Behaviour therapy

With behavior therapy (CBT ) is a range of methods is referred to in the art of psychotherapy. This is common, despite numerous differences in theoretical assumptions and practical methods to evaluate the model of classical conditioning as central to the processes in the human psyche. Another feature of behavioral therapy method is the help for self-help for the patient. The focus is on the patient and having considered the causes and genesis of his problems methods to put in our hands that will empower him to overcome his mental problems.

• 3.1 confrontation method
• 3.2 Operant procedures
• 3.3 Cognitive approaches
• 3.4 Other Processes

• 7.1 Situation in Germany

• 8.1 Development history of behavior therapy
• 8.2 Criticism of the behavior therapy

Principle of behavior therapy

Behavioral methods are based originally on the learning theory. The basic idea is that interference- conditioned behavior is learned and can be unlearned, or that adequate thought and behavior can be learned. Meanwhile, the behavioral therapy has been further developed in many ways and differentiated into different methods. In public, particularly known therapeutic techniques of behavior therapy are confrontations with triggering stimuli ( eg, exposure, systematic desensitization ) and the gain desired and the deletion of unwanted behavior.

Background

Basic assumptions

Originally pursued behavioral therapy according to John B. Watson (1878-1958) as opposed to deep psychological process, a "black -box " model, which essentially states that internal processes to outsiders remain obscure and should therefore not be analyzed. This attitude presented an attempt to get away from the intuitive approach of depth psychology, which, as Wolf Singer describes it, from the perspective of the first person ("I watch my feelings " ) lives and largely based on assumptions ( Oedipus complex, etc.) is dependent. behavior therapy examines the perspective of the third person ("we look together to the situation " ) and is therefore more similar to neurologically - neurobiological models, in which are a stimulus and the measurable response at the center.

Many authors describe the behavior therapy as a method to specifically treat symptoms of mental disorders and enhance the capacity of the patient. Depth psychological self-knowledge or exploring unconscious mental processes are not central. Behavior therapy techniques to enable the client a better self-regulation. Characteristic of the behavior therapy is the focus on current rather than past action causes to neglect without previous experience in the analysis of problem development. Thus, the focus is on observable behavior and its change.

The behavior therapy differs from psychoanalysis by the following assumptions: It is assumed that behaviors learned and can be unlearned. However, genetic differences are the causes of interference are taken into account, such as the vulnerability-stress models, so-called. Here, an inherited susceptibility to stress is considered as a prerequisite to a fault. In their assumptions about fault models, the etiological behavioral therapy is limited obliged certain theories and can therefore integrate new empirical insights into their models and theories.

It follows that problematic behavior should be seen as a result of learning processes in the first place and changed through the use of behavioral and learning principles. Decisive point here is a detailed behavioral analysis to determine the instantaneous causes a problem behavior. The treatment strategies are then customized to the patient's problems. In order to effect change, it is not absolutely necessary to explore the origins of the psychological problem exactly. Especially with well-defined, less complex mental disorders has shown good efficacy.

Method

Since a variety of behavioral therapy methods have been developed, there is not a single cognitive-behavioral standard procedures. Usually, however, stands at the beginning of a behavioral treatment, behavioral and problem analysis in which the patient's problems are examined in dependence on their conditions maintaining and in terms of their consequences. A widely used approach is the behavioral analysis to Frederick Kanfer, called the SORKC model.

This behavioral analysis took account of both the investigation of stimulus-response relationships usually have feelings, thoughts and physical processes with a. In addition, it also includes influences of the extended environment of the patient, such as the behavior of family members, work colleagues, friends and acquaintances. In the target analysis, the treatment goals are developed jointly with the patient, care being taken, whether the objectives are to achieve realistic and can be maintained after the therapy. The treatment finally ends often in a so-called " therapy contract " in which the patient and therapist mutually undertake to which tasks they undertake during therapy, respectively.

Modern and sophisticated forms of behavior therapy be considered in addition to the above SORKC model described aspects, the level of plans and system rules. Another analysis field is the therapist -client relationship, which nowadays is given more space than in the early days of behavior therapy. After the behavioral analysis / problem analysis together with the patient, the determination and specification of the goals of therapy, from which the therapist selects the interventions to be employed and used in consultation with and with the consent of the patient.

In the context of a specific therapy different behavioral methods can be used to refer to the behavioral and objective analysis. The overriding principle is the people to help themselves. That is, the patient should learn in therapy, again cope with their own lives. Known from the psychotherapy therapeutic basic variables such as authenticity, empathy and unconditional acceptance of the patient are an important aspect. In addition, the therapist usually pays attention also described in a complementary relationship formation, as Klaus Grawe. Another important step that must be taken into consideration in addition to the use of intervention methods, is to build a therapeutic alliance or of motivation for change. After using the actual interventions, an evaluation process will be conducted in which the success of the implemented methods is reviewed. This whole analysis and intervention steps are not strictly enforced in therapeutic practice separated from one another but are mutually dependent and are run in a feedback process over again.

