clinician evaluates the success of the change plan by 5. The focus in on assessing overt and covert behavior measuring progress toward the goals throughout the directly, identifying the problem, and evaluating change. duration of treatment. Outcome measures are given to the There is direct assessment of the target problem through client at the beginning of treatment and collected again observation and self-monitoring . Therapists also assess during and after treatment to determine if strategy and their client’s cultures as part of their social environment, plan are working. If not, adjustments are made. including social support networks relating to target • A key task of the therapist is to conduct follow up behaviors. Critical to behavioral approaches is the careful assessments to see whether the changes are durable over assessment and evaluation of the interventions used to time. Clients learn how to identify and cope with potential determine whether the behavior change resulted from the setbacks. The emphasis is on helping clients maintain procedure. changes over time and acquire behavioral and cognitive 6. Behavioral treatment interventions are individually coping skills to prevent relapses. tailored to specific problems expanded by clients. Several therapy techniques may be used to treat an individual Client’s Experience in Therapy: client’s problems. An important question that serves as a One of the unique contributions of behavior therapy is that it provides guide for this choice is: “What treatment by whom is the the therapist with a well-defined system of procedures to employ. Both most effective for this individual with that specific problem therapist and client have clearly defined roles, and the importance of and under what circumstances. client awareness and participation in the therapeutic process is stressed. This therapy is characterized by an active role for both The Therapeutic process: Therapeutic Goals: therapist and client. A large part of the therapist’s role is to teach Goals occupy a place of central importance in behavior therapy. The concrete skills through the provision of instruction, modeling, and general goals of behavior therapy are to increase personal choice and performance feedback. The client engages in behavioral rehearsal with to create new conditions for learning. The client with the help of the feedback until skills are well learned and generally receives active therapist defines specific treatment goals, at the onset of the homework assignments to complete between therapy sessions. These therapeutic process. Although assessment and treatment occur changes must be translated into their daily lives, and continue to work together, a formal assessment takes place prior to treatment to on changes begun in therapy throughout the week. Clients are determine behaviors that are targets of change. Continual assessment encouraged to experiment for the purpose of enlarging their repertoire throughout therapy determines the degree to which identified goals are of adaptive behaviors. It is clear that clients are expected to do more being met. It is important to devise a way to measure progress toward than merely gather insights; they need to be willing to make changed goals based on empirical validation. This process of determining goals and to continue implementing new behaviors once treatment has entails a negotiation between client and counselor that results in a ended. contract that guides the course of therapy. Therapists and clients alter their goals throughout the therapeutic process as needed. Relationship Between Therapist and Client: Research evidence suggests that a therapeutic relationship, even in the Therapists Function and Role: context of a behavioral orientation, can contribute significantly to the Behavior therapists conduct a thorough functional assessment or process of behavior change. Most behavioral professionals stress the behavioral analysis to identify the maintaining conditions by value of establishing a collaborative working relationship. A flexible systematically gathering information about situational antecedents, the repertoire of relationship styles, plus a wide range of techniques, dimensions of the problem behavior and the consequences of that enhances treatment outcomes. The main emphasis is the need for behavior. This is known as the ABC Model, which addresses therapeutic flexibility and versatility above all else. The skilled antecedents, behaviors, and consequences. This module of behavior therapist conceptualizes problems behaviorally and makes use of the client therapist relationship in facilitating change. As we recall, the experiential therapies ( existential, person centered, and Gestalt) place Relaxation Training and Related Methods: primary emphasis on the nature of the engagement of between client Relaxation training has become increasingly popular as a method of and counselor. In contrast, most behavioral practices contend that teaching people to cope with the stresses produced by daily living. IT is factors such as warmth, empathy, authenticity, permissiveness, and aimed at achieving muscle and mental relaxation and is easily learned. acceptance are necessary, but not sufficient for behavior change to After clients learn these techniques it is essential they practice these occur. The client- therapist relationship is a foundation on which exercises daily to obtain maximum results. Jacobson has been credited therapeutic strategies are built to help clients change directions they with developing the progressive muscle relaxation procedure. These wish. Therapists assume that clients make progress because of the include systematic desensitization, assertion training, self-management behavior techniques than because of the relationship with the programs, audiotape recordings of guided relaxation procedures, therapist. computer simulation programs, biofeedback induced relaxation. ect… Relaxation training involved several components that typically require Application: Therapeutic Techniques and Procedures 4-8 hours of instruction. Clients are given a se if instructions that A strength of behavioral approaches is the development of specific teaches them to relax. They assume a passive and relaxed position in a therapeutic procedures