BEHAVIOR THERAPY

Course: PSYCHOTHERAPY EC-2 Paper 2 (M.A PSYCHOLOGY SEM IV); Unit IV

By
Dr. Priyanka Kumari
Assistant Professor
Institute of Psychological Research and Service
Patna University
Contact No.7654991023; E-mail- Priyankakumari1483@yahoo.com
 BEHAVIOR THERAPY
Behavior therapy is the systematic application of principles of learning to
the analysis and treatment of disorders of behavior. The rationale
adopted by practioner of behavior therapy is that neurotic behavior and
other types of disorders are predominantly acquired and therefore
should be subject to established laws of learning. Knowledge regarding
the learning process concerns not only the acquisition of new behavior
patterns but the reduction or elimination of existing behavior patterns.

Acc. To Reber (1987): Behavior therapy is that type of psychotherapy that

seeks to change maladaptive or abnormal behavior patterns by the use
of extension and inhibitory process and positive and negative reinforces
in classical and operant conditioning situation.
Thus behavior theorists seeks principles of
learning, the process by which these behaviors change in response to the
environment.
Many learned behaviors are constructive and adaptive. They help
people to cope with daily challenges and to lead happy,
productive lives. However, abnormal and undesirable behaviors
also can be learned.

behaviorists has pointed three principles of conditioning through

which a behavior can be learned:
classical conditioning,
operant conditioning(or instrumental) conditioning, and
modeling.

In behavior therapy abnormal behaviors are modified by means

of conditioning.
 CLASSICAL CONDITIONING

Classical conditioning is a process of learning by temporal

association. When two events repeatedly occur close together
in time, they become fused in a person’s mind, and before long
the person responds in the same way to both events. If one
event elicits a response of joy, the other brings joy as well, if
one event brings feeling of relief, so does the other.
According to behaviorists, many human behavior are acquired
through classical conditioning.
The classical conditioning of abnormal behavior- Abnormal
behaviors, too can be acquired by classical conditioning.
 Treatments based on Classical Conditioning

Behavioral therapist first aims to identify the behaviors

that are causing the client’s problems. It then tries to
manipulate and replace them with more appropriate
ones. The therapist’s attitude towards the client is that
of teacher rather than healer. Classical conditioning
treatments are intended to change clients’
dysfunctional reactions to stimuli.
Techniques
Systematic desensitization
Aversion therapy
 Operant Conditioning
In operant conditioning, humans and animals learn to
behavior in certain ways because they receive reinforcements
from their environment whenever they do so. Behavior that
leads to satisfying consequences, or rewards, is likely to be
repeated, whereas behavior that leads to unsatisfying
unpleasant feeling is unlikely to be repeated.

The Operant Conditioning of Abnormal Behavior-

Behaviorists also claim that many abnormal behaviors
develop as a result of reinforcements. Some people learn to
abuse alcohol and drugs because initially the drug- related
behavior brought them calm, comfort, or pleasure. Others
may exhibit bizarre, psychotic behaviors because they enjoy
the attention they get when they do so.
 Treatments based on Operant conditioning
Therapists who rely on operant conditioning consistently provide rewards for
appropriate behavior and withhold rewards for inappropriate behavior. This
technique has been employed frequently, and often successfully, with people
experiencing psychosis. When these patients talk coherently and behave
normally, they are rewarded with food, privileges, attention, or something
else they value. Conversely, they receive no rewards when they speak
bizarrely or display other psychotic behaviors.

