Behavioral therapy - effective relief from phobias, addictions and mental disorders

Many people have a stereotype that the goal of any psychologist is to reveal the insides of the soul, get to the bottom of problems, find out the root causes of suffering that goes back to childhood, and work with them. In fact, this is far from the case. For example, one of the directions - behaviorism - studies primarily behavior. In their opinion, the most important things are reflexes, acquired skills, reactions to external stimuli and motivation. This is what determines the essence of a person’s mental organization. Based on this concept, behavioral psychotherapy was created and successfully applied in practice.

What it is

Behavioral psychotherapy is one of the most effective and popular areas in psychology and psychotherapy. Considers some mental illnesses as a consequence of incorrectly formed skills during life.

The scientific basis for it was behaviorism, so its alternative names are behavioral-behavioral therapy or simply behavioral therapy. It is considered one of the newest methods, although in fact it has been used for a long time: its features can be seen in the combination-reflex therapy of Bekhterev, the practical application of Pavlov’s conditioned and unconditioned reflexes, the systematic desensitization of M. K. Jones - all this was actively introduced already in the 20s gg. XX century. Even the term itself was born in 1911 (it was first used by Thorndike in his writings).

The goal of behavioral therapy is to eliminate incorrect behavior strategies and instill useful skills in the patient. Typically, treatment follows a well-established scheme:

Behavior analysis → Identification of an incorrectly formed way of activity → Step-by-step correction by instilling a new skill → Practicing, training → Checking how successfully it can be applied in real life

Everyone is so accustomed to the fact that the root of any evil (be it physical or mental illness) lies in the causes and without eliminating them, recovery is impossible, that the behavioral direction in psychotherapy at first was often criticized and even ridiculed. However, soon his opponents and ill-wishers were defeated, since this method has no equal when working with phobias, eating disorders, autism and alcohol addiction. Patients are completely freed from them. Other concepts cannot boast of such results.

Through the pages of history. Despite the fact that behavioral psychotherapy took shape as an independent direction only in the 50s of the 20th century, its methods have been used in the USSR since the 20s. In the Soviet scientific literature of those times it was referred to as “conditioned reflex psychotherapy.”

Operant conditioning theory (conditioned operations)

In operant conditioning, behavior is determined not only by antecedent stimuli, but also by the various outcomes that accompany it.

The foundations of operant conditioning were laid by the behaviorist B.F. Skinner, who also tried to apply them to complex forms of behavior.

Operant conditioning takes into account the consequences of actions. This raises a fundamental question: how can behavior be influenced by its outcome?

The first answer is that a person or animal understands what their behavior can lead to and acts based on their values. That is, there is a direct connection between the result and behavior.

However, this concept is completely opposed to the position of behaviorism, which holds that any assumptions about internal states of mind, values, or intentions are unscientific.

The second option is that the result influences behavior, but indirectly. To know how, you just need to describe the external conditions that cause the behavior and the consequences associated with it.

It is this answer that Skinner takes as the basis for his research.

Differences between conditional response and conditional operation

There are two main points that clarify the difference between conditioning and operant conditioning:

• When conditioned by an external stimulus, the behavior of animals or people is not accompanied by specific consequences for the environment.

• In operant conditioning, the behavior of humans or animals has an effect on the environment that determines whether the behavior will be repeated.

In a conditioned response, behavior is associated with reflexes: it represents a reaction to a specific stimulus. In operant conditioning, responses to stimuli are viewed not as reflexes, but as complex behavior.

Operant conditioning in education

Having laid the foundations of operant conditioning, behaviorist B.F. Skinner began using them in education and therapy in the 1960s.

According to Skinner, the goal of any learning is to create new forms of behavior in the student. Thus, teaching is nothing more than creating the conditions in which students find themselves. This principle is called “ programmed learning ”.

Programmed instruction requires setting an educational goal (desired behavior) and defining steps to follow (pedagogical development) to achieve it.

Skinner advocated an education system that met the following criteria:

• Continuous interaction between the student and the taught discipline;
• Teaching only that part of the discipline that is closest to the student’s current capabilities;
• Training must correspond to the student’s capabilities and must necessarily lead to an increase in knowledge;
• The student must be actively interested in the discipline and see his results in its study;
• The possibility of errors in training should be minimized.

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To strictly adhere to these criteria, Skinner developed a "teaching machine", which in some ways is the ancestor of educational software used today.

However, Skinner's enthusiasm for creating a new educational system met cultural resistance, and his program was challenged.

