Chapter 4 - Behavior Therapy and Integrated Psychopharmacology

Major Classes of Medications for Anxiety, Depression, and Behavioral and Mood Disorders

■ Anti-anxiety medications: anxiolytics ➞ Clinical anxiety disorder usually consists of four components: (1) mental apprehension, (2) physical tension, (3) dissociative anxiety, and (4) physical anxiety symptoms ➞ Drugs that treat anxiety disorders are called anxiolytics ➞ Many anxiety medications are also included under the larger category of central nervous system (CNS) depressants. CNS depressants include the barbiturates, the benzodiazepines, and alcohol ➞ CNS depressants reduce neuron excitability. Therefore, anxiolytic drugs reduce the feelings of tension, worry, and signs of stress. Drugs that reduce anxiety produce a calm and relaxed state and drowsiness, a lack of coordination, and a prolonged reaction time ➞ Benzodiazepines are highly effective for anxiety reduction. It reduces anxiety without producing excessive sedation ■ Antidepressants ➞ Antidepressant drugs can be used to treat both anxiety and depression. Oftentimes, anxiety and depression occur within the same person, and a single antidepressant drug can be used to treat both conditions ➞ Antidepressants have been linked with neurotransmitters in the brain. These chemicals include serotonin, dopamine, and norepinephrine ➞ Selective serotonin reuptake inhibitors (SSRIs) are also commonly prescribed antidepressants. Drugs in this category control anxiety disorder by inhibiting the reuptake of serotonin, a neurotransmitter that is associated with feelings of well-being and euphoria ■ Bipolar medications: mood stabilizers ➞ Mood stabilizers balance neurotransmitters that control emotional states and behavior ➞ They are used to treat mania and to prevent the return of both manic and depressive episodes in bipolar disorder ■ Stimulants ➞ These psychotropic medications stimulate the CNS by increasing the release of certain chemicals in the brain ➞ Stimulants increase the levels of dopamine in the brain, a neurotransmitter that is related to concentration, attention, and feelings of reward and pleasure ➞ Some stimulant drugs also increase the level of glutamate, a neurotransmitter associated with behavioral control and inhibition. People with attention deficit disorder often have low levels of glutamate ■ Antipsychotic medications ➞ Antipsychotic medications are prescribed to decrease symptoms such as hallucinations, paranoia, extreme agitation, and aggression ➞ Antipsychotics with high potency can produce movement disorders in clients

Anxiety Hierarchy

■ Anxiety Hierarchy - A hierarchy of situations that bring on anxiety from the least to the most anxiety-producing triggers. Therapists work with clients to create an anxiety hierarchy as part of a behavior therapy technique known as systematic desensitization. If a client has anxiety triggers whenever she is asked to engage in public speaking, the therapist might first ask her to speak at a family dinner, then to a group at her work setting, and finally in front of a large business group

Current Trends in Behavior Therapy - Applied Behavioral Analysis

■ Application of operant and classical conditioning to modify human behavior or the application to teach an individual new skills while replacing undesirable behavior with desirable behavior. ■ Successfully helped children diagnosed with autism spectrum disorder and many other issues ■ Identify the observable relationship of a person's behavior to his or her environment, and they point out the antecedents and consequences of a particular behavior ■ The dimensions of a functional behavior assessment must be accountable, public (meaning it must be completely visible and public), doable (a wide variety of individuals can implement applied behavior procedures), and optimistic)

The Therapeutic Process - Role of the Client

■ Behavior therapy adopts an active role for both the therapist and the client ■ Behavior therapy rests on the assumption that the clients who come for therapy are motivated to change ■ Homework assignments and behavioral rehearsal ■ Engage in adaptive behaviors ➞ Clients are expected to do more than just gain insights about their behavior ➞ Role play, role rehearsal, relaxation training, and assertion training

