Psychology- Counselling Techniques
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Chapter 9
Behavior Therapy
Professor Petrie Spring 2021
Copyright © 2021 Cengage
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Introduction
Behavior therapy focuses on directly observable behavior, current determinants of behavior, and learning experiences.
Anxiety disorders, depression, posttraumatic stress disorder, and so on have been treated.
It is used in the fields of developmental disabilities, mental illness, education, community psychology, sports, medicine, and so on.
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A-B-C model: This model of behavior posits that behavior (B) is influenced by some particular events that precede it, called antecedents (A), and by certain events that follow it called consequences (C).
Acceptance: A process involving receiving our present experience without judgment or preference, but with curiosity and gentleness, and striving for full awareness of the present moment.
Acceptance and commitment therapy (ACT): A mindfulness-based program that encourages clients to accept, rather than attempt to control or change, unpleasant sensations.
Anger management training: A social skills program designed for individuals who have trouble with aggressive behavior.
Antecedent events: Ones that cue or elicit a certain behavior.
Applied behavior analysis: Another term for behavior modification; this approach seeks to understand the causes of behavior and address these causes by changing antecedents and consequences.
Assessment interview: Questioning that enables the therapist to identify the particular antecedent and consequent events that influence or are functionally related to an individual’s behavior.
BASIC I.D.: The conceptual framework of multimodal therapy, based on the premise that human personality can be understood by assessing seven major areas of functioning: behavior, affective responses, sensations, images, cognitions, interpersonal relationships, and drugs/biological functions.
Behavior modification: A therapeutic approach that deals with analyzing and modifying human behavior.
Behavior rehearsal: A technique consisting of trying out in therapy new behaviors (performing target behaviors) that are to be used in everyday situations.
Behavior therapy: This approach refers to the application of diverse techniques and procedures, which are supported by empirical evidence.
Behavioral analysis: Identifying the maintaining conditions by systematically gathering information about situational antecedents, the dimensions of the problem behavior, and the consequences of the problem.
Behavioral assessment: A set of procedures used to get information that will guide the development of a tailor-made treatment plan for each client and help measure the effectiveness of treatment.
Classical conditioning: Also known as Pavlovian conditioning and respondent conditioning. A form of learning in which a neutral stimulus is repeatedly paired with a stimulus that naturally elicits a particular response. The result is that eventually the neutral stimulus alone elicits the response.
Cognitive behavior therapy (CBT): An approach that blends both cognitive and behavioral
Cognitive behavior therapy (CBT): An approach that blends both cognitive and behavioral methods to bring about change. (The term CBT has largely replaced the term “behavior therapy,” due to the increasing emphasis on the interaction among affective, behavioral, and cognitive dimensions).
Cognitive behavioral coping skills therapy: Procedures aimed at teaching clients specific skills to deal effectively with problematic situations.
Cognitive processes: Internal events such as thoughts, beliefs, perceptions, and self-statements.
Consequences: Events that take place as a result of a specific behavior being performed.
Contingency contracting: Written agreement between a client and another person that specifies the relationship between performing target behaviors and their consequences.
Dialectical behavior therapy (DBT): A blend of behavioral and psychoanalytic techniques aimed at treating borderline personality disorders; primarily developed by Marsha Linehan.
Evidence-based treatments: Therapeutic interventions that have empirical evidence to support their use.
Exposure therapies: Treatment for fears and other negative emotional responses by carefully exposing clients to situations or events contributing to such problems.
Extinction: When a previously reinforced behavior is no longer followed by the reinforcing consequences, the result is a decrease in the frequency of the behavior in the future.
Eye movement desensitization and reprocessing (EMDR): An exposure-based therapy that involves imaginal flooding, cognitive restructuring, and the use of rhythmic eye movements and other bilateral stimulation to treat traumatic stress disorders and fearful memories of clients.
Flooding: Prolonged and intensive in vivo or imaginal exposure to highly anxiety-evoking stimuli without the opportunity to avoid or escape from them.
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Functional assessment: The process of systematically generating information on the events preceding and following the behavior in an attempt to determine which antecedents and consequences are associated with the occurrence of the 97 behavior.
