Behavioral Therapy

Behavioral Therapy Techniques & Guide

Hello to all my readers. I am Akshaya Kawle welcoming you to my article on Behavioral Therapy. Hope this article puts light on certain facts and insights on the topic, helping you better understand the meaning and uses of the therapy.

Behavior refers to “the actions of a system or organism, usually in relation to its environment, which includes the other systems or organisms around as well as the physical environment. It is the response of the system or organism to various stimuli or inputs, whether internal or external, conscious or subconscious, overt or covert, and voluntary or involuntary”.

Behaviors can be either innate or learned. Innate behavior is that part which is hard-wired to our nervous system, and it is usually inflexible. e.g. A new born baby knows how to cry for its mother’s milk. A separate part of our behavior is made up of actions and responses that we learn and modify with the help of our experiences. This is learned behavior and here is where the learning theory comes in. This theory establishes a relationship between our actions and the subsequent consequences. For e.g. all of us at some point in time, have burnt our tongue trying to have that hot cup of coffee. Due to the unpleasant results we learn to blow on it and let it cool down so that we do not scald our tongue again.

Our experiences can be pleasant or unpleasant and these experiences often decide how we behave the next time we face a similar situation. A child who has recently lost someone dear in a car accident may never want to travel in a car again. Hence we can see that our experiences are such an important factor in our behavior that we sometimes tend to develop a response to a particular situation which is very difficult to let go of. In many cases these responses are unwanted but are too deeply ingrained in our brain for us to change them. These include our phobias, bad habits (such as substance abuse), etc. So how can we change our habits and modify our behavior so that it is more beneficial for us? The answer is simple. Just as we ‘learned’ and modified our behavior, we can ‘unlearn’ it and in place of it develop a new behavior. This is the essence of Behavioral Therapy.

Behavioral Therapy is an attempt to alter human behavior is such a way that objectionable or maladaptive behavior can be suitably changed so that one gains control over it and replaces it with one that is beneficial. This type of therapy is based on the principles of classical conditioning developed by Ivan Pavlov and operant conditioning developed by B. F. Skinner. Other major contributors to the development of the therapy were B. John B. Watson with his theory on Radical Behaviorism, and C. Edward L. Thorndike with his Reward Learning Theory.

Techniques to implement Behavioral therapy:
Behavioral therapy concentrates on teaching how one can change his/her behavior without focusing on the unconscious motives behind the maladaptive behavior. The therapy usually begins with the therapist analysing the behaviors of the patient which are causing him discomfort, stress, or reducing the patient’s quality of life, or have a negative impact on the patient in any way. Only after this does the therapist choose an appropriate treatment method (or in some cases a combination of methods).

The various treatment methods used by therapists include:
1. Systematic desensitization: This technique is especially useful for patients suffering from irrational fears and phobias. The patient is gradually exposed to a situation they fear so that it triggers the chain of reactions which are rather unpleasant for him. This can be done either virtually or in reality. Correspondingly, the therapist uses relaxation techniques to calm the patient down so that he can come to terms with his fear a small step at a time. For example, a patient in treatment for acrophobia, a fear of heights, will relax and then picture himself on the roof of his house. In the next session he might picture himself of the roof of a multi-storey building and try and get a hold of his emotions. The imagery used gets progressively more intense until he finally faces his phobia in reality.

This way through the combination of the fear producing situation and a desired response (relaxation), the patient eventually becomes used to his emotions, and has a grip on them when he encounters the situation again.

2. Flooding: In this technique the patient is directly subjected to the unpleasant situation either through simulation through thoughts or real life exposure. This is done so that the resultant reactions are extinguished and the patient has control over his emotional responses. This should be done with care and only after analysing the extent of the patient’s fears as it may lead to mental shock.

3. Conditioning: In this technique, a particular behavior is encouraged by rewarding the subject in an appropriate manner. For example children may be rewarded every time they carry out their chores on their own so that they are encouraged to do it over and over again.

4. Progressive relaxation: In this technique the therapist helps the patient relax his whole body, one part at a time, with the help of appropriate breathing techniques. Once the patient is completely relaxed and his body feels completely free he can concentrate on his mental state and control the emotions associated with an unpleasant situation or experience. This technique is used in tandem with systematic desensitization and flooding.

5. Assertiveness training: This technique is used to empower the patient so that he/she can face the situation with a positive frame of mind, while controlling any emotions that might grip the person. For example children with learning disabilities find it difficult to cope up and hence perform poorly in exams. They might associate studies in general with negative emotions and have a mental block to perform academically. This technique can help build up their confidence, and help them realize that they indeed have control over these situations and thus can be motivated to perform better in their studies.

6. Paradoxical intention technique: When a person tries to avoid his/her fears by trying to keep such thoughts away, it causes more anxiety than his actual fears. Instead of running away from one’s fears, this technique advises patients to embrace it and do the exact opposite of what they usually feel in such situations. The popular comic hero, Batman can be seen doing the exact thing to come to terms with his fear of bats. He himself goes into a cave full of bats so that his fear is completely eliminated.

7. Behavioral activation: This technique is useful especially in patients suffering from problems like depression. It involves making a list of all the activities that he/she likes doing or are required as a part of a normal lifestyle. Then the patient is encouraged to do things that are listed, according to his preference, one after another. This helps in exposing the patient to different situations which might help him get back on track.

8. Bio feedback: This technique makes use of a biological function in the patient, like heartbeat, which is amplified and the patient is exposed to this information. This way the patient can actively relax his heart rate, and other muscle functions, and have a better control over his bodily reactions.

