Behavior therapy

• Behavior therapy is the use of learning principles to make constructive

changes in behavior.
• Behavior therapy is an action therapy that uses learning principles to make
constructive changes in behavior.
• Behavior therapists assume that people have learned to be the way they
are.
• If they have learned responses that cause problems, then they can change
them by relearning more appropriate behaviors.
• Broadly speaking, behavior modification refers to any use of classical or
operant conditioning to directly alter human behavior (Miltenberger, 2008;
Spiegler & Guevremont, 2003).
• of behavior therapy, also called behavior modification, is to modify
specific problem behaviors, not to change the entire personality. And,
rather thanfocusing on the past, behavior therapists focus on current
behaviors.Behavior therapists assume that maladaptive behaviors are
learned, just as adaptive behaviors are. Thus, the basic strategy in
behavior therapy involves unlearning maladaptive behaviors and
learning more adaptive behaviors in their place. Behavior therapists
employ techniques that are based on the learning principles of
classical conditioning, operant conditioning, and observational
learning to modify the problem behavior.
CLASSICAL CONDITIONING
• Life is full of interesting associations.
• Do you ever hear songs on the radio or find yourself in places that instantly
make you feel good because they’re connected to special times you’ve had?
• When you smell the aroma of popcorn or freshly baked cookies, does your
mouth water or your stomach growl?
• These examples illustrate a learning process called classical conditioning.
• in which an organism learns to associate two stimuli (e.g., a song and a
pleasant event), such that one stimulus (the song) comes to elicit a
response (feeling happy) that originally was elicited only by the other
stimulus (the pleasant event).
CLASSICAL CONDITIONING.
• An organism learns to
• associate two stimuli (e.g., a song and a pleasant event),
• such that one stimulus (the song) comes to elicit a response (feeling
happy) that originally was elicited only by the other stimulus (the
pleasant event).
Phase 1: Before Conditioning
• The first part of the classical conditioning process requires a naturally
occurring stimulus that will automatically elicit a response.
• Salivating in response to the smell of food is a good example of a
naturally occurring stimulus.
Phase 2: During Conditioning
• During the second phase of the classical conditioning process, the
previously neutral stimulus is repeatedly paired with the
unconditioned stimulus. As a result of this pairing, an association
between the previously neutral stimulus and the UCS is formed.
Phase 3: After Conditioning
• Once the association has been made between the UCS and the CS,
presenting the conditioned stimulus alone will come to evoke a
response even without the unconditioned stimulus. The resulting
response is known as the conditioned response (CR)
• Systematic desensitization usually starts with imagining yourself in a
progression of fearful situations and using relaxation strategies that
compete with anxiety.
• Once you can successfully manage your anxiety while imagining
fearful events, you can use the technique in real-life situations.
• This therapy aims to remove the fear response of a phobia, and
substitute a relaxation response to the conditional stimulus gradually
using counter conditioning.
SYSTEMATIC DESENSITIZATION
• Systematic desensitization, in which a therapist guides the client
through a series of steps meant to reduce fear and anxiety, is
normally used to treat phobic disorders and consists of a three-step
process.
• First, the client must learn to relax through deep muscle relaxation
training.
• Next, the client and the therapist construct a list, beginning with the
object or situation that causes the least fear to the client, eventually
working up to the object or situation that produces the greatest
degree of fear.
Systematic desensitization
• Systematic desensitization falls under the broad category of
exposure techniques in behaviour psychotherapy or
therapy.
• Clients are required to expose themselves to anxiety
arousing images to reduce anxiety gradually / systematically
they become desensitized or less sensitive to the anxiety
arousing situation.
Systematic desensitization
• Systematic desensitization is a
• counterconditioning procedure in which

• a fear response to an object or situation is replaced with a

• relaxation response in a series of progressively increasing fear-

arousing steps.
• SYSTEMATIC DESENSITIZATION
• AVERSION THERAPY
• EXPOSURE THERAPIES
• Systematic desensitization consists of three steps

