Behavior therapy

Behavior therapy (also called behavior modification) is defined in the Encyclopedia Britannica as “psychological counseling to change activity that is undesirable or potentially harmful. Treatment most often is directed toward changing harmful habits such as dieting to lose weight, controlling drug and alcohol abuse, or managing stress . . . “

Parents, teachers and coaches utilize behavior modification when attempting to guide children’s habits and self management skills. Discipline can take the form of behavior modification when methods such as reward, punishment, and reinforcement are used. The efficacy of these methodologies relies on appropriate and measured use, a skill that requires maturity and wisdom. When this is absent, behavior modification methods can take negative forms.

Psychologists have practiced a variety of methods of behavior therapy over the past century. The Miriam Webster Dictionary defines it as, “psychotherapy that emphasizes the application of the principles of learning to substitute desirable responses and behavior patterns for undesirable ones. . .”

Overview

Behavior therapy is a form of psychotherapy used to treat depression, anxiety disorders, phobias, and other forms of psychopathology. It arose out of the German mechanist theory of psychology in the nineteenth century. Building upon the experimental work of Edward L. Thorndike and Ivan Pavlov, the behaviorists theorized that human activity was based upon a learning model depending upon trial and error. Behavior that produced a pleasurable of useful result was retained and all other behavior was ignored and abandoned over time. Pavlov expanded Thorndike’s basic learning theory to include unconditioned and conditioned stimuli and reflexes in which a primary (unconditioned) stimulus and reflex could be paired to a secondary (conditioned) stimulus to link the unconditioned reflex to a new, conditioned stimulus. B. F. Skinner expanded the scope of behavior modification with his concept of operant conditioning, which stated that learning may be shaped by the intentional rewarding of behaviors that approximate a desired behavior. For example a chicken can learn to walk a tightrope with an umbrella in its beak when it is given food for learning to walk in a straight line, then for walking along a narrow board, then a thinner board, etc. until it learns it will receive corn when it walks along a cord strung between two platforms. The combination of Pavlov’s and Skinner’s work led to the modern use of behavioral tools for shaping behavior in the educational and clinical arenas with such tools as token economies, aversive conditioning and modeling.

Historical development

Behaviorism as a psychological approach

Methods of modifying behavior for the benefit of society or that of the individual date to the earliest recorded history. The military, religious orders, schools, families, and penal codes contain elements found in modern behavioral modification techniques such as modeling, positive and negative reinforcement, token economies and systematic desensitization. Behavioral therapy grew out of the academic theory of behaviorism which began to flourish in the latter part of the nineteenth century and reached its zenith in the mid twentieth century.

The origin of modern behaviorism can be traced to the work of the German mechanists in the nineteenth century who rejected any phenomena that could not be directly observed and measured by a researcher. Research on animal behavior began to gain legitimacy as pertinent to human behavior with the growing acceptance of Darwin’s work and the inclusion of man in the animal kingdom. During the nineteenth century the work of William James and Wilhelm Wundt focused on experimentation and introspection of one’s own mind. In academic circles, it became clear that the study of feelings, thoughts, perceptions, mind and soul could not be directly observed or adequately defined and seemed to put psychology at a distinct disadvantage in comparison to the “hard sciences” which dealt only with observable, recordable “facts.” The experimental focus of James and Wundt was retained in the behaviorist movement while the practice of introspection was abandoned. Two early behavioral theorists who subscribed to the mechanistic theory were Edward Thorndike and Ivan Pavlov.

Edward L. Thorndike, a pioneer in linking animal experimentation to human behavior studied the behavior of chickens, dogs and cats in learning to escape from cages to obtain rewards such as food, and concluded animal learning was based solely on trial and error. From this he formulated two laws of learning that he called the Law of Effect, which states that positive reinforcement of an accidental behavior will stimulate the behavior and lack of positive reinforcement will not. The Law of Exercise says a behavior becomes stronger with repeated use. He believed that human learning followed the same rules.

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Ivan Pavlov

Ivan Pavlov was a Russian physiologist who studied digestive processes in dogs. To observe the gastric secretions of the stomach he devised an external pouch created from a portion of the stomach. After the dogs had been studied for a while Pavlov noted that the secretion of gastric juices and saliva was stimulated simply by the appearance of their handlers and after more study, concluded the existence of a “conditioned stimulus and reflex” at one remove from the “unconditioned stimulus of the food and the unconditioned reflexes of salivation and gastric secretion.. The dogs had learned to associate the arrival of their keepers with food, which produced the physiological reflexes of secreting gastric juices and salivating. The theories of learning formulated by Thorndike and Pavlov became the basis of behaviorism and later of behavioral therapy.

