- Behavior Therapy for OCD is rooted in the principles of behaviorism, a school of thought focused on the idea that we learn from our environment, this approach emerged during the early part of the 20th-century and became a dominant force in the field for many years.
- Edward Thorndike was one of the first to refer to the idea of modifying behavior.
- The goal is to reinforce desirable behaviors and eliminate unwanted ones.
- The behavioral approach to therapy assumes that behavior that is associated with psychological problems develops through the same processes of learning that affects the development of other behaviors.
- Therefore, behaviorists see personality problems in the way that personality was developed.
Principles of Behavior Therapy for OCD
Behavior therapy is based upon the principles of classical conditioning developed by Ivan Pavlov and operant conditioning developed by B.F. Skinner.
- Classical conditioning in Behavior Therapy for OCD happens when a neutral stimulus comes right before another stimulus that triggers a reflexive response. The idea is that if the neutral stimulus and whatever other stimulus that triggers a response is paired together often enough that the neutral stimulus will produce the reflexive response.
- Operant conditioning in Behavior Therapy for OCD emphasized operant conditioning, where behavior is influenced by its consequences.
- Reinforcement (increasing behavior) and punishment (decreasing behavior) shape our actions.
Key concepts of Operant conditioning
Operationally four groups of events can be conceptualized in Behavior Therapy for OCD as consequences:
(I) Positive reinforcement: Involves the introduction of a desirable stimulus to increase a specific behavior.
(ii) Negative reinforcement: Involves the removal of a negative stimulus to increase a specific behavior.
(iii) Positive punishment: Involves the introduction of an undesirable stimulus to decrease a specific behavior.
(iv) negative punishment: Involves the removal of a desirable stimulus to decrease a specific behavior.
Systematic Desensitization in Behavior Therapy for OCD
Systematic Desensitization in Behavior Therapy for OCD is a type of exposure therapy based on the principle of classical conditioning. Joseph Wolpe developed it during the 1950s to treat phobias and anxiety disorders. This Behavior Therapy for OCD aims to gradually remove fear response of phobia & substitute a relaxation response to the conditional stimulus using counter conditioning. The patient is counter-conditioned, taught new association that is to counter the original behavior learnt. The new response they learn is relaxation instead of fear because fear & relaxation cannot coexist.
Phases Behavior Therapy for OCD
Systematic desensitization involves three phases of training:
Relaxation training:
• During relaxation training, the client is trained to learn to relax himself by using any of the relaxation procedures.
• Various methods of relaxation training are used, depending on the suitability for the client and expertise of the therapist.
• However, JPMR technique is generally used. The other relaxation techniques include meditation, yoga, hypnosis and drugs.
Construction of hierarchies:
• With relaxation training, the client is given ‘home-work’ to prepare a hierarchy of scenes in descending order, at the top of which remains the most anxiety arousing scene and at the bottom, the least anxiety provoking (neutral) scene.
• Here, hierarchy of scenes refers to a graded series of events or situations that a client has to imagine during relaxation.
• Therefore, the scenes must be as realistic as possible, with vivid details of the scene which are relevant to the concrete situations that the client either has experienced or expects to experience.
• The extent to which a scene or an actual event evokes distress to a client is called subjective unit of distress (SUD).
• The hierarchy of events or scenes is marked according to the level of distress they generate in the client. A hierarchy of events can be prepared by asking the clients to rate each item.
Desensitization procedure (gradual exposure):
• Desensitization training is introduced only after the client has mastered the act of relaxation.
• While the client relaxes completely in a comfortable chair or couch with his eyes closed, the therapist directs him to imagine and experience each situation in the hierarchy from the pleasant or neutral to the most anxiety-provoking one in a graded manner.
• Initially, the lowest scene in the hierarchy is presented; if the client relaxes well, the therapist moves progressively up to the next item.
• The scene at which the client experiences anxiety is indicated by raising his index finger and the treatment is discontinued and restarted with the next below item.
• It continues until the client remains relaxed and vividly imagines the scene.
Behavioral modification in Behavior Therapy for OCD
Behavioral problems:
- Excess behavior
- Deficit behavior
- Asset behavior
- Accelerative techniques in Behavior Therapy for OCD
- Shaping:
• Shaping is a procedure by which new behaviors are learned by systematically reinforcing successive approximations toward a terminal behavior.
