Behavior therapy

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With behavioral therapy (CBT) , a range of methods is in the field of psychotherapy called. Despite numerous differences in theoretical assumptions and practical methods, what they have in common is that they evaluate the model of ( classical and operant ) conditioning as central to the processes in the human psyche . Another characteristic of behavioral therapy procedures is that they help the patient to help themselves. The focus is on providing the patient with methods that will empower him to overcome his psychological complaints, after understanding the causes and history of his problems .

Principle of behavior therapy

Behavioral therapeutic procedures are originally based on learning theory . The basic idea is that disorder-related behavior has been learned and can be unlearned again, or that more appropriate ways of thinking and behavior can be learned. In the meantime, behavior therapy has been further developed in many ways and differentiated into various methods. The therapeutic techniques of behavioral therapy that are particularly well known to the public are confrontations with triggering stimuli (e.g. exposure, systematic desensitization) as well as the reinforcement of desired behavior and the elimination of undesirable behavior.

backgrounds

Basic assumptions

Originally, behavior therapy according to John B. Watson (1878-1958) followed a " black box model ", in contrast to depth psychological methods , which essentially states that internal processes remain opaque to outsiders and should therefore not be analyzed. This attitude was an attempt to get away from the intuitive approach of depth psychology , which, as Wolf Singer describes it, lives from the perspective of the first person (“I observe my feelings”) and is largely dependent on assumptions ( Oedipus complex etc.). Behavioral therapy seeks the perspective of the third person (“We look at the situation together”) and is therefore more based on neurological-neurobiological models, in which a stimulus and the measurable reaction are the focus.

Many authors describe behavioral therapy as a method that is intended to treat symptoms of mental disorders in a targeted manner and to expand the patient's ability to act. Deep psychological self-knowledge or the exploration of unconscious mental processes are not central. Behavioral therapy techniques should enable the client to better self-regulate. A characteristic of behavior therapy is the concentration on present rather than past causes of action, without neglecting previous experience in the analysis of problem development. Thus, the focus is on observable behavior and its change.

Behavioral therapy differs from psychoanalysis by the following assumptions: It is assumed that behaviors can be learned and unlearned again. However, genetic differences are also taken into account as causes of disorders, for example in the so-called vulnerability-stress models. An inherited susceptibility to stress is taken into account as a prerequisite for a disorder. In its assumptions about etiological disorder models, behavior therapy is only bound to certain theories to a limited extent and can therefore integrate new empirical findings into its models and theories.

It follows that problematic behavior is primarily seen as the result of learning processes and should be changed through the use of behavioral and learning principles. A precise behavior analysis to determine the current causes of problematic behavior is decisive for this. The treatment strategies are then individually adapted to the patient's problems. In order to bring about change, it is not necessarily necessary to fathom the origins of the psychological problem. It is particularly effective in well-defined, less complex mental disorders.

method

Since a large number of different behavioral therapy methods have evolved, there is no one standard behavioral therapy procedure. Usually, however, behavior therapy begins with behavior and problem analysis , in which the patient's problems are examined in relation to their sustaining conditions and with regard to their consequences. An underlying concept is the behavior analysis according to Frederick Kanfer , the so-called SORKC model . In addition to the investigation of stimulus-reaction relationships, feelings, thoughts and physical processes are usually also included. Likewise, the influences of the patient's extended environment, such as the behavior of family members, work colleagues, friends and acquaintances. The level of the plans and system rules is also taken into account. Another field of analysis is the therapist-client relationship, which is given more space today than in the early days of behavioral therapy.

In the goal analysis, realistic therapy goals are determined and concretized together with the patient, from which the therapist selects the interventions to be used and uses them in consultation and with the patient's consent. Following these steps, a therapy contract is often agreed in which the patient and therapist decide on goals and tasks during the therapy.

In the further course of the therapy, various behavioral therapeutic procedures can be used, which relate to the behavior and goal analysis. The overriding principle is helping people to help themselves. This means that the patient should learn in therapy to come to terms with their own life (again). The basic therapeutic variables known from conversation psychotherapy, such as authenticity, empathy and unrestricted acceptance of the patient, are an important aspect. In addition, the therapist usually pays attention to a complementary relationship structure , as described by Klaus Grawe . Another important step that must be considered in addition to the use of intervention methods is the establishment of a therapeutic alliance or the motivation to change. After the actual interventions have been implemented, an evaluation process is carried out in which the success of the methods implemented is checked. The described analysis and intervention steps are not carried out strictly separately from each other in therapeutic practice, but are mutually dependent and are repeated over and over again in a feedback process.

