Insight therapies assume that many psychological problems diminish as self-awareness grows and hidden tensions are released. Behavior therapies doubt the success of self-awareness. For example, you can know why you are anxious about an upcoming test, but still be anxious. Behavior therapies believe that the behaviors are the problems, and apply learning principles to the elimination of unwanted behaviors.
Classical conditioning has proven successful in behavior therapy. One psychologist, O. H. Mowrer, was able to cure chronic bedwetting in three cases out of four by combining bedwetting with an alarm that wakes the child out of sleep. As the body associates relaxing the bladder with being woken up, it no longer relaxed the bladder. Another behavior therapy technique that uses classical conditioning is called counterconditioning, which tries to evoke new responses to stimuli that are triggering unwanted behaviors. Two types of counterconditioning are exposure therapies and systematic desensitization.
Exposure Therapies are behavioral techniques that treat anxieties by exposing people (in imagination or actual situations) to the thing they fear and avoid. As discussed in our section on phobias, phobias are strengthened by avoidance behavior. By forcing patients to confront their fears (literally) many times, patients habituate and reduce their anxiety. One popular type of exposure therapy is systematic desensitization. As it is assumed that you cannot be simultaneously anxious and relaxed, a therapist would begin by having the patient enter a relaxed state. They would then introduce the fear, like a spider, as a thought concept. If this made you too tense, you’d return to the relaxed state. Over time, the anxiety would lessen, and the therapist may increase to pictures of spiders, to spiders from a distance, perhaps eventually handling live spiders.
If a particular anxiety-arousing situation is too expensive, difficult, or embarrassing to recreate, virtual reality exposure therapy is a developing field that progressively exposes people to electronic simulations of their greatest fears in a safe environment. Instead of trying to force a patient onto a plane (which can be expensive and dangerous), a good simulation can provide the initial contact instead.
Systematic desensitization therapy’s goal is to replace a negative response with a positive one to a harmless stimulus. In aversive conditioning, the goal is to replace a positive response to something harmful with something negative, generally an unpleasant state. The most common application of aversive conditioning is trying to treat alcohol abuse. By providing a patient drinks laced with a drug that creates strong nausea, the patient begins to associate alcohol with nausea, and can no longer drink it. Another example is providing nasty tasting polish to fingernails to prevent nail biting. Studies show that this works in the short run, however after a few years patients are likely to continue their bad habits, as they understand that outside of the therapy, they can drink or bite their nails without worry.
Operant Conditioning-based Therapies Operant conditioning, the idea that voluntary behaviors are influenced by their consequences, is applied in therapy by the use of behavior modification, or reinforcing desired behaviors and withholding reinforcement for undesired ones. Operant conditioning therapy has proven successful for otherwise “hopeless” cases, such as teaching children and adults with intellectual disability to care for themselves, or helping those with schizophrenia behave more rationally. In the most extreme cases, it has also proven successful, but it requires a very intensive series of therapy, with support from both professionals and families.
Rewards for desired behavior can be things like praise or food. One commonly used system, especially in institutional settings, is a token economy (like it Mr. West’s paper). A token economy is when people earn a token for exhibiting the desired behavior, and can later trade those tokens in towards privileges or treats.
Criticisms of Operant Modification The first criticism of operant modification is concerns about how durable the behaviors are. Will they last once the therapy finishes, or does the lack of extrinsic rewards cause extinction? The second criticism is of an ethical nature: Is it right for one human to control another’s behavior? By setting up a token economy, you are also potentially depriving a person of what they desire, and only giving it to them in return for modified behavior.
Cognitive Therapy Like with the cognitive approach, cognitive therapy assumes that our thinking colors our feelings, and teaches people new, more adaptive ways of thinking. This is based on the assumption that thoughts intervene between events and our emotional reaction. A depressed person many see suggestions as criticism, disagreement as dislike, and friendliness as pity. If such thought patterns are learned, then cognitive therapists believe that people can be taught new, more constructive ways of thinking.
Rational-emotive Behavior Therapy Psychologist Albert Ellis created what is called rational-emotive behavior therapy (REBT), which is a confrontational therapy that vigorously challenges people’s illogical, self-defeating attitudes and assumptions. It points out the negative self-concepts as absurd, and challenges people to try to explain why they think that, usually proving them unfounded.
Cognitive-behavioral Therapy Cognitive-behavioral therapy (CBT) is a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior). It seeks to make people aware of the irrational negative thinking, to replace it with new methods of thinking, and to practice the more positive approach in everyday settings. Behavior change is usually addressed first, followed by cognitive change, and seeks to both maintain and prevent relapses. This has proven successful for people with obsessive-compulsive disorder (OCD). When a patient feels a compulsion, like the urge to wash their hands again, they would tell themselves “I am having a compulsive urge” and attribute it to their abnormal brain activity. They would then instead do something enjoyable, like talking a walk or gardening. CBT has worked for other types of abnormal behavior, and can be used over the internet.
Group and Family Therapy Except for traditional psychoanalysis most therapies may also occur in small groups. Group therapy is conducted with groups rather than individuals, and allows for therapeutic benefits from group interaction. While it doesn’t offer the same degree as therapist involvement per patient, it does offer several benefits: • It saves therapists’ time and patients’ money, often with no less effectiveness • It offers a “social laboratory” for exploring social behaviors and developing social skills. Allows people to try out new behaviors in a safe setting • It enables people to see that others share their problems. This is especially valuable in groups such as Alcoholics Anonymous, and others • It provides feedback as patients try out new methods of behaving. Hearing that you look confident, even if you actually very nervous, can be reassuring.
Family Therapy Therapists understand the importance of interactions with family. Family Therapy is a therapy that treats the family as a system, and views an individual’s unwanted behaviors as influenced by, or directed at, other family members. Family therapists attempt, with a reasonable degree of success, to open up communication within the family or to help family members find new ways to prevent or resolve conflicts.
Self-Help Groups Many people also participate in self-help and support groups. In 2000, it was reported that 14,000 self-help groups focus on stigmatized or hard-to-discuss illnesses (such as AIDS), and that many of these groups are online. Anorexia and alcoholism are also popular support group topics. Alcoholics Anonymous (AA), mentioned earlier, is one of the original support groups, with over two million members in over 100,000 groups worldwide. (A common “joke” about AA is that it’s the largest organization nobody wanted to join.)