In addiction, parents, teachers, and therapists have successfully used operant

conditioning techniques to change problem in children, such as repeated
tantrums, and to teach skills to individuals with mental retardation. Rewards
have included meals, recreation time, hugs, and statements of approval.
Techniques
 Token economy
 Shaping
Time out
Contingency contracting
Response cost
Premark Principle
 Modeling
Modeling is a form of conditioning through observation and imitation. Individuals
acquire responses by observing other people(the models) and repeating their
behaviors. Observers are especially likely to imitate models they find important or
who are themselves being rewarded for the behaviors
Behaviorists believe that many everyday human behaviors are learned through
modeling.
The Modeling of Abnormal behavior
Modeling, too, can lead to abnormal behavior. A famous study had young children
observe adult models who are acting aggressively towards a doll (Bandura, Ross
and Ross, 1963). Later, in the same setting, many of the children behaved in the
same highly aggressive manner. Other children who had not observed the adult
models behaved much less aggressively.
Similarly, children of poorly functioning people may themselves develop
maladaptive reactions because of their exposure to inadequate parental models.
Techniques
Modeling
Social skill training
Exposure therapy
Assertiveness therapy or training
 Techniques of behavior therapy
Exposure-based Treatments (Pavlovian Conditioning Methods)

The assumption behind behavior therapies based on Pavlovian

conditioning is that abnormal behavior is due to inappropriate
classically conditioned emotions, especially fear and anxiety.
These emotions then motivate avoidance and other behaviors
that are rewarded by anxiety reductions. Since the Pavlovian
methods share the feature of exposing the client in client in
various ways to the feared object, these methods are now
called expose-based treatment. It is also argued that these
methods do not work because of classical conditioning but
rather, they work because they increase the individual’s sense
of coping and mastering.
 Techniques of behavior therapy
Desensitization
SYSTEMATIC DESENSITIZATION
This is the best known and most widely used application of Wolpe’s reciprocal inhibition principle
for the treatment of phobic reactions. It is based on the simple principle that one cannot be both
relaxed and anxious at the same time. Consequently , if increasingly more anxiety-provoking
stimuli are experienced while the patient is in a deeply relaxed state, the relaxation response will
be substituted for the anxiety response. He will thus be desensitized to the original anxiety-
inducing stimuli.
Therapy starts with one or a few interviews and the administration of some personality
questionnaires, mainly intended to discover the patient’s major sources of anxiety. Before
desensitization proper begins, the patient is first trained in relaxation and an anxiety hierarchy is
created. The patient is taught the methods of progressive deep relaxation. In the desensitization
sessions, the patient is first asked to visualize the least intense item and simultaneously to relax
completely. The therapist describes the scene and for some ten or fifteen seconds the patient
imagines himself in it. As long as the tension produced is less strong than the relaxation
response, relaxation will dominate. Thus a patient imagines the scene a number of times, the
amount of anxiety is successfully reduced as no ill effects are experienced. After some minutes of
relaxation, the therapist moves to the next disturbed stimulus on the hierarchy, and the
procedure is repeated. If at any point, the image produces too great rush of anxiety, the therapist
moves back to the lower level, until the patient is ready to start upward again. After several
sessions, the patient should be able to visualize stimuli at the highest level without anxiety being
aroused.
 SYSTEMATIC DESENSITIZATION
Systematic desensitization is indicated in the cases of clearly identifiable anxiety
provoking stimulus, such as
Phobias
OCD
Sexual Disorders
Other Anxiety Disorders

Procedure
Systematic desensitization consists of three steps

Relaxation Training
Hierarchy construction
Desensitization of stimulus
 Relaxation Training
This is the first step of systematic desensitization. Relaxation
produces physiological effects opposite to those of anxiety.
The signs of relation are

a. Physiological sign- Slow heart rate, increased peripheral

blood flow, increased peripheral temperature, pupil
constriction, neuromuscular stability, decreased oxygen
consumption.
b. Cognition signs- altered state of consciousness, heightened
concentration on single mental image.
c. Behavior change- lack of attention and concern for the
environmental stimuli, no verbal interaction, no voluntary
change in the position.
 Relaxation
Techniques used for relaxation are
a. Jacobson progressive muscle relation (JPMR)
--Most often used relaxation training, developed by the psychiatrist Edmund Jacobson.
--In this client must learn to relax through deep muscle relaxation training.
--Patients relax major muscle group in a fixed order, beginning with the small muscle
group of the feet and working cephal head or vice-versa.

