Behaviourism see psychological disorders as the result of maladaptive learning. They do not assume that sets of symptoms reflect single underlying causes.
Behaviourism assumes that all behaviour is learnt from the enviroment and symptoms are acquired through classical and operant conditioning.
Consequently, if a behaviour is learnt, it can also be unlearned. There are two aspects to behaviour therapy.
Functional analysis: the therapist analyses the clients problem in terms of:
1. Which behaviours are actually the problemTreatment: the therapist designs a programme to help the client:2. Which environmental stimuli trigger the behaviour
1. Unlearn the maladaptive responses2. Learn more adaptive behaviours (if appropriate)
Behaviour Therapies
(Therapies based on classical conditioning)Behaviour therapies are based on the theory of classical conditioning. The premise is that all behaviour is learned; faulty learning (i.e. conditioning) is the cause of abnormal behaviour. Therefore the individual has to learn the correct or acceptable behaviour. An important feature of behaviour therapy is its focus on current problems and behaviour, and on attempts to remove behaviour the patient finds troublesome. This contrasts greatly with psychodynamic therapy (re: Freud), where the focus is much more on trying to uncover unresolved conflicts from childhood (i.e. the cause of abnormal behaviour).
The theory of classical conditioning suggests a response is learned and repeated through immediate association. Behaviour therapies based on classical conditioning aim to break the association between stimulus and undesired response (e.g. phobia, additional etc).
Systematic Desensitisation
· Based on the idea of incompatible responses
· Aims to substitute the patient’s anxiety response with a relaxation responseThis therapy aims to remove the fear response of a phobia, and substitute a relaxation response to the conditional stimulus gradually. This is done by forming a hierarchy of fear, involving the conditioned stimulus (e.g. a spider), that are ranked from least fearful to most fearful.
Thus, for example, a spider phobic might regard one small, stationary spider 5 metres away as only modestly threatening, but a large, rapidly moving spider 1 metre away as highly threatening. The client reaches a state of deep relaxation, and is then asked to imagine (or is confronted by) the least threatening situation in the anxiety hierarchy. The client repeatedly imagines (or is confronted by) this situation until it fails to evoke any anxiety at all, indicating that the therapy has been successful. This process is repeated while working through all of the situations in the anxiety hierarchy until the most anxiety-provoking.
The patient is also given training in relaxation techniques. However, studies have shown that neither relaxation nor hierarchies are necessary, and that the important factor is just exposure to the feared object or situation.
Functional Analysis
· The therapist and patient construct a hierarchy of fears.
· A number of phobic situations are described
· The client ranks them in order of fearfulness
· The therapist and client agree of the goals of therapy
Desensitisation Therapy
· The client is taught a number of relaxation techniques
· E.g. control over breathing, muscle detensioning
· The client is gradually exposed to the phobic stimulus
· Intensity follows the hierarchy of fears
· During exposure, the client applies their relaxation techniques
· Once relaxation is possible, the intensity of the phobic stimulus is increased
The number of sessions required depends on the severity of the phobia. Usually 4-6 sessions, up to 12 for a severe phobia. The therapy is complete once the agreed therapeutic goals are met (not necessarily when the person’s fears have been completely removed).
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
Appropriateness of Systematic Desensitisation
Effectiveness of Systematic Desensitisation
Summary
· SD is highly effective where the problem is learned anxiety of specific objects/situations.
· Functional analysis must be done carefully to avoid overexposing the client and making matters worse.
· SD could help treating some of the additional problems that may accompany anorexia and schizophrenia.
· However, it will not be effective in treating the underlying causes of these disorders.
Aversion Therapy
Aversion therapy is used when there are stimulus situations and associated behaviour patterns that are attractive to the client, but which the therapist and the client both regard as undesirable. For example, alcoholics enjoy going to pubs and consuming large amounts of alcohol Aversion therapy involves associating such stimuli and behaviour with a very unpleasant unconditioned stimulus, such as an electric shock. The client thus learns to associate the undesirable behaviour with the electric shock, and a link is formed between the undesirable behaviour and the reflex response to an electric shock.
In the case of alcoholism, what is often done is to require the client to take a sip of alcohol while under the effect of a nausea-inducing drug. Sipping the drink is followed almost at once by vomiting. In future the smell of alcohol produces a memory of vomiting and should stop the patient wanting a drink.
Apart from ethical considerations, there are two other issues relating to the use of aversion therapy. First, it is not very clear how the shocks or drugs have their effects. It may be that they make the previously attractive stimulus (e.g. sight/smell/taste of alcohol) aversive, or it may be that they inhibit (i.e. reduce) the behaviour of drinking. Second, there are doubts about the long-term effectiveness of aversion therapy. It can have dramatic effects in the therapist’s office. However, it is often much less effective in the outside world, where no nausea-inducing drug has been taken and it is obvious that no shocks will be given.
Also, relapse rates are very high – the success of the therapy depends of whether the patient can avoid the stimulus they have been conditioned against. Aversion therapy also has many ethical problems.
Implosion Therapy and Flooding
In implosion therapy the subject is asked to imagine the worst possible situation involving the phobia. Whereas in flooding the worse possible situation is actually physically and continuously presented. For example, the client could be put in a room full of spiders. The client is initially flooded or overwhelmed by fear and anxiety. However, the fear typically starts to subside after some time. If the client can be persuaded to remain in the situation for long enough, there is often a marked reduction in fear.
