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In the fourth table, we have classified the most important measures of behaviour therapy: desensitivization, operating conditioning, aversive therapy and negative learning. These courses of action can play an important role in psychiatry and can enrich the therapeutic repertory through their rational use, placed in a general plan of treatment. Moreover, these methods are usually excluded from the tought theories and they do not see in the neurotic troubles a consequence of unconscious conflicts; these conflicts must become conscious again, but they must appear, then, as the result of the learning of bad behaviour.
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In a controlled outcome study of phobias, 111 adult patients (69% women, 31% men) received a course of 26 weekly treatment sessions consisting of (1) behavior therapy and imipramine hydrochloride (2) behavior therapy and placebo, or (3) supportive psychotherapy and imipramine. Patients were classified as agoraphobic, mixed phobic, or simple phobic. The great majority of patients in all groups showed moderate to marked global improvement (70% to 86%, depending on rater). In agoraphobics and mixed phobics (both groups experiencing spontaneous panic attacks), imipramine was significantly superior to placebo. There was no difference between behavior therapy and supportive therapy, both resulting in high improvement rates (76% to 100%, depending on rater). In simple phobic patients, there was a high rate of improvement with all treatment regimens (72% to 93%, depending on rater), with no significant difference between imipramine and placebo or between behavior therapy and supportive therapy. Of 88 moderately to markedly improved patients followed up for one year after completing treatment, 83% maintained their gains and 17% relapsed. No patients showed symptom substitution. Eighteen percent of the patients receiving imipramine hydrochloride showed marked stimulant side effects on from 5 to 75 mg/day.
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In a study of the management of obesity 43 patients were randomly assigned to behavior therapy, will power, and no-treatment control groups. The behavioral treatment involved contingency contracting, stimulus control, self-monitoring, energy expenditure, and group reinforcement procedures over an 18-week period. The will power patients were told to do the same thing as the behavior therapy patients; however, instead of having formal contingencies and meeting regularly, they were told to apply "will power" on their own, as this was the most important aspect of losing weight. The third group was a standard no-treatment control group. Analyses of covariance indicated that (a) the behavior therapy group lost significantly more weight than the will power (p less than .05) and no-treatment control (p less than .01) groups, and (b) the will power and no-treatment control groups did not differ significantly from each other. An 18-week maintenance follow-up of the behavior therapy group indicated that there was no significant weight gain from the end of treatment to follow-up. Also, an analysis of time spent per patient suggested that the behavioral treatment employed in this study was more efficient than previous treatments.
The author critically examines the evidence for the effectiveness of the behavior therapies as described in the American Psychaitric Association's task force report on behavior therapy. He concludes that current attempts to evaluate behavior therapy suffer from inadequate methodology and that the claims for its therapeutic efficacy are excessive and unsupported by the controlled clinical evidence.
Mazindol, diethylpropion, and a placebo were compared with behavioral therapy for effectiveness in producing weight reduction in an outpatient obesity clinic. Each method was also compared in cost and harmful side effects. The patients were recruited from the middle and lower socioeconomic groups. Of the 120 patients beginning treatment, only 33 completed the entire 14-week study. There was no statistically significant difference in the weight loss among the treatment groups. The program of behavioral therapy was administered by a dietitian who as experienced in the techniques of behavior modification; the drug treatment groups were seen by physicians. We conclude that behavioral therapy may be the treatment of choice in an outpatient obese population since it requires little physician time, is less expensive, and avoids the side effects of anorectic drugs.
Recent efforts to integrate biomedical and behavioral science perspectives and techniques have revealed the creativity and efficacy of behavioral health approaches to health enhancement and disease prevention. There are expectations that behavioral medicine and behavioral health will be significant in approaches toward changing life style, improving patient's compliance with medical advice, and in rehabilitation. Three examples of actual practice of behavioral procedures in a public health center are studied-behavior therapies for obesity and hypercholesterolemia, and prompting of patient clinic utilization behavior by a letter of introduction. The importance of proper selection of target problems, staff training is emphasized. In conclusion, it is recommended that behavioral science and its techniques of assessment and treatment are incorporated into public health activities, especially in the field of health education.
