Behavioral therapy is a term that describes a wide range of techniques used to change maladaptive behaviors. The goal is to reinforce desirable behaviors and eliminate undesirable behaviors.
Behavioral therapy has its roots in the principles of behaviorism, a school of thought centered on the idea that we learn from our environment. This approach emerged in the early 20th century and became a dominant force in the field for many years. Edward Thorndike was one of the first to refer to the idea of behavior modification.
Unlike types of therapy that are insight-based (such as psychoanalytic therapy and humanistic therapies), behavioral therapy is action-based. Thus, behavioral therapy tends to be very focused. The behavior itself is the problem and the goal is to teach people new behaviors to minimize or eliminate the problem.
Behavioral therapy suggests that because the old learning led to the development of a problem, the new learning can solve it.
Types of behavioral therapy
There are several types of behavioral therapy. The type of therapy used may depend on a number of factors, such as the condition being treated and the severity of the person’s symptoms.
- Applied behavioral analysis uses operant conditioning to shape and modify problem behaviors.
- Cognitive behavioral therapy (CBT) is based on behavioral techniques, but adds a cognitive element, focusing on the problematic thoughts underlying the behaviors.
- Cognitive-behavioral play therapy uses play to assess, prevent or treat psychosocial problems. The therapist may use play to help the child learn to think and behave differently.
- Dialectical-behavioral therapy (DBT) is a form of CBT that uses behavioral and cognitive techniques to help people learn to manage their emotions, cope with distress, and improve interpersonal relationships.
- Exposure therapy uses behavioral techniques to help people overcome their fears of situations or objects. This approach incorporates techniques that expose people to the source of their fears while practicing relaxation strategies. It is useful in treating specific phobias and other forms of anxiety.
- Rational emotive therapy (REBT) focuses on identifying negative or destructive thoughts and feelings. People then actively challenge those thoughts and replace them with more rational and realistic ones.
- Social learning theory focuses on how people learn through observation. Observing others being rewarded or punished for their actions can lead to learning and behavior change.
Techniques used in behavioral therapy
To understand how behavioral therapy works, it is important to know more about the basic principles that contribute to behavioral therapy. The techniques used in this type of treatment are based on the theories of classical conditioning and operant conditioning.
Classical conditioning
The classical conditioning involves the formation of associations between stimuli. Previously neutral stimuli are paired with a stimulus that naturally and automatically evokes a response. After repeated pairings, an association is formed and the previously neutral stimulus will come to evoke the response on its own.
Classical conditioning is a way of altering behavior. Several different techniques and strategies are used in this therapeutic approach.
- Aversion therapy: This process involves pairing an undesirable behavior with an aversive stimulus in the hope that the undesirable behavior will eventually be reduced. For example, someone with an alcohol use disorder might take Antabuse (disulfiram), a drug that causes severe symptoms (such as headaches, nausea, anxiety and vomiting) when combined with alcohol.3
- Flooding: This process involves exposing people to fear-provoking objects or situations intensely and rapidly. It is often used to treat phobias. During the process, the individual is prevented from escaping or avoiding the situation.
- Systematic desensitization: In this technique, people make a list of fears and then learn to relax while concentrating on those fears. Starting with the element that produces the least fear and working their way up to the element that produces the most fear, people systematically confront these fears under the direction of a therapist. Systematic desensitization is often used to treat phobias and other anxiety disorders.
Operant conditioning
Operant conditioning focuses on how reinforcement and punishment can be used to increase or decrease the frequency of a behavior. Behaviors followed by desirable consequences are more likely to be repeated in the future, while those followed by negative consequences are less likely to occur.
Behavioral therapy techniques use reinforcement, punishment, shaping, modeling and other related techniques to alter behavior. These methods have the advantage of being highly focused, which means they can produce quick and effective results.
