Behavior Therapy

Well, how did I get here?

• I wouldn’t blame you if you’re feeling a bit
disillusioned…
 Well, how did I get here?
• In response to the psychodynamic lecture…
– “But Ian, how can you be sure that’s what happens in the
mind?”
– “Isn’t is just a judgement”
• “Don’t you hate judgements?”
– “That can’t be disproven. So, it’s worse than useless,
right?”
• In response to the humanistic lecture…
– “How, exactly, do you define empathy, unconditional
positive regard, and genuineness?”
– “If they actually help, shouldn’t we be able to observe and
measure them?”
 Well, how did I get here?
• These are all great questions and raise serious issues
– Any instructor or practitioner would have little choice but
to concede that the psychodynamic and humanistic
approaches are not entirely empirical
– The are characterized by speculations of mental
processes that can’t be defined, directly observed, or
scientifically tested
• If you’re feeling disillusioned, you need to look
elsewhere
– … to behavioral therapy
 Behavior Therapy
• Behavior therapy – an approach to psychotherapy
emphasizing
– Empiricism
– Observable and quantifiable problems and progress
– A lack of speculation about internal mental processes
• Behavior therapy is the clinical application of
behavioral principles
 Origins of Behavior Therapy
• Ivan Pavlov (1849 – 1936)
– Began his career as a physiologist
who studied the digestive
systems of dogs
– He would routinely present food
to dogs and measure the amount
of saliva the dogs produced
• This was a natural, automatic
response from any canine shown a
potential meal
– At one point he noticed that the
dogs were salivating before the
food was presented “Where my dogs at?” –
Ivan Pavlov (1927)
 Origins of Behavior Therapy
• Ivan Pavlov (1849 – 1936)
– He came across a remarkable
phenomenon he called “classical
conditioning”
– Through experience dogs learned
that food was often preceded by a
particular stimulus
• The sight of the researcher, the sound
of the food being prepared, or similar
events
– He left his work on digestion and
focused on psychology
• Conducted many pioneering studies
on the topic “Where my dogs at?” –
Ivan Pavlov (1927)
 Origins of Behavior Therapy
• John Watson (1878-1958)
– Argued that psychology should
study only
• Overt, observable responses
• The overt, observable stimuli that
precede them
• Psychology should not study the inner
workings of the mind that may occur in
between
– Feelings, thoughts, consciousness,
and other internal mental processes
• Not suitable for scientific study
• Not as powerful as conditioning in
determining behavior
 Origins of Behavior Therapy
• John Watson (1930)
– “Give me a dozen healthy infants,
well-formed, and my own specified
world to bring them up in and I’ll
guarantee to take any one at
random and train him to become
any type of specialist I might select
– doctor, lawyer, artist, merchant-
chief and, yes, even beggar-man
and thief, regardless of his talents,
penchants, tendencies, abilities,
vocations, and race of his
ancestors.”
