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Behavior Therapy Behavior Therapy By- Sweta Pathak INTRODUCTION • Therapy -Treatment intended to relieve or heal a disorder: "cancer therapies". 0R • The treatment of mental or psychological disorders by psychological means: like- "he is currently in therapy"; "therapy sessions". • Psychotherapy -The treatment of mental disorder by psychological rather than medical means Behaviour therapy Behavior therapy (BT) is based on behaviorism utilizes a philosophy of naturalism and the spirit of logical positivism. Behaviorism is a reaction to psychodynamic thought and philosophy, particularly to its introspection and its hypothesized inner, human realities such as drives, instincts, ego, id, superego, repression etc. Like Freudian psychoanalysis, behaviorism is Darwinian in outlook. A major assumption of this- Abnormal behavior is acquired in the same way as normal behavior-that is by learning. Techniques of BT Guided exposure therapy-is intended to treat anxiety disorders and involves the exposure to the feared object or context without any danger in order to overcome their anxiety. Or It involves presenting the person with a harmless but fear evoking stimuli until the stimuli no longer elicit fear. Exposure is a form of therapy commonly used in treating phobias and other anxiety disorders. Exposure-based therapy may be effective in preventing the progression from acute stress disorder to post-traumatic stress disorder. During exposure therapy, the person is presented with a fear-evoking stimuli in a controlled, prolonged fashion, until the fear diminishes. Treatment is collaborative, with the patient and therapist working together to decide how and when exposure will take place. Exposure duration depends upon – the type of feared stimuli and the severity of the person’s fears. Typically, an exposure session lasts 20 to 90 minutes, and sessions are repeated until the fear is eliminated. Sessions may be either therapist-assisted or may be completed by the patient as a form of homework assignment. Ways that exposure can be conducted- real stimuli simply imagine the stimuli. intensely fear-evoking stimuli, or gradual, working up a hierarchy of feared stimuli. These 2 dimensions- real Vs imaginable and intense Vs gradual, form the four basic exposure techniques: flooding, implosion, graded in vivo exposure, and systematic desensitization. Basic exposure techniques: Flooding Implosion Flooding involves intense exposure to real Implosion similarly involves exposing the stimuli. person to intensely fear-evoking stimuli, The advantage of flooding is that it rapidly but in this case the stimuli are imagined. reduces phobias. Often used in the treatment of Four 2-hour sessions are often all that is posttraumatic stress disorder, where the goal is required. to reduce the fear and associated distress Disadvantages- associated with traumatic memories. flooding requires the person to tolerate a Can lead to reductions in re experiencing great deal of distress. symptoms (e.g., nightmares, flashbacks), flooding can produce temporary but intense hyper arousal symptoms (e.g., irritability, side effects such as irritability and increased startle response), and avoidance nightmares. and numbing symptoms (e.g., avoidance of reminders of the traumatic event). Third, flooding is often too difficult for patients to conduct alone, and so this form It enables the patient to overcome fears for of treatment does not teach patients a skill which live exposure is impossible or that they can readily use on their own. impractical. Eg- Fear of thunderstorms. Required- when there is some pressing need for the person to rapidly overcome his or her fears. Graded in vivo exposure Systematic desensitization First, the patient is instructed how Systematic desensitization to rate his or her fear using a consists of gradual, imaginal Subjective Units of Distress Scale exposure to stimuli organized (SUDS). on a hierarchy. This measure of fear and distress ranges from 0 to 100, where 0 = none, 50 = moderate, and 100 = extreme. Second, the therapist and patient devise a hierarchy of real fear- evoking stimuli, ranging from stimuli that evoke little or no fear or distress, through to extremely frightening or upsetting stimuli Systematic desensitization is developed by Joseph Wolpe for the treatment of fear- and anxiety-related disorders, includes three basic procedural elements. 1. Relaxation training-The patient is taught to relax his or her voluntary musculature using a procedure known as progressive relaxation training(technique for learning to control the state of tension in ones muscles. It was developed by American physician). 