CHAPTER 9 Behavior Therapy
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.
Four Areas of Development
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
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.
Basic Characteristic and Assumptions
A set of clinical procedures relying on experimental findings of psychological research
oBased on principles of learning that are systematically applied
oFocus is on the client’s current problems and on assessing behavior through observation or self-
monitoring.
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.
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.
Therapist’s Function and Role
Behavior therapists conduct a thorough functional assessment.
A-B-C model
oAntecedent(s)—influenced by events that precede it
oBehavior(s)—model of behavior
oConsequence(s)—influenced by events that follow it
Client’s Experience in Therapy
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 Client and Therapist
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
Positive and negative reinforcement
oGoal: to increase target behavior
Extinction
oGoal: to decrease or eliminate a behavior by withholding reinforcement from a previously
reinforced response
Positive and negative punishment
oGoal: to decrease target behavior
Progressive Muscle Relaxation
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
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
In Vivo Desensitization
oInvolves client exposure to the actual anxiety-evoking events rather than simply imagining these
situations
Flooding
oIn vivo or imaginal exposure to anxiety-evoking stimuli for a prolonged period of time without
the feared consequences
Eye Movement Desensitization and Reprocessing
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.
EMDR compresses three-pronged methodology to identify and process:
omemories of past adverse life experiences that underlie present problems
ocurrent situations that elicit disturbance
oneeded skills that will provide positive memory templates to guide the client’s future behavior
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.
Self-Management Programs and Self-Directed Behavior
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 Behavioral Therapy
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.
oThe five interrelated core themes follow:
Psychological health
Acceptable outcomes in therapy
Acceptance
Mindfulness
Creating a life worth living
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:
oDialectical behavior therapy
oMindfulness-based stress reduction
oMindfulness-based cognitive therapy
oAcceptance and commitment therapy
Multimodal Therapy: BASIC ID
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 Behavioral Therapy
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)
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)
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)
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
Rely on empirical support and tend to be brief
Emphasize self-management skills and thought restructuring
oThe 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
The four approaches applied to the practice of behavioral groups follow:
oSocial skills training groups
oPsychoeducational groups with specific themes
oStress management groups
oMindfulness and acceptance-based behavior therapy in groups
Strengths From a Diversity Perspective
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
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
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
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.
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.
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