 |
| | | | | | |
Theory and Design in Counseling and Psychotherapy
Susan X Day , Iowa State University and University of Houston
| | | | | | | | | | | |
CHAPTER 8: Behavioral Therapies
Key Terms and Essential Concepts
Learning theory: Conceptual framework for how animals and people
learn through the systematic reinforcement of behavior in the presence of specific
conditions.
Classical conditioning: Classical conditioning experiments
demonstrated how learning occurs by repeated associations. A stimulus, such
as illuminating a light, paired with a response, such as Pavlov’s dogs salivating
for food, established a connection between the behavior and the stimulus. After
repeated trials, the dogs would salivate when they saw the light, even when
food was not present. The dogs learned to salivate to the light.
Stimulus: An internal or external condition that is associated
with a specific response.
Response: A definable behavior associated with specific conditions.
Discrimination: Making distinctions between different stimuli.
Generalization: A conditioned response occurs when a new stimulus
that is similar to the original cue is introduced.
Counterconditioning: Reversing previous learning by changing
the response set. For example, an aversive situation will no longer stimulate
anxiety if the negative responses are replaced with pleasant ones.
Extinction: When a learned response occurs and the stimulus
is withdrawn, eventually the behavior will cease. For example, with Pavlov’s
dogs, no longer ringing a bell when the dogs were fed would eliminate the dogs’
salivating to the sound. The dogs no longer associated the bell’s sound with
eating.
Response burst: An increase in behaviors when reinforcement
is withdrawn. The increase is an attempt to bring back the reinforcement, expecting
that the intermittent nature of reinforcement be in play. Response bursts discontinue
when it is clear the reinforcement will not reoccur.
Operant/ Instrumental conditioning: The conditions following
a specific response or behavior are manipulated. Such conditioning makes the
doing of the behavior instrumental in gaining the reward or reinforcement. Rewards
are given only when the targeted behavior occurs. The subject does the behavior
to gain the reward. The reward or reinforcer is contingent upon the response.
Law of exercise: Thorndike demonstrated the law of exercise
showing the connection between the response and stimulus becomes stronger the
more often the pairing of the stimulus and response sequence is repeated. For
example, a person who awakens every morning at the same time to an alarm would
become more likely to respond to the alarm daily. Conversely, the more often
the consequence does not follow the behavior, the weaker the connection between
the two. That is, the more often a person ignores the alarm, the less likely
they will awaken when the alarm rings.
Law of effect: Thorndike also demonstrated the law of effect
stating that the level of satisfaction determines the strength of the connection
between the stimulus and response. For example, if a person enjoys conversations
with a friend, seeing the friend would elicit the behavior of talking whereas
if conversing with another person is annoying to the person, seeing that person
might elicit less conversation. If the consequence of a particular behavior
is satisfying, the connection of the behavior and the consequence is strengthened.
Conversely, if the consequence is not satisfying the weaker the connection.
Reinforcement: An occurrence that increases the tendency to
repeat a response.
Schedule of reinforcement: The rate and frequency with which
rewards are given for specific behavior.
Intermittent reinforcement: Experimentation has shown that
if the reinforcement occurs every time a behavior occurs, the person will learn
the behavior quickly but will also cease the behavior quickly when the reinforcers
are withdrawn. If the reinforcement is intermittent, occurring only some of
the times when the behavior occurs, the learning will be slower, but giving
up the behavior will also be slower. The timing and frequency of delivering
rewards is called a schedule of reinforcement.
Positive reinforcement: Using desirable consequences or rewards
to increase behaviors.
Negative reinforcement: Using undesirable consequences of not
performing a behavior in order to increase the behavior. For example, a person
will use his or her hearing aid when not hearing things becomes bothersome enough.
Punishment: Negative consequences applied to reduce the frequency
of response.
Immediate consequences: Punishment or reward that follows a
behavior directly after the action is formed is more effective because the connection
between the behavior and the resulting consequence is obvious to the learner.
For punishment, immediacy is particularly important because the side effects
of aversive penalties, such as discouragement, risk teaching unwanted lessons.