9. Aversive conditioning: It involves generating an unpleasant experience for the subject if he behaves in an unsuitable manner. This way a permanent aversion is created in the mind of the subject towards his unsuitable behavior. To combat addictions like smoking or drinking in adults, they are injected with a nausea-producing drug every time they smoke or drink, so that unpleasant associations are paired with the addictive behavior. In addition to smoking and alcoholism, aversive therapy has also been used to treat nail biting, sex addiction, and other strong habits or addictions.

Other techniques include learning new behaviors through observations, rehearsed behavior, social skills training, hypnosis, and guided imagery.

Treatment according to behavioral therapy is typically administered in an out-patient setting in either a group or individual session. Treatment is relatively short compared to other forms of psychotherapy, usually lasting no longer than 16 weeks or sessions. It is sometimes also used with medication, according to the patient’s problem and its severity.

Where can Behavioral Therapy be used?
Behavioral therapy essentially works by changing the behavioral patterns of the subject. Hence it may be applied to any problem which may be improved by a change in behavior of the patient. This makes it a very effective and essential treatment tool for a host of mental problems.

Behavioral Therapy for adults can be used to treat the following problems:
1. Substance abuse: The problems of alcohol and drug abuse are one of the most common and most serious. It not only has a devastating effect on the individual’s physical and mental health, but also has a traumatizing effect on family and friends. Behavioral therapy can be used on such individuals to remove the craving for alcohol or drugs. Assertive conditioning can be used so that the victim feels he is in control over his urges and does not give in to his withdrawal symptoms.

2. Getting over phobias and anxiety disorders: Behavioral therapy is one of the most effective tools to get rid of one’s phobias. Techniques like systematic conditioning, flooding, and paradoxical intention can be used on the patient so that he comes to terms with his fears and accepts them rather than run away from them.

3. Using the method of conditioning, a patient’s aggressive behavior, or anger management issues can be effectively dealt with. Through the therapy, the patient can gain control over his emotions so that he does not burst out of anger when he faces an adverse situation.

4. In some cases, behavior therapy is used as a treatment for obesity. After analyzing the eating and activity patterns and other habits, the therapist then identifies positive strategies for promoting weight loss, healthier eating habits, and helps develop a more positive self-image. This therapy is also used to help anorexia patients.

5. Patients with developmental disabilities have also experienced positive results with the use of this therapy, which is also effective with severely disturbed psychotic patients.

6. In some cases, patients who are severely ill cannot participate actively in cognitive therapy or other insight-oriented therapies. Behavioral therapy is the best choice for such patients.

7. Incontinence is the problem wherein the patient does not have proper bowel or urinary control. These conditions can also be stopped by changing the behaviors that lead to it.

8. Mental conditions like Obsessive Compulsive disorder (OCD), Attention Deficit disorder (ADD) can be improved using the therapy. For example a woman who is obsessed with cleanliness can be encouraged to stay in a dirty room, helping her accept the inconvenience she is facing. Patients suffering from insomnia are sometimes encouraged to consciously stay awake so that they do not face the anxiety of unsuccessfully trying to sleep.

Conditions in Children where Behavioral Therapy can be of major help are:
1. Separation Anxiety Disorder (SAD): This is a condition in which children four years old or more face anguish and distress on being separated from their parents. They might cling on to their parents whole day long, following them wherever they go. This condition can be treated by encouraging the child to do certain tasks, like sleeping in his separate room, in exchange of certain rewards. Studies have shown that the therapy has an effect in just four weeks.

2. OCD in children can be treated using techniques like exposure and response prevention, where in the child is exposed to the situation where he feels compelled to do a certain thing, and then prevented from doing it. It helps the child get a sense that he can do without giving in to his obsession and that things do not change if he does not do it.

3. Many children suffer from social phobias where they are unable to interact properly with others. Treating this condition might be a little difficult as the child might feel inconvenient to talk to the therapist as well. In such cases treatment is carried out with medication, to ease the child’s anxiety levels. Techniques like guided imagery, wherein the therapist involves the child in imagining situations where he is successfully interacting with people can be used. The therapist can also make use of relaxation techniques and rehearsal therapy during this treatment.

4. Another childhood problem that can be improved is attention deficit/hyperactivity disorder (ADHD). The parents can exercise a firm control over the child’s activities to monitor the same. Care should be taken so that the child does not feel tightly controlled as this may result in stress and a sense of anger in the child.

Precautions while carrying out Behavioral therapy:
Behavioral therapy may not be suitable for some patients. People who do not have a specific issue which can be singled out and treated, are better off with psychodynamic therapy.

Behavioral therapy may also be inappropriate for cognitively-impaired individuals (e.g., patients with organic brain disease or a traumatic brain injury) depending on their level of functioning.

Behavioral therapy is brief in terms of duration, which causes relapse in some patients. However, follow-up sessions can frequently put patients back on track to recovery.

The effectiveness of behavioral therapy lies totally in the hands of the patient as he is the most active participant in the treatment process. Behavioral treatment discourages patients from getting overly dependent on the therapist so that they feel empowered to change themselves during the treatment. The success of the treatment depends on how well the patient copes with the changes in behavior and relies on the strength of his will power to ensure that the behavioral change is a permanent one.

With the increasing stress levels not only among adults, but also among children due to the fast pacing lifestyle, alternative solutions to problems have become a necessity. The age old science of Behavioral Therapy fulfills this gap left in by medicines. When used with proper precautions, and a professional therapist, the therapy can prove to benefit anyone with any problem, leading to a healthier way of living.

Authors Brief Bio: Akshaya Kawle is a Bachelor of Arts with Political Science Majors, is currently pursuing her MBA (HR), and is a professional swimmer, and dancer. A keen learner, she is also pursuing a course on Counseling and Graphology. When not working on her various hobbies like driving, interacting with people, and spending time with family and her pets, she volunteers for an NGO for stray animals.

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