BEHAVIOUR TECHNIQUES

Done by Anitha Blessie

Systematic Desensitization
• Developed by Joseph Wolpe (1958), systematic desensitization was designed to treat
patients who presented with extreme anxiety or fear toward specific events, people, or
objects, or had generalized fears.
• The basic approach is to have clients replace their anxious feelings with relaxation.
STEPS
The first step is to teach the client relaxation responses that compete with and replace
anxiety.
Second, the events that make the client anxious are assessed and arranged by degrees of
anxiety.
The third step is to have the client imagine anxiety-evoking situations while being relaxed.
Repeated in a gradual manner, so that relaxation is paired with thoughts of events that had
previously evoked anxiety, the client is systematically desensitized to situations that had
previously created anxiety.
 Three major procedures of systematic
desensitization: Relaxation
• Relaxation. The process of progressive relaxation was first developed by
Jacobson (1938).
• Involves tensing and relaxing muscle groups, including arms, face, neck,
shoulders, chest, stomach, and legs, to achieve deeper and deeper levels of
relaxation.
• In work with his patients, Wolpe would ask them to devote 10 to 15 minutes
twice a day to relaxation.
• Wolpe often used five or six sessions to teach relaxation with different sessions
addressing different parts of the body.
• Continued relaxation practice throughout the course of therapy was important
so that a state of relaxation could be paired with imagined anxious situations.
 Hierarchy Construction

• Obtaining detailed and highly specific information about events that cause a
client to become anxious is the essence of constructing an anxiety hierarchy.
Often several hierarchies representing different fears are constructed.
• After describing the events that elicit anxiety, clients then list them in order
from least anxiety evoking to most anxiety evoking. This is often done by
assigning a number from 0 to 100 to each event. In this way a subjective units
of discomfort scale (SUDs) is developed, with 0 representing total relaxation
and 100 representing extremely high anxiety.
• These units are subjective and apply only to the individual. As systematic
desensitization progresses, events that originally had high SUDs ratings have
lower SUDs ratings.
Miss C. as a 24-year-old art student seeking treatment primarily
because she had failed exams due to her extreme anxiety.
Further interviewing revealed that Miss C was anxious not only EXAMPLE
about examinations but also about being watched or scrutinized by
others, being criticized or devalued by others, and seeing others
disagreeing or arguing. A brief hierarchy based on the latter
concern that was developed by Miss C.
Discord between other people
1. Her mother shouts at a servant (50)
2. Her younger sister whines to her sister (40)
3. Her sister engages in a dispute with her father (30)
4. Her mother shouts at her sister (20)
5. She sees two strangers quarrel (10)

Having established a hierarchy like this one, the process of

desensitization could be started.
 Desensitization

• During the first desensitization session, the therapist asks clients, after they
are relaxed, how many SUDs they are experiencing. If the level is too high,
above 25, relaxation is continued.
• The first scene presented is a neutral one, such as a flower against a
background. This provides an opportunity for the therapist to gauge how well
the client is able to imagine or visualize.
• Then the therapist proceeds in a way similar to that of Wolpe in his work
with Miss C.
• First, he has her imagine a neutral scene, then one from her hierarchy of her
fear of examinations, and then number 5, from the discord hierarchy.
 Desensitization contd.

• After the end of 17 desensitization sessions, Wolpe reports that Miss C. Was
able to be relaxed while imagining any items from each of the four
hierarchies and to be relaxed in the actual situations themselves. Four
months later Miss C. took her examinations without being anxious and passed
them.
• Although Wolpe’s approach to desensitization is typical, there are variations.
• Some therapists have used pleasant thoughts as a substitute for deep muscle
relaxation.
• Although commonly used with anxiety, desensitization has also been used in
working with anger, asthmatic attacks, insomnia, nightmares, problem
drinking, speech disorders, and other problems.
 Desensitization contd.
• Wolpe explains the application of systematic desensitization, regardless of the
type of response used to compete with different emotions, as
counterconditioning, drawing a parallel between desensitization and classical
conditioning.
• However, other principles of behavior can be used to describe this process as
well.
• Note that both physical behaviors (tensing parts of the body) and covert
behaviors (imagination of scenes) are used to bring about change. In systematic
desensitization, a gradual exposure to anxiety-producing situations is produced
through use of imagined scenes. Other techniques make use of dramatic scenes
of anxiety-producing situations.
 IMAGINAL FLOODING THERAPIES
• Another form of exposure therapy is flooding, which refers to either in vivo or imaginal
exposure to anxiety-evoking stimuli for a prolonged period of time.
• In imaginal flooding, the client is exposed to the mental image of a frightening or
anxiety-producing object or event and continues to experience the image of the event
until the anxiety gradually diminishes.
• The exposure is not to the actual situation but to an image of a frightening situation
such as being mugged or being in an airplane.
• The basic procedure in imaginal flooding is:
To develop scenes that frighten or induce anxiety in the client and
Have the client imagine the scene fully and indicate the SUDs.
The client is asked to imagine the scene again in the same session and in
future sessions, indicating the SUDs.
• Flooding involves imaginal presentation of anxiety producing events.
 IMAGINAL FLOODING THERAPIES Contd..

