Behavior Therapy (BT)

Also known as Behavioral Therapy, this is the first empirically based therapy. That is its treatments were based not just on theory or on what seemed to help or not, but on pure scientific research about how animals and humans actually learned to react emotionally and behaviorally. This basic scientific research about how emotions, situations and behavior were interacting (in both animal studies and controlled human studies) guided how psychologists then approached actual patients reporting anxiety and depression problems. Classic scientific studies about how we learn to react emotionally were done by household names like, Pavlov and Skinner. These early scientific behavioral researchers guided the work of the first behavior therapist such as Joseph Wolpe and modern world renowned behavioral therapists like David Barlow (Boston University Hospital) and Edna Foa (University of Pennsylvania).

The techniques of behavior therapy are often confused and oversimplified with those of behavior modification (changing the consequences of rewards and punishments). Simple Behavior modification is still great for changing the behavior of children. However behavior therapy is much more than simple behavior modification.

To this day behavior therapy continues to offer some of the most effective forms of anxiety treatment. A main type of behavior therapy is called exposure, exposure-response prevention and/or desensitization. All types of exposure require that patients gradually and systematically come into contact with (expose oneself to) exactly the things that trigger their discomfort. Traditional behavior therapist used to do this only with situational types of avoidance, e.g., people, places or things. At Suffolk Cognitive-Behavioral, we use several types of exposure, imaginal exposure (phobic imagery and thoughts), in vivo exposure (our staff accompany patients into actual situations that cause anxiety) and exposure-response prevention (special exposure for OCD). Modern behavior therapists have begun applying exposure to subtler avoided things like, emotions, sensations, intrusive thoughts, memories, etc. Somatic exposure or “internal” types of exposure treatment are being effectively used to treat pure obsessions, traumatic memories, panic sensations and general worry thoughts.

Lately a type of behavioral treatment called “behavioral activation” (BA) is targeting “avoidance traps” as an important type of “exposure” treatment for depression. During depressed episodes it may be particularly important to break avoidance tendencies which can maintain depression. Avoidant “coping” (sometimes referred to as aversive control) is a common form of misguided decision making. In depression this type of aversive avoidance is often based on avoiding feelings of further loss, rejection, incompetence, embarrassment and frustration. Two major new studies on BA are showing BA is as or even more effective than medication or cognitive therapy (Martell, Addis & Jacobsen, 2001).

Behavior therapies can also include a very wide array of strategies and skills, such as relaxation training and breathing retraining. Behavioral change can also include targeting interpersonal (social) behavior and problems that involve in-effective relationship styles. These types of behavior therapies often focus on changing “interpersonal” or social behavior which often exacerbates and/or maintains depression. Several major variations of modern Behavior Therapy include, i.e., Exposure Response Prevention (ERP), Behavioral, Behavioral Activation (BA), Inter-personal Psychotherapy for Depression (IPT), Functional Analytic Psychotherapy (FAP).

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