Behavioral and Cognitive Therapies

1. Behavioral and Cognitive Therapies Information in this presentation is taken from UCCP Content

2. Behavioral and Cognitive Therapies While psychodynamic and humanistic therapies focus on gaining insight into one’s thoughts and feelings, behavioral and cognitive therapies focus on changing problematic behaviors and not on uncovering the root cause of those behaviors. The behavioral and cognitive approaches largely rely on approaches introduced by learning theorists such as John Watson, B.F. Skinner and Ivan Pavlov. These types of therapy emphasize the scientific process by using techniques such as classical or operant conditioning, and deemphasize the role of underlying or inferred variables by focusing on behaviors or on cognitions about behaviors.

3. Behavioral Therapy Because behavioral therapies are derived from learning theory and rely on conditioning techniques, they are most effective when used to eliminate specific unwanted behaviors. They are particularly useful in treating phobias, which are persistent, irrational fears about objects or situations. In recent years, behavioral therapists have become increasingly integrative in their techniques. Most therapists use a variety of techniques and use them not only with different patients but also for the same patient at different points in the treatment process. Thus, while each of these techniques can serve a specific purpose, they are also complementary and may be most effective when used together.

4. Techniques in Behavioral Therapy There are two basic clusters of behavioral therapy: those that use classical conditioning techniques and those that use operant conditioning techniques. We will discuss three types of therapies utilizing classical conditioning techniques. Classical conditioning techniques involve pairing the unwanted behavior (e.g. nail biting, fear of heights) with a new response that gradually overtakes the original response. Therapies that utilize classical conditioning theory: 1. Systematic Desensitization 2. Implosive Technique 3. Aversive Technique

5. Systematic Desensitization The most well known of the classical conditioning techniques is systematic desensitization. This technique is used to reduce anxiety, and was developed from the basic idea that it is impossible to be both relaxed and anxious at the same time. The protocol involves introducing a stimulus which evokes anxiety to patients when they are in a relaxing, pleasurable state. Thus, this procedure counter-conditions relaxation to situations that originally produced anxiety.

6. Systematic Desensitization While this method seems to be a very simple conditioning process in which the patient takes a passive role, this may not be the case. Aspects of the therapist-patient interaction and patients’ expectations of the treatment both seem to affect the outcome of treatment. When patients expect that systematic desensitization will help them overcome their problematic fears or behaviors they consistently show more improvement than patients who aren’t as optimistic. In a study of the treatment of snake phobias, researchers found that systematic desensitization worked best when the therapist used reinforcing comments like “Excellent,” and “You’re doing fine,” when patients were able to visualize a snake scene without anxiety and made progress in approaching a snake in practice sessions.

7. Implosive Therapy Technique A second technique that is similar to systematic desensitization in its theoretical underpinnings, yet differs dramatically in practice, is implosive therapy. The basic idea of this sort of therapy is that people who have chronic unreasonable fears have not been able to learn that the object or situation they are afraid of is actually harmless because they avoid exposure to the source of their fear. Thus, according to this perspective, patients only need to encounter and remain in the feared situation to realize that their fears are unfounded. The anxiety reaction to the situation should then be extinguished because it was not reinforced with any actual negative events.

8. Implosive Therapy Technique In start contrast to systematic desensitization, implosive therapy does not take small steps in building up to the feared event – rather it “floods” the patient with the negative stimuli and maximizes their emotional arousal to the situation. Therapists using this technique report excellent results. Implosive therapy is not to be taken lightly – it should only be performed by trained professionals who have determined the patient is a good candidate for such treatment. Trying to cure a friend’s phobia about dogs by pushing them into a room full of friendly canines could potentially be harmful to their emotional state!

9. Aversive Therapy Technique The most controversial of the behavioral therapy techniques is aversive conditioning which tries to rid the patient of a negative behavior by pairing that behavior with a negative consequence. Basically, the many procedures used with this therapeutic technique involve punishing the undesirable behavior to create a negative association with the behavior.

10. Aversive Therapy Technique This type of therapy is identical in principle to that of giving a “time-out” or a spanking to a misbehaving child. However, the application of this type of therapy should differ from the typical parent-child conflict. First the aversive agent, or punishment, should be administered very systematically such that it is always given immediately following the negative behavior. Second, the punishment should be consistently applied - every time the negative behavior is demonstrated it should be met with the punishment. Often parents are unable to punish children immediately or consistently, thus children may learn that they can “get away” with the behavior, and thus continue to misbehave.

11. Aversive Therapy Technique This technique has been called into question because of the nature of many of the aversive agents used. Therapists have paired electric shocks, nausea-inducing medication, and shaming with negative behaviors, and many critics argue that these agents may violate patient dignity and are closer to torture than therapy. Others believe that aversive techniques have merit and if used in a sensitive fashion can be helpful to patients. Overall, these types of techniques are generally used only after many other types of therapy have failed, and are used to treat seriously debilitating problems such as alcoholism or drug addiction.