Operant conditioning in therapy

In addition to the educational sphere, B.F. Skinner developed conditioning programs in the field of therapy.

Before Skinner, behavior therapy was based on classical decontamination procedures developed from the work of Pavlov.

Skinner proposed replacing these procedures with therapeutic methods based on operant conditioning. It is about replacing unwanted behavior with desirable behavior through the intervention of a therapist.

Modification of unwanted behavior can also be carried out by the patient himself. This type of behavior therapy requires good self-control. It involves teaching the patient to control the stimuli associated with the problem behavior.

Basic principles

The principles on which behavioral therapy works are constantly being updated and improved.

Patterns play a major role in disease

These are the very skills and patterns of behavior that are formed throughout a person’s life. They are the source and essence of a mental disorder, play a decisive role in its development and even cause reactions from the endocrine and autonomic systems.

Treatment methods are only proven

In behavioral psychotherapy, only those treatment methods are used that have been tested more than once in laboratory conditions and bring only positive results. No experiments on patients.

"Here and now"

As in Gestalt therapy, behavioral therapy does not use hypnosis with the goal of looking into childhood and finding there the psychological trauma that becomes the cause of all troubles in the present. The work is aimed at what is bothering a person at the moment and how to cope with this problem “here and now.”

Minimal Intrusion

The specialist does not meticulously delve into the soul, does not ask to bring out hidden thoughts and desires, does not look into the corners of the past. Maximum patient comfort and respect for his personal boundaries are one of the main principles of this direction.

Everything is relative

An alcoholic for society is a patient who requires long-term and compulsory treatment. For a psychotherapist working in the behavioral direction, this is the same person as everyone else, but he has formed an incorrect attitude towards alcohol, which can be corrected.

The opposite situation. Most members of society live the rest of their days with phobias and do not find it necessary to get rid of them (unless they take a pathological form). Nobody considers them sick. And in behavioral psychotherapy these are the main patients. So here they emphasize the relativity of such concepts as “norm-deviation” and “health-illness”.

Psychotherapist - dominant

When you come to see a psychotherapist, you don’t need to try to explain your experiences and formulate the problem. The “speaking out” technique is practically not used here. The main tool is dialogue, and the leading role in it is played by the specialist. He asks questions according to a certain pattern, and after making a diagnosis he gives tasks and exercises. So, if you want to cry into your vest, this is definitely not the place.

Using outside help

This cannot be called family psychotherapy, since it does not work with common problems. Sometimes people close to the patient can be invited to classes, but only for the purpose of helping him consolidate (or, conversely, “unfasten”) a skill.

What is the essence of cognitive behavioral therapy?

The essence of CBT cannot be understood without its basic concepts, among which the most important are: • Schemas, which are deep mental attitudes responsible for a person’s attitude towards himself and the realities of life. They can be adaptive and non-adaptive (the whole world is a mess, and there is no point in trying to figure it out), positive and negative, idiosyncratic (individual) or universal. • Automatic thoughts are conclusions that form in the mind so quickly that they do not have time to be fully comprehended, but they manage to influence emotions, the adoption of one decision or another, and the behavioral response of the individual. Usually these are frequently repeated thoughts when communicating with people around you - parents, children, bosses, friends and colleagues. After automation, the brain gets used to not thinking about thoughts, but simply “retrieving” them from memory along with the emotions and action patterns they previously evoked. If the experience of an automatic thought has brought positive results, then it can be useful in making a quick decision, but if the automatic thought was initially incorrect, then following it can only do harm. That is why identifying such thoughts, extracting them from the subconscious and convincing counterargumentation makes it possible to rewrite erroneous mental attitudes and accordingly change behavior patterns. • Cognitive errors, or otherwise distorted thought patterns that incorrectly reflect existing reality. • Arbitrary conclusions are conclusions made without confirmation by facts or in the presence of facts that contradict this conclusion. • Overgeneralization. Occurs when comprehensive conclusions are drawn from a single episode. • Exaggeration and understatement of one's role and the significance of ongoing events. By exaggerating the complexity of the situation, the individual underestimates his capabilities in resolving it. • Personalization - observed when the patient considers certain external events as relevant to him, when in fact they do not concern him at all. • Maximalism - putting forward excessive demands on oneself or the world around us in the form of opposing attitudes. For example, “if I don’t make a million, then I’m a complete insignificance,” “if I don’t become famous, then this life will be a swamp,” etc. • Obligation is an overdeveloped sense of duty and responsibility, often imposed from the outside and not allowing for alternative behavior. It can seriously poison a person’s life and prevent him from self-realization. The psychotherapist faces the difficult task of determining the predominant motive that led to mental disorder and irrational behavior, especially since there may be several of them. The doctor should find out all this and develop a treatment plan already in the first sessions, and the patient’s task is to help him with this. First of all, when preparing for the visit, it is advisable for the patient to think through and formulate the final goals of treatment in advance, i.e. what he would like to achieve and/or get rid of.

