Clinical-Psychology-Module-8.pdf

Module 8 Clinical Psychology Classic Behavioral Therapies COLLEGE OF ARTS AND SCIENCES...

Module 8 Clinical Psychology Classic Behavioral Therapies COLLEGE OF ARTS AND SCIENCES C_Outline Frederick Edward Fabella, Ph. D. Instructor [email protected] San Mateo Municipal College Gen. Luna St. Guitnang Bayan I, San Mateo, Rizal Tel. No. (02) 997-9070  Learning Objectives: After completing this module, you should be able to: 1. Explain the basis of Behavior Therapy 2. Describe Token Economy 3. Explain a Contingency contract 4. Define Exposure Therapy 5. Explain Flooding 6. Describe Aversion Therapy 7. Define Anxiety Hierarchy 8. Explain Behavior Rehearsal Input Information: Origins of Behavior Therapy Token Economy Contingency Contract Exposure Therapy Flooding Aversion Therapy Anxiety Hierarchy Behavior Rehearsal REMINDER This module is for personal and academic use of the reader and is not intended for commercial use or sale. Distribution to non-SMMC or uploading to other sites is PROHIBITED. History of Behavior Therapy The first use of the term “behavior modification” appears to have been by Edward Thorndike in 1911. His article “Provisional Laws of Acquired Behavior or Learning” makes frequent use of the phrase “modifying behavior.” Through early research in the 1940s and the 1950s the term was used by Joseph Wolpe’s research group. In general, behavior therapy is seen as having three distinct points of origin: South Africa (Wolpe’s group), the United States (B. F. Skinner ), and the United Kingdom (Rachman and Eysenck). Each had its own distinct approach to viewing behavior problems. B. F. Skinner developed the idea of operant conditioning in 1937, when he tested the learning of rats through reinforcement and punishment in what is now called a Skinner box. Ivan Pavlov’s famous experiments with dogs provide the most familiar example of the classical-conditioning procedure. Exposure therapy was first reported in 1924 by Mary Cover Jones, who is considered the mother of behavior therapy. Jones used exposure therapy with a boy named Peter to help him overcome his fear of rabbits. Thirty years later, Joseph Wolpe (1958) refined Jones’s techniques, giving us the technique of exposure therapy that is used today. In the second half of the 20th century, many therapists coupled behavior therapy with the cognitive therapy of Aaron Beck and Albert Ellis, forming cognitive behavioral therapy (CBT). Defining the Behavioral Approach and Applied Behavioral Analysis Behavior therapy is a treatment approach that is based on the idea that abnormal behavior is learned. It applies the principles of operant conditioning, classical conditioning, and observational learning to eliminate inappropriate or maladaptive behaviors and replace them with more adaptive responses. Behavior therapy methods sometimes focus only on behaviors, and sometimes on combinations of thoughts and feelings that might be influencing behaviors. Those who practice behavior therapy, known as behaviorists, tend to look more at specific, learned behaviors and how the environment has an impact on those behaviors. Behaviorists tend to look for treatment outcomes that are objectively measurable. Behavior therapy stands apart from insight-based therapies (such as psychoanalytic and humanistic therapy) because the goal is to teach clients new behaviors to minimize or eliminate problems, rather than digging deeply into their subconscious or uncovering repressed feelings. The basic premise is that the individual has learned behaviors that are problematic and maladaptive, and so he or she must learn new behaviors that are adaptive. Foundations Behaviorism focuses on learning that is brought about by a change in external behavior, achieved through a repetition of desirable actions and the rewarding of good habits and the discouragement of bad habits. There are two basic theories of learning that build the foundation for behaviorism: Operant conditioning is a type of learning in which an individual’s behavior is modified by its consequences; the behavior may change in form, frequency, or strength. Classical conditioning is a form of learning in which a subject comes to respond to a previously neutral stimulus by continually pairing it with an unconditioned stimulus that elicits the desired response. Operant Conditioning Approaches Applied behavioral analysis (ABA) is a type of behavior therapy that uses the principles of operant conditioning; it is commonly used in the treatment of children with autism spectrum disorder (ASD). In this treatment, child-specific reinforcers (e.g., stickers, praise, candy, bubbles, and extra play time) are used to reward and motivate children with ASD when they demonstrate desired behaviors, such as sitting on a chair when requested, verbalizing a greeting, or making eye contact. Punishment such as a timeout or a sharp “No!” from the therapist or parent might be used to discourage undesirable behaviors such as pinching, scratching, and pulling hair. The use of token economies is a behavior-therapy technique in which clients are reinforced with tokens that are considered a type of currency that can be exchanged for special privileges or desired items. Token economies are mainly used in institutional and therapeutic settings. Over time, tokens need to be replaced with less tangible rewards, such as