BEHAVIOUR THERAPY

PSYCHOTHERAPY:

Psychotherapy is the treatment by psychological means, of problems of an emotional nature,

in which a trained person deliberately establishes a professional relationship with the patient
with the object of:

 Removing , modifying or retarding existing symptoms

 Mediating disturbed patterns of behavior

 Promoting personality growth and development (Wolberg, 1977).

BEHAVIOUR THERAPY:

It‟s a type of Re educative Therapy. It uses psychotherapeutic techniques which are aimed at
altering maladaptive or unwanted behaviour patterns, especially through the application of
principles of conditioning and learning.

The basic assumption being that most forms of mental disorder can be interpreted as
maladaptive patterns of behaviour, that these patterns result from learning processes, and the
appropriate treatment involves the unlearning of these maladaptive patterns of behaviour and the
learning of new ones.

Behaviour therapy emerged as a technology of behavior change in the 1930‟s and is considered
an important milestone in the development of psychology as a behavioral science. Its adherence
to principles of learning distinguishes it from other approaches to behavior change. It includes all
those procedures which are derived from or at least consistent with the findings of experimental
psychology, particularly in the field of learning (Chesser, 1970). Its primary focus is on the
present behavior, therefore, it is considered as „here-and-now‟ approach.

Increasing dissatisfaction with the traditional models of psychopathology, such as

psychoanalysis or human existentialism, and their questionable theoretical validity and practical
ineffectiveness, created a fertile ground for the development of behaviorism. In this context,
behavior therapy emerged as a powerful movement in conceptualizing the treatment of behavior
pathology. It has influenced not only the contemporary practice of clinical psychology, social
work, and other human services but, also revolutionized our current understanding of
psychopathology of human behavior. Introduction of sophisticated techniques of observation and
analysis has expanded our understanding in many unexplored areas of human behavior.
Behavior analysts‟ prime concern is to analyse the behavior-environment relationship and
reprogramme the interaction in a manner that facilitates development and sustains desirable
responding.

In contemporary scientific literature, terms like „behaviour therapy‟, „behaviour modification‟,

and „applied behavior analysis‟ are often used interchangeably, although there are finer
paradigmatic differences in conceptualization of the analysis of behavior in terms of cause and
effect relationship. Here paradigm refers to the constellation of beliefs, values, techniques and so
on, shared by the members of the scientific community (Kuhn, 1970). The behavior analysts
primarily focus on the environmental variable that include the antecedents (A), behavior (B), and
its consequences (C), popularly known as the A-B-C paradigm, or three term contingency.
Modern behavior therapists have expanded it to include the organismic variable (O) also. It is
symbolically stated as the „A-O-B-C paradigm‟ (Paniagua and Baer,1981).

Learning theories alone does not provide the adequate foundation to the current development of
behavior therapy. Modern behavior therapists incorporate knowledge from diverse disciplines.
Therefore, it has attained an eclectic quality. Based on these observations, one may make the
following assumptions about behavior therapy:

1. Behavior therapy is an empirical approach

2. Most behavior is learned, and therefore cannot be unlearned
3. Maladaptive behaviors are learned in the same manner as adaptive ones
4. Historical account of development of problem behavior is less relevant than the present
ones
5. Behavior therapy rejects the assumptions of traditional trait theory (Eysenck 1959)

The methods used in behavior therapy are tailored and adapted to the situation and the individual
client. The same behaviors may have quite different learning histories, therefore, they require
different treatments too. Thus individualized behavior analysis is considered as a prerequisite for
behavioral intervention.

HISTORICAL PERSPECTIVE:

Behavior therapy has a long past but a short history. Glimpses of its guiding principles have been
found in the Vedic tradition of treatment and in the writings of Upanishads, the most ancient
literature of the world (Singh and Oberhummer 1980). Many Buddhist treatments of klesha
(psychological stress), have close similarity with modern techniques of behavior modification

Behaviorism as an active philosophy of human behavior is a product of the 20th century. The
roots of behavior therapy lie in the behaviorism of John.B.Watson. He highlighted the role of
learning in shaping behavior.
The classical experimental work on behavior therapy originated in laboratory experimentation of
Bekhterew (1912) in former Soviet Union. The scientific optimism attached to behavior change
was then closely connected with explorations in the field of conditioning of animal behavior.
Although as early as 1920, Watson and Rayner, demonstrated experimental induction and
elimination of fear in a young child, the scope of behavior modification was much restricted until
Pavlov (1927), developed the classical conditioning theory. He conducted a series of experiments
on animals. It broadened the base of behavioral explanation of psychopathology. He explained
that conditionability is the function of the strength, that is the excitability of the nervous system.
Behavior problems were considered as the consequences of disorders in two basic central
processes- excitation and inhibition. These are adversely affected when there is either (i) intense
stimulation, (ii) increased delay between conditional and unconditional stimulus, and (iii)
simultaneous occurrence of positively and negatively conditioned stimuli.

