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Chapter 28: Psychotherapies
disorders receive a reward for performing a desired behavior,
such as tokens that they can use to purchase luxury items or
certain privileges. The process, known as
token economy,
has
successfully altered behavior. Table 28.8-3 gives a summary of
some clinical applications of behavior therapy.
Figure 28.8-1
Treatment of addicts at Tham Krabok Monastery in Thailand results
in a 70 percent success rate, according to its records. The 10-day
free treatment begins with a vow to Buddha never to use narcotics
again. Then, patients are given an herbal medicine that makes them
vomit immediately. (FromWhite PT, Raymer S. The poppy—for good
and evil.
National Geographic.
1985;167:187, with permission.)
Table 28.8-3
Some Common Clinical Applications of Behavior Therapy
Disorder
Comments
Agoraphobia
Graded exposure and flooding can reduce the fear of being in crowded places. About 60% of patients so treated
improve. In some cases, the spouse can serve as the model while accompanying the patient into the fear situation;
however, the patient cannot get a secondary gain by keeping the spouse nearby and displaying symptoms.
Alcohol
dependence
Aversion therapy in which the alcohol-dependent patient is made to vomit (by adding an emetic to the alcohol)
every time a drink is ingested is effective in treating alcohol dependence. Disulfiram (Antabuse) can be given
to alcohol-dependent patients when they are alcohol free. Such patients are warned of the severe physiological
consequences of drinking (e.g., nausea, vomiting, hypotension, collapse) with disulfiram in the system.
Anorexia nervosa Observe eating behavior; contingency management; record weight
Bulimia nervosa Record bulimic episodes; log moods
Hyperventilation Hyperventilation test; controlled breathing; direct observation
Other phobias
Systematic desensitization has been effective in treating phobias, such as fears of heights, animals, and flying.
Social skills training has also been used for shyness and fear of other people.
Paraphilias
Electric shocks or other noxious stimuli can be applied at the time of a paraphilic impulse, and eventually the
impulse subsides. Shocks can be administered by either the therapist or the patient. The results are satisfactory
but must be reinforced at regular intervals.
Schizophrenia
The token economy procedure, in which tokens are awarded for desirable behavior and can be used to buy ward
privileges, has been useful in treating inpatients with schizophrenia. Social skills training teaches patients with
schizophrenia how to interact with others in a socially acceptable way so that negative feedback is eliminated. In
addition, the aggressive behavior of some patients with schizophrenia can be diminished through those methods.
Sexual
dysfunctions
Sex therapy, developed by William Masters and Virginia Johnson, is a behavior therapy technique used for various
sexual dysfunctions, especially male erectile disorder, orgasm disorders, and premature ejaculation. It uses
relaxation, desensitization, and graded exposure as the primary techniques.
Shy bladder
Inability to void in a public bathroom; relaxation exercises
Type A behavior
Physiological assessment, muscle relaxation, biofeedback (on electromyogram [EMG]
Charles was a 70-year-old retired business executive. Through-
out his life, his work consumed him. Although he married and had
a family, his job was his primary focus. He went to the office early
and came home late. He enjoyed what he did—it was stimulating
and made him feel important and useful. But as he got older, his
performance was not what it used to be, and he decided it was time
to retire. However, his mood was pretty low when he no longer had a
job. He did not have the energy to get more involved in his church or
to develop other hobbies, so he sat around all day, without any social
contacts. His wife and best friend encouraged him to go talk to
someone. The therapist suggested that they try behavioral activation.
Charles was somewhat skeptical, as it seemed too simple, but he
needed to do something. The therapist spent some time with Charles
talking about the kinds of activities that used to make him feel good
and some of the things he used to enjoy. They then put together a
list of things he might be able do—even if he did not feel much like
it—just to see what would happen. The list included looking for vol-
unteer work where he could use his job skills, spending more time
with his wife in some of the activities they once had enjoyed (e.g.,
watching movies, taking walks), and rejuvenating an old hobby from
his college days—fishing. Charles initially agreed to do some easy
activities—go to one movie a week, take one walk a week, and con-
tact his church activity leader about possible volunteer activities. He
was surprised to find that even these “baby steps” helped him feel
better. He had the chance to talk with other people and began to see
that even in retirement, he could find useful and fun things to do.
(Courtesy of M. A. Stanley, Ph.D., and D. C. Beidel, Ph.D.)
