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71.1 – Explain how the basic assumption of behavior therapy differs from those of psychodynamic and humanistic therapies, and describe the techniques used in exposure therapies and aversive conditioning. Behavior Therapy
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71.1 – Explain how the basic assumption of behavior therapy differs from those of psychodynamic and humanistic therapies, and describe the techniques used in exposure therapies and aversive conditioning. Behavior Therapy • Behavior therapy proposes that psychological problems originate from learned behaviors. Behavior therapists believe that learned behaviors that contribute to psychological problems can be unlearned. By addressing these problematic learned behaviors, the behavioral therapist can teach his or her client new, more effective learned behaviors. This type of therapy is based on the principles of the behavioral and social-cognitive approach, incorporating the ideas of John B. Watson, Ivan Pavlov, B.F. Skinner, and Albert Ellis. The process of behavioral therapy would take the approach in the following steps: • A behavior therapist first establishes a productive client-therapist relationship. • The therapist identifies negative thoughts and behavior, which may have contributed to the client’s psychological problems. • The therapist then becomes a teacher, or mentor, demonstrating positive learning techniques, which will counteract the client’s present thoughts and actions. • The therapist continues to monitor the client’s progress, checking and reevaluating the techniques, providing helpful suggestions and words of encouragement.
71.1 – Explain how the basic assumption of behavior therapy differs from those of psychodynamic and humanistic therapies, and describe the techniques used in exposure therapies and aversive conditioning. Behavior Therapy • These are different versions of behavioral therapy. Behavior therapy utilizes the principles of classical conditioning. Another version, behavior modification, focuses on the principles of operant conditioning, and a third type, cognitive-behavior therapy, addresses both thoughts and behaviors associated with the problem.
71.1 – Explain how the basic assumption of behavior therapy differs from those of psychodynamic and humanistic therapies, and describe the techniques used in exposure therapies and aversive conditioning. Behavior Techniques Emphasizing Classical Conditioning • Ivan Pavlov demonstrated that a dog, through repeated pairings, could learn to associate the ringing of a bell with food, which would eventually results in the dog’s responding – through salivation – solely to the bell. Behavioral therapists believe that association learning does not occur only between natural and unnatural stimuli, but also between stimuli and emotional reactions. For example, Watson was able to show that fear could be conditioned, as demonstrated with “Little Albert”. Albert developed a fear of a rat, which he originally did not view as threatening, through repeated pairings with a loud noise, a natural fear-evoking stimulus. Albert not only developed a fear of the rat from associating it with the loud noise, but also a fear of any stimuli that resembles the rat, referred to as stimulus generalization.
71.1 – Explain how the basic assumption of behavior therapy differs from those of psychodynamic and humanistic therapies, and describe the techniques used in exposure therapies and aversive conditioning. Behavior Techniques Emphasizing Classical Conditioning • Watson never tried to suppress Little Albert’s fears. Psychologist Mary Cover Jones contemplated whether a learned fear could be reversed. Jones worked with a little boy named Peter, who was fearful of all furry animals, especially rabbits. Jones used a process called counterconditioning, the learning of a new conditioned response that is the opposite of the original learned response. In order to establish this new conditioned response, Jones conducted a series of steps. She brought the rabbit, in a cage, into the room, far away from Peter but visible to him. Next she gave Peter his favorite snack, milk and crackers. Jones believed that if Peter were to associate a positive feeling, form eating milk and crackers, with the established, original response of fear associated with the rabbit, that would help to counteract the fear. For about two months, Jones worked with Peter to establish this new response. Jones also used observational learning techniques to help Peter overcome his fear by having him observe other kids playing harmlessly with rabbits. Each day the rabbit was brought closer as Peter ate mile and crackers and observed others playing with rabbits. Eventually Peter was able to hold the rabbit while eating his favorite snack. Peter was able to hold the rabbis because he learned to associate the pleasant feelings of his snack with the rabbit. Jones is acknowledged as one of the first behavioral therapists because of her success with Peter. She paved the way for other behaviorists by demonstrating how counterconditioning could eliminate learned fears.
71.1 – Explain how the basic assumption of behavior therapy differs from those of psychodynamic and humanistic therapies, and describe the techniques used in exposure therapies and aversive conditioning. Systematic Desensitization and Exposure Techniques • Joseph Wolpe developed systematic desensitization to treat phobias and other anxiety disorders. Systematic desensitization involves gradual learning of a new conditioned response that will replace, or inhibit, an established maladaptive response such as fear or anxiety. There are three progressive steps involved in this process. • The patient experiences progressive relaxation, the process of increasing relaxation throughout the body in the presence of a fearful stimulus, as he or she is taught to relax each muscle of his or her body. • The patient is then asked to identify and generate a list of all images or stimuli associated with the anxiety-provoking stimulus. The patient ranks these images and thoughts in an anxiety hierarchy, ranging from most to least stressful. The patient is also asked to image a relaxing moment, referred to as a control scene, to help him or her relax when anxiety arises. • The actual process of desensitization involves having the patient, while relaxed, first imagine the least stressful image on the anxiety hierarchy; then, as long as he or she is still relaxed, he or she goes to the next image. If anxiety arises at any point as the patient progresses through the anxiety hierarchy, the patient is told to think about the control scene.