• Thus, two fundamental procedures are involved in shaping; the presentation of prompts and then refining the successively approximate response.
• Gradual altering of stimulus characteristics (prompts) to facilitate appropriate responding is called stimulus shaping, whereas refining the response is called response shaping.
- Chaining:
• Before proceeding to the procedural details of chaining, we must make a distinction between shaping and chaining.
• The fundamental difference between shaping and chaining is that shaping is used to develop new behaviors, whereas chaining is usually used to develop a sequence of behaviors using responses that approach the terminal goal
• At the outset, it is required that the complex task be divided into a series of teachable sub-tasks. Then, they are sequentially linked (chained) to teach complex skills. The sequence of responses is considered as ‘chains.
• A careful task analysis is required to identify the chains.
Chaining is done step by step. After teaching one sub-skill in the chain, the therapist links it to the next.
• As stated earlier, task analysis is a fundamental requirement for chaining. The main purpose of task analysis is to identify each discriminative stimulus (SD) and response (R) in the chain of behaviors for performing a complex task.
Types of chaining:
• Forward chaining is a procedure in which a complex behavior is taught in steps beginning with the first link in the chain to the end. The basic purpose is to establish a series of stimulus–response chains through reinforcement (SD R S+).
• Each higher stage of learning requires mastery of the previous ones. The first chain is taught until there is no prompt, and then it is linked with the second. In this manner, the therapist proceeds from first to the last in a cumulative sequence. The step at which the client has difficulty may be broken to smaller steps.
- Backward Chaining: Some skills are taught better through backward chaining, in which
the behavioral chains are taught in a backward fashion starting with the last link in the chain.
• This method has a theoretical advantage over forward chaining, as terminal reinforcement
is made available much earlier and more frequently. Terminal reinforcement means the
reinforcement that is provided after completion of the entire task; that is, the last
behavior in the chain.
• It serves as a secondary reinforcer for the steps performed prior to that. On the contrary, in
forward chaining, terminal reinforcement is available only after performing all the steps
successfully.
- Prompting:
• Prompting is a method of providing assistance, cues or signals to elicit desired responding. Two types of prompts are frequently used: stimulus prompts and response prompts.
• A stimulus prompt is a cue that facilitates a desired response. Some particular aspect of the actual stimulus or a signal is provided to the client in order to facilitate a complete response. Various types of stimulus prompts have been used to promote acquisition of new skills, such as verbal, visual and gestural prompts.
• Response prompt is also called physical guidance, in which the client is physically assisted by the therapist to perform a response. Different types of response prompts are used by therapists and trainers, such as increasing assistance, decreasing assistance, graduated guidance, and delayed guidance
- Fading
• Fading is the reversal of prompting procedure, in the sense that in the former technique assistance and cues are presented to elicit the response in a specific context, whereas in fading, they are gradually withdrawn, as the behavior reaches a criterion level of success, so that it can occur independently without assistance.
• Response fading involves systematic withdrawal of therapist’s assistance. Most response fading procedures are arranged in the most-to-least prompt fading sequence. The therapist starts with the most intrusive assistance to the least. With increasing independence, the level of assistance is reduced, until the client achieves complete independence. Accelerative techniques.
• Stimulus fading may be defined as the gradual removal of stimulus prompts, or artificially introduced discriminative stimuli for successful maintenance of a response in the natural environment.
- Modelling:
• An observer may learn much new and complex behavior by merely matching a model’s performance.
• A model may be either a live or a symbolic one. A live model may include individuals (e.g. a peer, parent, teacher, a religious guru or an authority figure), performing the behavior in reality,
• whereas a symbolic model may be a character in a novel, cartoon, film, or a television serial. They may serve as models, under specific circumstances for specific behaviors.
- Decelerative techniques
- Changing the antecedent
- Differential reinforcement of incompatible behavior (DRI)
• DRI schedule requires reinforcing those responses, which are topographically incompatible with the undesired target response. This means that the presence of one type of behavior should eliminate the possibility of another type. Both cannot occur together.
