Introduction to Behavioral Therapy


Behavioral Therapy is a relative new counseling theory, with a history that only goes back to the 1950’s (Corsini, 2011).  However, Rosenthal (2005) notes that it in a few early scholars.  For example, it has “roots in John Locke’s philosophy of associationism which notes that mental states operate by association with one another (Rosenthal, 2005).”  It is also influenced heavily by John Locke’s notion of the “tabla raza (Rosenthal, 2005)”, which notes that the mind is blank at brith and the environment molds it. Finally, it has origins in Edward Thorndike’s work on Animal Intelligence which notes the “law of effect” as influencing animal behavior.  Those responses that yield satisfactory outcomes are repeated.

Overall, behavioral therapies are quite popular today with their emphasis on the scientific method and empirically-based technique, (Corsini, 2011). With managed care and the desire to curb costs, brief therapies based on empirical research are strongly emphasized (Corsini, 2011). This bodes well for the future of behavioral therapy. So what is behavioral therapy anyway?

 Overview & Types of…

What is Behavioral Therapy?

“Behavioral therapy is not really a single therapy but a collection of therapies that reduces dysfunctional behaviors and refine productive behaviors (Rosenthal 2005).”  Behavioral therapy focuses on covert and overt behaviors and follow an approach that reflects the scientific approach.  The client is described as a problematic target behavior as a baseline measure, using a clear operational definition (Rosenthal, 2005).  After the intervention is utilized examines the effectiveness of this approach.   This process occurs much like the experimental process.  “Hard core behavioral therapists believe that if you can’t measure it, it doesn’t exist at all (Rosenthal 2005).”

Three Main Approaches

In attempting to make sense of the key forms of behavioral therapy, I utilized Rosenthal (2005), collection of CD’s for the NCE exam, as well as an old textbook by Corsini & Wedding (2011). Rosenthal (2005) divides his discussion of behavioral therapy into main categories: one based on skinner’s work, and another based on pavlov’s work.  However, Corsini & Wedding (2011) note: “Behavior therapy can no longer be defined simply as the clinical application of classical and operant conditioning theory, (p. 235).”  Contemporary behavioral approaches fall into three broad categories.  I will discuss these each in separate posts in greater detail and include links below.

Applied Behavioral Analysis

Applied Behavioral Analysis “is a direct extension of Skinner’s radical behaviorism. It relies on operant conditioning, the fundamental assumption that behaviorism is a function of its consequences. Accordingly, treatment procedures are based on altering relationships between overt behaviors and their consequences. Applied behavioral analysis makes use of reinforcement, punishment, extinction, stimulus control…(Corsini & Wedding, 2011, p. 236).”
The focus is on learning of voluntary behaviors through the manipulation of cconsequences
Antecedents are triggers which precede a behavior (i.e. situations, thoughts & emotions).
Consequences refer to the events that follow the behavior.
Maladaptive behaviors are a function of their consequences altering these alleviates them.  
Learning is the reassortment of an individuals responses to a situation (Shunk, 1991).  
Reinforcers are stimuli which follow a behavior that increase its recurrence.
Conditioning is the strengthening of a behavior through reinforcement.
Extinction is the decline in a specific behavior due to the absence of a reinforcer.
Behavior should be examined as a dependent variable & function of learning processes
Learning is an active and participatory endeavor.
Neobehavioristic Mediational Stimulus-Response Model
This approach features the application of principles of  classical conditioning and derives from the learning theories of Ivan Pavlov…Unlike the operant approach, the S-R model is mediational, with intervening variables and hypothetical constructs prominently featured..techniques of systematic desensitization and flooding, (Corsini & Wedding, 2011, p. 236)” are use in this model.

The focus is on on response conditioning of involuntary emotions and responses.

People have expectations of outcome in a situation based on previous experience.

Conditioned stimuli are known to occur before an event (bell), and elicit a conditioned response (salivation).
Unconditioned stimuli have no correlation to an event, (eating) and do not elicit a response (salivation).
Learning occurs through pairing of a stimulus with a response.
Extinction occurs when the conditioned stimulus no longer occurs before an event.
Consequence (i.e. reward / punishment) is not essential for learning.
Instead the close association in time between stimulus and response is critical.
Behavior is elicited and conceived of from a biological perspective.
Therefore, the client plays a passive and reflexive role in learning.