• With continual exposure, the SUDs should be reduced to a point where

discomfort is no longer experienced.
• For illustration purposes, a simplified example of treating Al, who is afraid of
riding on elevators, is described below. Al is asked to imagine these scenes:
1. The client rides on an elevator with his mother from the fourth floor of a
four-story building to the first floor.
2. The client rides an elevator from the top floor of a four-story building to the
first floor, with no one else in the elevator.
3. The client rides in an elevator alone from the 30th floor of a 30-story building
to the basement.
 IMAGINAL FLOODING THERAPIES Contd..

• After Al indicates his SUDs ratings to each of these situations, the therapist
has him imagine the situations until they no longer create anxiety.
• Then the therapist would have Al imagine another scene.
• Often relaxation exercises are practiced before flooding to make the
imagerymore real and, after the flooding, to return to a low level of
anxiety
 IMPLOSIVE THERAPY

• Another imaginal flooding approach is implosive therapy, developed by Thomas

Stampfl (1966).
• In implosive therapy, the scenes are exaggerated rather than realistic, and
hypotheses are made about stimuli in the scene that may cause the fear or
anxiety. Stampfl (1970) makes use of the client’s description of the scene as
well as a psychoanalytic interpretation of the scene
 IN VIVO THERAPIES
• The term in vivo refers to procedures that occur in the client’s actual environment. In vivo
exposure involves client exposure to the actual anxiety-evoking events rather than simply
imagining these situations. Live exposure has been a cornerstone of behavior therapy for
decades (Hazlett-Stevens & Craske, 2003). Together, the therapist and the client generate a
hierarchy of situations for the client to encounter in ascending order of diffi culty. Clients
engage in brief and graduated series of exposures to feared events. Clients can terminate
exposure if they experience a high level of anxiety
• Basically, the two types of in vivo therapy are those in which the client approaches the feared
stimuli gradually (similar to systematic desensitization) and those in which the client works
directly with the feared situation (similar to imaginal flooding).
• With the graduated approach, clients often learn and practice relaxation techniques that will
compete with the exposure to anxious situations.
• In some cases, other competing responses, such as pleasant images, are also used to compete
with the anxiety experienced in the actual situation. A client choosing a graduated approach
to reducing fears and anxiety would discuss with therapists which situations are likely to
arouse varying degrees of anxiety, establishing a hierarchy or list of events.
 For example, al’s fear of elevators, a list such as
the following may be produced.

1. Walk to an elevator door in the presence of the therapist.

2. Watch as the therapist presses the button to open the elevator door.
3. The client presses the elevator button while the therapist watches.
4. Therapist and client walk into the elevator and back out again on the same floor.
5. The therapist holds the elevator door while the client walks around inside the elevator.
6. The therapist and client take the elevator one flight and exit.
7. The client and therapist ride up and ride down one flight in the elevator.
8. The client and therapist go up two flights together and back again, and so forth.
9. The client rides up one flight by himself, to be met by the therapist.
10. The client rides up two flights, three flights, and so forth by him
 GRADUATED EXTINCTION

Graduated extinction is a technique designed to eliminate avoidance and fearful

behaviours by gradual exposure of the individual to the fear-evoking stimuli.
Graduated extinction may be seen as a technique of response prevention.
Graduated extinction proceeds by the systematic presentation of aversive stimuli,
beginning with extremely weak versions that do not elicit avoidance or defensive
behaviour and gradually moving on to more aversive scenes.
Avoidance behaviour may be prevented by always presenting stimuli that are too
weak to elicit the avoidance behaviour.
GRADUATED EXTINCTION contnd…

After minimally aversive stimuli have been presented, it is assumed that slightly
more aversive stimuli will no longer elicit the avoidance behaviour, although if
they had been presented initially avoidance would have occurred.
 Initial presentations of minimally aversive stimuli allow for the occurrence of
behaviours that are alternatives to avoidance behaviours and that these
competing responses are likely to generalize to other situations and complex
stimuli that are somewhat more aversive.
HERZBERG(1941)

• He treated a patient suffering from agoraphobia of such intensity that she

refused to leave the house alone.
• Treatment initially consisted of having the woman walk by herself in a park, a
sort of outing she did not fear greatly.
• The settings for her walks were gradually expanded to streets, first quite and
then busy ones, until finally she was able to walk almost anywhere she wished
without experiencing her previously debilitating anxieties.
 ARORA & MURTHY(1976)

