Behavioral Therapy: Principles, Methods, and Effectiveness

Introduction to Behavioral Therapy

Behavioral therapy has its roots in basic behaviorism — the principle that human behavior can be modified through systematic training or interventions. Since B.F. Skinner first laid the foundations for behaviorism through experimentation, the methods used in behavioral therapy have changed dramatically. Behavioral therapy, or behavior therapy, is not one but a variety of approaches that psychological counselors use to help clients change their behaviors. The Centers for Disease Control and Prevention (2017) advocates the use of behavior therapy as an "effective treatment for attention deficit/hyperactivity disorder (ADHD)" (p. 1).

Behavior therapies are designed not just to change target behaviors but also to change the ways people feel about themselves and the world, which is why behavior therapy can improve self-esteem (Herkov, 2016). Some of the most common approaches to behavioral therapy fall under the rubric of cognitive-behavioral therapy (CBT), which is used in a variety of clinical settings. In fact, Craske (2010) claims cognitive-behavioral therapy is "the most popular model of psychotherapy used in contemporary clinical practice" (p. 17). The literature on cognitive-behavioral therapy shows that it can be effective for multiple types of clinical disorders, from addictions and mood disorders to psychotic disorders like schizophrenia (Butler, Chapman, Forman & Beck, 2006).

Core Principles and Theoretical Foundations

All types of behavior therapies draw on the underlying principles of basic behaviorism, including positive and negative reinforcement. Early behavioral therapies evolved largely as a reaction to — or backlash against — Freudian psychoanalysis. Subsequent theorists, however, drew from research in perception and cognition to enhance the field (Hayes, 2004). As a result, more recent behavioral therapies are diverse and evidence-based. Although the goals of behavioral therapy necessarily focus on client behaviors and how to optimize them, different methods are used to achieve those therapeutic goals.

The Stages of Behavioral Therapy

The first stage in any behavioral therapy is self-monitoring and self-awareness (Herkov, 2016). When the client is a young child, such as a child with ADHD, parents can help the child develop the necessary self-awareness to make behavioral interventions effective. Indeed, behavioral therapy for ADHD is most effective when delivered by parents (Centers for Disease Control and Prevention, 2017). Behavioral therapy can also serve as an effective substitute for pharmacological interventions, precluding the need for ongoing psychoanalysis. A meta-analysis of studies on the effectiveness of cognitive-behavioral therapy for anxiety disorders found that behavioral approaches have much stronger long-term effects than pharmacological solutions (Butler, Chapman, Forman & Beck, 2006). Behavioral therapies therefore offer long-term, solution-focused options for clients.

After initial self-monitoring and assessment, a therapist helps the client set behavioral change goals. Often, those goals are highly specific — such as smoking cessation within a defined time frame. The therapist may work with the client to develop a schedule and new routines to support the behavioral changes. As Skinner demonstrated through his conditioning experiments, rewards are critical for reinforcing desirable behaviors. The behavioral therapist helps the client identify rewards that motivate continued desirable behavior. Likewise, the therapist may suggest negative reinforcements to discourage unwanted behaviors.

Social feedback is also an important component of behavioral therapy. Behavioral therapy helps the client change how they act, which in turn changes their self-concept. Changing behavior also alters the way a person is perceived by others. When other people react differently to the client, this reinforces the new behaviors and helps the client reject dysfunctional patterns such as angry outbursts. Just as dysfunctional thoughts or harmful emotions can cause destructive or unwanted behaviors, a person's behaviors can also influence how they think and feel. Behavioral therapy helps the person recognize this bi-directional relationship between behaviors and cognitive patterns.