BEHAVIOR THERAPY

PROPONENTS relate to others

Albert Bandura Bandura
B.F. Skinner Skinner was a broadened the
prominent scope of behavior
spokesperson for therapy by
behaviorism and exploring the
can be considered inner cognitive-
the father of the affective
behavioral forces that
approach to motivate human
psychology. He behavior. In Self-
acknowledged Efficacy: The
that feelings and Exercise of
thoughts exist, Control (Bandura,
but he denied 1997), Bandura
that they caused shows the
our actions. comprehensive
Skinner was applications of his
extremely theory of self-
interested in the efficacy to areas
concept of such as human
reinforcement, development,
which he applied psychology,
to his own life. psychiatry,
Joseph Wolpe Joseph Wolpe was education,
a South African medicine and
psychiatrist and health, athletics,
one of the most business, social
influential figures and political
in behavior change, and
therapy. For many international
suffering from an affairs.
anxiety-inducing
phobia, new calm DESCRIPTION
behaviors may be This approach applies the principles of
learned to learning to the resolution of specific
replace the fear behavioral problems. Results are subject to
through a method continual experimentation. The
Wolpe developed. methods of this approach are always in the
Wolpe's method process of refinement. The mindfulness
of exposure and acceptance-based approaches are
therapy is called rapidly gaining popularity.
systematic
desensitization. BASIC TENETS/PRINCIPLES
Arnold Lazarus Arnold Lazarus Seven key characteristics define behavior
was a South therapy and its assumptions.
African-born 1. Behavior therapy is based on the
clinical principles and procedures of the
psychologist and scientific method.
researcher who
coined the term 2. The key characteristic of a
“multimodal behavior is that it is something
behavioral that can be operationally
therapy”. The defined.
idea behind the
term is built on 3. Behavior therapy recognizes the
the premise that importance of the individual, the
we are all basic individual’s environment, and
biological beings the interaction between the
who think, smell, person and the environment in
touch, experience facilitating change.
emotions, and
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4. Behavior therapy is an action- behavior (B) is influenced by

oriented and an educational some particular events that
approach, and learning is viewed precede it, called antecedents
as being at the core of therapy. (A), and by certain
events that follow it, called
consequences (C).
5. This approach assumes that Antecedent events cue or
change can take place without elicit a certain behavior.
insight into underlying dynamics Consequences are events
and without understanding the that maintain a behavior in
origins of a psychological some way, either by increasing
problem. or decreasing it.
 In doing a behavioral
assessment interview, the
6. Assessment is an ongoing therapist’s task is to identify
process of observation and self- the particular antecedent and
monitoring that focuses on the consequent events that
current determinants of influence, or are functionally
behavior, including identifying related to, an individual’s
the problem and evaluating the behavior (Cormier, Nurius, &
change. Osborn, 2013).

TECHNIQUES AND PROCEDURES

7. Behavioral treatment
interventions are individually Applied Behavioral Analysis: Operant
tailored to specific problems Conditioning Techniques
experienced by the client.
The goal of reinforcement,
WHEN IS IT USED? whether positive or negative, is to
Behavior therapy has been used to treat increase the target behavior.
a wide range of psychological disorders
with specific client populations. Anxiety
disorders, depression, posttraumatic Positive Reinforcement
stress disorder, substance abuse, eating  involves the addition of
and weight disorders, sexual problems, something of value to the
pain management, and hypertension individual (such as praise,
have all been successfully treated using attention, money, or food) as a
this approach (Wilson, 2011). consequence of certain
behavior. The stimulus that
THERAPEUTIC GOALS follows the behavior is the
 The general goals of behavior positive reinforcer.
therapy are to increase
personal choice and to create Negative Reinforcement
new conditions for learning.
 Eliminate maladaptive  involves the escape from or the
behavior. avoidance of aversive
(unpleasant) stimuli. The
THERAPIST’S FUNCTION AND ROLE individual is motivated to
 Behavior therapists conduct a exhibit a desired behavior to
thorough functional avoid the unpleasant condition.
assessment (or behavioral
analysis) to identify the Punishment is sometimes referred
maintaining conditions by to as aversive control. The goal of
systematically gathering punishment is to decrease target
information about situational behavior.
antecedents (A), the
dimensions of the problem
behavior (B), and the Positive Punishment
consequences (C) of the  an aversive stimulus is added
problem which is also known as after the behavior to decrease
ABC model. The ABC model of the frequency of a behavior.
behavior suggests that Negative Punishment
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 a reinforcing stimulus is and briefly describes what is

