The Behaviour Modification Techniques have been one of the central elements on which cognitive-behavioural intervention has traditionally been based. At their birth, the Theories of Learning proposed by Thorndike, Watson, Pavlov or Skinner emphasized the role played by the stimulus that accompanies the learning situation (by association or by contingency).

Later, after the rise of Cognitive Theories, it seems to have been demonstrated that the psychological change in the individual is deeper and more complete when the modification of deep cognitions and beliefs is also worked on , and not only the most behavioural part.

According to this, let’s see two of the techniques that try to illustrate what this change consists of and how it is carried out at a more internal and mental level: the Training in Self-Instruction and the Inoculation of Stress .

Self-Instruction (EA) Training

Self-Instruction Training highlights the role of the person’s own internal verbalizations about their future performance in carrying out a certain behavior.

An internal verbalization (or self verbalization) could be defined as a set of commands or instructions that the person gives to himself to guide the handling of his behavior during his performance. Depending on how this instruction is given, the person will feel more or less able to perform the behaviour effectively.

This technique can be applied as a therapeutic element in itself or can also be considered as a component within the Stress Inoculation therapy , as will be explained later.

Components of Self-Instruction Training

The EA is composed of several elements: modelling, behavioural testing and cognitive restructuring . Let’s detail what each of them consists of:

1. Modeling (M)

Modeling is a behavioral technique that is based on the idea that all behavior can be learned by observation and imitation (Social Learning). It is used in order to acquire or strengthen new, more adaptive response patterns, to weaken those that are inappropriate or to facilitate those that the person already possesses but does not put into practice for various reasons (performance anxiety, for example).

To carry out the procedure it is necessary that a model performs the successful behavior in the presence of the person and that the person practices it in a way that gradually increases his autonomy as the help received by the model decreases. In addition, the model informs the person about the adequacy of the execution of the behavior and indicates possible aspects to improve.

2. Behavior Test (CB)

This technique is similar to the previous one, since it also serves to learn new behavioral skills, especially social or interpersonal ones. It consists of staging a potentially anxious behavioural repertoire in the context of the professional’s consultation, so that the subject may feel more secure as the reproductions are artificial and easily manipulated.

Therefore, the EC allows the decrease of the level of anxiety of the subject before the execution and a greater predisposition to “train” its conduct without fear of suffering the consequences that would have if the situation was in the real context. At first, the representations proposed are very much guided by the professional and gradually become more flexible and natural.

3. Cognitive Restructuring (CR)

It is based on the idea that psychological problems are caused and maintained by the way a person interprets their environment and circumstances. That is, that an event by itself has no positive or negative emotional value , but that the evaluation that is made of this event is the one that provokes one type of emotion or another. If the event is conceptually interpreted as something positive, the emotional state derived will also be pleasant. On the other hand, if a negative cognitive evaluation is made, a state of emotional discomfort will be derived.

The idea of negative interpretation of the event is usually followed immediately by a series of thoughts that are known as irrational beliefs , since they are expressed in an absolutist and dogmatic way (all or nothing) and do not take into account other possible alternative explanations. How, for example, to overemphasize the negative, to exaggerate the unbearable or to condemn people or the world if they do not provide the person with what he or she believes he or she deserves.

Cognitive Restructuring is the main element of Albert Ellis’ Rational Emotional Behavioral Therapy, which aims to modify this inadequate belief system and provide the individual with a new, more adaptive and realistic philosophy of life.

The central practice of CR lies in the performance of an exercise (mental or written) in which the initial irrational cognitions derived from the situation that has occurred, the emotions that these have generated and, finally, a set of reflections of an objective and rational nature that question the negative thoughts mentioned, must be included. This record is known as the ABC Model.

Procedure

The procedure of the AD begins with self-observation and the recording of the verbalizations that the person makes about him/herself with the aim of eliminating those that are inappropriate or irrelevant and that are interfering with the successful execution of the behaviour (For example: everything goes wrong for me, I am to blame for everything that has happened, etc.). Later on, the establishment and new more correct self-talk is carried out (For example: making a mistake is sometimes normal, I will succeed, I am calm, I feel capable, etc.).