The Therapeutic Process

■ Behavior therapy emphasizes modifying and gaining control over unwanted behaviors ➞ Oftentimes, people who seek behavior therapy have a deficit or an excess of a given behavior that they want to increase or decrease ■ The behavioral theorist's worldview is characterized by the following perspectives: ➞ Counseling and psychotherapy should focus on clients' observable behavior and their life responses ➞ Client's learning in behavior therapy is carefully structured ➞ Clients' changes in behavior are governed by the law of effect >> Clients change their behaviors as they discover relationships between sequences of events and their behaviors ➞ Behavioral assessment examines the current determinants of behavior ➞ Behavior therapists must commit to the scientific method in their work with clients ➞ Behavior therapy takes a nonpathological approach to what other schools of thought label as mental illness; behaviorists conceptualize these challenges as problems in living ■ Therapy begins with problem identification and assessment ➞ Therapist's first task is to identify and understand the client's presenting issues ➞ The therapist proceeds to conduct a functional analysis of the client's presenting issue

Introduction

■ Behaviorism - A psychotherapeutic treatment approach that emphasizes only actual behavior that is appropriate for therapy and scientific study - Behaviorism maintains that psychological disorders are a result of maladaptive learning ■ Behavior Therapy - Psychotherapy where the therapist's goal is to extinguish or inhibit abnormal or maladaptive behavior by reinforcing desired behavior and extinguishing undesired behavior ➞ The techniques in behavior therapy are based on the theories of classical conditioning and operant conditioning ■ Recently researchers have begun to discuss the development of behavior therapy in terms of the three waves of behavior therapy (1) During the first wave, behavior therapists questioned the conventional belief that inner experience was central to understanding human behavior ➞ As a result, behaviorists during the first wave used classical and operant conditioning principles to explain behavior without referring to events inside the person's head—his or her emotions ➞ The focus was on the development of treatments that emphasized modifying behavior through stimulus control and contingency management. Observable behavior was the mantra and the focus of attention ➞ Contingency Management - A plan in which a person's access to a high probability behavior (one that is likely to occur) is made contingent on a low probability behavior (one that is unlikely to occur). The person learns that participating in a desired activity depends on completing an undesirable task. Sometimes parents state, "Complete your homework and you can go to the movies." In this example, the undesirable activity is completing homework, while the desired activity is going to the movies. Contingency management is sometimes referred to as the Premack principle. When the contingency management plan is written down, it becomes a behavior contract (2) The cognitive revolution during the 1970s brought about the second wave of behavior therapy. It stressed the significance of mediating variables in explaining and changing behavior ➞ Soon concepts such as irrational beliefs, schemas, and self-efficacy began to dominate the field ➞ The second wave of behavior therapy challenged the conventional wisdom of prior behaviorists who asserted that cognitive variables were irrelevant to understanding a person's behavior (3) Currently, the field is experiencing the emergence of a third generation or a third wave of behavior therapists. The third wave of cognitive behavior therapists draws from Eastern traditions, such as the mindfulness therapy approach of the Chinese, and less empirically oriented therapeutic approaches ➞ The third-wave movement has redefined the behavioral therapeutic landscape, and it now includes acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness-based cognitive therapy (MBCT)

Contributions and Criticisms

Contributions of Behavior Therapy ■ Evidence-based therapy - Behaviorists conduct well-controlled research studies; therefore, good research exists on how behavioral techniques affect the process of counseling ■ Demystification of psychotherapy ➞ Possible to measure effectiveness ■ Strong self-management focus ■ Treats a wide range of psychological conditions ➞ Behavioral techniques have been used in more areas of human functioning than have any of the therapeutic approaches discussed in this book - Behavior modification techniques have been used in schools and parenting classes, and they have helped individuals cope with pain >> Behavior Modification - Seeks to extinguish or inhibit abnormal or maladaptive behavior by reinforcing desired behavior and extinguishing undesired behavior ■ Several researchers have summarized the contributions of behavior therapy as follows: 1. Behavior modification studies produced a high number of cases reported. Many of the treatments that work in psychotherapy are behavioral or cognitive behavioral in orientation. Behavioral approaches dominate the number of empirically supported treatments (ESTs). Such approaches tend to use careful measurement and assessment techniques, and they clearly define treatments. As a result, many behavioral treatments are reported in manuals that give a step-by-step approach that can be used by other therapists. 2. Behavior therapy focuses on clients' current problems and the forces influencing them. Less attention is given to completing a historical analysis of clients' issues, although behaviorists may investigate how environmental events contribute to current problem behaviors. Client relief from symptoms is much quicker than with other therapies. 3. Behavior therapy advocates a self-control approach that helps clients learn self-management strategies. Clients are empowered to take control of therapy by accepting responsibility for changes in their lives Criticisms of Behavior Therapy ■ Control and manipulation by the therapist ■ Treats symptoms rather than causes ■ Ignores relational factors in therapy ■ Does not produce client insight ■ May detract from client's experience of emotions. ■ Not always enough emphasis on therapeutic relationship

