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Behaviour therapy

 
Britannica Concise Encyclopedia: behaviour therapy
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Application of experimentally derived principles of learning to the treatment of psychological disorders and the control of behaviour. The concept, which has its roots in the work of Edward L. Thorndike, was popularized in the U.S. by theorists of behaviourism, including B.F. Skinner. Behaviour-therapy techniques are based on the principle of operant conditioning, in which desired behaviours are rewarded. There is little or no concern for conscious experience or unconscious processes. Such techniques have been applied with some success to disturbances such as enuresis, tics, phobias, stuttering, obsessive-compulsive disorder, and various neuroses. Behaviour modification more generally refers to the application of reinforcement techniques for shaping individual behaviour toward some desired end or for controlling behaviour in classrooms or institutional situations. See also psychotherapy.

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Food and Fitness: behaviour therapy
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Behaviour therapy uses psychological techniques to overcome problem behaviours. It is used to change the habits of those with eating disorders, whether they are overeating or undereating. Therapists usually achieve this by establishing new attitudes and by focusing, not on the food, but on a person's behaviour around the food. The therapy uses a wide range of psychological techniques including stimulus control where, for example, a person susceptible to impulse buying, learns to shop only after eating, or shopping only from a prescribed list. Appropriate rewards, such as praise from friends or treats, are used in the therapy to reinforce good behaviour. Subjects learn to control eating behaviour so that they can eat the correct amount of food. Those who should be eating less can learn to put down their knife and fork between mouthfuls of food and to chew food fully.

Setting appropriate goals is an important part of behaviour therapy. Subjects are discouraged from using words such as ‘always’ or ‘never’, and encouraged to set themselves achievable tasks. Physical activity could be increased, even by changing a simple routine, such as by walking to the corner shop rather than taking a car. Continuous feedback forms an essential part of most behaviour therapy. Eating and exercise habits are monitored by using a food and exercise diary. This enables problems to be identified and good behaviour to be rewarded. Behaviour therapy can be very effective, but it may take a long time to overcome problems. Those with serious eating disorders should seek professional help from a clinical psychologist.

Behaviour therapy is also used by athletes who suffer from excessive anxiety before competition. Some competitions, such as the Olympic Games, which are seen by millions of people may invoke a feeling of fear in even the most seasoned athlete. Behaviour therapy uses relaxation techniques and other procedures which enable the athlete to approach such a competition with optimal levels of physiological arousal and minimum anxiety.

Philosophy Dictionary: behaviour therapy
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An offspring of behaviourism, in which underlying cognitive states are ignored, but behaviour is itself rewarded or punished with different stimuli, in order to encourage or suppress it.

Sports Science and Medicine: behaviour therapy
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A technique for changing problem behaviour, including relaxation procedures requiring the subject to approach a feared situation gradually while maintaining physiological arousal at a low level.

World of the Mind: behaviour therapy
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The term 'behaviour therapy' was coined towards the end of the 1950s by H. J. Eysenck to denote a method of treatment of neurotic disorders that was based on laboratory studies of conditioning, and on modern learning theory. Behaviour therapy is derived from a general theory of neurotic disorder which differs profoundly from psychoanalytic or orthodox psychiatric theories. Before presenting this theory (which is basic to the therapeutic application of the various methods comprised under the general term 'behaviour therapy'), it may be useful to distinguish behaviour therapy from psychotherapy and from behaviour modification, two terms that partly overlap with behaviour therapy, and are partly contrasted with it.

Psychotherapy denotes the use of psychological theories and methods in the treatment of psychiatric disorders; in its generic sense it therefore includes behaviour therapy as one of the methods used by psychologists and psychiatrists, and is partly synonymous with it. However, psychotherapy also has a narrower meaning, namely the use of interpretative (mostly Freudian) methods of therapy; in this sense psychotherapy and behaviour therapy are antonyms, the former relying on verbal and symbolic methods, the latter on the direct manipulation of motor and autonomic behaviours. Thus psychotherapy in the wider sense can be usefully divided into psychotherapy in the narrower sense and behaviour therapy. Both psychotherapy and behaviour therapy refer to a whole set of methods; they are not confined to one single method, as the terms used might suggest.

