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
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
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
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