Reviews of the book “Psychotherapy. Systemic behavioral approach" Andrey Kurpatov

The purpose of this textbook is to give the reader a meaningful introduction to modern psychotherapeutic methods, ways of mastering the profession of a psychotherapist and quality standards for psychotherapeutic care, as well as to outline the boundaries of professional practice.

Approaches such as psychoanalysis and psychoanalytic therapy, Jung's analytical psychology, neurolinguistic programming, person-centered approach, systemic family psychotherapy, cognitive behavioral psychotherapy, psychodrama and Gestalt therapy are considered, as well as the ethical foundations of psychotherapy and the study of its problems abroad.

Cognitive-behavioural psychotherapy and psychoanalysis are traditionally considered the two main areas of modern psychotherapy. Thus, in Germany, only these two areas are recognized at universities, and in order to receive a state certificate as a psychotherapist with the right to pay through insurance companies, you must have basic training in one of them. Gestalt- therapy, psychodrama, systemic family psychotherapy, despite their popularity, are still recognized only as types of additional specialization.

Cognitive-behavioral, or cognitive-behavioral, psychotherapy is much younger than psychoanalysis. Although behaviorism as a theoretical direction in psychology arose and developed around the same time as psychoanalysis, that is, from the end of the last century, attempts to systematically apply the principles of learning theory for psychotherapeutic purposes date back to the late 50s and early 60s. At this time, in England, at the famous Maudsley Hospital, G. Eysenck was the first to apply the principles of learning theory to treat mental disorders. In US clinics, the technique of positive reinforcement of desired reactions in patients with severely disrupted behavior, the so-called “token saving” technique, is beginning to be used everywhere. All positively assessed actions of patients (for example, washed oneself, made the bed, etc.) receive reinforcement in the form of issuing a special token. Then this patient token can be exchanged for sweets or given a day off to visit family, etc. In South Africa, D. Wolpe, together with his employees A. Lazarus and Rahman, applies the Pavlovian principle of conditioned reflex formation to treat pathological fears and develops a method of systematic desensitization - the destruction of the conditioned reflex reaction of fear through gradual habituation to a frightening stimulus using imagery and relaxation techniques (Wolpe, Lazarus, 1966).

However, at this time, behaviorism as an explanatory model of human behavior was sharply criticized for its mechanism and ignoring the inner life of a person. The stimulus-reactive scheme, which described human behavior as a sum of reactions to various stimuli and was the main theoretical paradigm in the work of most American psychologists since the 20s, has clearly been exhausted itself as a means of studying the psyche. At this time, a cognitive revolution was taking place in psychology, which proved the role of so-called internal variables, or internal cognitive processes, in human behavior; information models of the human psyche appeared, which describe a person as actively processing information coming from outside and creating various models of reality, and not just passively reacting to stimuli from the outside. Behaviorism was significantly modified, and the psychotherapy that arose on its basis was no longer behavioral, but behavioral-cognitive. Today we can only talk about individual techniques based primarily on the stimulus-reactive scheme, which are actively used to this day; These are, first of all, the already mentioned techniques for modifying fear reactions, based on the principle of desensitization, and some others.

Currently, we can talk about the existence of various cognitive-behavioral approaches, which various authors combine into groups for various reasons. It seems to us possible to distinguish three blocks of cognitive-behavioral approaches:

1. Methods that are closer to classical behaviorism and based primarily on learning theory, that is, on the principles of direct and latent conditioning. These approaches use techniques of systematic desensitization, confrontation with a fearful stimulus, paradoxical intention, positive and negative reinforcement techniques, and behavior modeling techniques, that is, learning based on observing the behavior of a model. Domestic approaches to this group of methods include Rozhnov’s emotional stress psychotherapy;
2. Methods based primarily on information theory, using the principles of step-by-step construction of internal models for processing information and regulating behavior on their basis. These techniques, although they pay more attention to internal cognitive patterns of action, just like the first group of techniques, consider the patterns of human behavior in a simplified manner, reducing them to a computer model. This includes various problem-solving techniques (Zurilla, 1988) and techniques for developing coping skills (Rerun, Rokke, 1988);
3. Methods based on the integration of the principles of learning theory and information theory, as well as the principles of reconstruction of the so-called dysfunctional cognitive processes and some principles of dynamic psychotherapy. These are, first of all, rational-emotive psychotherapy by Albert Ellis and cognitive psychotherapy by Aron Beck. This also includes the approaches of V. Guidano (Guidano, 1988) and G. Liotti (Liotti, 1988), as well as M. Mahoney (Machoney, 1993). These integrative cognitive-behavioral approaches, freely using the techniques of the first two blocks, set as the main goal the change of dysfunctional ways of thinking, which, according to the authors, are the source of inappropriate illness behavior. At the same time, different authors pay more or less attention to past experiences in which ideas, beliefs and attitudes were formed that determine the flow of dysfunctional (for example, anxious or depressive) thoughts. It is the latter that makes methodologists of the cognitive-behavioral approach talk about the lack of theoretical purity of these models and accuse its representatives of sliding towards dynamic psychotherapy (Dobson, 1988). More neutral methodologists speak of the borderline status of this group, calling these approaches “a bridge between behaviorism and psychoanalysis” (Durssen, 1985).

Story

Despite the fact that behavioral therapy is one of the newest methods of treatment in psychiatry, the techniques that it uses have existed since ancient times. It has long been known that people’s behavior can be controlled using positive and negative reinforcements, that is, rewards and punishments (the “carrot and stick” method). However, only with the advent of the theory of behaviorism did these methods receive scientific justification.

Behaviorism as a theoretical direction in psychology arose and developed at approximately the same time as psychoanalysis (that is, from the end of the 19th century). However, the systematic application of the principles of behaviorism for psychotherapeutic purposes dates back to the late 50s and early 60s.

Behavioral therapy methods are largely based on the ideas of Russian scientists Vladimir Mikhailovich Bekhterev (1857-1927) and Ivan Petrovich Pavlov (1849-1936). The works of Pavlov and Bekhterev were well known abroad, in particular, Bekhterev’s book “Objective Psychology” had a great influence on John Watson. All the major behaviorists in the West call Pavlov their teacher. (See also: reflexology)

Already in 1915-1918, V. M. Bekhterev proposed the method of “combination-reflex therapy.” I.P. Pavlov became the creator of the theory of conditioned and unconditioned reflexes and reinforcement, with the help of which behavior can be changed (due to the development of desirable conditioned reflexes or the “extinction” of unwanted conditioned reflexes). Conducting experiments with animals, Pavlov found that if feeding a dog is combined with a neutral stimulus, for example, the ringing of a bell, then this sound will subsequently cause salivation in the animal. Pavlov also described phenomena associated with the development and disappearance of conditioned reflexes:

1. Extinction of a conditioned reflex: if within a certain time a neutral stimulus is no longer accompanied by reinforcement (for example, the ringing of a bell is not accompanied by feeding), then the previously developed conditioned reflex gradually disappears.
2. Generalization of a conditioned reflex: a reflex response can occur not only under the influence of a reinforced stimulus, but also under the influence of stimuli more or less close to it. This idea was later used to create a theory of phobias: for example, if initially the patient’s phobia concerned only a specific situation, then later, under the influence of the generalization process, fear will be caused by an increasing number of situations that have some similarity with the one which caused fear in the beginning.

Thus, Pavlov proved that new forms of behavior can arise as a result of establishing a connection between innate forms of behavior (unconditioned reflexes) and a new (conditioned) stimulus. Pavlov's method was later called classical conditioning.