Multicultural Positives & Limitations

Multicultural Positives ■ Tailored to individual, taking into account environmental influences ➞ Assessment data are gathered from multiple sources, including questionnaires, in an approach that recognizes the diversity of environmental influences and pathways that offer the potentiality of symptom reduction ■ Complete assessment of conditions that influence client, including discrimination, economic forces, and cultural issues ➞ Purpose of determining the conditions that contribute to the client's problems and to discern if these conditions are amenable to change and therapeutic intervention ■ Emphasis on problem solving, not judgment ■ Collaborative nature of treatment ➞ Although the therapist is the expert on developing a treatment plan, the client is the expert on himself or herself and his or her problems ■ Focuses on changing specific client behavior instead of changing clients' feelings and on their sharing of their personal concerns with the therapist ■ Goal-oriented, directive, and time-limited - conforms with some cultural conceptions of expertise ■ One strong point of behavioral counseling is that it takes into account the social and cultural dimensions of a client's life ➞ Takes into consideration the client's cultural conception of problem behaviors, and it uses appropriate social influence agent ➞ The conceptual behavioral framework is well suited to take into consideration the idiographic nature of the client's problems in terms of cultural factors and the influence of immigration, somatic complaints, interpersonal relationships, and other areas of importance that influence a client's psychological well-being Multicultural Limitations ■ Historically, behavior therapy has evidence of a lack of attention to diversity issues; however, things have begun to change as the world is witnessing a multicultural revolution ■ Currently, many behavior therapists are not trained to conduct cultural assessments related to their clients' issues ➞ It is important that behavior therapists conduct cultural assessments related to how a client's culture is influencing his or her difficulties

Key Concepts - Theory of Personality: Classical Conditioning

■ Classical Conditioning - Learning that creates a response through pairing; a form of associative learning ➞ Unconditioned Stimulus (UCS): stimulus that naturally and automatically triggers a response - Smell of food ➞ Unconditioned Response (UCR): unlearned response that occurs naturally in response to the unconditioned stimulus. - Salivation in response to food ➞ Conditioned Stimulus (CS): neutral stimulus associated with UCS - Bell ➞ Conditioned Response (CR): learned response given to the previously neutral stimulus - Drool in response to bell ■ Classical conditioning is a type of associative learning ➞ That is, if the CS and the UCS are repeatedly paired, the two stimuli become associated, and the person or animal gives a behavioral response to the CS ➞ In the latter instance, the bell is the CS because it signals to the dog that food is coming, and the dog's salivation at the sound of the bell is the CR

Behavioral Activation - A Promising Treatment for Depression

■ Conceptualizes depression as a consequence of an individual's lack of positive reinforcement. ■ Aims to increase engagement in adaptive activities, decrease engagement in activities that maintain/increase risk for depression, and solve problems that limit access to reward or increase aversive control ■ Clinicians intervene in two primary ways: ➞ Increase the amount of positive reinforcement a person experiences ➞ Eliminate negative behavior patterns that contribute to the person's depression. ■ Clinician replaces a person's negative avoidant behaviors with new rewarding behaviors ■ The basic premise of functional behavioral assessment is that behavior serves a purpose, and behavior is related to the environment in which it occurs ➞ The counselor tries to identify what takes place prior to (antecedents to) the student's display of problem behavior and what occurs after (consequences of) problem behavior