The terms behaviour therapy and behaviour modification are also partly synonymous, partly antonymous. In the United States, particularly, both terms are used indiscriminately to refer to two sets of rather different theories and methods. Both these sets do, indeed, make use of psychological theories of learning and conditioning, and to that extent there is some overlap. However, psychologists make a fairly clear (although probably not absolute) distinction between two kinds of conditioning: Pavlovian or classical, and instrumental or operant. Behaviour therapy in the narrower sense is concerned with Pavlovian conditioning, behaviour modification with instrumental conditioning. In this sense these methods and theories are antonymous, and we may say that behaviour therapy in the wider sense can be usefully subdivided into behaviour therapy in the narrower sense and behaviour modification. These complications of nomenclature are bothersome and annoying, but they have become so firmly entrenched that they have to be dealt with; clearly anyone writing about these various therapies should indicate in which sense the terms are being used.

Pavlovian conditioning forms associations between conditioned stimuli (neutral before conditioning) and unconditioned stimuli and responses by simple pairing: the animal or human being conditioned does not perform any act that would affect the outcome. Thus a dog may be conditioned to lift his paw upon a signal by fixing to his foot a device that delivers an electric shock and activating it shortly after giving a signal (the conditioned stimulus). The shock makes the dog lift his leg and, although this movement does not enable the dog to escape from the shock, nevertheless the movement becomes conditioned. Instrumental conditioning, pioneered by Pavlov's rival Bekhterev, is based on similar associations, but in this case the action performed by the animal or human is the crucial factor. Thus the shock to the leg of the dog may be delivered through a grid on which the foot of the animal rests; if he lifts his foot in response to the conditioned stimulus he avoids the shock. This is a profound difference, and E. L. Thorndike, B. F. Skinner (see behaviourism, B. F. Skinner on), and other American psychologists have elaborated practical methods of using positive and negative reinforcements (rewards and punishments) in order to modify behaviour. These are usually related to explicit behaviour patterns: for instance they may be used to make schoolchildren less boisterous, criminals better behaved, or psychotic in-patients more responsive to the demands of society. In each case the stress is on segments of large-scale behaviour: the child may be required to learn to sit quietly for certain periods of time, the criminal to carry out a series of acts such as making his own bed, keeping his room clean, and working adequately for a certain period of time. The psychotic may be required to come to meals punctually, keep himself tidy, work in the laundry, associate with other people, and so on. Methods have been worked out for the optimum use of rewards ('token economies') according to the laws of operant conditioning, and many practical applications of these methods have been developed, particularly in the treatment of deteriorated psychotics. But little attempt has been made to use these methods in connection with the treatment of the far more widespread neurotic disorders, and in clinical practice there is little doubt that Pavlovian methods are much more frequently used, and much more efficacious.

Operant conditioning applies, for the most part, to motor activities and the performance of integrated activities. Pavlovian conditioning applies, for the most part, to the activity of the autonomic system, i.e. to emotions; thus it is no accident that neurotic behaviour, which is largely characterized by emotional upsets and difficulties, is more closely related to Pavlovian conditioning. (This distinction is not an absolute one, but it is very useful and far-reaching; most human activities, as well as most animal activities studied in the laboratory, partake of both operant and classical conditioning, and complex methods of analysis are required to sort out the respective contributions of these two processes.) The theory of neurosis from which behaviour therapy derives states that neurotic disorders are essentially conditioned emotional responses; they are acquired through some traumatic emotional event, or a series of subtraumatic emotional events, in which some previously neutral conditioned stimulus becomes linked (perhaps quite accidentally) with a fear-producing unconditioned stimulus. This theory is clearly different from psychoanalytic and other psychiatric theories according to which the observed signs of the disorder are merely symptoms of some underlying 'complex'; according to Freud and his followers, this 'complex' must be eliminated before any permanent cure is possible. Behaviour therapists deny the existence of these alleged 'complexes', and they assert that the putative 'symptoms' are not in fact symptoms of anything — they are the disorder. The aim of behaviour therapy is to eliminate these 'symptoms'; if this can be accomplished, then no 'disease' or 'complex' will remain. Freud predicted that 'purely symptomatic treatment', which did not eliminate the 'complex' allegedly underlying the outward manifestations of the disorder, would lead to relapse or to symptom substitution, i.e. either the 'symptom' would return, or else another one would arise in its place. Behaviour therapists have been on the lookout for such effects, but although they have succeeded much more completely than others in eliminating the 'symptoms', relapse and symptom substitution have been notable mainly by their failure to occur.

