Applied behavior analysis in psychotherapy applies the concepts of operant conditioning to the treatment of mental health issues in the traditional context of discussion-based psychological treatment. Today, behavior analysis is most commonly encountered in combination with cognitive therapy approaches in cognitive behavior therapy (CBT), one of the most effective psychotherapeutic techniques.
Applied behavior analysis has a long history of use in psychotherapies, emerging from theories of operant conditioning developed in the 1930s.
Psychotherapy is a collaborative treatment based on the relationship between psychologist and patient. Psychotherapeutic approaches are rooted in dialog but psychologists are increasingly adopting various scientifically validated approaches from applied behavior therapy to enhance and improve patient outcomes.
Traditional behavioral psychotherapy eschewed the type of Freudian analysis that had come to dominate psychological treatments by the early twentieth century. Rather, the behaviorists focused exclusively on actions, holding that they were the true expression of inner thoughts and feelings and that articulation held little benefit. If the behaviors that were problematic could be corrected through the use of calculated reinforcement, probing the thoughts behind them was beside the point.
Using Behavioral Techniques to Treat Psychological Problems
One of the early practitioners of behavioral therapy was a South African doctor named Joseph Wolpe. During the Second World War, as a military psychiatrist, Wolpe pioneered something he called desensitization treatment for soldiers suffering from shell-shock… known today as Post Traumatic Stress Disorder (PTSD). Wolpe applied operant conditioning techniques to pair trigger mechanisms, such as loud noises, with positive feedback reinforcers, gradually training afflicted soldiers to not react as if they were still in combat any time a car backfired.
Wolpe and other adherents to the theory built this technique up into a series of stages, called systematic desensitization, to progressively build up tolerance. In addition to PTSD, the method soon found application in treating phobias and various anxiety disorders. A person with a phobia of spiders, for instance, might gradually be cured through a series of steps, guided by the therapist, involving increasing exposure:
- Thinking about spiders in a controlled environment
- Viewing pictures of spiders
- Viewing an actual spider in a jar
- Viewing an actual spider on a table
As each step progressed with no ill-effects, the patient would gradually lose the phobia. The operant conditioning of exposure unaccompanied by the imagined horrors tended to reduce the negative behaviors, such as avoidance, that accompanied the phobia, a process called extinction.
Behavioral therapists also teach coping strategies, which borrow from applied behavior therapy by putting positive reinforcers into scenarios where a phobia or other psychological issue typically results in a negative reinforcer. For instance, in the example above, the patient might be given a series of positive thoughts to focus on if they saw a spider in the wild. Typically, the avoidance of the spider would remove the fear, enhancing the phobia. By creating a positive coping mechanism, the phobia can be decreased instead.
Blending Behavioral and Cognitive Therapies Has Resulted in the Greatest Success
Although behavioral therapies were largely adopted in a rejection of traditional cognitive psychotherapy approaches, over the past thirty years a combination of the two approaches has been proven to be one of the most effective treatments for a number of different psychological problems, including:
- Clinical depression
- PTSD
- Obsessive Compulsive Disorder (OCD)
- Anxiety
- Eating disorder
- Borderline Personality Disorder (BPD)
- Addiction
CBT has been shown in clinical trials to be even more effective than medications in treating many disorders. It has even been used successfully for pain management in cancer treatments.
CBT combines traditional cognitive talk therapy, in which the therapist guides the patient through a discussion of their issues, with behavioral strategies that reinforce the substance of the discussions. The idea behind CBT is that problematic behaviors are sustained and reinforced by certain automatic, negative thoughts that occur to the patient. Using cognitive techniques, those thoughts are examined, and using behavioral techniques, the behaviors themselves are addressed, hitting the reinforcement cycle from both sides.
Preparing for a Career as a Behavioral Psychotherapist
Most behavioral psychotherapists are licensed psychologists with doctoral degrees in psychology. It is common to specialize in a particular type of disorder rather than a particular type of treatment, so their background in general psychology may afford a number of different avenues to treat a specific condition based on the particular facts in an individual patient’s case.
Advanced training in applied behavioral therapy is often obtained by acquiring a master’s certificate in applied behavior analysis, followed by certification from the Behavior Analyst Certification Board (BACB) as a Board Certified Behavior Analyst (BCBA®). Many psychologists with doctoral degrees are eligible for the advanced BCBA®-D, or Doctoral, designation.
Some counselors and ABAs provide psychotherapy services within a particular specialty such as addiction or autism treatment. These positions often require only a master’s degree, in applied behavior analysis, psychology, or education, but you will still need a BCBA®. Practicing in these fields often relies on specialized applications of behavioral therapy, those that have shown particular efficacy in treating the conditions usually found in their patients.
The common thread in all of these positions is obtaining an advanced degree, related to psychology or social work, with a focus or concentration in applied behavior analysis. Specialized CBT training is also common, such as the series of Certified Cognitive-Behavioral Therapist certificates offered by the National Association of Cognitive-Behavioral Therapists.
ABAs offering psychotherapeutic services are most commonly employed by private treatment centers and clinics. Some may work for school systems or for other healthcare providers, such as hospitals and long-term care facilities.
Further Resources for Applied Behavioral Analysis in Psychotherapy
Association for Behavioral and Cognitive Therapies – A non-profit professional association dedicated to the advancement of scientific, evidence-based therapeutic treatments in mental health care.
American Psychological Association’s Division 25 – Division 25 of the APA is dedicated to the study of behavioral analysis in the practice of psychology.
National Association of Cognitive Behavioral Therapists – A national associate of CBT practitioners.
Association for Behavior Analysis International – The ABAI has several different Special Interest Groups of interest to ABAs in psychotherapy, including Behavioral Medicine and Clinical provider groups.