Behavior therapy: information & behavior therapists

What is behavioral therapy?

Behavioral therapy (VT) has been developed since the 1950s. Today, behavioral therapy encompasses a variety of methods that have the following things in common:

• they are strongly oriented towards current research findings and are constantly being further developed on the basis of this
• many approaches are disorder-specific, i.e. they are only used for certain disorders
• the improvement of symptoms is understood as a problem-solving process in which the patient must actively participate. The aim is to increase the patient's ability to solve similar problems in the future. In this sense, the approach of behavioral therapy is very transparent, goal- and action-oriented.
• They focus on understanding the conditions that trigger and maintain a problem. This should enable the patient to solve the problem permanently

Behavioral therapy therefore sees itself as helping patients to help themselves. It promotes the development and expansion of active coping strategies and helps the patient to become an expert on their own disorder.

At the heart of behavioral therapy: behavioral analysis

Behavioral analysis is at the heart of behavioral therapy diagnostics. It works out

• the conditions under which a problem manifests itself,
• how the affected person deals with it and
• what consequences follow.

For example, panic attacks often occur when the affected person is relatively stressed due to lack of sleep or other stress. If a panic attack occurs in a store, for example, those affected often flee the situation. It is not uncommon for such attacks to result in the partner starting to do the shopping, for example.

This information is very important for the subsequent problem-solving process of behavioral therapy. On the one hand, it suggests how the likelihood of panic attacks can possibly be reduced. This could be, for example, regular sleep and reducing stress factors.

On the other hand, they point out that the relief provided by the partner is, so to speak, a reward for the panic attacks. Such reward effects help to reinforce problem behavior - mind you, without this being the direct intention of those affected!

Instruments of behavioral therapy

A number of established behavioral therapy tools are used in the context of individual problem-solving processes. The most important of these instruments are briefly presented below.

Stimulus confrontation / exposure

Many people avoid situations that trigger symptoms such as anxiety or compulsive behavior. In the context of stimulus confrontation, they seek these out in a targeted manner. The aim is to overcome the symptoms and thereby regain more living space.

This is a very effective method of behavioral therapy, but it is very strenuous for the patient. It demands a high level of motivation. Therefore, before each stimulus confrontation, it is important to plan exactly what the patient is prepared to put up with and in which steps an improvement is feasible.

For example, a patient with panic disorder avoids enclosed spaces with lots of people. Together with her therapist, she first seeks out enclosed spaces with relatively few people (e.g. a public authority). Next, she goes to rooms with a medium number of people (e.g. a supermarket) and finally to a cramped and crowded department store.

Once she has mastered these situations, she carries out these steps alone in the next stage of behavioral therapy.

Operant methods

Operant methods specifically control behavior in the context of behavior therapy. Control methods are:

• "punishment" of problem behavior and (this is much more important!) "reward" of desired behavior
• by optimally shaping the environment

An example of this would be the treatment of binge eating: on the one hand, drawing up a meal plan helps the patient to eat sufficient quantities on a regular basis to avoid cravings.

If he sticks to this eating plan, he rewards himself in a previously agreed way (e.g. going to the movies). In addition, the design of the environment ensures that, for example, large quantities of high-calorie food are not stored in the household.

If this behavioral control is largely taken over by the patient themselves, this is referred to as increasing "self-management".

Building up skills

Many patients are poorly able to, for example

• assert themselves in conflicts,
• express their opinion confidently or
• solve problems independently.

Social skills training or problem-solving training is ideal for such situations. This usually involves first discussing in groups which behavior can be classified as appropriate and then practicing it step by step.

Cognitive methods of behavioral therapy

In cognitive methods, the therapist works with the patient to identify the ways in which they have a distorted view. For example, depressed people often have a very pessimistic view of the world, while anxiety patients see many events as excessively dangerous. They discuss alternative perspectives and the patient adopts these.

One example would be the panic patient mentioned above, who repeatedly develops the fear that she might faint during her panic attacks. The therapist discusses with her the reasons for and against her fainting in enclosed spaces.

This includes, for example

• Considering how often she has fainted so far (usually never!),
• how often she has experienced this and
• whether any known cases have recognizable causes (e.g. an aunt fainted in a stuffy room on a hot summer's day. However, she had drunk almost nothing all day).

From this, it is deduced during the conversation that her fears are very unrealistic. This is an important prerequisite for the willingness to actively seek out the feared situations in the next step of behavioral therapy.