compliments, so that the client will be prepared when they leave the therapeutic setting. Contingency contracts are formal, written contracts between the client and the therapist. They outline behavior-change goals, reinforcements, rewards, and penalties for not meeting the terms of the agreement. Modeling involves learning through observation and emulating the behavior of others. The modeling process involves a person being subjected to watching other individuals who demonstrate behavior that is considered adaptive and that should be adopted by the client. In some cases, the therapist might model the desired behavior; in other instances, watching peers demonstrate the behaviors may be helpful. The process is based on Albert Bandura’s social learning theory, which emphasizes the social components of the learning process. Classical Conditioning Approaches One commonly used classical conditioning therapeutic technique is aversive conditioning, which uses an unpleasant stimulus to stop an undesirable behavior. Therapists apply this technique to eliminate addictive behaviors, such as smoking, nail biting, and drinking. In aversion therapy, clients will typically engage in a specific behavior (such as nail biting) and at the same time are exposed to something unpleasant, such as a mild electric shock or a bad taste. After repeated associations between the unpleasant stimulus and the behavior, the client can learn to stop the unwanted behavior. In exposure therapy, a therapist seeks to treat clients’ fears or anxiety by presenting them with the object or situation that causes their problem, with the idea that they will eventually get used to it. This can be done via reality, imagination, or virtual reality. A popular form of exposure therapy is systematic desensitization, wherein a calm and pleasant state is gradually associated with increasing levels of anxiety-inducing stimuli. Virtual reality exposure therapy uses simulations when it’s either too impractical or expensive to re-create anxiety-producing situations; it has been used effectively to treat numerous anxiety disorders such as the fear of public speaking, claustrophobia (fear of enclosed spaces), aviophobia (fear of flying), and post-traumatic stress disorder (PTSD). Flooding is the general technique in which an individual is exposed to anxiety-provoking stimuli, while at the same time prevented from having any avoidance responses. It is often used to treat phobias, anxiety, and other stress-related disorders. For example, flooding might be used to help a client who is suffering from an intense fear of birds. The individual may be forced to stay in a room with a harmless bird for an extended period of time and over repeated sessions. The theory is that after a while, the individual will realize that nothing bad is happening and the fear response will diminish. Relaxation training is a type of behavior therapy that involves clients learning to lower arousal to reduce their stress by tensing and releasing certain muscle groups throughout their body. Social skills training teaches clients skills to access natural reinforcers and lessen life punishment. Definition of Anxiety Hierarchy Treatment The American Psychological Association defines a hierarchy for anxiety as “a series of graduated anxiety-arousing stimuli centering on a specific source of anxiety in a specific individual.”The goal of the treatment is to start with situations that cause you the least amount of anxiety and then move stop by step up the hierarchy to face the situation that causes you the most the amount of anxiety. It’s a gradual, systematic process of desensitization. Real-World Vs. Imaginary Exposure Real-world exposure is called “in vivo exposure.” In this therapy, you actually go into the situation in real life. If you’re afraid of spiders, you would be in a situation where you are in the same room with a real spider during in vivo exposure. The other type, imaginal exposure, is when you merely think of or picture in your mind the thing that brings up your anxiety symptoms. For example, if memories of a traumatic event are causing you anxiety, you would vividly imagine the sights and sounds that you remember from the traumatic event and describe them in detail. Steps: You and your therapist can brainstorm to find as many different possible situations that bring up anxiety for you. You do this during therapy sessions, and your counselor might also ask you to work on it at home between sessions. The longer the list, the more detailed your exposure plan can be. The next step is to rank each situation from the least feared to most feared. Your counselor can work with you to order them using the Subjective Units of Discomfort (SUDS) scale. This is a tool that helps you rate situations from 0 to 10, with zero meaning that you feel calm and peaceful, and ten meaning you feel the most extreme fear in that situation. Your treatment process will begin with items you’re your list ranked as zero and progress to those you ranked as ten. An Example: Social Anxiety Hierarchies are often the first-line treatment for social anxiety. The first step in your order might be to imagine yourself talking to a stranger. You might feel a little fearful, but the more you imagined it, the less fear you might feel. The next step might be initiating a conversation with a coworker. Another step might