Behavioral direction of psychocorrection

General characteristics

Behavioral psychotherapy is currently one of the leading areas of modern psychotherapy.

Behavior is the core concept of this field. In the most general form, behavioral psychotherapy can be defined as psychotherapy centered on a change of behavior. Nevertheless, when behavioral changes occur, corresponding transformations in other areas - cognitive, emotional and volitional - inevitably occur. Consequently, a number of authors believe it is possible to consider that this field is based on the psychology of behaviorism and uses principles of learning to change cognitive, emotional and behavioral structures.

As defined by the American Association for Behavioral Psychotherapy, this area of psychological intervention "includes primarily the use of principles that have developed in experimental mental and social psychology. Behavioral psychotherapy is supposed to reduce human suffering limitations in the ability to act. Behavioral psychotherapy involves restructuring the environment and social interaction and, to a lesser extent, modifying somatic processes through biological interventions. Its purpose is mainly to form and strengthen the ability to act, acquiring techniques for improving self-control" (cited in B.D. Karvasarsky, 1998). Behavioral therapy (or "behavior modification") is treatment that uses principles of learning to change behavior and thinking (Alexandrov A.A., 1997).

Behavioral psychotherapy includes a wide range of methods. Development of methodical approaches within the framework of this direction reflects the evolution of the goals of behavioral psychotherapy from external to internal learning: from methods aimed at changing overt forms of behavior and immediately observable behavioral reactions (based primarily on classical and operant conditioning) to methods aimed at changing deeper, more closed psychological entities (based on theories of social learning, modeling and cognitive approaches).

At first, the term "behavior" in behavioral psychotherapy meant everything that had externally observable characteristics, but now this concept includes emotional-subjective, motivational-affective, cognitive and verbal-cognitive manifestations, and modern behavioral psychotherapy also includes beliefs, attitudes and expectations. Combining such heterogeneous manifestations into a single concept of behavior indicates that they are all subject to common patterns of learning, on which we can control them just as we control a relatively simple behavioral act.

Contemporary behavioral psychotherapy is not limited to the application of classical and operant conditioning principles and procedures to the treatment of clinical problems. Approaches in behavior therapy differ in the degree to which cognitive concepts and procedures are used. A. P. Fedorov believes in this connection that there is a real danger of losing the specificity of the term "behavioral" due to an overly broad understanding and desire to call very heterogeneous techniques behavioral.

At one end of the continuum of behavior therapy procedures is functional behavior analysis, which focuses exclusively on observable behavior and rejects all intermediate cognitive processes; at the other end is social learning theory and cognitive behavior modification, which draw on cognitive theories.

The theoretical basis of behavioral psychotherapy is the psychology of behaviorism.

The concept of pathology

Behaviorism, which is the psychological basis of behavioral psychotherapy and behavioral medicine, also defines their approach to the problem of health and illness: health and illness are the result of what one has and has not learned, and personality is the experience one acquires throughout life. In this case, neurosis is not viewed as an independent nosological entity, since there is essentially no nosological approach. In the focus of attention there is not so much an illness as a symptom, which is understood as behavior, or, more precisely, as behavioral disorders.

A neurotic symptom (neurotic behavior) is considered to be a maladaptive, or pathological behavior resulting from improper learning. Thus, J. Wolpe defines neurotic behavior as a habit of maladaptive behavior in a physiologically normal organism, and X. J. Eysenck and S. Rachman - as internalized patterns of behavior which have become maladaptive due to any reasons.

Adaptation, from a behaviorist perspective, is the primary goal of behavior, so behavior that does not provide adaptation will be pathological. Behavioral disorders within behaviorism are acquired, representing learned maladaptive reactions that do not provide the necessary level of adaptation.

This maladaptive reaction is formed as a result of "incorrect" learning. An example of such "wrong" learning is the interaction of parents with the child: parents pay attention to the child, take him in their arms only if he does something wrong, for example, is capricious, or the child, who lacks external displays of love, attention, warmth and care, receives them in excess when he is ill. Thus, the child's need for attention is fully satisfied only when he or she behaves "badly," in other words, "bad," maladaptive behavior is positively reinforced (a meaningful need is satisfied).

The main points of behavioral psychotherapy

Representatives of the behavioral direction consider maladaptive behavior and clinical symptoms as a result of the fact that the person has not learned something or has learned it incorrectly, as the learned maladaptive reaction which has developed as a result of incorrect learning.

