Behavior Therapies

What is Behaviour Therapy?

Why do people behave as they do? Why do some people behave in socially approved ways and others in a manner condemned or despised by society? Is it possible to predict what people are likely to do? What can be done to change behaviour that is harmful to an individual or destructive to the society? There are good reasons for continuing to investigate human behaviour and Behaviour Therapy is associated with the information of development of certain behaviours in human beings which may help parents and teachers find the best way of child-rearing or teaching.

Behaviour Therapy refers to the techniques used to try and decrease or increase a particular type of behaviour or reaction. This might sound very technical, but it’s used very frequently by all of us. Parents use this to teach their children right from wrong. Therapists use it to promote healthy behaviours in their clients. Animal trainers use it to develop obedience between a pet and its owner. We even use it in our relationships with friends and significant other. Our responses to them teach them what we like and what we don’t. Behaviour Therapy seeks to identify and help change potentially self-destructive or unhealthy behaviours. It functions on the idea that all behaviours are learned and that unhealthy behaviours can be changed. The focus of therapy is often on current problems and how to change them.

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What does Behaviour Therapy involve?

The behavioural explanation states that human behaviour both adaptive and maladaptive, is learned. Learning occurs as a result of the consequences of behaviour. To put it very simply, behaviour that is followed by pleasant consequences tends to be repeated and thus learned. Behaviour that is followed by unpleasant consequences tends not to be repeated and thus not learned.

Behaviour Therapy largely relies on the concept of conditioning. There are two major types of conditioning; Classical, Respondent or Pavlovian conditioning and Operant or Instrumental conditioning.

CLASSICAL CONDITIONING

Ivan Pavlov was a Russian scientist whose work with dogs has been influential in understanding how learning occurs. Through his research, he established the theory of classical conditioning. The best-known of Pavlov’s experiments involves the study of the salivation of dogs. Pavlov was originally studying the saliva of dogs as it related to digestion, but as he conducted his research, he noticed that the dogs would begin to salivate every time he entered the room, even if he had no food. The dogs were associating his entrance into the room with being fed. This led Pavlov to design a series of experiments in which he used various sound objects, such as a buzzer, to condition the salivation response in dogs. He started by sounding a buzzer each time food was given to the dogs and found that the dogs would start salivating immediately after hearing the buzzer—even before seeing the food. After a period of time, Pavlov began sounding the buzzer without giving any food at all and found that the dogs continued to salivate at the sound of the buzzer even in the absence of food. They had learned to associate the sound of the buzzer with being fed.

Pavlov had successfully associated an unconditioned response (natural salivation in response to food) with a conditioned stimulus (a buzzer), eventually creating a conditioned response (salivation in response to a buzzer). With these results, Pavlov established his theory of classical conditioning. Before conditioning, an unconditioned stimulus (food) produces an unconditioned response (salivation), and a neutral stimulus (bell) does not have an effect. During conditioning, the unconditioned stimulus (food) is presented repeatedly just after the presentation of the neutral stimulus (bell). After conditioning, the neutral stimulus alone produces a conditioned response (salivation), thus becoming a conditioned stimulus.

Neurological Response to Conditioning

Consider how the conditioned response occurs in the brain. When a dog sees food, the visual and olfactory stimuli send information to the brain through their respective neural pathways, ultimately activating the salivation glands to secrete saliva. This reaction is a natural biological process as saliva aids in the digestion of food. When a dog hears a buzzer and at the same time sees food, the auditory stimulus activates the associated neural pathways. However, because these pathways are being activated at the same time as the other neural pathways, there are weak synapse reactions that occur between the auditory stimulus and the behavioural response. Over time, these synapses are strengthened so that it only takes the sound of a buzzer (or a bell) to activate the pathway leading to salivation. (See Neuroplasticity)

According to Ivan Pavlov, conditioning does not involve the acquisition of any new behaviour, but rather the tendency to respond in old ways to new stimuli. Pavlov’s research further led to the development of important behaviour-therapy techniques, such as flooding, desensitizing, extinction and spontaneous recovery, for individuals who struggle with fear and anxiety.