Pavlov's ideas were further developed in the works of the American psychologist John Watson (1878-1958). Watson concluded that the classical conditioning that Pavlov observed in animals also exists in humans and is the cause of phobias. In 1920, Watson conducted an experiment with an infant. While the child was playing with a white rat, the experimenters induced fear in him using a loud sound. Gradually, the child began to be afraid of white rats, and later also of any furry animals. (See also: the “whistle” method (NLP))

In 1924, Watson's assistant, Mary Cover Jones, used a similar method to cure a child of a phobia. The child was afraid of rabbits, and Mary Jones used the following techniques:

1. The rabbit was shown to the child from afar, while the child was feeding.
2. At the moment when the child saw the rabbit, the experimenter gave him a toy or candy.
3. The child could watch other children playing with rabbits.
4. As the child got used to the sight of the rabbit, the animal was brought closer and closer.

Thanks to the use of these techniques, the child’s fear gradually disappeared. Thus, Mary Jones created a systematic desensitization method that has been successfully used to treat phobias. Psychologist Joseph Wolpe (1915–1997) called Jones "the mother of behavior therapy."

The term "behavior therapy" was first mentioned in 1911 by Edward Thorndike (1874-1949). In the 1940s, the term was used by Joseph Wolpe's research group.

Volpe conducted the following experiment: placing cats in a cage, he subjected them to electric shocks. The cats very soon developed a phobia: they began to be afraid of the cage; if they were brought close to this cage, they tried to break free and run away. Then Wolpe began to gradually reduce the distance between the animals and the cage and give the cats food the moment they were near the cage. Gradually, the animals' fear disappeared. Wolpe suggested that using a similar method, phobias and fears in people could be eliminated. Thus, a method of systematic desensitization was created. Wolpe used this method mainly to treat phobias, social anxiety and sexual disorders associated with increased anxiety.

The further development of behavioral therapy is associated primarily with the names of Edward Thorndike and Frederick Skinner, who created the theory of operant conditioning. In classical Pavlovian conditioning, behavior can be changed by modifying the initial conditions in which the behavior occurs. In the case of operant conditioning, behavior can be changed by stimuli that follow the behavior (“rewards” and “punishments”).

Edward Thorndike (1874-1949), conducting experiments with animals, formulated two laws that are still used in behavioral psychotherapy:

1. The Law of Exercise, which states that repeating a behavior makes that behavior more likely to occur in the future.
2. Law of effect: If a behavior has a positive outcome for an individual, it is more likely to be repeated in the future. If an action leads to unpleasant results, in the future it will appear less and less often or disappear altogether.

Frederick Skinner (1904–1990) continued Thorndike's research and made significant contributions to the development of the theory of operant conditioning. From Skinner's point of view, in both animals and humans, the likelihood of a behavior occurring is directly related to the consequences that the behavior has had in the past. In particular, Skinner established that the disappearance of a particular behavior pattern can be caused not only by an unpleasant result for the individual, but also by the absence of any result. The only difference is that in the presence of an unpleasant result, the behavior pattern disappears faster than in the absence of any result.

The method of classical conditioning was also used in the conditioning therapy clinic of Andrew Salter (1914-1996).

The ideas of behavior therapy became widespread thanks to the publications of Hans Eysenck (1916–1997) in the early 1960s. Eysenck defined behavior therapy as the application of modern learning theory to the treatment of behavioral and emotional disorders. In 1963, the first journal devoted exclusively to behavioral psychotherapy, Behavior Research and Therapy, was founded.

In the 1950s and 1960s, the theory of behavior therapy developed mainly in three research centers:

• In South Africa - Wolpe, Arnold Lazarus and Stanley Rachman. This group developed mainly methods of self-affirmation training and systematic desensitization.
• In the United States, Skinner's students Ogden Linsley and Teodoro Aylon began to apply the principles of operant conditioning to treat mental patients, including using the technique of token reinforcement. In addition, a group of Albert Bandura and Richard H. Walters worked at Stanford University, developing learning theory.
• Shapiro MB, Yates AJ and Eysenck worked at the Institute of Psychiatry at the University of London.

Behavioral psychotherapy was established as an independent field around 1950. The popularity of this method was facilitated by the growing dissatisfaction with psychoanalysis, due to the insufficient empirical basis of analytical methods, as well as due to the duration and high cost of analytical therapy, while behavioral techniques have proven their effectiveness, and the effect was achieved in just a few therapy sessions.

By the end of the 60s, behavioral psychotherapy was recognized as an independent and effective form of psychotherapy. Currently, this area of ​​psychotherapy has become one of the leading methods of psychotherapeutic treatment. In the 1970s, methods of behavioral psychology began to be used not only in psychotherapy, but also in pedagogy, management and business.

Initially, behavioral therapy methods were based exclusively on the ideas of behaviorism, that is, on the theory of conditioned reflexes and on the theory of learning. But currently there is a tendency towards a significant expansion of the theoretical and instrumental base of behavioral therapy: it can include any method whose effectiveness has been proven experimentally. Arnold Lazarus called this approach Broad Spectrum Behavioral Therapy or Multimodal Psychotherapy. For example, relaxation techniques and breathing exercises (in particular, diaphragmatic breathing) are currently used in behavioral therapy. Thus, although behavioral therapy is based on evidence-based methods, it is eclectic in nature. The techniques that are used in it are united only by the fact that they are all aimed at changing behavioral skills and abilities. According to the American Psychological Association, “Behavioral psychotherapy involves, first of all, the use of principles that have been developed in experimental and social psychology... The main goal of behavioral therapy is to build and strengthen the ability to act and increase self-control.”

Methods similar to those of behavioral therapy were used in the Soviet Union starting in the 1920s. However, in the domestic literature for a long time, instead of the term “behavioral psychotherapy,” the term “conditioned reflex psychotherapy” was used.

Behaviorism as a science of behavior

Definition 1
The essence of the ideas of behaviorism is that any human behavior is determined by its response to the external environment. This may be a reaction to an existing situation, or a person’s course of action that is aimed at acquiring reinforcement, or behavior predetermined by the desire to avoid punishment.

Behaviorism was founded by the American psychologist and educator Edward Thorndike. In his studies on animals, he discovered two patterns:

1. “The Law of Exercise” - the essence of this law is that learning is accomplished faster by repeating a set action.
2. “Law of effect” - if the development of a connection between a stimulus and a response generates a feeling of satisfaction, then the connection is reinforced; if the formation of a connection is accompanied by pain or irritation, the connection weakens. This law has been revised over time.

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Thorndike developed the trial and error method, in which the situation itself can act as a stimulus, and behavior is developed in the process of acts (actions). Thorndike formed a theory that was based on the fact that behavior is formed by feelings: discomfort and pleasure.

At the beginning of the 20th century, Ivan Petrovich Pavlov, a Soviet and Russian physiologist, also conducted research on animals with the task of establishing the relationship between stimuli and reactions. He discovered the presence in animals of reflexes that were inherent in nature itself, as well as the ability to artificially form individual reflexes using stimulation.

Thorndike's compatriot John Brodes Watson rejected the fact of consciousness as such. In his opinion, psychology is a natural science discipline whose purpose is to calculate the manifestation of human reactions to stimuli, predict behavior and control it. In his research, he identified three primary reactions - love, anger and fear. All other behavior, according to Watson, is a layering on the primary reactive behavior. John Watson's research was not appreciated by the Puritan American public, and its conclusions were of dubious reliability.

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Indications

Behavioral psychotherapy is used for a wide range of disorders: mental and so-called psychosomatic disorders, as well as purely somatic diseases. It is especially useful in the treatment of anxiety disorders, in particular panic disorders, phobias, obsessions, as well as the treatment of depression and other mood disorders, eating disorders, sexual problems, schizophrenia, antisocial behavior, sleep and attention disorders, hyperactivity, autism, difficulties in learning and other developmental disorders in childhood, as well as language and conversation problems.