In accordance with such views of norms and pathology, the primary goal of clinical and psychological interventions within the behavioral approach is to retrain, to replace maladaptive behaviors with adaptive, "correct," reference, normative ones, and the task of behavioral psychotherapy as a therapeutic system proper is the reduction or elimination of a symptom.

In general, behavioral psychotherapy (behavior modification) is aimed at controlling a person's behavior, retraining, reduction or elimination of symptoms and approximation of behavior to certain adaptive forms - replacement of fear and anxiety with relaxation until the reduction or total elimination of symptoms is achieved in the process of learning by application of certain techniques. Learning within the framework of behavioral psychotherapy is carried out on the basis of the theories of learning formulated by behaviorism that we have already reviewed.

Behavioral therapy strives to ensure that as a result of treatment, the patient acquires the so-called corrective learning experience, which assumes acquisition of new coping skills (coping skills), improvement of communicative competence, overcoming maladaptive stereotypes and destructive emotional conflicts.

This learning experience of modern behavior therapy is not limited to modifying a narrow range of responses in overt behavior, but provides major changes in the cognitive, affective, and behavioral spheres of functioning.

In behavioral psychotherapy, learning is carried out directly and is a process purposeful, systematic and consciously realized by both the therapist and the patient. The behavioral psychotherapist considers all problems to be pedagogical in nature and can therefore be resolved by direct training in new behaviors. The patient must learn new alternative behaviors and train them. The therapist's behavior in this case is also completely defined by theoretical orientation; if the tasks of psychotherapy consist of training, the role and position of the psychotherapist has to correspond to the role and position of the teacher or technical instructor, and the relationship between the patient and the psychotherapist has a teaching (educational, educational) character and can be defined as a "teacher-student" type relationship. Psychotherapy is an open, systematic process directly controlled by the therapist. The psychotherapist together with the patient draws up a treatment program with a clear definition of the goal (establishing the specific behavioural response (the symptom) to be modified), an explanation of the tasks, mechanisms and stages of the therapeutic process and the definition of what the psychotherapist will do and what the patient will do. After each psychotherapy session, the patient is given concrete tasks and the psychotherapist supervises their implementation. The psychotherapist's main function is to organize an effective learning process.

А. A. Alexandrov describes the procedure of behavioral psychotherapy. Behavioral therapy starts with identification and understanding of the patient's problem, about which the therapist tries to receive detailed information - how the disorder started, the severity and frequency of its manifestations, what the patient has undertaken to overcome the problem, what he or she thinks about the problem, whether the patient has addressed therapists before. In order to get an answer to these questions (which can be painful and confusing for the patient), a relationship of trust and mutual understanding must first be established with the patient. Therefore, the therapist listens carefully and seeks empathic contact.

The therapist then conducts a functional analysis of the problem, attempting to identify specific situational and personality variables that support maladaptive thoughts, feelings, and behavior. Focusing on the variables that support the problem in the present moment does not mean ignoring the patient's history. However, past experiences are important only insofar as they are still active in causing present distress.

In a behaviorally oriented interview, the therapist rarely asks the patient the "why?" question, such as: "Why do you experience fear in crowds?" Questions beginning with "how?", "when?", "where?", "what?" are more useful for identifying personal and situational variables that support the patient's present problems. The therapist relies primarily on patients' self-reports, particularly in assessing thoughts, fantasies, and feelings. Such self-reports are more reliable predictors of behavior than the judgment of clinicians or the results of personality tests.

The actual learning in behavioral psychotherapy is carried out on the basis of the previously discussed schemes related to the general theories of learning formulated by behaviorism. Methodologically, behavioral psychotherapy does not go beyond the traditional behaviorist "stimulus-intermediate variable-response" scheme. Each school of behavioral psychotherapy concentrates psychotherapeutic influence on particular elements and combinations within this scheme.

А. A. Alexandrov cites the main provisions characterizing behavior therapy in general:

1. Many cases of pathological behavior, which have previously been regarded as illness or as symptoms of illness, from the point of view of behavior therapy are non-pathological "problems of life. Such problems include, first of all, anxious reactions, sexual deviations, behavioral disorders.

