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Understanding Behavioural Therapies

Behavioural therapists take a practical approach to helping individuals overcome mental illness or substance abuse disorders. They use a talking-based approach that focuses on the way an individual thinks and how this affects behaviour. Often, those who require therapy have acquired habits and methods of coping throughout their life that are harmful. These behaviours may negatively affect the sufferer and their loved ones, which can lead to poor quality of life.

Behavioural therapy doesn’t solely look to examine the cause of these beliefs and behaviours. Its aim is to show the service user that certain ingrained ways of thinking lead them to carry out undesirable behaviours. Many of the beliefs that govern our behaviour were formed at a very young age. Behavioural therapy aims to update an individual’s belief systems to make them more constructive.

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Definition of Behavioural Therapies

This type of therapy operates under the ethos that behaviour is learned, therefore new patterns of behaviour can be taught. Our brains are more impressionable and learning is easier during childhood. However, as adults, we still have the same capacity for learning new skills; the process usually just takes longer. It also becomes an active process, whereas during childhood we are passively learning behaviours.

Behavioural therapy can enable people to take control of a mental or behavioural problem such as OCD, anxiety, addiction and phobias. This can be an empowering experience for those who have often had a negative view of themselves since childhood.

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Types of Behavioural Therapy

Behavioural therapy differs from psychoanalytic therapy in that while it delves into the past of the patient, the main focus is on current behaviours and how to amend these. One of the main principles of behavioural therapy is that suffering is the result of how we interpret what has happened to us, as opposed to being an innate response to stimuli. There are three main subcategories of behavioural therapy:

  • Social Learning Theory: This type of therapy has its roots in the idea that as a social species, our behaviours are learned through imitation.
  • Applied Behaviour Analysis: This type of therapy applies positive reinforcement and classical and/or operant conditioning.
  • Cognitive Behavioural Therapy: This is considered an integrated approach that combines elements of cognitive therapy and behavioural therapy.

Cognitive-Behavioural Therapy (CBT)

Cognitive behavioural therapy has become one of the preferred methods for therapy in the United Kingdom. It can be highly effective at helping people who suffer from depression, anxiety, addiction, obsessive-compulsive disorder and other illnesses that negatively affect people’s behaviour. These negative patterns of behaviour usually have their root cause in negative emotions the individual feels towards themselves. CBT can help people to form new, healthy belief systems.

CBT can also be an effective treatment for people who suffer from chronic pain, chronic fatigue syndrome and other general health problems. This is not because these problems are psychosomatic, but rather that people can learn coping strategies and methods to help deal with pain or other physical symptoms.

How does cognitive behavioural therapy work?

CBT is a short-term therapy. Courses are usually composed of weekly hour-long sessions that can last from four to 12 weeks. The therapist works to help the service user become aware of when they are making negative interpretations. They also show the individual how these negative thoughts and feelings can lead to negative behavioural patterns.

Once the person understands the basis of their distorted thinking, the therapist helps them to implement new coping strategies.

Benefits of cognitive behavioural therapy (CBT)

While CBT acknowledges the past in order to help the individual understand why they behave as they do, its focus is on the present and the future. People who go through this type of therapy can become more self-aware, positive and happy as a result. It can be applied in an individual or group setting, and people can even access a CBT course online.

Cognitive behavioural therapy and addictive substances (alcohol, marijuana, cocaine, methamphetamine, nicotine)

There are often underlying thought patterns that govern the use of illicit drugs. It is generally accepted that many people who suffer from substance dependence disorders are self-medicating to an extent. CBT therapists help the individual to understand the thoughts and feelings that lead them to behave in a way that is harmful to their health. Once the person understands what is causing them to behave this way, they can actively change their behaviour.

Cognitive behavioural therapy techniques

CBT therapists often ask the patient to write down a list of goals they wish to work on. Using a combination of diagrams and worksheets, they then address specific fears and triggers. The therapist teaches the individual to confront these fears in a manageable, gradual way that helps build self-esteem. Mood diaries or substance use diaries are often recommended for people who are going through CBT.

Thought records

The basic principle of thought records is that an individual doesn’t have to believe every thought they have. Everyone — even those who don’t suffer from addiction or mental illness — has thoughts that are irrational or unfounded. Thought records are a method of putting thoughts on trial and accepting when they are not constructive. They have been found to be an effective method that has a beneficial therapeutic impact on anxiety, beliefs and behaviour.

Interoceptive exposure

This is a CBT method that encourages the person suffering from the addiction or mental health problem to expose themselves to triggers that cause feelings of anxiety or panic in the body. These feelings of anxiety or emotional pain often become magnified in a person’s memory, and this perpetuates the problem. By facing up to these feelings, the individual can begin to learn how to cope with them.

