Transcript Behavioral and Cognitive Therapies

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