Behavioral therapy: principles and applications

Behavioral therapy has its roots in basic behaviorism, the principle that human behavior can be modified through systematic training or interventions. Since B.F. Skinner first laid the foundations for behaviorism through experimentation, the methods used in behavioral therapy have changed dramatically. Behavioral therapy, or behavior therapy, is not one but a variety of approaches that psychological counselors use to help clients change their behaviors. The Centers for Disease Control and Prevention (2017) advocates the use of behavior therapy as an “effective treatment for attention deficit/hyperactivity disorder (ADHD),” (p. 1).

Behavior therapies are designed not just to change target behaviors but also to change the ways people feel about themselves and the world, which is why behavior therapy can improve self-esteem (Herkov, 2016). Some of the most common approaches to behavioral therapy fall under the rubric of cognitive-behavioral therapy, which is used in a variety of clinical settings. In fact, Craske (2010) claims cognitive-behavioral therapy is “the most popular model of psychotherapy used in contemporary clinical practice,” (p. 17). The literature on cognitive-behavioral therapy shows that it can be effective for multiple types of clinical disorders from addictions and mood disorders to psychotic disorders like schizophrenia (Butler, Chapman, Forman & Beck, 2006). All types of behavior therapies use the underlying principles of basic behaviorism, including positive and negative reinforcement.

The first stage in any behavioral therapy is self-monitoring and self-awareness (Herkov, 2016). When the client is a young child, such as a child with ADHD, the parents can help the child develop the necessary self-awareness to make the behavioral interventions work. In fact, behavioral therapy for ADHD is most effective when it is delivered by parents (Centers for Disease Control and Prevention, 2017). Behavioral therapy can be an effective substitute for pharmacological interventions and also precludes the need for ongoing psychoanalysis. A meta-analysis of studies on the effectiveness of cognitive-behavioral therapy on anxiety disorder showed that behavioral approaches have much stronger long-term effects than pharmacological solutions (Butler, Chapman, Forman & Beck, 2006). Therefore, behavioral therapies offer long-term and solution-focused options for clients.

After initial self-monitoring and assessment, a therapist helps the client to set behavioral change goals. Often, those goals will be highly specific such as smoking cessation within a certain time frame. The therapist might work with the client to develop a schedule and new routines to inculcate the behavioral changes. As Skinner showed with his dog and bell experiments rewards are critical for reinforcing desirable behaviors. The behavioral therapist will help the client come up with a list of rewards that motivate the client to continue the desirable behaviors. Likewise, the therapist might offer suggestions for negative reinforcements that can be used to discourage undesirable behaviors. Social feedback can be an important component of behavioral therapy. Behavioral therapy helps the client change how they act, which in turn changes their self-concept. Changing behavior also alters the way the person is perceived by others. When other people react differently to the client, he or she reinforces the new behaviors and learns to reject dysfunctional behaviors like angry outbursts. Just as dysfunctional thoughts or harmful emotions can cause destructive or unwanted behaviors, a person’s behaviors can also impact how one thinks or feels. Behavioral therapy helps the person recognize the bi-directional relationship between behaviors and cognitive patterns.

Behavioral therapy is used to treat anxiety, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, schizophrenia, anger, marital distress and other interpersonal relationships, eating disorders, chronic pain, and sexual offending (Butler, Chapman, Forman & Beck, 2006). However, the means and methods of behavioral therapy will be different depending on the unique circumstances of the client. Recent developments in behavior therapy include Dialectical Behavior Therapy (DBT), Functional Analytic Psychotherapy (FAP), Integrative Behavioral Couples Therapy (IBCT), and Mindfulness-Based Cognitive Therapy (MBCT). The latter refers specifically to the integration of mindfulness meditation and general mindfulness techniques to encourage self-awareness while solidifying behavioral change. These so-called “third wave” techniques further expand the potential of behavioral therapy to aid multiple types of clients (Hayes, 2004). Behavioral therapies now take into account the complexities of human cognition. Whereas early behavioral therapies evolved largely in reaction to or as backlash against Freudian psychoanalysis, subsequent theorists drew from research in perception and cognition to enhance the field (Hayes, 2004). As a result, recent behavioral therapies are diverse and evidence-based. The goals of behavioral therapy will necessarily focus on client behaviors and how to optimize them, but use different methods to achieve therapeutic goals.

Scientific literature consistently shows that behavioral therapy is effective, but it could take a long time for results to emerge. Changing ingrained or patterned behaviors can be difficult, especially in adults who have habituated themselves to think, react, feel, and act certain ways. Social and environmental contexts can also hinder change. For example, some dysfunctional behaviors might have become normative in a family or community. Changing those behaviors can threaten to undermine interpersonal relationships, causing internal conflict. One of the reasons why behavioral therapy is effective and recommended for young clients including children is that it can help create positive habits like self-monitoring that can last a lifetime.






References

Butler, A.C., Chapman, J.E., Forman, E.M. & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychological Review 26(1): 17-31.
Centers for Disease Control and Prevention (2017). Behavior therapy for young children with ADHD. Retrieved online: https://www.cdc.gov/ncbddd/adhd/behavior-therapy.html
Craske, M.G. (2010). Theories of psychotherapy. Cognitive–behavioral therapy. Washington, DC: American Psychological Association.
Hayes, S.C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy 35, 629-665.
Herkov, M. (2016). About Behavior Therapy. Psych Central. Retrieved on November 7, 2017, from https://psychcentral.com/lib/about-behavior-therapy/