Behavior Therapy

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Behavior Therapy

• A set of clinical procedures relying on
  experimental findings of psychological research
• Based on principles of learning that are
  systematically applied
• Treatment goals are specific and measurable
• Focusing on the clients current problems
• To help people change maladaptive to adaptive
  behaviors
• The therapy is largely educational - teaching
  clients skills of self-management

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Basic Characteristics of all Behavior Therapy

• Practical
• Symptoms seen as problems in living
• Empirically derived
• Requires patient collaboration
• Acknowledges underlying precursors of symptoms,
  but focuses on the present
• Sees behavior (normal and abnormal) as learned
• Treatment driven by functional analysis of
  behavior (ABCs)

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Other Key Contrasts of Behavior Therapy Compared
to Other Systems

• Can include family systems when appropriate
• Does not create symptom substitution
• More broadly applicable than most therapies
• Empirical studies generally show it to be more
  effective than verbal therapies
• Treatment of choice for phobias, OCD, sexual
  dysfunction and many childhood disorders

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Ways Behavior Therapy Meets the Needs of Children
and Adolescents

• Practical, here and now, experiential emphasis
• Techniques can be adapted to meet the
  developmental level of the patient
• Action oriented which matches fact that children
  learn by doing
• Incorporates rewards which helps engage the
  patient

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The History of Behavior Therapy

• Rise of behaviorism in 1900s as espoused by
  Watson
• Ivan Pavlovs research
• E.L. Thorndikes studies
• Joseph Wolpes systematic
• desensitization
• Eysencks description of
• BT as applied science
• Skinners operant conditioning paradigms
• Banduras social learning theories

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Four Aspects of Behavior Therapy

• 1. Classical Conditioning
• In classical conditioning certain respondent
  behaviors, such as knee jerks and salivation, are
  elicited from a passive organism
• 2. Operant Conditioning
• Focuses on actions that operate on the
  environment to produce consequences
• If the environmental change brought about by the
  behavior is reinforcing, the chances are
  strengthened that the behavior will occur again.
• If the environmental changes produce no
  reinforcement, the chances are lessened that the
  behavior will recur

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Four Aspects of Behavior Therapy

• 3. Social Learning Approach
• Gives prominence to the reciprocal interactions
  between an individuals behavior and the
  environment
• 4. Cognitive Behavior Therapy
• Emphasizes cognitive processes and private events
  (such as clients self-talk) as mediators of
  behavior change

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Basic Principles of Learning
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Learning

• A relatively permanent change in behavior, not
  due to fatigue, drugs, or maturation

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Classical ConditioningPavlovs Study

• Food is presented to the dog and the dog
  salivates No learning involved
• A neutral stimulus is presented to the dog (a
  tone) The dog does not salivate

• The tone is presented simultaneously with the
  food The dog salivates
• Then, the tone is presented alone and the dog
  salivates Learning has occurred

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Classical Conditioning

• UCS UCR
• Unconditional Stimulus----gt Unconditioned
  Response
• (sight of food)
  (salivation)
• CS
  CR
• Conditioned Stimulus-------gt Conditioned
  Response
• (tone)
  (salivation)

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Why would a dog salivate to a Bell?

• The UCS and CS are repeatedly paired together
  until the UCR is elicited by the CS
• In other words , the CS elicits the same behavior
  which is now termed the CR

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Would the dog salivate to other sounds?

• Maybe
• If Stimulus Generalization occurs the dog might
  respond to related stimuli with the same or
  similar response
• If Stimulus Discrimination occurs the dog might
  not respond

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Extinction

• After learning has occurred, removing the UCS
  ultimately results in a decreased probability
  that the CR will be made
• This is because the dog learns that the bell no
  longer means food will follow

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Spontaneous Recovery

• After a time delay if the stimulus is represented
  the CR will reoccur
• This behavior will extinguish rapidly if the UCS
  does not follow quickly

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How is This Related to Mental Health?