Current Trends in Behavior Therapy -Integrated Behavioral Pharmacology

■ Drug therapy is the most common treatment method for mental illnesses ➞ psychoactive or psychotropic medications: drugs capable of affecting individuals' mind, emotion, or behavior. ■ Psychopharmacology: study of the use of medications in the treatment of mental disorders that affect an individual's mood, attention, behavior, and thought processes ➞ Behavioral psychopharmacology is a branch of psychology that studies the effects of behavior-altering drugs ➞ In general, these medications (psychoactive drugs) function by targeting neurotransmitters in the brain—most often by stimulating or inhibiting their release or blocking their reuptake in a person's nervous system

The Therapeutic Process - Goals of Therapy

■ Eliminating maladaptive behavior - Unproductive actions are replaced with productive ways of responding ■ Form the basis of contract ➞ Outline specific clear, concrete goals agreed on by client and therapist ■ Goals stated in measurable terms ■ Goal-setting process ➞ The counselor informs the client about the need for goals, the role that they play in therapy, and the client's involvement in the goal-setting process ➞ Next, the client indicates the positive changes he or she desires from therapy. Emphasis is placed on what the client wants rather than what he or she does not want ➞ The therapist highlights that change can only come from the client and the fact that the client must accept responsibility for the desired change in behavior ➞ Throughout the therapy process, the client and the therapist work on identified goals, revising them as the need arises. A plan of action is developed to achieve the identified goals

Behavior Therapy Techniques - Exposure Therapies

■ Exposure Therapies ➞ Designed to treat phobias and a wide range of other behaviors ➞ Introduce clients to situations that have contributed to their problems ➞ Types of exposure techniques: (1) Flooding - Involves forced, prolonged exposure to the actual stimulus that provoked the original trauma. In real practice, flooding can be difficult to enact. It isn't really practical to fill a room with snakes and spiders, for example, and force someone to sit in it for hours. Flooding uses relaxation skills to help a client face the most anxiety-provoking situation real life or imaginal exposure to anxiety-evoking stimuli for a prolonged period of time at maximum intensity - Stop reinforcing avoidance - No aversive consequences take place - Based on belief anxiety cannot be sustained with prolonged/repeated exposure (2) Systematic Desensitization (already mentioned) (3) In vivo - Exposure treatment can be conducted in real-life situations, which is labeled in vivo exposure, or it can be done through imagination, which is called imaginal exposure - The term in vivo refers to procedures that take place in the client's actual environment (4) Implosive Therapy - May be defined as a type of intensive and prolonged exposure therapy in which the therapist asks the client to imagine increasingly anxiety-provoking scenes about the feared stimuli, such as imagining spiders getting closer and closer to the client - Implosive therapy may be conceptualized as having the following characteristics: (a) The client imagines all anxiety situations, (b) the imagined anxiety scenes are exaggerated to elicit as much anxiety as possible, and (c) the imagined scenes are based on hypothesized sources of anxiety, which are psychodynamic in nature

Key Concepts - View of Human Nature

■ From the behavioral perspective, people are basically neutral at birth; they are neither good nor bad ➞ The laws of learning suggest that people are influenced by what happens to them and by what they learn ■ Behaviorists argue that intrapsychic conceptions of personality underuse the pervasive effect of learning and external events on individuals ➞ In contrast, clients' overt behavior is of interest only to the extent that their behavior is representative of deep-seated personality traits

The Therapeutic Process - Role of the Therapist

■ Function as consultants ➞ Motivate, support ➞ Redesign goals and procedures ■ Assess and reassess the effectiveness of therapy ■ Active and directive during counseling. ➞ Set up learning experiences ➞ Teach concrete skills to the client by instruction, modeling, and performance feedback >> Modeling - Involves having an individual demonstrate behavior that is to be learned. Role-playing is a frequent way in which modeling is completed. Albert Bandura introduced the concepts of modeling and behavior rehearsal to behavior therapists. He also emphasized observational learning and modeling (learning by watching another person perform a behavior) as well as behavior rehearsal (acting out a behavior to learn it and refine it as a skill)