- Contingency management: This approach uses a formal written contract between client and therapist (or parent or teacher) that outlines behavior change goals, reinforcers, rewards, and punishments. Contingency contracts can be very effective in producing behavior change because the rules are clearly spelled out, preventing both parties from backing out of their promises.
- Extinction: Another way to produce behavior change is to stop reinforcing the behavior in order to eliminate the response. Time-outs are a perfect example of the extinction process. During a time-out, the person is removed from a situation that provides reinforcement. By taking away what was rewarding, the unwanted behavior is eventually extinguished.
- Behavioral modeling: This technique involves learning by observing and modeling the behavior of others. Rather than relying simply on reinforcement or punishment, modeling allows individuals to learn new skills or acceptable behaviors by observing another person perform those desired skills.
- Token economies: This strategy relies on reinforcement to modify behavior. Parents and teachers often use token economies, allowing children to earn tokens for performing preferred behaviors and lose tokens for undesired behaviors. These tokens can be exchanged for rewards such as candy, toys or extra time to play with a favorite toy.
How can behavioral therapy help?
Behavioral therapy can be used to treat a wide range of psychological conditions and disorders, including:
- Bipolar disorder
- Alcohol and substance use disorders
- Anxiety
- Attention-deficit/hyperactivity disorder (ADHD)
- Autism spectrum disorders
- Borderline personality disorder (BPD)
- Depression
- Eating disorders
- Panic disorder
- Phobias
- Obsessive-compulsive disorder (OCD)
Behavioral therapy is problem-focused and action-oriented. For this reason, it can also be useful in treating specific psychological problems, such as anger management and stress management.
Treatments that incorporate behavioral techniques usually focus on producing results in a relatively short period of time.
Benefits of behavioral therapy
Behavioral therapy is widely used and has been shown to be effective in the treatment of a number of different conditions. Cognitive behavioral therapy, in particular, is often considered the “gold standard” in the treatment of many disorders, and cognitive behavioral play therapy, specifically, can be effective for children where other types of therapy are not.
CBT is often more affordable than other types of therapy and results are usually seen in five to 20 sessions. Research has shown that CBT is most effective for the treatment of:
- Anger problems
- Anxiety
- Bulimia
- Depression
- Somatic symptom disorder
- Stress
- Substance abuse and relapse prevention
In addition, behavioral therapy has been proven to help people with the following:
- Communication
- Coping strategies
- Healthier thinking patterns
- Self-esteem
how effective is it?
The effectiveness of behavioral therapy depends on factors such as the specific type of treatment used and the condition being treated.
In general, research has found that approximately 67% of people who try psychotherapy experience some type of positive improvement.
This does not mean that CBT or other behavioral approaches are the only types of therapy that can treat mental illness. Nor does it mean that behavioral therapy is the right choice for all situations.
Anxiety disorders, such as post-traumatic stress disorder (PTSD), panic disorder, obsessive-compulsive disorder (OCD) and phobias, for example, often respond well to behavioral treatments. However, the researchers found that the effectiveness of behavioral therapy, specifically CBT, in the treatment of substance use disorders can vary depending on the substance being used.
CBT also demonstrated beneficial effects on some symptoms of schizophrenia, but did not show benefits on relapse and hospital admission compared to other forms of treatment
Limitations of behavioral therapy
Behavioral therapy has a number of advantages. However, behavioral approaches are not always the best solution.
Not sufficient for complex mental disorders
When treating certain psychiatric disorders such as major depression and schizophrenia, behavioral therapy often must be used in conjunction with other medical and therapeutic treatments. Behavioral therapy can help clients manage or cope with certain aspects of these psychiatric conditions, but it should not be used alone.
May miss underlying problems
Behavioral treatments tend to focus on current functioning problems and may not fully appreciate or address the underlying factors that are contributing to a mental health problem.
May not address the whole picture
Behavioral approaches focus on the individual working to change their behaviors. However, some of these approaches often fail to address how situations and interpersonal relationships may be contributing to a person’s problems
