Behavior Therapy in Clinical Social Work

Behavior Therapy in Clinical Social Work

Behavior Therapy in Clinical Social Work: An Overview

Behavioral therapy is an umbrella term for types of therapy that treat mental health disorders. This form of therapy seeks to identify and help change potentially self-destructive or unhealthy behaviors. It functions on the idea that all behaviors are learned and that unhealthy behaviors can be changed.

In behavior therapy, parents and children learn to promote desirable behaviors and reduce unwanted behaviors. One common trap that families fall into is unintentionally rewarding the wrong behavior.

Behavioral techniques are a core component of many evidence-based psychotherapies, including Prolonged Exposure, Cognitive Behavior Theory (CBT) for Insomnia, and CBT for Depression, just to name a few. These techniques have in common a focus on changing behaviors to improve mood and overall functioning.

Types of Behavioral Therapy

There are a number of different types of behavioral therapy. The type of therapy used can depend on a variety of factors, including the condition that is being treated and the severity of the symptoms.

  • Applied behavior analysis uses operant conditioning to shape and modify problematic behaviors.
  • Cognitive behavioral therapy (CBT) relies on behavioral techniques but adds a cognitive element, focusing on the problematic thoughts that lie behind behaviors.
  • Dialectical behavioral therapy is a form of CBT that utilizes both behavioral and cognitive techniques to help people learn to manage their emotions, cope with distress, and improve interpersonal relationships.
  • Exposure therapy utilizes behavioral techniques to help people overcome their fears of situations or objects. This approach incorporates techniques that expose people to the source of their fears while practicing relaxation strategies. It is useful for treating specific phobias and other forms of anxiety.
  • Rational emotive behavior therapy (REBT) focuses on identifying negative or destructive thoughts and feelings. People then actively challenge those thoughts and replace them with more rational, realistic ones.
  • Social learning theory centers on how people learn through observation. Observing others being rewarded or punished for their actions can lead to learning and behavior change.

Uses

 

Behavioral therapy can be utilized to treat a wide range of psychological conditions. Some of the disorders that behavioral therapy can be used to treat include:

  • Alcohol and substance use disorders
  • Anxiety
  • Attention deficit hyperactivity disorder (ADHD)
  • Autism spectrum disorders
  • Bipolar disorder
  • Borderline personality disorder (BPD)
  • Depression
  • Eating disorders
  • Panic disorder
  • Phobias
  • Obsessive-compulsive disorder (OCD)

Behavioral therapy is problem-focused and action-oriented. For this reason, it can also be useful for addressing specific psychological concerns such as anger management and stress management.

 

Impact

Behavioral therapy is widely used and has been shown to be effective in treating a number of different conditions. Cognitive behavioral therapy, in particular, is often considered the “gold standard” in the treatment of many disorders[1]. 

Research has shown that CBT is most effective for the treatment of[2]:

  • Anger issues
  • Anxiety
  • Bulimia
  • Depression
  • Somatic symptom disorder
  • Stress
  • Substance abuse

The Basic View of Clinical Social Work

Clinical social work today operates in a variety of settings in the statutory, voluntary, and private sectors. Social workers apply their practice in hospitals, physicians’ clinics, schools, nurseries, prisons, institutions, as well as in a wide variety of primary social work agencies and welfare services. Cree (2004) argued that no clear definition exists concerning how social workers apply interventions to help clients in these varied settings, and that current definitions continue to raise questions about social work and postmodern society. Mostly, an acceptance of the notions that postmodern society is a “risk society” (Beck, 1992) and that social work cannot be separated from society (Cree, 2004) implies that the goals of social work comprise coping with risk and practicing effective means to help clients cope.

Clinical social workers adequately help meet client needs (Wodarski, 1981). Their multitarget and multimethod approaches are directed toward the achievement of positive change and the resolution of human problems (Schinken, 1981). In addition, clinical social workers aim to embrace shaping, educating, and teaching roles, for example, to implement self-help skills or problem-solving models. Another distinctive component of clinical social work is its development of innovative prevention programs to foster clients’ ability to cope and manage better in the future (Hardiker & Barker, 1981; Wodarski, 1981).

Clinical social workers have always been interested in helping clients change effectively. The evolution of new intervention modes has permitted the achievement of rapid outcomes on the one hand (Marks, 1987; Ost, Salkovskis, & Hellstrom, 1991) and an increasing emphasis on valuative and comparative studies of treatment efficacy on the other hand (Garfield, 1983; Kazdin, 1982, 1986). The issues of the client’s right to effective treatment and the therapist’s responsibility to provide that efficacy have started gaining crucial attention in psychotherapy in general, and in social work in particular (Alford & Beck, 1997; Bergin & Garfield, 1994; Giles, 1993).

