Behavioral Theory and Therapy

Chapter Seven
 Introduction
• Scientific behaviorism holds the premise that
psychology is an objective, natural science; Behavior
therapy is the therapeutic application of scientific
behaviorism.
• Michael Mahoney referred to psychoanalysis and
behaviorism as the “yin and yang of determinism”
(1984).
 Key Figures and Historical Context
Behavioral approaches to human change came in three
major stages:
•1. Behaviorism as a scientific endeavor
•2. Behavior therapy approaches
•3. Cognitive behavior therapy
In the early 1900s, a new and different view of human
psychology, led by John B. Watson, arose:
“Psychology as a behaviorist views it is a purely objective branch
of natural science” (Watson, 1913, p. 158).
 Key Figures and Historical Context
Behaviorists excluded consciousness and introspection,
believing in determinism rather than free will—in stark
contrast to the prevailing view.
Little Hans and Little Albert (working with phobias)
•Watson began testing his beliefs about human
psychopathology partly in reaction to what Freud’s
“unscientific,” irrelevant, psychoanalytic treatments
with “Little Hans” (Freud’s “castration anxiety”).
•In his now famous experiments with 11-month-old
Little Albert (and a white rat), Watson demonstrated
that classical conditioning was quick and efficient.
 Little Albert
• https://www.youtube.com/watch?
v=FMnhyGozLyE&ab_channel=JaapvanderSte
en
 Mary Cover Jones and Little Peter
• In 1924, Watson’s former student, Mary Cover Jones,
experimented with the effectiveness of
counterconditioning to eliminate anxiety in a 3-year-old
boy named Little Peter.
• Counterconditioning is the pairing of a positive (and
often incompatible) stimulus with a stimulus that elicits
a negative or undesirable response (e.g., fear).
• It was Jones’s study, not Watson’s, that illustrated how
classical conditioning techniques can remediate fears
and phobias.
 Behavior Therapy
In a testament to the behavioral zeitgeist of the 1950s,
three different research groups introduced the term
behavior therapy to modern psychology:
• B. F. Skinner in the United States (operant
conditioning)
• Joseph Wolpe, Arnold Lazarus, and Stanley Rachman
in South Africa (Psychotherapy by Reciprocal Inhibition,
Wolpe, 1958; or, systematic desensitization)
• Hans Eysenck and the Maudsley Group in the UK
(Application of modern learning theory to the
understanding and treatment of behavioral and
psychiatric problems)
 Cognitive Behavior Modification
• Behavior therapy continues to evolve. Cyril Franks
wrote, behavior therapy is designed to evolve
• Most behavior therapists now acknowledge and work
with cognition, and focus on thoughts, expectations,
and emotions.
• The Association for the Advancement of Behavior
Therapy (AABT) renamed itself the Association for
Behavioral and Cognitive Therapies (ABCT) in (2005).
 Theoretical Principles
Two primary convictions characterize behaviorists and
behavioral theory—both then and now:
•Behavior therapists employ techniques based on
modern learning theories.
•Behavior therapists employ techniques derived from
scientific research.
•Lazarus (1971) pointed out that there is no single
“learning theory,” but instead, many learning theories
(in plural).
Theoretical Models
• Operant Conditioning: Applied
Behavior Analysis
• Operant conditioning is a form of
behavior modification that involves
manipulation of behavioral
antecedents (“what comes before”)
and consequences (“what comes
after”).
• Behavior is a function of its
consequences, based on a stimulus-
response (SR) theory.
• Applied behavior analysis focuses on
observable behaviors. Therapy
proceeds through manipulating
environmental variables to produce
behavior change.
Classical Conditioning: The Neobehavioristic,
Mediational Stimulus-Response Model
Pavlov, Watson, Mowrer, and Wolpe helped to develop
classical conditioning principles. Classical conditioning is
sometimes referred as respondent conditioning.
Premise: An unconditioned stimulus naturally produces a
specific physical-emotional response; higher-order cognitive
processes are not required for conditioning to occur.
 Process
• Stimulus generalization (extension of the fear
response) i.e. little albert
• Stimulus discrimination (new stimuli do not elicit fear)
• Extinction (gradual elimination of conditioned
response)
• if Watson had kept working with Little Albert and repeatedly
exposed him to a white rat without a frightening sound of metal
clanging, eventually Little Albert might lose his conditioned fear
response to rats
• Counterconditioning (new associative learning)
• i.e. little peter
• Spontaneous recovery (old response returns
suddenly)
 Theory of Psychopathology
Maladaptive behavior is learned, and it can be
unlearned or replaced by new learning.
Psychopathology can also involve a skill deficit.
Behaviorists systematically:
•Observe and assess client maladaptive or unskilled
behaviors.