In addition, behavioral psychotherapy can be used to cope with stress and treat clinical manifestations of high blood pressure, headaches, asthma and some gastrointestinal diseases, in particular enteritis and chronic pain.

Researchers' findings

Walkup and his colleagues concluded that all three types of treatment—cognitive behavioral therapy, Zoloft, or a combination of the two—are effective short-term treatments for children with anxiety disorders. “Among these effective treatments, combination therapy offers the best chance of a positive outcome,” they conclude.

• Zoloft worked quickly, with rapid initial improvement, but showed little additional improvement after eight weeks of treatment.
• CPS required 8-12 weeks for the first results to become noticeable.

Behavioral therapy plus Zoloft

Most children with anxiety disorders go undiagnosed and untreated, notes Graham J. Emslie, MD, of the University of Texas Southwestern Medical Center at Dallas. That's too bad, he says, because research has shown that untreated anxiety persists into adulthood. "This study answers the most compelling question about treatment for anxiety disorders: Treatment does work," Emslie said.

Zoloft is an antidepressant. Like other members of this class, the drug has been linked to suicidal ideation in children and adults. But in this study, children taking Zoloft did not have more suicidal thoughts than children taking placebo pills. However, children who took Zoloft reported more insomnia, fatigue, sedation, and anxiety than children in the CBT group.

Cognitive behavioral therapy was developed in the 60s of the 20th century by American psychiatrist Aaron Beck. The basic idea behind this form of therapeutic treatment is the belief that a person's thoughts, emotions and behaviors influence each other, creating patterns of behavior that are not always appropriate.

A person, under the influence of emotions, reinforces certain forms of behavior in certain situations. Sometimes copies the behavior of others. Reacts to various phenomena and situations in the way he is used to, often without realizing that he is harming others or himself.

Therapy is needed when behavior or beliefs are not objective and can create problems for normal life. Cognitive behavioral psychotherapy allows you to detect this distorted perception of reality and replace it with the right one.

Basic principles

• A tenet of behavior therapy is the idea that behavioral patterns play a critical role in the development of psychological disorders. For example, in depression, social isolation is not only a consequence of depression, but also a factor that aggravates the patient’s depressive state. It is assumed that behavior can be changed through the use of certain therapeutic methods.
• In behavioral therapy, only methods are used whose effectiveness has been confirmed experimentally, with preference given to techniques that have a clearly positive effect.
• The starting point of therapy is the problem that worries the patient at the moment. One of the basic principles of behavior therapy is the “here and now” rule.
• The “principle of minimal intrusion” (Kafner, 1991) postulates that behavior therapy should interfere with the patient's inner life only to the extent necessary to solve his actual problems.
• The relativity of the concepts “health-disease” and “norm-deviation”. The behavioral therapist does not impose on the client his ideas about what is normal and healthy behavior - the goal of therapy is to develop behavior that will be optimal and desirable for that particular client.
• In behavior therapy, the therapist typically plays an active and directive role. The technique of “talking out” one’s problems and experiences is not encouraged in behavioral therapy. The patient mainly answers questions that are asked of him and performs exercises that the therapist recommends. The therapist usually works according to a pre-determined plan, from which he does not deviate unless necessary.
• One of the features of behavioral therapy is that it sometimes uses the help of family members of the patient (with the patient's consent), for example, to complete “homework”, to help with self-monitoring, to increase motivation, etc.

Behavioral therapy scheme

Assessing the client's condition

This procedure is called "functional analysis" or "applied behavior analysis" in behavior therapy. At this stage, the first step is to compile a list of behavior patterns that have negative consequences for the patient. Each behavior pattern is described according to the following scheme:

• When and how does this type of behavior occur?
• How often?
• How long does it last?
• What are its consequences in the short and long term?
• In behavioral therapy, however, only what can be observed is taken into account. For example, instead of talking about the fear that he is experiencing, the patient should talk about specific sensations associated with fear (palpitations, breathing problems, etc.)

Then situations and events are identified that cause a neurotic behavioral reaction (fear, avoidance, etc.). Using self-observation, the patient must answer the question: what factors can increase or decrease the likelihood of a desired or undesirable behavior pattern? It should also be checked whether the undesirable pattern of behavior has any “secondary benefit” for the patient, that is, a hidden positive reinforcement of this behavior. The therapist then determines which strengths in the patient's character can be used in the therapeutic process. It is also important to find out what the patient's expectations are regarding what psychotherapy can give him: the patient is asked to formulate his expectations in specific terms, that is, to indicate which behavioral patterns he would like to get rid of and what forms of behavior he would like to learn. It is necessary to check whether these expectations are realistic. In order to obtain the most complete picture of the patient's condition, the therapist gives him a questionnaire, which the patient must fill out at home, using, if necessary, the method of self-observation. Sometimes the initial assessment phase takes several weeks because it is critical in behavior therapy to obtain a complete and accurate description of the patient's problem.

In behavior therapy, the data obtained at the preliminary analysis stage is called the “baseline” or “starting point”. These data are subsequently used to evaluate the effectiveness of therapy. In addition, they allow the patient to realize that his condition is gradually improving, which increases motivation to continue therapy.

Drawing up a treatment plan

In behavioral therapy, it is necessary for the therapist to adhere to a specific plan when working with the patient, so after assessing the patient's condition, the therapist and patient draw up a list of problems that need to be solved. However, it is not recommended to work on several problems at the same time. Multiple problems must be addressed sequentially. You should not move on to the next problem until you have made significant improvement on the previous problem. If there is a complex problem, it is advisable to break it down into several components. If necessary, the therapist creates a “problem ladder,” which is a diagram that shows the order in which the therapist will work with the client's problems. The behavior pattern that should be changed first is selected as a “target”. The following criteria are used for selection:

• The severity of the problem, that is, how much harm this problem causes to the patient (for example, interferes with his professional activities) or poses a danger to the patient (for example, severe alcohol dependence);
• What causes the most unpleasant sensations (for example, panic attacks);
• "Centrality" of the problem. This criterion takes into account how much the solution to this problem will help solve other problems of the patient.

If the patient is insufficiently motivated or lacks self-confidence, therapeutic work can begin not with the most important problems, but with easily achievable goals, that is, with those behavior patterns that are easiest to change, or that the patient wants to change first. The transition to more complex problems is made only after simpler problems have been solved. During therapy, the therapist constantly checks the effectiveness of the methods used. If the initially chosen techniques are ineffective, the therapist should change the therapy strategy and use other techniques.

The priority in choosing a goal is always consistent with the patient. Sometimes therapeutic priorities may be revised during therapy.

Behavioral therapy theorists believe that the more specific the goals of therapy are formulated, the more effective the therapist's work will be. At this stage, you should also find out how great the patient's motivation is to change a particular type of behavior.

In behavior therapy, a critical success factor is how well the patient understands the meaning of the techniques the therapist uses. For this reason, usually at the very beginning of therapy, the basic principles of this approach are explained to the patient in detail, and the purpose of each specific method is explained. The therapist then uses questions to check how well the patient has understood his explanations and answers questions if necessary. This not only helps the patient correctly perform the exercises recommended by the therapist, but also increases the patient's motivation to perform these exercises daily.

In behavioral therapy, the use of self-observation and the use of “homework” are widespread, which the patient must complete daily, or even, if necessary, several times a day. For self-observation, the same questions that were asked to the patient at the preliminary assessment stage are used:

• When and how does this type of behavior occur?
• How often?
• How long does it last?
• What are the triggers and reinforcing factors for this behavior pattern?
• What are its consequences in the short and long term?

When giving a patient “homework,” the therapist must check whether the patient correctly understands what he is supposed to do and whether the patient has the desire and ability to complete this task every day.

