Behavior Therapy Powerpoint

7/24/2019 Behavior Therapy Powerpoint

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Traditional Techniques

of Behavior therapy


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Before we discuss specic behavior thetechniques, let us note both the importanc

therapeutic relationship and the tendenmodern behavior therapists to use mul

techniques with the same patient.


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The relationship

Relationship is a contributing factor in the success of behtherapists therapeutic methods.

In olpes !"#$%& accounts of systematic desensiti'atithat the therapist is e(horted to adopt an attitude of atoward patients, to e(plain their di)culties to them, an

clear the behavioral rationale for treatment.

In fact, there are data that indicate clients perceive refactors to be very important to successful behavior theoutcome, similar to clients perceptions concerning othpsychotherapy !loane, taples, +ristol, -or*ston, "#/$a&.


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Behavior therapists may be e(perienceand accepting of the clients0 treatmentcollaborative and more 1educational2 in

interventions are clearly lin*ed to the pbehaviors that have been targeted for cclient and therapist !piegler 3uevre

6ne can never a7ord to ignore aspects of the relationship ascontributors to successful therapeutic intervention. 8fter all, it isthrough the therapy relationship that the patients e(pectations ohelp can be nurtured so that behavioral therapy will be accepteda viable alternative !3oldfried 9avison, "##:0 piegler 3uevremont, 45"5&.


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o Behavior therapy is not going to be

successful if the patient e(pects it to fail or isotherwise antagonistic toward it.

;Behavior therapists have sometimes beensaid to be cold and mechanistic in theirapproach to patients. This is probably moremyth or stereotype than fact. Indeed, loaneet al. !"#/$a& found that behavior therapistswere generally warmer and more empathicthan other psychotherapistsa'arus !"#/"a& refers to this as broad spectrum beh

pecic techniques in behavior therapy can serve a specicbut that, in reality, they are complementary.

?or e(ample, a woman who has trouble coping with a dominmay undergo assertiveness training to learn specic behavishe uses these behaviors, other sets of fears about their relbegin to worry her. Therefore, she may also require therapethat will help her restructure her beliefs about the marriageillogical and tend to perpetuate her submissive behavior. h

participate in modeling or observational learning to help he


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o 8 comprehensive behavioral assessment is conducted

before behavioral treatments or techniques are selectedand implemented.

?or e(ample, a functional analysis of the presentingproblem helps to identify !a& the stimulus or antecedentconditions that bring on the problematic behavior0 !b&the organismic variables !e.g., cognitive biases& that are

related to the problematic behavior0 !c& the e(actdescription of the problem0 and !d& the consequences ofthe problematic behavior. By completing such a detailedanalysis, behavior and cognitive behavioral therapistscan prescribe appropriate treatments.


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ystematic 9esensiti


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o This technique is typically applied when a patient hato respond adequately to a particular situation !or clsituations&, yet reacts with an(iety, fear, or avoidancsystematic desensiti'ation is a technique to reduce a

o 9eveloped by alter !"#:#& and olpe !"#$%&, it is breciprocal inhibition=the apparently simple principlecannot be rela(ed and an(ious simultaneously. The iteach patients to rela( and then, while they are in thstate, to introduce a gradually increasing series of aproducing stimuli. @ventually, the patient becomes dthe feared stimuli by virtue of having e(perienced th

rela(ed state.

o ystematic desensiti'ation has been shown e)caciophobias, public spea*ing an(iety, and social an(iety et al., "##%0 +hambless 6llendic*, 455"0 piegler 3uevremont, 45"5&.


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o ystematic desensiti'ation begins with the collection of ahistory of the patients problem. The principal reason for aof this is to pinpoint the locus of the patients an(iety. It isalso part of assessment to determine whether systematicdesensiti'ation is the proper treatment.

o Ae(t, the problem is e(plained to the patient.

o The ne(t two phases involve training in relaxation and theestablishment of an anxiety hierarchy. hile wor* is begunon the an(iety hierarchy, training in rela(ation is also start

Technique and roced


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o Relaxation. Behavior therapists frequently use the progressive rmethods of Cacobson !"#D%&. The patient is rst taught to tense aparticular muscle groups and then to distinguish between sensatrela(ation and tensing

o 3enerally, about si( sessions are devoted to rela(ation training. I

instances, hypnosis may be used to induce rela(ation. Eore commpatient may be as*ed to imagine rela(ing scenes andFor breathinare used to enhance rela(ation.