Behaviorism came into its own with the work of John B. Watson, a charismatic, energetic man who rose from obscure beginnings to become the chair of psychology at Johns Hopkins University. Watson’s early research focused on rats and maze solving abilities. From this work and his knowledge of the work of Thorndike and Pavlov, Watson began to formulate a new school of psychology based entirely on observable behavior. He entirely repudiated the existence of consciousness and considered “mind” to be only an updated term for the soul, which he considered an unproven religious concept. Watson devoted his life to popularizing his theories under the term “behaviorism” which he coined. His best known experiment is that of Little Albert which is cited in most texts of general psychology. Watson and his assistant conditioned the 11 month old child to have a fear of furry, white animals by creating a loud noise at the moment he was exposed to a white rat. This conditioned fear was demonstrated to have generalized to other animals and furry objects such as fur clothing, confirming Pavlov’s theory of conditioned and unconditioned stimuli and reflexes. This experiment led to one of the earliest uses of behavioral theory as a treatment method.

Mary Cover Jones, one of Watson’s graduate students worked with a group of children exhibiting fearful behavior. She used counterconditioning and social modeling to attempt to eliminate or reduce phobias.. Jones and her associates would expose the children to the feared object while they were enjoying a favorite food in an attempt to lessen the impact of the fear. The theory was that the pleasure associated with the food would override the fear associated with the feared object. The children would also watch and play with peers who were observed to be playing with the avoided object without fear. The concept of observing peers participating in a feared activity lead to the concept of modeling, as a behavioral technique.

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Burrhus Frederic Skinner

Burrhus F. Skinner, popularly known as B. F. Skinner is perhaps the best known of the behaviorists. He introduced the term, behavior therapy in psychological texts and to the general public though he did not treat human patients himself. He subscribed to William James’ statement that behavior precedes feelings and that “people are sorry because they cry,” rather than the more traditional belief that people cry because they are sorry. Skinner is best known for his theory of “operant conditioning” and his development of the Skinner box, a variation and improvement upon the cages Thorndike used in his animal experiments. Operant conditioning is based upon the intentional shaping of behavior by exposing a subject to a situation in which it is rewarded for minute movements toward the desired behavior. For example, in World War II, pigeons were trained to guide unmanned missiles toward a target by pecking at a spot on a guidance screen that kept the missile on course. This was accomplished by rewarding the pigeon with food each time its pecking on a screen more closely approached a chosen pattern.

In the human realm, Skinner began to experiment in the 1950’s on using operant conditioning in the class room, leading to teaching machines and more recently to computerized learning. Behavior modification was also used to treat severely disturbed patients in hospital settings and has been applied to prison populations, especially with sexual deviancy, with mixed results. Token economies are a variation of operant conditioning and are used in parenting training, teaching and penology, to name some typical applications. Parents have learned to use stars on refrigerator charts to reward desired behavior. Extinction of undesired behavior has been attempted with aversive techniques such as mild electric shocks, unpleasant tastes and other methods which have been applied to addictions and aberrant behavior. In parenting, some aversive techniques are “time outs” and “grounding.” The movie “A Clockwork Orange” popularized an extreme version of aversive conditioning using conditioned stimuli to eliminate antisocial behavior..

Skinner was a strict behaviorist. That is, he subscribed to Watson’s definition of psychology as excluding any reference to mind or thought, which he defined as a conditioned response to behavior. By the late fifties, this strict approach had run its course as it became clear that mind could not be excluded from theories of human behavior and is not merely a consequence, but a motivator of behavior. After using animal research with various species of animals it also became evident that an animal was not born as a “blank slate” but was pre-programmed with instinctive behavior governing its possibilities of learning. For instance, birds would instinctively peck at objects and this pattern could be used to program them to obtain food by pecking at a disk, while dogs would use their feet to operate a lever to obtain rewards. But dogs did not exhibit pecking behavior and birds did not operate levers with their wings. Because of these inborn instincts, it became clear that not all animal behavior could be directly transferred to humans. Over time, it also became evident that conditioned behavior in animals tended to self extinguish over time unless it was externally reinforced.

Humans, on the other hand, were observed to continue to react to conditioned stimuli long after reinforcement had ceased. Some theorists concluded the reinforcement schedule had been internalized and maintained by humans’ ability to imagine and create situations internally and autonomously. Because of this ability, humans had the possibility of altering responses to stimuli by using the power of imagery and cognition to alter the same behavior they had previously maintained and strengthened. These realizations led to the pairing of behavioral theory with cognitive and emotional approaches. Thoughts and feelings were defined as a type of behavior and incorporated into behavioral theory, producing the modern practice of cognitive behavioral therapy, as behaviorism moved into the clinical realm in the 1960’s.

