Describe the principal techniques of behavioral therapy and show how any two of them may be applied in the treatment of an anxiety disorder - What are the merits and demerits of this type of approach to psychological disorders?
Describe the principal techniques of behavioral therapy and show how any two of them may be applied in the treatment of an anxiety disorder.
What are the merits and demerits of this type of approach to psychological disorders?
Behavioural therapy is based on a behavioural model that suggests that all behaviour, normal and abnormal is learned, or conditioned. Any "symptoms" described by the client are learnt behaviour and not the results of some underlying complex. Therefore behavioural therapies help the client to improve his/her behaviour by learning and unlearning, conditioning and extinguishing forms of behaviour, which are adjusted or maladjusted (Eysenck, 1976).
This essay first describes behavioural therapies such as systematic desensitisation, in vivo exposure, flooding, modeling and behavioural rehearsal. Then it applies systematic desensitisation and modeling to a bird phobia and finally it discusses the advantages and disadvantages of these behavioural therapies when used to cure psychological disorders.
Systematic desensitisation and in vivo exposure are both counter-conditioning processes, and were first developed by Wolpe (1958). The client is first trained to achieve complete relaxation and respond quickly to suggestions to feel relaxed so that these can produce an immediate relaxation response (if people find it very hard to relax hypnotises or drugs can sometimes be used to help the client to relax). Relaxation inhibits any anxiety that might be elicited by the object, as it is difficult to be relaxed and anxious at the same time. After having learnt to relax, the client and therapist construct a hierarchy of the anxiety-producing stimuli. The situations are ranked in order from the one that produces the least anxiety to the one that is most fearful. In systematic desensitisation the client is then asked to relax and imagine each situation in the hierarchy, starting with the one that is least anxiety producing. As soon as the client can imagine her/himself in the situation without any increase in muscle tension, the therapist will ask him/her to imagine the next situation on the list until the list is completed and the anxiety-provoking situation eradicated. In vivo exposure requires the client to actually experience the anxiety-producing situations.
In flooding the patient is exposed to the conditioned stimulus that produces fear without the opportunity to escape until the fear subsides. The situation itself may be preceded by the client listening to a tape recording of an account of their most feared situation. This is repeatedly played until the client no longer fears the same degree of terror. He is then exposed to the actual situation. Flooding can only be carried out with the full consent of the clients involved.
In modeling the client is shown a "model" (in person or on a videotape) that copes well with his own fears and goes through the anxiety-provoking situation without getting hurt. This encourages him/her to replace their maladaptive responses with adaptive behaviour by imitating the models behaviour and applying useful coping strategies. It teaches the client new skills and reduces his/her fears. (Atkinson et al, 1996)
In Behavioural rehearsal the therapist determines the kinds of situations in which the person is passive and then teaches the client more adaptive behaviours and assertive responses by rehearsing and practicing them. ...
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In modeling the client is shown a "model" (in person or on a videotape) that copes well with his own fears and goes through the anxiety-provoking situation without getting hurt. This encourages him/her to replace their maladaptive responses with adaptive behaviour by imitating the models behaviour and applying useful coping strategies. It teaches the client new skills and reduces his/her fears. (Atkinson et al, 1996)
In Behavioural rehearsal the therapist determines the kinds of situations in which the person is passive and then teaches the client more adaptive behaviours and assertive responses by rehearsing and practicing them. This is done by using role-play techniques with the therapist in which the client rehearses effective responses to difficult situations and then gradually applies these in real-life situations (Atkinson et al, 1996).
To get better understanding of these techniques, systematic desensitisation and modeling are applied to the anxiety disorder of a person with a bird phobia. For both therapies the first session would consist of the therapist listening to the client to find out what exactly the problem is and where and in which situations anxiety arises. In a systematic desensitisation therapy, the patient would, in the next couple of sessions, be taught to relax. The client might learn to relax different muscles in a systematic way and will thereby know what muscles feel like when they are totally relaxed. If the client finds it very hard to relax, hypnotises or drugs might be used to help her/him to relax. The client might be encouraged to practice the learnt relaxation techniques in the sessions and at home until he/she can relax on command. Then a construction of an anxiety hierarchy would be made. This could look like follows:
) Seeing a picture of a bird.
2) Seeing a bird in a movie.
3) Seeing a bird out from behind a window.
4) Seeing a bird in nature
5) Being in a bird sanctuary.
