Chapter Seven: Behavioral Theory and Therapy

1. Chapter Seven: Behavioral Theory and Therapy

2. Historical Context • The Third Force • Behaviorism as science • Little Hans and Little Albert • Little Peter • Behavior Therapy • Skinner • Wolpe/Lazarus/Rachman

3. Theoretical Principles of Behavioral Theory and Therapy • Based on Learning Theory • Strong allegiance to efficacy research

4. Theoretical Models of Applied Learning Theory • Applied Behavioral Analysis • Neobehavioristic, Mediational Stimulus-Response Model • Social Learning Theory • Cognitive Behavioral

5. Theory of Psychopathology • All behavior, both adaptive and maladaptive, is learned. • “Pathology” is inadequate learning or skills deficit

6. The Practice of Behavior Therapy • Preparing yourself • Preparing your client • Assessment Issues and Procedures

7. Specific Therapy Techniques • Operant Conditioning • Relaxation Training • Systematic Desensitization • Other Exposure-Based Treatments

8. Specific Therapy Techniques (continued) • Skills Training • Assertiveness and other social behavior • Problem solving

9. Extended Case Examples • Assessment • Medical consult • Specific behavioral interpretations and instructions

10. Therapy Outcomes Research • Historical comments • Specific treatment for specific disorders • Conceptual commentary

11. Multicultural Perspectives • Some cultures prefer active, directive qualities of behavioral treatments

12. Concluding Comments • Behavior therapy has evolved • Less deterministic • Admirable allegiance to research

13. Student Review Assignments • Critical corner • Reviewing key terms • Review questions

14. Critical Corner • Some critics might claim that behavior therapy is fundamentally flawed because it involves one person (a designated expert) teaching another person (a vulnerable client) about what’s normal and acceptable behavior. Although behaviorists may hide behind “symptom reduction” as their lofty goal, in reality, they are simply teaching clients to ignore symptoms and the symptom’s important underlying messages to the client.

15. Critical Corner (continued) • Despite the emphasis in this chapter on the flexible, clinically astute behavior therapist, most behavior therapists are just technicians. For the most part, they aren’t attuned to or very interested in client’s feelings, the dynamics of the therapy relationship or life’s meaning and so they ignore these bigger issues, focusing instead on trivial and less important matters.

16. Critical Corner (continued) • Although there is ample scientific evidence attesting to the efficacy of behavior therapy, behavior therapists have generated most of this evidence. There is no doubt that behavior therapy researcher bias exists and that behavior therapist researchers construct outcome measures that rig the outcomes in their favor. Overall, the promotion of behavior therapies as “Empirically Validated Therapies” smacks of a business-related scam designed to improve insurance reimbursement rates for behaviorally oriented therapy providers.

17. Critical Corner (continued) • The length to which behavior therapists will go to dehumanize individuals is scary. Examples include aversive conditioning using electric shock, token economies that curtail the freedom and dignity of patients, and the excessive punishment of children in our schools. The biggest problem with behavior therapy is that humans are treated more like rats or pigeons than humans.

18. Critical Corner (continued)

19. Critical Corner (continued) • Behavior therapy is currently governed by so many divergent learning theories that the entire field is not much more than a hodge-podge of different techniques. If you look hard, you’ll find it’s difficult to find an underlying theory that guides the entire field. This lack of backbone will only get worse until behavior therapy begins to base itself on a coherent theory—rather than simply basing itself on scientific methodology.

20. Review Key Terms • Behavior therapy • Behaviorism • Classical conditioning • Operant conditioning • Counter-conditioning • Applied behavior analysis • Stimulus-Response (S-R) theory • Neobehavioristic mediational S-R model

21. Key Terms (continued) • Stimulus generalization • Stimulus discrimination • Extinction • Spontaneous recovery • Social learning theory • Observational learning • Positive reinforcement • Punishment

22. Key Terms (continued) • Negative reinforcement • Systematic desensitization • Self-efficacy • Cognitive-behavioral therapy • Behavioral ABCs • Operational definition • Self-monitoring • Token economy

23. Key Terms (continued) • Fading • Aversive conditioning • Progressive muscle relaxation • Exposure treatment • Imaginal and in-vivo exposure • Massed vs. spaced exposure • Virtual reality exposure • Interoceptive exposure

24. Key Terms (continued) • Response prevention • Participant modeling • Skills training • Assertiveness training • Problem-solving • Generating behavioral alternatives • Breathing retraining • Overbreathing • Empirically validated treatments

25. Review Questions • Discuss the relative importance of John Watson and Mary Cover Jones in the development of applied behavior therapy techniques. Which of these researchers amassed a large amount of practical information about counter-conditioning? • Who is the historical figure to which applied behavior analysis can be traced? Do applied behavior analysts believe in using cognitive constructs to understand human behavior?

26. Review Questions • What is the difference between S-R theory and neobehavioristic S-R theory? • Explain how self-efficacy can be viewed as a cognitive variable in a therapy situation. • What is the difference between counter-conditioning and extinction? Which of these experimental procedures is most directly linked to response prevention? Which one is linked to systematic desensitization?

27. Review Questions • List and describe the behavioral ABCs. • What are the main methods that behavior therapists use to teach clients assertiveness skills? • What are the five steps of problem-solving that behavior therapists teach clients as a part of skills training? Which of these steps was illustrated in the therapy excerpt with the aggressive adolescent?

28. Review Questions • In the case example involving Richard, it’s clear that Richard does not initially believe all of the educational information that his therapist is providing him. Is the therapist concerned about Richard’s disbelief? If so, what strategies does the therapist use to work on Richard’s adherence to therapy? • Explain how overbreathing can be used in an interoceptive exposure model? Why is this approach especially appropriate for clients with Panic Disorder?