Imagination based exposure

Imagination based exposure is when the therapist exposes the patient to situations they would find fearful in real life. By creating a realistic scenario, they can gain access to the thought patterns and feelings the person experiences in vivo. By understanding the person’s motivations, the therapist can go at their pace to gradually expose them to increasingly intense scenarios and hold their hand along the way.

Behavioural experiments

This is where a belief is explored experimentally in order to provide the client with a greater understanding of their issue. They are often given to the individual in the form of a worksheet that has been constructed by the therapist. The individual then carries out the experiment in the manner any scientific experiment would be carried out and then explores the results at their next therapy session.

Challenging cognitive distortion

Cognitive distortions can include thought processes such as overgeneralisation, filtering out the positives, catastrophising, jumping to conclusions, black and white thinking, labelling and personalisation. These are just some of the most common cognitive distortions that those who are suffering from a mental illness can experience. By understanding these processes, the client is less inclined to carry them out.

Cognitive restructuring

This is the process of restructuring the methods of coping that have led to negative behaviours. First, the client must understand which beliefs are driving their behaviour and why they are harmful. Then the therapist offers a range of alternative coping mechanisms for the client to gain an understanding of and learn how to apply to their everyday life.

Contingency Management Interventions/Motivational Incentives

Contingency management is a technique that applies operant conditioning methods of offering a reward to reinforce positive behaviours in recovery such as abstinence. Usually, there is a written contract between the therapist and the service user that outlines the expectations, rewards and punishments. This clear type of agreement can be very useful in indicating the severity of the problem and placing accountability on the individual.

Often, incremental periods of abstinence are rewarded with vouchers, money or some other form of meaningful prize. This type of therapy circumvents the reward system that becomes hijacked by addiction. By giving positive reinforcement to someone for not taking drugs, the therapist is overriding the craving with a desire for the contingency reward. People may also receive rewards for attending therapy or achieving other goals.

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How do contingency management interventions work?

The root of contingency management interventions is in the understanding of addiction as a behavioural issue. Operant conditioning theory states that addiction to substances is a learned behaviour and can, therefore, be reversed with behavioural therapy. The basic action of receiving a reward for positive behaviour can be an incredibly effective motivating factor.

Contingency management interventions and addictive substances (alcohol, stimulants, opioids, marijuana, nicotine)

This type of therapy has been studied extensively in recent years, and the majority of outcomes show it can be highly effective in treating people suffering from addiction. The receipt of reward and positive reinforcement has been proven to improve the attitude and willingness of care users to carry on with treatment.

Benefits of contingency management interventions

This type of programme can be a highly effective deterrent to drug use. It is often chosen for those who have been resistant to other types of therapy. The use of positive reinforcements and rewards engenders a different response from the service user that is more conducive to continued care. It can be difficult to promote enthusiasm from recovering drug addicts, and contingency management interventions can help to create this.

Community Reinforcement Approach Plus Vouchers

This type of approach aims to address the social influences that may be contributing to problems such as substance abuse. Therapists who have trained in this discipline have noted that the emphasis is on using reinforcement to engender behavioural change. This recognises that the practical application of learned theory can be very difficult for people with complex issues.

The incentive of a happier, healthier life as a metaphysical idea may not be enough to change some people’s behaviour. The therapist is not allowed to be confrontational and instead works with the individual to ascertain the function that substance abuse has in their life. The therapist will then explore and recommend pro-social (sober) activities to replace the drug use.

How does community reinforcement approach work?

Discovering the reasoning behind the person’s substance abuse is called functional analysis. The therapist asks the service user to explain the motivations and situations that commonly precede drug use. They then ask them to describe the benefits and drawbacks of substance abuse. The therapist often helps to teach job-seeking and recreational skills and encourages the individual to try new, healthy activities.

Community reinforcement approach and addictive substances (alcohol, cocaine, opioids)

This type of therapy was formulated specifically for those suffering from a substance abuse disorder. Not only does the person gain a reward in the form of a voucher, they gain a reward in the form of improved social relationships and experiences. The therapist guides them through the process, pointing out where drug use negatively affects their life and offering drug-free alternatives.

Benefits of community reinforcement approach

There is strong evidence that indicates the community reinforcement approach is a highly beneficial addition to treatment. The focus is on the benefits of a healthy social life as opposed to the negative aspects of the substance user’s experiences with drugs. By showing the client what they are missing out on and reducing the reason for using to a process, the individual comes to an organic decision themselves.