Key Concepts - Theory of Personality continued

■ Generalizations - A client or animal perceives similarity or a relationship between different stimuli. The person responds to the stimulus in a similar way. In classical conditioning, stimulus generalization is the tendency for the conditioned stimulus to evoke similar responses after the response has been conditioned >> A father praises his daughter for her excellent grade in math. The child perceives the praise as reinforcing, and she begins to generalize the behavior to her other subjects. If children are reinforced for whining with gifts, they will continue to whine to get the reward or reinforcer. The important task is to learn how to generalize appropriate behavior to similar situations. We can make both negative and positive generalizations for situations in our lives. We can also overgeneralize ■ Discrimination: deciding how to respond to which stimuli >> The pigeons in the Skinner experiment had to learn how to discriminate between the red and green light to get the food pellets ■ Shaping - Involves first reinforcing a behavior similar to the one desired. Once that is established, you look out for variations on the behavior that come closer to what you want ➞ When clients are learning new skills, counselors break down behavior into manageable units ➞ They help shape a client's behavior by the use of reinforcement, extinction, generalization, and discrimination >> For instance, a client desires to become more assertive in her or his work with others. The counselor gives homework assignments that require the client to practice the skill in diverse settings. Each time the client demonstrates a reasonable approximation of assertiveness, the therapist reinforces him or her. As the client reaches each target behavior, the counselor stops giving praise for reaching the previous target. The therapist has shaped the client's behavior so that it is now assertive ■ Counterconditioning -Occurs when a group of conditioning techniques is used to replace a negative conditioned response (CR) to a stimulus with a positive response. It is a technique of changing an undesirable response of an animal or a person to a stimulus by engaging the animal or person in another response that is incompatible with the first ➞ Replace a negative conditioned response to a stimulus with a positive response >> A second CR (approaching a snake) is introduced for the expressed purpose of counteracting or nullifying a previously conditioned or learned response (e.g., fear of snakes) ➞ Desensitization - A technique used in behavior therapy to treat phobias and other behavior problems that generate anxiety. A client is exposed to the threatening situation under relaxed conditions until the anxiety reaction is extinguished ➞ As the therapist increases the pairings of the anxiety-inhibiting response with anxiety-evoking stimuli, the client develops a new, more adaptive response ■ Token economies: gives clients short-term reinforcement for specific behaviors by giving them tokens (i.e. poker chips) that are exchanged for privileges or desired objects ➞ An advantage of using a token economy is that individuals decide how to use their tokens, thereby giving them a sense of control over their lives

Major Contributor: B. F. Skinner (1904-1990)

■ Invented the Skinner box ➞ In which a rat learns to obtain food by pressing a lever ■ Skinner developed the theory of operant conditioning ➞ Learning in which behaviors are influenced mainly by the consequences that follow them ■ His theory became known as radical behaviorism because he focused on the functional analysis of behavior—the relationship between environmental events and a particular response ➞ Behaviorism could explain everything ➞ Only behavior/response relationships, no allowance for cognitive processes

Key Concepts of Behavior Therapy - Assumptions

■ Largely action-oriented and educational— therapist teaches clients skills of self-management ■ Change can take place without insight into underlying dynamics and the origins of a psychological problem ■ Behavioral treatment interventions are individually tailored to specific problems experienced by the client ➞ Behaviorists ask, "What treatment, by whom, is the most effective for this individual with that specific problem and under which set of circumstances?"

Key Concepts - Theory of Maladaptive Behavior

■ Mental disorders are learned behaviors ➞ Behavior therapists focus on helping clients unlearn maladaptive behaviors and replace them with newly learned adaptive behaviors ■ Behaviorists believe that both adaptive and maladaptive behaviors are controlled by their consequences ➞ Maladaptive responses increase in frequency if they are followed by reinforcements and decrease if they are followed by punishments or if they go consistently unrewarded (extinction) ■ Behaviors can be sustained by a stimulus situation that sets up the occasion for the behavior >> For instance, a person is able to refrain from drugs while attending a rehabilitation center, but he relapses very quickly when he returns to his neighborhood because it contains stimuli (the building in which he shot up or familiar faces) that signal drug use for him >> Likewise, stimuli may also signal that reinforcement will not follow a behavior made under different stimulus situations. Hence, the corporate executive beats his wife at home but never in a public place. Aggressive behavior and drug use are reinforced in one situation but not in another ■ Behaviorists conceptualize psychopathology as behavior that is disadvantageous or dangerous to the person and/or to other people ■ Maladaptive behavior also results when we use a single reinforcer in a negative or destructive way >> Overeating, substance use