Behavior therapy method (selection)

In order to achieve the therapy goals agreed in the therapy contract, more than 50 individual behavior therapy procedures can be used in behavior therapy. Some of them are mentioned at this point:

Confrontation proceedings

In exposure therapy, methods are used that are based on the model of classical conditioning with the aim of achieving extinction , counter-conditioning or habituation . Exposure methods can be applied in a massaged or graduated form and in vivo or in sensu . In addition, the duration (continuously) and the extent of self-management (self-exposure) can be varied. These procedures are mainly used for phobias , panic and obsessive-compulsive disorders .

Operant procedure

In operant procedures, behavior is modified ( behavior modification ) by means of reinforcement (increasing the frequency (probability) of a behavior) or punishment (reducing the frequency of behavior ). Positive reinforcement occurs through the introduction of pleasant stimuli, negative reinforcement through the removal of unpleasant stimuli. Direct punishment takes place by introducing unpleasant stimuli, indirect punishment by taking away pleasant stimuli, e.g. B. Time-out technique . The principles for building behavior are: behavior shaping, behavior chaining , prompting , differential reinforcement, discrimination , fading and generalization and for breaking down behavior: deletion , punishment and forgetting .

Cognitive approaches

Cognitive approaches to VT are based on cognitive theories of behavior. An individual actively interprets and transforms information (environmental stimuli) and structures the experiences (ordering and evaluating reality). As transformed stimuli, cognitions influence behavior. Behavioral problems are the result of wrong assumptions, incomplete conclusions, inadequate self-instruction, and inadequate problem-solving skills.

Other procedures

Areas of application

Behavioral therapy methods are used nowadays for many mental disorders and psychosomatic illnesses. According to the opinion of the Scientific Advisory Board on Psychotherapy of the German Federal Government, psychotherapy can be indicated for:

to form

Behavioral medicine

Behavioral medicine emerged from behavioral therapy. It deals with the application of behavioral knowledge to general medical issues; for example with the supplementary treatment of physical illnesses such as high blood pressure , asthma , diabetes , tension headache , tinnitus with psychological means. This happens, for example, by the patient learning to deal more appropriately with his illness. Behavioral medicine deals with health behavior.

Training to become a behavior therapist

Situation in Germany

Behavioral therapist (psychological or medical psychotherapist with a certificate of expertise in behavioral therapy) is achieved through a 3 to 5 year training course and obtaining a state license to practice a medical profession. The prerequisite for training in therapy is that you have a university degree in medicine or psychology with a focus on clinical psychology . In addition to psychologists and medical professionals, qualified pedagogues , qualified social pedagogues , qualified social workers and qualified curative pedagogues can obtain approval as child and adolescent psychotherapists after completing a corresponding 3 to 5 year further training course . Approval as a psychotherapist can be applied for from the responsible district government after passing the state examination. In addition to a successful graduation, further requirements must be met, for example mental health, no criminal record.

History and reception

Development history of behavior therapy

Behavioral therapy has its origins in psychological learning theories . Paul Dubois and later Mary Cover Jones took the first steps that can be described as behavioral therapy in 1924. Jones treated anxious children by confronting them with the fear-inducing object. After the Second World War , it was possible to systematically use methods based on learning theory to treat mental disorders, especially phobias. So developed z. B. the South African Joseph Wolpe the systematic desensitization , a graduated exposure procedure, in combination with the progressive muscle relaxation of Edmund Jacobson . On the other hand, operant conditioning has been used by behaviorist therapists such as B. Ayllon and Azrin used for therapeutic behavior modification . With it, people with the most severe mental disorders such as schizophrenia could be given psychotherapeutic help for the first time with notable success . Since the 1970s, the principles of behavior therapy have also been transferred to educational fields (preschool, school, college, family, etc.). This area of ​​application is called “educational behavior modification”.