Motivational Enhancement Therapy (MET)

The ethos behind this type of therapy is that it aims to encourage internally motivated change. It has been demonstrated that individuals who only seek treatment to appease others or avoid a less desirable outcome such as prison have the lowest long-term abstinence rates. The people who are more likely to continue a programme of abstinence are those who are ready and willing to change. MET is often used concurrently with a 12-step or similar programme.

How does motivational enhancement therapy work?

MET is divided into four targeted treatment sessions, beginning with an initial assessment that the therapist uses for evaluation purposes. Then they work to set targets with the client based on work, education and personal relationships. Once goals are established, the therapist offers perspective on their problems and uses positive reinforcement to encourage sobriety.

Motivational enhancement therapy and addictive substances (alcohol, marijuana, nicotine)

MET therapists often work in conjunction with other medical staff, including the doctor who has assessed the physical effects of the drug on the body and any other clinical staff involved in the client’s care. MET can be effective for people who have received a dual diagnosis. Some of the concurrent mental health problems that can be addressed by MET include eating disorders, bipolar disorder, PTSD and OCD.

Benefits of motivational enhancement therapy

There are five main techniques that MET therapists deploy.

  • Teaching the client that they are responsible for their future and capable of reaching their goals.
  • Helping people suffering from an addiction to realise why they have previously resisted treatment. This can help defend against future resistance.
  • The therapist never argues with the client; instead, positive and constructive methods of communication are explored.
  • Giving the individual the tools to understand the difference between their self-perception and reality.
  • Empathy is given to the individual by the therapist and the therapist, in turn, teaches the individual the importance of empathising with others.

The Matrix Model

This model has been specifically devised for those who are suffering from an addiction to substances such as cocaine and amphetamines. During this approach, the therapist functions as a coach and teacher, building a positive connection with the client that is direct but not parental or confrontational. The dignity, self-esteem and self-worth of the individual are prioritized during therapy sessions.

How does the matrix model work?

The matrix model is an integrative therapy that draws on the wealth of resources available in the treatment of addiction. It is designed to be delivered in an intensive outpatient setting, with several hours of treatment given a day for several weeks. The method is highly structured, with each section thoroughly worked through before progression to the next. It is designed to last for 16 weeks but can go on for as long as a year.

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The matrix model and addictive substances (stimulants)

This style of therapy was specifically formulated for those suffering from an addiction to stimulants. However, it has been found to be effective in the treatment of other kinds of substance misuse disorders. It works by covering six clinical areas thought to be integral in the treatment of addiction:

  • Urine testing
  • Family education
  • Social support
  • Early recovery
  • Relapse prevention

Benefits of the matrix model

This style of therapy is thought to be highly effective due to the wealth of previous psychoanalytical and therapeutic methods it draws from. Some of the treatment approaches it draws from include 12-step meetings, group therapy, family therapy, person-centred therapy, behaviourism, CBT and MET.

12-Step Facilitation Therapy

This type of therapy is designed to encourage someone recovering from addiction to seek out and maintain involvement with a 12-step self-help group. It has been widely proven that people in recovery have a better chance of long-term success when they take part in these types of self-help groups. The main driving force behind these meetings is to encourage abstinence.

The 12-step facilitation therapist works hard to instil the key ideas that are predominant in 12-step programmes.

How does 12-step facilitation therapy work?

There are three main ideas that govern 12-step programmes; they have been found to be a highly effective method of long-term abstinence. Twelve-step programmes are governed by three main principles:

  • Regular participation in 12-step meetings and activities
  • Surrendering to a higher power and accepting that the individual is much weaker than a group
  • Accepting that drug use is a chronic, debilitating illness and that abstinence is the only way to remain in control

12-step facilitation therapy and addictive substances (alcohol, stimulants, opiates)

While the efficacy of the 12-step programme has been widely studied with regard to alcoholism, its effectiveness at treating other kinds of addiction isn’t yet confirmed. It is widely accepted that 12-step programmes can be some of the most effective long-term resources for alcoholics.

Benefits of 12-step facilitation therapy

The community support derived from 12-step programmes is thought to be a key factor in the continued abstinence of its users. The three principles that the meetings reinforce have also been found to be highly effective in helping service users to abstain. The groups encourage attendees to talk through their issues instead of internalising them, and this can be the difference between an individual turning to a substance or an understanding friend.

Dialectical Behavioural Therapy (DBT)

Dialectical behavioural therapy is a branch of CBT that was initially devised for the treatment of borderline personality disorder. Since its formulation, it has been found to be effective in treating depressive disorders, bipolar disorder, anxiety disorders, substance use disorders and PTSD. There is a poignant focus on self-acceptance, and the therapist encourages a positive discourse with the client that helps to motivate the service user to change.

