Behaviour Therapy.docx

Behaviour Therapy Behaviour therapies postulate that psychological distress arises because of faulty behaviour patterns or thought patterns. It is, therefore, focused on the behaviour and thoughts of the client in the present. The past is relevant only to the extent of understanding the origi...

Behaviour Therapy Behaviour therapies postulate that psychological distress arises because of faulty behaviour patterns or thought patterns. It is, therefore, focused on the behaviour and thoughts of the client in the present. The past is relevant only to the extent of understanding the origins of the faulty behaviour and thought patterns. The past is not activated or relived. Only the faulty patterns are corrected in the present. The clinical application of learning theory principles constitute behaviour therapy. Behaviour therapy consists of a large set of specific techniques and interventions. It is not a unified theory, which is applied irrespective of the clinical diagnosis or the symptoms present. The symptoms of the client and the clinical diagnosis are the guiding factors in the selection of the specific techniques or interventions to be applied. Treatment of phobias or excessive and crippling fears would require the use of one set of techniques while that of anger outbursts would require another. A depressed client would be treated differently from a client who is anxious. The foundation of behaviour therapy is on formulating dysfunctional or faulty behaviours, the factors which reinforce and maintain these behaviours, and devising methods by which they can be changed. Method of Treatment The client with psychological distress or with physical symptoms, which cannot be attributed to physical disease, is interviewed with a view to analyse her/ his behaviour patterns. Behavioural analysis is conducted to find malfunctioning behaviours, the antecedents of faulty learning, and the factors that maintain or continue faulty learning. Malfunctioning behaviours are those behaviours which cause distress to the client. Antecedent factors are those causes which predispose the person to indulge in that behaviour. Maintaining factors are those factors which lead to the persistence of the faulty behaviour. An example would be a young person who has acquired the malfunctioning behaviour of smoking and seeks help to get rid of smoking. Behavioural analysis conducted by interviewing the client and the family members reveals that the person started smoking when he was preparing for the annual examination. He had reported relief from anxiety upon smoking. Thus, anxiety-provoking situation becomes the causative or antecedent factor. The feeling of relief becomes the maintaining factor for him to continue smoking. The client has acquired the operant response of smoking, which is maintained by the reinforcing value of relief from anxiety. Once the faulty behaviours which cause distress, have been identified, a treatment package is chosen. The aim of the treatment is to extinguish or eliminate the faulty behaviours and substitute them with adaptive behaviour patterns. The therapist does this through establishing antecedent operations and consequent operations. Antecedent operations control behaviour by changing something that precedes such a behaviour. The change can be done by increasing or decreasing the reinforcing value of a particular consequence. This is called establishing operation. For example, if a child gives trouble in eating dinner, an establishing operation would be to decrease the quantity of food served at tea time. This would increase the hunger at dinner and thereby increase the reinforcing value of food at dinner. Praising the child when s/he eats properly tends to encourage this behaviour. The antecedent operation is the reduction of food at tea time and the consequent operation is praising the child for eating dinner. It establishes the response of eating dinner. Behavioural Techniques A range of techniques is available for changing behaviour. The principles of these techniques are to reduce the arousal level of the client, alter behaviour through classical conditioning or operant conditioning with different contingencies of reinforcements, as well as to use vicarious learning procedures, if necessary. Negative reinforcement and aversive conditioning are the two major techniques of behaviour modification. As you have already studied in Class XI, responses that lead organisms to get rid of painful stimuli or avoid and escape from them provide negative reinforcement. For example, one learns to put on woollen clothes, burn firewood or use electric heaters to avoid the unpleasant cold weather. One learns to move away from dangerous stimuli because they provide negative reinforcement. Aversive conditioning refers to repeated association of undesired response with an aversive consequence. For example, an alcoholic is given a mild electric shock and asked to smell the alcohol. With repeated pairings the smell of alcohol is aversive as the pain of the shock is associated