Desensitizing is a kind of reverse conditioning in which an individual is repeatedly exposed to the thing that is causing the anxiety.

Flooding is similar in that it exposes an individual to the thing causing the anxiety, but it does so in a more intense and prolonged way.

Extinction is the decrease in the conditioned response when the unconditioned stimulus is no longer presented with the conditioned stimulus. When presented with the conditioned stimulus alone, the individual would show a weaker and weaker response, and finally no response.

Spontaneous recovery refers to the return of a previously extinguished conditioned response following a rest period. Research has found that with repeated extinction/recovery cycles, the conditioned response tends to be less intense with each period of recovery.

Stimulus generalization is said to occur if, after a particular conditioned stimulus has come to elicit a conditioned response, another similar stimulus will elicit the same conditioned response. Usually the more similar are the conditioned stimulus (bell) and the test stimulus (cat bell) the stronger is the conditioned response to the test stimulus. The more the test stimulus (cat bell) differs from the conditioned stimulus (bell) the weaker the conditioned response will be or the more it will differ from that previously observed.

Stimulus discrimination can be observed when one stimulus elicits one conditioned response and another stimulus elicits either another conditioned response or no response at all thus being able to differentiate between the two stimuli.

OPERANT CONDITIONING

Burrhus Frederic Skinner, commonly known as B. F. Skinner, was an American psychologist, behaviourist, author, inventor, and social philosopher. Skinner considered free will an illusion and human action dependent on consequences of previous actions. If the consequences are bad, there is a high chance the action will not be repeated; if the consequences are good, the actions that led to it being repeated become more probable. Skinner called this the principle of reinforcement and its use to strengthen behaviour operant conditioning.

Positive reinforcement: is pairing a positive stimulus to a behaviour. A good example of this is when teachers reward their students for getting a good grade with stickers.

Negative reinforcement: is the opposite and is the pairing of a behaviour to the removal of a negative stimulus. A child that throws learns to stop a tantrum and communicate his needs because he or she doesn’t want to deal with the consequence of a time-out.

Positive punishment: (also referred to as punishment by contingent stimulation) This occurs when a behaviour (response) is followed by an aversive stimulus, such as pain from burning your finger from a candle flame, which results in a decrease in that behaviour.

Negative punishment: (penalty) (also called Punishment by contingent withdrawal) Occurs when a behaviour (response) is followed by the removal of a stimulus, such as taking away a child’s toy following an undesired behaviour, resulting in a decrease in that behaviour.

Aversion therapy: The pairing of an unpleasant stimulus to an unwanted behaviour to eliminate that behaviour. Some people bite their finger nails, and in order to stop this behaviour, applying neem oil on the finger nails makes them taste awful and helps stop the behaviour of biting nails.

In his operant conditioning experiments, Skinner often used an approach called shaping. Instead of rewarding only the target, or desired, behaviour, the process of shaping involves the reinforcement of successive approximations of the target behaviour. Behavioural approximations are behaviours that, over time, grow increasingly closer to the actual desired response.

Skinner believed that all behaviour is predetermined by past and present events in the objective world. He did not include room in his research for ideas such as free will or individual choice; instead, he posited that all behaviour could be explained using learned, physical aspects of the world, including life history and evolution.

How does Behaviour Therapy help?

Behaviour is learned and can therefore be un-learned via therapy. By nature, behavioural therapies are empirical (data-driven), contextual (focused on the environment and context), functional (interested in the effect or consequence a behaviour ultimately has), probabilistic (viewing behaviour as statistically predictable), and relational (analysing bidirectional interactions). Behavioural therapy develops, adds and provides behavioural intervention strategies and programs for clients, and training to people who care to facilitate successful lives in the communities.