6) Seeing the therapist handle a bird
7) Handling a bird
In the next couple of sessions, the client will be asked to imagine the situations in the hierarchy, starting with the first one on the list, whilst being relaxed. As soon as anxiety is felt, which is signalled by some previously arranged signal such as raising the finger, the therapist encourages relaxation and then, when relaxation is achieved, leads the client back to the item that had caused the anxiety to arise. The client moves through the hierarchy until the most feared stage can be imagined without eliciting any anxiety. The client should then be able to face birds in normal everyday life. If modeling is the chosen therapy form then the sessions might be built up as follows. To begin with, the client might be given a tape in which someone (the model that is not afraid of birds) talks about birds, how harmless they are and that he/she enjoys watching them. The client would listen to this tape over and over, both in the therapy sessions and at home. Then the client might be given videotape in which the model looks at and handles birds without a problem. This tape again, would be watched repeatedly. Then the patient would watch his therapist look at and handle birds. This should help the client to realise the irrationality of his fear by showing him that nothing happens to the therapist when handling them and thereby gives the client a rational approach to the phobia. The different models enable the client to watch another person go through the feared anxiety-provoking situation of seeing or handling birds without getting hurt. He/she will learn to act like the models in the tape, videotape and the therapist himself. The client will learn not to be afraid of birds. Both of these behaviour therapies and many others as well, could be used to cure this phobia, but the question is, how effective these really are in curing the disorder. This is discussed in the next section.
The movie "Clockwork Orange" portrayed a negative image of behaviour therapy, describing it as a mechanistic, anti-humanistic and maybe even cruel treatment. The "hero's" inappropriate behaviours were suppressed, but were not replaced with acceptable ones, resulting him to be helpless and unprotected. More specific demerits of behavioural therapies should be analysed. First of all, both psychoanalytic approaches and the medical model oppose the behavioural model and assert that symptoms are the expression of an underlying disease or complex. Purely symptomatic treatments such as behavioural therapies that do not cure the complex, result in the symptoms returning or being replaced by a new one and therefore do not cure the problem in the long term.
Secondly behavioural therapies can be extremely unpleasant experiences. Flooding, for example, can be very painful and difficult for the client. Although it is one of the most effective therapies, it is one of the least popular with patients. If the client is not strong enough to complete the session, it might have more negative then positive effects on, making the client even more scared and anxious.
Thirdly there is a risk of manipulation of the client by the therapist. Under hypnosis, which may be used to help the client relax in systematic desensitisation, the therapist has total control over the client, a power that could easily be misused.
Fourthly, as the patient and client rarely meet more then once a week, self-regulation is very important to ensure that progress is made outside the therapy session. If this is not maintained, then the possibility arises, that although progresses are made in the therapy sessions, these do not directly transfer to real life situations.
Finally behavioural therapies aim at changing maladaptive behaviour and teaching adaptive behaviour. The question therefore arises of who is to decide what behaviour is appropriate and what isn't. Homosexuality for example was in the past thought to be an inappropriate tendency, which was to be suppressed and changed.
Manipulation, possible long-term and real-life ineffectiveness, the difficulty for the patient to follow the therapy and ethical issues are to be taken into account when considering a behavioural therapy approach to a psychological disorder. Although these are a considerable number of demerits, empirical evidence has shown, that behavioural therapies yield a much higher level of success then most other therapies (Gregory, 2001).
The use of behavioural therapies has increased significantly in the past few years. Why is this? First of all, clinical and experimental studies have provided empirical evidence, which demonstrates a high level of efficiency and speed of the cure in behavioural therapies that other therapies lack.
Secondly, as behavioural therapies take much fewer sessions then traditional psychodynamic approaches, they are more cost and time efficient for the client. This fits very well into the current career-orientated, hurried lifestyle many people experience in most industrialised countries.
Thirdly, the client immediately learns how to handle difficult situations and can therefore experience an immediate improvement in his everyday life. Through other therapy methods such as psychoanalytic therapies, the client might come to understand how and why the maladaptive behaviour came to be, but will not be provided with the means to change it.
To summarize it should be pointed out, that behavioural therapies such as systematic desensitisation, in vivo exposure, flooding, selective reinforcement and modeling are very effective ways of treating psychological disorders. Furthermore, increased development of behavioural therapies has only occurred in the last 20 years, suggesting that in the future these should become even more refined and effective (Gregory, 2001).
References:
Atkinson, L., Atkinson, C., Smith, E., Bem, D., Nolen-Hoeksema, S. (1996). Hilgard's
Introduction to Psychology. Twelfth Edition. Harcourt Brace and Company.
Gregory, R., Zangwill, O. (2001). The Oxford Companion to the Mind, Oxford
University Press, New York.
Paul, G. (1966). Insight vs. desensitisation in psychotherapy. Stanford University Press.
Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford University Press.