During 1930‟s, various childhood problems were being successfully treated with behavior
therapy such as tics (Dunlap 1932), stuttering (Moore 1938), and enuresis (Morgan and Whitmer
1939; Mowrer and Mowrer 1938). Warren and Brown (1943) directed behavioral analysis to the
learning of young normal children. Fuller (1949), and Ferster and DeMyer (1961), tried to apply
behavior analysis to young autistic children.

Krasner(1971) traced out three distinct origins of behavior therapy. The first was that of
Lindsley, Skinner and Solomon‟s (1953) work that used the term „behaviour therapy‟. They
applied operant conditioning techniques to hospitalized clients. Second, in 1958 when Joseph
Wolpe, developed the concept of „reciprocal inhibition‟ as a procedure for dealing with
maladaptive autonomic responses like anxiety, by following Pavlovian and Hullian models of
conditioning. Third, when Lazarus (1958) used the term „behaviour therapy‟ referring to the
application of objective techniques designed to inhibit neurotic patterns.

About a year later, in 1959, Eysenck defined it as a method of treatment derived from modern
learning theory. He extended Pavlov‟s basic concept of types of nervous system to a two-
dimensional theory of personality. Through experimental works he explained learning efficiency,
that is conditionability as a function of the personality type such as introversion and extraversion.

BASIC PRINCIPLES OF LEARNING USED IN BEHAVIOUR THERAPY:

• Reconditioning: the process of again pairing the conditioned stimulus and unconditioned
stimulus after extinction.

• Spontaneous recovery: after an interval of time, an increase in the strength of a conditioned

response which had undergone extinction.

• Experimental extinction:
In operant conditioning, behavior that has been previously reinforced is no longer reinforced and
the behavior gradually stops occurring.

In classical conditioning, when a conditioned stimulus (bell/fearful object) is presented alone, so

that it no longer predicts the coming of the unconditioned stimulus (food/relaxation), and
conditioned responding (salivation/anxiety) gradually stops.

Stimulus - Response bond

• Conditioned stimulus (CS): neutral stimulus- which does not evoke a specific response

• Unconditioned stimulus (US): stimulus which consistently evokes a response

• Unconditioned response (UR): response that follows the unconditioned stimulus

• Conditioned response (CR): response that is learned in conditioning

Stimulus – response bond in Classical conditioning:

CS (bell) R (looking)

US (food) UR (salivation)

CS (bell) + US (food) UR (salivation)

Followed by

CS (bell) CR (salivation)

Pavlov noted that no saliva flowed when just the bell rang. Initially on the sound of the bell (CS),
dog looked at it (R). Presentation of only the food (US) produced salivation (UR). Next, on
pairing the sound of the bell (CS) with presentation of food (US) produced salivation (UR). After
a number of pairing trials, when just the sound of bell (CS) was produced without being followed
by food (US), it was found that salivation (CR) was produced. This way learning process took
place, which was termed as classical conditioning.

 Stimulus generalization: the tendency to react to stimuli that are different from, but
somewhat similar to, conditioned stimulus.

 Discrimination: the process of learning to make one response to one stimulus and different or
no response to another stimulus.

 Desensitization: rapid repetition of the stimulus and response with or without reinforcement.

 Counterconditioning: Mary Cover Jones (1924).

It is done by affiliating a different, opposing and incompatible response with the conditional
stimulus, followed by direct reinforcement of the opposing response.

 Punishment: the application of an unpleasant stimulus for the purpose of suppressing

behavior.
 Avoidance conditioning:

Hobard Mowrer (1960) who introduced two-factor theory focused on the interplay of classical
and operational contingencies and on this basis explained avoidance conditioning.

1. Based on the classical conditioning principles, an animal learns to fear a buzzer because it is
paired with a shock. This conditioned fear is called anxiety.

2. Based on the operant conditioning principles an animal learns to avoid a source of fear. To
avoid shock it runs away. Because a buzzer is paired with a shock, an animal learns to escape
from a harmless stimulus, from a buzzer.

It is called conditioned avoidance. Escape weakens fear and a response is reinforced by

consequences.