Technique and rocedu


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o The Anxiety Hierarchy. In discussions about specicproblems, the situations in which they occur, and theirdevelopment, the patient and the therapist wor* together tconstruct a hierarchy.

o

8 typical an(iety hierarchy consists of 45 to 4$ items inappro(imately equal intervals from low through moderate te(treme.

Technique and roced


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The following an(iety hierarchy was that of a 4:;year;old female se(perienced severe e(amination an(iety !olpe, "#/D&G

". ?our days before an e(amination.4. Three days before an e(amination.D. Two days before an e(amination.:. 6ne day before an e(amination.

$. The night before an e(amination.H. The e(amination paper lies face down before her./. 8waiting the distribution of e(amination papers.%. Before the unopened doors of the e(amination room.#. In the process of answering an e(amination paper."5. 6n the way to the university on the day of the e(amination.



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o This hierarchy illustrates two points. ?irst, it is organi'ed largalong spatial;temporal lines. econd, the items are not e(acorgani'ed in a logical fashion.

o In the desensiti'ation procedure, the patient is as*ed to imathe wea*est item in the hierarchy !the item that provo*es th

least an(iety& while being completely rela(ed. The therapistdescribes the scene, and the patient imagines !for about "5seconds& being in the scene. The therapist moves the patienthe hierarchy gradually !between two and ve items persession&.

Technique and roced


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o owever, if at any time the level of an(iety begins to increase, the instructed to signal, whereupon the therapist requests that the pativisuali'ing that scene. The therapist then helps the patient to rela(8fter a few minutes, the procedure can be started again. Ideally, ovseveral sessions, the patient will be able to imagine the highest itehierarchy without discomfort.



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o

8 typical e(ample of the instructions given to a male patienduring desensiti'ation is provided by 3oldfried and 9avison!"##:&G

!The client has been relaxing on his own in the reclining chair.) Onow just keep relaxing li*e that, nice and calm and comfortablemay nd it helpful to imagine a scene that is personally calm an

rela(ing, something well refer to as your pleasant sceneJ. ?ineAow, you recall that 5 to "55 scale weve been using in yourrela(ation practice, where 5 indicates complete rela(ation and "ma(imum tension. Tell me appro(imately where youd place youon that scaleJ. !Therapist is advised to look for a rating that reconsiderable calm and relaxation, often in the range of !" to #"

Technique and roced


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?ine. oon I shall as* you to imagine a scene. 8fter you hear the dethe situation, please imagine it as vividly as you can, through your as if you were actually there. Try to include all the details in the sceyoure visuali'ing the situation, you may continue feeling as rela(ednow. If so, thats good. 8fter $, "5, or "$ seconds, Ill as* you to stothe scene and return to your pleasant image and to Kust rela(. But ito feel even the slightest increase in an(iety or tension, please sign

meby raising your left forenger. hen you do this, Ill step in and as* imagining the situation and then will help you get rela(ed once moimportant that you indicate tension to me in this way, as we want tyour being e(posed to fearful situations without feeling an(ious. 6Lhave any questionsM J ?ine, well have ample opportunity afterwar

discuss things in full.



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o olpes e(planation for the success of systematic desensiti'atbased on the principle of counterconditioning $the substitutionrela(ation for an(iety&, others are not so sure !9avison ilso"#/D&. ome have argued that the operative process is reallyextinction.That is, when the patient repeatedly visuali'es an(generating situations but without ensuing bad e(periences, th

an(iety responses are eventually e(tinguished !ilson 9avis"#/"&.

o 8lternatively, Eathews !"#/"& argues on behalf of a habituatiohypothesis. %inally, some suggest that cognitive factors may bresponsible for the benecial e7ects of systematic desensiti'a

Rationale


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o The standard method of desensiti'ation is to present scenes in a gascending fashion to avoid premature arousal of an(iety that wouthe procedure.

o +onsequently, the patients e(pectations for improvement may a7process. 8nother crucial element may be positive reinforcement frtherapist following the patients reports of reduced an(iety, improoutside the consulting room, or the successful completion of an(iehierarchies.

o 3oldfried !"#/"& regards systematic desensiti'ation as training in control.