Search for appropriate therapies to treat psychological disorders

The early pioneers of behavioral therapy were primarily disaffected psychoanalysts, disappointed in the results of traditional Freudian therapy. The Freudian model had been unchallenged through the first half of the twentieth century and efforts to move psychology in a different direction took time and courage. Change is usually opposed by the dominant mental model in all walks of life. Psychology was not different in this regard. The pioneering psychologists that broke from the old paradigm met opposition and criticism from many of their peers though they were applying some of the experimental data from behaviorism to new clinical work. Two of the early practitioners were Joseph Wolpe and Albert Ellis.

Wolpe successfully treated phobias by combining progressive relaxation and emotive imagery. In this pairing, which is evocative of the combination of favorite food and a feared object developed by Jones, Wolpe had patients imagine a feared object or situation after achieving a state of deep relaxation. This approach had a high rate of effectiveness and achieved results quickly. It was called systematic desensitization and Wolpe was able to achieve the highest rate of cure of phobia ever recorded.

Albert Ellis, another disgruntled psychoanalyst, turned to a model based on behavior, mind and affect. This early model of cognitive therapy was based on the model of the Greek stoics and other early philosophers that postulated it is not events but beliefs about events that shape our view of reality and make life difficult. His ABC model theorizes that A, the activating event, activates a person’s personal belief system, B, which activates C, the person’s emotional response to the event. Therefore, to help people respond in a more constructive and creative way to events, Ellis believed the therapist must intervene at the only point at which the patient and therapist have any real power, the realm of beliefs. Ellis also included the use of Pavlovian conditioning in his therapy and in 1994 changed the name of his approach to Rational Emotive Behavior Therapy.

Aaron Beck’s cognitive therapy is similar to Ellis’ approach and has proven very effective in the treatment of depression. David Burns has expanded upon Beck’s approach and has developed a model for treating depression ,, anxiety, and obsessive compulsive disorders utilizing cognitive, behavioral and emotional interventions. Marsha Linnehan has developed Dialectical Behavioral Therapy as an effective treatment for severe character disorders. This approach is based upon intervening at the point of emotional disregulation and teaching alternative responses and ways to substitute other more functional behaviors.

Tools

Modification

Behavior modification is a technique of altering an individual's reactions to stimuli through positive reinforcement and the extinction of maladaptive behavior.

While founded in behaviorism, Behavior modification has long been used by psychotherapists, parents, and caretakers of the disabled, generally without any underlying behaviorist philosophy. It involves the most basic of methods to alter human behavior, such as reward and punishment, aversion therapy, reinforcement, and even biofeedback. The cultivation of life skills are often a central focus.

Analysis of the patients thoughts are not required, but many non-behaviorists feel the therapy can be powerfully improved with such cognitive analysis. Punishment is also frowned upon in many contexts, with extinction of conditioned reflexes often in its place.

A major focus of behavior modification is giving compliments, approval, encouragement and affirmation; a ratio of five compliments for every one complaint is found to be most effectual in altering another's behavior in a desired manner.

Behavior-based approaches to improving occupational safety performance focus on the study of safety behaviors before and after various interventions to the safety behavior of the individuals involved. The three items for introduction of a behavior-based system are: antecedent, behavior and consequence (ABC). According to behavior modification theory, worker behavior may be influenced by systematically reinforcing the right behavior until a new habit if formed.

From a sociological point-of-view, if punishment is too harsh or the withholding of rewards is too harsh, the subject may seem to be corrected of the maladaptive behavior by scientific measurements, but if a bad example is set — as described in social learning theory. This bad example and the bad feelings that are a result, as in causing an affective disorder (i.e. an emotional disorder), the subject could cause the re-infliction of punishment as a chain reaction in society. The punishment and the bad feelings that result may spread through society and be the cause of a contagious reaction referred to as social illness.

Systematic desensitization is a type of behavioral therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders. More specifically, it is a type of Pavlovian therapy developed by a South African psychiatrist, Joseph Wolpe. To begin the process of systematic desensitization, one must first be taught relaxation skills in order to control fear and anxiety responses to specific phobias. Once the individual has been taught these skills, he or she must use them to react towards and overcome situations in an established hierarchy of fears. The goal of this process is that an individual will learn to cope and overcome the fear in each step of the hierarchy, which will lead to overcoming the last step of the fear in the hierarchy. Systematic desensitization is sometimes called graduated exposure therapy.