The methods of behaviour therapy (in the narrower sense) derive from this general theory. If the manifestations of neurotic disorder are conditioned emotional responses, then a cure must consist in the extinction of these conditioned responses. Fortunately experimental psychologists, following the lead of Pavlov, have elaborated many different methods for attaining this aim, and these have been tried out very successfully in neurotic patients. The methods include desensitization or counter-conditioning (in which the conditioned stimulus that produces fear/anxiety responses in the patient is conditioned by the therapist to more positive anti-anxiety-producing unconditioned stimuli, such as relaxation or self-assertion); flooding (in which the patient is exposed for a lengthy period to the conditioned stimulus that produces fear/anxiety responses; by preventing the usual reactions of flight or whatever, the therapist forces the patient to face his fears, which then disappear quickly); and modelling (in which the patient is shown a 'model' who copes properly with his own difficulties and fears, and thus learns the absurdity of his conditioned responses). The effectiveness of these, and many other similar methods, is no longer in question; indeed, empirical evidence from clinical and experimental studies has shown that for no other therapy is there anything like as good evidence for speed and efficacy of cure.

(Published 1987)

— Hans J. Eysenck

    Bibliography
  • Eysenck, H. J. (ed.) (1973). Handbook of Abnormal Psychology.
  • — —  and Rachman, S. (1964). Causes and Cures of Neurosis.
  • Kazdin, A. E. (1978). History of Behavior Modification.
  • — —  and Wilson, T. (1978). Evaluation of Behavior Therapy.
  • Rachman, S. (1971). The Effects of Psychotherapy.
  • Ullmann, L. P., and Krasner, L. (1975). A Psychological Approach to Abnormal Behavior. (For a presentation of the theories and methods of behaviour modification.)

Wikipedia: Behaviour therapy
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Behavior therapy can be studied scientifically by observing overt behavior, without discussing internal mental states. Without holding inner states as causal, Skinner's radical behaviorism accepted internal states as part of a causal chain of behavior, but continued to hold that the only way to improve the internal state was through environmental manipulation.

Contents

History

Possibly the first occurrence of "behavior therapy" was in a 1953 research project by B.F. Skinner, Ogden Lindsley, and Harry C. Solomon.[1] Other early pioneers in behavior therapy include Joseph Wolpe and Hans Eysenck.[2]

In general, behavior therapy is seen as having three distinct points of origin: South Africa (Wolpe's group), The United States (Skinner), and the United Kingdom (Rachman and Eysenck). Each had its own distinct approach to viewing behavior problems. Eysenck in particular viewed behavior problems as an interplay between personality characteristics, environment, and behavior[3]. Skinner's group in the United States took more of an operant conditioning focus. The operant focus created a functional approach to assessment and interventions focused on contingency management such as the token economy and behavioral activation. Skinner's student Ogden Lindsley is credited with forming a movement called precision teaching, which developed a particular type of graphing program called the standard celeration chart to monitor the progress of clients. Skinner became interested in the individualizing of programs for improved learning in those with or without disabilities and worked with Fred S. Keller to develop programmed instruction. Programmed instruction had some clinical success in aphasia rehabilitation [4] Gerald Patterson used program instruction to develop his parenting text for children with conduct problems[5]. With age, respondent conditioning appears to slow but operant conditioning remains relatively stable[6]

While many behavior therapists remain staunchly committed to the basic operant and respondent paradigm, in the second half of the 20th century, many therapists coupled behavior therapy with the cognitive therapy of Aaron Beck and Albert Ellis, to form cognitive behavioral therapy. In some areas the cognitive component had an additive effect (for example, sex offender treatment) but in other areas it did not enhance the treatment, which led to the pursuit of Third Generation Behavior Therapies. Third generation behavior therapy uses basic principles of operant and respondent psychology but couples them with functional analysis and a case conceptualization of verbal behavior more inline with view of the behavior analysts.