 Origins of Behavior Therapy
• Edward Lee Thorndike
(1874-1949)
– Primary contribution was
the Law of Effect
• All organisms pay attention to
the consequences (or effects)
of their actions
– Actions followed by
pleasurable consequences
are more likely to occur
– Actions followed by
unpleasant consequences
are less likely to occur
 Origins of Behavior Therapy
• B. F. Skinner (1904-
1990)
– Devoted much of his
life’s work to
experimentation on the
law of effect
– Argued that operant
conditioning was as
great an influence on
human behavior as
classical conditioning
 Goals of Behavior Therapy
• The primary goal of behavior therapy is observable
behavior change
– This is in stark contrast to the emphasis on internal and
mental processes of the
• Psychodynamic approach
– Goal of making the unconscious conscious
• Humanistic approach
– Fostering self-actualization

• Behavior therapy
• Rose from the strong dissatisfaction with numerous aspects
of the psychodynamic approach that dominated through the
early 1900s
 Emphasis on Empiricism
• Behavioral therapists take the stance that the study of human
behavior should be scientific
– This is true whether the behavior is normal or abnormal
– Clinical psychologists treating clients should employ methods that
can be scientifically evaluated
• Theories regarding the treatment of problem behaviors should be stated as
testable hypotheses
– In this way, they can be supported, refuted, modified, and retested
• If theories of change are not stated as testable hypotheses
– They lack scientific rigor and might be best classified as conjecture, inference, or even
guesswork
– Behavioral therapists regularly collect empirical data on their clients
• e.g., a baseline measure at the outset of therapy and at the end of therapy
– This allows the therapist to evaluate change
 Defining Problems Behaviorally
• Client behaviors are not symptoms of some
underlying problem – those behaviors are the
problem
– Example – the client Ryan has a habit of excessively
checking the front door of his apartment at bedtime to
make sure it’s locked
• To a behavior therapist, Ryan’s door checking habit is just that – a
habit
– No need to invoke a deeper diagnosable problem that resides within Ryan
• They prefer not to make unprovable inferences about internal
causes and focus exclusively on the door-checking behavior as
the problem to be addressed
 Two Types of Conditioning
• Behavioral therapists contend that our behavior is the
byproduct of conditioning (i.e., learning)
– Conditioning explains all behavior (including disordered behavior)
• Classical Conditioning
– Conditioning in which an unconditioned stimulus that produces an
unconditioned response is paired with a conditioned stimulus such
that the conditioned stimulus elicits a similar response (i.e.,
conditioned response)
• Operant Conditioning
– Conditioning in which the organism “operates” on the environment,
notices the consequences of the behavior, and incorporates those
consequences into decisions regarding future behavior
Classical Conditioning
 Classical Conditioning
• Using the example of Pavlov’s dogs…
– Imagine a dog walking into Pavlov’s lab for the first time.
Here, everything is unconditioned
• Unconditioned stimulus – the stimulus that elicits the
unconditioned response before any conditioning has taken
place
– i.e., the dog food
• Unconditioned response – the response elicited by the
unconditioned stimulus before any conditioning has taken place
– i.e., the salivation
– No dog needs to learn this association – it’s inborn
 Classical Conditioning
• Still using the example of Pavlov’s dogs…
– Imagine a dog has spent time in Pavlov’s lab and notices that when
a certain bell rings, food comes out a few seconds later
• Here, the dog has become conditioned – it’s learned that the sound of the
bell predicts the arrival of food
– Conditioned stimulus – the stimulus paired with the unconditioned
stimulus that ultimately elicits the conditioned response
• i.e., the bell
– Conditioned response – the response elicited by the conditioned
stimulus after the conditioned stimulus has been paired with the
unconditioned stimulus
• i.e., the salivation
 Classical Conditioning
• Classical conditioning is passive
– Pavlov’s dogs didn’t need to do much of anything to experience the
conditioning
• Just remain awake alert
• It’s almost as if the classical conditioning happened to them
• Several variables can influence behavior surrounding the classical
conditioning process
– The extent to which the subject behaves will depend upon the extent
generalization and discrimination have taken place
– Generalization – a process by which the conditioned response is evoked by
stimuli that are similar to, but not an exact match for, the conditioned
stimulus
– Discrimination – a process by which the conditioned response is not evoked
by stimuli that are similar to, but not an exact match for, the conditioned
stimulus
 Operant Conditioning
• The basic principle of operant conditioning is that
behavior is a function of its consequences
– This is a more active style of learning than classical conditioning
• The subject must act first
– Example: what if one of Pavlov’s dogs whined?