be going to a party. At some point, you might give a speech in public. At each step up the hierarchy, you face another fear, experience the anxiety, and become more comfortable with the situation. Avoiding Safety Behaviors Most psychologists recommend that you avoid safety behaviors during exposure. What are the safety behaviors? They are unnecessary things you do that help you feel more comfortable or prevent any disasters you might imagine. So, why is it important to avoid these things that make you feel better? The reason is that engaging in safety behaviors prevents you from realizing that you will be fine even if you can’t do or have the things that make you comfortable. Source: https://www.betterhelp.com/advice/anxiety/anxiety-hierarchy-treatment-for-anxiety-disorders/ Behavioral Rehearsal Technique When implementing behavioral rehearsal, events that occur in daily life are role-played by the client and professional counselor in an attempt to decrease any anxieties the client may have when expressing himself (Thorpe & Olson, 1997). The client acts as himself, and the professional counselor plays the role of the person about whom the client has surrounding anxieties. The professional counselor instructs the client to communicate feelings about the anxiety-producing person or circumstance. The client needs to use a strong voice and repeat a feelings statement or appropriate behavior, while the professional counselor gives feedback to the client. The client continues rehearsing until the professional counselor indicates the statement or  behavior was communicated effectively (Wolpe, 1990). Naugle and Maher (2008) suggested that the professional counselor and client should attempt and master simple skills first, and only then move on to more complex skills. Naugle and Maher provided the following steps for the professional counselor to use in implementing the behavioral rehearsal technique: (1) Practice the behavior to be modeled; (2) build the client’s motivation through positive reinforcement strategies; (3) give the client plenty of focused, concrete feedback to help the client master the skill; and (4) use positive reinforcement strategies to shape and hone the skill behaviors (e.g., successive approximation). For behavioral rehearsal to be effective, Bootzin (1975) suggested clients practice the following six rules: (1) express emotions verbally; (2) present feelings nonverbally using body language; (3) contradict others when one disagrees with them; (4) speak in the first person, using the word I regularly; (5) agree with the counselor’s praise; and (6) “improvise, live for the moment”. Source: https://counselingpractices.wordpress.com/2017/10/17/behavioral-rehearsal/ Effectiveness of Behavior Therapy Behavior therapy has proven effective in many areas and has been used to address intimacy in couples, relationships, forgiveness, chronic pain, anorexia, chronic distress, substance abuse, depression, anxiety, insomnia, and obesity. Behavioral applications to these problems have left clinicians with considerable tools for enhancing therapeutic effectiveness. Many have argued that behavior therapy is at least as effective as drug treatment for depression, ADHD, and OCD. Systematic desensitization has been shown to successfully treat phobias about heights, driving, and insects, as well as any anxiety that a person may have. Virtual reality treatment has been shown to be effective for a fear of heights; it has also been shown to help with the treatment of a variety of anxiety disorders. Applied behavioral analysis has been shown to be an effective tool and is a very common treatment approach for children with autism (Lovaas, 1987, 2003; Sallows & Graupner, 2005; Wolf & Risley, 1967). Key Points Behavior therapy stands apart from insight-based therapies (such as psychoanalytic and humanistic therapy) because the goal is to teach clients new behaviors to minimize or eliminate problems, rather than focusing on the unconscious mind. Behavioral therapy is based on behaviorism, which defines itself by the belief that psychology should concern itself with the observable behavior of people and animals, rather than unobservable events that take place in their minds. Behavior therapy uses a wide range of techniques to treat a person’s psychological problems; it is based largely on the theories of classical conditioning and operant conditioning. Operant conditioning focuses on rewards and punishments, while classical conditioning works to pair a conditioned stimulus with an unconditioned stimulus, so that they may be associated in the individual’s mind. Some of the better-known types of treatments are applied behavioral analysis, aversion therapy, systematic desensitization, exposure therapy, and modeling. Behavior therapy has proven effective in many areas and has been used to address intimacy in couples, relationships, forgiveness, chronic pain, anorexia, chronic distress, substance abuse, depression, anxiety, insomnia, and obesity. Applied behavioral analysis (ABA) has been criticized for pathologizing and trying to “normalize” the behaviors of children with autism, in order to re-shape these behaviors to be more socially acceptable. Sources: https://courses.lumenlearning.com/boundless-psychology/chapter/approaches-to-psychotherapy/ Learning Activities: Reaction paper to related research Google forms Quiz