Rationale


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o In general, systematic desensiti'ation has proven to be amoderately useful form of psychological intervention for a varclinical conditions. 8s might be e(pected, research suggests this most e7ective when used to treat an(iety disorders, particuspecic phobias, social an(iety, public spea*ing an(iety, and

generali'ed an(iety disorder.

Rationale


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@(posure Therapy


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1

o The term exposure therapy describes a behavior ttechnique that is a renement of a set of procedur

*nown as Nooding or implosion.

o In e(posure therapy, patients e(pose themselves situations that were previously feared and avoided1e(posure2 can be in real life !in vivo& or in fantasyIn the latter version, patients are as*ed to imagine

the presence of the feared stimulus !e.g., a spideran(iety;provo*ing situation !e.g., spea*ing in frontaudience&.


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everal researchers suggest that certain features must be pre

treatments for the patient to achieve ma(imum benet !Barlo"#%%&G

". @(posure should be of long rather than short duration.4. @(posure should be repeated until all fearFan(iety is eliminaD. @(posure should be graduated, starting with low;an(iety

stimuliFsituations and progressing to high;an(iety stimuliFsitua:. atients must attend to the feared stimulus and interact witit as much as possible.$. @(posure must provo*e an(iety.


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o @(posure treatment can be used as a self;contained treatment ocomponent of a multimodal treatment.

o ?or e(ample, Barlow and +erny !"#%%& describe a psychological for panic disorder that includes rela(ation, cognitive restructuringe(posure components. They have patients e(pose themselves to icues&internal physiological stimuli such as rapid breathing and di

o

This modication was necessary because individuals su7ering frdisorder typically report that their panic attac*s are unpredictab1come out of the blue.2 In such cases, no e(ternal an(iety;provostimulus or situation is apparent.

o In contrast, individuals with other non;panic an(iety disorders rean(iety primarily in the face of certain e(ternal stimuli or situati


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o

+ras*e, Rowe, >ewin, and Aoriega;9imitri !"##/& comparee7ectiveness of two forms of treatment for panic disorderagoraphobia=one that included interoceptive e(posure aone that incorporated breathing retraining instead ofinteroceptive e(posure. 8lthough both forms of treatmente7ective, results indicated that panic disorder patients whreceived the interoceptive e(posure component reported

impairment and fewer panic attac*s at posttreatment andfollow;up. Thus, the addition of the interoceptive e(posurecomponent had some benecial e7ects.


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8nother e(ample of an e(posure based empirically supported treat

?oa !"##H& provides an overview of a typical e(posure plus respons

prevention treatment for 6+9G

". ?ifteen 4;hour e(posure sessions are conducted over the course owee*s.4. 9uring these sessions, patients are 1e(posed2 to the situations othat seem to trigger the obsessions. ?or e(ample, a patient who obsabout dirt and germs might be as*ed to rub newspaper print all ove

and face.D. In addition, patients are as*ed to imagine that the tragic consequanticipate occurring if they do not engage in compulsive behavior doccur. In this way, patients can begin thin*ing about these 1catastrowithout being mar*edly fearful.:. omewor* is assigned and involves repeating these e(posure e(


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$. 8t the same time that e(posure is introduced, the therapistensures that ritualistic compulsions that typically occur in the of the obsessional fear do not occur. ?or e(ample, the patient obsesses about dirt and germs and engages in e(cessive handwashing or showering would not be allowed to engage in thesbehaviors. 8t a later point in time, 1normal2 hand washing andshowering will be introduced.

H. ?inally, a maintenance phase of treatment involves about teo)ce visits or phone calls aimed at encouraging the patient areinforcing the therapeutic gains.

o @(posure plus response prevention is the most successfulpsychological treatment for obsessive compulsive disorde!@mmel*amp, 455:0 Rosa;8lca'ar et al., 455%&.


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The Technique. 8ccording to 3oldfried and 9avison !"##:&, the usebehavior rehearsal involves four stages.

o The rst stage is to prepare the patient by e(plaining the necessacquiring new behaviors, getting the patient to accept behavior ras a useful device, and reducing any initial an(iety over the pros

role;playing.

o. The second stage involves the selection of target situations. 8many therapists will draw up a hierarchy of role;playing or reheasituations.

