Behavior Therapy Chapter 9

Behavior Therapy Basic Assumptions Basic Assumptions Overt behavior holds primacy Overt behavior holds primacy Maladaptive behavior is learned in the same way as adaptive behavior Maladaptive behavior is learned in the same way as adaptive behavior Assessment and evaluation is key Assessment and evaluation is key Treatment is active, directive and collaborative Treatment is active, directive and collaborative

Behavior Therapy Based on the principles and procedures of the scientific method Based on the principles and procedures of the scientific method Learning new behaviors is the core of the therapy Learning new behaviors is the core of the therapy Interventions tailored to fit individual needs Interventions tailored to fit individual needs Therapy deals with client’s current problems and the factors influencing them Therapy deals with client’s current problems and the factors influencing them Does not deal with historical determinants Does not deal with historical determinants Treatment goals are stated in concrete and objective terms Treatment goals are stated in concrete and objective terms Conclusions are made based on what is observed Conclusions are made based on what is observed Therapy is a collaboration between therapist and client Therapy is a collaboration between therapist and client Clients are expected to be active Clients are expected to be active Clients ‘do something’ to bring about a change: engage in new behaviors Clients ‘do something’ to bring about a change: engage in new behaviors Interventions are monitored and frequently revised Interventions are monitored and frequently revised Clients monitor their behavior outside of sessions, learn coping skills, role-playing Clients monitor their behavior outside of sessions, learn coping skills, role-playing Several behavioral techniques are often combined in a treatment package to increase efficacy of treatment Several behavioral techniques are often combined in a treatment package to increase efficacy of treatment

Behavior Therapy Behavior therapy does not provide insight Behavior therapy does not provide insight Behavior therapists treat symptoms rather than causes Behavior therapists treat symptoms rather than causes Therapy involves control and manipulation by the therapist Therapy involves control and manipulation by the therapist Therapists use empirically supported techniques Therapists use empirically supported techniques Treatment is as brief as possible Treatment is as brief as possible

Behavior Therapy Therapists are willing to examine the effectiveness of their procedures in terms of generalizability and durability of change Therapists are willing to examine the effectiveness of their procedures in terms of generalizability and durability of change Therapists are ethical in their practice Therapists are ethical in their practice Clients have control and freedom Clients have control and freedom Clients can monitor and manage their interventions Clients can monitor and manage their interventions

Behavior Therapy: Therapeutic Relationship Varies Varies Between psychoanalysis and person- centered on Between psychoanalysis and person- centered on Genuineness Genuineness Empathy Empathy Warmth Warmth Positive regard not as important Positive regard not as important Positive expectancy and credibility very important Positive expectancy and credibility very important

Behavior Therapy: The 3 Cs Counterconditioning Counterconditioning Joseph Wolpe Joseph Wolpe Contingency Management Contingency Management B.F. Skinner B.F. Skinner Cognitive-Behavior Modification Cognitive-Behavior Modification Donald Meichenbaum Donald Meichenbaum

Chapter 9Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Counterconditioning Also known as reciprocal inhibition Also known as reciprocal inhibition Based on respondent conditioning Based on respondent conditioning Follows directly from the work of Pavlov Follows directly from the work of Pavlov UCSNS/CS UCR/CR

Counterconditioning Psychopathology Psychopathology Conditioned Anxiety (i.e. respondent conditioning) Conditioned Anxiety (i.e. respondent conditioning) Anxiety is a response of sympathetic nervous system Anxiety is a response of sympathetic nervous system Anxiety can be conditioned to any stimuli Anxiety can be conditioned to any stimuli Anxiety is cause of most behavioral disorders Anxiety is cause of most behavioral disorders Thoughts associated with threatening stimuli can elicit anxiety Thoughts associated with threatening stimuli can elicit anxiety Therapeutic Process – Unlearning responses Therapeutic Process – Unlearning responses Desensitization Desensitization Assertiveness Training Assertiveness Training Stimulus Control Stimulus Control

Contingency Management Psychopathology Psychopathology Behavior controlled by CONSEQUENCES Behavior controlled by CONSEQUENCES Reinforcement/Punishment Reinforcement/Punishment Excesses, deficits, inappropriateness Excesses, deficits, inappropriateness Therapeutic Process Therapeutic Process Various forms of control procedures Various forms of control procedures Functional Analysis Functional Analysis A-B-C A-B-C

Chapter 9Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Theory of Therapeutic Processes Environmental contingencies shape, maintain, & extinguish behavior Environmental contingencies shape, maintain, & extinguish behavior Behavior modification systematically controls contingencies to shape behavior Behavior modification systematically controls contingencies to shape behavior Change the contingencies and the behavior will change Change the contingencies and the behavior will change

Chapter 9Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. 6 Steps of Effective Contingency Management 1. State problem in behavioral terms 2. Identify behavioral objectives 3. Take baseline measures 4. Conduct naturalistic observations 5. Modify existing contingencies 6. Monitor the results

Chapter 9Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Cognitive-Behavior Modification Behaviorism was established as a radical alternative to mentalist theories Behaviorism was established as a radical alternative to mentalist theories Conditioning replaced cognition as the critical determinate of human behavior Conditioning replaced cognition as the critical determinate of human behavior Cognition gradually reintroduced in tx of human disorders Cognition gradually reintroduced in tx of human disorders Most behavior therapists now incorporate cognitive techniques Most behavior therapists now incorporate cognitive techniques Meichenbaum spearheaded this change Meichenbaum spearheaded this change

CB Modification Psychopathology Psychopathology Distorted information processing, expectancies and skill deficits Distorted information processing, expectancies and skill deficits Problems are characterized by Problems are characterized by Lack of coping response Lack of coping response Use of inappropriate cognitive responses (e.g., mislabeling) Use of inappropriate cognitive responses (e.g., mislabeling) Ineffective strategies for problem solving Ineffective strategies for problem solving Therapeutic Process Therapeutic Process Biofeedback Biofeedback Self-instructional training Self-instructional training Stress inoculation Stress inoculation

Phases of CBM Conceptualizing the problem Conceptualizing the problem Understand the nature of problem and enlist active collaboration Understand the nature of problem and enlist active collaboration Trying on the conceptualization Trying on the conceptualization Explore, sample and consolidate this view Explore, sample and consolidate this view Modifying cognitions & producing new behavior Modifying cognitions & producing new behavior Modify internal dialogues and enact new behavior to realign reciprocal interactions between mood cognition and behavior Modify internal dialogues and enact new behavior to realign reciprocal interactions between mood cognition and behavior STRESS INOCULATION

Behavior Therapy CONTRIBUTIONS Wide variety of techniques available Wide variety of techniques available Therapy stresses ‘doing’ Therapy stresses ‘doing’ Techniques have been extended to more areas of human functioning than any other therapeutic approach Techniques have been extended to more areas of human functioning than any other therapeutic approach Emphasis on research into and assessment of treatment outcomes Emphasis on research into and assessment of treatment outcomes

Behavior Therapy LIMITATIONS OF BEHAVIOR THERAPY Behavior therapy may change behaviors, but it does not change feelings Behavior therapy may change behaviors, but it does not change feelings Does not deal with the emotional process as fully as other approaches Does not deal with the emotional process as fully as other approaches Relationship between client and therapist is discounted Relationship between client and therapist is discounted