Behavior therapy:

Relaxation and systematic desensitization, Assertion training

LAJYA NAYAK
 CONDITIONED STIMULUS AND CONDITIONED RESPONSE
The presence of a Cockroach is a CS that elicits a CR of autonomic nervous system arousal
involving rapid heart rate, sweating hands, muscle tension, upset stomach, lightheadedness,
and a flushed face. The CR involves unpleasant sensations that people call anxiety.operant
behavior and the reinforcement

Operant behavior and the Reinforcement

The operant behavior involves involves screaming for my mother to come and kill the
cockroach and running away. Screaming for my mom is reinforced by the removal of the
spider (she kills it); running away is also reinforced by escape from the spider, as I remove
myself from the location where she saw the cockroach. When the cockroach is no longer
present, there is a corresponding reduction in the anxiety (unpleasant bodily sensations).
Thus, the behaviors of screaming and running away are negatively reinforced by the
removal of, or escape from, the spider and the reduction in anxiety.
 PROCEDURES TO REDUCE FEAR AND ANXIETY
A number of behavior modification procedures are used to help people overcome
problems of fear or anxiety. These procedures involve relaxation training,
systematic desensitization, and in vivo desensitization, and are based on principles
of respondent conditioning, operant conditioning, or a combination of the two.
 Progressive Muscle Relaxation

- In progressive muscle relaxation (PMR), the person systematically tenses and relaxes
each of the major muscle groups in the body. Tensing and relaxing the muscles
leaves them more relaxed than in their initial state.
 Diaphragmatic Breathing

- Because anxiety or autonomic arousal most often involves shallow, rapid breathing,
diaphragmatic breathing decreases anxiety by replacing this breathing pattern with
a more relaxed pattern.
 Attention-Focusing Exercises

- Attention-focusing exercises produce relaxation by directing attention to a neutral

or pleasant stimulus to remove the person’s attention from the anxiety-producing
stimulus. Procedures such as meditation, guided imagery, and hypnosis all produce
relaxation through a mechanism of attention focusing
 Systematic Desensitization

The use of the systematic desensitization procedure has three important steps.

1. The client learns relaxation skills using one of the procedures described earlier.

2. The therapist and client develop a hierarchy of fear-producing stimuli.

3. The client practices the relaxation skills while the therapist describes scenes
from the hierarchy
 In Vivo Desensitization
A number of behavior modification procedures are used to help people overcome
problems of fear or anxiety. These procedures involve relaxation training,
systematic desensitization, and in vivo desensitization, and are based on principles
of respondent conditioning, operant conditioning, or a combination of the two.
 PROCEDURES TO REDUCE FEAR AND ANXIETY
A number of behavior modification procedures are used to help people overcome
problems of fear or anxiety. These procedures involve relaxation training,
systematic desensitization, and in vivo desensitization, and are based on principles
of respondent conditioning, operant conditioning, or a combination of the two.
Skills training
● To perform a skill a person must:

HOW WHEN

PROFICIENT MOTIVATED

• Skills deficits are often maintaining conditions of clients’ problems.

● Skill deficits 🡪 deficiency in one or more of these four components that are
prerequisites for performing a skill.

● Thus, skills training refers to treatment packages designed to overcome clients’ skills
deficits.

● The training focuses on the specific deficient components:

Knowledge Proficiency Discrimination Motivation

● Skills training may include: direct instruction, prompting, shaping, reinforcement,
behaviour rehearsal, role-playing, and corrective feedback.

● But in skills training modelling is a key component since direct instruction often is
insufficient to communicate the subtleties of performing complex skills, and prompting
and shaping alone may be insufficient.

● The client may need to “see” the behaviour performed.

 Application

❖Skills training targeted the enormous skills deficits that children with autistic disorder have.

- Language skills are a prime example, and modelling is a critical component in teaching such

children to speak.

- The ability to imitate is a social skill called generalized imitation, and if it is not learned

naturally, it can be specifically taught through shaping. This is done by initially reinforcing any

behaviour the child imitates, whether or not it is an adaptive behaviour, so that the child begins

to imitate.
Assertion Training

● Assertive behaviours are actions that secure and maintain what one is entitled to in an
interpersonal situation without infringing on the rights of others, which includes
expressing desires and feelings.

● Assertive behaviours fall into five categories that are relatively distinct:-
Assertive behaviours are, for the most part are situation specific, which
has three important implications:

First, a person should Third, assertive

not be characterized as Second, training in one behaviours are not
assertive or unassertive. type of assertive always appropriate or
Rather, a person’s behavior may not adaptive.
behaviour in a particular generalize to other How appropriate or
situation or class of types. adaptive they are is
situations could be For example, refusing determined by the
assertive or unassertive. unreasonable requests consequences, for
And, it is true that some and expressing one’s oneself and others, of
people typically act desires usually requires being assertive in a
assertively or separate training. particular situation.
unassertively in many
situations (but not likely
all).
❖The appropriateness of acting assertively varies in different cultures:

⮚ Western cultures that value🡪 individualism and independence🡪 assertive

behaviors generally are considered admirable and appropriate.