• A 19 year old student who had experienced a gradual onset of difficulty in writing
that eventually produced a total inability to write unless he held the pencil in his hand
like a knife in stabbing position.
• Treatment involved the student initially hold a paintbrush b/w his index and middle
fingers and draw circles of increasingly smaller diameters. And then other shapes
such as spirals and straight lines were introduced and finally block letters.
• After this the same sequence was used with lead pencil and then with a pen.
• at the conclusion of treatment the client could write comfortably for up to a half
hour and this improvement was maintained throughout a 6-month follow up.
COVERT EXTINCTION

• Covert extinction is one of a family of techniques in which the reinforcing,

non-reinforcing or punitive consequences of a behaviour are imagined.
• Covert sensitisation involves the imagining of a problem behaviour with a
noxious or aversive correlate that persists in imagination as long as the
problem behaviour is imagined to be occurring.
Covert positive reinforcement: requires that a patient imagine a behaviour and then
be reinforced for it.
Covert negative reinforcement: requires that a patient imagine himself to be in an
anxiety-provoking situation, and then just as the anxiety peaks, shift to an imagined
scene in which he is performing a behaviour, the frequency of which is to be increased.
COVERT EXTINCTION Contd…

Example:
A client might imagine he is tied to a chair with a snake about to strike and then,
when this image is vivid and truly anxiety provoking, shift to a scene in which he is
delivering a public address before a large audience.
Clearly this is a procedure of covert or imaginal, avoidance conditioning.
• Covert extinction requires the client to imagine himself performing a problem
behaviour and then imagine a common reinforcing stimulus does not occur.
• Thus the client imaginally “ performs” behaviours in the absence of contingent
reinforcement conditions that have been shown effective in promoting the
extinction of overt behaviours.
COVERT EXTINCTION Contd…

• Like systematic desensitization, and other behaviour therapy techniques

involving the patients imagination, covert extinction initially includes the
therapists verbal discriptions of scenes to be imagined.
• Initially the client maybe told the rationale behine extinction procedures,
that his problem behaviour is being maintained by reinforcement from the
environment and that treatment will involve the elimination of the
reinforcement in the imagination.
• Then the client will be given “homework” assignments-trials he is to perform
by himself between sessions.
Example:
A client who complains of stuttering social situations may be asked first to imagine
that he is in a common situation, that he stutters, and that the stuttering evokes no
response from others.
You are sitting in your school cafeteria. Choose a place in which you usually sit.
(pause). You can hear and see students walking around, eating and talking.(pause) you
are eating your favourite lunch (pause). There is an empty seat next to you (pause). A
pretty girl comes over and asks you if she can sit down. (pause) you stammer “
ya…..yaa…yes” she absolutely reacts in no way to your stuttering.

 After the client has gone through the total scen, he must be asked to determine if the scene
was vivid and real. Then he may be asked to imagine it on his own, without the therapists
verbal description.
 He is asked to signal the therapist for example by raising his little finger on one hand when
the scene is finished and the therapist may again ask about its clarity.
 It is proposed that each therapy session have as many as 20 imagined scene, 10 with the
therapist verbalizing the scene and 10 with the client in his own.
 Furthermore the client is practice the scene 10 times each night at home and to modify the
scene on some trials to encourage extinction effects in a variety of situations.
 NEGATIVE PRACTICE

• In 1932, knight Dunlap published a book entitled Habits, “Their Making and
Unmaking”, in which he propounded a treatment procedure for the elimination
of small motor habits that had become problematic. The technique ran quite
clearly against “common sense” in that Dunlap proposed practicing the
behaviours, not to perfect their performance but to eliminate them; hence the
term Negative practice.
• Negative practice was initially used in treatment of enuresis, homosexuality
and masturbation as well as tics, typing errors, stuttering and speech blocking.
• It is a method of correcting errors by practicing the errors themselves with the
knowledge of their incorrectness.
• It consists of having a client actively and deliberately repeat an undesirable,
“automatic,” “involuntary” habit — such as a tic, nail biting, or stammering —
while paying careful attention to the behavior being practiced.
 Massed Negative Practice

• Hull proposed that one consequence of the repeated performance of a behaviour is the build-up of
fatigue.
• On the other hand, on consequence of any rest period is the dissipation of this fatigue which was
pleasurable and thus continued a negative reinforcer.
• The fatigue and other aversive events associated with practice eventually predispose the organism to
inhibit further practice(reactive inhibition). Since the aversive effects of fatigue and boredom occur
simultaneously with the performance of the practiced behaviour, they become conditioned to them
(classical conditioning), thus attaching aversive properties to the behaviours themselves(conditioned
inhibition).
• Since reactive inhibition (fatigue) dissipates after the practiced behaviour is creased, the negative
reinforcement of such dissipation is paired with the “ act” of “not-performing-the-practiced-
response”. Thus, lengthy practice produces inhibition of the practiced behaviour and reinforces the
habit of not responding. Extensive practice may eventually eliminated the behaviour practiced.