2. Anxiety hierarchy -Concurrently the patient and therapist develop detailed descriptions of realistic encounters with the objects and/or events that provoke fear or anxiety, and arrange those descriptions in order of fearsomeness. 3. Desensitization proper- Finally the patient is guided to visualize the scene descriptions in increasingly fearsome order while taking care to maintain a relaxed muscular state. In addition, treatment based on systematic desensitization often entails encouragement to rehearse the targeted encounters in real life after they have been visualized calmly. Ordered from least to most anxiety provoking. Desensitization Proper In this procedure, events Get client in a relaxed state which cause anxiety are recalled in imagination, and Present first item on hierarchy then a relaxation technique is used to dissipate the anxiety. With sufficient repetition If no anxiety is signaled, present item a second time. After two presentations without anxiety through practice, the move to next item imagined event loses its anxiety-provoking power. At the end of training, when you If anxiety is signaled, return to relaxation. actually face the real event, Present item again. If anxiety still occurs go you will find that it too, just back to earlier step or reconstruct hierarchy. like the imagined event, has lost its power to make you Continue up the hierarchy until all items can anxious. be imagined without anxiety Relaxation Training Usually the training is done according to the ―progressive relaxation‖ techniques that were developed by Edmund Jacobson during the 1930s. The first step a subdivision of the skeletal musculature into a number of muscle groups, usually 16; in relaxation proper is to demonstrate various exercises that will be used, exercises that create observable tension in several groups of muscles. The second step is to encourage the patient to seek clarification/ importance of exercises and, as needed, to repeat one or more of the demonstrations. In the third step the therapist reads the relaxation transcript with a few points in mind: (1) A training ―trial‖ for a muscle group is a tension-relaxation cycle. After instructions for tensing a specific muscle group have been read, 10 seconds or so are allowed for maintaining the tension. At that time instructions for relaxing or ―letting go‖ are read, after which another 20 seconds or so are allowed for relaxing and for attending to feedback differences from tense versus relaxed muscles. (2) Each muscle group is used for at least two consecutive trials. (3) The muscle tension should be easily observable but not extreme. Hierarchy Construction Relaxation training usually takes from five to seven sessions. Behavioral assessment will have provided the information necessary to begin hierarchy construction, In which a complete and detailed listing of the various cue-stimuli for fear are made. Types of desensitization hierarchies- spatiotemporal hierarchies- increasing the fearsomeness of successive scenarios is accomplished by decreasing the times and/or distances (in phobic) that separate the patient from targeted encounter. thematic hierarchies- increasing the fearsomeness of successive scenarios is accomplished by increasing the clarity or fatal(danger level) with which the scenario captures the fearsome theme & Items on the hierarchy share a basic theme. Systematic Desensitization Performed in two ways. ―orthodox‖ procedure- the patient is first exposed to abbreviated relaxation training by using fewer than 16 muscles groups. Then patient visualize for 10 to 15 seconds the least aversive hierarchy scenario and signal by elevating an index finger if the visualization is accompanied by discomfort or fear. After successful visualization then a 30 to 60 second period for relaxing follows and the next scenario on the hierarchy is presented for visualization. This process is repeated again and again as progressively more fearsome scenarios are visualized. What if patient feel fear in visualization?????????? Then he or she is instructed to stop visualizing and relax. After time for relaxation the scenario is visualized again. If the fear signal recurs, then the therapist repeats the previously desensitized scenario and, after relaxation, repeats the troublesome scene. If the patient still signals the presence of fear. Then the therapist and patient construct , on the spot, a new scenario that stands between the troublesome scenario and the last one that was successfully negotiated. Example A-Spatial-temporal hierarchy A temporal hierarchy for a public speaking phobia: Someone asks you to give a speech in two months Writing the speech a month before Rehearsing the speech a week before The morning of the speech Reciting the speech while dressing Approaching the auditorium Walking up to the podium Giving the speech B- A spatial hierarchy for a
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