Behavioral Therapy

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Kreezelle San Esteban

What is Behavioral Therapy?• Behavioural therapy is an action-based therapy that

looks to foster positive behaviour change. Other therapies such as psychoanalytic therapy tend to be more focused on insight and delving into the past. In behavioural therapy, the past is still important as it often reveals where and when the unwanted behaviour was learned, however it looks more so at present behaviour and ways in which it can be rectified.

• The premise behind behavioural therapy is that behaviour can be both learned and un-learned. The goal is to help the individual learn new, positive behaviours which will minimise or eliminate the issue.

There are various ways this can be done depending on the problem itself. The main disciplines of

behavioural therapy are:

Applied behaviour analysis• Where behaviour change is

instigated using operant and/or classical conditioning and positive reinforcement.

Cognitive behaviour therapy• An integrative therapy that combines

elements of behavioural therapy with cognitive therapy.

Social learning theory• A theory that revolves around the

nature of imitation and learning.

Principles of behavioural therapy

• There are two key principles that form the foundations of behavioural therapy - classical conditioning and operant conditioning.

Classical conditioning• Behavioural therapy that is based on

classical conditioning uses a number of techniques to bring about behaviour change.

1. Flooding2. Systematic desensitisation3. Aversion therapy

Flooding• Flooding is a process generally used for those with

phobias and anxiety and involves exposing the individual to objects/situations they are afraid of in an intense and fast manner.

• An example of this would be exposing a person who is afraid of dogs to a dog for an extended period of time. The longer this continues with nothing bad happening, the less fearful the person becomes.

• The idea is that the person cannot escape the object/situation during the process and therefore must confront their fear head on. Obviously this method can be disconcerting and may only be suitable for certain situations.

Systematic desensitisation• This technique works on a similar premise to flooding, however

it is more gradual. The therapist would begin by asking the individual to write a list of fears they have. Once this list is written, the therapist will teach relaxation techniques for the individual to use while thinking about the list of fears. Working their way up from the least fear-inducing item to the most fear-inducing item - the therapist will help the individual confront their fears in a relaxed state.

• An example of this would be a person who is afraid of small spaces. They may start by thinking about a small space or looking at an image of a small space while utilising relaxation techniques, and work their way up to being in a small space. This pairing of the fear-inducing item and newly learned relaxation behaviour aims to eliminate the phobia or anxiety.

Aversion therapy• This process pairs undesirable behaviour with

some form of aversive stimulus with the aim of reducing unwanted behaviour.

• An example of how this is commonly used is when an alcoholic is prescribed a certain drug that induces nausea, anxiety and headaches when combined with alcohol.

• This means every time the person drinks, they get negative side effects. This hopes to put off that person from drinking to help them overcome their addiction.

Contingency management• A more formal approach, contingency

management involves a written contract between the therapist and individual that outlines goals, rewards and penalties. For some, having this kind of clear agreement helps to change behaviour and add a sense of accountability.

Operant conditioning• Operant conditioning uses techniques

such as positive reinforcement, punishment and modelling to help alter behaviour. The following strategies may be used within this type of therapy:

• Token economies• Contingency management• Modelling• Extinction

Token economies• This strategy relies on positive

reinforcement - offering individuals 'tokens' that can be exchanged for privileges or desired items when positive behaviour is exhibited. This is a common tactic used by parents and teachers to help improve the behaviour of children.

Modelling• Modelling involves learning through

observation and imitation of others. Having a positive role model can give individuals something to aim for, allowing them to change their behaviour to match their role model's. This role model may be the therapist or someone the individual already knows.

Extinction• Extinction works by removing any type of

reinforcement to behaviour. • An example of this would be a disruptive

child who is given a time-out or told to sit on the 'naughty step'. By removing them from the situation (and associated attention) the behaviour should stop. This premise can be carried across to adults too - however the 'naughty step' will probably be given a different name.

What Is Behavioral Therapy Used For?