What is presently observed is not only a rapid increase in the number of publications, but also a major change in the theoretical principles of behavior therapy. The former onesidedness of a form of behavior therapy theoretically substantiated by classical conditioning only may be regarded as having been completely overcome. For example, this is evident from new approaches to behavior diagnosis as an essential prerequisite of differentiated therapy planning. Recent concepts of the theoretical substantiation of the effectiveness of behavior therapy lead to an increasing consideration of both cognitive and motivational aspects and also take into account the complexity of the patient's social relations. This, in turn, results in the availability of a wide range of indication-specific methods of behavior therapy.
A questionnaire survey of 50 patients treated by behavior therapy or short-term, analytically oriented psychotherapy revealed that both groups, as well as those patients who improved the most, placed a high value on insight, the patient-therapist relationship, catharsis, and trust. The findings suggest that behavior therapy patients tend to place more emphasis than do their therapists on factors that have traditionally been thought important in analytic psychotherapy.
Behavior therapy appears a promising drug abuse treatment and research approach of choice, reporting effective pilot studies utilizing such techniques as token economy, aversive conditioning, relaxation training, contract writing, covert conditioning, and combinative approaches. Behavior therapy appears to merit considerable investment of funds, time, and facilities to design and to execute carefully controlled research studies with systematic follow-up. Behavioral research and treatment is also consistent with presently available diagnostic techniques--the highly structured interview and the Synanon Game--and seems eminently applicable in specific work sites, to problems of staff selection and training, and to patient screening problems.
The theory of rational-emotive therapy (RET) and of cognitive-behavioral therapy (CBT) is briefly explained and is applied to group therapy. It is shown how RET and CBT therapy groups deal with transference, countertransference, levels of group intervention, process versus content orientation, identifying underlying group process themes, here-and-now activation, working with difficult group members, activity levels of therapist and group members, and other group problems. Although they particularly concentrate on people's tendencies to construct and create their own "emotional" difficulties, RET and CBT group procedures fully acknowledge the interactions of human thoughts, feelings, and actions and active-directively employ a variety of cognitive, emotive, and behavioral group therapy techniques.
OBJECTIVE: The authors studied the risk of relapse among depressed patients after cognitive behavior therapy in order to document the need and potential indications for longer-term models of treatment. METHOD: Forty-eight patients with major depression who responded during a 16-week course of cognitive behavior therapy entered a 1-year prospective follow-up study, as did two patients who received 20 weeks of therapy. Standardized, independent clinical assessments were completed 1, 3, 6, 9, and 12 months after treatment. Relapse was defined as, at minimum, a 2-week period in which the subject met the DSM-III-R criteria for major depression and had a Hamilton depression scale score of 15 or more. RESULTS: Sixteen patients (32%) relapsed during the 1-year follow-up. Correlates of relapse included a history of depressive episodes, higher levels of depressive symptoms and dysfunctional attitudes, slower response to therapy, and being unmarried. Patients who fully recovered during therapy (Hamilton depression score of 6 or less for 8 weeks or more) were at significantly lower risk for relapse than those who partially recovered (9% and 52%, respectively). Slower response to therapy, unmarried status, and high residual scores on the Dysfunctional Attitudes Scale were independently and additively related to increased risk of relapse. CONCLUSIONS: These findings provide further evidence of a relation between residual symptoms and relapse after cessation of active treatment. The authors strongly recommend that models of longer-term psychotherapy be developed for depressed patients who do not recover fully during time-limited cognitive behavior therapy.
The author reports the use of behavior therapy in the treatment of two cases of severe intractable depersonalization. Outcome criteria included full psychiatric assessment, patients' self-ratings, and psychometric test scores. Treatment by flooding was highly effective in one case, and associated obsessive symptoms and anticipatory anxiety were substantially decreased in the other. Behavioral techniques may prove especially helpful in cases in which anticipatory anxiety, phobic avoidance, and obsessive perseveration are exacerbating features.
In the discussion concerning which psychotherapeutic methods should come under the auspices of the medical health system in West Germany, the question is raised regarding the behavioral therapy. Can it be considered a distinct psychotherapeutic method? A review of the scientific literature in this area shows that "behavioral therapy" includes a conglomerate of therapeutic procedures which have no common basis neither in theory nor in practical application. These therapeutic procedures are usually pragmatic and symptom-orientated, many of them never having been sufficiently tested in experiments or in clinical application. Before behavioral therapy can be inclused as a legitimate therapeutic method, it is necessary first to establish a catalogue of acceptable procedures. Psychologists working as behavioral therapists must be required to go through thorough training in their own special field as well as basid training in the mental health sciences comparable to that of psychotherapists with a medical background.