Indications

Behavioral psychotherapy does not treat all mental disorders, but only those that are based on a clear and persistent violation of acquired skills and incorrectly developed methods of action. Indications for contacting such a specialist:

• panic attacks;
• phobias;
• obsessive-compulsive disorder;
• depression, dysthymia, bipolar affective disorder, cyclothymia, manic syndrome;
• eating disorders: bulimia, anorexia, psychogenic overeating, allotriophagia;
• sexual psychogenic problems based on psychopathy, endogenous psychoses and character accentuations;
• schizophrenia;
• antisocial, deviant behavior;
• insomnia, nightmares;
• hyperactivity;
• autism;
• poor performance at school, speech therapy problems in children.

As practice shows, therapy is effective in the treatment of many physiological diseases: hypertension, migraine, bronchial asthma, stomach problems.

Contraindications

Behavioral psychotherapy is contraindicated in some cases. This applies to those patients who have a persistent impairment of consciousness if they cannot understand what is required of them. This entails the inability to perform exercises and tasks aimed at treatment.

Absolute contraindications:

• worsened psychoses;
• prolonged depression in severe form;
• deep UO.

Relative contraindications:

• personality disorders - a course of treatment will be effective only if the psychotherapist manages to establish trusting contact with the patient;
• mild form of mental retardation - treatment is possible, but only with the selection of simple tasks and exercises that the patient can cope with.

Each specific case of contacting a psychotherapist is considered individually.

Human conditioning

After studying Pavlov's work, J. B. Watson concluded that studies of animal conditioning provided the key to the study of human behavior.

Watson's idea, as well as all behavioral psychology, is that conditioned reflexes are the basis of human behavior in all life situations.

Examples of human conditioning

To confirm his hypothesis, Watson, together with R. Rayner, conducted one of the most unethical experiments in the history of psychology in 1920 (details here). Researchers tried to instill a fear of rats in an 11-month-old baby named Albert.

They did research: before the experiment, Albert was a fairly calm child. Early on, Watson and Rayner gave him a white rat to play with. Albert looked delighted and showed no fear.

After making sure that little Albert was not afraid of rats, the researchers began making loud noises every time they gave a rat to the child. The surprised Albert began to cry at such moments.

Then Albert began to cry and tremble even at the sight of the rat. Thus, the rat, which was a neutral stimulus, became a conditioned fear stimulus.

Additionally, the fear of the white rat has spread to other furry and white objects such as white rabbits, Santa's beard, cotton, etc.

Methods

Imitative (observational, vicarious) learning through observation (modeled)

Basis: A. Bandura's theory of social learning.

Essence: The patient is taught a new skill through the process of imitating another person (a psychotherapist, a movie or book character).

Example: Diagnosis - Aichmophobia. During the sessions, the specialist gradually accustoms the person to the idea that nothing bad will happen to him if he uses a needle, knife, fork, razor, or nails in everyday life, demonstrating his skillful use of them.

Basic techniques: self-modeling (replaying successful moments in the patient’s behavior), prompting (encouragement), fading (reducing rewards as the desired form of behavior is consolidated).

Role-playing training (role play)

Basis: imagotherapy, play therapy.

Essence: Playing out a problematic situation for the patient. Moreover, he can play himself, or a psychotherapist can take on his role so that he can see how his behavior looks from the outside.

Example: Diagnosis - alcohol addiction. A romantic dinner situation is being played out. First, the therapist demonstrates the incorrect (true) behavior of his client, how he gets drunk and ruins the date. Then it shows the successful outcome of the event - if you abstain from alcohol. The patient himself participates in the third act.

Basic techniques: group training, confrontation, systematic desensitization.

Biofeedback (BFB procedure)

Basis: theories of conditioned reflexes of Sechenov and Pavlov, cortico-visceral connections of Bykov, functional systems of Anokhin, stable pathological conditions of Bekhterev.

Essence: Equipment is connected to the patient, with the help of which his physical condition is monitored. Along the way, a session is carried out with exercises and tasks. For every successful decision there is a “reward” in the form of relaxing and pleasant sensations that are created by the same equipment.