Role of the Therapist in Integrated Behavioral Psychopharmacology

■ Mental health consultants ➞ Contribute information about a client's overall assessment or address concerns from physicians about a client's need for medication ■ Information brokers ➞ Communicate rationale for taking drug to clients ■ Monitor progress for client's medication ➞ The practitioner makes simple inquiries about a client's physical condition, symptoms, and relevant social developments

Major Contributor: Joseph Wolpe (1915-1998)

■ One of Wolpe's primary contributions was that he developed the behavioral technique of systematic desensitization, which involved developing a hierarchy of anxiety-provoking situations and learning relaxation techniques and then learning to associate a previously anxiety-provoking situation with relaxation ➞ Hierarchy of anxiety - A list of stimuli on a specific topic that are ranked according to the amount of anxiety they elicit. A therapist uses a hierarchy as a graded set of anxiety-producing stimuli so that the client is exposed to the least anxiety-producing stimuli first ■ Experiments on cats - eating while in presence of conditioned fear stimulus ➞ Cats were given mild electric shocks accompanied by specific sounds and visual stimuli. Once the cats equated the unpleasant shock with these images or sounds, the signals created a feeling of fear ➞ Wolpe wanted to prove that we could unlearn our fears. He gradually exposed the cats to these same sights and sounds, only this time providing them with food instead of shocks ➞ The cats gradually "unlearned" their fear of these sights and sounds when they were paired with food ■Assertiveness training - can't be angry/irritated along with assertive feelings ➞ Wolpe maintained that he could teach clients relaxation techniques and that he could reduce their fears by having them gradually rehearse fearful or stressful situations until they were able to handle the fear-producing objects. One major contribution of Wolpe's research was that it led to assertiveness training

Key Concepts - Theory of Personality: Operant Conditioning

■ Operant conditioning is a form of learning in which behavior is changed by systematically changing the consequences ■ Operant Conditioning - Term used by B. F. Skinner to describe the effects of the consequences of a particular behavior on the future occurrence of that behavior ➞ One definition of operant conditioning is that it occurs when a behavior is followed by a consequence, and the nature of the consequence changes a person's or an organism's tendency to repeat the behavior in the future ➞ The idea is that we are rewarded or punished for actions and that we learn to discriminate between behaviors that bring rewards and those that do not ■ Reinforcement - Defined as a consequence that follows an operant response that increases (or attempts to increase) the likelihood of that response occurring in the future ■ Skinner outlined four types of operant conditioning: (1) Positive Reinforcement - When a specific behavior is strengthened by the consequence of experiencing a positive condition >> For instance, a hungry rat presses a bar in its cage and receives food. The food is a positive reinforcer for the hungry rat. The rat presses the bar again and again receives food. The rat's behavior of pressing the bar is strengthened by the consequence of receiving food (2) Negative Reinforcement - When a specific behavior is strengthened by the consequence of stopping or avoiding a negative condition. In an attempt to increase the likelihood of a behavior occurring in the future, an operant response is followed by the removal of an aversive stimulus >> For example, a rat is placed in a cage and immediately receives a mild electrical shock on its feet. The shock is a negative condition for the rat. The rat presses a bar and the shock stops. The rat receives another shock, presses the bar again, and again the shock stops. The rat's behavior of pressing the bar is strengthened by the consequence of stopping the shock (3) Punishment - Technique used to weaken a specific behavior as a consequence of the person or animal experiencing a negative condition >> For example, a rat presses a bar in its cage and receives a mild electrical shock on its feet. The shock is a negative condition for the rat. The rat presses the bar again and again receives a shock. The rat's behavior of pressing the bar is weakened by the consequence of receiving a shock (4) Extinction - Conditioning phenomenon in which a previously learned response to a cue is reduced when the cue is presented in the absence of the previously paired aversive stimulus. When the conditioned stimulus (CS) is presented without the aversive unconditioned stimulus (UCS), the animal or person gradually "unlearns" the CS-UCS association >> A child acts out in class because he wants to obtain attention from his teacher and class members. When he receives their attention, the child is reinforced. Soon the class and teacher ignore the acting-out child each time he demonstrates a negative attention-getting behavior. Without the reinforcement of the class's attention, the child eventually stops the acting-out behavior ➞ Both positive and negative reinforcements strengthen behavior while both punishment and extinction weaken behavior