Method of behavior therapy (selection)

In order to achieve the agreed objectives in the therapy contract therapy, more than 50 individual cognitive-behavioral therapy techniques can be used in behavioral therapy now. Some of them may be mentioned at this point:

Confrontation method

In the confrontation therapy methods are used that are based on the model of classical conditioning to achieve the target an extinction, counterconditioning or habituation. Exposure can be applied in a method for in - sensu massed or graduate form and in in vivo or. In addition, the time ( continuous) and the extent of the self-management (self exposure) can be varied. These methods are primarily used for phobias, panic and obsessive-compulsive disorder.

• Systematic desensitization: exposure to aversive stimuli hierarchically structured, first in sensu, then in vivo, coupled with relaxation
• Flooding ( overstimulation ): Direct confrontation with stimuli of the highest intensity
• Aversion therapy
• Response prevention
• Screen technology
• Eye Movement Desensitization and Reprocessing ( EMDR ) Francine Shapiro after
• Extinction ( habituation ) training ( graduated extinction ): In vivo confrontation with graded aversive stimuli
• Implosion ( from depth psychological tradition ): Confrontation with fear stimuli in the imagination
• Paradoxical intervention: statements that run counter to the expectations (especially in systemic therapy)
• Anxiety management training: combining different exposure strategies with other coping strategies

Operant procedures

Operant methods are based on the model of operant conditioning. The behavior by reinforcement ( increasing the frequency (probability ) of a behavior ) is or punishment (reduction of behavior frequency ) modified ( behavior modification). Positive reinforcement is done by supplying pleasant stimuli, negative reinforcement by removal of unpleasant stimuli. Direct punishment is done by supplying unpleasant stimuli, indirect punishment by removal of pleasant stimuli, such as time-out technique. Principles in the development of behavior: behavior shaping ( shaping), Verhaltenskettung ( chaining ), prompting, differential reinforcement, discrimination, fading and generalization and for the degradation of behavior: extinction, punishment and forgetting.

• Biofeedback Miller
• Token system (token economy)
• Response Cost
• Kontingenzverträge: target behavior and amplifiers are exactly (in writing) set
• Dialectical behavior therapy of borderline personality disorder by Marsha M. Linehan
• Social skills training ( social skills training), such as assertiveness training programs by Ullrich & Ullrich de Muynck; group training of social skills by Hinsch & Pfingsten or Personal Effectiveness Training by Libermann. In the related form of training of interpersonal skills is an essential component of Dialectical behavioral therapy ( DBT) by Marsha M. Linehan
• Habit Reversal Training by Azrin & Nunn
• RPG
• Communication Training
• Training of relaxation techniques (by a progressive muscle relaxation and autogenic training )
• Euthyme therapy ( enjoyment therapy)

Cognitive approaches

Cognitive approaches are based on cognitive theories of VT of behavior. An individual interprets and actively transformed information ( environmental stimuli ) and structures the experience ( organizing and evaluating the reality). Cognitions influence behavior as transformed stimuli. Behavior problems are the result of false assumptions, incomplete conclusions, inadequate self- instructions and inadequate problem -solving skills.

• Cognitive Therapy by Aaron T. Beck
• Rational Emotive Behavior Therapy ( REBT ), previously shortened Rational Emotive Therapy called (RET ), by Albert Ellis
• Anger Management by Raymond W. Novaco
• Stress management or stress inoculation training by Donald Meichenbaum
• Selbstverbalisation or self-instruction training by Donald Meichenbaum
• Problem solving training to D' Zurilla & Goldfried
• Attributionstherapie ( Seligman, Bandura )
• Self-management therapy after Frederick Kanfer
• Mindfulness-based stress reduction by Jon Kabat-Zinn
• Acceptance and Commitment Therapy ( ACT): Steven C. Hayes
• Cognitive restructuring
• Schema Therapy by Jeffrey E. Young

Other procedures

• Multimodal therapy ( BASIC ID) by Arnold A. Lazarus

Applications

Behavior therapy methods are used today in many mental disorders and psychosomatic diseases. According to the Opinion of the Scientific Advisory Board psychotherapy of the German Federal Government psychotherapy may be indicated in:

• Dependencies of psychotropic substances (eg alcohol dependence)
• (Partial) remitted psychotic disorders ( schizophrenia and Others ) and delusional disorders
• Mood disorders ( eg, depression )
• Anxiety disorders (eg, agoraphobia, specific phobia (list), social phobia, panic disorder, obsessive compulsive disorder)
• Stress disorders (eg, posttraumatic stress disorder )
• Dissociative, conversion and somatoform disorders
• Eating disorders (such as anorexia nervosa, bulimia nervosa)
• Personality disorders ( eg borderline personality disorder )
• Psychosomatic disorders (eg, tension headache, high blood pressure)

Molding

• Individual behavior therapy (CBT ) or cognitive behavior therapy (CBT, KogVT )
• Couples Therapy
• Family therapy
• Group therapy
• Community psychology
• Prevention

Behavioral Medicine

From behavioral therapy behavioral medicine has emerged. It deals with the application of behavioral therapy findings on general medical issues; For example, with the complementary treatment of physical illnesses such as hypertension, asthma, diabetes, tension headache, tinnitus by psychological means. This is about the fact that the patient learns adequate to deal with his illness. The behavioral health deals with health behavior.