Procedure
Make the patient in a comfortable position
Provide light or soft music/ pleasant visual cues/quiet room
Give a brief explanation about the progressive muscle relaxation.
Instruct the client to tense each muscle group approximately for 10 sec.
Explain the tension of the muscle and uncomfortable the body part feels.
Ask the client to relax each muscle.
Make the client feel difference between both the situation.
 Relaxation Techniques
b. Hypnosis
Some clinicians use hypnosis to facilitate the
relaxation.
c. Mental imaginary
It is relaxation method in which patient are
instructed to image themselves in a place
associated with the pleasant relaxed memories.
Such images allow the clients to enter a relaxed
state of experience , the relaxation response.
 Hierarchy Construction
when constructing a hierarchy, clinician determine all the conditions that elicit
anxiety, and then client create a hierarchy list consisting of scenes in order of
increasing anxiety.
Example
 Desensitization

Desensitization of the stimulus is the final step, patients proceed

systematically through the list from the least to the most anxiety
provoking scene while in deeply relaxed state.

Under the guidance of the therapist the client begins the item on the list
that causes minimal fear and look at it, thinks about it, or actually
confronts it, all while remaining in a relaxed state.

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 a 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 the person then proceeds to the next item on the hierarchy
until the phobia is done.
Extinction
Implosive therapy
Implosive therapy is both an extension of the desensitization work and a direct
application of academic research on extinction. While Wolpe moves from least to
most disturbing stimuli, so that all along the way the patient should suffer minimal
anxiety, implosive therapy operates in precisely the reverse way, starting as it were at
the top. The therapist describes the most frightening event the patient can conceive,
dwelling in the most vivid detail on the worst possible consequences of the
experience, in order to bring out the greatest amount of anxiety. This is done in a
number of sessions, and in between the patient must visualize these situations at
home. The fundamental assumption is that anxiety is extinguished to the extent that
the patient can reinstate, as literally and graphically as possible, the cues to which the
anxiety response had originally been conditioned, but now without primary
reinforcement.

Implosion involves making the client vividly imagine all aspects of whatever is
frightening until he or she becomes relaxed.
 IMPLOSIVE METHOD
In this method, the patient is confronted in imagination with his most feared
situation or stimulus at once and encouraged to remain in contact with that
situation until the avoidance response is extinguished.
Punishment
Aversion therapy
If a response is followed by pain or punishment, its strength should be weakened.
Thus, behavior change can be achieved by conditioning an aversive response to an
undesirable behavior. The first use of aversion therapy was made by
KANTOWICH(1930) who administered electric shock to alcoholics. In clinical
practice, aversive techniques have been applied mainly in the effort to eliminate
to eliminate addictions and destructive or deviant behaviors. The best known
illustration of such an approach is in the management of chronic alcoholism.
Aversive conditioning techniques is based on principle that if a response is
followed by pain or punishment its strength will be weakened. It produces
unpleasant consequences for undesirable behavior. Behavior change can
be achieved by conditioning and aversive response to an undesirable
behavior. This technique have been used in the treatment of a whole range of
Maladaptive behavior i.e. smoking, drinking and destructive behavior.

For Example- If an individual consumes alcohol while on Antabuse therapy,

symptoms of severe nausea, vomiting, palpitation and headache. Instead of
euphoria feeling normally experienced from the alcohol, the individual received a
punishment that is intended to extinguish the unacceptable behavior.
Aversion therapy has, in recent years, been used mainly with sexual
problems. In a typical study, Feldman and MacCulloch (1965) showed slides
of partially or fully nude men and women to male homosexuals. When a
male picture was on the screen the subject had had to signal quickly for
another slide or he got a painful shock. Following shock, a picture of a
woman was shown. After about fifteen 20 minute sessions, the study was
terminated. The authors report that homosexual behavior was eliminated in
about half the cases when they were checked up to fourteen months later.
This study also illustrates the principle of aversion-relief conditioning, that a
stimulus associated with the termination of pain can be positively
reinforced.