Behavior Therapy Techniques - Relaxation Training

■ Progressive Relaxation - The PMR technique teaches you to relax your muscles through a two-step process. First you deliberately apply tension to certain muscle groups, and then you stop the tension and turn your attention to noticing how the muscles relax as the tension flows away. Through repetitive practice, you quickly learn to recognize—and distinguish—the associated feelings of a tensed muscle and a completely relaxed muscle ➞ Based on idea that muscle tension increases anxiety ➞ Therapists teach clients how to relax muscles throughout body ➞ Therapists teach clients how to tell that their muscles are contracted ➞ Give clients understanding of what tension is and how to control it

Major Contributor: Donald Meichenbaum (1940-)

■ Pushed behavior therapy to cognitive- behavioral perspective ■ He is credited with developing the concepts of self-management, self-instructional learning, and stress inoculation ➞ He conceptualized self-instructional training as a means by which people could teach themselves how to deal effectively with situations that had caused problems in prior situations ➞ Self-instructional training has been used to deal with anxiety, anger, eating problems, addiction, and creative blocks ➞ It also has been applied to assertiveness training - A form of behavior therapy designed to help people stand up for themselves. Originally, the approach was used during the 1970s to encourage women to stand up for themselves appropriately. Assertiveness training is designed to help clients maintain an appropriate balance between passivity and aggression

Behavior Therapy Techniques - Reciprocal Inhibition and Systematic Desensitization

■ Reciprocal Inhibition ➞ Based on the inhibition of responses by the occurrence of another response that is incompatible with it ➞ Deep breathing and muscle relaxation techniques in response to anxiety-provoking and fearful situations ■ Systematic Desensitization ➞ Pairing of a neutral event or stimulus with a stimulus that already elicits fear ➞ Components include counterconditioning, reciprocal inhibition, and substitution of one type of response for another ➞ Systematic desensitization is composed of three primary steps: (1) training in deep muscle relaxation, (2) constructing anxiety hierarchies, and (3) matching specific anxiety situations from the hierarchies with relaxation training ➞ The technique is based on the fact that it is impossible to be relaxed and anxious at the same time ➞ A major purpose of systematic desensitization is to train the client to have an automatic relaxation response when the previously feared object appears

Brief Overview

■ Second major force in psychotherapy - involves behavior therapy and cognitive therapy ■ Significant differences with other psychotherapies. ➞ Constructed from discoveries made on animals in experimental psychology and physiology laboratories. ➞ Focus on directly observable behavior and learning experiences ■ Cognitive influences. ➞ In general, behavior therapists are now inclined to identify themselves as cognitive behavioral therapists rather than as simply behavioral therapists

Behavior Activation Techniques

■ Some techniques a therapist might use in behavioral activation include self-monitoring of activities and mode, activity structuring and scheduling, shaping, social skill training, reward, and life area assessment (finding out what one really wants out of life) ■ Some positive activities for behavioral activation include the following: ➞ Daily activity diary: This is a daily log a client can use to indicate how they spend their time. The log should be detailed and specific with regard to time ➞ Behavioral activation worksheet: For rewards, fun, and achievement, the person schedules positive reinforcement activities, such as spending more time with family and friends. Scheduled activities should target the client's core issues and problems the client is facing. Activation should be sensitive to the client's cultural values and they should be concrete and specific ➞ Behavioral strategies for managing depression: The therapist discusses the client's avoidance strategies that lead to depression. In general, negative life events lead to depression. The clinician helps the client to identify and discuss his or her common emotional and behavioral responses to negative life events causing depression. The therapist discusses how the client's responses lead to more negative life events—essentially the spiral or cycle of depression. The therapist works with the client to establish a goal of breaking the cycle