Social-Cognitive Theory

The social-cognitive approach depends on the theory that behavior is based on three separate but interacting regulatory systems….external stimulus events,,,external reinforcement , and…cognitive mediational processes…(Corsini & Wedding, 2011, p. 236).” Examples of theorists from this perspective include Beck & Bandura.
The relationship between the individual and his environment is seen as reciprocal.
The environment influences our behavior and the environment.
Learning is a byproduct of the interaction between an the individual, their environment and behavioral responses.
In contrast to the previous behavioral models, individuals and initiate change independently.
People desire to self-efficacy and act as agents of change in their own lives., this requires the skills of “forethought, performance, and self-reflection” (Shunk, 2011).
Enactive learning involves learning through doing while vicarious learning occurs through observing others.
An event or stimulus that produces change, but an individual’s interpretation of these specific factors.
Cognitive processes are also part of the behavior learning process and should be addressed for therapeutic success (Corsini & Wedding, 2011).

Assumptions

Based on the insights of Ivan Pavlov, B.F. Skinner, and Watson theory can be thought of as a “learning theory” (Corsini, 2011). While several variants exist, they are based on a few notable assumptions.

Behaviors Are The Result Of Consequences.

What are the consequences of this assumption? The behavioral therapist focuses on understand how a stimulus is perceived, and related motivationally to a response (Corsini, 2011). Interventions utilized for this involve an adjustment of perceived consequences for a behavior with techniques such as operant conditioning and reinforcement (Corsini, 2011)

Current Determinants Are the Priority.

“Behavioral assessment focuses on current determinants of behavior rather than on the analysis of historical antecedents.” (Corsini, 2011, 237).   Of lesser importance are internal personality factors, such as symptomatology, or temperament (Corsini, 2011). Additionally, the historical context of a person’s life isn’t focused upon much within this therapy technique (Corsini, 2011).

Understanding a problem doesn’t yield change it.

Instead change happens through the process of reconditioning behavior (Corsini, 2011). Doing so involves changing preferred ways of coping, homework, and an array of “corrective learning experiences” (Corsini, 2011).

Radical Acceptance & The Third Wave.

While not a key component of all types of behavioral therapy, newer forms of this therapy introduce concepts such as mindfulness and the idea of a “radical acceptance” into the mix (Corsini, 2011). Newer “third wave” versions of behavioral therapy, have introduced these concepts to address the emotive components of behavior (Corsini, 2011).

Uses & Applications

So based on this brief description, in what circumstances and situations might it most ideally be applicable? Behavioral therapy has been fairly useful in an array of psychiatric conditions such as PTSD and OCD as well as an assortment of addictive behaviors (Corsini, 2011). Its greatest use and benefits are for those presenting problems that aren’t affectively address through understanding, practical logic, or emotive release alone (Marom, 2003).

Anxiety, Panic Disorders, & OCD.

Often used in conjunction with psychiatric medication, the utilization of behavioral therapy for anxiety, panic disorders, and OCD has proven particularly beneficial (Clark, 2005; Marom, 2003). The presenting problem in these cases is that of altered brain function. Seemingly inert situations, events and/or objects are associated with a strong anxiety producing response for clients (Clark, 2005; Marom, 2003). In the midst of an extreme panic in the presence of key triggers, behavioral therapy provides clients an opportunity to learn new ways of coping (Clark, 2005; Marom, 2003). These treatment methods are often multimodal, including techniques to help relax and self soothe as well as a systematic exposure program (Clark, 2005; Marom, 2003). These interventions are aimed at reducing maladaptive coping strategies (Clark, 2005). Foremost among these are irrational safety behaviors. (i.e repetitive handwashing, and hoarding), which are utilized in response to anxiety producing triggers (Moran, 2003). When occurring alongside psychiatric follow up, as well as group and individual therapy these methods have been proven effective (Clark, 2005; Marom, 2003).

PTSD & Behavioral Therapy.

Post Traumatic Stress Disorder is a psychiatric disorder that arises in response to an intensely stressful and traumatic event (Corsini, 2011; Jaycox, 2002). In the aftermath of such events, clients are left with an array of troubling symptoms (Corsini, 2011; Jaycox, 2002). Foremost among these is the re-experiencing of feelings associated with the initial trauma in the midst of triggers that produce memories of the event (Jaycox, 2002; Linehan, 1993). Adding to this key symptom is a vacillation between hyper arousal and emotional numbing (Jaycox, 2002; Linehan, 1993). This hyper arousal state is felt in the form of an intense anxiety when confronted with situations that produce memories of the trauma (Jaycox, 2002; Linehan, 1993). In response to this, PTSD sufferers tend to engage in an array of avoidance, and emotional numbing, as a way of coping (Jaycox, 2002; Linehan, 1993).