Contingency management: Manipulating the circumstances (stimuli)
before a behavior or the responses (consequences) after a behavior.
Stimulus control: Managing the conditions that encourage the
desired behavior. Manipulating the situation that precedes the behavior can
make the conditions more conducive for the behavior to occur.
Shaping: Rewarding behaviors that approach the desired behavior
in successive approximations. Used to develop behaviors that would not occur
naturally, such as teaching children self-control.
Successive approximation: Part of shaping: rewarding any behavior
that is in the direction of the desired response. Then rewarding behaviors that
come even closer to the desired response in a progression until the desired
behavior occurs.
Differential reinforcement: Rewards are given when the client
does not do undesirable behavior and performs an alternative behavior instead.
Response withdrawal: Withdrawing rewards to reduce the frequency
of behaviors. Time Outs for children who misbehave removes attention from them,
which is why Time Outs eliminate misbehavior faster than paying attention to
it.
Token economies: Clients can earn tokens or vouchers
to gain rewards for behaviors, to pay for misbehaviors, and to pay for privileges.
Social Learning Theory: The recognition on the part of behaviorists
that social cues and interactions serve as reinforcements for learning. Obviously
children learn by imitating adults, and Social Learning Theory posits concepts
that describe how such learning occurs throughout life. The most well-known
author of Social Learning Theory is Bandura who extended behaviorism to human
internal reactions; emphasizing this, he revised the name of the theory to Social
Cognitive Theory in 1986.
Modeling: A major factor in Social Learning Theory is the concept
of modeling, when a person observes another person and imitates the behavior
observed. People who are admired and those who share similar characteristics
to the learner serve as the most effective models
Covert modeling occurs when the person imagines a model to
remind him of the behavior.
Participant modeling uses group members who are most skilled
to demonstrate behavior for others who are not as adept.
Negative, contrast, and stressful modeling demonstrate consequences
of behaviors that are to be avoided. Contrast modeling shows behavior that is
the opposite of socially desirable behavior to demonstrate negative consequences.
Stressful modeling shows the stress that can be eliminated through more considered
behavior.
Therapy goals: Behavioral therapists require clear, well-defined
goals for counseling. Typically, goals called targeted behaviors are
explicit behaviors that will change. Preferably goals are observable and measurable
so progress can be easily determined. In a behavioral model considerable effort
is spent determining goals before therapeutic interventions are implemented.
Goals can change as the clients grapple with the implications of what they want
to change.
Reactivity of measurement: To determine the specific conditions
and responses for behavioral change and to track progress, accurate measurement
is needed. Clients are often assigned tasks of keeping records of their behavior
or filling out questionnaires summarizing behaviors. However, the measurement
tasks may create change in the client’s actions. Behavioral therapists define
such initial change and take that into account as therapy proceeds.
Baseline: A record of behavior before treatment begins is used
as a measure of the client’s starting point. The record serves as a comparison
for behavior after treatment interventions to indicate if improvement has taken
place.
Excess, deficit, inappropriateness: Categories for classifying
behavioral difficulties: Too much of the behavior (excess); not enough of the
behavior (deficit) or a behavior that is out of place in the circumstances (inappropriateness).
Transfer of training: As with the concept of generalization,
new behaviors learned in treatment are applied to other situations not directly
addressed in therapy.
Reciprocal inhibition: A client is taught nonanxious responses
to threatening cues. Wolpe developed the therapeutic treatment where anxiety
responses to fearful stimuli are replaced with positive responses. Clients learn
to relax or to use assertive statements and then practice using these behaviors
under anxiety-provoking circumstances. The new behaviors reduce anxious reactions
because relaxation and assertion are not compatible with anxiety or social inhibition.
Progressive relaxation: A technique where muscles are tightened
and then relaxed in a progression throughout the body. This is
used in reciprocal inhibition training.
Anxiety hierarchy: A list of anxiety-provoking situations organized
in descending order from those that create a little fear to those that create
the most. Used during desensitization treatment where each item on the list
is imagined while the client is relaxed until the client can experience the
most threatening item without anxiety.
