Behavior therapy

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Behaviour therapy, or behavior therapy (behavior modification) is an approach to psychotherapy based on learning theory which aims to treat psychopathology through techniques designed to reinforce desired and eliminate undesired behaviors.[1]

History

Precursors of certain fundamental aspects of behavior therapy have been identified in various ancient philosophical traditions, particularly Stoicism.[2] For example, Wolpe and Lazarus wrote,

While the modern behavior therapist deliberately applies principles of learning to this therapeutic operations, empirical behavior therapy is probably as old as civilisation – if we consider civilisation as having begun when man first did things to further the well-being of other men. From the time that this became a feature of human life there must have been occasions when a man complained of his ills to another who advised or persuaded him of a course of action. In a broad sense, this could be called behavior therapy whenever the behavior itself was conceived as the therapeutic agent. Ancient writings contain innumerable behavioral prescriptions that accord with this broad conception of behavior therapy.[3]

Possibly the first occurrence of the term "behavior therapy" was in a 1953 research project by B.F. Skinner, Ogden Lindsley, Nathan H. Azrin and Harry C. Solomon.[4] Other early pioneers in behaviour therapy include Joseph Wolpe and Hans Eysenck.[5]

In general, behaviour therapy is seen as having three distinct points of origin: South Africa (Wolpe's group), The United States (Skinner), and the United Kingdom (Rachman and Eysenck). Each had its own distinct approach to viewing behaviour problems. Eysenck in particular viewed behaviour problems as an interplay between personality characteristics, environment, and behaviour[6]. Skinner's group in the United States took more of an operant conditioning focus. The operant focus created a functional approach to assessment and interventions focused on contingency management such as the token economy and behavioural activation. Skinner's student Ogden Lindsley is credited with forming a movement called precision teaching, which developed a particular type of graphing program called the standard celeration chart to monitor the progress of clients. Skinner became interested in the individualizing of programs for improved learning in those with or without disabilities and worked with Fred S. Keller to develop programmed instruction. Programmed instruction had some clinical success in aphasia rehabilitation [7] Gerald Patterson used program instruction to develop his parenting text for children with conduct problems[8]. (see Parent Management Training). With age, respondent conditioning appears to slow but operant conditioning remains relatively stable[9]

While many behaviour therapists remain staunchly committed to the basic operant and respondent paradigm, in the second half of the 20th century, many therapists coupled behaviour therapy with the cognitive therapy of Aaron Beck and Albert Ellis, to form cognitive behavioural therapy. In some areas the cognitive component had an additive effect (for example, evidence suggests that cognitive interventions improve the result of social phobia treatment.[10]) but in other areas it did not enhance the treatment, which led to the pursuit of Third Generation Behavior Therapies. Third generation behaviour therapy uses basic principles of operant and respondent psychology but couples them with functional analysis and a Clinical formulation / case conceptualization of verbal behaviour more inline with view of the behaviour analysts. Some research supports these therapies as being more effective in some cases than cogntive therapy [11] overall the question is still in need of answers[12].

Scientific basis

Behaviour therapy is based upon the principles of classical conditioning developed by Ivan Pavlov and operant conditioning developed by B.F. Skinner. There has been a good deal of confusion on how these two conditionings differ and whether the various techniques of Behaviour Therapy have any common scientific base. One answer has come from an online paper called Reinforcing Behaviour Therapy, which more and more psychologists are now studying and appreciating.

Contingency management programs are a direct product of research from operant conditioning. These programs have been highly successful, producing results even with adults who suffer from schizophrenia[13]

Systematic desensitization and exposure and response prevention both evolved from respondent conditioning and have also received considerable research.