Of particular benefit in such cases are the “third waves” behavioral therapies such as Dialectical Behavioral Therapy (Jaycox, 2002; Linehan, 1993). DBT includes traditional behavioral techniques with an intermingling of insights from Asian philosophers (Linehan, 1993). For example, its notion of radical acceptance, bears great similarity to Ellis’s concept and is particular helpful in enabling clients to move forward (Linehan, 1993).

The key logic underlying the idea of radical acceptance is that that non-acceptance yields suffering (Linehan, 1993). The goal is to aid clients in coming to terms with traumatic experience by understand this notion (Linehan, 1993). Adding to this insight are components such as mindfulness, self-soothing, and behavioral techniques (Linehan, 1993). Together they can aide clients in moving beyond a desire to resist very real fact that the trauma happened (Linehan, 1993). While therapy can’t ever help erase the event or allow it to be forgotten, the goal is to alter a client’s way of relating to the experience (Linehan, 1993). Ideally, memories of the trauma don’t produce a hyper aroused state they once had (Linehan, 1993). Additionally, in the place of a desire to avoid and engage in emotional numbing is a meaningful processing of the experience (Linehan, 1993).

Addictive Behaviors.

Addictive behaviors, such as hoarding, alcoholism, and compulsive over-eating, and even anorexia nervosa are well suited for behavioral therapies (Corsini, 2011). The key benefit of behavioral therapy, in these instances is in its ability to hit the heart of the issue with these presenting problems (Corsini, 2011).   Clients are provided a structure around which they can come to truly understand emotionally the consequences of their current methods of coping (Corsini, 2011). They can be allowed to understand the faulty thinking underlying their maladaptive behavior (Corsini, 2011).

Behavioral Therapy For Children.

In the Lifespan Development course for this program, a brief mention was made of behavioral therapy (Broderick, 2010). When providing therapy for children, it is important to consider the very real cognitive limitations they present with developmentally (Broderick, 2010). While assessments need to be made on a case-by-case basis, some generalizations can be made note of (Broderick, 2010). In particular, throughout much of our childhood, we are often unable to process abstract concepts (Broderick, 2010). Additionally, our ability to see beyond our own perspective is limited (Broderick, 2010). In a nutshell, you have a population of individual’s best described as concrete egoists (Broderick, 2010). On the basis of this fact, behavioral therapy is ideal suited to address behavioral disorders in this population (Broderick, 2010).   Providing children with a concrete sets of behavior patterns to better cope, not only heightens their effectiveness, but can boost self-esteem (Broderick, 2010). While schemas regarding the self concept are fairly indelible at this age, with consistency and time, they can be effective (Broderick, 2010).

Behavioral Family Therapy

This portion of the post includes excerpts from a paper for a marriage and family counseling course….

In an effort to dispel a historically negative caricature of behavioral therapy in family therapy, Gurman (2013) provides a historical review of behavioral therapy’s course of development. According to Gurman (2013), despite the historical distrust of this method, approximately 80% of all couple and family therapists now utilize it (p115).   Next is a review of Gurman’s (2013) description of behavioral therapy’s development and application in the field of family therapy.

Individual Behavioral Therapy.

Behavioral therapy’s origins begin with Pavlov’s classical condition and Skinners operant conditioning models. During individual behavioral therapy’s first wave of development in the 50’s and 60’s, efforts were being undertaken to address the deficits of psychoanalysis (Gurman, 2013). The stimulus-response learning perspectives of early behavioral therapy were nonetheless criticized as emphasizing first-order changes and a mechanistic in orientation (Gurman, 2013). Bandura’s social learning theory introduced behavioral therapy’s second wave of development (Gurman, 2013). In an effort to address a wider range of difficulties, cognitive variables were incorporated with behavioral therapy methods.   Finally during behavioral therapy’s third wave of development cognitive behavioral approaches were applied to an ever increasingly range of issues. The influences of eastern thought and Buddhist practices were then integrated into many third wave therapies, including Acceptance and Commitment Therapy, and DBT (Gurnman, 2013). In reaction to the early first-wave behavioral therapies, these third wave CBT therapies emphasized a holistic perspective that considers the importance of context.

Behavioral Couple’s Therapy (BCT).

Interestingly, the development of Behavioral Couples Therapy (BCT) followed a similar path as its individualized variant. During its first wave of development Gurnman, (2013) describes Operant-Interpersonal Treatment for Marital Discord (OMIT, and Traditional Behavioral Couple Therapy (TBCT). OMIT, closely resembling early forms of individual behavioral therapy and focuses on each partner’s responsibility. OMIT focuses on changing behavior with techniques that include techniques and marital token economies, and Quid Pro Quo Contracts (Gurnman, 2013). TBCT, also a first wave couples behavioral therapy, includes a rewards vs. cost perspective.   Skill development became the focus for TBCT, based on the notion that “nastiness begets nastiness” (Gurnman, 2013, 119).   Since Gotmann’s research has confirmed the uselessness of these early interventions, BCT has developed well beyond its historical origins.