Though in fact aversive methods are being used increasingly(Rachman and

Teasdale, 1969), many concerned behavior therapists (e.g., A. A.
Lazarus,1971) consider them last resort.
 Biofeedback
Biofeedback is a treatment technique in which people are trained to
improve their health by using signals from their own bodies.
Psychologists use it to help tense and anxious clients learn to relax.
Specialists in many different fields use biofeedback to help their patients cope
with pain.
Migraine headache, tension headaches and many other types of pain. Most
patients who benefit from biofeedback are trained to relax and modify their
behavior.
BIOFEEDBACK
SKILL TRAINING (OPERANT CONDITIONING METHODS)

Behavior therapist who use operant conditioning

methods assume that many types of abnormal
behavior, such as shyness or even schizophrenic
symptoms, are due to a lack of skills or to a poor
environment or both. Shy individuals lack the social
skills to understand and make contact with other
people with operant methods, the collaborative role of
the therapist is emphasized. The therapist act as an
instructor or consultant to guide the client or parent in
choosing and making changes.
 Social Skills Training (Assertion Training)
Assertion Training, now called social skills training was
originally designed to help shy, retiring people become
better able to deal with other people. Assertive
therapy includes a variety of training techniques for
several social skills and is used with diverse types of
clients individually and in groups. It is based on
operant conditioning in that operant behaviors that
display social skills, such as conversation, asking for
dates, and dealing with bosses, are rewarded by
praise from the therapist or by the success of the
behaviors themselves.
 Shaping and covert practices
Shaping and covert practices are also sometimes used by therapists to teach
social skills. Shaping, also called successive approximation, involves the
client making closer and closer approximations to the desired response. Each
step closer to the desired behavior is rewarded with praise from the
therapist or group. In covert practice , the person imagines performing the
social skills competently. The Shy person is asked to imagine carrying on
lively conversations.

An important element of social skills training is feedback. As clients rehearse

and role play, the therapist and group members give feedback on the
effectiveness of the rehearsed social skills. They point out which aspects of
the performance need to be improved and which were done well. The more
specific the feedback, the more useful it is. Videotaping the role play is an
effective way to give accurate feedback. The rewarding behaviors of the
therapist are an important part of social skills training. Warm praise for
successful social skills performance reinforces the behavior.
 Shaping
Shaping is based on operant conditioning principles. The patient is
systematically instructed to do what he fears and is rewarded by the therapist
with praise when he succeeds and with no response if he fails. This method is
useful in the treatment of phobias and obsessions.
 CONTINGENCY MANAGEMENT (behavior Modification)

A set of behavioral management techniques known as contingency

management also called behavior modification or applied behavior
analysis, utilizes operant conditioning principles. These behavior
changing methods involve simply the planned use of
rewards to increase wanted behavior and of extinction to
decrease unwanted behavior.