- Differential reinforcement of Alternate behavior (DRA)
• DRA is also a reinforcement-related reductive procedure like DRI but does not require the target behavior to be incompatible with inappropriate behavior.
• In a DRA schedule, the target behavior to be reinforced need not be topographically incompatible. It may be any desirable alternative behavior.
- Differential reinforcement of Low frequency behavior (DRL)
• Reinforcement is given when a particular maladaptive behavior is performed less no. of times/days.
• The goal of this schedule is to stabilize behavior at a lower rate of occurrence to prevent it from being excessive. The undesirable behavior is tolerated as long as it does not interfere with others’ freedom or privacy.
- Stimulus satiation
• stimulus satiation in which the client is flooded with the reinforcer repeatedly until it loses much or all of its reinforcing effect. A child who keeps playing with matches might be sat down with a large number of matches to strike and light.
- Overcorrection
• Alternative form of punishment is overcorrection. In positive practice overcorrection the client is required to practice correct behaviors each time an episode of the undesired behaviors occurs.
- Time out:
• This refers to the punishment procedure in which the punishment is a period of time during which reinforcement is not available.
- Complex techniques
- Contingency contracting:
• A variation of operant procedures is contingency contracting; this is a program in which the operant contingencies are well specified and clearly understood by everyone involved.
• These contingencies, reinforcements and punishments that can be expected for different behaviors, are formalized into a contract which is often written.
• Sometimes the contract is imposed on people; but often the best approach is to negotiate, as much as possible, with all people involved about the nature of the contract.
- Token economy:
• Tokens are secondary reinforcers, which can be exchanged for other primary or backups reinforcers. Plastic chips, stars, coins, paper currency or cards with specific denominations are some of the examples. A reinforcement system, which is based on delivery of tokens is referred to as ‘token economy’.
- Stimulus control:
• For all operant behaviors there are stimuli, called discriminative stimuli (SD), which tend to cue the response. Discriminative stimuli do not elicit the behavior, as the CS elicits the CR, but rather set the occasion for the behavior, making it more or less probable the behavior will occur. Thus, we can often alter operant behavior by altering discriminative stimuli.
Extinction in Behavior Therapy for OCD
• Gradual reduction of a behavior following removal of the reinforcing event is generally termed as extinction.
• As most undesirable behaviors are maintained by their reinforcing consequences, extinction is often used as a technique for weakening or eliminating them.
Techniques of Extinction in Behavior Therapy for OCD
Graded Exposure
• Graded exposure: This involves exposing you to the source of your fear gradually by going up the ladder one step at a time.
Flooding & response prevention
• Flooding & response prevention: During flooding, you stay present with your fear until your body’s fight-or-flight response relaxes. This intense exposure may help you realize that you’re actually OK and allows your brain to form a new association with your fear.
Implosion
• Implosion or implosive therapy is a variant of flooding but it takes place at the imaginary level.
• It involves prolonged exposure of the client to relevant negative fantasies connected with an anxiety-provoking event.
• It involves prolonged exposure of the client to relevant negative fantasies connected with an anxiety-provoking event. The therapist’s task is to describe the scenes in an involved and dramatic manner repeatedly with variation in order to arouse maximal anxiety, maintaining it almost at an intolerable level, so that the stress/anxiety caused by it dissipates. The scenes are usually unrealistic, exaggerated or physically damaging events,
that are unlikely to happen in real life.
Covert Extinction
- Covert Extinction is a technique where the client imagines performing a problem
behavior without receiving reinforcement.
• Covert extinction is a method used to decrease the rate of troublesome target behaviors. It consists of imaginations of behaviors followed by no reinforcement.
Negative Practice
• Negative Practice is a Behavior Therapy for OCD technique. It consists of having a client actively and deliberately repeat an undesirable, “automatic,” “involuntary” habit such as a tic, nail biting, or stammering while paying careful attention to the behavior being practiced. The goal of negative practice is to become more aware of the habit and, ultimately, to reduce the habit.
• It involves deliberately repeating an undesirable habit to become more aware of it and reduce it. It is based on the idea that repeating an action produces reactive inhibition, which makes subsequent repetitions more difficult.
Stimulus satiation
• Stimulus satiation is a behavioral therapy technique that occurs when a stimulus loses its motivating effect on a person’s behavior after repeated exposure or prolonged access.