• Relaxation Training
• Hierarchy construction
• Desensitization of stimulus
• Joseph Wolpe, a pioneer of behavioral therapy, developed a
technique called systematic desensitization for the treatment of
anxiety related disorders and phobias.
• This technique is based on the principles of classical conditioning and
the premise that what has been learned (conditioned) can be
unlearned.
• Ample research shows that systematic desensitization is effective in
reducing anxiety and panic attacks associated with fearful situations.
goal of systematic desensitization
• The goal of systematic desensitization is to become gradually
desensitized to the triggers that are causing your distress.
• •Before beginning systematic desensitization, one need to have
mastered relaxation training and developed a hierarchy (from least
feared to most feared) list of his/her feared situations.
• Before we can begin gradually exposing oneself to the feared
situations, one must first learn and practice some relaxation
techniques.
• Some techniques commonly used in relaxation training include: •
Deep Breathing • Progressive Muscle Relaxation • Visualization
DESENSITIZATION
• How is behavior therapy used to treat phobias, fears, and anxieties?
• Assume that you are a swimming instructor who wants to help a child
named Jamie overcome fear of the high diving board.
• How might you proceed?
• Directly forcing Jamie off the high board could be a psychological disaster.
• Obviously, a better approach would be to begin by teaching her to dive
off the edge of the pool.
• Then she could be taught to dive off the low board, followed by a
platform 6 feet above the water, and then an 8-foot platform. As a last
step, Jamie could try the high board.
Exposure can be done in two ways:

• In vitro – the client imagines exposure to the

phobic stimulus.
• In vivo – the client is actually exposed to the
phobic stimulus.
• Research has found that in vivo techniques are
more successful than in vitro (Menzies & Clarke,
1993)
• Exposure A behavioral treatment for anxiety in which people are
confronted either suddenly or gradually with a stimulus that they fear.
• exposure. Exposure is a behavioral treatment for anxiety in which people
areconfronted either suddenly or gradually with a stimulus that they
fear.
• However,unlike systematic desensitization, relaxation training is omitted.
• Exposure allows the maladaptive response of anxiety or avoidance to
extinguish, and research shows that this approach is generally as
effective as systematic desensitization (Havermans etal., 2007;
Hoffmann, 2007; Bush, 2008).
In-vivo
• The most realistic level of exposure is in vivo exposure,
in which the client makes real-life contact with phobic
object.
• Implosion therapy, or flooding, is an extreme form of
in vivo exposure in which the client experiences
extreme exposure to the phobic object, such as asking a
person who is arachnophobic to hold three hairy
tarantulas at once.ur-ak-nuh-fow-bee-uh.intense fear
of spiders.
• Systematic desensitization involves three levels of exposure to a
phobic object: imagined, virtual, or real. In imagined exposure,
people simply imagine contact with the phobic object.
• The next level is virtual reality exposure.
• At this stage, the individual may be shown photographs or exposed to
a virtual reality computer simulation.
• For instance, one type of virtual reality software allows clients to
simulate flying during treatment for flying phobia, as depicted in
Figure 16.7 (Wiederhold & Wieder hold, 2005).
. Virtual reality
• Recently, virtual reality computer technology has been added to this
arsenal of weapons.
• Virtual reality bridges the gap between imagining feared stimuli in a
therapist’s office and in vivo exposure in the field by simulating a
feared situation.
• Clients wear a head-mounted display with small video monitors and
stereo earphones that integrate visual and auditory cues to immerse
the client in a computer-generated virtual environment.
Virtual -reality
• For example, a person with a fear of flying may be exposed to stimuli
that simulate sitting in a plane with the plane’s engines roaring
beneath him.
• A person with a fear of public speaking may experience simulation of
standing at a podium.
• Therapists can control the images the clients receive while
monitoring the clients’ heart rates, respiration, and skin temperature
so that they can effectively grade the clients’ fear responses during
the sessions (Bender, 2004).
• Rather than using
• mental imaging or actual physical experiences of a fearful situation,
modern systematic desensitization can use the latest in computer
technology—virtual reality headsets and data gloves.
• What kind of “virtual” experiences do you think a therapist might
provide for a client with a fear of spiders?
Evidence of virtual reality
• Evidence suggests that virtual reality technology is an effective
treatment for people who have a fear of heights and of flying (Krijn,
Emmelkamp, Olafsson, & Biemond, 2004; Rothbaum, Hodges, Kooper,
Opdyke, & Williford, 1995; Rothbaum, Hodges, Watson, Kessler, &
Opdyke, 1996; Wiederhold, Jang, Kim, & Wiederhold,2002)
• Preliminary research suggests that virtual reality technology also may
be a use-ful tool in treating driving phobia (Wald & Taylor, 2003),
public speaking (Harris,Kemmerling, & North, 2002), panic disorders
(Botella et al., 2004), and post traumaticstress disorder (Difede &
Hoffman, 2002). However, to date the results of such research are not
conclusive.
Virtual reality
• Virtual reality therapy is similar to systematic desensitization, but the patient is
exposed to computer simula-tions of his fears in a progressively anxiety-
provoking manner.
• Wearing a motion-sensitive display helmet that projects a three- dimensional
virtual world, the patient experiences seemingly real computer-generated images
rather than imagined and actual situations as in systematic desensitization.
• When the patient achieves relaxation,the simulated scene becomes more fearful
until the patientcan relax in the simulated presence of the feared object or
situation.
• Virtual reality therapy has been used success-fully to treat specific phobias, social
phobias, and someother anxiety disorders (Krijn, Emmelkamp, Olafsson,
&Biemond, 2004).
• A team of researchers developed a virtual reality system