BASIC PROCEDURES –

• Desensitization
• Extinction
• Punishment
• Counterconditioning

THE ASSUMPTIONS OF BEHAVIOUR THERAPY:

• BT tends to concentrate on maladaptive behaviour itself, rather than on some presumed

underlying cause.

• BT assumes that maladaptive behaviours, are to a considerable degree, acquired through

learning, the same way that any behaviour is learned.

• BT assumes that psychological principles, especially learning principles, can be extremely

effective in modifying maladaptive behaviour.

• BT involves setting specific, clearly defined treatment and goals.

• The behaviour therapist adapts his method of treatment to the client‟s problem

• BT concentrates on the here and now

• Any technique subsumed under the label BT have been subjected to emperical test and have
been found to be relatively effective.
GOALS OF THERAPY:

• Client specifies positive changes that he/she wants from counseling

• Focus on what client wants to do rather than what client does not want to do

• Client has ownership of goals

• Client and counselor see if goals are realistic

• Define the goals in concrete terms; target behaviors

• Discuss behaviors associated with the goals; antecedents and consequences

• A plan of action to work towards the goals

THERAPIST ROLE AND FUNCTION:

• Get information about antecedents, dimensions of the problem, and consequences

• Clarify the problem

• Design a target behavior

• Formulate goals with client

• Identify maintaining conditions

• Implement a change plan/intervention

• Evaluate the intervention; formative and summative

BEHAVIOURAL DIAGNOSIS:

Seven stage analysis for conducting behavioural diagnosis (Kanfer and Saslow, 1969):

• Initial analysis of problem situation – prioritization of target behaviours and study of

situations that elicit and sustain target behavior. Behavioural deficits, excess and assets are
identified.
• Clarification of problem situation- how the problem behavior is perceived by others and how
do they respond to them.
• Motivational analysis – analysis of reinforcement and punishment history that maintain the
problematic behavior of the client.
• Developmental analysis – any associated physical disorders or biological deviations and
limitations. Socio-cultural background and peer influences.
• Analysis of self control – client‟s ability to control his behaviour and significant others who
can control his behaviour.
• Analysis of social relationships – behavior of other people in client‟s environment.
• Analysis of the social-cultural-physical environment – behavior of the client in different
social settings like school, occupation, etc.

BEHAVIOURAL ASSESSMENT:

• Defining target behaviour - objectively defined behaviour

• Checklists – to assess behavioral adequacies in different areas of functioning

• Self-assessment – evaluation of change in severity and intensity of behavior by the client

himself

• Direct behavioural observation – by the therapist and in different settings.

TECHNIQUES OF BEHAVIOUR THERAPY:

RELAXATION: Jacobson (1938)

It‟s a self control procedure that requires the client to develop a set of responses to modify
autonomic arousal. (counterconditioning)

Procedure:

• I. Make the patient in a comfortable position or lie down straight

• II. Provide dim light
• III. Give a brief explanation about the progressive muscle relaxation
• IV. Instruct the client to tense each muscle group approximately for 10-15 seconds
• V. Explain the tension of the muscle and uncomfortable the body part feels
• VI. Ask the client to relax each muscle (15-20 seconds)
• VII. Make client to feel the difference between both the situation

• Starts with fist, forearm, wrist, arms.

• 2nd – head (back, top), eyebrow, eyes, cheeks
• 3rd – tongue, jaw, lips, neck
• 4th – shoulder, back, thorax, abdomen
• 6th – thighs and legs

• Each step is practiced twice

Automatic relaxation of respiratory muscles takes place with normal exhalation. The autonomic
effects that accompany deep relaxation are diametrically opposed to those characteristic of
anxiety.
SYSTEMATIC DESENSITIZATION:

Wolpe, 1958

It can be explained through 3 theories:

Reciprocal inhibition: (Joseph Wolpe 1958)

If a response inhibiting anxiety can be made to occur in the presence of anxiety evoking stimuli,
it will weaken the bond between these stimuli and the anxiety.

Habituation theory: the waning of a response to a stimulus due to its repeated presentation.

Cognitive theory: lowering of physiological arousal in presence of anxiety-provoking stimulus

enhances the client‟s belief that he/she can cope with the phobic situation.

• Phobias
• Obsessive compulsive disorder
• Sexual disorders
• Anxiety disorder

It is employing a counteracting emotion to overcome an undesirable emotional habit step by step.