• Important in acquisition of physiological
  responses, esp. maladaptive ones
• Relaxation response to nicotine use
• Eating paired with stimuli that are not hunger
  related
• Acquisition of phobias such as fainting at the
  sight of blood

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Operant or Instrumental Conditioning (B.F.
Skinner)

• A response is emitted, perhaps randomly at first,
  and results in consequences
• Hence, the probability of the responses future
  occurrence is changed

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Reinforcement

• A reinforcer is defined by its effects
• Any stimulus is a reinforcer if it increases the
  probability of a response

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• Punishment
• A punisher is defined by its effects
• Any stimulus is a punisher if it decreases the
  probability of a response

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Helpful Hint

• Remember in behavioral terms positive and
  negative are used differently than in general
  language
• Positive Add
• Negative Take Away

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Operant Learning

• Add Stimulus Remove Stimulus

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Continuous Reinforcement

• Every response is followed by a reinforcement,
  resulting in fast learning (acquisition) but also
  resulting in fast extinction

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Intermittent (or partial) reinforcement

• Not every response is reinforced but this yields
  a stronger response ultimately

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Fixed ratio schedule

• Delivers reinforcement after a fixed number of
  responses and produces high response rate
• Example Commission Work

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Fixed interval schedule

• Reinforces the next response which occurs after a
  fixed period of time elapses
• Example
• Scheduled Exam

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Variable interval schedule

• Deliver reinforcements after unpredictable time
  periods
• Example Pop Quizzes or Fishing

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Variable ratio schedule

• Yields the highest rates of response and greatest
  resistance to extinction
• Example
• Gambling

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Behavioral Effect of the Reinforcement Schedules

• Schedule Effect
• Fixed Ratio Relatively Fast Rate of Response
• Fixed Interval Response Rate Drops to Almost
• Zero After Reward Picks Up Rapidly
  Before Next Reward
• Variable Interval Slow Steady Response
• Variable Ratio Constant High Rate of
  Response May be Hardest Behavior to Break

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Applied Behavior Analysis

• Extension of Skinners radical behaviorism
• Cognition is ignored
• Focus is on overt behavior
• To alter behavior one attempts to alter the
  relationship between behavior and consequences

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Social-Cognitive Theory

• Initially espoused by Albert Bandura
• Recognizes the interconnection between stimulus,
  reinforcement and cognition
• Sees the critical role of vicarious learning,
  cognitions, self regulation and expectations
• Person is seen as the agent for change
• Self efficacy seen as a critical variable

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Exposure Therapies

• In Vivo Desensitization
• Brief and graduated exposure to an actual fear
  situation or event
• Flooding
• Prolonged intensive in vivo or imaginal
  exposure to highly anxiety-evoking stimuli
  without the opportunity to avoid them
• 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

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Therapeutic Techniques

• Relaxation Training to cope with stress
• Systematic Desensitization for anxiety and
  avoidance reactions
• Modeling observational learning
• Assertion Training social-skills training
• Self-Management Programs giving psychology
  away
• Multimodal Therapy a technical eclecticism

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Sample Functional Analysis
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Psychotherapy Process

• Establish Target Behaviors to Change
• Behaviors to Increase and to Decrease
• Behaviors Should be Small, Discrete, and Chosen
  Based on Severity, Immediacy, Centrality and
  Potential for Success
• Develop a Behavioral Contract with Goals and
  Rewards
• Problem Solve about Possible Obstacles
• Periodically Reevaluate

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Sample Behavior Therapy Treatment Techniques
(Non-Relaxation Based)

• Role Playing
• Physiological Monitoring
• Self Monitoring
• Behavioral Observation
• Cognitive Restructuring
• Assertiveness Training
• Social Skills Training
• Self Control Techniques

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Sample Behavior Therapy Treatment
Techniques (Relaxation Based)
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Required Elements for the Relaxation Response

