Friday, August 28, 2009

Behavior Theory -- the big picture

So, lets back up a bit to the big picture behind Behavior Therapy -- Behavior Theory.

  • Behavior Therapy is the application of techniques intended to create behavioral changes that are based on the principles of the conditioning theories of learning.
  • These are characterized by multiple theories and techniques.
  • The foundation is in Pavlov's classical conditioning, Skinner's operant conditioning and Bandura's Social Learning theaory.
  • Skinner: behavior can be empirically investigated only through the measurement of observable behavior
  • Withholding reinforcement = extinction
  • This paradigm also includes Cognitive Behavior approaches
  • All behavior is learned and can be defined and changed
  • Change occurs by rearranging "contingencies of reinforcement" - altering what happens before and after the behavior

Social Learning Theory: Comprised of 3 elements

  1. Target Behaviors (the target of change)
  2. Anticedent behaviors or events (events that precede the behavior)
  3. Consequences (events that follow the behavior)

Behavior Therapy Paradigm A-B-C

A (anticBoldentent) ->B (behavior) -> C (consequences)

  • In treatment the client(s) must identify DESIRED behaviors not just the undesired

Key Terms

  • Coercive Process - negative reinforcement, the termination of a behavior (threats) upon occurrence of the desired behavior (compliance)
  • Information processing- acquisition, storage and utilization of information (includes perception, language and memory).
  • Beliefs and Belief Systems- ideas attitudes and expectations about self, others and experience
  • Self Statements- private monologues that influence behavior and feelings
  • Problem solving and coping - conceptual and symbolic processes involved in arriving at effective responses to problematic situations.

Behavioral Social Work Practice: goal is to increase desireable behavior and decrease undesirable behavior so the client can improve daily functioning.

  • Focus on the here and now
  • Build on client strengths
  • Etiology of behavior is not investigated
  • Traditionally a diagnostic label was not pursued and thought of as stigmatizing but with current approaches, there is more integration of diagnostic classifications (likely due to requirements from insurance companies)
  • Build a strong therapeutic relationship
  • Involve the client as much as possible in each step of the assessment/intervention

Assessment steps:

  1. Identify problematic behavior (perception of who does what)
  2. Identify priorities, antecedents & consequences
  3. Identify contingencies
  4. Identify recurrent patterns
  5. Secure a commitment
  6. Begin to identify targets (desireable behaviors)
  7. Discuss possible targets
  8. Allow time for all family members to present concerns (if applicable)
  9. When targets are established, set conditions for a baseline measure
  10. Determine if assessment indicates a change, does one or more participants require more attention (i.e. should it be couples therapy rather than family therapy?)

Implementation

  1. Identify target behaviors
  2. Establish new antecedents
  3. Establish new consequences
  4. Formulate a written contract
  5. Follow up call
  6. Reference contract, any changes require a consensus from family/clients
  7. Check tally (in families parents usually tally target behaviors) provide positive reinforcement
  8. Discuss problems between sessions
  9. Conflict resolution
  10. Evaluate program design
  11. When target behaviors reach desired frequency, move toward termination

Termination

  1. Evaluate progress
  2. Set conditions for maintenance
  3. Review basic learning principles
  4. Have family continue tally for 4 weeks
  5. Set up appt at 4 weeks for termination and f/u

Summary

  • Very helpful for anxiety, depression, phobias, addiction, sexual dysfunction, relationship issues.
  • Often paired with systematic desensitization
  • Most recommended treatment for Phobic Disorders
  • Also indicated for social skills training, hyperactivity, developmental problems
  • Interventions must consider cultural issues and differences
  • Empirically validated
  • Sometimes combined with pharmacotherapy
  • Need to maintain a record of what approaches work most effectively with what problems

Adapted from Social Work Treatment by Francis J. Turner, 4th Ed.