Social skills training teaches clients skills to access reinforcers and lessen life punishment. Operant conditioning procedures in meta-analysis had the largest effect size for training social skills, followed by modelling, coaching, and social cognitive techniques in that order [14] Social skills training has some empirical support particularly for schizophrenia[15][16] However, with schizophrenia, behavioural programs have generally lost favour.[17]

Applied to problem behaviour

Behaviour therapy based its core interventions on functional analysis. Just a few of the many problems that behaviour therapy have functionally analysed include intimacy in couples relationships[18][19][20], forgiveness in couples[21], chronic pain[22], stress related behaviour problems of being an adult child of an alcoholic[23], anorexia[24], chronic distress[25], substance abuse[26], depression[27], anxiety [28], and obesity.[29]

Functional analysis has even been applied to problems that therapists commonly encounter like client resistance, particially engaged clients and involuntary clients.[30][31] Applications to these problems have left clinicans with considerable tools for enhancing therapeutic effectiveness. One way to enhance therapeutic effectiveness is to use positive reenforcement or operant conditioning.

Many have argued that behaviour therapy is at least as effective as drug treatment for depression, ADHD, and OCD.[32] Considerable policy implications have been inspired by behavioural views of various forms of psychopathology. One form of behavior therapy Habit reversal training has been found to be highly effective for treating tics.

Third generation

Of particular interest, in behaviour therapy today are the areas often referred to as Third Generation Behavior Therapy.[33] This movement has been called clinical behavior analysis because it represents a movement away from cognitivism and back toward radical behaviourism and other forms of behaviourism, in particular functional analysis and behavioural models of verbal behaviour. This area includes Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Analysis System of Psychotherapy (CBASP) (McCullough, 2000), behavioural activation (BA), Kohlenberg & Tsai's Functional Analytic Psychotherapy, Integrative behavioral couples therapy and dialectical behavioural therapy. These approaches are squarely within the applied behaviour analysis tradition of behaviour therapy.

Acceptance and Commitment Therapy is probably the most well-researched of all the third generation behaviour therapy models. It is based on Relational Frame Theory.[34]

Functional Analytic Psychotherapy is based on a functional analysis of the therapeutic relationship.[35] It places a greater emphasis on the therapeutic context and returns to the use of in session reinforcement [36] In general, 40 years of research supports the idea that in-session reinforcement of behaviour can lead to behavioural change.[37]

Behavioural activation emerged from a component analysis of cognitive behaviour therapy. This research found no additive effect for the cognitive component.[38] Behavioural activation is based on a matching model of reinforcement.[39] A recent review of the research, supports the notion that the use of behavioural activation is clinically important for the treatment of depression.[40]

Integrative behavioral couples therapy developed from dissatisfaction with traditional behavioural couples therapy. Integrative behavioural couples therapy looks to Skinner (1966) for the difference between contingency shaped and rule governed behaviour.[41] It couples this analysis with a thorough functional assessment of the couples relationship. Recent efforts have used radical behavioural concepts to interpret a number of clinical phenomena including forgiveness.[42]

Organizations

Many organizations exist for behaviour therapists around the world. The World Assocaition for Behavior Analysis offers a certification in behavior therapy [12] In the United States, the American Psychological Association's Division 25 is the division for behaviour analysis. The Association for Contextual Behavior Therapy is another professional organization. ACBS is home to many clinicians with specific interest in third generation behaviour therapy. The Association for Behavioral and Cognitive Therapies (formerly the Association for the Advancement of Behavior Therapy) is for those with a more cognitive orientation. Internationally, most behaviour therapists find a core intellectual home in the International Association for Behavior Analysis (ABA:I) [13].

Characteristics

By nature, behavioural therapies are empirical (data-driven), contextual (focused on the environment and context), functional (interested in the effect or consequence a behaviour ultimately has), probabilistic (viewing behaviour as statistically predictable), monistic (rejecting mind-body dualism and treating the person as a unit), and relational (analysing bidirectional interactions).[43]

