Psychotherapy and Cognitive Behavioral Approaches

Behavioral therapy was originally developed largely as a reaction against the practice of psychoanalysis. The psychologists felt that psychoanalysis lacked empirical support and its effectiveness was not guaranteed. In those early years there was no appreciation among psychoanalysts and behavior therapists.

Since the early 1920, when Pavlov and Watson showed the power of conditioning to affect behavior, we observed a steady increase in the use of learning-based procedures developed to reduce levels of emotional discomfort of patients and eliminate maladaptive behaviors . As discussed below, the first approaches to behavioral therapy or behavior modification as it was known then, completely denying the importance of cognitions in the process of clinical improvement. Cognitions were not directly observable and could not be measured reliably, and therefore, advocates of behavioral therapy felt that an emphasis on cognitions was irrelevant to a science of behavior change. However, in the 1970s brought the beginnings of a radical change in this position. Psychologists began to integrate cognitive processes with behavioral techniques in the practice of what became known as cognitive behavioral therapy.

HISTORICAL FOUNDATIONS OF BEHAVIORAL THERAPY

Pavlov, Watson and classical conditioning

The practice of behavior therapy is closely linked to the principles of learning theory. Another chapter described the development of learning theory, starting with the observations of the Russian physiologist Ivan Pavlov that the dogs learned to salivate in anticipation of the meal, a response to which he referred to as reflex. Pavlov's work was refined and distributed in the U.S. thanks to psychologist John Watson. Watson worked to determine the principles of learning, focusing primarily on overt behavior and observable. Watson believed that people born with three basic emotions: fear, anger and love. However, it also

acknowledged that there were large differences between people in the stimuli that trigger those emotions. To explain this variability in the emotional response, Watson argued that people learn different stimulus-response associations through conditioning.

The experiment of Watson and Rayner was the first empirical evidence that emotions can be learned, this experiment was also the first laboratory demonstration of an "experimental neurosis? a human being: the acquisition of anxiety in response to a stimulus that does not represent a real threat to the individual.

Watson wanted to be able to apply the principles of learning and conditioning behavior modification or maladaptive problems. Despite the relevance of research with little Albert Watson and Peter were case studies, ie, interesting examples of how emotions can be learned and modified through the associated conditions. The studies of Watson planted the seeds for subsequent development of interventions based on principles of conditioning. In 1983 O.H. Howrer and W. M. Mowrer, described a conceptualization of bedwetting as a child's failure to respond to bladder distension waking and contracting the sphincter. Reported the use of a behavioral process of toilet training to treat bedwetting in children. Was placed in a child's bed pad attached to a bell, and rang the bell every time the pad is wet. After several trials with this procedure in children associated with the distinction of the bladder and sphincter contraction was prevented from enuresis.

Skinner and operant conditioning

In science and human behavior, Skinner proposed that the principles of operant conditioning could explain much of human behavior. A more important in the context of clinical psychology, Skinner was harshly criticized the psychoanalytic approach, which prevailed in psychotherapy, and instead offered a conceptualization behavioral therapy, behavior modification.

And reciprocal inhibition Wolpe

J. Wolpe (1958), based on the principle of reciprocal inhibition described by Sherrington (1906), argues that if a response is matched antagonistic to anxiety in the presence of anxiogenic stimuli, so that is accompanied by a complete or partial removal the anxiety response, the link between these stimuli and the anxiety responses weakens. In other words, if the patient is taught to experience relaxation instead of anxiety while imagining these scenes the real life situation that the scene is cause less discomfort.

Eysenck and behavioral therapy

Hans Eysenck wrote in 1951, which undoubtedly is one of the most controversial scientific articles in the history of clinical psychology, which questioned the effectiveness of traditional psychotherapy. This article encouraged clinical psychologists to develop new forms of treatment. Eysenck in 1959 coined the term behavioral therapy, and a year later published a book titled Behaviour Therapy major and the Neuroses. In 1963, his student S. J. Rachman, Eysenck founded the first journal exclusively behavioral, Behavior Research and Therapy, a journal where behavioral therapists still running today.

