...The REsource for Advancing Children's Health

Behavioral Therapy

Basic concepts of behavioral therapy were first used in the 1920s. It was in the 1950s and 60s, however, that a systematic and comprehensive form of behavioral therapy emerged: with Joseph Wolpe in South Africa, Hans Jurgen Eyseneck and MB Shapiro in Great Britain, and BF Skinner in the United States.

Behavioral therapy, which generally is of shorter duration and less expensive to administer than most other therapies, tries to change behavior without worrying about a person's inner conflicts; it strives to unlearn problem behaviors and teach new, more adaptive behaviors. This therapy is usually used as a treatment for phobias, separation anxiety, obsessive-compulsive disorder, alcohol dependence, eating disorders (e.g., anorexia nervosa or bulimia nervosa), hyperventilation, attention deficit-hyperactivity disorder, and conduct problems.

When using behavioral therapy, the therapist, child, and child's family must answer the following questions:

• What are the problems and goals for the therapy?
• How will progress be measured or monitored?
• What outside influences are enabling the problem to continue?
• Which interventions will be most effective?

Types of Interventions

Systematic Desensitization (usually progresses in three steps):

1. Relaxation Training. Relaxation will inhibit anxiety. Relaxation is usually achieved through training the person in progressive relaxation, hypnosis, or thinking of pleasant or relaxing mental images.
2. Hierarchy Construction. Determine the conditions that cause the anxiety; then create a list of such scenes in order of increasing anxiety.
3. Desensitization of Stimulus. Over time and while relaxed, the person is exposed to the anxiety invoking scenes they listed while in deeply relaxed state until "exposure" (visualization) no longer causes undue anxiety.

Graded Exposure:

This intervention is similar to the systematic desensitization described above, but uses exposure of the person to the real-life feared situations (as opposed to imagery) and no relaxation.

Exposure and Response Prevention:

The child/adolescent deliberately and voluntarily confronts the feared object or idea, either directly or by imagination. At the same time, he or she is strongly encouraged to refrain from doing any symptom-like habits, compulsions or rituals, with support and structure provided by the therapist.

Flooding:

This technique is based on the theory that escaping an anxiety-evoking situation reinforces the anxiety. Therefore, the child is directed to confront their fear directly and remain in the situation until the fear subsides.

Participant Modeling:

The child learns new behavior (new ways to deal with a situation) by watching someone else approach the feared object or situation and by observing how that person interacts or reacts with the anxiety-inducing object/situation.

Positive Reinforcement:

The child is given a reward when he or she does the desired behavior (e.g., attending to a task, facing a fear), or refrains from showing an undesirable behavior (e.g., aggression, temper outbursts, etc.).

Response Cost:

The child is penalized by removing points or some other type of positive item if he or she shows an undesirable behavior. Commonly, the response cost technique may be combined with a positive reinforcement system, so that appropriate behaviors are "rewarded," while negative behaviors are penalized, all using the same system. When the rewards and "punishments" are put into a common system of points (or stickers, stars, smiley faces, etc.), such a system is called a "token economy."