What is Behavior Therapy?

by Charles S. Mansueto, Ph.D., BTC Director

Deciding to get help for a psychological or behavioral problem is an important decision. From whom to get that help is equally important. While location, cost, specialties, accessibility and other considerations are usually taken into account when choosing a therapist, the theoretical orientation of the therapist also matters. Most people, though, know little about these factors. After all, it's hard enough to keep differences between psychologists and psychiatrists straight, so trying to choose wisely among psychoanalysts, family systems therapists, cognitive behavior therapists, interpersonal therapists, eclectic therapists, and others can seem well beyond the competence of mere mortals. This article will highlight one area within the psychotherapeutic terrain - the approach called Behavior Therapy.

First, the term Behavior Therapy (BT) requires some explanation. It turns out that a number of different names have been given to therapies that are highly similar in spirit and practice but which tend to have somewhat different emphases. Other approaches that can be included under the behavior therapy umbrella go by the names of Cognitive Behavior Therapy (CBT), Cognitive Therapy (CT), Applied Behavioral Analysis (ABA), Behavior Modification and others.

Therapists describing their approach by one or another of these terms can certainly point to differences in how they view the nature of problems, what they emphasize in their work with their patients and even what they do in the course of therapy. Arguably, these approaches have much more in common than they do differences and all can be considered "behavior therapies."

Now we can return to the central question: Just what is BT? Let's start with the idea that it is a particular approach to treatment that is designed to help people achieve specific changes and to reach their goals in the most efficient and effective ways possible. To accomplish this, BT draws from over a hundred years of scientific research that has clarified the ways people develop problems in terms of how they act, how they feel and how they think. Because it follows the scientific tradition in psychology, BT is the form of psychotherapy that is most concerned with precision and grounding in scientific facts. The term that is getting a lot of play these days is "evidence-based" therapy, which means that a lot of what is done in BT has been tested and found to be effective.

Other characteristics of BT? It is an active therapy. Patients in BT actually do something about their problems. Together, the patient and therapist devise tasks for the patient to perform, often as homework assignments and often in the natural environment. They focus on what is going on in the present. While childhood experiences are of interest, the bulk of therapeutic time is spent on managing current factors that impact on the individual’s difficulties. Finally, there is a huge emphasis on learning in BT as the primary mechanism of therapeutic change. By following principles of learning that have been identified and studied over the past century, the behavior therapist teaches the client to use these principles to self-manage his/her own life—to substitute healthy modes of behaviors, emotions and thinking to replace the patterns of thoughts, feelings and actions that constitute the problem. This can often be done surprisingly quickly. BT is designed to be relatively brief and can often be administered in intense formats when time is of the essence.

So what might you expect to experience if you choose to participate in BT? While there are so-called “package treatments” for some particular disorders, most treatments are highly individualized to fit the specific needs of that one individual — to match the unique characteristics of the person as determined in a critical assessment phase performed early in treatment. Perhaps a few examples will give you a feel for what goes on in BT:
A woman who has a very low opinion of herself learns to identify patterns of self-defeating thoughts and to substitute ways of “talking to herself” that enhance her self- esteem.

A man who fears driving on the Beltway learns to use self-calming tactics—controlled breathing, muscle relaxation, and quieting thoughts to regain a sense of comfort when driving on any road.

A mom learns to eliminate her three-year-old’s temper tantrums by ignoring the meltdowns and giving him praise and attention during his brief quiet spells.

A man overcomes his “shyness” by learning conversational skills. His therapist models them, then he practices them with therapist feedback, then he polishes them up in homework assignments in real-life situations.

A woman who gets “the scariest, strangest ideas” in her head that push her to do things that she knows “are crazy” learns how to confront these ideas, regain control of her behavior, and ultimately return to a comfortable, productive life.

A man who has lived with terrible cosmetic damage, and awful emotional distress, learns to stop the pattern of scratching and picking at his skin that has kept him from moving ahead in his work and social life.

Well I could go on and on, but maybe that’s enough to convey the “flavor” of BT. One last thing: Behavior therapists do care about the quality of the relationship between themselves and their patients. Perhaps because BT requires a true partnership between two individuals working together to attain important goals, most patients notice that behavior therapists tend to reveal their humanity and tend not to maintain the kind of therapist “mystique” that is typically present in therapist/patient relationships. Most patients find that refreshing.

That, more or less, is one person’s view of the essential features of BT. I hope it serves to illuminate an often murky portion of the psychotherapeutic landscape and that it makes for a more sure-footed journey for those who may choose to tread there.