2. Pathological behavior is largely acquired and maintained in the same ways as normal behavior. It can be treated with behavioral treatments.

3. Behavioral diagnosis focuses more on the determinants of present behavior than on past life analysis. The distinguishing feature of behavioral diagnosis is its specificity: a person can be better understood, described and evaluated by what he or she does in a particular situation.

4. Treatment requires a preliminary analysis of the problem, highlighting its specific components. These specific components are then subjected to systematic exposure to behavioral procedures.

5. Treatment strategies are developed individually for different problems in different individuals.

6. Understanding the origin of the psychological problem (psychogenesis) is not essential for the realization of behavioral change; success in changing problem behavior does not imply knowledge of its etiology.

7. Behavioral therapy is based on a scientific approach. This means, firstly, that it is guided by a clear conceptual basis that can be tested experimentally; secondly, the therapy is consistent with the content and method of experimental-clinical psychology; thirdly, the techniques used can be described with sufficient precision to be measured objectively or replicated; fourthly, therapeutic methods and concepts can be experimentally evaluated.

Within the framework of behavioral psychotherapy, it is possible to distinguish three basic kinds (or three groups of methods) directly connected with the three types of learning:

1) a direction methodologically based on the classical paradigm;

2) a direction methodologically based on the operant paradigm;

3) a direction methodologically based on the social learning paradigm.

Methods based on Pavlov's classical paradigm, classical conditioning, use a stimulus-response scheme and systematic desensitization or other symptom reduction techniques. An example of such a methodical approach is Wolpe's method of classical systematic desensitization, which aims at the reduction or complete elimination of a symptom by replacing it with relaxation.

Methods based on Skinner's operant paradigm use the "reaction-stimulus" scheme and various types of reinforcement. An example of such a methodological approach is the so-called "token system," some types of training.

Methods based on the social learning paradigm use the "stimulus-intermediate variables-response" scheme. Various systems of directive psychotherapy are used here, the goal of which is to change numerous psychological parameters that are taken as intermediate variables. Depending on which psychological processes are regarded as mediators (attitudes, as in Ellis's rational-emotional psychotherapy, or cognitions, as in Beck's cognitive psychotherapy), the psychotherapeutic targets are determined. Thus, all existing methods of behavioral psychotherapy are directly connected to one or another theory of learning.

Behavioral psychotherapy is an evolving field. Beginning with stimulus-response theories of learning, it then uses cognitive and social theories of learning, and in recent years has also tried to rely on theories of information processing, communication and even large systems. Accordingly, old techniques of behavioral psychotherapy are being modified and the range of new techniques is expanding.

In clinical practice, behaviorism, which is the theoretical basis of behavioral psychotherapy, has also had a considerable influence on the development of such therapy as environment therapy.

Application of behavioral therapy

1. anxiety conditions. Clinical studies in various countries have shown that behavior therapy is effective in treating phobic disorders; moreover, behavior therapy is the treatment of choice for phobias. The basic technique is systematic exposure (the concept "exposure" unites all techniques based on presentation of an object of fear); in addition, for some agoraphobic disorders, cognitive-behavioral strategies (cognitive restructuring, behavioral marital therapy, etc.) are used. Most patients are cured, and this is confirmed by follow-up information lasting from 5 to 9 years. Therapeutic failures are noted in 10-40% of patients with agoraphobia (G. T. Wilson).

2. Sexual disorders. It is generally recognized that behavioral therapy is preferred for sexual dysfunctions such as impotence, premature ejaculation, orgasmic dysfunction, and vaginismus. The best known example is the two-week sexual dysfunction treatment program (Masters and Johnson).

Interpersonal and marital problems. Social skills training and affirmative behavior training are used in a wide range of interpersonal problems, from limiting socio-behavioral repertoires to sociophobia. Behavioral marital therapy (Jocobson and Margolin) is a method of teaching partners positive and productive ways to achieve desired behavioral changes in each other.