Interpersonal effectiveness: A process that involves learning to ask for what one needs and how to say “no” while maintaining self-respect and relationships with others.
In vivo desensitization: Brief and graduated exposure to an actual fear situation or event.
In vivo exposure: Involves client exposure to actual anxiety-evoking events rather than merely imagining these situations.
In vivo flooding: Intense and prolonged exposure to the actual anxiety-producing stimuli.
Mindfulness: A process that involves becoming increasingly observant and aware of external and internal stimuli in the present moment and adopting an open attitude toward accepting what is, rather than judging the current situation.
Mindfulness-based cognitive therapy (MBCT): A comprehensive integration of the principles and skills of mindfulness applied to the treatment of depression.
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Mindfulness-based stress reduction (MBSR): This program applies mindfulness techniques to coping with stress and promoting physical and psychological health.
Modeling: Learning through observation and imitation.
Multimodal therapy: A model endorsing technical eclecticism; uses procedures drawn from various sources without necessarily subscribing to the theories behind these techniques; developed by Arnold Lazarus.
Negative punishment: A reinforcing stimulus is removed following the behavior to decrease the frequency of a target behavior.
Negative reinforcement: The termination or withdrawal of an unpleasant stimulus as a result of performing some desired behavior.
Operant conditioning: A type of learning in which behaviors are influenced mainly by the consequences that follow them.
Positive punishment: An aversive stimulus is added after the behavior to decrease the frequency of a behavior.
Positive reinforcement: An individual receives something desirable as a consequence of his or her behavior; a reward that increases the probability of its recurrence. Progressive muscle relaxation: A method of teaching people to cope with the stresses produced by daily living. It is aimed at achieving muscle and mental relaxation and is easily learned.
Punishment: The process in which a behavior is followed by a consequence that results in a decrease in the future probability of a behavior.
Reinforcement: A specified event that strengthens the tendency for a response to be repeated. It involves some kind of reward or the removal of an aversive stimulus following a response.
Self-compassion: Being understanding toward ourselves when we suffer or fail rather than being self-critical.
Self-directed behavior: A basic assumption is that people are capable of self-directed behavior change and the person is the agent of change.
Self-efficacy: An individual’s belief or expectation that he or she can master a situation and bring about desired change.
Self-management: Strategies include teaching clients how to select realistic goals, how to translate these goals into 98 target behaviors, how to create an action plan for change, and ways to self-monitor and evaluate their actions.
Self-modification: A collection of cognitive behavioral strategies based on the idea that change can be brought about by teaching people to use coping skills in various problematic situations.
Self-monitoring: The process of observing one’s own behavior patterns as well as one’s interactions in various social situations.
Social effectiveness training (SET): A multifaceted treatment program designed to reduce social anxiety, improve interpersonal skills, and increase the range of enjoyable social activities.
Social learning approach (or social-cognitive approach): A perspective holding that behavior is best understood by taking into consideration the social conditions under which learning occurs; developed primarily by Albert Bandura.
Social skills training: A broad category of learning that deals with an individual’s ability to interact effectively with others in various social situations. A treatment package used to teach clients skills that include modeling, behavior rehearsal, and reinforcement.
Systematic desensitization: A procedure based on the principles of classical conditioning in which the client is taught to relax while imagining a graded series of progressively anxiety-arousing situations. Eventually, the client reaches a point at which the anxiety-producing stimulus no longer brings about the anxious response.
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Four Areas of Development
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1. Classical (or Respondent) Conditioning
Refers to what happens prior to learning that creates a response through pairing
2. Operant Conditioning
Focuses on a type of learning in which behaviors are influenced mainly by the consequences that follow them
Four Areas of Development
3. Social Learning (or Social-Cognitive) Approach
Gives prominence to the triadic reciprocal interaction between an individual’s behavior, personal factors, and the environment
4. Cognitive Behavior Therapy
Social skills training, cognitive therapy, stress management training, mindfulness, and acceptance-based practices all represent the cognitive behavioral tradition.
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Basic Characteristic and Assumptions
A set of clinical procedures relying on experimental findings of psychological research
Based on principles of learning that are systematically applied
Focus is on the client’s current problems and on assessing behavior through observation or self-monitoring.
