Behavioral Therapy

Behavioral therapy is rooted in Behaviorism which is a school of thought and a type of therapy that says that people learn from their environment. This came in the early 20th century and became very popular. Edward Thorndike was the first person to work in this field. This therapy is action-based rather than insight-based like psychoanalytic therapy. It is grounded on a scientific view of human behavior that includes a systematic and structured approach to therapy. Therapists make goals with objectives to make the interventions of the clients possible. Problematic behavior are assessed and the conditions that maintain them then behavioral concepts and procedures are applied.

This therapy gives clients a sense of freedom and helps in overcoming maladaptive behaviors. According to researches, behavior therapy helps people to develop the capacity to choose how they will respond to external events and use behavioral methods taught in the sessions. In behavioral therapy, therapists not only deal with overt actions but also internal processes of clients like their beliefs, cognitions, images, beliefs and emotions. Clients learn new behavior in sessions and apply them in their outside world.

There are also many types of Behavioral Therapy :

• Cognitive Behavioral Therapy (CBT) which deals with problematic thoughts and beliefs.

• Dialectical Behavioral Therapy (DBT) that helps people learn mindfulness, how to manage their emotions, cope with distress and improve interpersonal relations.

• Rational Emotive Behavioral Therapy (REBT) focuses on challenging destructive thoughts and feelings and replaces them with rational and positive ones.

• Acceptance and Commitment Therapy (ACT) teaches people mindfulness and acceptance strategies

Goals of Behavioral Therapy

The main goal of Behavioral Therapy is to increase the clients’ personal choice and to help them learn new behaviors. The client with support and help from the therapist makes a proper treatment plan in the beginning of the therapeutic process. But before that, assessment is also done to determine the maladaptive behaviors that are the targets of change. Also, assessment is done throughout the duration of therapy to see if the goals are met. Many goals are made to achieve desirable behaviors which must be clear, concrete and easy to understand. Behavioral therapy includes making a contract that guides the whole process of therapy.

How Behavioral Therapy works?

Behavioral Therapists conduct a functional assessment to identify the problem and the conditions that maintain it by gathering information from the client like, situational antecedents (A), dimensions of problematic behavior (B) and the consequences of the problematic behavior (C). This is known as ABC Model.

Therapist tries to understand the functioning of the client regularly keeping in mind the ABC model and measure the progress towards the goals throughout the therapy. Therapist also plays close attention to the cues provided by the client to modify the treatment if needed. Several techniques are used in the therapy sessions to achieve the desirable behavior.

Therapeutic Relationship in Behavioral Therapy

Both the therapist and the client have an active role in the behavior therapy. Therapist teaches many skills through instructions, modeling and feedback to the client. Client works hard until all the skills are learned and also gets regular homework assignments in the therapy sessions. Client also learns how to apply all the learning in the daily life with the support from the therapist. Therapist regularly guides the client towards the way of achieving goals. This bonding, guidance and support in the therapeutic relationship make sure that the therapy will be successful. Clients are also made aware of when goals are accomplished and it is time to terminate the therapy.

Techniques in Behavioral Therapy

In Psychoanalytic Therapy, a variety of techniques are used to deal with a person’s maladaptive behavior:

1. Applied Behavior Analysis

It offers a functional approach the helps to understand client’s problems and address the problems by changing antecedents and consequences. This technique includes principles of operant conditioning and applying them in the therapy sessions:

• Positive Reinforcement involves addition of something good as a consequence of a certain behavior. For example, a child gets praise from the teacher when scored good marks.

• Negative Reinforcement involves avoidance of and escaping from a bad stimulus. Thus, one person will exhibit desirable behavior to avoid the unpleasant stimuli. For example, to avoid fine, the person will stop at red light on road.

• Another one is Extinction which involves withholding reinforcement from a previously reinforced response. For example, parents give attention to their child when the child shows tantrums so with the principle of extinction parent can break the connection between attention and tantrums to increase desirable behavior.

• The principle of Positive Punishment includes adding an aversive stimulus after a behavior to decrease its frequency. For example, a child was scolded by the parent when child did some misbehavior.

• Negative punishment involves removing reinforced stimulus to decrease unwanted behavior. For example, reducing pocket money for a child’s misbehavior.

2. Progressive Muscle Relaxation

It is a popular method of teaching clients how to cope with stress occurring in daily life. This technique helps in relaxing the muscles through some exercise that have maximum benefits for both mind and body. This was given by Jacobson which is used with many other relaxation procedures. In this, clients are given a set of instructions that teaches them to relax.

They assume a relaxed position in a quiet environment and simultaneously takes deep breathes that provides relaxation. Clients are instructed to feel the tension building up and muscles getting tighter and then are taught to relax the muscles while visualizing the different parts of the body. Firstly, arm muscles are relaxed, followed by head, neck, back, abdomen and then lower limbs. It takes about 25 minutes daily. It is used in areas like preparing patients for surgery, migraines, dealing with stressful situations, etc. it is also used to deal with problems related to stress and anxiety which are expressed in psychosomatic symptoms.