removed following the behavior involved. A three-step process
to decrease the frequency of a is carried out in the
target behavior. desensitization process.
1. Relaxation training
2. Development of a
Another operant method of
graduated anxiety
changing behavior is extinction,
hierarchy
which refers to
3. systematic desensitization
withholding reinforcement from a
through a presentation of
previously reinforced response
hierarchy items while the
client is deeply relaxed.
Progressive Muscle Relaxation  Homework and follow-up are
 It is aimed at achieving essential components of
muscle and mental successful desensitization.
relaxation and is easily
learned. In Vivo Exposure and Flooding
 Clients are given a set of
instructions that teaches them Exposure is a key process in
to relax. They assume a treating a wide range of problems
passive and relaxed position in associated with fear and anxiety.
a quiet environment while
alternately contracting and
relaxing muscles. In Vivo Exposure
 Clients are instructed to feel  involves repeated systematic
and experience the tension exposure to fear items,
building up, to notice their beginning from the bottom of
muscles getting tighter and the hierarchy.
study this tension, and to hold
and fully experience the
tension. Flooding refers to either in vivo or
 Relaxation becomes a well- imaginal exposure to anxiety-
learned response, which can evoking stimuli for a prolonged
become a habitual pattern if period.
practiced daily for about 25
minutes each day.
In Vivo Flooding
Systematic Desensitization  consists of intense and
 Based on the principle of prolonged exposure to the
classical conditioning, is a basic actual anxiety-producing
behavioral procedure stimuli.
developed by Joseph Wolpe,
one of the pioneers of behavior Eye Movement Desensitization and
therapy. Reprocessing
 This procedure can be  a form of exposure therapy
considered a form of exposure developed by Francine
therapy because clients are Shapiro that entails
required to expose themselves assessment and preparation,
to anxiety-arousing images as imaginal flooding, and
a way to reduce anxiety. cognitive restructuring in the
 Before implementing the treatment of individuals with
desensitization procedure, the traumatic memories.
therapist conducts an initial  The treatment involves the use
interview to identify specific of rapid, rhythmic eye
information about the anxiety movements and other
and to gather relevant bilateral stimulation to treat
background information about clients who have experienced
the client. traumatic stress.
 If the decision is made to use  “EMDR comprises eight
the desensitization procedure, phases and a three-pronged
the therapist gives the client a methodology to identify and
rationale for the procedure process:
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1. memories of past adverse obstacles and think of ways to

life experiences that negotiate them.
underlie present 3. Self-monitoring
problems.  Deliberately and systematically
2. current situations that observe your own behavior,
elicit disturbance. and keep a behavioral diary in
3. needed skills that will which you record your actions,
provide positive memory thoughts, and feelings along
templates to guide the with comments about the
client’s future behavior. relevant antecedent cues and
consequences
Social Skills Training 4. Working out a plan for change
 Social skills training is a
broad category that deals with  A good plan involves
an individual’s ability to substituting new thoughts and
interact effectively with others behaviors for ineffective
in various social situations; it is thoughts and behaviors.
used to help clients develop 5. Evaluating an action plan
and achieve skills in  Evaluate the plan for change to
interpersonal competence. determine whether goals are
 Social skills involve being being achieved and adjust and
able to communicate with revise the plan as other ways
others in a way that is both to meet goals are learned.
appropriate and effective.
 Key elements of social skills Multimodal Therapy: Clinical Behavior
training include assessment, Therapy
direct instruction and coaching,  Multimodal therapy is a
modeling, role playing, and comprehensive, systematic,
homework assignments. holistic approach to behavior
 Individuals actively practice therapy developed by the late
desired behaviors through role Arnold Lazarus (1989,1997,
playing. 2005, 2008a), a key pioneer in
 A popular variation of social clinical behavior therapy.
skills training is anger  Multimodal therapy is grounded
management training, which in social cognitive learning
is designed for individuals who theory.
have trouble with aggressive  It is an open system that
behavior. encourages technical
eclecticism in that it applies
Self-Management Programs and Self- diverse behavioral techniques
Directed Behavior from a variety of theories to a
 Self-management strategies wide range of problems.
include teaching clients how to  Multimodal therapists take
select realistic goals, how to great pains to determine
translate these goals into precisely what relationship and
target behaviors, how to create what treatment strategies will
an action plan for change, and work best with each client and
ways to self-monitor and under which particular
evaluate their actions. circumstances.
 Basic steps provided by Watson
and Tharp: Mindfulness and Acceptance-Based
1. Selecting Goals Approaches
 Goals should be established  Mindfulness is “the
one at a time, and they should awareness that emerges
be measurable, attainable, through having attention on
positive, and significant for purpose, in the present
you. moment, and nonjudgmentally,
2. Translating goals into target to the unfolding of experience
behaviors moment by moment.”
 In mindfulness practice, clients
 Identify behaviors targeted for train themselves to
change. Once targets for intentionally focus on their
change are selected, anticipate
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present experience with Distress Tolerance

