Health ministry of republic of moldova the university of medicine and pharmacy nicolae testemiţanu



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Medical psychology.book (1)

cognitive behavior therapy
 
to 
change clients’ unhealthy behavior by replacing negative or self-defea-
ting thought patterns with more positive ones. As an initial step in many 
types of behavioral therapy, the client monitors his or her own behavior 
carefully, often keeping a written record. The client and therapist esta-
blish a set of specific goals that will result in gradual behavior change. 
The therapist’s role is often similar to that of a coach or teacher who 
gives the client “homework assignments” and provides advice and 
encouragement. Therapists continuously monitor and evaluate the cour-
se of the treatment itself, making any necessary adjustments to increase 
its effectiveness. A number of specific techniques are commonly used in 
behavioral therapy. Human behavior is routinely motivated and rewar-
ded by positive reinforcement. A more specialized version of this pheno-
menon, called 
systematic positive reinforcement,
is used by behavior-
oriented therapists. Rules are established that specify particular beha-
viors that are to be reinforced, and a reward system is set up. With chil-
dren, this sometimes takes the form of tokens that may be accumulated 
and later exchanged for certain privileges. Just as providing reinforce-
ment strengthens behaviors, withholding it weakens them. Eradicating 
undesirable behavior by deliberately withholding reinforcement is anot-
her popular treatment method called 
extinction.
For example, a child 
who habitually shouts to attract attention may be ignored unless he or 
she speaks in a conversational tone. 
Aversive conditioning
 
employs the 
principles of classical conditioning to lessen the appeal of a behavior 
that is difficult to change because it is either very habitual or temporarily 
rewarding. The client is exposed to an unpleasant stimulus while enga-
ged in or thinking about the behavior in question. Eventually the beha-
vior itself becomes associated with unpleasant rather than pleasant fee-
lings. One treatment method used with alcoholics is the administration 
of a nausea-inducing drug together with an alcoholic beverage to produ-
ce an aversion to the taste and smell
 
of alcohol by having it become 
associated with nausea. In counter conditioning, a maladaptive response 
is weakened by the strengthening of a response that is incompatible with 
it. A well-known type of counter conditioning is systematic desensitiza-
tion, which counteracts the anxiety connected with a particular behavior 
or situation by inducing a relaxed response to it instead. This method is 


137 
often used in the treatment of people who are afraid of flying. 
Modeling,
 
another treatment method, is based on the human tendency to learn 
through observation and imitation. A desired behavior is performed by 
another person while the client watches. In some cases, the client prac-
tices the behavior together with a model, who is often the therapist. 

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