4. chronic mental disorders. Behavioral therapy is not effective in acute mental disorders. Behavioral treatments (predominantly the token system) are the method of choice in patients with severe personality changes and low levels of self-care

5. Child psychopathology. From the very beginning of the emergence of behavioral therapy, its methods have been used in the treatment of various kinds of disorders in childhood. These include behavioral disorders, aggression and delinquency. Token reinforcement is widely used in the treatment of hyperactive behavior. The success of behavioral therapy in improving the academic performance of hyperactive children leads to the belief that behavioral therapy should complement widespread medication therapy to control hyperactivity, or even be an alternative to medication therapy in some cases (O'Leary). It is generally recognized that autism is a particularly severe childhood disorder with a poor prognosis. Traditional psychological treatments and pharmacotherapy have proven ineffective. Behavioral methods, on the other hand, have achieved notable success here. Lovaas reports that intensive, long-term behavioral treatment of autistic children resulted in normal intellectual and behavioral functioning in 47% of cases. The other 40% found mild retardation and were referred to schools for children with speech delays. In the control group of autistic children, only 2% achieved normal functioning. These results are the best ever obtained in treating autistic children. Bedwetting has proven to be one of the most curable problems in behavioral therapy treatment.

Technical procedures

Systematic desensitization

The official beginning of behavioral therapy is associated with the name of Joseph Wolpe. Wolpe defined neurotic behavior as "a fixed habit of maladaptive behavior acquired through learning. Anxiety, which is a component of the situation in which neurotic learning occurs, as well as a component of the neurotic syndrome, is of principle importance. Anxiety, according to Wolpe, is "a persistent response of the autonomous nervous system acquired in the process of classical conditioning. Wolpe developed a special technique designed to extinguish these conditioned autonomic responses - systematic desensitization.

In order to explain the mechanism of psychotherapeutic influence, Wolpe created the theory of reciprocal inhibition. It is about inhibition of anxious reactions as a result of simultaneous causing of other reactions which from the physiological point of view are antagonistic to anxiety, incompatible with it. If a reaction incompatible with anxiety is provoked simultaneously with the impulse that has so far provoked anxiety, the conditioned connection between that impulse and anxiety is weakened. Such antagonistic reactions to anxiety are eating, self-affirmation reactions, sexual reactions, and a state of relaxation. Muscle relaxation proved to be the most effective stimulus in eliminating anxiety. Wolpe used the technique of progressive muscle relaxation (J. Jacobson). Having trained the patient in the technique of deep relaxation, we proceed to the second step - drawing up a hierarchy of situations causing fear. Next, the patient, who is in a state of relaxation, is offered to vividly visualize the situation occupying the lowest position in the hierarchy, i.e. the one least associated with fear.

As an example, fifteen scenes from the hierarchy offered to the patient with fear of flying in an airplane (D. Bernstein, E. Roy et al.):

1. You read the newspaper and notice an airline ad.
2. You're watching a television program and you see a group of people boarding a plane.
3. Your boss says you need to take a business trip by plane.
4. There are two weeks left before your trip, and you ask the secretary to book your plane ticket.
5. You're in your bedroom, packing your suitcase for the trip.
6. You take a shower in the morning before your trip.
7. You're in a cab on your way to the airport.
8. You check in at the airport.
9. You are in the waiting room and hear the announcement about boarding your flight.
10. You are standing in line in front of the plane.
11. You are sitting in your seat on the plane and you hear the plane's engine start to run.
12. The plane comes into motion, and you hear the flight attendant's voice: "Fasten your seat belts, please.
13. You look out the window as the airplane begins to scatter down the track.
14. You are looking out the window as the plane is about to take off.
15. You look out the window as the plane leaves the ground.

In the other variant, systematic desensitization is carried out not in a representation, but in vivo, by real immersion into a phobic situation. This variant presents great technical difficulties, but, according to some authors, it is more effective and can be used for treatment of patients with a poor ability to evoke representations. The literature cites a case in which a person suffering from claustrophobia learned to tolerate increasing restriction to the point that he or she felt comfortable in a zippered sleeping bag.

Systematic desensitization can be conducted by a technique called fading, in which slides with images of the phobia object or special films containing scenes that evoke fear (for example, scenes of flying on an airplane for a phobia of flying) are used instead of stimulation of imagination.

Methods based on fading

These methods, also called immersion, are based on direct presentation of an object of fear without preliminary relaxation. These methods are based on the mechanism of extinction discovered by I.P. Pavlov, according to which presentation of a conditioned stimulus without unconditioned reinforcement leads to disappearance of the conditioned reaction. The immersion methods include "flooding," "implosion," and "paradoxical intension.

