Contemporary Behavioral Practices

Whereas psychodynamic theory posits that difficult relationships with early caregivers are the source of much psychological distress, behavioral theory casts a broader net--it proposes that interactions between a person and their environment are the main drivers of psychological experience. If you place a person who was previously emotionally-well into an aversive environment, like a hostile workplace, over time they will develop symptoms such as anxiety in response to that environment. This is most clearly illustrated by the example of posttraumatic stress following combat exposure. A soldier may deploy feeling good, but then return from duty with a host of symptoms after being exposed to violent and disturbing circumstances. What is particularly problematic is that not only will the soldier develop symptoms, such as anxiety, but those symptoms will start to shape their behavior even after they have left the aversive environment because they have now been programmed by their negative lived experiences to expect certain negative possibilities. Hence, a soldier who has returned home may find themselves avoiding certain people, areas or sights that remind them of their time in combat. The behavioral approach to resolving psychological symptoms is to essentially ‘re-train’ a symptomatic person’s expectation of threat by exposing that person to new, safe environments repeatedly until it becomes clear through these new experiences that there is nothing to fear. As this new learning sets in, the person’s symptoms diminish. This is called exposure therapy, and it remains the basis for a host of effective behavioral interventions for difficulties such as social anxiety, obsessive-compulsive disorder, and posttraumatic stress disorder.

Exposure therapy usually involves helping people develop a structured plan for how to approach feared situations in graduating steps of difficulty, and also involves helping them develop skills to better cope once in those situations. However, there can be challenges associated with exposure therapy. First, it can at times be hard to convince people to engage in an activity that requires them to face a feared situation. Second, not every clinical condition revolves around approaching a feared situation. For example, while social anxiety lends itself well to exposure therapy due to there being a very clear trigger (i.e. other people), generalized anxiety--a tendency to chronically and excessively worry about a variety of things such as family members, finances, job performance and health--sometimes does not.

Behavioral therapies have adapted to these problems by adding interventions that address not just a person's behaviors but also their thoughts (i.e. ‘cognitive’ interventions). The first major therapy that made this change is called, aptly, Cognitive-Behavioral Therapy (aka CBT). In CBT, not only are people encouraged to face feared situations, they are also asked to look at the thoughts that they have about those situations. In many cases, those thoughts will have assumptions that exaggerate the risk that something negative will happen, as well as the consequence of how painful it would be if that negative event did happen. People are encouraged to come up with alternative ways of looking at those situations that makes it easier for them to engage in the exposure activities that ultimately reduce their symptoms. People dealing with issues where there are no clear feared stimuli are similarly asked to evaluate assumptions they may be making that are contributing to distress. For example, a person who is experiencing generalized anxiety stemming from a sense that other people will view their efforts as inadequate may be asked to examine the evidence that they have for this conclusion and whether there is another way of interpreting how other people view their efforts that is less distressing.

The ‘cognitive’ portion of CBT assumes that people can be taught to look at potentially negative situations in a more balanced manner and that their distress over those situations will diminish as a result. At times this is true, while at other times people may be able to note that their thinking is not entirely logical but still find themselves feeling very upset about the situation in question. More recently popularized behavioral therapies, such as Dialectical-Behavior Therapy (aka DBT) and Acceptance and Commitment Therapy (aka ACT), have incorporated a concept known as mindfulness into the treatment of distressing thought processes. Mindfulness involves learning to stay in touch with the present-moment with an attitude of openness and receptiveness to whatever comes up in a person’s field of awareness, as opposed to letting one’s mind float off into the past or into the future, or actively avoiding being in touch with one’s present experiences. Part of mindful practices involves learning to become aware of and non-judgmentally observe one’s own stream of thoughts. Having a thought does not necessarily make it true, and being mindful allows a person to see their thoughts simply as transient mental events that come and go, rather than as absolute truths that they must struggle against. For example, a person who has the thought ‘I’m inadequate’ and automatically accepts this to be true will have a significantly different emotional experience from someone who has the same thought and then is able to quickly take a step back and tell themselves that they are just having the thought that they are inadequate. The first person may fall into a depressive state, while the second person may experience momentary discomfort before returning their attention to the present.