Behavior Therapy Techniques - Stress Inoculation Training

■ Stress Inoculation Training ➞ Help protect people against collapse as they experience stress ➞ The primary goal in stress inoculation was to change individuals' beliefs about the behaviors and statements they make to themselves regarding how they deal with stress (e.g., "I come apart under stress" or "I'm at my best when I am under stress") ➞ Stress inoculation training helps clients to induce a relaxation response, engage in cognitive restructuring, and perform effective problem-solving skills ➞ Treatment can be directed toward changing client behavior by imagining fearful or anxious situations or by confronting them in a real-life situation ➞ Three phases: (1) Conceptual: gather information about how to conceptualize the client's challenge >> Therapist asks client to pay attention to/log the self statements they make about the anxiety-provoking situation (2) Skills Acquisition: relaxation training, cognitive restructuring, problem-solving skills, and positive self talk and affirmations (3) Application: put skills to use

Major Contributor: John Watson (1878- 1958)

■ Study observable animal and human behaviors instead of states of consciousness ■ Experiment on Little Albert. ➞ One of Watson's best-known experiments was with his graduate assistant, Rayner, and an 11-month-old child named Albert B ("Little Albert") ➞ He and Rayner conditioned the child to fear rats and other furry animals ➞ They placed a white rat by Little Albert, and when he reached for it, they frightened him with a loud noise. Several times, they repeated this sequence of actions, thereby conditioning Albert to cry each time he saw the rat ➞ As a consequence of conditioning, Albert began to associate the scary noise with any furry thing, including dogs, rabbits, fur coats, and cotton balls ➞ Watson and Rayner's (1920) work demonstrated that human emotions are learned and can be generalized. Little Albert generalized his fear of rats to white, furry objects

Behavioral Assessment - The Functional Assessment Model

■ Study of antecedent events (A), resultant behavior (B), and consequences of that behavior (C) ➞ The behavior therapist seeks to find out what happens just prior to a specific behavior, how the specific behavior manifested itself, and what the result or consequence of that behavior was on the client ■ First, clinician identifies presenting problem - what does the problem feel like? How does it manifest in the client's life? ■ Next, collect more information - (a) when the behavior occurs, (b) how frequently it takes place, (c) what usually comes before and after the behavior, (d) what the client thinks and feels during the behavior, and (e) what the client has already tried to do to resolve the problem ■ During the second phase of assessment, the clinician conducts a functional analysis of the client's problem, identifies specific environmental and person variables that maintain the problem behavior ➞ Not why, but how, when, where, what questions ■ Learning how the behavior develops and maintains itself via a system of rewards or reinforcers and punishments ➞ The underlying principle is that what follows a particular behavior will increase the likelihood of it taking place again ➞ Patterns of attention that people gain ■ Breaks down an amorphous idea (e.g., depression) into manageable behavioral units (e.g, "sleeping too much") ■ Clients learn what brings on the depression and can learn alternate reaction

Key Concepts - Theory of Personality

■ The behavioral theory of personality is based on a theory of learning that states that all behaviors are acquired through learning and conditioning ➞ Skinner argued that "a self or personality is at best a repertoire of behavior imparted by an organized set of contingencies" ➞ Behaviorists consider personality an individual's particular series of reactions to specific stimuli ■ Behavioral definitions of personality maintain that personality consists of behavior-environment contingencies that are subject to control and modification by the environment and heredity ➞ Behaviorists view personality as being in a state of flux, as something that is stable yet changing depending on the contingencies in one's environment

Major Contributor: Mary Cover Jones (1897- 1987)

■ Wanted to explore whether conditioning could be used to make children less fearful of stimulus ➞ Peter, rabbits and candy

The Therapeutic Process - The Therapeutic Relationship

■ Warm and empathic ➞ Therapists must be able to get clients to trust them with deepest fears ■Collaborative client-therapist relationship ■Clients learn self-control and self- management techniques so that they are in control of their lives ➞ Behavior therapists are more directive than therapists who subscribe to the psychodynamic or existential-humanistic schools