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Basic Characteristic and Assumptions
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Largely action-oriented and educational—therapist teaches clients skills of self-management.
Behavior is something that can be operationally defined; it includes overt actions as well as internal processes.
Change can take place without insight into underlying dynamics and the origins of a psychological problem.
Basic Characteristic and Assumptions
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Behavioral treatment interventions are individually tailored to specific problems experienced by the client.
Behaviorists ask, “What treatment, by whom, is the most effective for this individual with that specific problem and under which set of circumstances?”
Therapeutic Goals
The general goals of behavior therapy are to increase personal choice and to create new conditions for learning.
Measure progress toward goals based on empirical validation.
Goals must be clear, concrete, understood, and agreed on by the client and the counselor.
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Therapist’s Function and Role
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Behavior therapists conduct a thorough functional assessment.
A-B-C model
Antecedent(s)—influenced by events that precede it
Behavior(s)—model of behavior
Consequence(s)—influenced by events that follow it
Client’s Experience in Therapy
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Therapist and client have the importance of client awareness and participation in the therapeutic process.
Teaching concrete skills through the provision of instructions, modeling, and performance feedback.
Clients are expected to do more than merely gather insights; they need to be willing to make changes.
Relationship Between Therapist and Client
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Recognized the role of the therapeutic relationship and therapist behavior as critical factors.
Experimental therapies emphasis on the nature of the engagement between counselor and client.
It helps the clients’ change in the direction they wish.
Applied Behavioral Analysis: Operant Conditioning Techniques
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Positive and negative reinforcement
Goal: to increase target behavior
Extinction
Goal: to decrease or eliminate a behavior by withholding reinforcement from a previously reinforced response
Positive and negative punishment
Goal: to decrease target behavior
Progressive Muscle Relaxation Let’s try one!
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Progressive muscle relaxation is a popular method of teaching people to cope with the stresses produced by daily living.
Relaxation becomes a well-learned response, which can become a habitual pattern if practiced daily.
Relaxation procedures have been applied to a variety of clinical problems ranging from chronic pain to panic disorder.
Systematic Desensitization
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Based on classical conditioning, systematic desensitization (SD) was developed by Joseph Wolpe.
SD is effective and efficient in reducing maladaptive anxiety and treating anxiety-related disorders, particularly specific phobias.
SD entails relaxation training, development of a graduated anxiety hierarchy, and presentation of hierarchy items while client is deeply relaxed.
In Vivo Exposure and Flooding
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In Vivo Desensitization
Involves client exposure to the actual anxiety-evoking events rather than simply imagining these situations
Flooding
In vivo or imaginal exposure to anxiety-evoking stimuli for a prolonged period of time without the feared consequences
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Eye Movement Desensitization and Reprocessing
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An exposure-based therapy
Involves imaginal flooding, cognitive restructuring, and the use of rhythmic eye movements and other bilateral stimulation to treat traumatic stress disorders
Extensive research has validated EMDR.
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Eye Movement Desensitization and Reprocessing
EMDR compresses three-pronged methodology to identify and process:
memories of past adverse life experiences that underlie present problems
current situations that elicit disturbance
needed skills that will provide positive memory templates to guide the client’s future behavior
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Social Skills Training
Helps clients develop and achieve skills in interpersonal competence.
May involve behavioral techniques (e.g., psychoeducation, modeling, behavior rehearsal, and feedback).
If clients can correct their problematic behaviors in practice situations, they can then apply these new skills in daily life.
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Self-Management Programs and Self-Directed Behavior
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In S-M programs, people make decisions concerning specific behaviors they want to control or change.
The process includes selecting goals, translating goals into target behaviors, self-monitoring, working out a plan for change, and evaluating an action plan.
S-M strategies have been successfully applied to many populations and problems.
Multimodal Therapy: Clinical Behavior Therapy
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A comprehensive, systematic, holistic approach to behavior therapy developed by Arnold Lazarus.
Grounded in social-cognitive learning theory.
Applies diverse behavioral techniques to a wide range of problems; that encourages technical eclecticism.