71.1 – Explain how the basic assumption of behavior therapy differs from those of psychodynamic and humanistic therapies, and describe the techniques used in exposure therapies and aversive conditioning. Once the patient is able to reach the top of the anxiety hierarchy, the therapist will start to introduce the actual feared stimulus. If the patient doesn’t exhibit fear, then he or she has acquired a new response – relaxation and comfort – instead of the original maladaptive response. Observational learning is also used to demonstrate that other people are not experiencing harm or discomfort when interacting with the feared object.
71.1 – Explain how the basic assumption of behavior therapy differs from those of psychodynamic and humanistic therapies, and describe the techniques used in exposure therapies and aversive conditioning. A recent application of systematic desensitization, virtual reality graded exposure, allows clients to experience their fears in a controlled computerized setting without a real-world context. Clients prefer this simulated gradual exposure because they find it prepares them for later real-world exposure.
71.1 – Explain how the basic assumption of behavior therapy differs from those of psychodynamic and humanistic therapies, and describe the techniques used in exposure therapies and aversive conditioning. Exposure techniques involve direct exposure to the feared image or event. The patient is positioned in a room face-to-face with the object he fears without the chance of escape, but the patient is never put in real danger. This process is referred to as flooding, which produces constant exposure to the feared object. After being constantly exposed to the object, the patient learns that nothing harmful will occur. Flooding is similar to going right to the highest step on the anxiety hierarchy in systematic desensitization as a result, some people may find it too stressful, preferring a more gradual approach.
71.1 – Explain how the basic assumption of behavior therapy differs from those of psychodynamic and humanistic therapies, and describe the techniques used in exposure therapies and aversive conditioning. Aversion Conditioning • Aversion conditioning is also based on the principles of classical conditioning. Aversion conditioning involves pairing a harmful stimulus with an unpleasant stimulus, a distasteful substance. For example, when a person takes Disulfiram (a drug used in aversion conditioning) and then consumes alcohol, he or she ends up nauseous. The purpose is to have the patient associate nausea (conditioned response) with the alcohol, which hopefully will result in him or her no longer wanting to consume alcohol. Aversion conditioning has not provided as successful as once hoped, as results have only been temporary. The popularity of aversion conditioning has declined because clients often find the process uncomfortable.
71.2 – State the main premise of therapy based on operant conditioning principles, and describe the views of its proponents and critics. • Operant conditioning is the belief that behavior is shaped trough followed consequences. In turn, behavioral modification therapists believe that maladaptive behavior can also be modified through consequential actions. Positive reinforcement and extinction are tow operant terms that have been applied to the behavioral modification process. Positive reinforcement is the presentation of a pleasant stimulus after a desired behavior is performed, increasing the chances of that behavior being repeated. For example, token economies operate on the principles of operant conditioning, specifically using the concept of positive reinforcement. In a token economy, a person is given a token for every desire behavior performed. The tokens can be collected and later used to buy snacks, magazines, or other desirable merchandise. Token economies are often used with severely mentally disabled individuals or in institutional settings, such as rehabilitation centers.
71.2 – State the main premise of therapy based on operant conditioning principles, and describe the views of its proponents and critics. • Extinction is another operant technique that is used to extinguish or stop a given undesirable behavior. For example, most people continue to perform an action because they are being rewarded after the behavior. A student may continue to disrupt a class because the student earns laughter and applause from other students, which reinforces the nondesired distraction. Nonreinforcement decreases the undesirable behavior by not providing the expected reinforcement. Parents are told that ignoring a child who is having temper tantrums will decrease the tantrums; showing the child a lot of attention during the tantrum will encourage further bad behavior.
71.2 – State the main premise of therapy based on operant conditioning principles, and describe the views of its proponents and critics. • Punishment, based on the premise of operant conditioning, involves the presentation of an unpleasant stimulus in response to an undesirable behavior, which reduces the chances that the behavior will be repeated. For example, if a child throws a toy in anger (undesirable behavior), the parent is told to raise his or her voice and correct the child (unpleasant stimulus).