3. Vivo Exposure and Flooding

These exposure therapies include exposing clients to the fears under controlled conditions. In vivo exposure, client is exposed to the actual anxiety-provoking situation rather than imagining them. Therapist and client together make a hierarchy of the client’s fears and begin from the bottom level. And the client learns responses involving muscle relaxation. Like a person with claustrophobia might spend some time in an elevator while doing deep breathing exercises and just staying calm.

Whereas in flooding, client is exposed to the actual anxiety-provoking situation but is not allowed to engage in any anxiety-reducing behavior and then anxiety decreases on its own. There is also an imaginal flooding, where the client imagines the anxiety-provoking situation and this is very effective as there is no restriction and limit. The scene is re-created in mind and every detail is imagined and thus anxiety related to it starts vanishing. It is very important that the therapist also works along with the client as discomfort level is high. According to a study in 2010, it was proved that exposure therapies are the best behavioral procedures for anxiety disorders and effects are also long lasting.

4. Eye Movement Desensitization and Reprocessing

It is a form of exposure therapy that includes:

• Assessment and preparation

• Imaginal flooding

• Cognitive restructuring

This technique is effective for people with traumatic memories. This was developed by Francine Shapiro and in this the client has to use rapid and rhythmic eye movements for the treatment of anxiety or any fear in mind. It was designed to deal with post-traumatic stress disorders, anxiety, panic, depression, grief and addictions as well. EMDR is used for variety of populations like children, couples, sexual abuse victims, victims of crime, survivors of accidents or natural disasters, etc.

5. Systematic Desensitization

This technique is based on the principle of classical conditioning and is developed by Joseph Wolpe. Therapist takes an interview initially to get all the important information about the client’s anxiety and then gets a good understanding about the client. Information like in what situations anxiety occurs, what other factors are there, how does the client reacts, etc. is taken into consideration before starting the therapy. Some therapists even take a questionnaire to gather additional data about anxiety-provoking situations.

Clients have to imagine anxiety-provoking situations and at the same time they engage in behavior that reduces anxiety. So, overtime, clients become less sensitive to the anxiety-provoking situations. It has three steps:

1. Relaxation training

2. Development of hierarchy of anxiety

3. Proper systematic desensitization is employed in session

The client is also made to do progressive muscle relaxation while imagining anxiety-provoking situation. Clients are encouraged to practice this in their daily life also. It is a time-consuming but an effective and efficient way of reducing anxiety. It is proven to be really effective for anxiety-related disorders especially phobias. It has a very good record in dealing with fears, anger, nightmares, insomnia, panic attacks and motion sickness.

6. Social Skills Training

It helps clients to interact effectively with others in various social situations and develop skills in interpersonal competence. This is necessary for people with psychosocial problems caused by interpersonal difficulties. Various techniques that are used in social skills training are psycho-education, modeling, behavioral rehearsal and feedback, coaching, assessment, instructions, role-playing and homework assignment. Therapist provides all the required information to the client so that those skills and information can be modeled in the real life situation. Client’s successes and failures are also tracked to modify the plan.

Constant feedback and reinforcement helps the clients in developing new set of skills and enhance their interpersonal relationships. This technique is used for attention-deficit hyperactivity disorder, social anxiety, anger management, depression, bullying and any other behavioral problem.

7. Multimodal Therapy

It was developed by Lazarus and it applies diverse behavioral techniques to a variety of problems. This approach is divided into seven major areas: B = behavior, A = affective responses, S = sensations, I = images, C = cognitions, I=interpersonal relationships and D = drugs, biological functions and exercise. These 7 areas of the client are assessed and then a proper treatment program is finalized. Each and every area is explored and any issue is managed properly in the therapy session.

Critical Evaluation of Behavioral therapy

Behavioral therapy approach deals directly with symptoms because most clients seek help for specific problem. Also, it focuses on the here and now. A client does not have to examine the past to obtain help in the present. But it does not deal with the total person, just explicit behaviour. Critics have said that many behaviourists have taken the person out of personality. This approach is supported by exceptionally good research on how behavioural techniques affect the process of therapy. Behavioural therapy is best demonstrated under controlled conditions that may be difficult to replicate in normal situations. It also ignores the client’s past history and unconscious forces that might be important in the therapy.

Visit Medavas to seek professional therapy

If you engage in irrational and negative thinking and it is affecting your mental health, then, behavioral therapy can really help you. At Medavas, various mental health professionals like psychologists, counselors and therapists are available who are trained in behavior therapy. They will help you in identifying problems, set goals and work to achieve them. They are highly efficient in making treatment plans in behavior therapy for their clients. You can book your session at Medavas in any mode like chats, audio calls or video calls. This process is totally dependent on your convenience and comfort.