Throughout this history of behavioral therapy, Watson and Skinner Wope, it is clear that although there are important differences of approach early behavioral approaches all were united by two convictions: first, it was unnecessary to posit the existence of drives and unconscious processes, and second, it is more likely that the therapy is effective if you focus on maladaptive behaviors rather than discrete categories of psychiatric diagnosis more diffuse.

BEHAVIORAL THERAPY

All forms of behavior therapy focus largely on providing learning experiences designed to change maladaptive behaviors of the patient. The following are five principles that represent the strongest foundation on which behavioral therapies are built:

All behavior, normal and abnormal, is acquired and maintained in accordance with the same basic principles of learning. It is not necessary to infer a cause or underlying reason for maladaptive behaviors, conduct disorder are, they are not a manifestation or sign of a disorder or underlying disease process. Usually it is not necessary to know how learned a specific problem behavior, the emphasis of treatment must not be historical, but the factors that currently maintain the behavior. Most abnormal behaviors are subject to change by applying the principles of learning, by which unlearn maladaptive behaviors are learned behaviors and replace them with new and better adapted. Treatment methods are specified accurately be replicated and adapted to the needs, strengths and situation of each client treatment progress is evaluated on an ongoing basis, and performs an objective assessment of treatment outcome.

Goals

Given the emphasis in behavioral therapy the patient's maladaptive behaviors, an important overall goal of this form of therapy is to reduce or eliminate the patient's problem behaviors and increase the frequency of behaviors more adapted. The goals of behavior therapy, in general, be clear and specific. In addition, behavioral therapists actively working in partnership with their patients in the planning of therapy goals and implementation of procedures designed to achieve those goals. Much of the work in behavior therapy occurs outside the therapist's office, whether the therapy is performed directly in the environment of the patient or the assignment of tasks performed by the patient between sessions.

Training and supervision

Unlike psychoanalysts, behavior therapists are not required to undergo therapy. Behavioral therapy, as noted. It is a

strong empirical psychotherapeutic approach spleen, firmly on the principles of learning. Therefore, behavioral therapists must know in depth the main theories of learning, including classical and operant conditioning and social learning theory. The great importance designed to overt behavior and behavior change also extends to monitoring in behavior therapy. Therefore, it is not surprising that behavioral therapists are supervised frequently observed by their supervisors when conducting therapy and are qualified scales that assess their skills and progress as behavioral therapists.

The importance of assessment in behavior therapy

The relationship between evaluation and therapy is stronger for behavioral counseling therapies than any other approach to psychotherapy, including psychoanalysis and phenomenological therapies. It should be emphasized that from a behavioral perspective, the evaluation has profound implications for therapy. Mueser and Liberman (1995) outlined a behavioral approach to assessment and therapy describes the interdependence of these two tasks. These researchers note the importance of identifying the behavior or problem behavior so objectively and accurately as possible using a variety of assessment procedures that include self-report questionnaires, structured interviews, self-monitoring and behavioral observation.

Methods

Behavior therapists have a wide variety of techniques to teach or increase adaptive behaviors and eliminate maladaptive behaviors. Due to the number of available techniques to change behavior, it is tempting to consider behavioral therapy as a single collection or array of procedures.

BEHAVIORAL THERAPY APPLICATIONS SPECIFIC PROBLEMS? Ficosa

Procedures to reduce the fear

Based on recent epidemiological studies, it is known that the fears and phobias are among the most common forms of psychological distress. Fears can also be learned indirectly, through observation. Most behavioral approaches to reducing the fear involve some form of patient exposure to the feared stimulus. In

Sometimes this exposure is performed using the patient's imagination, ie the patient is instructed to imagine getting in touch with the feared object or situation. At other times the show is real, or live, a situation where the individual actually faces the purpose of your fear.

