Which behavior therapy technique is commonly used to treat anxiety disorders?

Have you ever found yourself doing something over and over again that you know may be harmful, but you're not sure how to change it? Maybe you bite your nails or yell at your siblings too much. One way or another, these behaviors were likely learned, which means that there is hope for them to be unlearned.

• Behavioral therapy definition.
• Behavioral therapy techniques.
• Types of behavioral therapy.
• Cognitive-behavioral therapy (CBT).
• Dialectical behavioral therapy (DBT).

Behavioral Therapy Definition

Not all psychotherapies are made alike. While some psychotherapies focus on treating the mind in order to change a person's behavior, behavioral therapy believes that the behavior itself should be treated. Behavioral therapies operate under the assumption that if a behavior can be learned, then it can be unlearned.

Behavioral therapy is primarily used to treat depression, anxiety, panic disorders, excessive anger, social anxiety, substance use disorder, autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). Behavioral therapy is also commonly used to help treat children and adolescents, as they are more malleable compared to adults.

Behavioral Therapy Techniques

Behavioral therapy is based on the two primary behaviorism concepts: classical conditioning and operant conditioning.

Classical Conditioning Techniques

Classical conditioning techniques are based on the work of Ivan Pavlov, who is best known for his work conditioning dogs. In these experiments, Pavlov reveals that we can learn behaviors and emotions through classical conditioning.

Classical conditioning: unconscious and automatic learning that results in a conditioned response to an unconditioned or neutral stimulus.

Behavioral therapies that use conditioning therapy have proven successful for cases such as bedwetting. Children are woken up by a sensor that detects moisture so that, over time, they learn that wetting the bed means losing sleep. Other forms of behavioral therapies that use classical conditioning techniques include exposure therapies and aversive conditioning therapies, but more on that later.

Operant Conditioning Techniques

Based on the work of B. F. Skinner and the "Skinner box," operant conditioning techniques use positive and negative reinforcers to either promote desired behaviors or diminish unwanted behaviors (Skinner, 1948).1

A reinforcer: a stimulus that increases the likelihood of a behavior or response occurring.

The idea is that when a behavior is rewarded, we are more likely to repeat them. However, if our behavior is punished, then we are less likely to repeat them. Behavioral therapy that uses operant conditioning techniques is behavior modification therapy.

Types of Behavioral Therapy

Now, let's explore some of the types of behavioral therapy mentioned above: exposure therapy, aversive conditioning therapy, and behavior modification therapy.

Exposure Therapy

Exposure therapies use a method called counterconditioning, a concept originally developed by Mary Cover Jones. While working with a three-year-old child named Peter, Jones was able to help him be rid of his fear of rabbits (Jones, 1924). To do this, she created a relaxing environment for Peter while slowly bringing the fuzzy rabbit closer and closer to him a little at a time. Eventually, Peter was holding and stroking the rabbit without distress. Jones' counterconditioning set the framework for systematic desensitization.

Systematic desensitization: an exposure therapy technique in which a person connects a relaxed state to an anxiety-provoking stimulus.

The goal here is to tell your mind and your body that you are safe by envisioning yourself in a distressing situation but using mindfulness strategies to remain calm. The therapist will usually guide this by gently reminding the client to recenter themselves if they start becoming upset. The goal is for the person to eventually associate calmness with a previously upsetting situation, giving them more confidence when they are actually in that situation. This practice has proven especially helpful in anxiety disorders.

If someone is afraid of public speaking, a behavioral therapist may have them repeatedly expose themselves to situations in which they must engage in public speaking. Each time, they will practice mindfulness strategies to remain calm, similar to when you hear people suggest imagining everyone in their underwear.

The idea is that a person cannot be anxious and relaxed at the same time – one cancels out the other. However, the key is for the therapist to take a gradual approach. To do this, the client must rank their anxiety-provoking situations from mild to severe. This way, they can conquer the easiest situations first and work their way up to more challenging situations. In the example above, someone may start by simply asking a question in a small class and work their way up towards giving a class presentation.

Aversive Conditioning Therapy

While the goal of exposure therapies is to increase behaviors you should do, the goal of aversive conditioning therapy, another classical conditioning technique, is to decrease behaviors you shouldn't do.

Aversive conditioning: a therapy technique that reduces or eliminates harmful behaviors by creating an unpleasant (aversive) response.

Over time, the person starts to associate their harmful behavior with a negative consequence which should, in turn, decrease that behavior. This has been most often used as a way to treat alcohol use disorder in which the therapist will give a person drinks with a drug that produces severe nausea. The hope is that the person will associate alcohol with nausea to the point at which they no longer desire alcohol. This method, however, has only shown short-term success in alcohol use disorders and has yet to produce strong long-term effects.

Behavior Modification Therapy

Another type of behavioral therapy is behavior modification therapy which draws from operant conditioning techniques. Behavior modification therapy is simply therapy that aims to change unwanted behavior. It can sometimes be intensive, but it has proven successful in shaping the behavior of people with schizophrenia or children with autism spectrum disorder (ASD).

Most likely, we have all undergone some form of behavior modification, especially in school. We were given a gold star for picking up our toys or a piece of candy for saying a correct answer. This method reinforces desirable behaviors and withholds reinforcement of unwanted behaviors.

In some forms of behavior modification therapy, the therapist may create what's called a token economy in which some kind of token or point system is used to reinforce positive behaviors. The points can later be used to redeem and receive rewards such as TV time, extra recess time, or day trips. This technique is great to use in group therapy, homes, or institutions.

Token economies are most commonly used in classrooms, homes, or detention facilities.

Cognitive-Behavioral Therapy

On many occasions, behavioral therapy may be combined with other types of therapy.

Cognitive-behavioral therapy: a therapy that combines behavioral therapy with cognitive therapies.

Cognitive therapies aim to change a person's thinking in order to change their feelings. Cognitive-behavioral therapy recognizes that our thoughts, feelings, and behaviors interact with one another to influence our psychological well-being.

One of the major criticisms of behavioral therapy is the suggestion that the learned (or unlearned) behaviors may not be durable. Earlier, we mentioned that aversion therapy does not always produce longer-term results. Cognitive-behavioral therapy may fill some of the missing gaps in behavioral therapy through the added benefit of aligning a person's thoughts with their behaviors.

Other criticisms of behavioral therapy include claims that it is too authoritarian. In other words, it has too much control over someone's actions and choices. In cognitive-behavioral therapy, however, one of the primary goals is to promote autonomy by providing the client with information and tools that they can use in everyday life.

Cognitive-behavioral therapy is one of the most widely used therapies. It has been proven to be an evidence-based treatment for conditions including:

• Anxiety disorders

• Bipolar disorders

• Depression

• Eating disorders

• Chronic pain

• Obsessive-compulsive disorder (OCD)

• Schizophrenia

• Sleep disorders

• Phobias

• Post-traumatic stress disorder (PTSD)

Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) is another branch of cognitive-behavioral therapy that was originally created to help treat borderline personality disorder. It can also be effective in changing harmful or suicidal behavioral patterns.

DBT's goal is to help a person find a path toward acceptance and change by improving the following:

• Mindfulness.

• Emotional regulation.

• Interpersonal effectiveness.

• Distress tolerance.

DBT can be in either an individual or group setting and may incorporate skills training or one-on-one coaching. In either case, it is especially important for the therapist to create a safe and non-judgemental space. DBT draws from behavioral therapy techniques by identifying behaviors that may help achieve the client's goals of acceptance and change.

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