Cognitive-Behavioral Couple’s Therapy (CBCT) constitutes the second wave of BCT’s evolution and development (Gurnman, 2013).   With this perspective the emphasis on skills training was now considered too limiting. Internal psychological process including automatic thoughts and schemas gained attention in BCT’s ongoing development. Internal belief structures, and each partner’s attachment history, gained new attention through CBCT.

Integrative Behavioral Couple’s Therapy (IBCT)– The Third Wave

Gurnman, (2013) concludes his paper with a description of BCT’s third wave approach: Integrative Behavioral Couple’s Therapy. IBCT is a unique form of behavioral therapy that appreciates individual differences and facilitates empathy (Gurnman, 2013). Central to this approach is non-judgmental perspective in which a holistic analysis is given priority. The context of a given situation, is important in understanding why behaviors and interactions persist. In IBCT, context refers to “the term used for changeable steams of events that can exert an organizing influence on behavior” (Gurnman, 2013). Understanding the function and purpose of behavioral patterns means examining context. This requires a close examining of a early child experiences, attachment histories and recurrent core themes or patterns in a relationship.

Unlike the earlier forms of Behavioral Couple’s Therapy (BCT) in its third wave of development, insights have been incorporated to address effectively Gotmann’s perpetual problems (Gurnman, 2013).   Functional analysis is useful in explaining how the effects of context and the causal historical underpinnings of ongoing interpersonal relationship patterns. Techniques and skills taught therapy, can provide a secure and safe place to discuss issue openly during a session. For example, carefully wording one’s words, by using “I” to discuss one’s feelings and “it” to describe problems in a neutral third-part context are convenient examples (Gurnman, 2013).   Other unique interventions include tolerance-building, which involves a process of learning to find new experiential meaning in the midst of ongoing unsolvable conflicts. This technique is quite intriguing since it reflects an insight of the Gottman’s regarding masters and disasters and how they take in life experiences.

References

Biography.com (n.d.) John Locke – Philosopher.  Retrieved from: http://www.biography.com/people/john-locke-9384544
Broderick, P.C. & Blewitt, P. (2010). Life Span Development: Human Development for Helping Professionals. (3rd. Ed.) Boston, MA: Pearson.
Clark, D. (2005). Focus on “cognition” in cognitive behavioral therapy for OCD: Is it really necessary? Cognitive Behavior Therapy. 34(3), 134-139.
Corsini, R. J. & Wedding, W. (2011). Current Psychotherapies. Belmont, CA: Brooks/Cole
Dixon, D. R., Vogel, T., & Tarbox, J. (2012). A Brief History of Functional Analysis and Applied Behavior Analysis.  Retrieved from:  https://scholar.google.com/scholar?cluster=6590433815737513224&hl=en&as_sdt=0,28&as_ylo=2012
Gurman, A. S. (2013). Behavioral couple therapy: Building a secure base for therapeutic integration. Family Process, 52(1), 115-138. doi:10.1111/famp.12014
Holland, J. (Director & Schein, L. (Producer. (1995). The Angry Couple [Video File]. Psychotherapy.net. Retrieved November 11, 2015, from The Psychotherapy.net Collection.
Jaycox, L., Zoeliner, L. & Foa, E. (2002). Cognitive behavior therapy for PTSD in rape survivors. Journal of Clinical Psychology. 58(8). 891-906.
Lebow, J. (2006, Sep). FROM RESEARCH TO PRACTICE, scoreboard for couples therapies. Psychotherapy Networker, 30 Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/233324408  ?accountid=28125
Linehan, M.M. (1993). Cognitive behavioral therapy for borderline personality disorder. New York: Guilford Press.
Marom, S. & Hermesh, H. (2003). Cognitive behavior therapy (CBT) in anxiety disorders. The Israel Journal of Psychiatry and Related Sciences. 40(2) 135-144.
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.
Schunk, D. H. (1991). Learning theories: An educational perspective. Retrieved from: http://s3.amazonaws.com/academia.edu.documents/44670152/_Dale_H._Schunk__Learning_Theories_An_Educational..pdf?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1475602918&Signature=jyd3eErVXh%2F6RaD8I%2B056ea%2FlNw%3D&response-content-disposition=inline%3B%20filename%3DDale_H._Schunk_Learning_Theories_An_Edu.pdf

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