Steps:

A) Relaxation training

B) The construction of anxiety hierarchies (Establishment of the use of a scale of subjective

anxiety (SUD: 0-100)

C) Counterposing relaxation and anxiety-evoking stimuli from the hierarchies: an anxiety

hierarchy is a list of stimuli on a theme, ranked according to the amount of anxiety they
evoke.

The subjective anxiety scale: the scale is introduced to the patient by addressing him as follows:
“think of the worst anxiety you have ever experienced, or can imagine experiencing, and assign
to this the number 100. Now think of the state of being absolutely calm and call this zero. Now
you have a scale of anxiety. On this scale how do you rate yourself at this moment?”

Scenes (imaginary) in session – 8-10

Duration of scene – 5 seconds
Interval between scenes – 10-20 seconds

The idea is that the phobic object or the situation is conditioned stimulus that the client has
learned to fear because it was originally paired with a real fearful stimulus.
By pairing the old conditioned stimulus with a new relaxation response that is compatible with
the emotions and the physical arousal associated with the fear, the person‟s fear is reduced and
relieved.

Desensitization can be done in groups, which is known as group desensitization. Another is

automated desensitization which refers to the presentation of the desensitization instructions to
the subject in some sort of mechanical fashion, with little or no contact with the therapist.

THERAPEUTIC GRADED EXPOSURE:

Therapeutic graded exposure is similar to the systematic desensitization, except- the relaxation
training not involved and treatment is carried out in a real life context that is the individual must
be brought in contact with the warning stimulus to learn firsthand that no dangerous
consequences will ensue.

EXTINCTION PROCEDURE:

 NEGATIVE PRACTICE: Dunlap proposed practicing behaviours, not to perfect their

performance but to eliminate them. Hence the term negative practice. The withdrawal of
contingent reinforcement and reinforcement of alternative behavior.

• Graduated extinction: is a technique designed to eliminate avoidance and fearful

behaviours by the gradual reexposure of the individual to the fear-evoking stimuli.

• Covert extinction: it requires the client to imagine himself performing a problem

behavior and then to imagine that a common reinforcing stimulus does not occur.

• STIMULUS SATIATION: the repeated presentation of such stimuli to the client until the
attractiveness of the stimuli is reduced.

IMPLOSION:

It‟s a technique designed to eliminate avoidance behaviour by process of extinction. It is

developed by Thomas Stampfl (1966). The fear-provoking scenes are presented verbally in an
exaggerated and dramatic manner. It usually takes place at an imaginary level. The eight primary
areas of concern and the elements of relevant implosive scenes:

Orality, anality, sexual concerns, aggression, rejection, loss of impulse control, guilt and central
or autonomic nervous system reactivity.

FLOODING: Polin, 1959; (based on Mowrerian learning theory)

It involves therapist-controlled prolonged exposure to anxiety-provoking conditioned stimuli

(CS) (object/situation) simultaneously blocking the individual‟s chance of escape and avoidance.

It helps in habituation to the anxiety-provoking conditioned stimuli.

Flooding is based on the premise that escaping from an anxiety provoking reinforces the
anxiety through conditioning. Client is prevented from the conditioned avoidance of the behavior
by not allowing the patient to escape the situation. (RESPONSE PREVENTION). No relaxation
therapy is used and patient experiences fear, which gradually subsides after some time. The
success of the procedure depends on having the patients remain in the fear generating situation
until they are calm and feel a sense of mastery.

• Phobias
• Post traumatic stress disorder
• Obsessive compulsive disorder

FLOODING AND SYSTEMATIC DESENSITIZATION:

• Flooding • systematic desensitization

The client is flooded with the anxiety The client is trained to deeply relax, and then the
provoking stimulus until the avoidance required relaxation is paired with the anxiety-
response habituates. provoking stimulus gradually step by step.

FLOODING AND GRADED EXPOSURE:

• Flooding • Graded exposure

The hierarchy is introduced with The hierarchy is followed from least anxiety
extreme fear provoking object or producing situation to most anxiety provoking
situation towards the least fear situation. For example the patients afraid of cats might
provoking situation. progress from looking at a picture of a cat holding
one.

ASSERTIVE TRAINING: Wolpe, 1958

Assertive behaviour is defined as the proper expression of any emotion other than anxiety in a
socially acceptable manner towards another person. It is the interpersonal behavior involving
honest and relatively straightforward expression of feelings.