•Develop hypothesis about the cause, maintenance, and
treatment for these behaviors.
•Test behavioral hypotheses with empirically supported
interventions.
•Observe and evaluate results of their interpretations.
•Revise and continue testing new hypotheses as needed.
 The Practice of Behavior Therapy
When preparing to do behavior therapy, be sure to get
out your clipboard, because behavior therapists:
•Take notes and think like scientists
• Educate…like educators
Your job as a behavior therapist is to:
•Help clients unlearn old, maladaptive behaviors
•Help clients learn new, adaptive behaviors
What Is Contemporary Behavior Therapy?
Nearly all cognitive therapies are used in conjunction
with behavior therapies. In fact, cognitive-behavioral
therapy (CBT) is currently the most popular and
scientifically evaluated approach to psychotherapy.
Several newer “third wave” cognitive-behavioral
therapies include:
• Dialectical Behavior Therapy (DBT)
• Acceptance and Commitment Therapy (ACT)
• Eye Movement Desensitization Reprocessing
(EMDR)
 Assessment Issues and Procedures
• Direct observation is the behavioral assessment “gold
standard”: Behavior therapists directly observe their
clients in their natural environment to understand the
behavioral ABCs.
• In a “perfect” behavioral world, behavior therapists
would directly observe clients in their natural
environments, to obtain specific information about
exactly what happens before, during, and after both
adaptive and maladaptive behaviors.
 Functional Behavior Analysis (FBA)
FBA can also be described as an assessment of
Behavioral “ABCs”:
A = The behavior’s antecedents (everything that
happens just before maladaptive behavior)
B = The behavior (the problem as defined in concrete
behavioral terms: “yelling or swearing six times a day
and punching others twice daily”)
C = The behavior’s consequences (everything that
happens immediately following a problem behavior
 The Behavioral Interview
For behaviorists, the specific, measurable
characteristics of client symptoms are crucial behavioral
assessment. Behavior therapists aren’t satisfied when
clients describe themselves as “depressed” or “anxious.”
Typical behavior therapy intake interview questions:
•“Tell me everything that happens during a day when
you’re depressed. Let’s start with when you wake up in
the morning and cover everything that happens until you
go to bed at night. Then we’ll talk about how you’re
sleeping.”
•“Describe the physical sensations you experience in your
body when you’re feeling anxious.”
 Self-Monitoring
Teaching clients to self-monitor their behavior is an
easy and essential skill for behavior therapists.
Advantages and Disadvantages:
•Self-monitoring is inexpensive, practical and often
convenient; it also shows therapeutic benefits; clients
can begin improving solely as a function of self-
monitoring (Davies, Jones, & Rafoth, 2010; Mairs &
Mullan, 2015).
•The downside: clients may collect inadequate or
inaccurate information, or resist collecting any
information at all.
 Self-Monitoring
In cognitive-behavior therapy, clients frequently keep
thought or emotion logs that include at least three
components:
1. Disturbing emotional states
2. The exact behavior engaged in at the time of the
emotional state
3. Thoughts that linked to the emotions
Standardized Objective Questionnaires:
Behaviorists prefer “objective” assessment measures
over “subjective” projective assessment procedures
(Groth-Marnat & Wright, 2016), and focus on overt,
observable behaviors, not internal mental processes.
 Operant Conditioning and Variants
Contingency Management and Token Economies
“. . .the systematic delivery or reinforcing of punishing
consequences contingent on the occurrence of a target
response, and the withholding of those consequences in the
absence of the target response.” (Schumacher et al., 2007,
p. 823)

Fading helps to generalize learning across settings.

Behavioral Activation (BA), originally activity scheduling,
involves working with clients to schedule activities that
increase positive, reinforcing events. Research suggests BA
may be as good as CBT package for depressive disorders.
 Relaxation Training
• Edmund Jacobson was the first modern scientist to
write about relaxation training as a treatment
procedure In the book, Progressive Relaxation
(Jacobson, 1924).
• Progressive Muscle Relaxation (PMR) was initially
based on the assumption that muscular tension is an
underlying cause of mental and emotional problems.
Today, PMR is an evidence-based treatment, viewed
as a kind of counter-conditioning—but others, such as
breathwork, meditation, imagery, and hypnosis, are
common.
 Systematic Desensitization and
Exposure-Based Treatment
• Systematic desensitization (SD) combines Mary Cover
Jones’s (1924) deconditioning approach and Jacobson’s
PMR procedure. Joseph Wolpe (1958) formally introduced
it as a treatment technique.
• SD is an exposure treatment
• More recently, it appears that the PMR step may not be
necessary (D. Dobson & K. S. Dobson, 2009).
 Imaginal or In Vivo Exposure
and Desensitization
There are three ways to expose clients to their fears
during systematic desensitization (SD):
•Imaginal exposure (mental imagery) allows clients to
complete treatment without leaving their therapist’s office.