Scientific basis

Behavior therapy is based upon the principles of classical conditioning developed by Ivan Pavlov and operant conditioning developed by B.F. Skinner. There has been up to now a good deal of confusion about how exactly these two conditionings differ and whether the various techniques of Behaviour Therapy have any common scientific base. One answer has come in the form of an online paper called Reinforcing Behaviour Therapy which more and more psychologists are now studying and appreciating.

Contingency management programs are a direct product of research from operant conditioning. These programs have been highly successful, producing results even with adults who suffer from schizophrenia[7]

Systematic desensitization and exposure and response prevention both evolved from respondent conditioning and have also received considerable research.

Social skills training teaches clients skills to access reinforcers and lessen life punishment. Operant conditioning procedures in meta-analysis had the largest effect size for training social skills, followed by modeling, coaching, and social cognitive techniques in that order [8] Social skills training has some empirical support particularly for schizophrenia[9] [10] However, with schizophrenia, behavioral programs have generally lost favor[11]

Applied to problem behavior

Behavior therapy based its core interventions on functional analysis. Just a few of the many problems that behavior therapy have functionally analysed include intimacy in couples relationships[12] [13] [14], forgiveness in couples[15], chronic pain[16], stress related behavior problems of being an adult child of an alcoholic[17], anorexia[18], chronic distress[19], substance abuse[20], depression[21], anxiety [22], and obesity.[23]

Functional analysis has even been applied to problems that therapists commonly encounter like client resistance, particially engaged clients and involuntary clients.[24][25] Applications to these problems have left clinicans with considerable tools for enhancing therapeutic effectiveness. One way to enhance therapeutic effectiveness is to use positive reenforcement or operant conditioning.

Many have argued that Behavior Therapy is at least as effective as drug treatment for depression, ADHD, and OCD.[26] Considerable policy implications have been inspired by behavioral views of various forms of psychopathology.

Third generation

Of particular interest, in behavior therapy today are the areas often referred to as Third Generation Behavior Therapy.[27] This movement has been called clinical behavior analysis because it represents a movement away from cognitivism and back toward radical behaviorism and other forms of behaviorism, in particular functional analysis and behavioral models of Verbal behavior. This area includes Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Analysis System of Psychotherapy (CBASP) (McCullough, 2000), Behavioral activation (BA), Kohlenberg & Tsai's Functional Analytic Psychotherapy, Integrative behavioral couples therapy and dialectical behavior therapy. These approaches are squarely within the applied behavior analysis tradition of behavior therapy.

Acceptance and Commitment Therapy is probably the most well-researched of all the third generation behavior therapy models. It is based on Relational Frame Theory.[28]

Functional Analytic Psychotherapy is based on a functional analysis of the therapeutic relationship.[29] It places a greater emphasis on the therapeutic context and returns to the use of in session reinforcement [30] In general, 40 years of research supports the idea that in-session reinforcement of behavior can lead to behavioral change.[31]

Behavioral activation emerged from a component analysis of cognitive behavior therapy. This research found no additive effect for the cognitive component.[32] Behavioral activation is based on a matching model of reinforcement.[33] A recent review of the research, supports the notion that the use of behavioral activation is clinically important for the treatment of depression.[34][www.behavior-analyst-online.org]

Integrative behavioral couples therapy developed from dissatisfaction with traditional behavioral couples therapy. Integrative behavioral couples therapy looks to Skinner (1966) for the difference between contingency shaped and rule governed behavior.[35] It couples this analysis with a thorough functional assessment of the couples relationship. Recent efforts have used radical behavioral concepts to interpret a number of clinical phenomena including forgiveness.[36]

Organizations

Many organizations exist for behavior therapists around the world. In the United States, the American Psychological Association's Division 25 is the division for behavior analysis. The Association for Contextual Behavior Therapy is another professional organization. ACBS is home to many clinicians with specific interest in third generation behavior therapy. The Association for Cognitive and Behavior Therapy (formerly the Association for the Advancement of Behavior Therapy) is for those with a more cognitive orientation. Internationally, most behavior therapists find a core intellectual home in the International Association of Behavior Analysis (ABA:I) [11].