Training as behavior therapists

Situation in Germany

Behavioral therapist (psychological or medical psychotherapist with technical instruction in behavioral therapy) Going through a 3 - to 5 - year training and obtaining a state license to practice practicing medicine. Is a prerequisite for the therapy training that one has a university degree in medicine or psychology with a focus on Clinical Psychology. In addition to the psychologists and medical doctors graduate teachers, social pedagogues, social workers and graduate diploma special educators can search for a corresponding 3 - obtain approval as a child and adolescent psychotherapist to 5 years of training. The license to practice as a psychotherapist can be applied for at the competent district government after passing the state exam. In addition to a successful conclusion it must be further conditions, such as mental health, no criminal record.

History and reception

Evolution of behavior therapy

Behavior therapy has its origins in the psychological theories of learning. Getting Started, which may be referred to as behavioral therapy, already took Paul Dubois and later Mary Cover Jones 1924. Jones therapied anxious children through confrontation with the anxiety-provoking object. After the 2nd World War, it was possible theoretically sound learning method systematically used to treat mental disorders, particularly phobias, where appropriate. Thus developed, for example, the South Africans Joseph Wolpe the Systematic desensitization, a graduate confrontation method, in combination with the Progressive muscle relaxation by Edmund Jacobson. On the other hand, the operant conditioning of behaviorist -oriented therapists such as Ayllon and Azrin was harnessed for therapeutic behavior modification. With her ​​were people with severe mental disorders such as schizophrenia be helped with psychotherapy with significant success for the first time. Since the 1970s, the principles of behavioral therapy on educational fields ( preschool, school, college, family, etc. ) have been transferred. This application is called "Pedagogical behavior modification".

Since the 60s and 70s of the 20th century, this classic behavioral therapy has adopted and increasingly integrates other areas of scientific psychology and psychotherapy. The term cognitive behavioral therapy or cognitive therapy reflects the fact that the behavior therapy, except with the external behavior change is also concerned with change in cognitive, conceptual schemes of man. Founder and pioneer of cognitive behavioral therapy have included Albert Ellis, Aaron T. Beck and Donald Meichenbaum. After this so-called cognitive turn of cognitive-behavioral therapies for the majority of mental disorders have developed. Among the newest forms of treatment include, for example, the Dialectical Behavioral Therapy (DBT ) for emotionally - unstable personality disorders. The DBT is based as other behavioral approaches to learning theory principles, but is significantly broader both of the topics that will be included in the treatment, as well as the methods repertory is as classic behavioral approaches. For example, value and meaning issues are discussed and meditative practices of Buddhist embossing integrated into the treatment. Increasingly there is talk of a "third wave" of behavior therapy, in addition to the DBT approaches such as functional analytic psychotherapy (FAP ), the Acceptance and Commitment Therapy ( ACT) or the Mindfulness-based Cognitive Therapy of Depression (English Mindfulness Based Cognitive Therapy, MBCT ) are attributed.

Criticism of behavior therapy

Behavior therapy is a proven effective treatment for numerous mental illness symptoms. Nevertheless directed against the behavior therapy or some of their techniques as well criticism as against other therapy and treatment procedures as well. Especially behaviorism than previous basis of VT has been criticized because of its reductionist approach. In behaviorism, it is assumed that internal mental processes such as thinking, feeling, etc. can not be scientifically explored. He goes in his research of the behavior of a black box. Furthermore, it is almost impossible to prove the causation of mental disorders through scientific learning experiences. Even compass -like circuits could be used in the documents for the accuracy of the assumptions of behaviorism incorrectly. Today, cognitivism is regarded as the leading paradigm in psychology. He can also be understood as the basis of behavior therapy, which always sees itself as a practical application of the findings of psychology. Cognitive change was necessary mainly because of inadequate explanations for recent findings of behaviorism. Cognitivism is criticized mainly because of its theoretical approach. " The concepts of cognitive psychology (eg, schemas ) are vague and not always well defined. " Critics argue that explanations of cognitive psychopathology were unhelpful. So is the claim that, for example Depressive have negative thoughts, hardly helpful for the explanation of the origin of this disorder, as it is already part of the diagnosis. The conclusion that trigger depression negative thoughts is not conclusive, since the postulated negative thought patterns can be the cause, but also a result of the depression.

Also criticized the use of aversion procedure. In the process of the client's aversion are mediated unpleasant stimuli in combination with problematic behavior, situations or objects, which is partially considered unethical. Aversion method is therefore only play a minor and largely historical role in the spectrum of behavior therapy.