Parent Training- Modifying the problem behaviors of children is

often accomplished by training the parents to use operant techniques.
Therapists teach the parents these techniques in group classes, in
couples, or individually with such methods as role playing and
videotaping. Basically, parents are taught to reward behavior they want
in their children and to remove the reward behavior they want in their
children and to remove the rewards for behaviors they don’t want.
Time-out
Token economy
 TIME OUT
Timeout is used to eliminate unwanted behavior or as a
consequence for not performing wanted behavior. Time- out
involves removing children from the rewarding situation to a
place where there are no social rewards and so it can be
viewed as an extinction procedure.
 TOKEN ECONOMY
Token economies are behavior modification programs sometimes used in
psychiatric wards in hospitals. They are also used in classrooms and
institutions for the mentally retarded. Token economies are based on operant
procedures, and rewards are given for desired behavior and not for undesired
behavior. Since it is difficult to give actual rewards for each desired behavior,
tokens are commonly given to patients instead, hence the name of the
programs. When significant numbers of tokens are collected, patients can
exchange them for designated rewards such as ten tokens for a pack of
cigarettes or five for extra desert. Undesirable behavior, such as psychotic talk
or failure to show up for therapy appointments, may either be ignored have a
consequence such as being docked tokens.
In applied settings, a wide range of tokens have been used
a. Coins
b. Points
c. Checkmarks
d. Images
These symbols and objects are completely worthless outside of the
patient clinician relationship, but they can be exchanged for other things.
The purpose of using tokens rather than reinforcers is that they bridge the
delay between the occurrence of the desired behavior and the ultimate
reinforcement. Thus, as the patient makes his bed, sweeps the floor, or
takes on a job responsibility, he immediately, receives the requisite tokens.
In some problems each time a token is given a social reinforcement
accompanies. The patient is complimented on doing a fine job.

The goals of a token program are to develop behaviors that will lead to
social reinforcement from others, to enhance the skills necessary for the
individual to take a responsible social role in the institution and eventually,
to live successfully outside the institution. Basically, the individual learns
that he can control his own environment in such a way that he will elicit
positive reinforcement from others ( Krasner, 1971)

Token programs have also been used effectively in working with mental
retardates, delinquents, and disturbed school children.
 Contingency Contracting
Lavendusky and his colleagues (1983) reported that Contingency Contracting is a type
of intervention that is used to increase desirable behaviours or decrease undesirable
ones. A contingency contract may be entered into by a teacher and student, a
parent and child, or a therapist and client. It specifies the target behaviour,
the conditions under which the behaviour will occur, and the benefits or
consequences that come with meeting or failing to meet the target.

The patient is fully informed and actively involved in deciding on the behaviours and
rewards to be covered by the program. This type of patient involvement would
appear to reduce the potential for manipulation and coercion.

For example, a parent and child enter into a contingency contract to get the child to
finish his homework before dinner time, after which, he earns some TV time. Every
time he satisfactorily finishes his homework before dinner time, he gets to watch
an hour of TV after dinner. If he fails to finish his homework satisfactorily, then
instead of enjoying some TV time, he has to use that time to finish his
homework. work well as token economy.
SELF-MANAGEMENT

Behaviorists can teach individuals to use operant and

contingency management techniques to modify their own
behaviors, as such behavior modification treatments use self-
monitoring , self reward, and techniques of problem solving and
coping as well as contingency contracting.

Self-monitoring involves keeping track of the targeted behavior,

including when and in what context it occurs. Self-reward allows
clients to give themselves a chosen reward. Self-reward follows
Grandma’s Rule “First you work, then you play”
 PREMACK PRINCIPAL
The Premark principle is a theory of reinforcement that
states that a less desired behaviour can be reinforced by
the opportunity to engage in a more desired behaviour.
The theory is named after its originator, psychologist
David Premack.
The Premack principle is used all the time with children. Many parents have told children they must
eat their vegetables before they can have dessert or they have to finish their homework before
they’re allowed to play a video game. This tendency of caregivers to use the principle is why it is
sometimes called “grandma’s rule.” While it can be very effective with children of all ages, it’s important to
note that not all children are equally motivated by the same rewards. Therefore, in order to successfully
apply the Premack principle, caregivers must determine the behaviors that are most highly motivating to
the child.
There are special techniques used in self-management with
problem-solving training. Clients are taught first to define
and assess the problem, second, to recognize their reaction to it,
such as anger, which might be part of the problem, third to
generate several alternative solutions or responses to the
problem, fourth to evaluate the solutions and decide to act on
one, and fifth, to assess the effect of the attempted solution.
Coping and coping imagery exercises may be part of problem
solving. The therapist and client review possible coping
strategies for the client’s problem, and the clients imagine using
them in various situations. In reviewing coping strategies, the
therapist may teach coping skills that the client lacks or has not
thought of before.
Punishment
Delivering punishment for operant behavior is rarely
used because of ethical concerns. However,
punishment has been used to quickly suppress
psychotic behavior such as self-injury in retarded or
autistic children.

