Transcript Pomerantz chapter 14 ppt

Chapter 14
Behavioral Psychotherapy
Behavioral Psychotherapy

Behavioral therapy represents a reaction
against the lack of empiricism inherent in
psychodynamic and humanistic approaches

A reaction against mental processes that can’t be
precisely defined, directly observed, or
scientifically tested
Origins of Behavioral
Psychotherapy


The clinical application of behavioral principles
Roots of behaviorism include



Ivan Pavlov’s classical conditioning studies with
dogs in Russia
John Watson’s efforts to bring classical
conditioning to U. S.
B. F. Skinner’s and E. L. Thorndike’s studies of
operant conditioning
Goal of Behavioral
Psychotherapy


The primary goal of behavioral psychotherapy
is observable behavior change
No emphasis on internal, mental processes

In contrast to previous approaches (e.g.,
psychodynamic and humanistic)
Goal of Behavioral
Psychotherapy (cont.)

Emphasis on empiricism


Study of human behavior should be scientific
Clinical methods should be scientifically evaluated
via testable hypotheses and empirical data based
on observable variables

For example, baseline measures of problem behavior at
outset; subsequent measures after some therapy
Goals of Behavioral
Psychotherapy (cont.)
Steps of the Scientific Method
How Applied by Behavioral Therapists
1. Observing a phenomenon
●
Assessing client behavior via observation, interview, or testing
●
Defining a target behavior
●
Establishing a baseline level of target behavior
●
Functional analysis of target behavior to determine the factors that
2. Developing hypotheses to explain the
phenomenon
3. Testing the hypotheses through
cause or influence it
●
Establishing specific behavioral goals for treatment
●
Planning interventions to alter behavior in preferred manner
●
Implement interventions as planned
●
Collect data on changes in the target behavior
●
Compare data collected during or after treatment to baseline data
●
Compare data to goals
●
Modify treatment plan as suggested by observed outcomes
●
Restart scientific process with revised hypotheses
experimentation
4. Observing the outcome of the tests
5. Revising the hypotheses
Goal of Behavioral
Psychotherapy (cont.)

Defining problems behaviorally


Client behaviors are not symptoms of some
underlying problem—those behaviors are the
problem
Behavioral definitions make it easy to identify
target behaviors and measure changes in therapy

Clients’ own definitions can be very hard to assess or
measure
Goal of Behavioral
Psychotherapy (cont.)

Measuring change observably


Other kinds of therapists may measure change in
clients in more inferential ways, but behavioral
therapists use more unambiguous indications of
progress
Introspection is not an acceptable way to measure
progress—not directly observable
Two Types of Conditioning

Classical conditioning




Exemplified by Pavlov’s dog studies
UCS evokes UCR
UCS and CS are paired (occur together)
CS evokes CR


CR is essentially the same as UCR, but in response to CS
Generalization or discrimination to similar stimuli
may take place
Two Types of Conditioning
(cont.)

Operant conditioning



The organism “operates” on the environment,
notices the consequences of the behavior, and
incorporates those consequences into decisions
regarding future behavior
More active style of learning than classical
conditioning
Contingencies, or internal “if…then…” statements,
are the product of operant conditioning
Techniques Based on
Classical Conditioning

Exposure therapy

Systematic desensitization

Assertiveness training
Techniques Based on
Classical Conditioning (cont.)

Exposure therapy



Version of “facing your fears”
Often used to treat anxiety disorders
Client is repeatedly “exposed” to the feared object
and the expected aversive outcome does not take
place  client no longer experiences the fear
response
Techniques Based on
Classical Conditioning (cont.)

Exposure therapy (cont.)


Exposure is typically gradual (“graded”
exposure), following an anxiety hierarchy
Exposures can be imaginal or in vivo (real)
Techniques Based on Classical
Conditioning (cont.)

Exposure therapy (cont.)

Exposure-plus-response-prevention is a particular
form of exposure with empirical evidence in the
treatment of OCD

Anxiety hierarchy
Stimulus
Hearing a dog bark in another room
Subjective Distress (0 = No Fear; 100 = Maximum Fear)
5
Standing within 20 feet of a dog on a leash
25
Standing within 5 feet of a dog on a leash
45
Petting a dog for 1 second
65
Petting a dog continuously for 10 seconds
75
Petting a dog continuously for 3 minutes
95
Techniques Based on Classical
Conditioning (cont.)

Systematic desensitization


Often used for phobias and other anxiety
disorders
Similar to exposure therapy, but relaxation
training is included
Relaxation is incompatible with anxiety
 Counterconditioning occurs when relaxation
response replaces anxiety response

Techniques Based on Classical
Conditioning (cont.)

Assertiveness training

A specific application of classical conditioning that
targets clients’ social anxieties


Includes elements of exposure and systematic
desensitization


Benefits people whose timidity negatively influences
their lives
Facing interpersonal fears
Includes direct instructions, modeling, rehearsal,
and homework
Techniques Based on
Operant Conditioning






Contingency management
Extinction
Token economies
Shaping
Behavioral activation
Observational learning (or modeling)
Techniques Based on
Operant Conditioning (cont.)

Contingency management

Powerful way to change behavior  change
the contingencies controlling it


If consequences change, behavior changes
Reinforcement and punishment should be
identified and altered as needed
Reinforcement is typically preferred over
punishment
 Aversion therapy is one type based on
punishment of unwanted behavior

Techniques Based on Operant
Conditioning (cont.)

Extinction



Removal of an expected reinforcement that
results in decreased frequency of a behavior
Effective way to decrease unwanted behaviors
Initially, can cause extinction burst (an increase in
unwanted behavior), but ultimately, if
reinforcement is still withheld, decrease will occur
Techniques Based on Operant
Conditioning (cont.)

Token economies

Setting in which clients earn tokens for
participating in predetermined target
behaviors


Tokens can be traded for reinforcements
Most feasible in sites where behavior is
continuously monitored

e.g., Inpatient unit, correctional facility
Techniques Based on Operant
Conditioning (cont.)

Shaping



Reinforcing successive approximations of
the target behavior
Reward each “baby step” toward the
desired behavior
Best for changing behaviors that are
complex, challenging, or novel for client
Techniques Based on Operant
Conditioning (cont.)

Behavioral activation


Based on simple idea that depressed
people lack positive reinforcement
Goal is to increase frequency of positively
reinforcing behaviors


Structured daily routine including rewarding
behaviors (recalled from non-depressed time)
May have classical conditioning
components too
Techniques Based on Operant
Conditioning (cont.)

Observational learning (or modeling)


Learning from the contingencies applied to other
people
Client observes demonstration of desired behavior
and its consequences  client given chances to
imitate it


Both imitation and vicarious learning can occur
Certain qualities of the model influence
effectiveness of observational learning

For example, similarity to client increases learning
Alternatives to Behavior
Therapy

Behavioral consultation



Indirect way for a behavior therapist to
modify a client’s behavior
Three parties involved: the client, the
consultee, and the consultant (therapist)
Consultee spends significant time in natural
setting with client

e.g., Parent, caretaker, manager
Alternatives to Behavior
Therapy (cont.)

Parent training



Specific form of behavioral consultation
Parents seek help with problematic behaviors of
their children
Teacher training


Specific form of behavioral consultation
Teachers seek help with problematic behaviors of
their students
How Well Does Behavioral
Therapy Work?

Behavioral therapies have a significant
amount of empirical support, especially
in comparison to most other forms of
therapy


Especially for anxiety disorders, depression,
and children’s behavior disorders
May also be most empirically testable forms
of therapy