Читать книгу Introduction to Abnormal Child and Adolescent Psychology - Robert Weis - Страница 175

Behavior therapy focuses primarily on the client’s overt actions. Behavior therapy has its origins in the work of Joseph Wolpe (1958), Hans Eysenck (1959), and B. F. Skinner (1974). Behavior therapists address clients’ problems at the symptom level. Behavior therapists do not assume that underlying personality traits or unconscious conflicts influence behavior. Instead, behavior is determined by environmental contingencies—that is, conditions in the person’s surroundings that elicit, reinforce, or punish their actions. The goal of behavior therapy is usually to alter these environmental contingencies to increase the likelihood that clients will engage in more adaptive patterns of action.

Recall that behavior therapists typically perform a functional analysis of their clients’ problematic behavior in order to determine situations that elicit the behavior (antecedents) or conditions that reinforce it over time (consequences). Then, behavior therapists work with clients to find ways to avoid these environmental triggers or alter the consequences of the behavior that maintain it (Miltenberger, Miller, & Zerger, 2015).

Recall that Anna’s most problematic behavior is her tendency to binge and purge. A behavior therapist would carefully note the frequency of Anna’s bingeing. Then, the therapist would try to identify situations that often precede a binge. For example, Anna might report that she tends to binge after school, when she is feeling lonely, and when she is hungry. The therapist would also try to determine how Anna’s bingeing is maintained over time. Anna might report feeling less lonely and hungry immediately after bingeing; thus, bingeing is negatively reinforced by the withdrawal of these unpleasant feelings (Fishman, 2018a).

Over the course of treatment, a behavior therapist might teach Anna to monitor her binge eating, its antecedents, and its consequences. Then, the therapist might help Anna avoid antecedents that trigger binges. For example, the therapist might help Anna eat more regular, balanced meals to avoid feelings of intense hunger. Similarly, the therapist might help Anna identify ways to avoid the loneliness and boredom that often elicit her binges. The therapist might encourage Anna to become more involved in after-school activities or teach her to develop more satisfying peer relationships. Alternatively, the therapist might help Anna identify coping strategies, like relaxation techniques or exercise, to manage negative emotions. By altering environmental factors that elicit or reinforce her binges, Anna should be able to decrease their frequency.