• In Stimulus satiation the client is flooded with the reinforcer repeatedly until it loses much or all of its reinforcing effect.
Social Skill Training in Behavior Therapy for OCD
- Social Skills Training in Behavior Therapy for OCD is a type of psychotherapy that works to help people improve their social skills so they can become socially competent.
- Social skills training (SST) is a method to train individuals and teach them how to convey their emotions and become more socially competent. This can help them to achieve their goals and learn to live independently.
- Improving social skills can also help individuals with behavioral disorders who find it difficult to show their emotions, feelings and thoughts in the right way. Social skills are the basic elements of an individual’s behavior that allows them to adapt, learn and understand various social circumstances.
Social skills training techniques in Behavior Therapy for OCD
• Behavioral rehearsal
– Behavioral rehearsal is a therapy technique in which behaviors, responses, and social skills are practiced and imagined being in use in order to prepare for when they will be used in reality.
• Corrective feedback
– Describing the behavior and offering and eliciting and alternative action what could have
been done differently
– Corrective feedback can take various forms, including verbal communication, non-verbal
cues, and even written messages.
• Instruction
– It teaches appropriate interpersonal communication skills, self-discipline and problem-solving skills.
– It combines a number of strategies to prevent and replace problem behaviors and increase
skills and behaviors leading to social competence. It is most effective when it becomes a part of the daily academic curriculum and is implemented on a class wide and schoolwide basis.
• Positive reinforcement
– It involves providing positive consequences, such as praise or rewards, following a desired behavior. This encourages the individual to repeat the behavior in the future. Consistent reinforcement helps solidify social skills and motivates individuals to engage in positive social interactions.
• Assertiveness Training
– Assertive Behavior is interpersonal behavior involving the honest and relatively straightforward expression of feelings.
– Simply stated, assertive training includes any therapeutic procedure aimed at increasing the client’s ability to engage in such behavior in a socially appropriate manner
- Modelling
– Modeling involves demonstrating desired behaviors so that individuals can observe and imitate them. This technique is effective for teaching a wide range of social skills, from simple greetings to more complex interactions.
– Therapists or client act out the appropriate behavior, providing a clear example for the learner to follow. The key to successful modeling lies in the clarity and consistency of the demonstration.
- Role Playing
– Role-playing allows individuals to practice social interactions in a controlled environment. This technique helps them prepare for real-life situations by simulating various scenarios, such as starting a conversation or handling a disagreement. By practicing these scenarios, individuals gain confidence and competence in their social interactions.
Aversion Therapy in Behavior Therapy for OCD
• Punishment may involve either the removal of desired reinforces or the use of aversive stimuli, but the basic idea is to reduce the “temptation value” of stimuli that elicit undesirable behavior.
• This technique is based on classical conditioning. It involves repeated pairing of unwanted behavior with discomfort that causes a client to reduce or avoid an undesirable behavior pattern.
- How does Behavior Therapy for OCD work?
Behavior Therapy for OCD works by identifying problematic behaviors and teaching strategies to modify them. Through reinforcement, exposure, and skill-building, individuals learn to reduce distressing actions and improve overall functioning.
- Is Behavior Therapy for OCD suitable for children?
Yes, Behavior Therapy for OCD is highly effective for children, especially in managing ADHD, oppositional behavior, anxiety, and academic challenges. Techniques like positive reinforcement and token economies are commonly used.
- How is Behavior Therapy for OCD different from Cognitive Behavioral Therapy?
While Behavior Therapy for OCD focuses only on modifying actions, Cognitive Behavior Therapy for OCD combines behavioral strategies with cognitive restructuring. Cognitive Behavior Therapy for OCD addresses both thoughts and behaviors, whereas Behavior Therapy for OCD primarily targets observable actions.
- What makes Behavior Therapy for OCD unique?
Behavior Therapy for OCD stands out because it is action-oriented, structured, and based on observable change. Unlike other therapies, it emphasizes measurable progress and practical skills for real-life situations.
- How long does Behavior Therapy for OCD take?
The duration of Behavior Therapy for OCD varies depending on the problem. Many clients notice improvements within 8–20 sessions, though long-term therapy may be required for chronic or severe issues.
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