Dialectic refers to a balancing of opposing thoughts and ideas and how these interact with each other and can be combined. The therapy aims to help people find a balance between accepting who they are and making changes that are necessary to live a healthier life.

How does dialectical behavioural therapy work?

DBT works by the therapist developing a close, trusting relationship with the client in which there is no judgment or criticism. They use a mixture of acceptance techniques and change techniques with a focus on understanding how the person developed certain behaviours. Once a level of understanding is reached, the client and the therapist work together to devise new, healthy coping mechanisms.

Dialectical behavioural therapy and addictive substances

DBT can be highly effective when treating addiction because it helps the individual understand why they do things such as self-harming. Drug use can be seen as a form of self-harm due to it being a behaviour that physically damages the user while causing more negative effects than positive. The therapist helps the client to realise that this behaviour may legitimately be the most effective coping mechanism they have come across. From this state of acceptance, they can seek better methods for coping.

Benefits of dialectical behavioural therapy

DBT draws on the most effective aspects of CBT with the addition of methods and theories. It is a highly structured form of therapy that teaches service users that emotions are not their enemies. Borderline personality disorder is an illness whereby the sufferer has great difficulty in regulating their emotions. It aims to teach methods and strategies that help people regulate emotions that may lead to destructive behaviour such as drug-taking.

Family Behaviour Therapy

This type of therapy can be highly effective for adults and adolescents. It involves treating the patient alongside one of their loved ones. This could be a cohabiting parent or spouse. Family therapy can help people to circumvent certain misunderstandings that are common between people who are suffering from substance misuse disorders.
Sometimes close relationships can trigger behavioural responses that go back to early childhood. A therapist can help an individual and their family to understand why certain behaviours have manifested themselves. Once the causation is understood, they can all work together to develop new coping strategies and learn to avoid conflict and harmful behaviour.

How does family behaviour therapy work?

Therapists aim to help the family to engage in actively applying behavioural strategies learned during therapy to help them improve the home environment. Addiction can cause conflicts and fractious relationships in even the most stable of families. Substance abuse can cause people to behave in ways that are out of character, and it is important that family members do not learn to define the service user by these negative behaviours.

Benefits of family behaviour therapy

Family behaviour therapy is arguably one of the most holistic approaches to therapy currently available. Individual therapy is an excellent method of providing sufferers of addiction or mental illness with understanding and coping strategies to help manage their problem. If these teachings are at odds with the beliefs of their spouse or parent, the service user can quickly regress and eventually relapse. Family therapy helps to synergise the understanding of both parties.

Rational Emotive Behavioural Therapy (REBT)

This type of therapy is focused on how to help individuals change irrational beliefs. The therapy was born from its inventor’s fear of speaking to women in spite of an intense desire to do so. He realised his irrational fear of speaking to women was inhibiting him from experiencing the companionship he longed for. In order to combat this issue, he spent a month talking to over 100 women in a park near where he lived. He found that this active aversion therapy helped considerably.

As his career as a therapist evolved, he found the psychoanalytic approach to be lacking. While he found that he could help his patients to understand the reasoning behind their unwanted behaviour, comprehension alone wasn’t enough for them to actually change. He decided to take an action-oriented approach to his clients and devised rational emotive behavioural therapy.

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How does rational emotive behavioural therapy work?

REBT noted that people often irrationally blame external events for their unhappiness without looking inwards. He believed it was the way people interpret these events that lie at the heart of psychological distress. His method involves identifying the underlying beliefs and thought patterns, challenging irrational beliefs and finally gaining the insight to recognise and challenge these, thus stopping the behaviour.

Benefits of rational emotive behavioural therapy

This type of therapy requires the therapist to be blunt, honest and direct about when the client is being irrational. Sometimes confrontational methods may be applied in order to demonstrate how unhealthy the behaviour is and outline the urgent need for change.

Behavioural Therapies Primarily for Adolescents

It is widely accepted that addressing problems with mental health and/or substance abuse disorders during adolescence is more effective than tackling them later in life. There are a range of therapies and treatments available for adolescents and their families, many of which can be highly effective. There is some trial and error associated with finding the right therapy, but it is much better to put them to the test rather than hoping the situation will sort itself out.

Multisystemic therapy

This type of therapy is focused on making positive changes in the adolescent’s social systems. It is an intensive community-based style of therapy that addresses family, school, community and peer relations. It teaches the family and the child to maintain the success observed within a clinical setting.

