'Treatment' is a broad term when it comes to mental illness and could (and often does) encompass a wide variety of methods which focus on different areas. Some involve tackling the underlying thoughts, some work on just the behaviour at hand and some work to modify the release of neurotransmitters. All of these are important in their own right; here, we will discuss behavioural therapy.
- First and foremost, we will aim to understand the behavioural therapy definition.
- We will then discuss the behaviour therapy techniques commonly used.
- Then, we will look at applying behavioural therapy for depression.
- Finally, we will explore the advantages and disadvantages of behaviour therapy.
The Behavioural Therapy Definition
The behavioural approach suggests that behaviour is learned; for this reason, it can be unlearned and therefore changed. It focuses on the problem at hand and identifies ways to address it.
Behavioural therapy is a means of treating mental illness by identifying the problem behaviour and exploring ways by which it can be changed - to be better suited to the individual themselves and the society of which they are a part.
A wide range of mental illnesses can benefit from behavioural therapy, including but not limited to disorders like depression, anxiety, phobias, bipolar disorders, obsessive-compulsive disorders, etc.
Figure 1: Many forms of therapy are used to treat a variety of mental illnesses.
Behavioural Therapy Techniques
Behavioural therapy involves different techniques to treat various mental illnesses effectively, and phobias are one of the most common illnesses treated by this method. The main techniques for phobia treatment focus on classical and operant conditioning. Let's first understand what classical, and operant conditioning are and then discuss the main techniques used in behavioural therapy for phobias.
Classical conditioning is a learning process that involves pairing a new association with a response.
A famous example of the classical conditioning process is Pavlov's dog experiment!
Operant conditioning is a learning process that relies on the principle that if our behaviour is rewarded, it will be maintained. If punished, the behaviour will unlikely be repeated. It can be used to change behaviour either via punishment or reinforcement.
Reinforcement can further be classified into positive and negative - positive reinforcement is when something is added, and negative reinforcement is when something is taken away.
If a child is given pocket money when he completes his chores, it acts as a means of positive reinforcement - in this case, pocket money is what is being added.
Similarly, suppose someone is lactose-intolerant but wants to eat dairy. In that case, their decision to take a medicine to combat the adverse effects is a means of negative reinforcement - in this case, the negative effects of dairy are taken away.
Keeping both of these ideas in mind, let's now look at some of the behavioural therapy techniques.
Behavioural therapy Examples: Systematic Desensitisation
A process that relies heavily on classical conditioning is systematic desensitisation.
Systematic desensitisation is a form of exposure therapy which combines relaxation techniques with gradual exposure to reduce one's sensitivity to anxiety-inducing situations.
As the name suggests, it is a 'systematic' process whereby each step is clearly defined, and one must achieve each step in the order stated to be effective. The three steps included in systematic desensitisation are:
- The individual becomes familiar with relaxation techniques they can use, e.g. diaphragmatic breathing, meditation and mindfulness techniques.
- The client and therapist then list all the situations that would cause them anxiety.
- Finally, once the list has been created and triggers identified, they are gradually exposed to their fears. They are encouraged to use the relaxation techniques learned in the first step to combat the anxiety they may experience.
Exposing an individual to their fears begins with the one that triggers the least anxiety and then increases to the one that triggers the most.
Behavioural Therapy Examples: Aversion Therapy
Aversion therapy is used to reduce and/or eliminate an undesirable behaviour pattern and is commonly used for individuals with substance abuse habits.
Aversion therapy is when individuals are taught to associate a behaviour (that's pleasant for them but still unhealthy) with discomfort and unpleasant feelings; this causes them to develop an aversion to that behaviour.
During this form of therapy, an individual may be exposed to their problem behaviour, i.e., gambling, alcohol and drugs, while at the same time being subjected to something unpleasant such as a foul smell, a sour/bitter taste, or even mild electric shocks.
Once the behaviour is associated with these unpleasant feelings, aversion therapy hopes to reduce the likelihood of occurrence of that behaviour or even eliminate it entirely.
For those struggling with alcohol abuse, the therapist may decide that chemical aversion therapy is what's best for them. In this case, a doctor will first administer a drug that induces nausea or vomiting, after which they will proceed to give the individual some alcohol, causing him to be sick. This will be repeated until the association that 'alcohol makes you sick' is made, stopping the individual from craving it.
The type of aversion therapy to be used depends on the undesirable behaviour. Still, no matter the type, the goal is to condition one's body to stop associating feelings of pleasure with harmful behaviour.
Behavioural Therapy Examples: Flooding
Another standard method used to treat phobias, flooding, is another type of exposure therapy.
Flooding is a treatment method by which the individual is directly exposed to their fears without the slow introduction to the stimuli.
Flooding works on the idea that fear is a limited-time response. The intervention assumes that while the individual may panic and experience anxiety when exposed to their fear initially, as time passes, the body will experience a period of exhaustion, causing the anxiety level to reduce.