In the "flood" technique, the patient, together with the therapist, is placed in a situation in which he or she has fear, but is not harmed by it, and stays in this situation until the fear diminishes. It is important that the possibility of concealed avoidance of the fear must be eliminated. For example, during a trip on transportation, the patient tries to divert his attention (by thinking of something pleasant or engaging in conversation with others), thus reducing the intensity of his fear. It should be explained to the patient that implicit avoidance reinforces avoidance behavior. During the flooding session, the patient should feel as strong an emotion of fear as possible.

Implosion is a technique of flooding in the imagination. In general terms, it repeats the technique of systematic desensitization, but is conducted without accompanying relaxation. At first, a hierarchy of fears is drawn up, and then the implosion itself - the representation of situations of fear - is performed. The therapist evaluates the patient's behavior (motor activity, muscle tension, facial expressions, vegetative reactions) in terms of the level of involvement of the patient and the intensity of the fear he or she experiences. The task of the therapist is to keep the level of fear high enough. If the level of anxiety decreases, the therapist introduces additional descriptions of the situation to intensify the fear. For example, a patient suffering from snake phobia is asked to imagine taking a snake in his hands; as the level of fear decreases, the patient may be asked to imagine the snake biting his finger or face, etc. The therapist's imagination here can be limitless. One should strive to maintain a sufficiently high level of fear for 40-45 minutes.

Paradoxical Intention is a method of immersion proposed by Viktor Frank]. Frankl considered the so-called "anticipatory anxiety" an essential pathogenic factor in the etiology of neuroses. The anticipatory anxiety often causes exactly that situation which the patient fears. Another pathogenic factor in the etiology of neuroses, according to Frankl, is excessive striving (intension). Excessive striving makes it difficult to realize the goal. Frankl bases his paradoxical intension technique on these facts.

In this technique, the patient is asked to stop struggling with the symptom and instead to deliberately induce it and even try to intensify it. The technique involves a radical change in the patient's attitude toward his or her symptom, his or her illness. This method involves not only a reversal of the patient's attitude toward his phobia, but also a humorous attitude in its use. Simply put, the patient must disengage from his neurosis by laughing about it. Frankl quotes Allport, who said that "the neurotic who has learned to laugh at himself is already on his way to mastery over himself, and perhaps to a cure.

Frankl relates the case of a boy who suffered from a severe stutter. One day he was riding in a streetcar as a "hare. Caught by the conductor, he decided that the only way to get out was to make the conductor feel sorry for the "poor little stutterer. But trying to stutter, there was no way he could do it! Unaware of this, he resorted to a paradoxical intention, though by no means for therapeutic purposes.

Modeling

Therapists often teach patients the desired behavior by demonstrating, or modeling it. For example, in vivo desensitization can be particularly effective when the therapist shows the patient how to behave calmly in situations that evoke feelings of fear. In one case, a therapist showed a patient with a severe spider phobia how to kill spiders with a clapper, and taught her this art at home using a set of rubber spiders (MacDonald and Bernstein).

Training in assertive behavior and social skills

This technique is intended for insecure patients who are unable to openly express their feelings and do not know how to assert their legal rights. They are often exploited by others, experience anxiety in social situations, and suffer from low self-esteem. Like systematic desensitization techniques, assertiveness training also relies on the use of a response antagonistic to fear: active, self-assertive behavior is incompatible with feelings of fear and anxiety. A person suffering from sociophobia avoids meeting with people because of the possible negative consequences: passivity, insecurity, timidity, defensiveness behavior, as a rule, does not elicit approval from other people.

Training is conducted in groups. In the course of the sessions, the patient becomes convinced that self-affirming behavior leads to a change in the reactions of those around him or her. This in turn reinforces this behavior and leads to higher self-esteem and even greater self-confidence. Note that self-affirming behavior does not imply aggression; rather, it is a direct expression of both positive and negative feelings in asserting one's rights while respecting the rights of others.

Modeling and role-playing are the main technical means of self-confidence training. The therapist helps patients to be more open and expressive in social situations. For example, a patient who is afraid to ask for a pay raise can acquire the necessary skills by role-playing this situation several times with the therapist or other members of the group. Attention is given to the development of non-verbal and verbal expressive behavior, i.e., body postures, voice production, eye contact. The therapist then encourages the patient to perform affirmative actions in a real environment in order to ensure generalization.

