The purpose of this paper is to define behavior therapy and examine some of the effective strategies used. Two empirical studies will be discussed that support behavior therapy. Behavior therapy includes many different techniques and skills that focus on overt behaviors. Some therapists have included cognitive, or covert behaviors into their treatment to provide more inclusive approach to changing a person’s thinking and physical behaviors. Behavior therapy is based on three models: operant conditioning, classical conditioning, and modeling.
Ivan Pavlov’s popular classical conditioning experiment with salivating dogs and later Hobart and Wilie Mowrer treatment for childhood bedwetting influenced the behavior therapy principles. Mowrer’s treatment used a special pad that was put under the bed sheet and when a small amount of urine contacted the pad, a bell rang and awoke the child. B. F. Skinner introduced the operant conditioning principles with his experiments with rats that were placed in a box with a lever that immediately drop a food pellet when the rats pushed the lever.
Operant conditioning is increasing or decreasing a behavior by changing the consequences. Skinner’s principles were applied to therapy in humans using rewards to encourage desirable behaviors and using punishment to extinguish less desirable behaviors. Classical and operant conditioning emphasize a person’s actions and behaviors that can be observed. Modeling techniques, such as role-playing and assertiveness training are based on the works of Albert Bandura’s observational learning theory. A core belief in behavior therapy is that people behave the way they do because of external stimuli.
Individuals often respond in predictable ways to certain stimuli or life events. Behavior that is rewarding or reinforcing will be repeated and the individual will learn from experience. Many other techniques including systematic desensitization, which reduces the fear response by incorporating relaxation exercises and the use of imagery also help the client manage anxious events or memories. Behavior therapy focuses on changing current behavior, goal setting, and self- management skills. Behavior therapy is an action therapy, unlike verbal therapies such as client-centered and psychoanalysis.
Homework assignments are often part of therapy that may include rehearsing coping skills, recording behaviors, or identifying trigger behaviors. Four common characteristics of behavior therapy defined by Spiegler are: individualized therapy, stepwise progression, treatment packages, and brevity . Treatment is tailored to each client’s personal issues, progresses from simple to more complex tasks, often combines more than one behavioral therapy procedure, and is relatively short in duration (Spiegler, 2010).
It is essential for counselors to build a strong therapeutic relationship with the client, this enables the counselor to establish trust and he is able to identify the behaviors the client wishes to change. The counselor can then establish goals for the client and determine which techniques would apply best to the client’s situation. One technique that will be discussed in detail is Stress Inoculation Training (SIT). This therapy combines behavioral and cognitive techniques to prepare the client in advance to handle stressful events.
Stress inoculation has three phases: the initial conceptualization phase, skills acquisition and rehearsal phase, and application and follow through phase. First the client is educated about the source of stress and how it may be effecting their physiological and psychological wellbeing. Coping skills such as relaxation techniques are discussed. Lastly, clients are exposed to real or simulated situations to practice the learned coping skills. Stress Inoculation Training has been used in the treatment of military combat, medical illness, PTSD, preparation for surgery, and occupational stress.
In Stress Inoculation Training, the therapist helps the client identify cues for their anxiety and fear. Clients are also taught breathing and relaxation skills to help them manage their anxiety. By combining behavioral techniques with cognitive techniques, therapists are able to provide a more comprehensive treatment plan. A study of 60 male athletes who were undergoing arthroscopic knee surgery were randomly assigned to either treatment (SIT and physical therapy) or control conditions (physical therapy only).
Participants in the treatment group completed a pain scale assessment rating their current pain level and an anxiety inventory questionnaire that they filled out using a rating scale prior to surgery. Stress Inoculation procedures included providing participants with an understanding of their cognitive and emotional responses to surgery, becoming aware and monitoring indicators of pain, and applying relaxation techniques. Participants were also taught positive coping statements. Participants were instructed to rehearse these strategies several times a day and use them when they recognized discomfort.
Results showed that participants had reduced self-reported anxiety and pain during the rehabilitation process. The findings also indicated stress inoculation training reduced the amount of time to return athletes to a criterion level of physical functioning (Ross & Berger, 1996). Another study assigned forty multiple sclerosis patients in either a stress inoculation training group (SIT) or in their current available care group. The SIT treatment included cognitive-behavioral psychotherapy paired with relaxation exercises.
The SIT group participated in six sessions that included daily self-monitoring of stressors, feedback to enhance self-monitoring, identifying stress cues, and relaxation imagery. The current available care group was provided with their usual clinic services. Results showed that the SIT group was less depressed, anxious, and distressed than the available care group. Coping was facilitated by developing increased ability to control psychological symptoms and by altering the process that was generally used to cope.
Patients utilized more problem-focused coping strategies. In the previous studies SIT has been shown to help clients gain confidence in their ability to cope with anxiety, fear, and pain. The main goal of behavior therapy is to replace undesirable behaviors with desirable ones. The success of behavior therapy lies in the individual. In order to successfully deal with emotional distress, one must first realize that certain behaviors can be controlled.
Perception has a great deal to do with the way that one feels and acts which can effect one’s interpretation and behaviors. Many times behavior therapy is paired with cognitive therapy to change the way a person feels about and reacts to a situation. This combination helps a person gain a better understanding of the relationship between their thoughts, feelings, and actions. A key principle in behavior therapy is to be aware of your negative thinking (cognitive) and to not allow those thoughts to control your plans or actions.
By using a behavioral-cognitive plan, clients will receive a more inclusive treatment experience. Cognitive behavioral therapy, in the form of stress inoculation training, is successful in reducing stress. Clinical studies have shown that even brief treatments of six sessions reduce anxiety, fear, and pain. Clients are taught to identify their emotions, thoughts, and behaviors, build skills to cope with those reactions, and apply those skills to their daily situations. Stress inoculation training continues to be used to treat mental disorders and disease.