Behavior Rehearsal


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o 8 sample hierarchy of target situationsG

". -ou as* a secretary for information about a class.4. -ou as* a student in class about last wee*s assignment.D. 8fter class, you approach the instructor with a question abothe lecture.:. -ou go to the instructors o)ce and engage her in conversa

about a certain point.$. -ou purposely engage another student, who you *nowdisagrees with you, in a minor debate about some issue.

Behavior Rehearsal


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o The third stage is the actual behavior rehearsal. Eoving up the hiethe patient plays the appropriate roles, with the therapist providincoaching and feedbac* regarding the adequacy of the patientsperformance.

o The nal stage is the patients actual utili'ation of newly acquired

real;life situations. 8fter such in vivo e(periences, the patient andtherapist discuss the patients performance and feelings about thee(periences.

Behavior Rehearsal


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Assertiveness Training. 6ne application of behavioral rehearsis assertiveness training. 'olpe regarded assertive responses asan e(ample of how reciprocal inhibition wor*s. That is, it isimpossible to behave assertively and to be passive simultaneou

o But assertiveness training has also been used in treatingse(ual problems, depression, and marital conNicts. It isimportant to note that cognitive self;statements !e.g., 1I wathin*ing that I am perfectly free to say no2& may enhance the7ects of assertiveness training. In fact, many procedures cbe used to increase assertiveness. Behavior rehearsal isperhaps the most obvious one.

Behavior Rehearsal


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>ac* of assertiveness may stem from a variety of sourcesG

o The cause may be a simple lac* of information, in which case the might center largely on providing information.

o In other instances, a *ind of anticipatory an(iety may prevent per

behaving assertively. In such cases, the treatment may involvedesensiti'ation.

o 6ther individuals may have unrealistic !negative& e(pectations abwill ensue if they become assertive. ome clinicians would deal we(pectations through interpretation or rational;emotive technique

imilar techniques might be applied to patients who feel that assert

wrong.

Behavior Rehearsal


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o ?inally, there are patients whose lac* of assertiveness involva behavioral decit=they do not *now how to behaveassertively. ?or such patients, behavior rehearsal, modeling,and related procedures would be used.

o 8ssertiveness training is not the same as trying to teach

people to be aggressive. It is really a method of training peoto e(press how they feel without trampling on the rights ofothers in the process !olpe >a'arus, "#HH&.

Behavior Rehearsal


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+ontingency Eanage


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1

8 variety of *innerian or operant techniques are all recontingency management procedures.They share theof controlling behavior by manipulating its consequencmany children are brought by their parents to receive treatment, particularly for 1acting;out2 or rule;brea*incontingency management techniques are used very co

child and adolescent patients.


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o (haping 8 desired behavior is developed by rst rewarding abehavior that appro(imates it. 3radually, through selectivereinforcement of behavior more and more closely resemblingthe desired behavior, the nal behavior is shaped. Thistechnique is sometimes called successive approximation.

o Time*out Ondesirable behavior is e(tinguished by removingthe person temporarily from a situation in which that behaviois reinforced. 8 child who disrupts the class is removed so thathe disruptive behavior cannot be reinforced by the attentionothers.

Techniques


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o +ontingency contracting 8 formal agreement or contract is struc*therapist and patient, specifying the consequences of certain behathe part of both.

o -randmas rule/The basic idea is a*in to 3randmas e(hortationwor*, then you play


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In establishing a to*en economy, there are three maKorconsiderations !Lrasner, "#/"&G

o ?irst, there must be a clear and careful specication of thedesirable behaviors that will be reinforced.

o econd, a clearly dened reinforcer !or medium of e(changee.g., colored po*er chips, cards, or coins& must be decidedupon.

o Third, bac*up reinforcers are established.

To*en @conomies


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o To*en economies are used to promote desired behavior through thof reinforcements.

o To*ens are used because the e7ect of reinforcement is greater if treinforcement occurs immediately after the behavior occurs.

To*en @conomies


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8version Therapy


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1

8version therapy consists, operationally, of administerstimulus to inhibit an unwanted emotional response, thdiminishing its habit strength !olpe, "#/D&.


