Behaviorist Therapies

Behaviorist Psychotherapy
Key Terms:
Behavioral Shaping Unconditioned Stimulus Unconditioned Response Conditioned Stimulus Conditioned Response Operant Conditioning
Positive Reinforcement Negative Reinforcement Positive Punishment
Negative Punishment Removal of Reinforcement Extinction
Shaping Chaining Token Economy
Base Rates Nonverbal Operant Response Verbal Operant Response Self-Monitoring Behavioral Observation Assertiveness Training
Self-Control Procedures Implosion Therapy Flooding w/Response
Reciprocal Inhibition Systematic Desensitization

Thought Questions:
1. Is behaviorist theory Lockean, Kantian, or Constructivist in epistemology?
2. What forms of causality do behaviorists assume?
3. What forms of causality does their theory not account for or actively theorize against?
4. What forms of meaning exist in behaviorist theory?
5. What forms of reasoning exist in behaviorist theory?
6. What does it mean to you that we are inherently products of reinforcement?
7. Are you comfortable viewing clients in terms of their reinforcement history?
8. Would you feel comfortable if someone understood you strictly in terms of your reinforcement history?
9. Are warm and positive feelings between counselor and client “real”, or simply reinforcers, or simply epiphenomenal?
10. In your opinion, what disorders are explained most simply by behaviorists?
11. How can you see yourself applying behaviorist techniques?
12. According to behaviorist theory, is morality “real”?
13. According to behaviorist theory, are there “adaptive” and “maladaptive” behaviors?


B. F. Skinner on theorizing: “An effort to explain behavior in terms of something going on in another universe, such as the mind or the nervous system” (Evans, 1968, p. 88).


Objectives:
1. To review basic concepts of behaviorist theory
2. To discuss basic concepts of behaviorist theory
3. To practice applying behaviorist theory to a case
4. To discuss techniques of behaviorist theory
5. To critically think about behaviorist theory starting with thought questions

Don’t dismiss behaviorist theory; don’t turn off your brain too quickly
Story about B.F. Skinner as told by Carl Rogers:

“A paper given by Dr. Skinner led me to direct these remarks to him: From what I understand Dr. Skinner to say, it is his understanding that though he might have thought he chose to come to this meeting, might have thought he had a purpose in giving this speech, such thoughts are really illusory. He actually made certain remarks on paper and emitted certain sounds here simply because his genetic makeup and his past environment had operantly conditioned his behavior in such a way that it was rewarding to make these sounds, and that he as a person doesn’t enter into this. In fact if I get his thinking correctly, from his strictly scientific point of view, he, as a person, does not exist.” In his reply Dr. Skinner said that he would not go into the question of whether he had any choice in the matter (presumably because the whole issue was illusory) but stated, “I do accept your characterization of my own presence here” (Rogers, 1963, pp. 271 – 272).

What do you think about this?

Fundamental assumption: We are biological organisms genetically programmed for survival. As such, any behaviors we emit are behaviors that should further our chances of survival and/or the survival of our offspring. We are genetically predisposed to seek out pleasant or life-giving stimuli and to avoid unpleasant or life-destroying stimuli. However, the environment does not always offer stimuli in a consistent manner, and problems can occur.

One of the primary ideas offered by behaviorist theory is that of Behavioral Shaping. Behavioral Shaping is the process by which reinforcers and punishments are applied to an organism to gradually and consistently elicit the behavioral response desired.
Two examples:
1. Junior and the mini-wheats
2. Teaching Jotham how to dress himself

But first, let us review some terms:
Unconditioned Stimulus: A stimulus that elicits a response physiologically and naturally, without learning having to take place.
Unconditioned Response: The natural physiological response elicited by the unconditioned stimulus without learning taking place.
Conditioned Stimulus: A conditioned stimulus is one that is paired with an unconditioned stimulus to elicit the same response that the unconditioned stimulus did.
Conditioned Response: A conditioned response is one that is elicited by the conditioned stimulus to demonstrate that learning has taken place. It is identical to the unconditioned response, only elicited by the conditioned stimulus.
1. Pavlov’s dogs
2. Nausea-inducing drugs to fight alcoholism (US = drug, UR = vomiting, CS = alcohol, CR = aversion)