In addition to reinforcing affirmative behavior, the training is designed to improve communication abilities, including active listening, giving feedback, and establishing trust through self-disclosure.

Positive reinforcement

Positive reinforcement techniques use the principles of operant conditioning to make connections between behavior and its consequences. Reinforcement is systematically used by therapists to modify problematic behaviors, from nail biting, childhood excitability, and adolescent delinquency to schizophrenia and food refusal. Example. Anna, a four-year-old girl, communicated normally with teachers and other adults, but was timid, silent and withdrawn with children. The psychologist working at school noticed that teachers unintentionally rewarded her reticence with excessive attention and persuasion. Then a program was developed to modify the girl's behavior. Teachers had to pay attention to Anna only when she was playing with other children or at least being close to them. Later, teachers began to reward Anna only for real interaction with children. Playing alone was also ignored. As a result, Anna began to spend more time with children than with adults (Allen et al.).

To improve the behavior of patients with severe personality disorders or mental retardation in psychiatric institutions, behavioral therapists have developed what is known as a token system (Ayllon and Azrin) in which desired behaviors are rewarded with tokens, which patients then exchange for sweets, walks, watching TV and other privileges. The staff, in collaboration with the patient (when possible), draws up a list of desired behavior goals (behavior targets) based on each patient's behavior patterns. These targets may consist of the requirement to speak more clearly, do homework, play with other children, tidy the bed, etc. A price list is then established, according to which the patient receives a certain number of tokens as soon as a particular behavioral target is achieved.

The token system can be very effective in changing behavior. Several studies have shown that in psychiatric patients with severe apatoabolic personality changes, the token system significantly improved their appearance, social interaction, table manners, and at the same time reduced oddities in behavior. Most significantly, the token system prepared patients with severe behavioral disorders for life outside the psychiatric hospital (Ayllon and Azrin).

Disgust Technique

The aversion-inducing technique (aversive therapy) uses the principles of classical conditioning. For example, alcoholism is treated with a combination of small doses of alcohol with substances that cause vomiting or other unpleasant feelings. Electric shocks are used to eliminate neurotic stuttering, hand tremors, sexual perversions, and nocturnal enuresis.

The described type of therapy was first substantiated by V.M. Bekhterev. He pointed out that when treating chronic alcoholism with a long-used combination of alcohol and vomiting-inducing substances, the therapy is based on the development of the gagging conditioned ("combinative", according to Bekhterev) reflex. The method of alcoholism treatment by injection of apomorphine before alcohol intake was first used in Russia by I.F. Sluchevsky and A.A. Friken in 1933.

Punishment

Unlike aversive conditioning, in which an unpleasant stimulus is combined with an undesirable behavior, punishment follows the undesirable behavior. For example, a patient with a tremor form of scribal spasm is asked to master the task of hitting a metal stick into a series of holes of decreasing diameter located on a plate. Accurate hitting these holes spares him or her from an electrical discharge. The presence of the tremor leads to hitting the edges of the hole and shorting the electrical circuit. The patient then experiences a shock of electric current. In the spastic form of writing spasm, the patient uses a special fountain pen, excessive pressure on which also leads to shorting of the electric circuit and, consequently, to punishment. In the process of training, the patient learns to relax the necessary muscle groups.

Procedures for self-monitoring

Behavioral therapists strive to have patients (both children and adults) play an active role in setting treatment goals and executing the therapeutic program. Many self-monitoring procedures are used for this purpose (Bandura.Kanfer). Self-control is the basis for successful self-regulation of behavior. It makes patients more aware of their specific problems and actions. The therapist helps the patient to set goals or standards that govern behavior. When treating overweight, for example, daily caloric intake is jointly set.

The likelihood of successful self-monitoring is increased by formulating very specific, clear, and short-term goals. For example, you cannot formulate a goal in such a vague form as: "Starting next week, I will limit my food intake"; you need a clear and specific goal: "I will consume no more than 1200 calories per day." Failure to achieve vague goals causes negative self-esteem in patients, whereas successful achievement of specific and clear goals leads to self-reinforcement, which increases the likelihood that self-regulatory behavior will continue to be maintained.

Progressive relaxation training used to overcome stress reactions, including insomnia, headaches and hypertension, can be considered as one of the methods of self-control. Biofeedback techniques used to treat various psychosomatic disorders also fall into the category of self-monitoring procedures.

