Chapter 13 Advanced Behavioral Methods for Therapy

1. Chapter 13Advanced Behavioral Methods for Therapy

2. Biofeedback • biofeedback is a technique in which information about physiological functioning is used to learn to control physiological responses • biofeedback is based on operant concepts • physiological processes are the behaviors • feedback is the consequence • control requires training • training often employs shaping techniques

3. Biological Systems Controlled by Biofeedback • blood pressure • systolic pressure is exerted by the contraction of the ventricles • diastolic pressure is the resting pressure between beats • EKG shows heart rate and the regularity of its beat • galvanic skin response measures skin conductivity

4. Biological Systems Controlled by Biofeedback (continued) • an electroencephalogram shows brain waves • an electromyogram shows electrical activity of muscles • temperature measures show changes in blood flow

5. Types of Feedback • instruments like a thermometer can provide direct measures on a gauge • changes in pitch or volume of a tone can vary to reflect changes in rate or intensity • changes in the brightness of a light can vary to reflect changes in rate or intensity

6. Biofeedback Applications • maintenance of control of certain brain wave patterns is used with epilepsy • relaxation procedures reduce high blood pressure • EMG feedback helps to: • relax muscles and may serve as a general relaxation technique • reeducate muscles and nerves that signal muscles

7. Biofeedback Applications (continued) • overcome certain types of paralysis • weaken spasms • reduce muscle contraction headaches • migraine headaches responds to blood flow biofeedback

8. Flooding and Implosion flooding and implosion are anxiety-induction therapies for phobias that: • expose the individual to the feared object without chance of escape • designed to extinguish the response

9. Flooding Procedures • the therapist exposes the person to a highly feared situation and prevents escape or avoidance • the person should not be exposed to further CS-US pairings that would serve to strengthen the fear • anxiety is encouraged • relaxation training is not a part of the procedure

10. Flooding Procedures (continued) • phobias with a more focused CS may be extinguished in one training session • phobias with more diffuse or multi-element CSs may require many sessions

11. Concerns About Flooding • the fear-arousing situation can be introduced gradually when it produces an intolerable fear • high anxiety may lead to avoidance of treatment • the therapist may consider accompany the client during the most feared encounters • flooding appears to be relatively safe

12. Effectiveness of Flooding • in vivo and imaginal flooding are equally effective • in vivo procedures may be difficult to apply • flooding is about as effective as desensitization • imaginal flooding is more effective than imaginal desensitization • flooding may be more effective than drug therapies

13. Implosive Therapy • implosive therapy requires the person to imagine unrealistic, exaggerated, or unlikely harmful events that are associated with the fear • exaggeration does not seem to make implosion more effective than flooding

14. Modeling Applications: Training Professional Skills • videotapes are often used to train skills • observing a video may be more effective than role playing • videotapes may lose their effectiveness if the trainee is distracted by an interesting story line

15. Modeling Applications: Assertion Training • assertiveness training involves teaching how to express feelings and beliefs in a direct and honest and socially appropriate manner • treatment might increase or decrease assertiveness • assertion training may not generalize to all types of assertiveness

16. Assessing Assertiveness • interviews allow the individual to describe problems with their assertiveness • excesses and deficits of assertiveness can be observed in role playing of an assertive act • assertiveness questionnaires ask the person to select descriptions of how they would behave in assertion situations

17. Assertiveness Training Techniques • overt modeling techniques have been used effectively to train assertion skills • clients are shown examples of appropriate assertive behavior • Clients are then asked to imitate the behavior (behavioral rehearsal) • covert modeling requires the person to imagine making assertive responses • the therapist provides suggestions about what to include in the scene

18. Assertiveness Training Techniques (continued) • the individual creates a clear image of the situation • the person is instructed to incorporate into the scene a positive outcome • training often includes homework assignments, preparation for uncooperative responses to their assertiveness, and booster sessions to prevent relapse

19. Modeling Applications: Reducing Anxiety in Medical Settings • videotaped modeling is effective for reducing anxiety associated with medical treatment • videos should show the procedures and a calm but realistic emotional response by the model • studies evaluating videotaped modeling show decreases in anxiety and faster recovery

20. Aversion Therapy • aversion therapy introduces a noxious stimulus in association with an unwanted behavior • aversive stimuli have included: • electric shock • nausea • paralysis • humiliation • aversion therapy is a form of counterconditioning

21. Aversion Therapy: Smoking • smoking and associated activities have been paired with electric shock • imagined negative scenes can serve as the aversive stimulus • rapid smoking uses the smoke as an aversive stimulus by requiring very high rates of smoking • overindulgence in smoke seems to serve as a more effective aversive stimulus than shock or imagined scenes

22. Aversion Therapy: Drinking • shock and nausea have been used as aversive stimuli to stop excessive drinking • shock seems relatively ineffective • more effective treatments use drugs such as emetine to associate the taste of alcohol with nausea

23. Problems with Aversion Therapy for Drinking aversion therapy has not had widespread application with alcohol abuse for several reasons: • questions have been raised about the ethics of the treatment • the treatment requires close supervision by a therapist and is expensive • clients tend to circumvent the aversive contingencies