acceptance and develop an  aimed at helping individuals to
attitude of curiosity and calmly recognizing emotions
compassion toward present associated with negative
experience. situations without becoming
 Acceptance is a process overwhelmed by these
involving receiving one’s situations. Clients learn how to
present experience without tolerate pain or discomfort
judgment or preference, but skillfully.
with curiosity and kindness,
and striving for full awareness Mindfulness-Based Stress Reduction
of the present moment (MBSR)
(Germer, 2013).  Jon Kabat-Zinn, at the
University of Massachusetts,
RECENT DEVELOPMENTS IN THE developed MBSR in 1979.
COGNITIVE BEHAVIORAL TRADITION  The eight-week structured
group program involves
Dialectical Behavior Therapy training people in mindfulness
 Formulated by Linehan meditation, and today
(1993a, 1993b, 2015), who was instructors are often not mental
motivated to alleviate health clinicians.
emotional suffering for those  The essence of mindfulness-
miserable enough to consider based stress reduction (MBSR)
suicide, DBT has been proven consists of the notion that
effective in treating a wide much of our distress and
range of disorders, including suffering results from
substance dependence, continually wanting things to
depression, posttraumatic be different from how they
stress disorder (PTSD), actually are.
eating disorders, suicidal  MBSR assists people in learning
behavior, and nonsuicidal self- how to live more fully in the
injury (Linehan, 2015). present rather than
 DBT treatment includes both ruminating about the past or
acceptance and change- being overly concerned about
oriented strategies the future.
 It generally involves a  MBSR programs are offered in
minimum of one year of hospitals, clinics, schools,
treatment and includes both workplaces, corporate offices,
individual therapy and skills law schools, prisons, and inner-
training done in a group. city health centers.
 DBT promotes a structured,
predictable therapeutic Mindfulness-Based Cognitive Therapy
environment. (MBCT)
Skills are taught in four modules:  This program is a
Mindfulness comprehensive integration of
 is a fundamental skill in DBT the principles and skills of
that teaches individuals to be mindfulness applied to the
aware of and accept the world treatment of depression.
as it is and to respond to each  MBCT is an eight-week group
moment effectively. treatment program of two-
Interpersonal effectiveness hour weekly sessions adapted
 teaches clients to ask for what from Kabat-Zinn’s MBSR
they need and how to say “no” program.
while maintaining self-respect  The primary aim is to change
and relationships with others. clients’ awareness of and
Emotional Regulation relation to their negative
thoughts.
 includes identifying emotions,  Segal, Williams, and Teasdale
identifying obstacles to (2013) describe kindness and
changing emotions, reducing self-compassion as essential
vulnerability, and increasing components of MBCT.
positive emotions.
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 Mindfulness is a way of therapy is toward developing procedures

developing self-compassion, that give control to clients and thus
which is a form of self-care increase their range of freedom.
when facing difficult situations. Behavior therapy aims to increase
 When we acknowledge our people’s skills so that they have more
shortcomings without critical options for responding. By overcoming
judgment, we can begin to debilitating behaviors that restrict
treat ourselves with kindness. choices, people are freer to select from
 Mindfulness is something that possibilities that were not available to
is caught more than something them earlier, which increases individual
that is taught. freedom.
 MBCT emphasizes experiential
learning, in-session practice,
learning from feedback,
completing homework
assignments, and applying
what is learned in the program
to challenging situations
encountered outside of the
sessions.

Acceptance and Commitment Therapy

 ACT is a unique empirically
based psychological
intervention that uses
acceptance and mindfulness
strategies, together with
commitment and behavior
change strategies, to increase
psychological flexibility.
 ACT involves fully accepting
present experience and
mindfully letting go of
obstacles.
 Values are a basic part of the
therapeutic process, and the
work of ACT depends on what
an individual wants and values.
 ACT has been empirically
shown to be effective in the
treatment of a variety of
disorders, including substance
abuse, depression, anxiety,
phobias, posttraumatic stress
disorder, and chronic pain
(Batten & Cairrochi, 2015).

BASIC QUESTIONS
 What treatment, by whom, is
the most effective for this
individual with that specific
problem and under which set of
circumstances?
 What do you want your life to
stand for?

CONTEMPORARY TRENDS
Contemporary behavior therapy is
grounded on a scientific view of human
behavior that accommodates a
systematic and structured approach to
counseling. The current trend in behavior