Systematic desensitization: Using the reasoning of reciprocal
inhibition, relaxation is paired with clearly defined fearful cues. The client
describes his internal fear structure specifying what makes him most anxious
and what is least anxiety provoking. The therapist creates an anxiety hierarchy
starting with the least troubling situation and progressing to the most disturbing.
The client then practices relaxation techniques in the presence of the least
difficult circumstances and proceeds through the sequence until the relaxation
response can be summoned in the most difficult situation.
Imaginal treatment: Learning methods can be applied in the
client’s imagination. The client can imagine himself doing the targeted behavior,
or a model can be pictured for observation. The client can imagine fearful situations
while using relaxation methods. Using images to establish responses can then
be transferred to real-life situations.
In vivo treatment: Rather than using imaginary methods, clients
can be coached to use behaviors in real-life circumstances. Exposing clients
to approach fearful situations or to practice new behaviors with therapeutic
support reduces negative reactions and can assist in behavioral changes.
Manualization: The use of written, standard procedures by therapists
to treat particular client concerns.
Self-management therapy: Therapists teach the concepts and
methods of learning theory to help individuals establish or change their own
behavior. Clients may need assistance in defining the targeted behaviors, in
recognizing the cues that elicit negative behaviors, and in determining effective
rewards as well as learning procedures that will be helpful in creating and
maintaining changes.
Reality therapy: A counseling approach that stresses the consequences
of behavior and self responsibility.
Psychoeducational: A behavioral approach implies the necessity
for clients to learn and for counselors to teach psychological concepts and
methods that will improve the clients’ lives. A collaborative rather than a
didactic process is most common, though behaviorists are typically efficient
in offering information and techniques as they are needed rather than depending
on an internal change process fostered by humanistic approaches. Use of psychoeducational
groups where a number of clients are taught basic concepts and can assist each
other in learning new behaviors is also a natural extension of a behavioral
approach.
Assertiveness training: A common difficulty for clients is
the ability to determine and openly express their legitimate needs in social
interactions. Satisfying relationships require communication open enough to
meet the needs of the parties involved. When a person is unable to relay important
messages that will improve mutual understanding, relationships become unsatisfying
to all involved. Assertiveness training starts with educating the client about
the necessity for articulating needs and then helps the client determine legitimate
requests, requirements, and desires. Finally, the client learns effective phrases
that are spoken with respectful clarity, which is neither too hostile nor too
passive, so another can hear the messages.
Aversive therapy: Methods of treatment providing a negative
impact are sometimes effective in eliminating unwanted responses or behavior.
Flooding is a technique that forces a person to endure anxiety-provoking conditions
so she will learn that the consequences are not as destructive as imagined.
Imploding is another aversive technique in which the client imagines a fearful
scene that is intensified by the counselor adding anxiety-provoking images such
as symbols with sexual and hostile implications.
Response cost: A term in aversion therapy indicating the price
paid for negative behavior. For example, in forced smoking to the point of nausea
the sick feeling is the response cost.
Avoidance repression: Avoiding the thought of aversive conditions
so anxiety is not felt.
Exposure and response prevention: Exposing a client to feared
events and preventing the client from escaping or withdrawing. Such a technique
is used when the client’s imagined fears are greater than the actual reality.
By exposure to the fearful situation, the client learns his or her fears are
exaggerated.
Flooding: Intense and prolonged exposure to anxiety-provoking
events until the fearful response dissipates. The treatment is predicated on
the fact that when fear subsides, the client learns that she can face the fear
without dire consequences. This treatment contrasts with systematic desensitization
in which the threat is introduced in tiny steps.
Implosive therapy: A variant on the flooding technique, this
therapy uses inner stimuli associated with aggression, sex, and threatening
events. The exposure scenes called forth with great intensity are in the imagination
rather than reality.
Biofeedback: Instruments signal bodily states giving the participant
information regarding physical reactions. When a person gains control of the
physical reaction, a mind state will also change, given the mind-body connection.
| | | | | | | |
|
|
|