We should not forget that behavioral therapy is not limited to eliminating unwanted behavior patterns. From the point of view of the theory of behaviorism, any behavior (both adaptive and problematic) always performs some function in a person’s life. For this reason, when problem behavior disappears, a vacuum of sorts is created in a person's life, which may be filled by new problem behavior. To prevent this from happening, when drawing up a behavioral therapy plan, the psychologist provides for what forms of adaptive behavior should be developed to replace problematic behavior patterns. For example, therapy for a phobia will not be complete unless it is established what forms of adaptive behavior will fill the time that the patient devotes to phobic experiences. The treatment plan should be written in positive terms and indicate what the patient should do rather than what he should not do. This rule is called the "living person rule" in behavior therapy - because the behavior of a living person is described in positive terms (what he is capable of doing), while the behavior of a dead person can only be described in negative terms (for example, a dead person does not may have bad habits, experience fear, show aggression, etc.).

Completion of therapy

As Judith Beck emphasizes, therapy that focuses on behavior change does not eliminate the client's problems once and for all. The goal of therapy is simply to learn how to cope with difficulties as they arise, that is, to “become your own therapist.” The famous behavioral psychotherapist Mahoney (1976) even believes that the client should become a “scientist-researcher” of his own personality and behavior, which will help him solve problems as they arise (in behavioral therapy this is referred to as self-management). For this reason, at the final stage of therapy, the therapist asks the client what techniques and techniques were most useful for him. The therapist then recommends using these techniques independently, not only when a problem arises, but also for preventive purposes. The therapist also teaches the client to recognize signs that a problem has arisen or returned, as this will allow the client to take proactive steps to cope with the problem or at least reduce the negative impact of the problem.

• How does ABA therapy work?

With this approach, all skills that are difficult for autistic people, including speech, contact, creative play, listening, looking into the eyes, etc., are divided into separate small blocks - actions. Then each action is learned separately with the child, and subsequently the actions are connected into a single chain, forming one complex action. In the process of learning actions to a child with autism spectrum disorders, a specialist at an autism treatment center gives a task; if he cannot cope with it alone, then he gives a hint, and then rewards the child for correct answers, while ignoring incorrect ones.

STAGE No. 1: “LANGUAGE - UNDERSTANDING” . For example, one exercise from the ABA program “Language - Comprehension”. The therapist at the autism treatment center gives the child a stimulus or task, for example, “raise your hand,” then gives a hint (he himself raises the child’s hand up), then rewards him for the correct answer. Having made a certain number of attempts together (task - hint - reward), they make an attempt without a hint: the specialist gives the child the task: “Raise your hand,” and waits for the child to give the correct answer on his own. If he answers correctly without prompting from the therapist, he receives a reward (the child is praised, allowed to play, given something tasty, etc.). If the child does not give an answer or gives an incorrect answer, the therapist tries again several times using a prompt, and then tries again without a prompt. The exercise ends when the child gives the correct answer without prompting.

When a child with autism begins to answer correctly without prompting in 90% of cases given a task, a new stimulus is introduced, for example, “nod your head.” It is important that the first two tasks are as different as possible. The “nod your head” task is practiced in the same way as “raise your hand.”

STAGE No. 2: COMPLEXATION . When the child masters the task “nod your head” (abbreviated “KG”) in 90% of cases, the tasks begin to alternate in a free order, “nod your head” and “raise your hand”: first “KG” - “PR”, then “KG” – “KG” – “PR”, and in any other order. These two stimuli are considered mastered by the child when he randomly gives 90% of correct answers out of 100% when alternating two back or stimuli. After this, the third stimulus is introduced and practiced until assimilation, then all three are alternated, the fourth is introduced, and so on.

STAGE No. 3: GENERALIZATION OF SKILLS . When a child accumulates a lot of mastered stimuli in his stock (including such stimuli necessary for daily life as “take (name of object)”, “give (name of object)”, “come here” and others), they begin to work with the child on generalization. Generalization of skills is nothing more than conducting exercises in some unexpected places, unusual for training: in the bathroom, in a store, on the street. Then they begin to alternate people who give tasks (therapists, mom and dad, grandparents, other children).

STAGE No. 4: “EXITING THE WORLD” . At some point, the child not only masters the stimuli practiced with him, but also begins to independently understand new stimuli without additional training (for example, they show him “close the door” once or twice, and that’s enough). When this happens, the program is considered mastered - the autistic child can learn further information from the environment, just as typically developing children do.

ABA therapy has several hundred different programs in its arsenal, including the treatment of autism with mental retardation (mental development delay), nonverbal and verbal imitation, gross and fine motor skills, understanding the speaker’s language, naming objects and actions, classifying objects (laying out cards with a dog and a cat in one pile, and cards with a spoon and fork in another). In addition, correction of autism in children includes programs such as “show me how you…” (the child pretends to put on a hat / comb his hair / put out a fire / turn the steering wheel / meow, catch mice, etc.), mastering pronouns (teach the child to correctly use “I” I’m standing” - “you’re standing”), answers to questions “who”, “what”, “how”, “where”, “when”, the use of words “yes” and “no”, etc. The question of which program is more effective in the treatment of autism, in fact, does not matter, since each child has his own individual characteristics, and an individual approach to him is also required. At the same time, we can name more advanced ABA programs - “Tell what will happen if ...” (the child predicts the outcome of the action), “Do as (any peer’s name)”, “Tell a story”, “Call (peer’s name) to play” , and so on.

The ultimate goal of ABA therapy is to give a child with autism the tools to master the world around him independently.

Behavioral therapy methods

• Imitation Training—In this method, the client is asked to observe and imitate desired behavior patterns (for example, the behavior of a therapist or therapist's assistant). For this, not only a “living model” (a real person) can be used, but also a “symbolic model”, which can be a book hero or an image created by the client’s own imagination. One form of learning by example is self-modeling. This technique involves the therapist making a video recording of successful moments of the client’s behavior and then showing the video recording to the client.
• Role-playing training is a technique used to teach certain types of behavior (for example, training communication skills), and is a type of role-playing game. The effect of role-playing training is based on a combination of confrontation techniques, systematic desensitization (which helps reduce anxiety) and reinforcement of successful behavior in the form of positive feedback from the therapist. In this technique, the patient and therapist role-play a problematic situation. This technique can also be used in group therapy. Most often, the patient plays himself, but sometimes this is done by a therapist or one of the group members, which allows the patient to see his problem from the outside, and also to understand that in this problematic situation it is possible to act differently.
• Biofeedback is a technique that uses equipment to monitor signs of stress in a patient. As the patient achieves a state of muscle relaxation, he receives positive visual or auditory reinforcement (for example, pleasant music or an image on a computer screen).
• Unlearning methods (aversive therapy)
• Systematic desensitization
• Implosion therapy
• Shaping (behavior modeling)
• Auto-instruction method
• Stress vaccination therapy
• "Thought stopping" method

Methods of behavioral therapy in educational practice

Functional behavior analysis is a discipline based on the scientific views of B. F. Skinner, and in particular, on the concept of operant conditioning. The leading method of behavior analysis is the method of functional assessment - identifying antecedents (preceding conditions) and postcedents (consequences) of certain actions in order to find factors associated with the manifestation of the behavior of interest to the therapist. Applied behavior analysis is a technological implementation of functional behavior analysis: methods for analyzing and changing conditions in order to correct behavior. Applied behavior analysis is used in the education system both to improve indicators - academic performance, discipline, attendance of all children, and to include children with disabilities and problems with socialization (for example, with ASD) in general education classes.