• If the whining brought forth treats, the dog would be more likely to
whine
• If the whine brought forth a slap, the dog would be less likely to whine
– The subject experiments with a new behavior, pays attention to
the outcome, and uses that outcome as a factor in future
decisions
 Operant Conditioning
• Skinner and other proponents of operant conditioning
thought that consequences shape all behavior
– Including behavior labeled as abnormal
• In effect, all our actions are governed by…
– Contingencies – the “if…, then…” statements connecting
actions to outcomes that organisms learn through operant
conditioning
• These include those labeled as abnormal
• Behavioral therapists induce behavior change by
revising contingencies that control a client’s behavior
 Techniques Based on Conditioning
• Both classical and operant conditioning can be applied to address
problematic or unwanted behaviors
– Both form the foundation for most behavior therapy techniques
• Techniques based on classical conditioning
– Exposure therapy
– Systematic desensitization
– Assertiveness training
• Techniques based on operant conditioning
– Contingency management
– Reinforcement and punishment
– Extinction
– Token economies
– Shaping
– Behavioral activation
– Observational Learning (Modeling)
 Exposure Therapy
• Exposure therapy – a form of behavior therapy based
on classical conditioning in which clients gradually face
a feared object or situation
– The clinical psychologist's version of “facing your fears”
• Phobias
– According to the behavior therapist, these are the result of
classical conditioning
• A particular stimulus (e.g., spiders, heights, the dark, etc.)
becomes paired with an aversive outcome (e.g., anxiety, pain, etc.)
• This pairing can be weakened and eliminated if the client
experiences one without the other
 Exposure Therapy
• The behavior therapist has several choices when
conducting exposure therapy
– Imaginal exposure – exposure to anxiety-provoking
objects via imagination
• This might involve visualizing the feared object or related items
• Could also take the form of writing about the feared object
– In vivo exposure – exposure to anxiety-provoking objects
in real life
• These can be interoceptive, focusing on sensations within the
client’s own body
– For example, a therapist may ask a client to climb a flight of steps to raise
the client’s heart rate
 Exposure Therapy
• Another important choice is the rate of exposure to the
client
– Graded exposure – a gradual approach to exposing clients to
feared objects or situations
• Requires the client and therapist to collaboratively create an anxiety
hierarchy
– Here, exposure begins at the lowest level and then proceeds through the hierarchy
until the client reaches the highest level
– Flooding or Implosion – all-at-once in vivo exposure to feared
objects or situations
• These can produce rapid change quickly or be intolerable and/or
traumatizing for clients
• For this reason
– The anxiety hierarchy is done collaboratively
– It is used cautiously and infrequently
Exposure Therapy
 Exposure Therapy
• Exposure and Response Prevention (ERP)
– Involves graded exposure to
• Obsessive thoughts
– e.g., “My hands are filthy – I must wash them.”
• Situations that elicit such thoughts
– Involves the simultaneous preventing of the client’s typical
response (e.g., handwashing)
• This typical response
– Brings temporary relief
– Has also come to interfere with the client’s daily life
– Has received substantial empirical support for the treatment
of obsessive-compulsive disorder
 Systematic Desensitization
• Systematic desensitization
– Involves re-pairing (or counterconditioning) the feared object
with a new response (e.g., relaxation) that is incompatible
with anxiety
• Counterconditioning – re-pairing a conditioned response that is
incompatible with the previously conditioned response
– In exposure therapy
• The feared object is eventually paired with nothing
– In systematic desensitization
• The feared object is paired with a new response that replaces and
blocks the fear response
– Used primarily for phobias and other anxiety disorders
 Systematic Desensitization
• Most often, the new response that replaces and
blocks the fear response is relaxation
– Relaxation training – when the behavior therapist teaches
the client progressive relaxation techniques that induce a
relaxation response incompatible with anxiety
• Typically, muscles are systematically tensed and relaxed
• Usually, the behavior therapist uses scripted instructions during
relaxation training
– These instructions are then recorded and shared with the client
• The client first learns and masters the relaxation
• Then, the client relaxes before each exposure to the anxiety-
provoking stimulus
 Assertiveness Training
• Assertiveness training – a form of behavior
therapy based on classical conditioning in which
clients improve on timid, apprehensive, or
ineffectual social behaviors
– Includes some aspects of exposure therapy (and
maybe systematic desensitization)
• Exposure comes in the form of facing interpersonal fears
– Simply exposing oneself to the situations can reduce anxiety
• Counterconditioning may come into play
– Assertiveness may replace relaxation as the new response that
inhibits anxiety
 Contingency Management
• Contingencies are “if…, then…” statements that govern
behavior
– All behavior occurs because of its consequences
• If those consequences change, the behavior will change correspondingly
• Contingency management – the consequences following
selected behaviors are changed to produce more desirable
behavior
• Behavioral therapists often emphasize that powerful but often
overlooked contingencies can contribute and maintain mental
disorders
– “If I behave in a depressed way, I get attention from friends and
family and I am excused from responsibilities.”
