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Treatment of Psychological Disorders

Behavior Therapy

Behavioral therapy focuses on changing maladaptive behaviors rather than identifying past causes of psychological problems.

Behavioral therapy does not focus on the origin of psychological problems. Instead, behavior therapists use learning principles to modify maladaptive behaviors. While behaviorism emerged as a school of psychology in the 1920s, it was not applied as a form of therapy until the 1950s. One behavior change technique is a token economy, a system that uses tokens (small rewards) to elicit desired behaviors. Tokens may include buttons, stickers, or fake money that can be exchanged for other rewards (e.g., privileges or snacks). Behavior shaping through successive approximation is a technique first proposed by American psychologist B.F. Skinner. Through shaping, a person can gradually learn to complete a complex behavior through reinforced behaviors that are close to the desired one. For example, if a father wants his daughter to learn to eat her yogurt with a spoon, he may first praise (reinforce) her for simply picking up the spoon. Next he will praise her for dipping the spoon into the yogurt cup and then for putting the spoon with the yogurt in her mouth. Eventually, he will only reinforce the act of eating the yogurt off the spoon to affirm this behavior.

Aversive conditioning occurs when a behavior is paired with an unpleasant stimulus to discourage the behavior. For example, a woman who would like to overcome excessive drinking may take a medication that induces nausea when paired with alcohol. As she is conditioned to associate drinking alcohol with becoming ill, she develops an aversion to alcohol.

Joseph Wolpe, a South African behaviorist, pioneered a technique called systematic desensitization, in which phobias and anxiety responses are reduced through gradual exposure to feared situations. The therapist first builds an anxiety hierarchy with the client. An anxiety hierarchy often begins with imagined scenarios, such as thinking about a snake or seeing a snake on TV. It then progresses gradually to varying degrees of real-life exposure, such as allowing a snake to crawl up one's arm. The therapist trains the client using relaxation techniques (e.g., deep breathing exercises and positive self-talk) to uncouple the stimulus and fear response as they move through the hierarchy. Systematic desensitization can be used for any feared situation, from fear of flying to fear of getting an injection.

Systematic Desensitization for an Injection Phobia

In systematic desensitization, therapists slowly expose people to feared situations, starting with situations that create only mild fear. Each new task will temporarily increase fear and signs of physical arousal, such as heart rate. Clients learn the fear and intense physical reaction will decrease if they stay in the feared situation. Over time, clients work up to facing very challenging situations.
Another form of behavior therapy, commonly used to treat obsessive-compulsive disorder, is exposure and response prevention (ERP). This approach is used to decouple a distressing stimulus and associated compulsions. For example, a person who experiences intrusive thoughts about germs may spend hours per day scrubbing their counters and utensils with bleach. The scrubbing temporarily reduces the distress caused by thoughts of germs. However, in the long term it creates the belief that the person only stayed safe because they did the scrubbing ritual. ERP involves exposing oneself to situations that create intrusive thoughts without engaging in the ritual typically used to reduce distress. In ERP the client would gradually work toward eating off an unbleached plate. They learn that the obsessive thoughts and distress will subside even without the ritual. They also learn that skipping the ritual does not lead to any harm.

Social skills training is a type of behavior therapy meant to improve a client's interpersonal skills. Training may be conducted with either individuals or groups. Strategies include modeling, watching others perform desired social behaviors; behavioral rehearsal, practicing behaviors during role-playing; and shaping, gradual exposure to increasingly difficult social situations where individuals will apply what they have learned. Social skills training is often used for people with disruptive behavior, psychotic disorders, and autism spectrum disorders.