Systematic desensitization

Systematic desensitization is one of the most studied behavioral and widely applied for the reduction of fears and phobias. It is usually used when a patient has the skills to engage in appropriate behaviors or adapted, but instead, avoid feared stimulus or situation. Systematic desensitization is one of the behavioral techniques designed to reduce anxiety in humans first are clearly defined and tested. There are three distinct steps in systematic desensitization. First, as the patient may be anxious when you are relaxed, is trained in one or more specific techniques of relaxation. The second stage involves the development of a hierarchy of anxiety and final step is really the heart of this procedure: successive pairing relaxation with each of the stimuli in the hierarchy of patient anxiety.

Exposure treatments

As with many procedures in behavior therapy, exposure treatments have their roots in animal models of psychopathology. Behavior therapy for fears and phobias can often involve exposure to feared objects. Implosive therapy seeks to extinguish the fear response by exposing individuals eager to situations that cause fear and forced to stay in these situations until the activation is reduced or eliminated.

A variant of implosive therapy, known as response prevention, has been used successfully in the treatment of obsessive-compulsive disorder. Patients with this disorder characterized by unwanted thoughts and behaviors and can not stop. Response prevention in patients exposed to stimuli that cause obsessive thoughts, but are prevented from performing the compulsive behavior used to reduce the anxiety associated with the stimuli.

Difficulties in social functioning

Social skills and assertiveness training, behavioral therapists have used social skills training to treat disorders characterized by difficulties in social or interpersonal. In the past two decades, a large amount of published psychological research has shown a consistent association between problematic social functioning and psychopathology, usually depression and anxiety, but also social phobia and schizophrenia. Many researchers have interpreted these findings show that people with these particular forms of psychopathology are deficient in social skills.

Behavior therapists use several procedures to help a patient to acquire more social skills or be more assertive. The most effective programs for social skills training include many of the following components:

Evaluation of the benefits, behavioral deficits and excesses of the patient in social situations. Selection of specific social behavior modification. Modeling appropriate behavior by the therapist. Instruction or training of appropriate behaviors and role-playing and review by the client. Feedback and positive reinforcement of small steps that lead to desired behavior. Frequent tasks to engage in particular social behaviors outside of therapy.

Contingency management

Contingency management is a general term used to describe a class of procedures based on the principles of operant conditioning to change behavior by controlling its consequences.

Shaping

Put in the simplest way, the concept of strengthening a behavior through reinforcement requires that the conduct is issued first, and then reinforces it. However, in practice the process is not as simple, as there are many behaviors that are not emitted spontaneously. In such cases the desired behaviors are not likely to strengthen because they occur naturally, hence, is used to develop a behavior shaping final reinforcing successive approaches, or gradual steps to the finish line. At first, they reinforce the behaviors that represent the first step to display the desired behavior, and then gradually raise the standard of behavior which is reinforced, until the individual issuing the final desired behavior.

Contingency Contract

The contract contingencies, usually involves developing and signing a formal agreement that describes exactly the behavior expected of each participant and the precise consequences of behavior. Contingency contracts can be established between the therapist and patient, describing in detail the target behaviors and the consequences of doing or not.

Token economy program

The token economy programs represent applications of the principles of contingency management to groups of people rather than individuals. In fact, much of our society is, in essence, a token economy system based on the principles of contingency management: people are rewarded with tokens contingent on performance or conduct. There are several aspects of the development and implementation of token economy programs. For example, changing behaviors that will be operationalized to be selected first and also the symbolic tokens or other reinforcers. Participants must be able to exchange these tokens for goods, services or privileges.

Reduction of undesired behavior: aversive conditioning

The goal of aversive conditioning to reduce the occurrence of undesirable behaviors such as drinking, smoking or overeating, by pairing the behavior with a noxious stimulus. Thus, a behavior which at first

was associated with pleasure or reward, is conditioned to be associated, however, with negative emotions and feelings such as anxiety and nausea. As can be inferred, such procedures often are unpleasant and can include harmful chemicals or electric shock. Most often, aversive conditioning is used to remove or destructive addictive behaviors.

Cognitive Behavioral Therapy

Modeling

Albert Bandura was a pioneer both in the therapeutic use of modeling or observational learning, to address fears and phobias, such as teaching skills and positive behaviors. Bandura noted that the model can be used to facilitate or inhibit the expression of behavior that individuals can and do. The model allows more complex behaviors are learned relatively quickly through observation.