Since the 1960s and 1970s, this classic behavior therapy has increasingly taken up and integrated other areas of scientific psychology and psychotherapy . The term cognitive behavioral therapy or cognitive therapy takes into account the fact that behavior therapy deals not only with changing external behavior but also with changing people's cognitive, mental schemes. The founders and pioneers of cognitive behavioral therapy included Albert Ellis , Aaron T. Beck and Donald Meichenbaum . After this so-called cognitive turnaround , cognitive-behavioral therapies for the majority of mental disorders have developed. The latest forms of therapy include dialectical behavioral therapy (DBT) for emotionally unstable personality disorders . Like other behavioral therapeutic approaches, DBT is based on basic learning-theoretical principles, but is much broader than classical behavioral approaches, both in terms of the topics that are included in the treatment and in terms of the repertoire of methods. For example, questions of value and meaning are discussed and meditative practices of Buddhist character are integrated into the treatment. Increasingly there is talk of a "third wave" of behavioral therapy, in addition to the DBT also approaches such as functional-analytic psychotherapy (FAP), the Acceptance and Commitment Therapy (ACT) or mindfulness-based cognitive therapy of depression (Engl. Mindfulness Based Cognitive Therapy, MBCT).

Criticism of behavior therapy

Behavioral therapy has been shown to be effective in treating numerous symptoms of mental illness. Nevertheless, criticism is directed against behavior therapy and some of its techniques as well as against other therapy and treatment methods. Above all, behaviorism as the earlier basis of the VT has been criticized for its reductionist approach. In behaviorism one assumes that inner-psychological processes such as thinking, feeling etc. cannot be scientifically researched. In his research into behavior, he assumes a black box . Furthermore, it is almost impossible to scientifically prove the cause of mental disorders through learning experiences. Also, circular inferences could be falsely used in the evidence for the correctness of the assumptions of behaviorism. Today, cognitivism is considered the guiding paradigm in psychology. It can thus also be understood as the basis of behavior therapy, which always sees itself as the practical application of the findings of psychology. The cognitive turn was necessary mainly because of the inadequate explanations of behaviorism for newer findings. Cognitivism is mainly criticized for its theoretical approach. "The concepts of cognitive psychology (e.g. schemata ) are vague and not always well defined." Critics object that the explanations of cognitive psychopathology are of little help. For example, the assertion that depressives have negative thoughts is hardly helpful for explaining the origin of this disorder, since this is already part of the diagnosis . The conclusion that negative thoughts trigger depression is not conclusive, since the postulated negative thought patterns can be the cause, but also the consequence of the depression.

The use of aversion procedures was also criticized. In aversion procedures, the client is given unpleasant stimuli in combination with problematic behavior, situations or objects, which is sometimes viewed as unethical. Aversion procedures therefore only play a subordinate and largely historical role in the spectrum of behavioral therapy procedures.

See also

literature

  • Anil Batra (Ed.): Behavioral Therapy. Basics, methods, areas of application . 4th edition. Thieme, Stuttgart 2013. ISBN 978-3-13-117784-1 .
  • Jürgen Margraf (ed.): Textbook of behavior therapy. 4 volumes. 3. Edition. Springer, Berlin 2009–2012
  • Jürgen Kriz : Basic concepts of psychotherapy. 7th, revised and expanded edition. Beltz Verlag, Weinheim, Basel 2014, Section II Behavioral Therapy , pp. 123–181. ISBN 978-3-621-28097-6 .
  • Eva-Lotta Brakemeier / Frank Jacobi: Behavioral therapy in practice. 1st edition. Beltz-Verlag, 2017. ISBN 978-3-621-28487-5 .
  • Michael Borg-Laufs (ed.): Textbook of behavior therapy with children and adolescents . 2 volumes. 2nd Edition. DGVT, Tübingen 2007, ISBN 978-3-87159-072-6 .
  • D. Meichenbaum, DC Turk: The patient's motivation for therapy. Your promotion in medicine and psychotherapy. A manual. Translated from English by Lothar Schattenburg. Huber, Bern 1994.
  • Hans Reinecker : Textbook of behavior therapy. DGVT, Tübingen 1999, ISBN 3-87159-020-7 .
  • A. Dutschmann: Behavior control in aggressive children and adolescents. Manual for type A of the ABPro. DGVT, Tübingen 2000.
  • F. Petermann (Ed.): Child behavior therapy. Basics and Applications. 5th, revised edition. Schneider Verlag Hohengehren, Baltmannsweiler 2015, ISBN 978-3-8340-1430-6 .
  • Jeffrey Young, Janet Klosko, Marjorie Weishaar: Schema Therapy . A practice-oriented manual. 2nd Edition. Junfermann Verlag, Paderborn 2008, ISBN 978-3-87387-578-4 .
  • Clemens Hillenbrand: Introduction to Behavioral Disorder Education. 3. Edition. Munich 2006.
  • Gerhard Zarbock: Practice book behavior therapy. Basics and applications of biographical-systemic behavior therapy . Papst Science Publishers, Lengerich 2008, ISBN 978-3-89967-471-2 .
  • W. Singer: Our view of man, neurobiological considerations. Auditorium Verlag, 2003.