Problems that arise during therapy

• The client's tendency to verbalize at length what he is thinking and feeling, as well as to try to find the causes of his problems in what he has experienced in the past. The reason for this may be the idea of ​​psychotherapy as a method that “allows you to speak out and understand yourself.” In this case, you should explain to the client that behavioral therapy consists of performing specific exercises, and its goal is not to understand the problem, but to eliminate its consequences. However, if the therapist sees that the client needs to express his feelings or find the underlying cause of his difficulties, then cognitive or humanistic psychotherapy techniques can be added to behavioral methods, for example.
• The client's fear that correcting his emotional manifestations will turn him into a “robot.” In this case, you should explain to him that thanks to behavioral therapy, his emotional world will not become poorer, just that negative and maladaptive emotions will be replaced by pleasant emotions.
• The client's passivity or fear of the effort required to perform the exercises. In this case, it is worth reminding the client what consequences such an installation may lead to in the long term. At the same time, you can review the treatment plan and start working with simpler tasks, breaking them down into separate stages.

Sometimes in such cases, behavioral therapy uses the help of the client's family members. Sometimes the client has dysfunctional beliefs and attitudes that interfere with his involvement in the therapeutic process. These settings include:

• Unrealistic or inflexible expectations about the methods and results of therapy, which may be a form of magical thinking (assuming that the therapist can fix any problem the client has). In this case, it is especially important to find out what the client's expectations are, and then create a clear treatment plan and discuss this plan with the client.
• The belief that only the therapist is responsible for the success of therapy, and that the client cannot and should not make any effort (external locus of control). This problem not only significantly slows down the progress of treatment, but also leads to relapses after stopping meetings with the therapist (the client does not consider it necessary to do his “homework” and follow the recommendations that were given to him at the time of completion of therapy). In this case, it is helpful to remind the client that in behavior therapy, success is not possible without the active cooperation of the client.
• Dramatizing the problem, for example: “I have too many difficulties, I will never cope with this.” In this case, it is useful to begin therapy with simple tasks and exercises that provide quick results, which increases the client's confidence in his ability to cope with his problems.
• Fear of judgment: The client is embarrassed to tell the therapist about some of his problems, and this prevents the development of an effective and realistic plan for therapeutic work.

If such dysfunctional beliefs exist, it makes sense to use cognitive psychotherapy methods to help the client reconsider his attitudes.

One of the obstacles to achieving success is the client's lack of motivation. As stated above, strong motivation is a prerequisite for the success of behavior therapy. For this reason, motivation for change should be assessed at the very beginning of therapy, and then, in the course of working with the client, its level should be constantly checked (we should not forget that sometimes the client’s demotivation takes hidden forms. For example, he may stop therapy, assuring that his problem has been solved. In behavioral therapy this is called “escape to recovery”). To increase motivation:

• It is necessary to provide clear and precise explanations about the importance and usefulness of the techniques used in therapy;
• You should choose specific therapeutic goals, coordinating your choice with the desires and preferences of the client;
• It has been noticed that clients often focus on problems that have not yet been solved and forget about the successes already achieved. In this case, it is useful to periodically evaluate the client's condition, visually showing him the progress achieved due to his efforts (this can be demonstrated, for example, using charts).
• A feature of behavioral therapy is its focus on quick, specific, observable (and measurable) results. Therefore, if there is no significant progress in the client's condition, then the client's motivation may disappear. In this case, the therapist must immediately reconsider the chosen tactics of working with the client.
• Because in behavior therapy the therapist works collaboratively with the client, it should be explained that the client is not obligated to blindly follow the therapist's recommendations. Objections on his part are welcome, and any objection should be immediately discussed with the client and, if necessary, changes to the work plan.
• To increase motivation, it is recommended to avoid monotony in working with a client; It is useful to use new methods that arouse the greatest interest in the client.

At the same time, the therapist should not forget that the failure of therapy may be associated not with the client’s dysfunctional attitudes, but with the hidden dysfunctional attitudes of the therapist himself and with errors in the application of behavioral therapy methods. For this reason, it is necessary to constantly use self-observation and the assistance of colleagues to identify which distorted cognitive attitudes and problematic behaviors prevent the therapist from achieving success in his work. The following errors are common in behavioral therapy:

• The therapist gives the client homework or a self-monitoring questionnaire, but then forgets about it or does not take the time to discuss the results. This approach can significantly reduce the client's motivation and reduce his trust in the therapist.
• It is common for inexperienced behavior therapists to deviate from a previously developed treatment plan: the therapist may move on to eliminating a new problem without completing work with the previous problem. All this reduces the effectiveness of therapy and reduces the client's motivation. For this reason, it is recommended in behavioral therapy to draw up a clear and realistic work plan in advance; The therapist should follow this plan as far as possible and not change it without the agreement of the client. If a change in plan is still necessary, one should not improvise - the therapist must, together with the client, develop a new work plan.
• Sometimes the therapist works only with individual symptoms and problems that correspond to certain techniques. At the same time, the holistic picture of violations is not taken into account and analyzed, which inevitably reduces work efficiency and can even lead to the opposite negative effect. For this reason, a behavioral psychotherapist must have in-depth knowledge of the clinical picture and psychological mechanisms of various syndromes and pathologies, and in his work he should always strive to understand what is behind a particular problem.

Basic principles and techniques of behavioral psychotherapy.

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Behavioral psychotherapy as a systematic approach to the diagnosis and treatment of psychological disorders arose relatively recently - in the late 50s.

Behavioral psychotherapy is a direction in psychotherapy based on the principles of behaviorism and considering mental disorders as ineffective forms of human behavior in the process of adaptation to existing conditions. It is one of the leading trends in modern psychotherapy. Behavior therapy is a treatment that uses learning principles to change behavior and thinking.

The goal of behavioral psychotherapy is the formation and strengthening of the ability to act, the acquisition of techniques to improve self-control.

Behavioral psychotherapy, according to J. Fadiman and R. Frager (1994):

1) strives to help people react to life situations the way they themselves would like to, i.e. help increase the potential of their personal behavior, thoughts, feelings and reduce or eliminate undesirable ways of responding;

2) the goal is not to change the emotional essence of relationships and feelings of the individual;

3) a positive therapeutic attitude is a necessary but not sufficient condition for effective psychotherapy;

4) the patient's complaints are accepted as significant material on which therapy is focused, and not as symptoms of the underlying problem;

5) the patient and psychotherapist agree on specific goals of psychotherapy, understood in such a way that both the patient and the psychotherapist know when and how these goals can be achieved.

The theoretical source of behavioral therapy was the concept of behaviorism of the American zoopsychologist J. Watson and his followers (1913), who understood the enormous scientific significance of Pavlov’s doctrine of scientific reflexes, but interpreted and used it mechanistically. According to the views of behaviorists, human mental activity should be studied, as in animals, only by recording external behavior and should be limited to establishing the relationship between stimuli and reactions, regardless of the influence of the individual. In essence, behaviorism followed Descartes's long-standing doctrine of “animal machines” and the concept of the 18th century French materialist. La Mettrie about “man-machine”. Behaviorism excluded from its scope of consideration all psychological phenomena that were not subject to strict scientific research, recording and measurement. All mental phenomena were reduced to reactions of the body, mainly motor ones: thinking was identified with speech motor acts, emotions - with changes within the body. The unit of behavior is the connection between stimulus and response. The main method of behaviorism is observation and experimental study of the body's reactions in response to environmental influences in order to identify correlations between these variables that can be described mathematically. At present, only a few American psychologists (the most consistent and irreconcilable is the American psychologist B. Skinner) continue to defend the postulates of behaviorism.

Let us consider various types of learning and their significance for psychotherapy.