that must be shown to be effective enough quiet atmosphere. There they are taught by the therapist how to “let objective means. The results become clear because of the continual go” and know the difference between the tense and relaxed feeling of feedback from the clients. The therapeutic procedures that area used the muscles. by therapists are specifically designed for a particular client that being randomly selected from a bag of techniques. It is clear that therapists Systematic Desensitization - This is based on the principle of classical do not have to restrict themselves only to methods derived from conditioning, is a behavioral procedure developed by Josephe Wolpe. learning theory. Likewise, behavioral techniques can be incorporated Clients imagine successively more anxiety arousing situations at the into other approaches. This is illustrated later in this chapter in the same time they engage in a behavior that competes with anxiety. section s on the integration of behavioral and psychoanalytic Gradually the clients become less sensitive to the anxiety arousing techniques and, as well, by the incorporation of mindfulness and situation. acceptance – based approaches into the approaches into the practice If the decision is made to use this procedure the therapist gives the of behavior therapy. This mindfulness and acceptance based client a rationale for the procedure and briefly describes what is approaches do not encompass the full spectrum of behavioral involved. approaches. These techniques do not encompass the full spectrum of • Relaxation training behavioral procedures, but they do represent a sample of the • Development if the anxiety hierarchy approaches used in contemporary behavior therapy. • Systematic desensitization proper. Applied Behavioral Analysis: Operant Conditioning Techniques The steps in the relaxation training was described earlier are presented Behaviorists believe we respond in predictable ways because if the to the client. gains or positive reinforcement we receive or escape the unpleasant consequence or negative consequences that occur. Once the client’s The therapist uses a quiet voice to teach progressive muscular goals have been assessed, specific behaviors are targeted. The goal of relaxation. The client is asked to create imagery of relaxing situations. reinforcement whether negative or positive behavior is to increase the IT is important that the client reach a state of clam and peacefulness. targeted behavior. The client is instructed to practice relaxation both as a part of the desensitization procedure and also outside the session on a daily basis. Positive reinforcement involves the addition of something of value to Then the therapist works with the client to develop an anxiety the individual as a consequence of certain behavior. The stimulus that hierarchy for each of the identified areas. The hierarchy is arranged in follows the behavior is the positive reinforcement. order from the worst situation down to the least anxiety provoking situation. Negative reinforcement involves the escape from or the avoidance of Desensitization – does not begin until several sessions after the initial unpleasant stimuli. The individual is motivated to exhibit a desired interview has been completed. Enough time is allowed for clients to behavior to avoid the unpleasant condition. learn relaxation techniques in therapy sessions, practice at home, and to construct their anxiety hierarchy. The process begins with the Another operant method of changing behavior is extinction. This refers client relaxing with their eyes closed. A neutral scene is presented and to withholding reinforcement from a previously reinforced response. the client is asked to imagine it. Once the client is fully relaxed they are In applied settings, extinction can be sued for behaviors that have been asked to imagine the least anxiety provoking scene and then the maintained by positive or negative reinforcement. therapist moves up the hierarchy it situations that have been developed. Another way behavior is controlled is through punishment, sometimes The core of this is repeated exposure in the imagination to anxiety referred to adverse control, in which the consequences of a certain evoking situations without experiencing any negative consequences. A behavior result in a decrease of that behavior. The goal of safeguard us that clients are in control of the process by going at their reinforcement is to increase target behavior and the opposite is true own pace and terminating exposure when they begin to experience with punishment. Its purpose is to decrease a target behavior. more anxiety than they want to tolerate. In positive punishment an aversive stimulus is added after the In Vivo Exposure and Flooding: behavior to decrease the frequency of a behavior. Exposure Therapies are designed to treat fears and other negative emotional responses by introducing clients under carefully controlled In negative punishment a reinforcing stimulus is removed following a conditions to situations that contributed to such problems. Exposure is behavior to decrease the frequency of a target behavior. a key process in treating a wide range of problems associated with fear and anxiety. It involves a confrontation with a feared stimulus, either The key principle in the applied behavior analysis approach is to use through imagination or live. the least aversive means to change behavior, and positive reinforcement is known to be the most powerful change agent. In Vivo - This involves a client exposing themselves to the actual can make the choice of whether to behave assertively in certain anxiety evoking event rather than imagining these situations. Live situations. It is important that the client replaces the maladaptive skills exposure has been a cornerstone of behavior therapy for decades. with new skills. Another goal is teaching people to express themselves in ways that reflect sensitivity to the feelings and rights of others. Flooding – This refers to either vivo or imagined exposure to anxiety Assertion does not mean aggression; truly assertive people do not evoking stimuli for a prolonged period of time. Even though the anxiety stand up for their rights at all
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