Chapter 14 -- Behavioral Psychotherapy

I. Origins of Behavior Therapy
A. Classical Conditioning
1. Dogs salivate before given food and other associated stimuli may cause salivation (Pavlov)
2. Loud noise paired with a white rat can create fear of the rat (Watson)
3. Eating a favorite food while exposed to a feared rabbit can reduce fear (Jones)
B. Operant Conditioning (Skinner)
1. Reinforcement increases specific behaviors
2. Punishment reduces specific behaviors
3. Extinction removes reinforcement and reduces behavior

II. Principles of Behavior Therapy
A. All behavior is acquired and maintained through principles of learning
B. The behaviors are the disorder, not a symptom of a personality disorder
C. Treatment should focus on current factors maintaining the behavior, not on past history
D. Modify abnormal behavior by applying learning principles to replace the maladaptive behaviors

III. Behavior Therapy Training
A. Therapist collaborates with client and much of the important work takes place outside of therapy with homework
B. Training does not require therapists to undergo therapy, but focuses on learning the relevant research findings
C. Supervision usually includes observations of therapy
D. Strong link between assessment and therapy
E. Therapy focuses more on understanding the principles than on the techniques

IV. Classical Conditioning Procedures
A. Exposure Therapy
1. Gradual exposure (move in small steps toward the feared situation)
2. Flooding (exposure all at once, stay until arousal drops)
3. Exposure plus response prevention (prevented from engaging in compulsive behavior)
B. Systematic Desensitization
1. Learn Progressive Muscle Relaxation
2. Develop an Anxiety Hierarchy of 20 to 25 events
3. Have client imagine least anxious events first for 10 seconds each followed by approximately 30 seconds of relaxation
4. Continue to the most feared event
C. Assertiveness Training
1. Move toward social situations
2. Relax and rehearse assertive responses in role-plays
3. Give homework in real-life situations

V. Operant Conditioning Procedures
A. Contingency Management
1. Positive reinforcement – give something good (pay)
2. Negative reinforcement – remove something bad (stop pain)
3. Positive punishment – give something bad (spanking)
4. Negative punishment – remove something good (fine or penalty)
5. Extinction – no response to behavior (ignoring)
B. Shape behavior with reinforcement for small steps in improvement
C. Contracts spell out the contingencies for individuals
D. Token Economy Programs apply the principles to groups of people in an institution
E. Behavioral activation for depression (increase positive emotions by increasing behaviors that bring rewards)
F. Observational Learning (Modeling) through imitation and vicarious learning about the consequences to someone else's behavior