Traditional Intervention Strategies
Because cognitive-behavioral interventions include aspects of both behavioral and cognitive interventions, this section provides a few examples of some commonly used intervention strategies. The separation of behavioral, cognitive, and cognitive-behavioral techniques is rather artificial, because most cognitive procedures include behavioral components, and some behavioral interventions also contain cognitive elements (Emmelkamp, 2004). That said, a sample of some techniques most often associated with behavioral approaches follows. In addition, cognitive interventions are described briefly. The greatest attention is devoted to providing detail of several cognitive-behavioral theories of counseling and psychotherapy.
Behavioral interventions focus primarily on changing specific behaviors. Examples of purely behavioral interventions include reinforcement, extinction, shaping, stimulus control, and aversive control.
Reinforcement is a well-known behavioral strategy. Positive reinforcement is a procedure in which some behavior is increased by following it with something rewarding; for example, children who clean their room are given praise and attention, a gold star, or a new toy. Most important about reinforcement is that the receiver views the reinforcer as positive. Negative reinforcement is the removal of something aversive to increase behavior. The buzz most cars make when the key is put in the ignition is a negative reinforcer designed to increase seat belt use. Both positive and negative reinforcement increase behavior and can be applied when clients want to increase a behavior.
Extinction is a behavioral intervention designed to decrease a problematic behavior. In this case, a reinforcer that has followed the behavior in the past is removed, and the problem behavior decreases. By the way of an example, think about the child who repeatedly gets out of his or her seat in a classroom. When the teacher notices and asks the child to sit down, the child may return to the seat. However, the attention of the teacher is reinforcing, and the problem of out-of-seat behavior usually continues. Extinction is the procedure in which the teacher ignores the behavior until it stops. Extinction is characterized by response burst, which is a phenomenon in which the child may get out of the seat and wander around and continue to engage in negative behavior in an increasing manner, still trying to get the attention of the teacher. If the teacher gives in and attends to the behavior now, negative behavior is actually being reinforced! Response burst is to be expected and usually subsides when the individual learns that no amount of negative behavior will get the attention that has been reinforcing.
Shaping is a behavioral intervention used to gradually increase the quality of a behavior. Often used to teach a new skill, shaping works by reinforcing the behavior as it gets closer to the final goal. Shaping is used when there is a clearly identified behavior to be changed and when differential reinforcement (reinforcing the behavior that gets closer and closer to the target while ignoring the other behavior) can be applied to successive approximations of the behavior.
In stimulus control, some event in the environment is used to cue behavior. When a stimulus leads to behavior that is desirable and will be reinforced, the cue is called a discriminative stimulus. For example, seeing exercise shoes in the living room may act as a cue to use an exercise tape to do aerobics. The exercise shoes are a discriminative stimulus for exercise.
One example of aversive control is punishment, which is defined as the addition of an unpleasant event following a negative behavior to decrease the occurrence of that behavior. Punishment is not used often by behaviorists, but it has been used to eliminate dangerous behavior such as head banging or other self-mutilative behaviors in children with severe emotional disorders.
Cognitive interventions focus on the role of cognitions in the life of clients. One excellent self-help book written by David Bums (1999), Feeling Good: The New Mood Therapy, can be especially useful for clients using a cognitive-behavioral approach to recover from depression. This book is strongly recommended in a national study of psychologists who rated self-help books (Norcross et al., 2003). The book is a source of information about the different types of cognitive distortions that can be identified and changed through the process of cognitive therapy. Some types of cognitive distortions include all-or-nothing thinking, disqualifying the positive, and catastrophizing (Bums, 1999).
All-or-nothing thinking is characterized by assuming that things are either 100% perfect or absolutely terrible; there is no gray area. Because few things are perfect, all-or-nothing thinking usually leads to depression since everything is viewed as terrible. Disqualifying the positive is defined as the rejection of any positive experiences (i.e., compliments) and assuming that these positive events do not really count for some reason. The person using this type of distortion may say "I only received an A because the test was so easy" or "She is only complimenting me because she wants a ride in my new car." Catastrophizing is the exaggeration of a negative event so that it has much more impact that it deserves. Making a mistake at work or receiving a B on a quiz may be catastrophized into losing the job or failing the course. (Note other books by Bums also used cognitive-behavioral interventions for self-esteem and panic attacks; see the Web site at feelinggood.com.)
Cognitive therapy works through using many kinds of procedures, including thought stopping and positive self-statements, to change these negative or maladaptive kinds of thoughts. Thought stopping is a procedure designed to interfere with thoughts that run through the mind of the client and make it difficult to change behavior. In this procedure, when the client imagines the troublesome thought running through her or his mind, the counselor or therapist shouts "Stop!" While the client may be a bit surprised, the shout does usually stop the thought. The client can then replace the thought with a more adaptive one, like "I can handle this situation." Clients can learn to do this procedure on their own and can stop their own thoughts and substitute more useful ones.
The use of positive self-statements can go along with thought stopping. Statements such as "My opinion is important" or "I am an assertive person" can be practiced over and over. It is normal that these thoughts may not feel quite right at first. The important point is that what clients tell themselves influences their feelings and behavior. The counselor or therapist may use the self-statements as a way to cue assertive behavior by saying, "If it were true that your opinion was important, how might you behave?" The client might be encouraged to try acting as if the statements were true.