Behavior Therapy (Chapter 9) A set of clinical procedures relying on experimental findings of psychological BEHAVIORAL research Based on principles of learning that are THERAPY systematically applied Psychology 460 Treatment goals are specific and measurable Focusing on the client’s current problems Counseling and Interviewing To help people change maladaptive to adaptive Sheila K. Grant, Ph.D. behaviors The therapy is largely educational - teaching clients skills of self-management 1 2 Exposure Therapies Four Aspects of Behavior Therapy In Vivo Desensitization Brief and graduated exposure to an actual fear 1. Classical Conditioning situation or event In classical conditioning certain respondent behaviors, such Flooding as knee jerks and salivation, are elicited from a passive Prolonged & intensive in vivo or imaginal exposure organism to highly anxiety-evoking stimuli without the 2. Operant Conditioning opportunity to avoid them Focuses on actions that operate on the environment to Eye Movement Desensitization and Reprocessing produce consequences (EMDR) If the environmental change brought about by the An exposure-based therapy that involves imaginal behavior is reinforcing, the chances are strengthened that flooding, cognitive restructuring, and the use of the behavior will occur again rhythmic eye movements and other bilateral If the environmental changes produce no reinforcement, stimulation to treat traumatic stress disorders and 3 the chances are lessened that the behavior will recur 4 fearful memories of clients Four Aspects of Behavior Therapy Blurring the Line 3. Social Learning Approach In broadest sense, behavior therapy “refers to practice based primarily on social cognitive theory & Gives prominence to the reciprocal interactions between an individual’s behavior and the encompasses a range of cognitive principles & environment procedures” (Wilson, 2000) 4. Cognitive Behavior Therapy Current behavior therapy tends to be integrated with cognitive therapy; often referred to as cognitive Emphasizes cognitive processes and private events behavior therapy (such as client’s self-talk) as mediators of behavior Ch. 9 deals mainly with applied aspects of behavior change therapy Ch. 10 will cover cognitive-behavioral approaches 5 6 1 Bridges Are Being Built Bridges Are Being Built Modern behavior therapy grounded on Current trend is toward developing procedures scientific view of human behavior that actually give control to clients & thus increase their skills so that they have more Does not rest, however, on a deterministic options for responding assumption that we humans are mere products Be overcoming debilitating behaviors that of our sociocultural conditioning restrict choices, people are freer to select from Instead, current perspective is that we are both possibilities that were not available earlier the producer and the product of our Therefore, behavior therapy can increase environment individual freedom 7 8 10 Key Characteristics of Behavior 10 Key Characteristics of Behavior Therapy Therapy 1. Based on principles & procedures of 4. Emphasizes teaching clients skills of self- scientific method management, with expectation they’re 2. Deals with client’s current problems (as responsible for transferring what’s learned in opposed to analysis of historical determinants) office to everyday lives & factors influencing them & factors that can 5. Focus on assessing overt & covert behaviors be used to modify performance directly, identifying problem, & evaluating 3. Clients expected to assume an active role by change engaging specific actions to deal with their 6. Emphasizes a self-control approach in problems which clients learn self-management strategies 9 10 10 Key Characteristics of Behavior 10 Key Characteristics of Behavior Therapy Therapy 7. Interventions individually tailored to specific 9. Emphasis on practical application problems Interventions applied to ALL facets of daily life in “What treatment, by whom, is the most effective for which this individual with that specific problem & under maladaptive behaviors are to be deceased & which set of circumstances?” (Paul, 1967) adaptive behaviors are to be increased 8. Based on collaborative partnership between 10. Therapists strive to therapist & client (clients informed about nature develop culture-specific procedures & & course of Rx) obtain clients’ adherence & cooperation 11 12 2 Therapeutic Goals Therapist’s Function & Role Goals occupy central importance Active & directive General goals are To increase personal choice & Consultants & problem-solvers To create new conditions for leaning Pay attention to clues presented by client Client, with help of therapist, defines specific goals