Self-administered punishment is sometimes used to

modify bad habits. For example- a cigarette smoker or
nail biter may put a rubber band around his/her wrist
and use it to give himself/herself a painful snap every
time she/he reaches for a cigarette or biter her nails.
Social learning methods (Modeling)
Behaviorist assumed that normal behavior can be learned in its
place, whatever its causes, through the normal social learning
process of imitation or modeling.
Modeling is probably an important component of assertion
training and other forms of therapy. Through demonstration and
role playing, the therapist models appropriate assertive
behavior. According to social learning theory, the client learns
assertion by observing and imitating the therapist.
Covert modeling, similar to covert practice, is imagining another
person engaging in the desired behavior. A therapist may tell a
child a story about another child who successfully stops fighting
with his siblings and learns ways to get attention. It is assumed
that imagining a successful model facilitates learning new
behavior that is similar to the model’s.
 MODELING
Modelling behaviour is a technique used by therapists to help their clients with an
array of issues. ... Modelling Behaviour Therapy is most effective when done live, as in
the patient is present with the person modelling the behaviour and witnesses the
situation in-person.
Bandura developed a form of behavior modification based on social
modeling.

As a therapeutic measure, Bandura points to three ways in which modeling

can influence behavior:
1. It can serve as a basis for learning new skills and behavior.
2. It can serve to eliminate fears and inhibitions.
3. It can facilitate preexisting behavior patterns.

In clinical practice, modeling has been found useful for the reduction of
unrealistic fears. This involves having the patient first watch the model in
contact with the phobic object in a series of successively more threatening
ways, for example, first touching, then holding, and finally allowing a snake
to crawl over one’s body.
In the next phase, guided participation, the therapist may guide the patient’s
hand and praise him for his efforts. In time, there is progressive reduction of
the amount of demonstration, protection, and guidance until the patient can
alone and unaided confront the feared experience
Bandura, Blanchard, and Ritter (1969) contrasted four treatment
group for treatment of phobias:
1. Live modeling with participation, the procedure just
described;
2. Symbolic modeling, in which subjects watched a film rather
than a live model in interplay with a snake;
3. Systematic desensitization, in the manner of Wolpe involving
imagined contact with snakes coupled with deep relaxation;
and
4. No treatment.
While all three treatment groups showed marked reductions of
fear compered to the untreated group who did not change, the
method of live participant modeling was clearly superior to the
others.
 FLOODING
In this method, the patient is confronted in reality with his most feared situation or
stimulus at once and encouraged to remain in contact with that situation until the
avoidance response is extinguished.
 Contingency management (Behavior Modification)

A set of behavioral management techniques known as

contingency management also called behavior modification or
applied analysis, utilizes operant conditioning principles. The
behavior changing methods involve simply the planned use of
rewards to increase wanted behavior and of extinction to
decrease unwanted behavior.
Parent Training- Modeling the problem behaviors of children is
often accomplished by training the parents to use operant
techniques. Therapists teach the parents these techniques in
group classes, in couples, or individually with such methods as
role playing and videotaping. Basically, parents are taught to
reward behavior they want in their children and to remove the
rewards for behaviors they don’t want.
REFERENCES
Arthur C. Bohart, Judith Todd; Foundations of Clinical and Counseling Psychology;

Korchin S.J (2004) Modern Clinical Psychology.

Palmer, S. (Ed.) (2006). Introduction to counselling and psychotherapy; The essential

guide, New Delhi, India Sage.

Google images.
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