Behaviour therapy

Behaviour therapy is a form of psychotherapy used to treat depression, anxiety disorders, phobias, and other forms of psychopathology. Its philosophical roots can be found in the school of behaviorism, which states that psychological matters can be studied scientifically by observing overt behavior, without discussing internal mental states. Without holding inner states as causal, Skinner's radical behaviorism accepted internal states as part of a causal chain of behavior, but continued to hold that the only way to improve the internal state was through environmental manipulation.

History

Possibly the first occurrence of "behavior therapy" was in a 1953 research project by B.F. Skinner, Ogden Lindsley, and Harry C. Solomon.cite paper
author = Lindsley, O., Skinner, B.F., Solomon, H.C.
title = Studies in behavior therapy (Status Report I)
publisher = Walthama, MA.: Metropolitan State Hospital
year = 1953] Other early pioneers in behavior therapy include Joseph Wolpe and Hans Eysenck.cite book
last = Clark
first = David M.
coauthors = Christopher G. Fairburn
authorlink = David Clark (psychiatrist)
title = Science and Practice of Cognitive Behaviour Therapy
publisher = Oxford University Press
year = 1997
id = ISBN 0192627260 ]

In general, behavior 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 behavior problems. Eysenck in particular viewed behavior problems as an interplay between personality characteristics, environment, and behavior [Yates,, A.J.(1970). Behavior Therapy. New York Wiley] . 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 behavioral 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 [Goldfarb, R. (2006): Operant Conditioning and Programmed Instruction in Aphasia Rehabilitation - "SLP-ABA, 1.(1)," 56-65 [http://www.behavior-analyst-online.org BAO] ] Gerald Patterson used program instruction to develop his parenting text for children with conduct problems (see [Patterson, G.R. (1969)."Families: A social learning approach to family life."] ). With age, respondent conditioning appears to slow but operant conditioning remains relatively stable [Perlmutter, M. and Hall, E. (1985). "Adult development and aging." New York: John Wiley.]

While many behavior therapists remain staunchly committed to the basic operant and respondent paradigm, in the second half of the 20th century, many therapists coupled behavior therapy with the cognitive therapy of Aaron Beck and Albert Ellis, to form cognitive behavioral therapy. In some areas the cognitive component had an additive effect (for example, sex offender treatment) but in other areas it did not enhance the treatment, which led to the pursuit of Third Generation Behavior Therapies. Third generation behavior therapy uses basic principles of operant and respondent psychology but couples them with functional analysis and a case conceptualization of verbal behavior more inline with view of the behavior analysts.

Scientific basis

Behavior therapy is based upon the principles of classical conditioning developed by Ivan Pavlov and operant conditioning developed by B.F. Skinner. There has been up to now a good deal of confusion about how exactly these two conditionings differ and whether the various techniques of Behaviour Therapy have any common scientific base. One answer has come in the form of 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. Even with adult who suffer from schizophrenia these programs produce results [Paul, G.L. & Lentz, R.J.(1977). Psychosocial treatment of chronic mental patients: Milieu versus social learning programs. Cambridge, MA: Harvard University Press.]

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 modeling, coaching, and social cognitive techniques in that order [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.] Social skills training has some empirical support particularly for schizophrenia [Corrigan, P.W. (1997). Behavior therapy empowers persons with severe mental illness. Behavior Modification, 21, 45-61] [Corrigan, P.W. Holmes, E.P.(1994). Patient identification of "street skills" for a psychosocial training module. Hospital and Community Psychiatry, 45, 273-276.] However, with schizophrenia, behavioral programs have generally lost favor [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 [http://www.uic.edu/htbin/cgiwrap/bin/ojs/index.php/bsi/article/view/365] ]

Applied to Problem Behavior

Behavior therapy based its core interventions on functional analysis. Just a few of the many problems that behavior therapy has created for functional analysis include intimacy in couples relationships [Cordova, J. (2003). Behavior Analysis and the Scientific Study of Couples. "The Behavior Analyst Today, 3 (4)," 412-419 [http://www.behavior-analyst-online.org] ] [Stuart, R.B. (1998). Updating Behavior Therapy with Couples. "The Family Journal," 6(1), 6-12 ] [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.] , forgiveness in couples [Cordova, J., Cautilli,J.D., Simon, C. & Axelrod-Sabtig, R. (2006). Behavior Analysis of Forgiveness in Couples Therapy - " IJBCT, 2.(2)," 192-208 [http://www.behavior-analyst-online.org] ] , chronic pain [Sanders, S.H. (2006). Behavioral Conceptualization and Treatment for Chronic Pain (2006). "The Behavior Analyst Today, 7(2)," 253-261. [http://www.behavior-analyst-online.org] ] , stress related behavior problems of being an adult child of an alcoholic [Ruben, D. H. (2001). Treating Adult Children of Alcoholics: A behavioral approach. San Diego, CA: Academic Press.] , anorexia [Lappalainen and Tuomisto (2005): Functional Analysis of Anorexia Nervosa: Applications to Clinical Practice."The Behavior Analyst Today, 6.(3)," 166-175 [http://www.behavior-analysis-online.org] ] , chronic distress [Holmes, Dykstra Williamns, Diwan, & River, (2003) Functional Analytic Rehabilitation: A Contextual Behavioral Approach to Chronic Distress. "The Behavior Analyst Today, 4 (1)", 34-45 [http://www.behavior-analst-online.org BAO] ] , substance abuse [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 [http://www.behavior-analyst-online.org BAO] ] , depression [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. [http://www.behavior-analyst-online.org BAO] ] , anxiety [ Hopko , D.R., Robertson, S. and Lejuez, C.W.(2006). Behavioral Activation for Anxiety Disorders. "The Behavior Analyst Today, 7(2)," 212-233 [http://www.behavior-analyst-online.org] ] , and obesity. [Stuart, R.B.(1967). Behavioral Control of overeating. Behavior research and therapy, 5, 357-365 [http://www.garfield.library.upenn.edu/classics1983/A1983QN93200001.pdf] ]