Classical conditioning. Classical conditioning is a method of forming a conditioned reflex, in which an initially indifferent stimulus, approaching in time the action of the stimulus that causes an unconditioned reflex, becomes a signal and causes the desired reaction. In this case, the role of reinforcement is played by the unconditioned stimulus, which always precedes the reaction.

The foundations of classical conditioning were created at the beginning of the century by I.P. Pavlov. In the experiments of I.P. Pavlov, a conditioned stimulus (bell) is combined with an unconditioned stimulus (feeding a dog), a connection is established between them in such a way that the previously neutral conditioned stimulus (bell) now causes a conditioned reaction (secretion of saliva).

An excellent example of classical conditioning is the experiment of J. Watson. In 1918, he began laboratory experiments with children. One experiment first showed that a nine-month-old boy, Albert, was not afraid of a white rat, a rabbit, or other white objects. J. Watson then struck the steel bar next to Albert's head every time a white rat appeared. After several blows, Albert, at the sight of the rat, began to shudder, cry and try to crawl away. He reacted in a similar way when other white objects were shown to him.

Another phenomenon discovered by I.P. Pavlov and used in behavioral procedures. The conditioned stimulus continues to evoke the conditioned response only if the unconditioned stimulus appears at least periodically. If the conditioned stimulus is not reinforced by the unconditioned one, then the strength of the conditioned reaction begins to decrease. The gradual disappearance of a conditioned response as a result of the elimination of the connection between the conditioned and unconditioned stimuli is called “extinction”.

Instrumental or operant conditioning. Stimulus is an influence that determines the dynamics of an individual’s mental states (designated as a reaction) and relates to it as cause and effect.

Reaction - any response of the body to a change in the external or internal environment - from the biochemical reaction of an individual cell to a complex behavioral act.

Reinforcement is an unconditioned stimulus that causes a biologically significant reaction, which, when combined with the preceding action of an indifferent stimulus, produces a classical conditioned reflex. Reinforcement that causes harm to the body is called negative, and that gives pleasure is called positive.

The principles of instrumental learning were discovered by the American psychologist E. Thorndike around the time when I.P. Pavlov conducted experiments in Russia. The animal, usually a hungry cat, was placed in a special cage and had to learn some kind of reaction - for example, step on a small lever in order to open the door and go outside. When the cat succeeded, she was rewarded with food and returned to the box. After several trials, the cat calmly approached the lever, pressed it with its paw, went out through the open door and ate.

The formation of the reaction occurred through trial and error, as a result of choosing the desired standard of behavior and its subsequent consolidation. Learning, according to Thorndike, is governed by the law of effect. According to this law, behavior is controlled by its results and consequences. Behaviors that lead to positive results are reinforced.

Several decades after the publication of Thorndike's works, another American psychologist, B. Skinner, developed Thorndike's ideas. Skinner emphasized that in instrumental conditioning, the animal operates with the environment, influences the environment. Operant conditioning is a term coined by American psychologist B.F. Skinner to designate such a way of forming conditioned connections between stimulus and response, in which the desired action is first performed, and only then reinforcement is given.

To study operant conditioning, Skinner invented an experimental chamber that was completely controlled. It is sound and lightproof and maintains a constant temperature. It contains a device that the animal can operate to receive a reward. For example, a rat, pressing a lever, receives food from a thin tube. The Skinner box allowed us to study the relationship between a response and its consequences and analyze how these consequences influence behavior.

When comparing classical and operant conditioned reflexes, it is clear that, firstly, classical conditioning requires repeated paired presentation of a neutral stimulus (bell) and a stimulus that causes an innate, unconditioned response (food). Ensuring such presentation is achieved by the participation of the experimenter. In experiments with operant conditioning, the animal itself carries out a selection of behavioral stereotypes - and the choice of the stereotype that leads to the achievement of a result occurs more actively. Second, operant reflexes are controlled by their outcome; in experiments with classical conditioning, the appearance of a conditioned response is controlled by the presentation of a previous stimulus. In real life, most learning is carried out according to the laws of the formation of operant conditioned reflexes.

Social learning. In the 60s The development of behavioral psychotherapy was influenced by the theory of learning (primarily social) through observation. The author of this theory, A. Bandura (1971), showed that just observing a model makes it possible to form new behavioral stereotypes that were previously absent in an animal or a person. This later led to theoretical generalizations called the concept of self-efficacy.

Most learning in people occurs when they are with other people. Most learning follows the principles of instrumental and classical conditioning. According to traditional views of conditioning, for learning to occur, the organism must have direct, personal experience with combinations of stimuli or with the consequences of responses (behaviors). Social learning theorists argue that people also learn from the experiences of others, through processes known as “vicarious conditioning” and “vicarious learning.”

General characteristics of behavior therapy. Behavioral therapy has two main characteristics that distinguish it from other therapeutic approaches. The first point is that behavioral therapy is based on a learning model - a psychological model that is fundamentally different from the psychodynamic model of mental illness. Second point: commitment to the scientific method.

From these two provisions the following follow:

1. Many cases of pathological behavior, which were previously considered as a disease or as symptoms of a disease from the point of view of behavior therapy, represent non-pathological “life problems”.

2. Pathological behavior is largely acquired and is maintained in the same ways as normal behavior. It can be treated using behavioral treatments.

3. Behavioral diagnosis focuses more on the determinants of present behavior than on past life analysis. The hallmark of behavioral diagnostics is its specificity: a person can be better understood, described, and assessed by what he does in a specific situation.

4. Treatment requires a preliminary analysis of the problem, identifying its individual components. These specific components are then subjected to systematic behavioral treatments.

5. Treatment strategies are tailored to suit different problems in different individuals.

6. Understanding the origin of a psychological problem (psychogenesis) is not essential for the implementation of behavioral changes.

7. Behavioral therapy is scientifically based: it starts from a clear conceptual framework; therapy is consistent with the content and method of experimental clinical psychology; the techniques used can be described in order to measure them objectively or to repeat them; therapeutic methods can be evaluated experimentally.

Goals of behavioral psychotherapy.

Behavioral therapy is based on the theory of learning and sees the cause of human difficulties and problems in the fact that in certain unfavorable environmental conditions the subject has learned “wrong” and maladaptive forms of behavior that bring suffering to him and the people around him. In contrast to psychoanalysis and the humanistic direction of therapy, behavioral consultants tend to focus not on internal conflicts and motives, but on human behavior visible to an external observer. Behavior therapists believe that problem behavior can be unlearned using special procedures based on the laws of learning.

The goal of behavioral therapy is to eliminate inappropriate behavior (eg, excessive anxiety) and teach adaptive behavior (social interaction skills and assertive behavior). How to overcome the fear of speaking in front of an audience, improve the behavior of a capricious and aggressive child, wean yourself from overeating, protect yourself in a conflict situation and learn to interact with the opposite sex - typical tasks solved in behavioral counseling. The emphasis of the work is not on self-understanding, but on exercises and practicing certain skills.

Behavioral theory is associated with the development of the ideas of Pavlov and American psychologists Watson, Skinner, Wolpe and Eysenck. John B. Watson (1878-1958) was the founder of an approach to psychology that aimed to study behavior and was called behaviorism (from the English word behavior). Wolpe and Eysenck made the most significant contribution to the development and popularization of the field now known as behavioral therapy and counseling.

Theorists in this direction are characterized by experimentation with animal behavior and the desire to impart strict scientific objectivity to their research.

Basic concepts and mechanisms of assistance.

How does organisms learn? There are several types of learning, each of which is used in specific behavioral therapeutic techniques.

The outstanding Russian physiologist Ivan Petrovich Pavlov (1849-1936) created the doctrine of the unconditioned and conditioned reflex, which was called classical or respondent conditioning.