Methods

See also

References

  1. ↑ behavior therapy. (n.d.). Memidex/WordNet. Retrieved July 15, 2010, from http://www.memidex.com/behaviour-therapy
  2. ↑ Robertson, D (2010). The Philosophy of Cognitive-Behavioural Therapy: Stoicism as Rational and Cognitive Psychotherapy. London: Karnac. ISBN 978-1855757561. http://books.google.co.uk/books?id=XsOFyJaR5vEC&lpg. 
  3. ↑ Wolpe,J. & Lazarus,A. (1966) Behavior Therapy Techniques: A Guide to the Treatment of Neuroses, pp. 1-2.
  4. ↑ Lindsley, O., Skinner, B.F., Solomon, H.C. (1953). Studies in behavior therapy (Status Report I). Walthama, MA.: Metropolitan State Hospital. 
  5. ↑ Clark, David M.; Christopher G. Fairburn (1997). Science and Practice of Cognitive Behaviour Therapy. Oxford University Press. ISBN 0192627260. 
  6. ↑ Yates,, A.J.(1970). Behavior Therapy. New York Wiley
  7. ↑ Goldfarb, R. (2006): Operant Conditioning and Programmed Instruction in Aphasia Rehabilitation - SLP-ABA, 1.(1), 56-65 BAO
  8. ↑ Patterson, G.R. (1969).Families: A social learning approach to family life.
  9. ↑ Perlmutter, M. and Hall, E. (1985). Adult development and aging. New York: John Wiley.
  10. ↑ Clark, David M; Ehlers, A; Hackmann, A; McManus, F; Fennell, M; Grey, N; Waddington, L; Wild, J (2006-06). "Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial". Journal of Consulting and Clinical Psychology 74 (3): 568–578. doi:10.1037/0022-006X.74.3.568. PMID 16822113. 
  11. ↑ Block, J.A. & Wulfert, E. (2000) Acceptance or Change: Treating Socially Anxious College Students with ACT or CBGT. The Behavior Analyst Today, 1(2), 3-10. BAO
  12. ↑ Öst, L. G. (2008). "Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis". Behaviour research and therapy 46 (3): 296–321
  13. ↑ Paul, G.L. & Lentz, R.J.(1977). Psychosocial treatment of chronic mental patients: Milieu versus social learning programs. Cambridge, MA: Harvard University Press.
  14. ↑ Schnieder, B.H. & Bryne, B.M. (1985). Children's social skills training: A meta-analysis. In B.H. Schneider, K. Rubin, & J.E. Ledingham (Eds.) Children's Peer relations: Issues in assessment and intervention (pp. 175-190). New York: Springer-Verlag.
  15. ↑ Corrigan, P.W. (1997). Behavior therapy empowers persons with severe mental illness. Behavior Modification, 21, 45-61
  16. ↑ Corrigan, P.W. Holmes, E.P.(1994). Patient identification of "street skills" for a psychosocial training module. Hospital and Community Psychiatry, 45, 273-276.
  17. ↑ Wong, S.E. (2006). Behavior Analysis of Psychotic Disorders: Scientific Dead End or Casualty of the Mental Health Political Economy? Behavior and Social Issues,15 (2),152-177 [1]
  18. ↑ Cordova, J. (2003). Behavior Analysis and the Scientific Study of Couples. The Behavior Analyst Today, 3 (4), 412-419 [2]
  19. ↑ Stuart, R.B. (1998). Updating Behavior Therapy with Couples. The Family Journal, 6(1), 6-12
  20. ↑ Christensen, A., Jacobson, N.S. & Babcock, J.C. (1995). Integrative behavioral couples therapy. In N.S. Jacobson & A.S. Gurman (Eds.) Clinical Handbook for Couples Therapy (pp. 31-64). New York: Guildford.
  21. ↑ Cordova, J., Cautilli,J.D., Simon, C. & Axelrod-sabag, R. (2006). Behavior Analysis of Forgiveness in Couples Therapy - IJBCT, 2.(2), 192-208 [3]
  22. ↑ Sanders, S.H. (2006). Behavioral Conceptualization and Treatment for Chronic Pain (2006). The Behavior Analyst Today, 7(2), 253-261. [4]
  23. ↑ Ruben, D. H. (2001). Treating Adult Children of Alcoholics: A behavioral approach. San Diego, CA: Academic Press.