with it and the person will give up alcohol. If an adaptive behaviour occurs rarely, positive reinforcement is given to increase the deficit. For example, if a child does not do homework regularly, positive reinforcement may be used by the child's mother by preparing the child's favourite dish whenever s/he does homework at the appointed time. The positive reinforcement of food will increase the behaviour of doing homework at the appointed time. Persons with behavioural problems can be given a token as a reward every time a wanted behaviour occurs. The tokens are collected and exchanged for a reward such as an outing for the patient or a treat for the child. This is known as token economy. Unwanted behaviour can be reduced and wanted behaviour can be increased simultaneously through differential reinforcement. Positive reinforcement for the wanted behaviour and negative reinforcement for the unwanted behaviour attempted together may be one such method. The other method is to positively reinforce the wanted behaviour and ignore the unwanted behaviour. The latter method is less painful and equally effective. For example, let us consider the case of a girl who sulks and cries when she is not taken to the cinema when she asks. The parent is instructed to take her to the cinema if she does not cry and sulk but not to take her if she does. Further, the parent is instructed to ignore the girl when she cries and sulks. The wanted behaviour of politely asking to be taken to the cinema increases and the unwanted behaviour of crying and sulking decreases. You read about phobias or irrational fears in the previous chapter. Systematic desensitisation is a technique introduced by Wolpe for treating phobias or irrational fears. The client is interviewed to elicit fear - provoking situations and together with the client, the therapist prepares a hierarchy of anxiety-provoking stimuli with the least anxiety-provoking stimuli at the bottom of the hierarchy. The therapist relaxes the client and asks the client to think about the least anxietyprovoking situation. Box 5.2 gives details of relaxation procedures. The client is asked to stop thinking of the fearful situation if the slightest tension is felt. Over sessions, the client is able to imagine more severe fear -provoking situations while maintaining the relaxation. The client gets systematically desensitised to the fear. The principle of reciprocal inhibition operates here. This principle states that the presence of two mutually opposing forces at the same time, inhibits the weaker force. Thus, the relaxation response is first built up and mildly anxiety-provoking scene is imagined, and the anxiety is overcome by the relaxation. The client is able to tolerate progressively greater levels of anxiety because of her/ his relaxed state. Modelling is the procedure wherein the client learns to behave in a certain way by observing the behaviour of a role model or the therapist who initially acts as the role model. Vicarious learning, i.e. learning by observing others, is used and through a process of rewarding small changes in the behaviour, the client gradually learns to acquire the behaviour of the model. There is a great variety of techniques. in behaviour therapy. The skill of the therapist lies in conducting an accurate behavioural analysis and building a treatment package with the appropriate techniques.\ \ Cognitive Therapy Cognitive therapies locate the cause of psychological distress in irrational thoughts and beliefs. Albert Ellis formulated the Rational Emotive Therapy (RET). The central thesis of this therapy is that irrational beliefs mediate between the antecedent events and their consequences. The first step in RET is the antecedent-belief-consequence (ABC) analysis. Antecedent events, which caused the psychological distress, are noted. The client is also interviewed to find the irrational beliefs, which are distorting the present reality. Irrational beliefs may not be supported by empirical evidence in the environment. These beliefs are characterised by thoughts with 'musts' and 'shoulds', i.e. things 'must' and 'should' be in a particular manner. Examples of irrational beliefs are, "One should be loved by everybody all the time", "Human misery is caused by external events over which one does not have any control", etc. This distorted perception of the antecedent event due to the irrational belief leads to the consequence, i.e. negative emotions and behaviours. Irrational beliefs are assessed through questionnaires and interviews. In the process of RET, the irrational beliefs are refuted by the therapist through a process of non-directive questioning. The nature of questioning is gentle, without probing or being directive. The questions make the client to think deeper into her/his assumptions about life and problems. Gradually the client is able to change the irrational beliefs by making a change in her/his philosophy about life. The rational belief system replaces the irrational belief system and there is a reduction in psychological distress.