The point of learning through classical conditioning is that the body begins to respond to an initially neutral signal that means nothing to it. Thus, by feeding dogs at the same time as turning on the metronome, it is possible to obtain a salivation response not to an unconditioned stimulus (food), but to a conditioned one - the sound of the metronome. A conditioned reflex is formed. The sound of the metronome affects the dog even in the absence of food. However, if the sound of the metronome is not repeatedly reinforced with food, then the salivation response to it fades away. The dog learned to respond to a stimulus (metronome), and then lost this skill.

If neutral stimuli are associated with danger, then in a calm situation they can provoke anxiety. For example, a person who accidentally gets stuck in an elevator and is very frightened may develop a fear of elevators. People with such neurotic fears, called phobias (from the Greek phobos - fear, fear), cannot bring themselves to sit in an elevator and, therefore, experience great inconvenience in ordinary life situations.

Behavioral psychologists have shown in their experiments that neurotic reactions of fear and anxiety can be formed experimentally. Joseph Volpe conducted fundamental laboratory research to teach cats neurotic fears and then wean them off them. The cats were first trained to search for food in response to a call. At the next stage of the experiment, feeding was carried out, the bell was turned on, and at the same time the cat was exposed to an electric shock when it showed a reaction aimed at obtaining food. 3-4 electric shocks were enough for the cats to resist being placed in the cage where the experiment was carried out, rushing around the cages, scratching, howling, crouching on the floor, breathing rapidly and raising their hair on end. Moreover, they refused to eat in the cages even after 2-3 days of fasting. All cats showed some of the symptoms outside the experimental cage. Their severity increased significantly upon presentation of the initial sound signals. Learned neurotic reactions inhibited the feeding of cats. This led Wolpe to believe that, under other circumstances, feeding might inhibit neurotic reactions. As the experiment continued, the cats were force-fed in anxiety-inducing cages. To do this, hungry neurotic cats in experimental cages were gradually pushed by a movable barrier towards a box containing appetizing food. The cats' reactions to the cage and the sound signal were gradually extinguished.

Wolpe explained the results as follows: when stimuli for the emergence of incompatible reactions are present simultaneously, the development of a dominant reaction in the current situation implies reciprocal (i.e., mutual) inhibition of other reactions.

Wolpe was a pioneer of behavioral counseling. He transferred the results of experimental studies to the practice of treating anxiety disorders. He showed that if a person simultaneously evokes relaxation reactions, sexual reactions or anger reactions at the same time as anxiety, this leads to the extinction of anxiety. This is the basis of his method of systematic desensitization (reducing hypersensitivity, from the Latin sensibilis - sensitive).

Systematic desensitization is a way to overcome fears and includes three elements:

1) Training in deep muscle relaxation.

2) Building a hierarchy of stimuli, i.e. ranking situations that provoke anxiety according to the strength of the anxiety caused.

3) Consistent imagination of disturbing situations from simple to more complex against the background of a state of relaxation induced in oneself.

After teaching the client muscle relaxation, the type of situations that cause anxiety is selected, for example, fear of public speaking, fear of communicating with the opposite sex, fear of riding the subway, flying on an airplane, etc. If a client has several fears, then each of them is a separate topic and is dealt with separately. Further, in the process of therapeutic work, a number of situations are built that subjectively cause tension in increasing degrees of anxiety.

Another American scientist, Burres Frederick Skinner (1904-1990), made a great contribution to behavioral psychology. Skinner was interested not so much in ways to extinguish old reactions, but rather in the laws of formation and control of new behavior. Experimenting with animal training, he became a virtuoso trainer and could teach a pigeon to dance in a few minutes.

Skinner believed that behavior is shaped and controlled by its consequences. Any stimulus that increases the likelihood of a particular response is a reinforcer. For example, if you reinforce every movement of a pigeon to the right with a grain, then very soon it will begin to intensify these movements. By now reinforcing only the strongest turns, it is possible to achieve using the method of successive approximations so that the pigeon makes rotational movements. The version of learning developed by Skinner is called operant conditioning. (From “operation,” the Latin word operatio is action. The use of the term “operant” emphasizes that behavior operates in the environment, producing consequences).

While Pavlov linked reinforcement to the stimulus (in classical conditioning, behavior is controlled by a stimulus that precedes the behavior), then according to Skinner's concept, behavior is dependent on the response. Classical and operant conditioning are the only two types of conditioning possible.

Scientific fact: Impact on the teacher using the Skinner method.

In one of the American colleges, students studying psychology performed the following experiment. Their teacher, while giving a lecture, had the habit of pacing from corner to corner. While he was walking to the window, the students who had agreed among themselves demonstrated in every possible way their interest in the subject. They carefully took notes, nodded, looked into his eyes and took interested poses. When the teacher walked to the door, the audience relaxed and showed a lack of attention and interest. Extraneous conversations began. After several lectures, the teacher’s walking stopped and he remained throughout the entire lecture in a certain corner by the window.

Problematic behavior in people can be seen from this perspective as the result of an ineffective system of reinforcement from significant others. For example, the social fear of a person who is constantly afraid of “doing wrong” may be due to the fact that he was repeatedly punished by parents who were impossible to please.

Close people constantly try to influence each other, using rewards and punishments. Why do they often not achieve the desired result?

There are several conditions for effectively shaping someone else’s behavior:

1) The reinforcement system should not be contradictory. For example, a child is naughty and demands candy. Mom gets irritated and, as a rule, does not give. However, sometimes she gives in and gives in, thereby reinforcing his whims. The child receives the signal that if he whines long enough, the mother may give in.

2) Reinforcements should be focused on the needs of the subject. People who know how to give gifts and always know what to give to their loved ones invariably have great influence over them.

3) Reinforcement should be timely and mark any slight progress. If you are learning to play tennis and are trying to develop a certain stroke, then the coach’s spoken word at the right time greatly influences the development of the skill. Another example: parents, punishing for poor studies, take away the opportunity to use a computer from their son. After some time, not only twos, but threes and even one four appear in his grades. The parents decide that as long as there are no stable B grades, their son will not see any relief. After some time, the boy's grades become the same. The unsupported effort immediately fades away.

4) Positive reinforcement should prevail over punishment.

The main reason punishments are ineffective is that they do not communicate what needs to be done. It prevents a person from learning what is the best behavior in a given situation. Prison is an excellent model for demonstrating the ineffectiveness of punishment. It does not teach prisoners more socially acceptable ways of behaving, rather it teaches the opposite.

Punishment also does not work well if it is very distant in time from the committed action. The subject may not form a connection between the punishment and his past actions. With delayed punishment in animals this connection is never formed. Another disadvantage of punishment is that it encourages the punisher himself, causing a desire to increase the punishment more and more, despite its obvious ineffectiveness. The punishing subject often solves not the problem of teaching the punished, but demonstrates his power and dominant position.

Punishment is more effective if it is used infrequently, is not harsh, occurs immediately after the problem behavior, and is stopped immediately when the behavior begins to improve.

When working with young children who have explosive temperaments, behavior consultants often suggest the Time Out procedure. In the case of aggressive behavior, time-out involves removing the child from a situation rich in interesting stimuli, such as a playroom, for a few minutes.

Skinner's ideas have permeated many areas and are used in individual sports teaching, animal training, computer training programs, parent-child interaction training, psychotherapy and counseling. If we consider psychotherapy as learning new reactions, then the influence of positive reinforcement on the part of the psychotherapist becomes clear.

Behavior therapists help their clients learn new, more effective behaviors. An important element of social skills training is assertiveness training. Confident behavior increases the possibility of choice and control over one’s life, and contributes to the growth of self-esteem. Typically, they distinguish between insecure, confident and aggressive behavior. An insecure person holds back his feelings due to anxiety, guilt, and poor social skills. An aggressive person violates the rights of others through dominance, humiliation and insult. Aggression is not based on mature self-esteem and is an attempt to satisfy one's needs at the expense of another. Confident behavior is the ability to assert your rights without humiliating others, and earns the respect of others.