More specifically, the AE consists of five phases:

  1. Modeling: the person observes how the model faces the negative situation and learns how he or she can carry it out.
  2. External guidance out loud: the person faces the negative situation by following the therapist’s instructions.
  3. Self-directed out loud: the person faces the negative situation while directing himself out loud.
  4. Voice self-instructions: the person faces the aversive situation while self-directing, but this time in a very low voice.
  5. Covert self-instruction: the person faces the negative situation by guiding his behavior through internal verbalizations.

Stress Inoculation (SI) Techniques

The Stress Inoculation Techniques have the objective of facilitating the subject to acquire certain abilities that allow him/her both to diminish or to annul the tension and physiological activation as well as to eliminate the previous cognitions (of pessimistic and negative character, frequently) by more optimistic assertions that facilitate an adaptive confrontation of the stressful situation that the subject must carry out.

One of the theories on which this technique is based is the Lazarus and Folkman Stress Coping Model. This procedure has proven its effectiveness especially in Generalized Anxiety Disorders.

Procedure

The development of Stress Inoculation is divided into three phases: an educational phase, a training phase and an application phase . This intervention acts both in the cognitive area and in the area of self-control and behavioural adaptation to the environment.

1. Educational phase

In the educational phase information is provided to the patient about the way in which anxiety-inducing emotions are generated , emphasizing the role of cognitions.

Subsequently, an operational definition of the person’s specific problem is made, using different data collection instruments such as an interview, a questionnaire or direct observation.

Finally, a series of strategies are implemented to encourage and facilitate the subject’s adherence to the treatment . For example, establishing an adequate therapeutic alliance based on the transmission of trust.

2. Training phase

In the training phase, the person is shown a series of procedures in order to integrate skills related to four major blocks: cognitive, emotional activation control, behavioral and palliative coping. To work on each of these blocks, the following techniques are put into practice:

  • H cognitive skills : in this block we work on cognitive restructuring strategies, problem-solving techniques and practice of self-instructional exercises accompanied by subsequent positive reinforcement.
  • C ontrol activation : this is about training in relaxation techniques centred on the sensation of muscle tension-distention.
  • Behavioural skills : here we deal with techniques such as behavioural exposure, modelling and behavioural testing.
  • Coping skills : finally, this block is composed of resources to enhance attention control, the change of expectation, the adequate expression of affection and emotions, as well as the correct management of perceived social support.

3. Application phase

In the application phase , the aim is for the person to be exposed to anxious situations (real and/or imagined) in a gradual way , putting into practice everything learned in the training phase. In addition, the effectiveness of the application of the techniques is checked and assessed and any doubts or difficulties are resolved during their execution. The procedures used are the following:

  • Imaginary test : the individual makes a visualization as vivid as possible of the confrontation to the anxious situation.
  • Behavioral rehearsal : the individual stages the situation in a safe environment.
  • Graduated in vivo exposure : the individual is in the real situation naturally.

Finally, to finish complementing the intervention in Stress Inoculation some more sessions are programmed in order to achieve a maintenance of the obtained achievements and to prevent possible relapses. In this last component, aspects such as the conceptual differentiation between fall -point – and relapse -more maintained in time- or the programming of follow-up sessions where an indirect contact with the therapist is continued, mainly) are worked on.

By way of conclusion

Throughout the text, it has been possible to observe how, as initially proposed, psychological intervention that addresses different components (cognitions and behaviors, in this case) can be increased in its effectiveness to achieve the psychological change proposed by a person. Thus, as shown by the principles sustained by the Psychology of Language, the messages that a person performs on himself tend to configure his perception of reality and therefore, his capacity for reasoning.

Therefore, an intervention focused also on this component will allow a greater probability in the maintenance of the psychological change obtained in the individual himself.

Bibliographic references:

  • Labrador, F. J. (2008). Behavior modification techniques. Madrid: Pirámide.
  • Marín, J. (2001) Psicología Social de la Salud. Madrid: Síntesis Psicología.
  • Olivares, J. Y Mendez, F. X. (2008). Behavior modification techniques. Madrid: Biblioteca nueva.