The term “behavioral therapy” refers to a range of psychotherapeutic methods. These methods support patients by helping them develop and expand active coping strategies—essentially, helping them help themselves. Behavioral analysis is at the heart of behavioral therapy.
Here you will find further information as well as a selection of behavioral therapists.
What is behavioral therapy?
Behavioral therapy (BT) has been in development since the 1950s. Today, behavioral therapy encompasses a wide range of approaches that share the following characteristics:
- they are strongly guided by current research findings and are continually refined based on them
- Many approaches are disorder-specific, meaning they are used only for certain conditions
- improvement in symptoms is understood as a problem-solving process in which the patient must actively participate. The goal is to increase the patient’s ability to solve similar problems in the future. In this sense, the behavioral therapy approach is very transparent, goal-oriented, and action-oriented.
- It focuses on understanding the conditions that trigger and maintain a problem. This is intended to enable the patient to resolve the problem permanently
Behavioral therapy is thus understood as a means of helping people help themselves. It promotes the development and expansion of active coping strategies and helps the patient become an expert on their own disorder.
At the Heart of Behavioral Therapy: Behavioral Analysis
The cornerstone of behavioral therapy diagnosis is behavioral analysis. It identifies
- under what conditions a problem arises,
- how the individual copes with it, and
- what the consequences are.
For example, panic attacks often occur when the person is under significant stress due to lack of sleep or other factors. If a panic attack occurs—say, in a store—the person often flees the situation. It is not uncommon for such attacks to result, for example, in the partner taking over the shopping.
This information is very important for the subsequent problem-solving process in behavioral therapy. On the one hand, it suggests ways in which the likelihood of panic attacks might be reduced—such as getting regular sleep and reducing stressors.
On the other hand, it highlights that the relief provided by the partner effectively serves as a reward for the panic attacks. Such reward effects contribute to reinforcing problem behavior—mind you, without this being the immediate intention of those affected!
Tools of Behavioral Therapy
A range of established behavioral therapy tools is used as part of individualized problem-solving processes. The most important of these tools are briefly presented below.
Stimulus Confrontation / Exposure
Many people avoid situations that trigger symptoms such as anxiety or compulsive behaviors. In stimulus confrontation, the patient deliberately seeks out these situations. The goal is to overcome the symptoms and thereby regain more freedom in life.
This is a highly effective behavioral therapy technique, though it can be very taxing for the patient. It requires a high level of motivation. Therefore, before each exposure session, it is essential to plan precisely what the patient is willing to attempt and in what steps improvement can be achieved.
An example: A patient with panic disorder particularly avoids enclosed spaces with many people. Together with her therapist, she first visits enclosed spaces with relatively few people (e.g., a government office). Next, she moves on to rooms with a moderate number of people (e.g., a supermarket) and, finally, enters a cramped and crowded department store.
Once she has mastered these situations, she carries out these steps on her own in the next stage of behavioral therapy.
Operant Methods
Operant methods specifically target behavior within the framework of behavioral therapy. Methods of control include:
- “punishment” of problem behavior and (this is much more important!) “reward” for desired behavior
- through optimal environmental design
An example of this would be the treatment of binge eating: On the one hand, creating a meal plan helps the patient eat sufficient amounts regularly to avoid cravings as much as possible.
If they stick to this meal plan, they reward themselves in a previously agreed-upon way (e.g., going to the movies). In addition, the environment is structured so that, for example, large quantities of high-calorie food are not stored in the home.
When this behavioral control is largely taken on by the patient themselves, it is referred to as increasing “self-management.”
Building Skills
Many patients are poorly equipped to, for example,
- assert themselves in conflicts,
- express their opinions confidently, or
- solve problems on their own.
In such situations, social skills training or problem-solving training is recommended. This typically begins with a group discussion to determine what behavior is considered appropriate, followed by step-by-step practice of that behavior.
Cognitive Approaches in Behavioral Therapy
In cognitive approaches, the therapist works with the patient to identify the ways in which the patient has a distorted perspective. For example, people with depression often view the world very pessimistically, while patients with anxiety tend to perceive many events as excessively dangerous. They explore alternative perspectives, and the patient adopts them.
One example would be the aforementioned patient with panic disorder who, during her panic attacks, repeatedly fears that she might faint. The therapist discusses with her the reasons for and against the idea that she might faint in enclosed spaces.
This includes, for example,
- considering how often she has fainted in the past (usually never!),
- how often she has witnessed such incidents, and
- whether any known cases have identifiable causes (e.g., an aunt fainted in a stuffy room on a hot summer day, but she had hardly drunk anything all day).
From this, it is concluded during the conversation that her fear is highly unrealistic. This is an important prerequisite for her willingness to actively seek out the feared situations in the next step of behavioral therapy.