⮚ Eastern cultures (Japanese and Puerto Rican) that value🡪 collectivism and
interdependence🡪 assertive behaviors are socially inappropriate.
Assertive and
Aggressive Behaviours
● Assertive and aggressive behaviours are
not the same.
● Although they may result in the same
end— obtaining what one wants or is
entitled to— they differ in the means by
which they accomplish the goal.

Assertive behaviours achieve their goal

without violating others’ rights;
Aggressive behaviours do so at someone
else’s expense.
❖Complete assessment of assertive behaviour deficits usually requires behavioural
observations.

● Behavioural observations, either naturalistic or simulated, make it possible to assess the

stylistic components of the client’s attempts to act assertively, such as voice tone and body posture
which are critical components of effective assertive behaviours.

● If feasible, systematic naturalistic observations are made of the client in the situations in which
the client is having difficulty behaving assertively.

● However, simulated observations are more typical because they are easier to arrange.

● Generally, the simulated observations involve the client’s role-playing responses to hypothetical
situations that call for assertive behaviours.
●Physical and Vocal Stylistic Components of Assertive, Unassertive, and
Aggressive Behaviours
Assertion Training Procedures

Assertion training refers to the specific social skills training procedures used to teach
clients how and when to behave assertively.

✔Modelling is especially valuable in teaching assertive behaviours because stylistic

components that are difficult to describe verbally can be modelled for the client (for
example, appropriate body posture, volume, and verbal expression to show
confidence).

✔Homework assignments are routinely part of assertion training.

✔Feedback on the client’s performance both in the therapy sessions and on

homework assignments is an important aspect of the training.
● The therapist reinforces the client for acting assertively but not for obtaining a
favourable outcome.

● The reason is that the outcome of an assertive behaviour rarely is totally in the
client’s control (for instance, securing a day off from work may depend on the
availability of other workers).

● Accordingly, clients are taught, through modelling and behaviour rehearsal, how
to react and cope when their appropriate assertive responses fail to obtain the
desired outcome.
● Assertion Training For Refusing Inappropriate Requests:

Amira, a 33-year-old woman from Yemen, had immigrated to the United States 3 years
ago. She worked as an insurance agent in an office where there were only three female
agents, and she was the newest agent. The male agents frequently asked Amira to do a
variety of demeaning tasks, such as getting coffee for them. Because Amira had been
raised with the traditional Yemenite value that serving men is appropriate, she
acquiesced. However, as she became increasingly assimilated into the dominant U.S.
culture, she became conflicted about being the “office housewife.” The following is an
excerpt from the initial assertion training session.
● Client: I know that my traditional upbringing feeds into my complying with my colleagues’
requests, but I don’t think it’s appropriate—this is not Yemen. It’s the United States. They are
taking advantage of me.

● Therapist: You know, you can refuse to comply with their inappropriate requests.

● Client: I’ve never done it before. It’s scary.

● Therapist: What we can do is to teach you appropriate assertive behaviours for the situation
and then you can practice them with me. When you feel comfortable enough, you can
gradually begin to use them in your office. What do you think?

● Client: I guess so, but it goes against all I’ve known for most of my life.

● Therapist: Well, let’s just try a simple role-play and see how it goes

● Client: Okay.
● Therapist: For the moment, let’s role-play a typical situation for you. You pretend that you
are one of your male co-workers, and I’ll pretend I am you. You ask me to do something
inappropriate, and I’ll give you an example of a suitable assertive response. Let’s try it. Ask
me to do something that is an inappropriate request.

● Client: All right. Bob might say, “Hey, Amira, you’re not doing anything important. How
about going to get us some coffee and donuts, like a good little girl.” [role playing] He said
something just like that yesterday.

● Therapist: “I’d love some coffee, Bob, but I’m in the middle of working up a quote. Maybe
you or someone else could get us all coffee.” [modelling]

● Client: I couldn’t say that.

● Therapist: Well, you certainly don’t have to use my exact words. I’m just giving you an
example. What would you feel comfortable saying for a start? Let’s switch roles. You be
yourself, and I’ll be Bob. You respond to what I say. “Amira, some of us would like some
coffee. How about getting it for us?” [role playing]

● Client: “Oh, I guess so. But I am busy right now. As soon as I finish, I guess I could.”
[behaviour rehearsal]

● Therapist: Not bad. [shaping] It sure isn’t totally giving in to the request; and you’re not
exactly saying that you will. [feedback] Do you think you could go one step further and tell
Bob you don’t want to get the coffee?

● Client: What would I say?

● Therapist: How about something like, “I’d rather not go for coffee.” [modelling] Words to
that effect make it clear that you don’t want to but you aren’t actually saying no, which may
be hard for you to say at first. [direct instruction] Let’s try again. “Amira, some of us would
like some coffee. How about getting it for us?” [role playing]

● Client: “I’m really busy, Bob, so this isn’t a good time for me to get coffee.” [behaviour
rehearsal]

● Therapist: Very good. [reinforcement] Much better. [feedback] Your first response indicated
you probably would get the coffee later. Now you are saying no, albeit indirectly. [shaping]
Do you see the difference?

After seven sessions of assertion training, Amira felt comfortable enough to attempt
responding assertively to inappropriate requests in everyday situations, but not at work. After
3 weeks of in vivo practice, she began to assert herself with her male co-workers.