Behavioural Therapy has successfully been used to treat a large number of conditions. It’s considered to be extremely effective. In 2012 (Hofmann & Asnani) a review of a comprehensive survey of meta-analyses examining the efficacy of Behavioural Therapy identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining Behavioural Therapy for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviours, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of Behavioural Therapy for various problems in children and elderly adults. The strongest support exists for Behavioural Therapy of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between Behaviour Therapy and other treatments or control conditions. Behaviour Therapy showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that Behaviour Therapy had lower response rates than comparison treatments. In general, the evidence-base of Behaviour Therapy is very strong.

In 2010 (Lang & Regester), a review of studies involving the treatment of anxiety in people with autism spectrum disorders (ASD) using Behaviour Therapy with the intent to inform practice and to identify areas for future research disclosed positive outcomes, suggesting Behaviour Therapy is an effective treatment for anxiety in individuals with Asperger’s.

In 2017 (Gharamaleki & Pourabdol) a study to determine the effectiveness of Behaviour Therapy in decreasing high risk behaviours among students suffering from Attention Deficit / Hyperactivity showed that there was a significant difference between high-risk behaviours of control and experiment groups in the post-test. According to the findings Behaviour Therapy was effective in controlling emotional behaviour and in regulation of emotions; and proved effective in decreasing psychological and behavioural problems, mainly high risk behaviours of teenagers suffering from attention deficit/hyperactivity disorder.

In general, behavioural therapy involves carefully observing current behaviours and then targeting specific ones for change. It looks at thoughts and feelings that lead to the behaviour or occur as a result of the behaviour to understand it on a deeper level. Therapists employ various techniques to increase positive or decrease maladaptive behaviour, and constantly collect data on success and failure. That way it is clear whether the child is making progress.

Who does Behaviour Therapy help?

Behaviour therapy is action-based and looks to foster positive behaviour change. Other therapies such as psychoanalytic therapy tend to be more focused on insight and delving into the past. In behavioural therapy, the past is still important as it often reveals where and when the unwanted behaviour was learned, however it looks more so at present behaviour and ways in which it can be rectified. The premise behind behavioural therapy is that behaviour can be both learned and un-learned. The goal is to help the individual learn new, positive behaviours to replace the old maladaptive ones thus minimising or eliminating the issues.

Imagine a treatment that could manage the behaviour of a child, help make one a better parent, and enlist teachers to help the child to do well in school, all without the side effects of medication. Behaviour therapy involves a series of techniques to improve parenting skills and a child’s behaviour.

There’s clear evidence that a behavioural approach will work for the majority of children with ADHD. Recent evidence suggests that children who are put on medication first never try behaviour therapy or they try it years later, if medication has stopped working. Medication decreases common ADHD symptoms like impulsivity and distractibility, but it doesn’t change behaviour. A child on medication might be disinclined to punch someone, because he’s less impulsive, but he doesn’t know what to do instead. Behaviour therapy fills in the blanks, by giving a child positive alternative behaviours to use. The benefit of using behaviour therapy first is that, if a child also needs medication, he can often get by with a smaller dose. According to a four-year study Pelham is conducting on medication and behaviour therapy, at the University at Buffalo, a child can take medication for 10 years, and when the child is off it or he decides not to take it anymore, as some 90 percent of teenagers do, the benefits stop. Then it’s a lot harder to learn from scratch how to deal with a teenager who’s acting out than it is with a five-year-old who is acting out. The parent would have lost 5 or 10 years relying on medication and not dealing with problems that behaviour therapy could have addressed. Although it’s never too late for a child to benefit from behaviour therapy, evidence suggests that it works best when started early in the child’s life.