The transition to cognitive therapy

The theory and results of Bandura's observational learning provided the basis for subsequent integration of cognitive and behavioral therapy. Michael Mahoney's book published in 1974, Cognition and Behavior Modification, and the volume published in 1977 Donald Meichenbaum, Cognitive-Behavior Modification: An Integrative Approach, developed further the role of cognition as a mediator of change in behavior therapy and strengthened the practice of behavioral therapy cognitvo. About the same time, Albert Ellis and Aaron Beck perfected his model of therapies for emotional disorders included not only a strong cognitive component, but, more importantly, highlighted the dysfunctional cognitions or problematic patterns of thinking, as a direct cause of psychological distress and as crucial to produce therapeutic change.

Cognitive Therapy

Both rational emotive therapy of Albert Ellis as Aaron Beck's cognitive therapy has caused a profound influence on the practice of clinical psychology. Based on his vision of the role of cognitions in contributing to problems in the emotions and behaviors, Ellis and Becj therapeutic interventions developed in order to change the way people think to improve their emotional and behavioral functioning.

Ellis' Rational Emotive Therapy

Ellis formulated what became known as the ABC theory of dysfunctional behavior. Contrary to the prevailing view at the time, they argued that stressful life events, known as activating events (A) do not cause psychopathology or emotional consequences (C) such as depression and anxiety. Instead, Ellis says they are irrational beliefs (B) or unrealistic interpretations people about events in their lives that leads them to be depressed or anxious, Ellis believes that when a person or a negative event experiemnta unpleasant is logical and rational belief about that fact, but also involves "automatically? in a series of irrational or dysfunctional beliefs about the event.

Beck's Cognitive Therapy

Beck developed cognitive therapy based on clinical experience with depressed patients. Beck's remarks that the dreams of depressed patients were full of negative content play a central role in the onset and course of depression. He postulated that depressed people have a negative view of themselves and the world and have no hope for the future. Beck also proposed that depressed people develop negative cognitive schemas or structures through which they perceive and interpret their experiences.

Cognitive therapy for depression and anxiety

Based on their theoretical formulations, Beck developed cognitive therapy as a way of treating depression and anxiety. Cognitive therapy focuses primarily on the identification or distorted cognitions with the belief that these changes will lead to a reduction in symptoms of discomfort. However, cognitive therapists can also assign behavioral tasks to patients and give them training in problem-solving skills. Cognitive therapy is time limited, rarely exceeding 30 sessions and usually employs 15 to 25 sessions.

In the first sessions of cognitive therapy, the therapist explains to the client's cognitive theory of emotional disorders, highlighting the way in which negative cognitions contribute to discomfort. The intermediate session of the

Cognitive therapy is dedicated to help clients identify and modify the underlying core beliefs that lead to negative thoughts. In the final sessions of cognitive therapy, the therapist has two important goals. First, working with clients to consolidate the gains already achieved this in therapy. Second, because many emotional disorders such as depression and anxiety show a high rate of recurrence or relapse, in recent sessions of cognitive therapy, the therapist focuses on trying to prevent the recurrence of the disorder.

Assessment of cognitive therapy

Barber and Muenz found that patients characterized by avoidance behaviors in relationships perform better in cognitive therapy to interpersonal psychotherapy, while patients with a more obsessive show the opposite pattern of response. Finally, it is important to note here that we have found that cognitive therapy is effective in the treatment of disorders other than depression. In his recent review of psychotherapy for adults with empirical support, DeRubeis and CritsChristoph adivirtieron that cognitive therapy has been used successfully in treating the following conditions: the generalized anxiety, obsessive-compulsive disorder and anxiety. There are also more and more texts that document the effectiveness of cognitive therapy in the treatment of eating disorders like bulimia and anorexia nervosa.

In addition to studies demonstrating the effectiveness of cognitive therapy in the treatment of various forms of cognitive therapy in the treatment of various forms of psychopathology in adults, rapidly growing literature that shows that cognitive therapy is also effective in the treatment of emotional disorders in children.