Treatment & Assessment

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Interventions Based on Behaviorism

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Behavior is generated and maintained by factors external to the person, by various environmental situational stimuli. Behavioral interventions fall into three categories:
1) Principle of Classical Conditioning
2) Principles of Operant Conditioning
3) Social Learning Theory

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Treatment Approaches Based on Principle of Classical Conditioning

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Unlearning previous problematic connections. Change is accomplished by techniques that rely on either counterconditioning or on classical conditioning.

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Counterconditioning

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Based on the principle of reciprocal
inhibition.

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Reciprocal inhibition

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is the notion that two incompatible responses cannot be experienced at the same time. Weakening the maladaptive conditioned response by strengthening or antagonistic response.

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Aversive Conditioning

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Only used to eliminate “deviant’ or “bad” behaviors. The conditioned stimulus is paired with a new and stronger stimulus. The new stimulus elicits a strong negative response that is incompatible with the old conditioned response of pleasure. Like electric shock. It can be done either invivo or in imagination. When it is done in imagination, it is called covert sensitization. While aversive conditioning may have short-term benefits, it is not effective in the long run, and it is associated with high rates of recidivism. Treatment of choice for delusional disorder.

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Counterconditioning

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Based on the principle of reciprocal inhibition. Treatments containing counterconditioning are: Aversive Conditioning, Systematic Desensitization, Sensate Focus, and Assertiveness Training

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Aversive Conditioning

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Only used to eliminate “deviant’ or “bad” behaviors. The conditioned stimulus is paired with a new and stronger stimulus. The new stimulus elicits a strong negative response that is incompatible with the old conditioned response of pleasure. Like electric shock. It can be done either in vivo or in imagination. When it is done in imagination, it is called covert sensitization. While aversive conditioning may have short-term benefits, it is not effective in the long run, and it is associated with high rates of recidivism.

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Systematic Desensitization

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A counterconditioning technique developed by Joseph Wolpe. It has most commonly been used to treat specific phobias. However, more recent research has concluded that treatments that emphasized prolonged and intense exposure (flooding) are most efficacious for specific phobias. Most critical component is Classical Extinction (not a prolonged extinction schedule). Behavioral therapy technique to diminish excessive fears, involving gradual exposure to the feared stimulus paired with a positive coping experience, usually relaxation. Behavior therapy technique that trains people to relax or behave in a manner that is inconsistent with experiencing anxiety, while in the presence of things that would normally make them anxious.

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Master’s and Johnson’s Technique of Sensate Focus

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A technique used by Master’s and Johnson’s. Uses pleasure as the counterconditioning response to inhibit performance anxiety. It is primarily to relieve performance expectations. They divided the sexual response cycle into four stages: excitement, plateau, orgasm, and resolution. In the excitement phase, arousal is initiated either through physical factors or psychological factors. It is this stage that sensate focus is designed to influence. The plateau phase involves further increases in stimulation and physiological functions. During the orgasm phase the person experiences an intense and pleasurable release of tension, and ejaculation occurs in the male. The resolution stage involves a gradual return to pre-excitement levels.

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Assertiveness Training

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this technique utilizes the assertive response, which is antagonistic to social anxiety. Patients practice assertive responses, initially by role-playing with the therapist, and eventually in real-life situation. A form of behavioral therapy that teaches assertiveness.

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Classical Extinction

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Treatment interventions based on classical extinction involve presenting the conditioned stimulus (CS) without the unconditioned stimulus (US) either over several trials, or for an extended period of time, to the point that the conditioned stimulus (CS) no longer elicits the conditioned response (CR). The reason most fears don’t extinguish naturally is because people avoid the CS or quickly flee from it when confronted by it. Classical conditioning can be accomplished using either flooding or implosive therapy.

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Flooding

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Can be implemented either in vivo or in imagination, and involves presenting the conditioned stimulus (CS) without the unconditioned stimulus (USD). Research shows in terms of extinction, prolonged exposure is more effective than multiple, briefer periods with exposure which can actually exacerbate the fear. “In-vivo flooding” is the single best treatment for Agoraphobia with 75% long term improvement. Flooding with response prevention appears to be more effective than systematic desensitization of agoraphobia, OCD and specific phobias. Treatment of choice for OCD involves: exposure with response prevention. A therapy in which the patient is directly exposed to things that they wish to avoid until the wish to avoid it is extinguished. In-vivo flooding: exposing an individual to anxiety-provoking stimuli while preventing an avoidance response. Flooding in vivo produces the greatest amount of anxiety vs. flooding in imagination, implosive thx, systematic desensitization. Treatment of choice for agoraphobia flooding, with 75% long term improvement. In-vivo flooding exposing an individual to anxiety-proviking stimuli while preventing an avoidance response. Research suggests that “In-vivo flooding” is the single best treatment for Agoraphobia.

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In-vivo flooding

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exposing an individual to anxiety-proviking stimuli while preventing an avoidance response.

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Implosive Therapy

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Developed by Stampfl, is conducted in imagination only. After the patient is exposed to the feared object in imagination, the therapist interprets possible psychosexual themes. Imaginable exposure to a stimulus at maximum intensity. Incorporates psychodynamic themes. Examples of negative reinforcement Escape conditioning and Avoidance conditioning.

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Treatment Approaches Based on Operant Conditioning

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It involves either reinforcement or punishment. Typically, a functional assessment is conducted prior to the implementation of a reinforcement or punishment paradigm. A functional assessment of behavior involves defining the target behavior, and determining its antecedents and consequences. It also includes identifying the contingencies that serve to maintain the behavior. These contingencies can then be manipulated as part of a behavior modification program.
B. F. Skinner’s entire system is based on operant conditioning. The organism is in the process of “operating” on the environment, which in ordinary terms means it is bouncing around its world, doing what it does. During this “operating,” the organism encounters a special kind of stimulus, called a reinforcing stimulus, or simply a reinforcer. This special stimulus has the effect of increasing the operant -- that is, the behavior occurring just before the reinforcer. This is operant conditioning: “the behavior is followed by a consequence, and the nature of the consequence modifies the organisms tendency to repeat the behavior in the future.”
A behavior followed by a reinforcing stimulus results in an increased probability of that behavior occurring in the future.

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Primary Reinforces

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those reinforces that reinforce everyone at all ages and in all cultures

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Secondary Reinforces

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Acquire their reinforcing value through training or experience

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Generalized Conditioned Reinforce

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Are not inherently reinforcing, however, they take on reinforcing value because they give the person access to other reinforces (money).