Mindfulness and Acceptance -Based Approaches
Emphasizes limits for behavioral therapists include mindfulness, acceptance, the therapeutic relationship, spirituality, and values.
The five interrelated core themes follow:
Psychological health
Acceptable outcomes in therapy
Acceptance
Mindfulness
Creating a life worth living
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Mindfulness and Acceptance - Based Approaches
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Mindfulness is “the awareness that emerges through having attention on purpose, in the present moment.”
Acceptance is a process involving receiving one’s present experience without judgment or preference.
Four major approaches:
Dialectical behavior therapy
Mindfulness-based stress reduction
Mindfulness-based cognitive therapy
Acceptance and commitment therapy
Multimodal Therapy: BASIC ID
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The complex personality of human beings can be divided into seven major areas of functioning:
B = behavior
A = affective responses
S = sensations
I = images
C = cognitions
I = interpersonal relationships
D = drugs, biological functions, nutrition, and exercise
Dialectical Behavior Therapy
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A promising blend of behavioral and psychoanalytic techniques for treating borderline personality disorders and other issues
Includes both acceptance-oriented and change-oriented strategies
Skills are taught in four modules: mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance.
Mindfulness-Based Stress Reduction (MBSR)
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MBSR is not a form of psychotherapy per se, but it can be an adjunct to therapy.
MBSR assists people in learning to live more fully in the present.
The skills taught in MBSR include sitting meditation and mindful yoga, aimed at cultivating mindfulness.
MBSR programs are offered in hospitals, clinics, schools, workplaces, offices, law schools, prisons, and health centers.
Mindfulness-Based Cognitive Therapy (MBCT)
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An eight-week group treatment program of two-hour weekly sessions adapted from MBSR that includes components of cognitive behavior therapy (CBT).
Clients learn to respond in skillful and intentional ways to their automatic negative thought patterns.
Kindness and self-compassion are essential components of MBCT.
Acceptance and Commitment Therapy (ACT)
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ACT involves fully accepting present experience and mindfully letting go of obstacles.
There is little emphasis on changing the content of a client’s thoughts. Instead, the emphasis is on acceptance (nonjudgmental awareness) of cognitions.
ACT uses acceptance and mindfulness strategy to increase psychological flexibility.
Application to Group Counseling
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Rely on empirical support and tend to be brief
Emphasize self-management skills and thought restructuring
The specific unique characteristics include the following:
Conducting a behavioral assessment
Spelling out collaborative treatment goals
Formulating specific procedure appropriate to a particular problem
Evaluating the outcomes of therapy
Application to Group Counseling
The four approaches applied to the practice of behavioral groups follow:
Social skills training groups
Psychoeducational groups with specific themes
Stress management groups
Mindfulness and acceptance-based behavior therapy in groups
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Strengths From a Diversity Perspective
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Behavior therapy may appeal to culturally diverse clients for many reasons.
Behavior therapy emphasizes on brief interventions, teaching coping strategies, and problem-solving orientation.
Behavior therapy focuses on environmental, social, and political conditions that contribute to a client’s problems.
Shortcomings From a Diversity Perspective
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Some counselors may use a variety of techniques in narrowly treating specific behavioral problems.
Therapists who do not assess the interpersonal and cultural dimensions of the client’s problem may not adequately prepare him or her for the consequences of newly acquired social skills.
Contributions of Behavior Therapy
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The specificity of the behavioral approaches helps clients translate unclear goals into concrete plans of action.
A wide variety of specific behavioral techniques have been developed.
Behavioral interventions have been subjected to more rigorous evaluation than other approaches.
Behavior therapy emphasizes ethical accountability.
Limitations and Criticisms of Behavior Therapy
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Heavy focus on behavioral change may detract from client’s experience of emotions.
Some counselors believe the therapist’s role as a teacher deemphasizes the important relational factors in the client–therapist relationship.
Behavior therapy does not provide insight.
Limitations and Criticisms of Behavior Therapy
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Behavior therapists emphasize changing current environmental circumstances to change behavior.
Behavior therapy recognizes the importance of making the social influence process explicit, and it emphasizes client-oriented behavioral goals.
Therapy progress is continually assessed and treatment is modified to ensure that the client’s goals.