Functional analysis has even been applied to problems that therapists commonly encounter like client resistance. [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. [http://www.behavior-analyst-online.org BAO] ] [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 [http://www.behavior-analyst-online.org BAO] ] Applications to these problems have left clinicans 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. [Flora, S.R. (2007)." Taking America off Drugs: why behavioral therapy is more effective for treating ADHD, OCD, Depression, and other psychological problems". SUNY] Considerable policy implications have been inspired by behavioral views of various forms of psychopathology.

Rise of a third generation of Behavior Therapy

Of particular interest, in behavior therapy today are the areas often referred to as Third Generation Behavior Therapy. [Kohlenberg, R., Boiling, M., Kanter, J. & Parker, C. (2002) Clinical Behavior Analysis: Where It Went Wrong, How It Was Made Good Again, and Why Its Future is So Bright.-The Behavior Analyst Today, 3 (3), 248-254. [http://www.behavior-analyst-online.org link] ] This movement has been called clinical behavior analysis because it represents a movement away from cognitivism and back toward radical behaviorism and other forms of behaviorism, in particular functional analysis and behavioral models of Verbal behavior. This area includes Acceptance and Commitment Therapy (ACT), Behavioral activation (BA), Kohlenberg & Tsai's Functional Analytic Psychotherapy, Integrative behavioral couples therapy and dialectical behavior therapy. These approaches are squarely within the applied behavior analysis tradition of behavior therapy.

Acceptance and Commitment Therapy is probably the most well-researched of all the third generation behavior therapy models. It is based on Relational Frame Theory. [Blackledge, J.T. (2003). An Introduction to Relational Frame Theory: Basics and Applications. "The Behavior Analyst Today, 3 (4)," 421-442 www.behavior-analyst-online.org]

Functional Analytic Psychotherapy is based on a functional analysis of the therapeutic relationship. [Kohlenberg, R. J. & Tsai, M. (1991) Functional Analytic Psychotherapy. New York: Plenum ] It places a greater emphasis on the therapeutic context and returns to the use of in session reinforcement [Wulfert (2002) Can Contextual Therapies Save Clinical Behavior Analysis? "The Behavior Analyst Today, 3 (3)," 254 [http://www.behavior-analyst-online.org] ] In general, 40 years of research supports the idea that in-session reinforcement of behavior can lead to behavioral change. [Cautilli,J. T. Chris Riley-Tillman, Saul Axelrod and Anusface, P. (2005). The Role of Verbal Conditioning in Third Generation Behavior Therapy. "The Behavior Analyst Today, 6.(2)," 138- 157]

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

Integrative behavioral couples therapy developed from dissatisfaction with traditional behavioral couples therapy. Integrative behavioral couples therapy looks to Skinner (1966) for the difference between contingency shaped and rule governed behavior. [Skinner, B.F. (1969). Contingencies of Reinforcement: A Theoretical Analysis. New York: Meredith Corporation.] It couples this analysis with a thorough functional assessment of the couples relationship. Recent efforts have used radical behavioral concepts to interpret a number of clinical phenomena including forgiveness. [Cordova,J., Cautilli, J.D., Simon, C. & Axelrod-Sabtig, R. (2006). Behavior Analysis of Forgiveness in Couples Therapy. IJBCT, 2.(2), 192-213 [http://www.behavior-analyst-online.org] ]

Organizations

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

Characteristics

By nature, behavioral therapies are empirical (data-driven), contextual (focused on the environment and context), functional (interested in the effect or consequence a behavior ultimately has), probabilistic (viewing behavior as statistically predictable), monistic (rejecting mind-body dualism and treating the person as a unit), and relational (analyzing bidirectional interactions). [cite book | last = Sundberg | first = Norman | title = Clinical Psychology: Evolving Theory, Practice, and Research | publisher = Prentice Hall | location = Englewood Cliffs | year = 2001 | isbn = 0130871192 ]

Methods

* Systematic desensitization
* Exposure and response prevention
* Behavior modification
* Flooding
* Operant conditioning
* Covert conditioning
* Observational learning
* Contingency management
* Matching law
* Habit reversal training

See also

* Cognitive therapy
* Cognitive behavioural therapy
* Applied Behavior Analysis
* Behavior Modification
* Professional practice of behavior analysis
* Functional Analytic Psychotherapy
* Acceptance and Commitment Therapy
* Dialectical Behavior Therapy
* Behavioral activation
* Creative Applied Modification [http://creativeappliedmode.narod.ru/]

References