Web links

Individual evidence

  1. ^ Dirk Revenstorf: Psychotherapeutic procedures . Volume 1, 2nd edition. Stuttgart 1994.
  2. ^ Brigitte Vetter: Psychiatry. 7th edition. Stuttgart 2007.
  3. ^ Stefan Priebe, Donna Wright: The provision of psychotherapy - An international comparison. In: Journal of Public Mental Health. 5 (3), 2006.
  4. ^ Doris K. Silverman: What Works in Psychotherapy and How Do We Know ?: What Evidence-Based Practice Has to Offer. In: Psychoanalytic Psychology. 22 (2), 2005.
  5. ^ T. Poehlke: Psychiatry. 17th edition. 2009.
  6. ↑ Klaus Schuster: Adventure behavior therapy - new experiences with yourself and the world. DTV, 1999.
  7. ↑ F. Kanfer, D. Schmelzer: Guide to behavior therapy - psychotherapy as an opportunity. Springer, 2001.
  8. ^ Dirk Revenstorf: Psychotherapeutic procedures. Volume II: Behavioral Therapy. Kohlhammer, 1996.
  9. ↑ Franziska Dietz: Psychology: Basics, disease models and psychotherapy . Marburg 2006.
  10. ↑ Anil Batra, Reinhard Wassmann, Gerhard Buchkremer: Behavior Therapy. Basics - methods - areas of application . 4th, completely revised edition. Thieme, 2013.
  11. ↑ Jürgen Markgraf, Silvia Schneider: Textbook of behavior therapy. Volume 1: Basics, diagnostics, procedures, framework conditions . Heidelberg 2009.
  12. ↑ Th. Heidenreich, J. Michalak (Ed.): The "third wave" of behavior therapy. Basics and practice . Beltz, 2013, ISBN 978-3-621-28037-2 .
  13. ↑ B. Kröner-Herwig: The effectiveness of behavior therapy in mental disorders of adults as well as children and adolescents: Expertise on the empirical evidence of the psychotherapy method behavior therapy. Dgvt-Verlag, 2004.
  14. ↑ FH Kanfer, D. Schmelzer: Guide to behavior therapy . Berlin 2005.
  15. ↑ Gerhard Zarbock: phase timetable VT: Tasks and structuring aids for therapists and supervisors . Pabst 2010.
  16. ↑ Scientific Advisory Board Psychotherapy wbpsychotherapie.de Retrieved on March 29, 2014.
  17. ↑ Volker Köllner, Michael Broda: Practical Behavioral Medicine . Stuttgart 2005.
  18. ↑ Peter Fiedler: Behavioral therapy mon amour: Myth - Fiction - Reality . Stuttgart 2010.
  19. ↑ Anil Batra, Reinhard Wassmann, Gerhard Buchkremer (ed.): Behavioral therapy. Basics - methods - areas of application . Thieme, 2006.
  20. ↑ Anil Batra, Gerhard Buchkremer, Reinhard Wassmann: Behavioral Therapy: Basics - Methods - Areas of Application. 4th edition. Stuttgart 2013.
  21. ↑ Michaela A. Swales, Heidi L. Heard: Dialectical behavior therapy . Junfermann, 2013.
  22. ↑ Th. Heidenreich, J. Michalak (Ed.): The "third wave" of behavior therapy. Basics and practice . Beltz, 2013.
  23. ↑ Opinion on the examination of the guideline procedures according to §§ 13 to 15 of the Psychotherapy Guideline, behavioral therapy opinion of the Federal Chamber of Psychotherapists of 10 November 2009
  24. ↑ a b c M. Hautzinger (Ed.); Gerald C. Davison, John M. Neale: Clinical Psychology . Belz PVU, Weinheim 2002.
  25. ^ H. Reinecker: Punishment . In: M. Linden, M. Hautzinger (Ed.): Behavioral Therapy Manual . 6th, completely revised and expanded edition. Springer, Heidelberg 2008, ISBN 978-3-540-75739-9 .