• that provided patients with the illusion that they were see-
• ing cockroaches in their surrounding physical environment

• (Botella et al., 2010). For example, the system made it

• possible for patients to see cockroaches crawling on their

• hands. The system also allowed the therapists to manipu-

• late features such as the number, size, and movement of

• the insects. Thus, it provided the flexibility the therapists

• needed to adapt the exposure therapy to suit the needs of
• each individual patient. The six patients in the study were
• systematically exposed to the virtual cockroaches in a single
• session that lasted, on average, just under two hours. After

• that single session of therapy, the patients showed consid-

• erable improvement in their ability, for example, to approach

• cockroaches. In follow-up assessments 3, 6, and 12 months

• after the original treatment, the patients continued to show
• substantial relief from their phobia.
flooding
• Another counterconditioning exposure therapy, flooding, does not
involve such gradual confrontation.
• In flooding, the patient is immediately exposed to the feared objector
situation.
• For example, in the case of the spider phobia,the person would
immediately have to confront live spiders.
• Flooding is often used instead of systematic desensitization when the
fear is so strong that the person is unable to make much progress in
systematic desensitization.
• Flooding. Flooding is a behavior therapy used in the treatment of phobias. It
involves
• exposing clients to the feared object or event (or asking them to imagine it
vividly) for
• an extended period, until their anxiety decreases. The person is exposed to
the fear
• all at once, not gradually as in systematic desensitization. An individual with a
fear
• of heights, for example, might have to go onto the roof of a tall building and
remain
• there until the fear subsided.
• Flooding sessions typically last from 30 minutes to 2 hours and should not be
• terminated until clients are markedly less afraid than they were at the
beginning of
• the session. Additional sessions are required until the fear response is
extinguished

• or reduced to an acceptable level. It is rare for a client to need more than six
treat-
• ment sessions ( Marshall & Segal, 1988 ). In vivo flooding, the real-life
experience,
• works faster and is more effective than simply imagining the feared object. That is,
in
• order for flooding to be effective, the fear-inducing stimulus must sufficiently
intense
• to bring about a physiologically based fear response ( Siegmund et al., 2011 ). Thus,
• a person who fears flying would benefit more from taking an actual plane trip than

• from just thinking about one, because an actual flight is far more likely than an
imag-
• ined one to provoke his body’s fear response.
• Systematic desensitization represents a gradual course
• of exposure to stimuli that provoke anxiety. Therapists have
• explored a variety of other techniques, some of which bring
• about exposure with less delay. For example, in a technique
• known as flooding, clients agree to be put directly into the
• phobic situation. A person with claustrophobia is made to sit
• in a dark closet, and a child with a fear of water is put into a
• pool. Researchers successfully treated a 21-year-old student’s
• phobia of balloon pops by having him experience three sessions
• in which he endured hundreds of balloons being popped
• (Houlihan et al., 1993). In the third session, the student was
• able to pop the last 115 balloons himself. Another form of
• flooding therapy begins with the use of imagination. In this
• procedure, the client may listen to a tape that describes the
• most terrifying version of the phobic fear in great detail for an
• hour or two. Once the terror subsides, the client is then taken
• to the feared situation.