Defining the Behavioral Approach and Applied Behavioral Analysis

Behavior therapy is a treatment approach that is based on the idea that abnormal behavior is learned. It applies the principles of operant conditioning, classical conditioning, and observational learning to eliminate inappropriate or maladaptive behaviors and replace them with more adaptive responses. Behavior therapy methods sometimes focus only on behaviors, and sometimes on combinations of thoughts and feelings that might be influencing behaviors. Those who practice behavior therapy, known as behaviorists, tend to look more at specific, learned behaviors and how the environment has an impact on those behaviors. Behaviorists tend to look for treatment outcomes that are objectively measurable.

Behavior therapy stands apart from insight-based therapies (such as psychoanalytic and humanistic therapy) because the goal is to teach clients new behaviors to minimize or eliminate problems, rather than digging deeply into their subconscious or uncovering repressed feelings. The basic premise is that the individual has learned behaviors that are problematic and maladaptive, and so he or she must learn new behaviors that are adaptive.

Foundations

Behaviorism focuses on learning that is brought about by a change in external behavior, achieved through a repetition of desirable actions and the rewarding of good habits and the discouragement of bad habits. There are two basic theories of learning that build the foundation for behaviorism:

• Operant conditioning is a type of learning in which an individual's behavior is modified by its consequences; the behavior may change in form, frequency, or strength. 
• Classical conditioning is a form of learning in which a subject comes to respond to a previously neutral stimulus by continually pairing it with an unconditioned stimulus that elicits the desired response. 

Operant Conditioning Approaches 

Applied behavioral analysis (ABA) is a type of behavior therapy that uses the principles of operant conditioning; it is commonly used in the treatment of children with autism spectrum disorder (ASD). In this treatment, child-specific reinforcers (e.g., stickers, praise, candy, bubbles, and extra play time) are used to reward and motivate children with ASD when they demonstrate desired behaviors, such as sitting on a chair when requested, verbalizing a greeting, or making eye contact. Punishment such as a timeout or a sharp “No!” from the therapist or parent might be used to discourage undesirable behaviors such as pinching, scratching, and pulling hair.

The use of token economies is a behavior-therapy technique in which clients are reinforced with tokens that are considered a type of currency that can be exchanged for special privileges or desired items. Token economies are mainly used in institutional and therapeutic settings. Over time, tokens need to be replaced with less tangible rewards, such as compliments, so that the client will be prepared when they leave the therapeutic setting.

Contingency contracts are formal, written contracts between the client and the therapist. They outline behavior-change goals, reinforcements, rewards, and penalties for not meeting the terms of the agreement.

Modeling involves learning through observation and emulating the behavior of others. The modeling process involves a person being subjected to watching other individuals who demonstrate behavior that is considered adaptive and that should be adopted by the client. In some cases, the therapist might model the desired behavior; in other instances, watching peers demonstrate the behaviors may be helpful. The process is based on Albert Bandura's social learning theory, which emphasizes the social components of the learning process.

Classical Conditioning Approaches

One commonly used classical conditioning therapeutic technique is aversive conditioning, which uses an unpleasant stimulus to stop an undesirable behavior. Therapists apply this technique to eliminate addictive behaviors, such as smoking, nail biting, and drinking. In aversion therapy, clients will typically engage in a specific behavior (such as nail biting) and at the same time are exposed to something unpleasant, such as a mild electric shock or a bad taste. After repeated associations between the unpleasant stimulus and the behavior, the client can learn to stop the unwanted behavior. 

In exposure therapy, a therapist seeks to treat clients’ fears or anxiety by presenting them with the object or situation that causes their problem, with the idea that they will eventually get used to it. This can be done via reality, imagination, or virtual reality. A popular form of exposure therapy is systematic desensitization, wherein a calm and pleasant state is gradually associated with increasing levels of anxiety-inducing stimuli. Virtual reality exposure therapy uses simulations when it's either too impractical or expensive to re-create anxiety-producing situations; it has been used effectively to treat numerous anxiety disorders such as the fear of public speaking, claustrophobia (fear of enclosed spaces), aviophobia (fear of flying), and post-traumatic stress disorder (PTSD).