Behavioral therapy is used by psychotherapists, psychiatrists, and other qualified medical professionals. It is usually used to help treat anxiety and mood disorders. These include:

• obsessive-compulsive disorder (OCD)

• post-traumatic stress disorder (PTSD)

• depression• social phobia• bipolar disorder• Schizophrenia

treatment can help patients cope with certain mental disorders. It can also be used to treat:

• autism• personality disorders• substance abuse• eating disorders

This therapy is also used on patients with chronic diseases to help manage pain. For example, cancer patients use learned techniques to better cope with radiation therapy. Doctors often recommend behavioral modification to pregnant women who can’t safely take medications. This form of treatment can also help with emotional grief.

Stages of Treatments

Role Playing• This is used to help the person develop new

skills and anticipate issues that may come up in social interactions.

Example:• One of the reasons that Bill stays home

alone so much is that he is shy around people. He does not know how to start a conversation with strangers. Bill and his therapist work on this by practicing with each other on how to start a conversation.

Self-Monitoring • This is the first stage of treatment. The person is

asked to keep a detailed log of all of their activities during the day. By examining the list at the next session, the therapist can see exactly what the person is doing.

Example: • Bill, who is being seen for depression, returns with

his self-monitoring list for the past week. His therapist notices that it consists of Bill going to work in the morning, returning home at 5:30 p.m. and watching television uninterrupted until 11 p.m. and then going to bed.

Schedule of Weekly Activities

• This is where the patient and therapist work together to develop new activities that will provide the patient with chances for positive experience.

Example:• Looking at his self-monitoring sheet, Bill and his

therapist determine that watching so much television alone gives little opportunity for positive social interaction. Therefore, they decide that Bill will have dinner out with a friend once a week after work and join a bowling league.

Behavior Modification• In this technique the patient will receive a

reward for engaging in positive behavior.Example:• Bill wants a new fishing rod. He and his

therapist set up a behavior modification contract where he will reward himself with a new fishing rod when he reduces his TV watching to one hour a day and becomes involved in three new activities.

Techniques UsedTherapists create treatment plans specifically tailored to individual conditions. Some exercises may include:

• discussions about coping mechanisms• role playing• breathing and relaxation methods• positive reinforcement• activities to promote focus• journal writing• social skills training• modifications in responses to anger, fear, and painTherapists sometimes ask patients to think about situations that scare them. The goal is not to frighten them but to help them develop different coping skills.

BenefitsThe general benefit is increased quality of life. Specific benefits vary depending on what condition is being treated. These can include:

• reduced incidents of self-harm• improved social skills• better functioning in unfamiliar situations• improved emotional expressions• less outbursts• better pain management• ability to recognize the need for medical help

Risks of Behavioral Therapy• The goal of behavioral therapy is to limit

self-harm. The risks for this treatment are minimal. Some patients consider the emotional aspects of the sessions risky. Exploring feelings and anxieties can cause bursts of crying and anger. The emotional aftermath of therapy can be physically exhausting and painful. A therapist will help to improve coping mechanisms and to minimize any side effects from therapy.

Preparing for Behavioral Therapy• Generally, a primary physician or neurologist will refer patients to

another doctor who specializes in behavioral therapy. Some psychotherapists also perform these treatments. Always check the credentials of your therapist. A credible behavioral therapist should have a degree as well as a license or certification.

• Because therapy sessions are frequent, it is important that the patient and doctor get on well. Patients can request a consultation before beginning treatment.

• Therapy sessions can become a financial burden. Some insurance providers do cover behavioral therapy. Others may only grant a portion of the costs or allot a certain number of sessions per year. Before beginning therapy, patients should discuss the coverage with your health insurance company and create a payment plan.

Results• Behavioral therapy is not a cure for any condition. It is

a teaching method to help cope with everyday life. Depending on individual needs, a person may only need it on a short-term basis. The exact length of a treatment plan depends on individual goals and progress made.

• During treatment it is important to continue taking any medications as prescribed by a doctor. Some research shows that learned techniques in therapy may gradually reduce the need for medicine. However, each case is different. Speak with a doctor if treatment doesn’t seem to be working.

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