  24. ↑ Lappalainen and Tuomisto (2005): Functional Analysis of Anorexia Nervosa: Applications to Clinical Practice.The Behavior Analyst Today, 6.(3), 166-175 [5]
  25. ↑ Holmes, Dykstra Williamns, Diwan, & River, (2003) Functional Analytic Rehabilitation: A Contextual Behavioral Approach to Chronic Distress. The Behavior Analyst Today, 4 (1), 34-45 BAO
  26. ↑ Smith, J.E., Milford, J.L and Meyers, R.J. (2004). CRA and CRAFT: Behavioral Approaches to Treating Substance-Abusing Individuals. The Behavior Analyst Today, 5.(4), 391-402 BAO
  27. ↑ Kanter, J.W., Cautilli, J.D., Busch, A.M. & Baruch, D.E. (2005). Toward a Comprehensive Functional Analysis of Depressive Behavior: Five Environmental Factors and a Possible Sixth and Seventh. The Behavior Analyst Today, 6.(1), Page 65-78. BAO
  28. ↑ Hopko , D.R., Robertson, S. and Lejuez, C.W.(2006). Behavioral Activation for Anxiety Disorders. The Behavior Analyst Today, 7(2), 212-233 [6]
  29. ↑ Stuart, R.B.(1967). Behavioral Control of overeating. Behavior research and therapy, 5, 357-365 [7]
  30. ↑ Cautilli,J., Tillman, T.C., Axelrod, S., Dziewolska, H. & Hineline, P. (2006): Resistance Is Not Futile: An experimental analogue of the effects of consultee “resistance” on the consultant’s therapeutic behavior in the consultation process: A replication and extension. IJBCT, 2.(3), 362 -376. BAO
  31. ↑ Cautilli,J.D. Riley-Tillman, T.C., Axelrod, S. & Hineline, P. (2005). Current Behavioral Models of Client and Consultee Resistance: A Critical Review. IJBCT, 1(2), 147-164 BAO
  32. ↑ Flora, S.R. (2007). Taking America off Drugs: why behavioral therapy is more effective for treating ADHD, OCD, Depression, and other psychological problems. SUNY
  33. ↑ Kohlenberg, R. J.; M. Y. Bolling, J. W. Kanter, C. R. Parker (2002). "Clinical behavior analysis: Where it went wrong, how it was made good again, and why its future is so bright" (PDF). The Behavior Analyst Today 3: 248–253. ISSN 15394352. https://pantherfile.uwm.edu/jkanter/www/pdf/publication/behavioranalysis.pdf. 
  34. ↑ Blackledge, J.T. (2003). An Introduction to Relational Frame Theory: Basics and Applications. The Behavior Analyst Today, 3 (4), 421-442 [8]
  35. ↑ Kohlenberg, R. J. & Tsai, M. (1991) Functional Analytic Psychotherapy. New York: Plenum
  36. ↑ Wulfert (2002) Can Contextual Therapies Save Clinical Behavior Analysis? The Behavior Analyst Today, 3 (3), 254 [9]
  37. ↑ Cautilli,J. T. Chris Riley-Tillman, Saul Axelrod and Hineline, P. (2005). The Role of Verbal Conditioning in Third Generation Behavior Therapy. The Behavior Analyst Today, 6.(2), 138- 157 BAO
  38. ↑ Jacobson, N.S., Martell, C.R., & Dimidjian, S.(2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8, 255-270.
  39. ↑ Cullen, J.M. Spates, C.R, Pagoto, S. & Doran, N. (2006). Behavioral Activation Treatment for Major Depressive Disorder: A Pilot Investigation - The Behavior Analyst Today, 7.(1), 151-164.
  40. ↑ Spates,C.R., Pagoto, S. and Kalata, A. (2006). A Qualitative And Quantitative Review of Behavioral Activation Treatment of Major Depressive Disorder. The Behavior Analyst Today, 7.(4), 508-512 [10]
  41. ↑ Skinner, B.F. (1969). Contingencies of Reinforcement: A Theoretical Analysis. New York: Meredith Corporation.
  42. ↑ Cordova,J., Cautilli, J.D., Simon, C. & Axelrod-sabag, R. (2006). Behavior Analysis of Forgiveness in Couples Therapy. IJBCT, 2.(2), 192-213 [11]
  43. ↑ Sundberg, Norman (2001). Clinical Psychology: Evolving Theory, Practice, and Research. Englewood Cliffs: Prentice Hall. ISBN 0130871192. 

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