Why is flooding or exposure effective? It teaches the patient that there is no objective basis to his or her fears (e.g., the spiders do not actually cause any bodily harm). In everyday life, the phobic person would avoid those stimuli relevant to the phobia, and so would have no chance to learn this.
Flooding and implosive therapy are considered to be the most successful at treating phobias. They are also cheap (in terms of time and money) to administer, but involve ethical problems of suffering from the therapy. Therefore, this type of therapy would not be suitable for someone with a bad heart or who suffered from nerves etc.
Behaviour Modification
Behaviour modification is a set of therapies / techniques based on operant conditioning, i.e. the reinforcement of desired behaviours and ignoring or punishing undesired ones. This is not as simple as it sounds — always reinforcing desired behaviour, for example, is basically bribery. The "schedule" of reinforcement is critical. Behaviour modification is much used in clinical and educational psychology, particularly with people with learning difficulties. In the conventional learning situation it applies largely to issues of class- and student management, rather than to learning content. It is very relevant to shaping skill performance, however. It applies at the micro-level: student feedback of high marks for good work is only behaviour modification in the broadest and weakest sense, whereas attention and praise at the second-by-second level are much more likely to follow its principles.
Therapy cannot be effective unless the behaviors to be changed are understood within a specific context. Therefore, a functional assessment is needed before performing behavior modification. One of the most simple yet effective methods of functional assessment is called the "ABC" approach, where observations are made on Antecedents, Behaviours, and Consequences. In other words, "What comes directly before the behavior?", "What does the behavior look like?", and "What comes directly after the behavior?" Once enough observations are made, the data are analyzed and patterns are identified. If there are consistent antecedents and/or consequences, then an intervention should target them in order to increase or decrease the target behavior.
A simple way of giving positive reinforcement in behavior modification is in providing compliments, approval, encouragement, and affirmation; a ratio of five compliments for every one complaint is generally seen as being the most effective in altering behavior in a desired manner.
Behavior Modification in the Classroom
Behaviour Shaping
This technique works by positively reinforcing successive approximation to the desired behaviour step by step. This has found to be an effective technique to needs to be maintained for the person to continue their behaviour.
Application
(For example, this can be used to improve the communication skills of an autistic child.)
• The therapist first identifies an activity which the child enjoys, such as playing with a special toy.
• Every time the child looks at the therapist she gives him the toy to play with.
• Eventually the child looks at the therapist in anticipation of the toy but she withholds it until the child reaches for the toy.
• Every time he reaches for the toy, he is given it as the therapist says “please”.
• When reaching has become established, the toy is withheld until the child himself makes a sound as he reaches, he is then given the toy.
• This continues, reinforcing behaviour and then withholding reinforcement until a more specific behaviour has become established.
Token Economy
· A type of behaviour modification therapy
· Only carried out in institutional settings (e.g. hospitals, schools)
· Based on the use of reinforcement to promote specific behaviours
· May involve punishment to extinguish unwanted behaviours
The principle here is that desired behaviour is rewarded with tokens which can easily be exchanged form something the individual wants. Tokens act as secondary reinforcers, and many studies have shown that both animals and humans will emit behaviours for tokens that are exchangeable for primary reinforcers (e.g. food) at a later time. This has been found to be very effective in managing psychiatric patients. However, the patients can become over reliant on the tokens, making it difficult for them once they leave prisons, hospital etc.
Functional Analysis
The management of the institution decides:
1. Which specific behaviours they wish to promote
2. Which (if any) specific behaviours they wish to extinguish
Therapy
· Institution staff closely monitor patients’ behaviour.
· When a patient displays desired behaviour, they receive a token.
· Different numbers of tokens can be exchanged for reinforcers.
· Staff may take away tokens if they wish to punish certain behaviours.
Tokens act as secondary reinforcers. They have no intrinsic value, but they can be used to obtain things that do (primary reinforcers). Primary reinforcers in a token economy could include:
· Sweets and drinks
· Cigarettes
· Access to television
· Trips out
· Increased freedom within the institution
Appropriateness of Token Economies
· Token economies do not cure people of psychological disorders
· However, they may reduce some behavioural problems that may accompany psychological disorders
· E.g. aggression, inappropriate social interaction
· They are particularly good for tackling ‘institutionalisation’
· People in long-stay care may lose their motivation for everyday self-care behaviour (e.g. dressing, washing)
· Token economy can help to restore these behaviours.
Effectiveness of Token Economies
Ethical Issues with Token Economies
Possible problems:
· Dehumanising – treats people like automata/circus animals.
· Makes clients dependent, not independent.
· Requires patients to be deprived of basic rights.
· Therapeutic goals not set by client.
· Possibly done for the benefit of the institution, not the patients.
Summary
· Most token economies bring about increases in targeted behaviours.
· Improvements may not last after release due to lack of reinforcement.
· Improvements last longer when reinforcement is gradually withdrawn before the patient is discharged.
· It is not clear whether improvements occur due to reinforcement or for other reasons.
· Alternative explanations include better organisation of wards and increased positive interaction with staff.
Home