But what about the gradual shaping of behavior that we talked about earlier with Junior and Jotham? For that we need to look at operant conditioning. Operant Conditioning in Skinner’s terms is the study of what used to be dealt with by the concept of purpose. The purpose of an act is the consequences it is going to have. These consequences are established by the environment in the past. Behavior is caused by the stimulus of the environment, not by any interior goal or felt intention. Another way of saying that is: “Operant conditioning focuses on the response and asserts that responses followed by reinforcers are likely to be carried out again, and the more we reinforce these responses (the operants) the more likely they will be to appear. This ties in with a fundamental assumption of behaviorist theory: People are not insane, nor are they bad, their environment merely taught them maladaptive behaviors and it is up to us to cause them to learn adaptive behaviors.
1. Anti-teleological argument

The process of operant conditioning: Operant conditioning relies on reinforcers and punishments to shape behavior. Behavior is shaped by what Skinner called “the method of successive approximation”. You encourage the behavior you want by reinforcing the behavior that approximates it. You then reinforce the behavior that better approximates it still. This is also known as shaping.

Do not confuse shaping with chaining. Chaining is the process by which entire behaviors are reinforced together to make an entire chain of behavior. For example, when driving you could shape someone to turn the wheel the appropriate amount to make a turn, and then chain that with all the other behaviors (clutch, gas, signal) so they could drive to Indianapolis safely. Shaping and chaining can take place apart or separate.

You do this by the application of reinforcements and punishments, defined as follows:
Positive Reinforcement: The application of a pleasant stimulus to encourage behavior.
Negative Reinforcement: The removal of an unpleasant stimulus to encourage behavior
Positive Punishment: The application of an unpleasant stimulus to discourage behavior
Negative Punishment: The removal of a pleasant stimulus to discourage behavior

One of the things that will happen if there is a removal of reinforcement in the environment is extinction. Extinction occurs when the behavior is no longer reinforced, so the organism no longer emits that behavior. A quick example: Children not saying “please” when they wanted something – response: ignore them.

Small Group Work
1. Think of a client suffering from Borderline Personality Disorder. Your client, Betty, exhibits the following behaviors in the comprehensive treatment clinic where you work. First, she “splits” the staff, which means that she idealizes whichever staff member she’s with (tells them how wonderful they are), while at the same token telling that staff member how “bad” the others are. She has even made hints about improprieties made by other staff members. This has the staff up in arms and fighting at staff meetings. Her other behaviors entail self-cutting “to distract from the pain” and repeated late-night calls to the on-call pager has resulted in two hospitalizations.
2. What are some reinforcers or punishments that you might try as a therapist? What behaviors would you want to extinguish by not reinforcing?

Now let’s talk about particular techniques used by behaviorist therapists.

1. Token economies: This usually takes place in residential treatment. The therapist designs a particular token and enlists the personnel of the entire staff. The staff then gives patients tokens based on their appropriate behaviors. In some places, staff even takes tokens away if the clients do not behave adaptively. The tokens are traded in for pleasant things that the patient might want. Something as simple as watching TV, getting chocolate from the hospital store, or even purchasing the opportunity to go on a field trip. In order for this to work, and end goal must be established, and base rates computed. Base rates are the measure of the frequency of a particular behavior before the token economy was established. As the token economy is implemented over time, the rates of change in behavior are compared against the base. If no change is occurring, then the system needs to change.
a. Example of work detail