Characteristics

By nature, behavioral therapies are empirical (data-driven), contextual (focused on the environment and context), functional (interested in the effect or consequence a behavior ultimately has), probabilistic (viewing behavior as statistically predictable), monistic (rejecting mind-body dualism and treating the person as a unit), and relational (analyzing bidirectional interactions).[37]

Methods

See also

References

  1. ^ Lindsley, O., Skinner, B.F., Solomon, H.C. (1953). Studies in behavior therapy (Status Report I). Walthama, MA.: Metropolitan State Hospital. 
  2. ^ Clark, David M.; Christopher G. Fairburn (1997). Science and Practice of Cognitive Behaviour Therapy. Oxford University Press. ISBN 0192627260. 
  3. ^ Yates,, A.J.(1970). Behavior Therapy. New York Wiley
  4. ^ Goldfarb, R. (2006): Operant Conditioning and Programmed Instruction in Aphasia Rehabilitation - SLP-ABA, 1.(1), 56-65BAO
  5. ^ Patterson, G.R. (1969).Families: A social learning approach to family life.
  6. ^ Perlmutter, M. and Hall, E. (1985). Adult development and aging. New York: John Wiley.
  7. ^ Paul, G.L. & Lentz, R.J.(1977). Psychosocial treatment of chronic mental patients: Milieu versus social learning programs. Cambridge, MA: Harvard University Press.
  8. ^ Schnieder, B.H. & Bryne, B.M. (1985). Children's social skills training: A meta-analysis. In B.H. Schneider, K. Rubin, & J.E. Ledingham (Eds.) Children's Peer relations: Issues in assessment and intervention (pp. 175-190). New York: Springer-Verlag.
  9. ^ Corrigan, P.W. (1997). Behavior therapy empowers persons with severe mental illness. Behavior Modification, 21, 45-61
  10. ^ Corrigan, P.W. Holmes, E.P.(1994). Patient identification of "street skills" for a psychosocial training module. Hospital and Community Psychiatry, 45, 273-276.
  11. ^ Wong, S.E. (2006). Behavior Analysis of Psychotic Disorders: Scientific Dead End or Casualty of the Mental Health Political Economy? Behavior and Social Issues,15 (2),152-177 [1]
  12. ^ Cordova, J. (2003). Behavior Analysis and the Scientific Study of Couples. The Behavior Analyst Today, 3 (4), 412-419 [2]
  13. ^ Stuart, R.B. (1998). Updating Behavior Therapy with Couples. The Family Journal, 6(1), 6-12
  14. ^ Christensen, A., Jacobson, N.S. & Babcock, J.C. (1995). Integrative behavioral couples therapy. In N.S. Jacobson & A.S. Gurman (Eds.) Clinical Handbook for Couples Therapy (pp. 31-64). New York: Guildford.
  15. ^ Cordova, J., Cautilli,J.D., Simon, C. & Axelrod-Sabtig, R. (2006). Behavior Analysis of Forgiveness in Couples Therapy - IJBCT, 2.(2), 192-208 [3]
  16. ^ Sanders, S.H. (2006). Behavioral Conceptualization and Treatment for Chronic Pain (2006). The Behavior Analyst Today, 7(2), 253-261. [4]
  17. ^ Ruben, D. H. (2001). Treating Adult Children of Alcoholics: A behavioral approach. San Diego, CA: Academic Press.
  18. ^ Lappalainen and Tuomisto (2005): Functional Analysis of Anorexia Nervosa: Applications to Clinical Practice.The Behavior Analyst Today, 6.(3), 166-175[5]
  19. ^ Holmes, Dykstra Williamns, Diwan, & River, (2003) Functional Analytic Rehabilitation: A Contextual Behavioral Approach to Chronic Distress. The Behavior Analyst Today, 4 (1), 34-45 BAO