Behavioural Therapy Examples: Rational Emotive Behaviour Therapy
Rational Emotive Behaviour Therapy (REBT) was developed by Albert Ellis and is a form of cognitive behavioural therapy.
It is an action-oriented form of therapy wherein individuals are helped to deal with irrational beliefs and are taught how to manage their thoughts, emotions and behaviours healthily.
Sometimes, mental illnesses result from individuals holding irrational beliefs about the world around them, which causes them to experience mental distress. With the help of REBT, they can recognise that these beliefs are irrational and change their thinking patterns. Doing this helps them reduce the distress they may be experiencing.
REBT works on the ABC model. Let's break this down further.
- Activating event - this is when something happens around the individual
- Beliefs - this refers to the thoughts an individual has about what has happened
- Consequence - this is an individual's emotional response to the situation
During this therapy, the activating event is addressed first, after which the therapist works with the individual to identify what beliefs led to their negative emotional response. By doing so, they help an individual look at situations differently and aim to change their beliefs at the core, which further helps in changing their emotional response.
You might be wondering how beliefs are changed. Well, one way of doing this is by using the method of disputation.
Disputation is when the therapist challenges an individual's irrational beliefs directly. This could include asking direct questions about their beliefs or suggesting that they consider another point of view on the situation.
Behavioural Therapy for Depression
In addition to working as an effective treatment method for phobias, behavioural therapy can even be used to treat depression.
Behavioural activation is "a structured, brief psychotherapeutic approach that aims to (a) increase engagement in adaptive activities (which often are those associated with the experience of pleasure or mastery), (b) decrease engagement in activities that maintain depression or increase the risk for depression, and (c) solve problems that limit access to reward or that maintain or increase aversive control”.¹
The behavioural model of depression suggests that it develops due to the lack of positive reinforcement in an individual's life. Due to this, the treatment method involves creating a set of positive reinforcements by changing the client’s behaviour and environment.
Let's look at the steps involved in behavioural therapy for depression.
- Firstly the individual monitors their activities and moods to understand better how their depressive symptoms work.
- Once this has been monitored, it is time for the individual to reflect. After reflection, the individual must list what activities make them the happiest and what makes them feel the lowest.
- The next step requires the individual to consider what matters to them in life and their overarching values. These differ from person to person because everyone considers different things to be important to them.
- The last step is for the individual to engage in the activity. This is not done immediately, but again, it comes after making a couple of lists. The first list should consist of activities they wish to engage in - exercise, cleaning, cooking, etc. Once these activities have been identified, the individual is required to rank these in order of how difficult they think each one would be to carry out.
Doing this not only reduces depressive symptoms but also gives the individual a sense of control when it comes to their feelings.
Advantages and Disadvantages of Behaviour Therapy
While beneficial in some ways, behavioural therapy comes with its own set of limitations. To evaluate this thoroughly, both the advantages of this therapy and its disadvantages must be discussed.
The fact that behavioural therapy has several types is one of the reasons it is considered an effective form of treatment for mental illnesses. Not everyone will have the same mental illness with the same severity, and different treatment types can provide the individual with some form of hope; if one method doesn't work, then others can be tried!
Further, with the constant development of the world around us, technology allows behavioural therapy to take place online instead of having the individual go in for treatment. Why is this such an important aspect?
Individuals might have certain mental illnesses which make it difficult for them to step outside their house, whereas some simply prefer to be in a comfortable environment when undergoing treatment of any kind. Therefore, offering this kind of therapy online allows them to hold onto some control, even if only a little bit.
As with any form of therapy, it is imperative for the individual to thoroughly engage with the treatment process for it to be effective, and this is where the main disadvantage comes in. If the individual has any qualms about the method of behavioural therapy being offered to them, they might not be 100% convinced that it will work for them. As a result, they may find themselves taking part half-heartedly.
Furthermore, behavioural therapy only attempts to change the behaviour that the mental illness is associated with rather than addressing the root cause of it. This can become difficult because if the root cause is not addressed and tackled at the forefront, the chances of relapse can be higher. As the therapy may treat mental illness, for the time being, it may not be an effective long-term solution.
Behavioural Therapy - Key takeaways
- Behavioural therapy is a means of treating mental illness by identifying the problem behaviour and exploring ways by which it can be changed.
- The main behavioural therapy techniques focus on classical and operant conditioning and involve systematic desensitisation, aversion therapy, flooding and rational emotive behaviour therapy.
- Behavioural therapy can also be used to treat depression by using the technique of behavioural activation.
- Behavioural therapy consists of different types and can be used to treat various mental illnesses and can also be offered online.
- A disadvantage of behavioural therapy is that if the individual is not thoroughly engaged with the treatment process, the therapy may be ineffective and may cause relapse.
References
- Dimidjian, S., Barrera, M., Martell, C., Muñoz, R.F., Lewinsohn, P.M. (2011). The Origins and Current Status of Behavioral Activation Treatments for Depression. Annual Review of Clinical Psychology, 7(1), 1-38.
- Figure 1: Photo by Alex Green on pexels.com.
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