Clinical Procedure

Specific phobias are one class of mental illness often treated through the cognitive-behavioral process of systematic desensitization. When individuals possess irrational fears of an object, they tend to avoid it. Since escaping from the phobic object reduces their anxiety, patients’ behavior to reduce fear is reinforced through negative reinforcement a concept defined in operant conditioning. The goal of SD is to overcome this avoidance pattern by gradually exposing patients to the phobic object until it can be tolerated. In classical conditioning terms the elicitation of the fear response is extinguished to the stimulus (or class of stimuli).

Coping Strategies

Prior to exposure, the therapist teaches the patient cognitive strategies to cope with anxiety. This is necessary because it provides the patient with a means of controlling their fear, rather than letting it build until it becomes unbearable. Relaxation training, such as meditation, is one type of coping strategy. Patients might be taught to focus on their breathing or to think about happy situations. Another means of relaxation is cognitive reappraisal of imagined outcomes. The therapist might encourage subjects to examine what they imagine happening when exposed to the phobic object, allowing them to recognize their catastrophic visions and contrast them with the actual outcome. For example, a patient with a snake phobia might realize that they imagine any snake they encounter would coil itself around their neck and strangling them, when this would not actually occur. Research at the University of Pennsylvania has demonstrated the effectiveness of this technique in helping subjects reduce similar animal phobias.

Progressive Exposure

The second component of systematic desensitization is gradual exposure to the feared object. Continuing with the snake example, the therapist would begin by asking their patient to develop a fear hierarchy, listing the relative unpleasantness of various types of exposure. For example, seeing a picture of a snake in a newspaper might be rated 5 of 100, while having several live snakes crawling on one’s neck would be the most fearful experience possible. Once the patient had practiced their relaxation technique, the therapist would then present them with the photograph, and help them calm down. They would then present increasingly unpleasant situations: a poster of a snake, a small snake in a box in the other room, a snake in a clear box in view, touching the snake, etc. At each step in the progression, the patient is desensitized to the phobia through the use of the coping technique. They realize that nothing bad happens to them, and the fear gradually extinguishes.

Current trends

Studies have shown cognitive behavior therapy to have equal effectiveness with medication in treating most situational depression and the combination of the two is rated the most effective approach available. This approach has become an accepted treatment of depression, anxiety and obsessive-compulsive disorders.

In the medical field, Carl Simonton has used behavioral tools in conjunction with conventional cancer treatment. In controlled trials at UCLA Medical Center, patients who received this combination of treatments lived twice as long as patients receiving only conventional cancer treatment. Behavioral concepts are also used in weight loss programs, smoking cessation and eating disorders where they are usually combined with other approaches with significant success.

In the century and a half since behaviorism was first formulated, the range of observable behavior has dramatically increased. Earlier tools such as blood pressure cuffs, x-rays, and EKG machines have been succeeded by a flood of technology such as PET and CAT scans that make it possible to actually observe changes in brain activity in response to carefully presented stimuli, bringing the brain and its activity directly into the realm of observable behavior. Similar advances have occurred in our knowledge of synapses, serotonin, and other messenger compounds in the nervous system, making the realm of the observable immeasurably more complex and vast than in nineteenth century Germany.

The realms of behavioral science have permeated our modern society. The realm of advertisement has grown increasingly sophisticated, and behavioral theory permeates the workplace with implemented theories of variable reinforcement, token reinforcement, and benefits.

In the first decade of the twenty-first century, behavioral therapy and its philosophical parent, behaviorism, have not become the definitive and final answer to the questions of mans’ motivations, nor the only approach to alleviating his problems and sufferings, but they are a vital and effective part of the search for meaning and understanding of human behavior that constitutes the core of psychology.

References

ISBN links support NWE through referral fees

Hunt, Morton, 1993. The Story of Psychology. NY: Doubleday Publishing.

External links

• ldonline.org - Behavior modification in the Classroom
• about.com - Changing Our Perspective Can Help Our Child To Behave
• ehow.com - How to Create a Behavior Modification Plan for Students With Behavioral Disabilities
• Association for Comprehensive NeuroTherapy - Behavior modification charts for home and school
• Self administered Systematic Desensitization
• American Psychological Association, 110th Convention 2002. Will the Real Behavior Therapy Please Stand Up?. Retrieved on December 20, 2006.
• - Behavior Therapy, Encyclopedia of Mental Health Academic Press, 1998.Harvard University College of Medicine. Retrieved on December 20, 2006.

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