at outset of therapeutic process Follow their clinical hunches Once goals are agreed upon, a process of defining Use some techniques common to other begins approaches ( e.g., summarizing, reflection, Counselor & client discuss the behaviors associated with goals, the circumstances required for change, the nature of clarification, & open-ended questioning) subgoals, to reconsider client’s initial goals, or to seek services of another practitioner Role-modeling for the client 13 14 Therapeutic Techniques Therapeutic Techniques Relaxation Training – to cope with stress Relaxation Training – to cope with stress Aimed at achieving muscle & mental relaxation & is easily Systematic Desensitization – for anxiety and learned avoidance reactions After learning, it is essential that clients practice exercises daily to obtain maximum results Modeling – observational learning Jacobson (1938) credited with initially developing the progressive relaxation procedure Assertion Training – social-skills training Since it has been refined & modified, & frequently used in combination with a number of other behavioral techniques Self-Management Programs – “giving Systematic desensitization psychology away” Assertion training Self-management programs Multimodal Therapy – a technical eclecticism Audiotape recordings of guided relaxation procedures, computer simulation programs, biofeedback-induced relaxation, hypnosis, 15 meditation 16 Therapeutic Techniques Therapeutic Techniques Systematic Desensitization – for anxiety and Modeling – observational learning avoidance reactions Having client observe therapist, others in group, of Developed by Joseph Wolpe (one of pioneers of behavior videotaped ‘models’ or self therapy) Very powerful technique, especially for clients Clients imagine successively more anxiety-arousing situations at the same time that they engage in a behavior with severe skills deficits that competes with anxiety (I.e., relaxation) Gradually (systematically) clients become less sensitive (desensitized) to the anxiety-arousing situation This procedure can be considered a form of exposure therapy because clients are required to expose themselves to anxiety-arousing images as a way to reduce anxiety 17 18 3 Therapeutic Techniques Therapeutic Techniques Assertion Training – social-skills training Can be useful for those Self-Management Programs – “giving Who cannot express anger or irritation psychology away” Who have difficulty saying no Psychologists who share their knowledge to so that Who are overly polite & allow others to take advantage of them “consumers” can increasing lead self-directed lives & Who find it difficult to express affection & other positive responses not be dependent on experts to deal with their problems Who feel they do not have a right to express their thoughts, beliefs, & feelings Basic steps of a self-management program (Watson & Who have social phobia Tharp, 2002): Basic assumption is that people have the right (not the obligation) Selecting realistic goals to express themselves Translating goals into target behavior Goals Self-monitoring to increase people’s behavioral repertoire so that they can make the choice Working out a plan for change of whether to behave assertively in certain situations Evaluating an action plan To teach people to express themselves in ways that reflect sensitivity to the feelings & rights of others (assertion d/n = aggression) 19 20 Therapeutic Techniques Therapeutic Techniques B = Behavior Multimodal Therapy – a technical eclecticism Refers primarily to overt behaviors, including acts, habits, & Grounded in social learning and cognitive theory reactions that are observable & measurable The BASIC I.D. - essence of approach is premise that the What would you like to change? complex personality of human beings can be divided into What specific behaviors keep you from getting what you want? 7 major areas of functioning: A = Affective responses B = behavior Refers to emotions, moods, & strong feelings A = affective responses What emotions are problematic for you? S = sensations S = Sensations I = images Refers to 5 basic senses (touch, taste, smell, sight & hearing) C = cognitions Do you suffer from unpleasant sensations e.g., pains, aches, dizziness etc.? I = interpersonal relationships I = Images D = drugs, biological functions, nutrition, & exercise Refers to ways we picture ourselves (including memories, dreams & 21 fantasies) 22 How do you view your body? Contributions to Therapeutic Techniques Multicultural Counseling C = Cognitions Refers to insights, philosophies, ideas, opinions, self-talk, & judgments that Clear advantages: constitute basic values, attitudes, & beliefs How do your thoughts affect your