2. What about talk therapy? Behaviorists have a distinct use for talk therapy as well. They distinguish between nonverbal operant responses and verbal operant responses. Nonverbal operant responses operate on the behavioral environment in some way, such as when we put a glass of soda to our lips because we are thirsty. Verbal operant responses, on the other hand, are “behavior reinforced through the mediation of other persons”. Verbal operant responses operate on the behavior of another person. For example, our putting a soda to our lips because we were thirsty is nonverbal, but us saying “Hey, grab me a soda” is verbal, because then your friend tosses you a soda. You emitted that verbal behavior and you were reinforced for it. Meaning or intention has nothing to do with this process. Verbal statements are under the control of the effects they have on other people, which is another way of saying the consequences of the verbal statements are to be noted in interpersonal behavior.
a. When you’re in the therapy room, the behaviorist counselor manipulates the verbal statements. The therapists are not the originators of this control any more than the clients are. The therapist, by behaving in an adaptive fashion, naturally responds positively to the adaptive verbal behaviors of the client, while punishing or removing reinforcement for the maladaptive verbal behaviors of the client.
i. How? By saying “mm-hmm” or “good” when the client says something that you would like to hear, such as “I think I can do this”. Behaviorist researchers have demonstrated that you can elicit certain verbal behaviors by doing this.

3. Another behaviorist technique entails both self-monitoring and behavioral observation. Self-monitoring is the process by which the client keeps meticulous track of certain behaviors as well as the context and what led up to certain behaviors. This is then followed by behavioral observation on the part of the treatment team or psychologist, who carefully tracks the patient’s behaviors. The psychologist then manipulates the environment or the behavior of the staff to elicit appropriate behaviors from the patients.
a. Inpatient obesity control program. Self-monitoring alone was effective as well as the manipulations of the psychologist.

4. Assertiveness training is another form of behavioral therapy. The therapist starts out by modeling assertive behavior, breaking it down in terms of eye contact, voice inflection and volume, as well as posture. They therapist then reinforces the client for successive approximations of assertive behavior. This works particularly well in groups where someone can get different models and different degrees of feedback from the other participants.
a. Social-skills training with someone who is socially avoidant

5. Self-Control procedures. This process is one in which the clients themselves monitor their own behavior and change their behavior when they’re away from the psychologist. The psychologist is an important ingredient for conditioning, but a good deal of the conditioning can happen outside of the therapist’s office. Self-control procedures are ones in which the client is given very detailed and very specific guidelines and even charts to monitor their behavior. Very specific goals are established for the behaviors, and charts are kept comparing the behavior of that moment to the goal by the client. For example, of someone is in an outpatient drug rehabilitation program, a specific goal might be set with the psychologist that the client will not take any illicit drugs. The client then keeps track of how they do in regards to this specific goal, and write down how well they did.

6. Implosion therapy. In the case of phobias, someone has learned that a particular stimulus creates overwhelming anxiety in them. So, they do whatever they can to avoid that stimulus. Implosive therapy requires that the client covertly expose themselves (imagine) anxiety-provoking stimulus, then interpret the stimulus psychodynamically. Seems to work more based more on extinction than interpretation.

a. Daryl, obsessively checking the clock 50 times a night to make sure that it was not turned on. If it were left on, he feared he would perish horribly in flames. He is instructed to imagine himself going home and leaving the radio on all night and to imagine that he is dying horribly in the resultant fire. This would then be psychodynamically interpreted.
7. Flooding with response prevention: This is the technique-of-choice for agoraphobia, and some would argue, for OCD. This is the process by which you expose your clients to a feared stimulus, and you prevent any response they might have to that stimulus. The conditioned stimulus (the feared object) floods them with anxiety (the unconditioned response). However, they are not allowed to leave the feared stimulus, thereby extinguishing the conditioned response (leaving).
a. Therapy for those afraid of snakes, heights, and the dark.

8. Systematic desensitization: Assumed by Wolpe’s reciprocal inhibition model which states that two incompatible responses cannot exist together (relaxation and tension, for example). In this procedure, an anxiety-provoking stimulus is paired with a relaxation response. Rather than pairing the actual stimulus with the relaxation response from the outset (which would be more like implosion therapy). Instead, the therapist pairs increasingly anxiety-provoking stimuli with the relaxation response. For example in the case of an arachnophobe, the therapist would induce a state of relaxation in the client, then show them a picture of a spider. Later, the therapist would show them a plastic model of a spider, then elicit the relaxation response. Then, still later, the therapist would have them hold the plastic spider, while inducing a relaxation response. The end goal would be to have the client hold an actual spider while perfectly relaxed. The process is one of desensitizing the client in a systematic way, making an anxiety provoking stimulus no longer salient.