71.3 – Discuss the goals and techniques of cognitive therapy and of cognitive-behavioral therapy. Cognitive-Behavior Therapy • Behavioral therapists understand that causes of many disorders are linked to different styles of thinking. Cognitive behavioral therapy utilizes learning principles to change people’s negative thought patterns. When an individual is made aware of certain thoughts that cause him or her to act in a certain way, his or her behavior then can be modified to it is more productive. In other words, clients are taught that thoughts are responsible for negative and positive actions.
71.3 – Discuss the goals and techniques of cognitive therapy and of cognitive-behavioral therapy. Rational-Emotive Behavior Therapy • Albert Ellis developed rational-emotive behavior therapy (REBT), based on the belief that distorted expectations and irrational beliefs contribute to psychological disorders. He said that individual are under the belief that external events are responsible for how they feel. However, he stated that it is not the external event, but the interpretation of such events, that leads to feelings of despair. This view is explained to clients through the “ABC” model: A = activating event, B = belief, C = consequences. • A = Activating Event – the individual can’t find a date for the prom. • B = Belief – “I guess nobody likes me enough to go with me to the prom”. • C = Consequences = Feelings of depression.
71.3 – Discuss the goals and techniques of cognitive therapy and of cognitive-behavioral therapy. Rational-Emotive Behavior Therapy • In this example, common sense would say that most people would attribute depression (consequence) to not finding a date for the prom (activating event”. But Ellis would suggest that most people are unaware that depression (consequence) actually is the result of their believing that “nobody likes me enough to go with me to the prom”. In therapy session, Ellis, is a supportive fashion, would explain this to the client, providing him or her with other reasons why he or she doesn’t’ have a date for the prom. For example, maybe other people assumed that person already had a date. Once Ellis was able to make the client aware of these self-defeating thinking patterns and other possible reasons for the outcome, the client would then try to use a more rational, more productive interpretation of all activating events. • Rational-emotive behavior therapy is a popular method because clients find it simple and understandable. It has been effective for people dealing with depression, phobias, and other anxiety disorders.
71.3 – Discuss the goals and techniques of cognitive therapy and of cognitive-behavioral therapy. Cognitive Therapy • Aaron T. Beck, who originally trained as a psychoanalyst, developed cognitive therapy (CT). Cognitive therapy is based on the idea that people have developed cognitive distortions, distorted perceptions, and interpretations of events that contribute to psychological disorders, especially depression and anxiety. He believed that clients tend to “blow out of proportion” outcomes of events. For example, a person may interpret failing a test to mean that as a result he or she will never get into college. In addition, clients tend to overpersonalize events: “Everybody is going to think I’m not smart”.
71.3 – Discuss the goals and techniques of cognitive therapy and of cognitive-behavioral therapy. Cognitive Therapy • Cognitive therapy is a directive approach. Clients are taught not only to identify negative thoughts, but also to actually go out and test those negative beliefs. For example, a client who believes that nobody likes him will be instructed to engage in conversations with other people. He will then be asked to report back with a log of his experiences. The therapist will build on any positive encounters, successful at making friends. If the client had been unsuccessful, the therapist would address the reasons why, identifying any negative beliefs, while providing a more rational viewpoint or explanation.
71.4 – Discuss the aims and benefits of group and family therapy. Group Therapy • Individualized psychotherapy provides a personal relationship between client and therapist, allowing the therapist to focus his or her attention solely on the client. However, the therapist is only able to gain information based on what the client is stating. The therapist is not able to see how the client interacts with other people. Group therapy allows one or more therapists to work with several people at the same time, observing social and interaction skills. Many health clinics and therapeutic practices have a group therapy session as part of their practice. Group therapy offers several advantages. Therapists are able to work and observe interaction skills among several people (usually experiencing the same problem); it is cost effective for the group’s members; and, most important, participants are able to gain support from listening and receiving advice from other members. Participants can empathize with other group members, relating to what they are going through, while also sharing, through personal revelations, what has been successful for them. Group members tend to listen more attentively, understanding that other members have experienced similar problems.
71.4 – Discuss the aims and benefits of group and family therapy. Group Therapy • Group therapy is administered and run by a trained mental health professional, while non-health professionals tend to direct support and social groups. A therapist may recommend a social support group, in addition to group therapy, to offer further support and build client confidence. For example, some clients find comfort in the presence of others who have had the same experiences. Family therapy focuses not so much on the individual as in group therapy, but on how each member of the family contributes to the family structure. The aim of family therapy is to make each member aware of how he or she is part of the family and, in turn, how he or she may be contributing to the problem. Family members are allowed to express their concerns and opinions in a constructive and controlled setting.
71.4 – Discuss the aims and benefits of group and family therapy. Group Therapy • Marital and couples therapy is similar to family therapy. During marital or couples therapy each person is made aware of the other person’s concerns and the partners discuss how they could improve the relationship. Communication skills, intimacy, and problem-solving skills are all addressed.