  20. ^ Smith, J.E., Milford, J.L and Meyers, R.J. (2004). CRA and CRAFT: Behavioral Approaches to Treating Substance-Abusing Individuals. The Behavior Analyst Today, 5.(4), 391-402 BAO
  21. ^ Kanter, J.W., Cautilli, J.D., Busch, A.M. & Baruch, D.E. (2005). Toward a Comprehensive Functional Analysis of Depressive Behavior: Five Environmental Factors and a Possible Sixth and Seventh. The Behavior Analyst Today, 6.(1), Page 65-78. BAO
  22. ^ Hopko , D.R., Robertson, S. and Lejuez, C.W.(2006). Behavioral Activation for Anxiety Disorders. The Behavior Analyst Today, 7(2), 212-233 [6]
  23. ^ Stuart, R.B.(1967). Behavioral Control of overeating. Behavior research and therapy, 5, 357-365[7]
  24. ^ Cautilli,J., Tillman, T.C., Axelrod, S., Dziewolska, H. & Hineline, P. (2006): Resistance Is Not Futile: An experimental analogue of the effects of consultee “resistance” on the consultant’s therapeutic behavior in the consultation process: A replication and extension. IJBCT, 2.(3), 362 -376. BAO
  25. ^ Cautilli,J.D. Riley-Tillman, T.C., Axelrod, S. & Hineline, P. (2005). Current Behavioral Models of Client and Consultee Resistance: A Critical Review. IJBCT, 1(2), 147-164 BAO
  26. ^ Flora, S.R. (2007). Taking America off Drugs: why behavioral therapy is more effective for treating ADHD, OCD, Depression, and other psychological problems. SUNY
  27. ^ Kohlenberg, R. J.; M. Y. Bolling, J. W. Kanter, C. R. Parker (2002). "Clinical behavior analysis: Where it went wrong, how it was made good again, and why its future is so bright" (PDF). The Behavior Analyst Today 3: 248-253. ISSN 15394352. http://www.uwm.edu/~jkanter/behavioranalysis.pdf. 
  28. ^ Blackledge, J.T. (2003). An Introduction to Relational Frame Theory: Basics and Applications. The Behavior Analyst Today, 3 (4), 421-442[8]
  29. ^ Kohlenberg, R. J. & Tsai, M. (1991) Functional Analytic Psychotherapy. New York: Plenum
  30. ^ Wulfert (2002) Can Contextual Therapies Save Clinical Behavior Analysis? The Behavior Analyst Today, 3 (3), 254 [9]
  31. ^ Cautilli,J. T. Chris Riley-Tillman, Saul Axelrod and Hineline, P. (2005). The Role of Verbal Conditioning in Third Generation Behavior Therapy. The Behavior Analyst Today, 6.(2), 138- 157BAO
  32. ^ Jacobson, N.S., Martell, C.R., & Dimidjian, S.(2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8, 255-270.
  33. ^ Cullen, J.M. Spates, C.R, Pagoto, S. & Doran, N. (2006). Behavioral Activation Treatment for Major Depressive Disorder: A Pilot Investigation - The Behavior Analyst Today, 7.(1), 151-164.
  34. ^ Spates,C.R., Pagoto, S. and Kalata, A. (2006). A Qualitative And Quantitative Review of Behavioral Activation Treatment of Major Depressive Disorder. The Behavior Analyst Today, 7.(4), 508-512
  35. ^ Skinner, B.F. (1969). Contingencies of Reinforcement: A Theoretical Analysis. New York: Meredith Corporation.
  36. ^ Cordova,J., Cautilli, J.D., Simon, C. & Axelrod-Sabtig, R. (2006). Behavior Analysis of Forgiveness in Couples Therapy. IJBCT, 2.(2), 192-213 [10]
  37. ^ Sundberg, Norman (2001). Clinical Psychology: Evolving Theory, Practice, and Research. Englewood Cliffs: Prentice Hall. ISBN 0130871192. 
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