Areas of Clinical Behavior Therapy

Chapter 28

ESTs

• Empirically Supported Treatments– Therapies that have been shown to be

effective through scientific clinical trials

Treatments for Phobias• Systematic Desensitization –

Counterconditioning• Based on Wolpe’s belief that phobias are

developed through respondent conditioning– To change response to feared stimulus must

establish a fear-antagonistic response to that stimulus

– Fear-antagonistic response: Relaxation– Uses three steps:

• Progressive relaxation• Development of anxiety hierarchy and control scene• Combination of progressive relaxation with anxiety

hierarchy

Treatments for Phobias

• Flooding – Exposure– If client faces feared stimulus, can’t

escape, and no aversive stimulus follows, fear response will become extinguished

– In vivo – in person• Preferred – maximizes generalization

– Can elicit fear at or near full intensity or, may use graded levels of exposure

• Participant Modeling – Both client and therapist are participating

together in feared situation– Therapist models approaches to feared

stimuli

Treatments for Other Anxiety Disorders

• Panic Disroder and Agoraphobia– In vivo exposure– Cognitive Behavioral Treatment

• Behavioral component – exposure• Cognitive component – changing client’s

misconception about panic attacks

Treatments for Other Anxiety Disorders

• Generalized Anxiety Disorder– Most effective treatments combine

cognitive and behavioral strategies– Exposure an efficient form of

behavioral treatment:• Teach client relaxation techniques• Client uses start of worrying as signal to

relax

– Cognitive techniques can be used to challenge and change client’s beliefs and thoughts

Treatments for Other Anxiety Disorders

• Obsessive-Compulsive Disorder– In vivo exposure and response prevention

• Client encouraged to engage in a behavior leading to the obsession while being prevented from compulsive behavior

• Prevention of compulsive response extinguishes anxiety that follows the obsession

• Exposure may be graded

– Cognitive Therapy• Used to change self statements clients makes

that help maintain the obsession

Treatments for Other Anxiety Disorders

• Posttraumatic Stress Disorder– Exposure treatment

• Imagination• Talking about event• Writing about event

– Combination of cognitive restructuring and exposure

Treatment of Depression• Depression

– Behavioral interventions:• Increasing contingency reinforcers in individuals’ lives• Encourage clients to seek out reinforcers through hobbies

and various social activities• Involve significant others in reinforcement

– Cognitive Interventions – Beck’s Cognitive Therapy• Negative cognitive schemas lead to negative

interpretation of life events, which, lead to depressed behavior

• Cognitive restructuring a key component• Homework includes behavioral activities• Behavioral activation – behavioral homework assignments

that are aimed at increasing contingency reinforcers– Research suggests these can be used alone as treatment for

depression

Treatment of Alcohol Problems

• Alcoholics Anonymous (AA) – abstinence based program– Research shows that behavior therapy can be as

or more effective than AA (Emmelkamp, 2004)• Behavioral approaches

– Moderation drinking programs teach drinkers to:• Use goal setting to drink in moderation• Control “triggers” (SD’s) for drinking• Learn problem-solving skills to avoid high-risk situations• Engage in self-monitoring to detect controlling cues and

maintaining consequences of drinking behaviors• Practice these techniques with various homework

assignments

Treatment of Alcohol Problems Continued

• Behavioral programs have utilized:– Motivational interview

• Therapist asks client questions, the answers for which act as motivational establishing operations for change

– Coping-skills training• Teach clients to deal with stressors that

may lead to excessive alcohol consumption

– Relapse prevention strategies

Treatments for Eating Disorders and Obesity

• Eating Disorders - Behavioral and Cognitive Interventions– Reinforcements for going for a particular time without

binges (time increases gradually)– Counteract client’s unrealistic beliefs about food and

weight and appearance• Obesity

– Focus on helping individuals adopt long-term lifestyle changes in eating habits, exercise, and attitudes toward both

• Self-monitoring – food intake, body weight• Stimulus control – restricting eating to specific location• Changing rate of eating – laying down utensils between bites;

taking breaks between courses• Behavioral contracting – agree to loose certain amount of

weight in a certain time period to get a reinforcer• Relapse prevention strategies

Treatments for Couple Distress

• Behavioral couple therapy includes:– Instigation of positive exchanges –

increasing behaviors that are pleasant to partner

– Communication training – teaching how to express thoughts and feelings; teaching to be an effective listener

– Problem-solving training – learn to use communication skills to identify and solve problems

– Program generality – look for signs of relapse and use skills learned

Treatment of Sexual Dysfunction

• Hypothesis that anxiety is a factor in sexual dysfunction– Exposure programs appear most

effective

• Masters and Johnson (1970)– Couple engage in pleasurable

stimulation– Relaxation, no pressure for orgasm– Goal is pleasure not performance

Treatments for Habit Disorders

• Habits – repetitive behaviors that are inconvenient and annoying– Ex: nail biting, lip biting, etc.

• Habit reversal – Three step program:1.Client learns to describe and identify problem

behavior2.Client leans and practices a behavior that is

incompatible with or competes with problem behavior

• Client practices competing behavior daily in front of mirror and engages in it immediately after the occurrence of the problem behavior

3.For motivation, the client reviews the inconvenience caused by disorder, records and graphs the behavior, and has a family member provide reinforcement for engaging in treatment