 Learning to say „NO‟

• Making requests
• Starting or initiating conversation
• Expressing emotions
PROCEDURE:

• Determining the need for assertive training – if the anxiety is clearly tied to the client‟s
inability to express his feelings in a way that is personally satisfying as well as socially
effective.
• Presenting the concept of assertive training to the client – to inform the client about assertive
training and enlist his cooperation.
• Behavioural rehearsal- this technique was originally called „behaviouristic psychodrama‟
(Wolpe, 1958). The client and therapist act out relevant interpersonal interactions.
Deconditioning of anxiety takes place in during behavioural rehearsal.
• Role reversal - It consists of acting out of short exchanges between the therapist and the
patient in settings from the patient‟s life.
• Use of hierarchy – development of hierarchies for behavioural rehearsal.

Passive assertiveness – it‟s a non-verbal or indirect way of expression of feelings. This

technique is restricted in use. It should be reserved for situations, where it is quite clear that more
direct approaches would meet with seriously negative consequences and where the client‟s
imminent escape from the situation is blocked.

Six modes of behaviour required in assertive behaviour (Salter, 1949)

 Feeling talk – deliberate utterance of spontaneously felt emotions

 Facial talk – display of emotion in face as far as appropriate
 Express contradiction or disagreement – when disagreeing with someone, do not pretend to
agree but contradict with as much feeling as reasonable
 Use of „I‟ – use of „I‟ in statements to involve oneself in the statement one makes.
 Agree when complimented – praises are to be accepted.
 Improvising – try to make spontaneous responses to immediate stimuli.

Assertive exercises: greeting, exchanging compliments, positive self statements, small talk in a
group, etc.

AVERSIVE TRAINING: Wikler, 1948, 1972

It consists of administering an aversive or unpleasant stimulus to inhibit an unwanted emotional

response, thereby diminishing its habit strength. It works on the principle of Reciprocal
inhibition. Aversive stimulus like electrical stimulation or drugs is used in this form of training.

It is form of behavior therapy in which an undesirable behavior is paired with an aversive

stimulus to reduce the frequency of the behavior.

• Eating disorder
• Alcohol abuse
• Paraphillias
• Homosexuality
• Tranvestism

Overt sensitization (Voegtlin & Lemere, 1942)

It is a type of aversion therapy that produces unpleasant consequences for undesirable behavior.

• For example if an individual consumes alcohol Instead of euphoria feeling normally

experienced from the alcohol, the individual receives a punishment or drug to induce severe
nausea, vomiting, palpitation and headache, that is intended to extinguish the unacceptable
behavior.

Covert sensitization (Cautela, 1966, 1967)

It relies on the individual produce symptoms rather than on medication. The technique is under
client‟s control and can be used whenever and wherever it is required. The individual learns
through mental imagery to visualize nauseating scenes and even to induce a mild feeling of
nausea.

It is based on the assumption that imagined association of aversive events exerts similar control
over overt behaviour as the actual aversive events do. Therefore overt behaviour can be changed
by imagining various consequences for them.

Aversive techniques, especially punishment, are rarely utilized alone; their effectiveness will be
maximized and potential problems minimized when they are used in conjunction with other
techniques designed to promote more effective behavior patterns.

THOUGHT STOPPING: J.G Taylor 1955

Covert assertion

• The establishment of an inhibitory habit by positive reinforcement.

• It‟s a cognitive behavioural method used for minimising the distress associated with intrusive
unwanted thoughts by interrupting them using a self-generated and obtrusive stimulus.

For e.g. As soon as the client indicates the occurrence of ruminative thought, the command
„STOP‟ is given by the therapist, which is later practiced by the client himself sub-vocally after
the training sessions. (e.g. Obsessions)
LIMITATIONS OF BEHAVIOR THERAPY

• Behavior therapy may change behaviors, but it does not change feelings.

• Does not deal with the emotional process as fully as other approaches.

• Behavior therapy does not provide insight.

• Behavior therapists treat symptoms rather than causes.

• Therapy involves control and manipulation by the therapist.

References:

Jena, S.P.K., (1995), Behaviour Therapy Techniques, Research and Applications, Sage
Publications, New Delhi.

Wolberg, L.R., 3rd edition., Part 1, (1977), The Technique of Psychotherapy, What is
Psychotherapy,

Morgan, C.T., King, R.A., et.al. 21st reprint (2003), Principles of Learning, Introduction to
Psychology, Tata McGraw-Hill publishing Company Limited, New Delhi, 141-146.

Wolpe, J., 2nd edition., (1973), The Practice Of Behaviour Therapy, Pergamon Press, United
States of America.

Rimm, D.C., Masters, J.C., (1973), Behaviour Therapy Techniques and Empirical Findings,
Academic Press, United States of America

--------- Dr. Soheli Datta