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o 8n unpleasant stimulus is placed in temporal contiguity with theundesirable behavior. The idea is that a permanent associationbetween the undesirable behavior and the unpleasant stimulus wforged, and conditioning will ta*e place.

o 8version therapy techniques have been around for eons, often in

form of such unsophisticated practices as span*ing, 13o to your roand 1Ao TP tonight for you.2 Eodern aversive therapy techniquesfrom these e(amples in at least two important ways. ?irst, thepresentation of the aversive agent is done systematically. Thetemporal contiguity is very carefully monitored. econd, thepunishment is consistently applied.

8version Therapy


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o 8mong the aversive agents that have been used most frequently ar

electrical stimulation and drugs.

o ?or e(ample, strong emetic drugs have been used aversively for ma!see, e.g., Poegtlin >emere, "#:4&, especially in the treatment ofalcoholism. The patient is given a drug that produces nausea or vomand then ta*es a drin* !or the drug may be mi(ed with the drin*&. Tpatient soon becomes ill. This combination of alcohol and emetic is

a wee* to "5 days. @ventually, Kust the sight of a drin* is su)cient tnausea and discomfort.

o olpe !"#/D& has described a variety of other aversive agents, incluholding ones breath, stale cigarette smo*e, vile;smelling solutions oasafetida, intense illumination, white noise, and shame. +learly, the

potential aversive agents is limited only by the imagination of resou

8versive 8gents


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o +autela !"#H/& developed a set of procedures, *nown as coversensiti2ation, that rely on imagery rather than the actual use opunishment, drugs, or stimulation.

o atients are as*ed to imagine themselves engaging in the behthey wish to eliminate. 6nce they have the undesired behavioin mind, they are instructed to imagine e(tremely aversive eve

ome of the instructions are vivid to say the least. 8 rather mie(ample from the treatment of a case of overeating should suyou touch the for*, you can feel food particles inching up your

-oure Kust about to vomit2 !+autela, "#H/, p. :H4&. The ensuindescriptions become more graphic.

+overt ensiti'ation


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o 3esponse cost is a techni4ue in which positive reinforcers !e.g., to*eto*en economy system& are removed following an undesired respona temper tantrum& made by a patient !piegler 3uevremont, 45"

o 8nother technique is called overcorrection. ere, the idea is that hapatient or client 1overcorrect2 the consequences of an act will ma*e

behavior less li*ely to recur !piegler 3uevremont, 45"5&.

6ther Techniques


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rominent behaviorists !e.g. *inner& have questioned the e7ectivepunishment in inNuencing and controlling behavior, and many clinichave de;emphasi'ed aversion methods in their behavioral therapyapproaches.

o >a'arus !"#/"a&, for e(ample, stated that the building of betterresponse repertoires and the reduction of an(iety produce longe

lasting results than do aversion techniques.

o Eany critics, both within and without the behavior therapy movhave been highly critical of aversion therapy. The concentrationpunishment and the use of what are sometimes terrifying stimuseem totally incompatible with human dignity. hether or not ppresent themselves voluntarily for treatment is beside the point

econd Thoughts


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o 6thers, however, maintain that aversive techniques, used in a sensfashion by reputable professionals, have real merit. Eost often, avetechniques are used after everything else has failed.

o ?urthermore, patients are not dragged *ic*ing and screaming into tsituation. Osually, the procedures are applied to people who have se

debilitating problems !alcoholism, e(cessive smo*ing, se(ual deviatwho are in despair because nothing else has wor*ed.

econd Thoughts


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o piegler and 3uevremont !45"5& remind us to *eep several addipoints in mind as we are evaluating the ethics of aversion therap

The aversive stimulus is of relatively brief duration and does notlong lasting e7ect0 and !b& clients are not required to engage in ttreatment but do so by choice. uch people voluntarily underta*aversion therapy as the lesser evil=in the same spirit, perhaps,

one submits yearly to that terrifying 1torture2 at the hands of a fdentist.

econd Thoughts


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Reference

Q resentation template by lides+arnival

Q hotographs by Onsplash

+linical sychology by Trull and rinstein
http://www.slidescarnival.com/http://unsplash.com/http://unsplash.com/http://www.slidescarnival.com/

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Behavior Therapy Powerpoint

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