Cognitive restructuring

The therapeutic methods in this category are based on the assumption that emotional disorders are the result of maladaptive thinking styles (cognitions). The task of cognitive restructuring (R. Lazarus) is to change these flawed cognitions. Therapists train patients to replace, in stressful situations (public speaking, exams, unpleasant conversations), maladaptive cognitions with calm, rational thoughts such as, "Relax, you can handle it if you just concentrate on the task and let go of thoughts of being perfect. Among these techniques, "stress inoculation training" (D. Meichenbaum), in which the patient imagines being in a stressful situation and uses the new cognitive skills he or she has acquired, is widely known. Rational-emotional therapy by Ellis and cognitive therapy by Beck are also forms of cognitive reconstruction, combining cognitive and behavioral methods.

Smile, nods and attention are all factors of encouragement. We tend to look for encouragement and rewards. Those from whom we receive encouragement become our friends; others we ignore or avoid. Money is also a strong means of encouragement and reward. We might say that we work because we are rewarded with money. In proper applied behavioral analysis, there is always a place for encouragement.

Although encouragement is a simple and accessible method, it is usually used in practice for manipulation rather than for constructive purposes. Here is an example of such an experiment.

The composition of the performers is: a) a professor who is being graded on his subject knowledge. He knows that his classes will be videotaped during the certification, but he does not know the instructions to the students; b) six students who are given the task of demonstrating an attentive attitude toward the professor (visual contact, listening, personal involvement).

Plot: In the first stage of the lecture, the students have to behave as usual. Then, on command, they switch to - attentive behavior. Then they go back to their normal behavior again. Question: What will be the dynamics of the professor's behavior? How will the students behave?

Events in outline form: A professor walks into the classroom, holding the tapes in his hands. He glances at the camera in the room and then at the recordings. He does not look at the assembled students. After a ZO second pause, he begins. The lecture is replete with references to -interesting research it is clear that the professor has been thoroughly preparing for the lecture. Accidentally, the professor pulls back from his notes and looks at the students, who are busy taking their usual notes. He returns to his notes and continues his lecture. For ten minutes his hands are motionless and remain on the table.

At the signal, the students' behavior changes. Their attention is focused on the professor. However, he does not take his eyes off his notes, does not look at the students for another 30 seconds, then casts a brief glance at them and notes that the students are watching him. Soon he looks up again and again gets -encouragement from the students. Then he looks at one student for a long time and notes that the student is watching him closely. He looks around the classroom. Everyone looks at him intently. He perks up, begins to gesticulate. His speech speeds up, his facial expressions enrich. Students ask a few questions, and discussion ensues without notes. Comprehension of the material is excellent, the professor makes fewer references to obscure studies. There is a very different atmosphere in the audience. One can feel the involvement of the students and the instructor.

At the signal, the students turn their attention off and return to their notes. The professor continues to speak, but his speech slows down. He looks at the students for support, but gets none. The speech slows down more and more. Resigned, he returns to his notes, and the rest of the lecture is no longer about his own knowledge, but about someone else's.

The students then confessed that they found it difficult to interrupt their attention and return to typical student behavior because they found the lecture material very interesting. The students claimed that they liked the material very much while they were paying attention, and they had the feeling that they were -leaving the professor when he needed them just as much as they needed him.

Psychologists call this simple example, the Greenspoon effect, after Dr. John Greenspoon. A class of psychology students engaged for years in nudging professors by smiling or ignoring them. It was a kind of game for the students to make the professor stand in a certain place or walk in front of them. Normally, students did not encourage or pamper professors with their attention. (Ivy and Lickle, 1963)

Although we have described a rather amusing case, it clearly illustrates how behaviorist techniques can be used to manipulate people. Fortunately, such experiments with humans are on the wane. Now the main thrust of behaviorist psychology is to teach clients effective techniques. A huge number of programs and concepts aimed at changing the behavior of children, prisoners, spouses, athletes, smokers, alcoholics, drug addicts are based on the elementary idea of encouragement and reward. As a natural extension of this, prisons, mental hospitals, schools and other institutions used a system of chips that were given in response to a desired action as a tangible reward. At the end of the week, the chips were exchanged for candy, cigarettes, and privileges. It is very important in this strategy that there is not a large gap in time between the desired behavior and the reward.