 Reinforcement and Punishment
• These are the consequences of behavior
– Reinforcement – any consequence that makes a
behavior more likely to recur in the future
– Punishment – any consequence that makes a
behavior less likely to recur in the future
• Individual differences
– Remember, one person’s reinforcement might be
another person’s punishment
 Reinforcement and Punishment
• “Incentive structures
work. So, you have to
be very careful of what
you incent people to do
because various
incentive structures
create all sorts of
consequences that you
can’t anticipate”
– Steve Jobs
 Reinforcement and Punishment
• Further divided into two groups
– In this context
• “Positive” refers to adding a consequence
• “Negative” refers to removing a consequence
– Positive reinforcement
• Getting something good
– Negative reinforcement
• Losing something bad
– Positive punishment
• Getting something bad
– Negative punishment
• Losing something good
 Reinforcement and Punishment
• Some examples
– Positive reinforcement
• If Barney attended all his classes without any verbal or physical outbursts, then
he received a new magazine of his choice
– Negative reinforcement
• If Barney attended his classes without any outbursts, then his ankle restraints –
necessary with the onset of his assaults – would be removed for the next day
– Positive punishment
• If barney engaged in any type of outburst, then he would receive a 2-hour
detention in a cell without magazines
– Negative punishment
• If Barney engaged in any type of outburst, then all his magazines would be
confiscated for the next day
 Extinction
• Extinction – the removal of an expected
reinforcement that results in a decrease in the
frequency of a behavior
– Extinction burst – the initial increase in intensity of
the unwanted behavior immediately after the
expected reinforcement is removed
• Like losing money at a soda machine 
– It’s difficult to accept at first…
 Token Economies
• Token economy – an environment in which
client’s earn tokens, exchangeable for
reinforcements, for performing predetermined
target behaviors
– A strength is their versatility across clients
• This is because different clients value different
reinforcements
– A limitation may be generalizability
• Ideally, you’d want the behaviors to extend beyond the
environment in which tokens are given
 Shaping
• Contingency management
– Based on reinforcing target behaviors in order to increase their
frequency
– But what if the target behavior is so complex, challenging, or novel that
it can’t be accomplished yet in its entirety???
• Shaping – reinforcing successive approximations of the target
behavior
– It’s a technique in which the therapist reinforced “baby steps” toward
the desired behavior
– A key variable is the increment between each successive approximation
• The steps shouldn’t be too difficult for the client
– If they are, the next step won’t be reached
• The steps must be at some difficulty
– If they aren’t, the process will take forever…
 Behavioral Activation
• Behavioral activation
– A form of behavior therapy for depression
– The goal is to increase the frequency of behaviors that
are positively reinforcing to the client
– Based on the profound notion that the lives of depressed
people have a shortage of positive reinforcement
– Allows the client to
• Experience more positive emotions
• Become more fully engaged in their lives
– Involve both operant and classical conditioning
 Observational Learning
• Observational learning
– Conditioning that takes
place when the
individual observes
contingencies applied to
others rather than the
self
• Also known as modeling
and social learning
• Studied extensively by
Albert Bandura
 Observational Learning
• Observational learning strategies actually afford
clients two different ways to learn
– Imitation – the client simply mimics the modeled behavior
– Vicarious learning – the client observes not only the
modeled behavior but also the model receiving
consequences for that modeled behavior
• With observational learning
– Clients can learn to expect reinforcement or punishment
for a target behavior by observing what the model
receives