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Behavior Therapy

Therapy that applies learning principles to the elimination of unwanted behaviors.

Does not look for inner causes.

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Classical Conditioning Techniques

Counterconditioning – The patient comes in with a stimuli that triggers unwanted

behaviors. This procedure tries to condition new responses to the stimuli

It is based on classical conditioning and includes: 1. Exposure therapy 2. Intensive Exposure therapy (flooding)3. Aversive conditioning.

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Exposure TherapyExpose patients to things they fear and avoid.

Can be in real or virtual environments.

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“Intensive Exposure Therapy” Flooding

Expose patients to things they fear

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Aversive Conditioning

A type of counterconditioning that associates an

unpleasant state with an unwanted

behavior.

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Operant Conditioning

Operant conditioning procedures enable therapists to use behavior modification,

in which desired behaviors are rewarded and undesired behaviors are either

unrewarded or punished.

A number of withdrawn, uncommunicative 3-year-old autistic children have been

successfully trained by giving and withdrawing reinforcements for desired

and undesired behaviors.

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Behavior Contracting

• Therapist and the client agree on behavior goals and on the reinforcement usually in the form of a contract with punishments and rewards. (Example behavior plans in school)

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Token Economy

In institutional settings therapists may create a token economy in which patients

exchange a token of some sort, earned for exhibiting the desired behavior, for

various privileges or treats.

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Group TherapyGroup therapy normally consists of 6-9 people attending a 90-minute session If the problems are interpersonal then why not broaden the therapy? Positives:

behaviors towards others show up quickly in a group setting

client social support, not only one with this problem, learn new behaviors seeing others will help insight, Clients benefit from knowing others have similar

problems.

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Family Therapy

• Goal: To change all family members’ behavior to the benefit of the family unit as well as the troubled individual.

• Method: – If one person is having problems, then it is likely the whole family

is.– Must improve communication, empathy, responsibility, and

reduce conflict.– Requires that all family members see the benefits.– Focus on changing self not others.

• Concerns: Key person won’t come or monopolizes the sessions.

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Couple Therapy

• Goal: To improve a couple’s problems in communication, interaction, and mutual expectations.

• Method: – Empathy Training – each is taught to share the inner feelings and

to listen to and understand the partner’s feelings before responding.

– Behavioral Techniques – schedule for caring actions– Cognitive Techniques – tries to dispel the cognitive distortions that

disrupt communication

• Concerns: Much more affective when it is two instead of one (56% vs. 29%)

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Self-Help Groups

• Goal: Low cost support and social network for a disorder

• Method: – Since 40 million Americans suffer from some form of

psychological disorder there are not enough psychologists to go around and they are expensive.

– These small local gatherings of people share a common problem and provide mutual assistance at a very low cost.

• AA is the best known.

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Evaluating PsychotherapiesWithin psychotherapies cognitive therapies

are most widely used, followed by psychoanalytic and family/group therapies.

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Outcome Research

Research shows that treated patients were 80% better than untreated ones.

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The Relative Effectiveness of Different Therapies

Which psychotherapy would be most effective for treating a particular problem?

Disorder Therapy

Depression Behavior, Cognition, Interpersonal

Anxiety Cognition, Exposure, Stress Inoculation

Bulimia Cognitive-behavior

Phobia Behavior

Bed Wetting

Behavior Modification

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Therapists & Their Training

Clinical psychologists: They have PhDs mostly. They are experts in research,

assessment, and therapy, all of which is verified through a supervised internship.

Clinical or Psychiatric Social Worker: They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with

everyday personal and family problems.

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Therapists & Their Training

Counselors: Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers and their victims, and substance abusers.

Psychiatrists: They are physicians who specialize in the treatment of

psychological disorders. Not all psychiatrists have extensive training in

psychotherapy, but as MDs they can prescribe medications.

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The Biomedical TherapiesThese include physical, medicinal, and

other forms of biological therapies.1. Drug Treatments2. Surgery3. Electric-shock therapy

Used if:1. The client is too agitated, disoriented, or

unresponsive for psychotherapy.2. The disorder has a strong biological

component.3. Dangerous to themselves or others.

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Antipsychotic Drugs

Classical antipsychotics [Chlorpromazine (Thorazine)]: Remove a number of positive symptoms associated with schizophrenia such as agitation,

delusions, and hallucinations.

Atypical antipsychotics [Clozapine (Clozaril)]: Remove negative symptoms associated with

schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and

difficulties in interacting with others.

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Atypical Antipsychotic

Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia.

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Antianxiety Drugs

Antianxiety drugs (Xanax and Valium) depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-

aminobutyric acid (GABA) neurotransmitter. GABA is the chief inhibitory neurotransmitter in the CNS

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Antidepressant Drugs

Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors

(SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake. MAO Inhibitors

increase the concentration of serotonin

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Mood-Stabilizing Medications

Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar

disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters.

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Brain Stimulation

Electroconvulsive Therapy (ECT)

ECT is used for severely depressed patients who do not respond to drugs.

The patient is anesthetized and given a

muscle relaxant. Patients usually get a 100 volt shock that

relieves them of depression.

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Psychosurgery

Psychosurgery was popular even in Neolithic times. Although used

sparingly today, about

200 such operations do take place in the

US alone.

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Psychosurgery

Psychosurgery is used as a last resort in alleviating psychological disturbances. Psychosurgery is

irreversible. Removal of brain tissue changes the mind.

Prefrontal lobotomy – The frontal lobes of the brain are severed from the deeper centers of the brain.

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Psychosurgery

Modern methods use stereotactic

neurosurgery and radiosurgery

(Laksell, 1951) that refine older methods

of psychosurgery.

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Psychological Disorders are Biopsychosocial in Nature