Multidimensional family therapy

In this type of therapy, the family and the adolescent are given the tools to develop problem-solving skills to address issues that have arisen to cause substance abuse or delinquency. Some sessions focus on the adolescent, some focus on the family and others address the family as a unit.

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Brief strategic family therapy

This type of therapy focuses on changing belief systems and addressing the behaviours that happen as a result of certain schemas. It encourages open communication between all members of the family that isn’t rooted in conflict or criticism. Therapy is seen as a collaborative process in which all the family members make valuable contributions.

Adolescent community reinforcement approach and assertive continuing care

ACRA is a treatment that is appropriate for young people aged 12 to 24 years old. This type of intervention can be offered in a residential, intensive outpatient or outpatient setting. Communication skills, coping methods and participation in meaningful social ventures are encouraged by therapists. ACC refers to the aftercare, often delivered in the adolescent’s home.

Functional family therapy

This is a short-term, high-intensity style of therapy that has been proven to help adolescents aged 11 to 18. It draws on established psychosocial theory, extensive clinical experience and empirically supported principles to help adolescents suffering from substance abuse and behavioural disorders by using a three-step clinical model starting with engagement and motivating, moving on to behavioural changed and maintained by generalisation.

What Should I From Expect Behavioural Therapy in Addiction Treatment?

Behavioural therapy is a modern technique that aims to actively instil new coping mechanisms while helping the individual understand how their behaviour has developed. Drug abuse is a behaviour that can consume someone’s entire life. The person suffering from addiction is encouraged to learn a new pattern of behaviour in order to change their lifestyle long term. Behavioural therapy places an emphasis on the client becoming self-aware.

This self-awareness leads to an increase in self-control and empowers the individual to address the emotions that lead to negative behaviour. Behavioural therapy explores the dichotomy of what we actually do and what we want to do. It can be baffling when someone feels like they want to lead a healthy life but still goes ahead and carries out harmful drug-taking behaviour. Behavioural therapy helps to bridge the gap between people’s intentions and actions.

Benefits of Behavioural Therapy in Addiction Treatment

Research has found that substance abuse disorders are often characterised by learning processes that are triggered by neurotransmitters activated by drug use. This type of treatment seeks to rewire these associations to be synergic with healthier activities. Behavioural therapy is thought to be effective at treating addiction because it targets aspects of the individual’s psyche, such as motivational barriers, and addresses operant learning processes and reward centres.

Provides incentives for maintaining abstinence

Some types of behavioural therapy that take an operant conditioning approach provide incentives in the form of vouchers, cash or prizes. In this method, individuals are often rewarded in increasing amounts according to the length of time they have remained abstinent.

Modifies negative behaviours and attitudes

The main objective of behavioural therapy is to actively modify the service user’s reactions to their thoughts and feelings. While introspection is required in order to understand how the behaviour has developed, it is more important to focus on how to modify the individual’s internal responses.

Enhances the ability to handle stressful situations and triggers

This type of therapy helps people to develop healthy coping strategies that can replace negative behaviours such as drug-taking or self-harm. The therapist helps the client to understand what their individual triggers are and explores methods to minimise their impact.

Improves life skills

Behavioural therapy helps people to understand the value of empathy and listening to other people. The individual is shown how people respond to them better when they demonstrate positive qualities.

Complementary Therapies

Complementary therapies are usually developed to be applied alongside conventional, accredited psychotherapy treatment. They have been known to improve well-being and quality of life.

Art therapy, pet therapy or music therapy

These types of activities can be highly therapeutic in nature and offer the individual an opportunity to release emotions in a way they may find difficult otherwise. This type of therapy is soothing and may involve the service user gaining confidence through learning a new skill.

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Biofeedback

Biofeedback is a practice in which people develop a method to control bodily functions such as heart rate. Often, they are attached to electrical monitoring systems that give them in-depth information about the body.

Neurofeedback

This is a branch of biofeedback in which the individual focuses upon teaching the regulation of brain function by using real-time displays of electrical brain activity.

Eye movement desensitization and reprocessing (EMDR)

This psychotherapy treatment was developed to help ease the distress associated with traumatic memories. In this type of therapy, the practitioner uses a hand movement as a focal point for the client while they speak. (27)

Trauma-focused therapies

Trauma-focused therapy focuses on the needs of children or adolescents who are dealing with PTSD. It is a branch of CBT that specifically helps children and their families deal with a traumatic event.

Meditation and other mindfulness practices

Mindfulness and meditation have been found to help prevent relapse in people suffering from addiction. It is believed that the increased awareness of the body and mind lead to an increase in self-control.

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