The therapy process and the therapist's position.

In behavioral therapy, the client's complaints are accepted as significant material, and not as symptoms of the underlying problem, which is typical, for example, of psychoanalysis. Specific actions need to be changed and modified rather than resolving the internal conflicts underlying those actions or reorganizing the personality. Therefore, in behavioral therapy, the client's desired goal is clearly defined in behavioral terms.

The central concept of psychotherapy is “human behavior”.

Despite the great diversity within behavioral psychotherapy, the philosophy and basic principles of the representatives of this direction remain relatively stable. By understanding these principles and behaviors, we are better able to understand specific practices that may differ significantly from each other.

The central concept in behavioral psychotherapy is the concept of behavior. The uniqueness of this concept in this direction is easier to highlight by performing a small task. Choose yourself or someone you know well and answer the question: what makes this person or you a unique person? When answering a question, you will probably first note physical characteristics, then you will include descriptions and psychological characteristics of the person, personality traits. You will describe someone or yourself as anxious, obliging, responsible, peaceful, etc. However, note that in such a description, the personality traits attributed to a person are the result of a generalization of observations of the behavior of that person. They do not exist objectively, they are a way of reducing the available information about a given person. Using personality trait descriptions allows you to convey a lot of information in a few words. However, when we are asked what the quality “obligatory” means in relation to a given person, we will be forced to describe a number of situations in which this quality is manifested.

So, when describing a person using personality traits, three steps are taken. First, we make initial observations of a given person's behavior, then generalize in terms of personality traits, and finally, to clarify the meaning of personality traits in relation to a given person, we return to the original observations, describing the situations in which the trait manifested itself.

Is it possible to reduce the number of steps when describing a person? It is possible if direct observation of behavior is used as the primary source of information about a person. This involves including in such a description and references to specific situations in which a certain behavior manifested itself. This will be the behavioral approach. As a result, we get a longer but more accurate description.

So, the behavioral approach involves describing a certain type of behavior in a situation. Reducing the step of description at the level of a personality trait, translating the description of a trait into behavior is an essential characteristic of a behavioral direction.

The behavioral approach does not involve studying the entire personality, but is limited to studying limited segments of behavior in a certain time period. For a behavioral therapist, a person is what he does. And what a person does is his behavior. The study of human behavior is the study of his personality. The behavioral approach denies any deep essence in personality.

This direction is characterized by the denial of global generalizations regarding the origins of this or that behavior, the presence of certain intrapersonal conflicts that have been going on since early childhood, therefore the tactics of a behavioral psychotherapist differ from the tactics of a psychodynamic psychotherapist. For example, if a patient comes to a behavioral psychotherapist complaining of persistent conflicts in the family, the therapist may treat such a patient or couple without necessarily examining their sexual relationships, unless at the diagnostic stage any connection between these two types of behavior is identified. So, the concept of behavior is the basic concept of behavioral psychotherapy. Through the prism of this concept, other concepts (thoughts, feelings) are introduced. They are viewed as internalized actions, specific behaviors, and the methods for modifying them are expected to be similar.

2. Two types of behavior: Open and Hidden.

Behavioral psychotherapy distinguishes two types of behavior: open and hidden. Overt behavior is behavior that can be observed by others through external signs. Covert behavior is behavior that we become aware of only indirectly and only through some form of overt behavior. Hidden behavior includes our thoughts, feelings, desires. The verbal report and the nature of verbalization is the main form by which we learn about covert behavior. Of course, you can get an idea of ​​hidden behavior by recording a number of physiological characteristics, that is, some parameters of overt behavior. For example, we can guess about the nature of the thoughts or feelings experienced by a person by recording his myogram from certain muscle groups, noting the connection between pulse rate, ECG, EEG with certain situations, etc. However, these are relatively labor-intensive methods, so the report and the nature of verbalization remain main for obtaining information about hidden behavior. But it should be clear that conclusions based on external behavior are closer to real behavior, to facts. In addition, they are made by others, therefore they are more objective and less susceptible to distortion associated with the emotional involvement of the observer. The observer is not divided between the role of the actor and the observer, as in self-observation and self-report, therefore, from the standpoint of behavioral therapy, it is preferable to rely on the client’s open behavior in analyzing the case.

Hidden and overt behavior are interconnected by reciprocal relationships. This provision includes two statements. The first, consisting in the fact that “our thoughts, desires, attitudes influence our behavior, seems self-evident and does not cause objections, is based on our practical experience. For example, the idea that a persistent night cough that interferes with sleep is associated with excessive smoking will certainly lead to appropriate action (limiting or stopping smoking). The second statement, which is that our actions (behavior) lead to changes in attitudes and ideas about ourselves, seems to be more dubious and requires justification. Behavioral psychotherapy proves this position through practical experience. As an example, we can cite the case of a change in attitude towards public speaking among a student who experienced fear in front of an audience and considered himself unable to overcome it. During the course of treatment, he was asked to perform as if he had such a skill, first in front of a limited number of close people. In the process of such repeated performances, a transformation took place in the student’s attitude towards performances, a new idea of ​​his capabilities was formed, that is, through the behavioral act carried out, a modification of his thoughts and self-perception occurred. This technique, which consists in the fact that a person initially behaves in accordance with the new attitude, training adequate open behavior, can sometimes become the shortest way to resolve problematic situations.

A behavioral psychotherapist is also characterized by a significant concentration on the present tense, on the present factors that cause and maintain certain behavior. The behavioral psychotherapist fundamentally avoids the question “why?” (why we reacted this way and not differently), since such questions inevitably lead us into the past, and since behavior is multifactorially determined, checking the correctness of one or another assumption based on past events is very difficult. When focusing on the present, we can easily test one or another hypothesis, easily modify one or another condition.

3. Conditions influencing behavior.

As important conditions (concepts) influencing behavior, two are identified: a triggering stimulus (object, phenomenon, antecedens), which is present before a certain act of behavior is carried out, that is, the triggering stimulus is already present in the environment, regardless of the behavior committed, according to time precedes a specific behavioral act. Consequences are the direct result of the behavior performed and occur after the behavior has been performed. Both the triggering stimulus and the consequences are usually very close in time to the behavioral act.

The ABC model of behavioral psychotherapy is a convenient diagram that helps to understand the Behavioral approach (A - antecedents - previous events; B - behavior; C - conseguences - consequences of behavior).

Antecedents (triggering stimuli) and consequences of behavior are the maintaining conditions of behavior. Or, in other words, certain events that precede and follow behavior, as a result of a specific behavioral act performed, support that behavior.

The functions of antecedents (triggering stimulus) and consequences are different. Preceding events indicate that the conditions are ripe for a particular behavior to occur. They indicate when a specific behavioral act needs to be performed. Antecedents can be viewed as stimuli, cues, or signs that indicate that the time, place, and circumstances are congruent for the performance of a particular behavioral act. That is why in Skinner's theory they are called discriminant stimuli.

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Contraindications to the use of behavioral psychotherapy

Behavioral psychotherapy should not be used in the following cases:

• psychoses in the acute stage;
• severe depressive states;
• profound mental retardation.

In these cases, the main problem is that the patient is unable to understand why he should do the exercises that the psychotherapist recommends.

If the patient has personality disorders, behavioral therapy is possible, but it may be less effective and take longer because it will be more difficult for the therapist to gain active cooperation from the patient. An insufficiently high level of intellectual development is not an obstacle to behavioral therapy, but in this case it is preferable to use simple techniques and exercises, the purpose of which the patient is able to understand.