Virtual reality therapy

Virtual reality therapy provides realistic, computer-based simulations that involve watching others performing the desired behaviors.

Flooding is the general technique in which an individual is exposed to anxiety-provoking stimuli, while at the same time prevented from having any avoidance responses. It is often used to treat phobias, anxiety, and other stress-related disorders. For example, flooding might be used to help a client who is suffering from an intense fear of birds. The individual may be forced to stay in a room with a harmless bird for an extended period of time and over repeated sessions. The theory is that after a while, the individual will realize that nothing bad is happening and the fear response will diminish.

Relaxation training is a type of behavior therapy that involves clients learning to lower arousal to reduce their stress by tensing and releasing certain muscle groups throughout their body. Social skills training teaches clients skills to access natural reinforcers and lessen life punishment.

History of Behavior Therapy

The first use of the term "behavior modification" appears to have been by Edward Thorndike in 1911. His article "Provisional Laws of Acquired Behavior or Learning" makes frequent use of the phrase "modifying behavior." Through early research in the 1940s and the 1950s the term was used by Joseph Wolpe's research group. In general, behavior therapy is seen as having three distinct points of origin: South Africa (Wolpe's group), the United States (B. F. Skinner), and the United Kingdom (Rachman and Eysenck). Each had its own distinct approach to viewing behavior problems. B. F. Skinner developed the idea of operant conditioning in 1937, when he tested the learning of rats through reinforcement and punishment in what is now called a Skinner box. Ivan Pavlov's famous experiments with dogs provide the most familiar example of the classical-conditioning procedure. 

Exposure therapy was first reported in 1924 by Mary Cover Jones, who is considered the mother of behavior therapy. Jones used exposure therapy with a boy named Peter to help him overcome his fear of rabbits. Thirty years later, Joseph Wolpe (1958) refined Jones’s techniques, giving us the technique of exposure therapy that is used today. 

In the second half of the 20th century, many therapists coupled behavior therapy with the cognitive therapy of Aaron Beck and Albert Ellis, forming cognitive behavioral therapy (CBT). 

Effectiveness of Behavior Therapy

Behavior therapy has proven effective in many areas and has been used to address intimacy in couples, relationships, forgiveness, chronic pain, anorexia, chronic distress, substance abuse, depression, anxiety, insomnia, and obesity. Behavioral applications to these problems have left clinicians with considerable tools for enhancing therapeutic effectiveness. 

Many have argued that behavior therapy is at least as effective as drug treatment for depression, ADHD, and OCD. Two large studies done by the Faculty of Health Sciences at Simon Fraser University indicates that behavior therapy and cognitive-behavioral therapy (CBT) are equally effective for OCD. CBT has been proven to perform slightly better at treating co-occurring depression. Systematic desensitization has been shown to successfully treat phobias about heights, driving, and insects, as well as any anxiety that a person may have. Virtual reality treatment has been shown to be effective for a fear of heights; it has also been shown to help with the treatment of a variety of anxiety disorders. Applied behavioral analysis has been shown to be an effective tool and is a very common treatment approach for children with autism (Lovaas, 1987, 2003; Sallows & Graupner, 2005; Wolf & Risley, 1967). 

Criticism of Behavior Therapy and Applied Behavioral Analysis

Applied behavioral analysis has been criticized for trying to "normalize" the behavior of children with autism; critics argue that children with autism express themselves in different ways that are not pathological, and that ABA pathologizes these behaviors and seeks to re-shape them into more socially acceptable behaviors. Other critics have argued that ABA and other behavior therapies are too rigid in their approach, and that effective treatment requires an acknowledgement of the subconscious as well as observable behaviors. Some have argued that certain types of behavior therapy may make a patient too dependent on external rewards rather than internal motivation to change. Finally, many have critiqued the use of punishment in certain forms of behavior therapy as inhumane.