Example: Diagnosis - depression. The devices record high blood pressure, rapid heartbeat, heavy breathing, hand tremors and other reactions from the autonomic system. The psychotherapist gives the patient the task of relaxation and peace, liberation from heavy, obsessive thoughts. As soon as he succeeds, he hears pleasant music, sees a beautiful clip on the computer monitor, and is treated to something tasty.

Basic technique: physiological mirror.

These are the main treatment methods used in behavioral psychotherapy. Other techniques may also be used:

• aversive therapy (weaning off addictions);
• systematic desensitization (reducing sensitivity to what causes anxiety and phobias);
• implosion therapy (reintegration of suppressed emotions through immersion in traumatic memories);
• shaping (a multi-step process, practicing a new skill through positive and negative reinforcements);
• method of auto-instructions / self-instruction training (use of inner speech to regulate behavior);
• stress vaccination therapy / stress vaccination / stress vaccination training (learning self-control techniques to help cope with traumatic and stressful situations);
• applied behavior analysis;
• “thought stopping” method.

Treatment methods are selected depending on the diagnosis.

Practical exercise

And now we would like to invite you to translate this information into a more practical plane and answer the following questions:

• Do you have conditioned fears and anxieties that you would like to unlearn?
• How might you apply relaxation (through Jacobson's progressive muscle relaxation, auto-training, or breathing exercises) to one of these situations?
• How else could you put yourself in a calm, confident, resourceful state before an interaction that creates fears or anxiety in you, and perceive and respond differently to what is happening?

Of course, it is not always possible to do a set of breathing exercises or relaxation according to Jacobson in real life, but it is worth thinking about how else you can neutralize fear with a state that replaces it. Perhaps you just need to remember a funny story from your life, be imbued with joy and fun, and in this mood approach your boss with a request or start talking to a beautiful stranger?

Can you think of ways to “reward” yourself with something pleasant and joyful that will be an effective “carrot” and a source of confidence, calmness, and inner strength? So, before an important and responsible event, you can, for example, call your loved one and ask him for support, listen to your favorite song, remember your victories and successes, or imagine how you are filled with the energy of confidence, strength and calmness descending from above. It is best to individually choose your own effective method, and with the “right” mood, take on what worries, frightens or stresses you.

Such techniques and life hacks are quite well-known and popular; they can be found in many books, seminars and programs for developing self-confidence and personal growth. We also have a large number of useful articles on our website with similar practical recommendations, for example, “Body language for self-confidence” or “Powerful ways to increase self-confidence.” We also have practical online training “Mental Self-Regulation”, which purposefully helps you master practical techniques for correcting your psycho-emotional state. Here you can find various methods of psychoregulation and emotion management that allow you to bring yourself into balance and better cope with the stresses of life.

Treatment

Despite the variety of methods, treatment in behavioral psychotherapy is carried out primarily according to one scheme:

Behavioral therapy is often used for children who are struggling in school. For example, the shaping method for speech therapy correction, when the main task is divided into a small chain of correct behavioral acts:

Repeat the syllable after the teacher → Read it correctly yourself → Read the whole word correctly → Read an unfamiliar word correctly → Read the whole phrase correctly

At each stage, a method of systematic desensitization is used.

Behavioral therapy is incredibly effective for autistic people. She breaks down all the skills that are difficult for them into separate blocks: speech, contact, play, listening and looking into the eyes. Each of these actions is mastered gradually.

An example of one of the very first exercises in behavioral psychotherapy for autism, “Language - Understanding”:

1. Assignment: Raise your hand when asked.
2. Hint: the specialist himself takes the child by the hand and raises it, pronouncing the task.
3. Stimulus: encouragement in the form of praise or sweets.
4. Independent completion of the task.

Autistic children perform this exercise only 5 or even 10 times.

Directions

Behavioral psychotherapy is evolving and has several branches.

Dialectical-behavioral psychotherapy

In 1987, the American psychologist M. Linehan gave birth to a new direction, which was called dialectical behavioral psychotherapy.

The goal is to treat borderline personality disorders.

Results:

• the risk of an emotional reaction to traumatic situations is reduced;
• the risk of suicide, aggression, and deviant behavior is reduced.

Dialectical psychotherapy received this name because the patient begins to realize that even the most hopeless situation has several ways of successful resolution. During the course of treatment, he learns to be calm, weigh the pros and cons, and choose the best outcome.

This is the eclectic movement of the “third wave”. Methods used: problem analysis, involvement in action, effective communication, non-judgment, meditative techniques, self-soothing, etc.