Chapter 13

Advanced Behavioral Methods for Therapy

Biofeedback

• biofeedback is a technique in which information about physiological functioning is used to learn to control physiological responses

• biofeedback is based on operant concepts– physiological processes are the behaviors– feedback is the consequence

• control requires training• training often employs shaping techniques

Biological Systems Controlled by Biofeedback

• blood pressure– systolic pressure is exerted by the contraction

of the ventricles– diastolic pressure is the resting pressure

between beats• EKG shows heart rate and the regularity of its beat• galvanic skin response measures skin

conductivity

Biological Systems Controlled by Biofeedback (continued)

• an electroencephalogram shows brain waves• an electromyogram shows electrical activity of

muscles• temperature measures show changes in blood flow

Types of Feedback

• instruments like a thermometer can provide direct measures on a gauge

• changes in pitch or volume of a tone can vary to reflect changes in rate or intensity

• changes in the brightness of a light can vary to reflect changes in rate or intensity

Biofeedback Applications

• maintenance of control of certain brain wave patterns is used with epilepsy

• relaxation procedures reduce high blood pressure• EMG feedback helps to:

– relax muscles and may serve as a general relaxation technique

– reeducate muscles and nerves that signal muscles

Biofeedback Applications (continued)

– overcome certain types of paralysis – weaken spasms– reduce muscle contraction headaches

• migraine headaches responds to blood flow biofeedback

Flooding and Implosion

flooding and implosion are anxiety-induction therapies for phobias that:

• expose the individual to the feared object without chance of escape

• designed to extinguish the response

Flooding Procedures

• the therapist exposes the person to a highly feared situation and prevents escape or avoidance

• the person should not be exposed to further CS-US pairings that would serve to strengthen the fear

• anxiety is encouraged• relaxation training is not a part of the procedure

Flooding Procedures (continued)

• phobias with a more focused CS may be extinguished in one training session

• phobias with more diffuse or multi-element CSs may require many sessions

Concerns About Flooding

• the fear-arousing situation can be introduced gradually when it produces an intolerable fear

• high anxiety may lead to avoidance of treatment• the therapist may consider accompany the client

during the most feared encounters• flooding appears to be relatively safe

Effectiveness of Flooding

• in vivo and imaginal flooding are equally effective• in vivo procedures may be difficult to apply• flooding is about as effective as desensitization• imaginal flooding is more effective than imaginal

desensitization• flooding may be more effective than drug

therapies

Implosive Therapy

• implosive therapy requires the person to imagine unrealistic, exaggerated, or unlikely harmful events that are associated with the fear

• exaggeration does not seem to make implosion more effective than flooding

Modeling Applications: Training Professional Skills

• videotapes are often used to train skills• observing a video may be more effective than role

playing• videotapes may lose their effectiveness if the

trainee is distracted by an interesting story line

Modeling Applications: Assertion Training

• assertiveness training involves teaching how to express feelings and beliefs in a direct and honest and socially appropriate manner

• treatment might increase or decrease assertiveness• assertion training may not generalize to all types

of assertiveness

Assessing Assertiveness

• interviews allow the individual to describe problems with their assertiveness

• excesses and deficits of assertiveness can be observed in role playing of an assertive act

• assertiveness questionnaires ask the person to select descriptions of how they would behave in assertion situations

Assertiveness Training Techniques

• overt modeling techniques have been used effectively to train assertion skills– clients are shown examples of appropriate assertive

behavior– Clients are then asked to imitate the behavior

(behavioral rehearsal)• covert modeling requires the person to imagine

making assertive responses– the therapist provides suggestions about what to

include in the scene

Assertiveness Training Techniques (continued)

– the individual creates a clear image of the situation

– the person is instructed to incorporate into the scene a positive outcome

• training often includes homework assignments, preparation for uncooperative responses to their assertiveness, and booster sessions to prevent relapse

Modeling Applications: Reducing Anxiety in

Medical Settings• videotaped modeling is effective for reducing

anxiety associated with medical treatment• videos should show the procedures and a calm but

realistic emotional response by the model• studies evaluating videotaped modeling show

decreases in anxiety and faster recovery

Aversion Therapy

• aversion therapy introduces a noxious stimulus in association with an unwanted behavior

• aversive stimuli have included:– electric shock– nausea– paralysis– humiliation

• aversion therapy is a form of counterconditioning

Aversion Therapy: Smoking

• smoking and associated activities have been paired with electric shock

• imagined negative scenes can serve as the aversive stimulus

• rapid smoking uses the smoke as an aversive stimulus by requiring very high rates of smoking

• overindulgence in smoke seems to serve as a more effective aversive stimulus than shock or imagined scenes

Aversion Therapy: Drinking

• shock and nausea have been used as aversive stimuli to stop excessive drinking

• shock seems relatively ineffective• more effective treatments use drugs such as

emetine to associate the taste of alcohol with nausea

Problems with Aversion Therapy for Drinking

aversion therapy has not had widespread application with alcohol abuse for several reasons:

• questions have been raised about the ethics of the treatment

• the treatment requires close supervision by a therapist and is expensive

• clients tend to circumvent the aversive contingencies