 

The Basics of CBT

The dynamic nature of CBT can be understood by reviewing its developments over the last 50 years (Ronen, 2002). Basic behavior theory focused on learning modes. Stimuli, response, and conditioning depicted classical conditioning (Wolpe, 1982), whereas operant conditioning utilized concepts such as behavior, outcomes, extinction, and reinforcement (Skinner, 1938). Social learning employed constructs such as modeling, environment, and observation (Bandura, 1969). Altogether, these constructs pinpointed the role of the environment in conditioning one’s behavior and the links between stimuli and responses; behaviors and outcomes; and expectancies, behaviors, and environments.

These main concepts and explanations also manifested themselves in the six thinking rules developed by Kanfer and Schefft (1988) to direct the cognitive behavior therapist in conducting treatment:

  1. Think behavior. Action should comprise the main dimension on which to focus interchanges in therapy.
  2. Think solution. Attention should be directed toward determining which problematic situation needs resolving, what is the desirable future, and some indication of how to achieve it.
  3. Think positive. Focus should be directed toward small changes and positive forces rather than on difficulties, and toward constantly reinforcing positive outcomes.
  4. Think small steps. The targeting of small gradual changes reduces fears, motivates clients, and helps therapists observe and pinpoint difficulties. An accumulation of many small changes constitutes one final, large, and significant change.
  5. Think flexible. Therapists should look for disconfirming evidence that points to alternatives. They should try to understand other people’s points of view and to adapt treatment to the client’s needs.
  6. Think future. CBT challenges therapists to think toward the future, predicting how their client will cope and how they themselves would like to be different or better in the future.

The addition of cognitive components brought about a major change in the basic behavior model of therapy, creating CBT. As a way of thinking and perceiving human functioning and needs, CBT offers a way of operating within the environment in order to achieve the most effective means for accomplishing one’s aims (Beck et al., 1990; Ronen, 1997, 2002). The cognitive theory of psychopathology and psychotherapy considers cognition as the key to psychological disorders. Cognition is defined as the function that involves inferences about one’s experiences, occurrences, and control of future events.

Reference

  1. 1.      Alford, B. A., & Beck, A. T. (1997). The integrative power of cognitive therapy. New York: Guilford.
  • Bandura, A. (1969). Principles of behavior modification. New York: Holt, Rinehart & Winston.
  • Beck, A. T., Freeman, A., & Associates. (1990). Cognitive therapy of personality disorders. New York: Guilford.
  • Beck, U. (1992). Risk society: Towards a new modernity. London: Sage.
  • Bergin, A. E., & Garfield, S. L. (1994). Handbook of psychotherapy and behavior change (4th ed.). New York: Wiley.
  • Cree, V. E. (2004). Social work and society. In Davies M. (Ed.), The Blackwell companion to social work (2nd ed., pp. 276–287). Oxford: Blackwell.
  • Garfield, S. L. (1983). Effectiveness of psychotherapy: The perennial controversy. Professional Psychology, 14, 35–43.
  • Giles, T. R. (1993). Handbook of effective psychotherapy. New York: Plenum.
  • Hardiker, P., & Barker, M. (1981). Theories of practice in social work. London: Academic Press.
  1. Kanfer, F. H., & Schefft, B. K. (1988). Guiding the process of therapeutic change. Champaign, IL: Research Press.
  1. Kazdin, A. E. (1982). Single case research designs. New York: Oxford University Press.
  1. Kazdin, A. E. (1986). The evaluation of psychotherapy: Research design and methodology. In Garfield S. L., & Bergin A. E. (Eds.), Handbook of psychotherapy and behavior change (3rd ed., pp. 23–68). New York: Wiley.
  1. Marks, I. (1987). Fears, phobias and rituals. New York: Oxford University Press.
  1. Ost, L. G., Salkovskis, P. M., & Hellstrom. K. (1991). One-session therapistdirected exposure vs. self-exposure in the treatment of spider phobia. Behavior Therapy, 22, 407–422.
  1. Ronen, T. (2002). Cognitive-behavioural therapy. In Davies M. (Ed.), The Blackwell companion to social work (2nd ed., pp. 165–174). Oxford: Blackwell.
  1. Schinken, S. P. (1981). Behavioral methods in social welfare. New York: Adline.
  1. Skinner, B. F. (1938). The behavior of organism. New York: Appleton-Century-Crofts.
  1. Wodarski, J. S. (1981). The role of research in clinical practice: A practical approach for the human service. Baltimore: University Press.
  1. Wolpe, J. (1982). The practice of behavior therapy (3rd ed.). New York: Pergamon.

[1] David D, Cristea I, Hofmann SG. Why cognitive behavioral therapy is the current gold standard of psychotherapy. Front Psychiatry. 2018;9:4. doi:10.3389/fpsyt.2018.00004

[2] Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res. 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1