Behavioral therapy focuses entirely on the patient’s present behavior and attitudes to bring about change. Instead of searching for the roots of psychological issues in childhood, patients are primarily taught techniques to better cope with current stresses.
American psychologist John B. Watson developed classical behavioral therapy (BT) at the beginning of the 20th century. Unlike traditional psychoanalysis, which places heavy emphasis on the patient’s life history and development, behavioral therapy works in the here and now to help patients learn new behaviors and attitudes that make their lives easier.
How does behavioral therapy work?
In BT, the psychotherapist uses various techniques, such as anxiety management strategies, role-playing, behavioral exercises, mental training, or relaxation methods. Exposure therapy is often employed in treating anxiety disorders and phobias. During exposure therapy, the patient is gradually and systematically exposed to the anxiety-provoking stimuli or situations in a controlled manner. The goal is for the patient to learn to reduce their anxiety responses and perceive these stimuli as less threatening.
Types of Exposure or Confrontation Therapy
Exposure therapy, also known as confrontation therapy, can be conducted in different ways:
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In-vivo exposure: The patient directly confronts the anxiety-provoking situation, such as entering a frightening place.
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Imaginal exposure: The patient visualizes the anxiety-provoking situation in their mind.
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Graduated exposure: The patient is exposed to anxiety-provoking stimuli gradually and in small steps, starting with less anxiety-inducing situations and gradually progressing.
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Flooding: The patient is immediately and intensely exposed to the anxiety-provoking situation to quickly reduce the anxiety response.
Behavioral therapy: duration and timing of treatment
Although exposure therapy has proven effective, it is far from pleasant. Moreover, patients often learn to better endure their fears, while true freedom from anxiety is rarely achieved. Newer methods, such as the Bernhardt Method, typically succeed in helping patients become anxiety-free within just a few weeks—without confronting anxiety-provoking situations.
Behavioral Therapy: Duration and Timeline of Treatment
The frequency of sessions in behavioral therapy (BT) can vary and depends on several factors, including the severity of symptoms, the type of disorder being treated, and the patient’s individual needs. Generally, the following guidelines can apply:
Acute Phase: At the start of therapy, especially during the acute phase or when symptoms are severe, sessions are typically held once a week. This helps establish a stable therapeutic relationship and ensures steady progress.
Progress Phase: As the patient begins to make progress and symptoms decrease, sessions may take place every two weeks. This allows the patient to apply what they’ve learned in everyday life while still receiving regular support from the therapist.
Maintenance Phase: In the maintenance phase, or toward the end of therapy, sessions can be reduced to once a month. This phase focuses on consolidating progress made and preventing relapse.
Follow-up: After the regular course of therapy, follow-up, or refresher sessions may be scheduled to support long-term therapeutic success and detect any early signs of relapse.
The exact frequency and duration of therapy are agreed upon individually between the patient and the therapist. Generally, between 10 and 40 sessions are recommended, depending on the severity of the condition.
Treating Anxiety Disorders with BT: What is the Relapse Rate?
Relapse rates depend on several factors, including the type of anxiety disorder, the duration, and intensity of therapy, individual differences among patients, and follow-up care. Here are some general findings:
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Generalized Anxiety Disorder (GAD): Studies show that about 30-40% of patients experience a relapse within a year after successful treatment with BT.
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Panic Disorder: Relapse rates for panic disorder after BT are around 20-30%. Patients who have learned to manage their panic attacks and apply exposure techniques mainly have lower relapse rates.
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Social Anxiety Disorder: Relapse rates vary between 20 and 40%, with long-term success often achieved through the continued application of techniques learned in therapy.
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Specific Phobias: Relapse rates for specific phobias are relatively low, often less than 20%, as exposure therapy tends to be more effective here.
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Obsessive-Compulsive Disorder (OCD): OCD is considered a complex anxiety disorder, and studies show that about 30–50% of patients experience a relapse after BT. Until recently, it was believed that combining BT with medication would improve success rates, but newer studies suggest that the opposite may be true.
Troy A.
Tampa, Florida