• 1. A quiet, calm environment with as few
  distractions as possible
• 2. A mental device to prevent mind-wandering
• 3. A passive, let-it-happen attitude
• 4. A comfortable position to prevent muscular
  tension

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Relaxation Techniques

• Diaphragmatic Breathing
• Breath-Focusing Exercises
• Mini-Relaxations
• Mind Focusing
• Coupling Breathing and Imagination
• Progressive Muscle Relaxation
• Repetitive Motion
• Self Hypnosis
• Visualization

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Breathing Awareness

• Close your eyes. Put your right hand on your
  abdomen, right at the waistline, and put your
  left hand on your chest, right in the center.
• Without trying to change your breathing, simply
  notice how you are breathing. Which hand rises
  the most as you inhale the hand on your chest
  or the hand on your belly?
• If your chest moves up and down with each
  breath, you need to learn how to breathe from
  your diaphragm (abdomen).

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How to Practice Diaphragmatic Breathing

• Find a comfortable place to sit or lie on your
  back.
• Place your hands just below your belly button.
• Close your eyes and imagine a balloon inside your
  abdomen. Visualize the balloon, what color is it?
• Each time you breathe in, imagine the balloon
  filling up with air.
• Each time you breathe out, imagine the balloon
  collapsing.

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Breath Counting

• Sit or lie in a comfortable position with your
  arms and legs uncrossed and your spine straight.
• Breathe in deeply into your abdomen. Let yourself
  pause before you exhale.
• As you exhale, count one to yourself. As you
  continue to inhale and exhale count each
  exhalation two.threefour.
• Continue counting your exhalations in sets of
  four for five to ten minutes.
• Notice your breathing gradually slowing, your
  body relaxing, and your mind calming as you
  practice this breathing meditation.

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Relaxing Sigh

• Sit or stand up straight.
• Sigh deeply, letting out a sound of deep relief
  as the air rushes out of your lungs.
• Dont think about inhaling, just let the air come
  in naturally.
• Take eight to twelve of these relaxing sighs and
  let yourself experience the feeling of
  relaxation. Repeat whenever you feel the need for
  it.

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Letting Go of Tension

• Sit comfortably in a chair with your feet on the
  floor.
• Breathe in deeply into your abdomen and say to
  yourself, Breathe in relaxation. Let yourself
  pause before you exhale.
• Breathe out from your abdomen and say to
  yourself, Breathe out tension. Pause before you
  inhale.
• Use each inhalation as a moment to become aware
  of any tension in your body.
• Use each exhalation as an opportunity to let go
  of tension.
• You may find it helpful to use your imagination
  to picture or feel the relaxation entering and
  the tension leaving your body.

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Progressive Muscle Relaxation

• Developed in 1929 by Edmund Jacobson, a Chicago
  physician, PMR is based on the premise that the
  body responds to anxiety-provoking thoughts and
  events with muscle tension
• This tension then increases the subjective
  experience of anxiety
• Deep muscle relaxation reduces physiological
  tension and is incompatible with anxiety
• Each muscle or muscle group is tensed from 5-10
  seconds and then relaxed for 20-30 seconds

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Visualization

• Loosen your clothing, lie down in a quiet place,
  and close your eyes.
• Scan your body, seeking tension in specific
  muscles, relaxing as much as you can.
• Form mental sense impressions. Imagine not only
  walking on the beach but the sound of the ocean
  and the feel of the sand on your feet.
• Use affirmations. Repeat positive statements such
  as I am letting go of tension.
• Practice is easiest in the morning and night
  while lying in bed.

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Some Areas Where Behavior Therapy Has Proven
Efficacy

• Anxiety Disorders
• Phobias, Panic Disorder, OCD
• Sexual Disorders
• Depression
• Marital Problems
• Behavioral Medicine
• Childhood Disorders
• Behavioral Problems, Hyperactivity, Autism,
  Enuresis
• Eating Disorders and Obesity
• Bulimia Nervosa and Binge Eating Disorder