In Early Behavioral Intervention, Brain Plasticity, and the Prevention of Autism Spectrum Disorder, (2008) Dawson, describes how early intensive behavioural treatments can help guide brain and behavioural development back toward a normal pathway. Children on the autism spectrum often need help with language, social interaction, and a variety of challenging behaviours from head-banging to tantrums to elopement. A lack of social motivation underlies many of these children’s deficits which explains why they lack eye contact focus on human faces and voices as often as typical people do. It would also help explain why they often fail to develop “joint attention,” that is, looking at or pointing to an object (like a toy or a puppy), making eye contact with a caregiver to indicate shared interest and enjoyment, and then looking back at the object together. Social blindness likely leads to a cascade of problems because the brain is waiting for important input resulting from early social interaction and the imitation that is a part of it. When it doesn’t get it, a child may not gain language, learn to read emotions, pick up social gestures, or come to understand the give and take of social relationships.

Fortunately, we have begun to understand that a brain that has been injured or is not developing properly can be influenced to begin to repair itself. The reorganization of connections in the brain that occurs during learning is a key part of this process. Therefore, behavioural interventions used to treat ASD may not just change outward behaviours, but may actually help rewire the brain.

Parents and teachers of gifted children are often at a loss to explain their extreme behaviours. A major cause of behaviour problems in gifted and twice-exceptional students is asynchronous development (AD), or unevenness in the rate at which sensory, emotional, physical, and executive function skills develop. Children experiencing this uneven development have some skills that seem superior and others that lag. AD can leave a child feeling frustrated. Frustration, plus the hypersensitivity to stimuli typical of gifted children, may be the reason why so many gifted children are incorrectly diagnosed with pathological psychiatric disorders. It’s possible to structure a child’s environment to minimize problem behaviour. When an environment is chaotic, inconsistent, and unpredictable, children respond in kind with similar behaviours. When an environment is structured, children know what to expect and tend to adjust and comply appropriately. The difficult behaviours that stem from asynchronous development can be managed through Behaviour therapy by enabling the child to learn to identify the triggers that lead to problem behaviour, be on the lookout for problem situations, help the child learn self-regulation techniques thereby empowering the child to face problem situations with greater calm and control which is a mentally healthy alternative to the damaging effects of inconsistency, yelling, hitting, or criticizing.

Behaviour Therapy at DIRECT

DIRECT has facilitated Behaviour Therapy for over 7 years for children of varied ages with diverse behavioural issues including Attention Deficit Hyperactivity Disorder, Attention Deficit Disorder, Autism Spectrum Disorder, Oppositional Defiance Disorder, Bipolar Disorder, Anti-social Personality Disorder, Giftedness, Developmental disorders and Psychological issues such as Anxiety, Depression and Aggression. To briefly describe how behaviour therapy works at Direct, the process usually follows a formal assessment that identifies the cognitive strengths and deficits as well as the positive and maladaptive behavioural patterns of the child. The therapist then investigates the history of the problem behaviours and identifies the baseline of the problem such as the frequency, duration and severity of the problem. There are several techniques used to assess and identify the problem. The next step of the process would be to recognize the best suited intervention and behavioural protocols to cater to the individual needs of the child. The frequency of sessions is usually directly proportional to the intensity of the behavioural issues ranging from a minimum of 1 to a maximum of 6 sessions per week, over an hour’s duration. The therapeutic relationship between the therapist and child focuses on interpreting the child’s behaviour, emphasising a collaborative and positive relationship with the child and valuing the use of objectivity to assess and understand the child. The child thereby acquires new coping skills, improves communication, or learns to break maladaptive habits and overcome self-defeating emotional conflicts. The progress of the intervention is assessed and consistently evaluated through time. The intervention is revised for any areas of developmental needs and successes are reinforced. Reinforcing success helps to keep the child motivated and ensures more success. Once success of the intervention is achieved, the therapist seeks to generalize the desired behaviour to the immediate environments of the child (home, school etc.)  Successfully implementing behaviour therapy at home is hard work. It requires that parent and child change the way they interact with each other and maintain those changes over time. Unlike the benefits of medication, behavioural improvements may not be apparent for weeks or months. The benefits a child receives from behavioural treatment are strongly influenced by the ability of the parent to consistently implement the behavioural protocols. The behavioural success that can be achieved with the integrative efforts of the child, therapist, family and school is evident through practice and research.