•In vivo exposure is direct exposure to the feared stimulus;
may produce outcomes superior to imaginal exposure.
•Virtual reality exposure (VRE), using computer simulation,
exposes clients to feared stimuli; has been empirically
validated.
 Interoceptive Exposure
Interoceptive exposure is identical to other exposure
techniques except the target exposure stimuli are
internal physical cues or somatic sensations (Boettcher
et al., 2017). At least six interoceptive exposure tasks
trigger anxiety (Lee et al., 2006):
•Hyperventilation
•Breath holding
•Breathing through a straw
•Spinning in circles
•Shaking head
•Chest breathing
 Response and Ritual Prevention
• When clients with phobia escape from a feared object
or situation, negative reinforcement of maladaptive
behavior occurs (Franklin, Ledley, & Foa, 2009).
• To be effective, exposure-based desensitization
treatment must include response prevention;
therapists must guide and support clients to not
engage in an avoidance response.
• Without response or ritual prevention, treatments
may exacerbate anxiety conditions.
 Participant Modeling
• In her work with Little Peter and other fearful
children, Mary Cover Jones reported that social
imitation (now known as participant modeling) was
one of two effective deconditioning strategies (Jones,
1924).
• Participant modeling should be always be applied
using good clinical skills and sensitivity.
• Group therapy can be effective for anxiety disorders
(Craske, 1999; Kocovski, Fleming, Hawley, Ho, &
Antony, 2015).
 Skills Training: Assertiveness and
Other Social Behaviors
• Skills training involves using behavioral techniques
to teach clients new skills. Traditional targets include
assertiveness, other social behaviors, and problem
solving.
• Assertiveness is defined as a social competence that
involves being able to stand up for your rights, while
not infringing on the rights of others; became
popular in the 1970s.
• Behavioral approaches to teaching assertiveness
include: Instruction; Feedback; Behavior rehearsal or
role playing; Coaching; Modeling; Social
reinforcement, and Relaxation training.
 Problem-Solving Therapy
Problem-solving therapy (PST) is a behavioral treatment
that focuses on how to approach and solve personal
problems. PST acts as a buffer that helps clients manage
stressful life events and achieve improved personal well-
being (D’Zurilla & Nezu, 2010; Nezu, Nezu, & D’Zurilla,
2013).
Two main components:
•Problem orientation: Teach clients to have positive
attitudes toward problem solving.
•Problem-solving style: Teach clients rational problem-
solving, including: problem definition, generating
alternatives, decision making, and monitoring outcomes.
 Evaluations and Applications
• Behavioral and cognitive therapies are far and away
the largest producers of therapy outcomes research.
• The most recent APA Division 12 list of ESTs includes 60
different treatment protocols, most of which are
behavioral or cognitive-behavioral.
• Problem-solving therapy has substantial research
support for treating depression and for contributing to
effective treatment with children and adolescents with
behavioral disorders (Cuijpers et al. 2007; Kazdin, 2010;
Kirkham et al., 2016; Nezu & Nezu, 2010).
 Cultural Sensitivity
• BT focuses directly on client problems and symptoms;
the client’s cultural background is less important than
symptom presentation.
• Some research indicates behavioral treatments are
effective with minority clients. But, the empirical support
for CBT [cognitive-behavioral therapy] derives almost
entirely from studies with white middle class Europeans
or Westerners (Michelle Craske, 2010).
• Behavior therapists need to make multicultural
adjustments in their practices.
 Gender and Sexuality
• BT doesn’t specifically address women’s issues; if
behavior therapy is implemented in a way that
supports women and helps them feel empowered, it
can be seen as supporting a feminist perspective.
• Recently, researchers have conducted multiple
randomized controlled trials (RCTs) on the efficacy of
LGB-affirmative psychotherapy.
• If you’re interested in using BT and CBT approaches
with sexual minority clients, you’ll be able to find
many intellectual and practical resources.
 Spirituality
• Behaviorists would be respectful of beliefs, but the
focus of therapy would be on behaviors—which
could include religious or spiritual behaviors. If
you’re following the logic here, then behavior
therapy is 100% compatible with religion and
spirituality.
• From a behavioral model, the question would be,
“Are your religious/spiritual behaviors causing you
distress or contributing to your well-being?”
 Concluding Comments
• Behavior therapists deserves credit for
demonstrating that particular approaches are
effective—based on a quantitative scientific-medical
model.
• Are behavioral therapy techniques more effective, or
are behavior therapy researchers simply better at
demonstrating efficacy?
“Regard no practice as immutable. Change and
be ready to change again. Accept no eternal
verity. Experiment.” (Skinner, 1970, p. viii)