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Evaluating Behaviour Therapies
It may be misleading to make global statements about the effectiveness of behaviour therapies, because they include many procedures designed for different purposes. The value of aversion therapy for sexual deviance, for example, has no bearing on the value of systematic desensitisation for phobias (Lambert & Bergin, 1992).
Behaviour therapies can impact significantly on the treatment of various conditions such as obsessive-compulsive disorders, phobias, drug-related problems, sexual dysfunction, schizophrenia, psychosomatic disorders, eating disorders, autism, hyperactivity and mental retardation. Such therapies are effective because they relieve a variety of psychological and behavioural symptoms, and focus on observable behaviours (Agras & Berkowitz, 1999; Emmelkamp, 1994; Papalia & Olds, 1988; Wiser et al., 1996). Behaviour therapies are not suited for the treatment of certain types of problems, for example, problems caused by past psychic conflicts as it deals with the current behaviour only.
Primary limitations for behavioural treatment include: 1) A shortage of trained specialists; 2) cost and variable insurance reimbursement, and 3) the assumption that medications are more efficacious (Smith, Perlis, Park, Smith, Pennington, Giles & Buysse, 2002). In a study of a comparative meta-analysis of pharmacotherapy and behaviour therapy for persistent insomnia conducted by Smith et al. (2002), it was established that behavioural interventions are not particularly efficacious in increasing total sleep time in the short-term.
Behaviour therapy is often criticised as it concentrates more on behaviour itself and less on the presumed underlying cause. Psychodynamic approaches predict that removing a symptom while ignoring the underlying cause will result in either the recurrence of that symptom or the appearance of a substitute symptom. Behaviour therapy concentrates on the present whilst clients beginning therapy often expect that they will be asked to delve into their early childhood experiences in minute detail. In fact, psychoanalytic and related approaches do strongly emphasise the importance of uncovering early events assumed to be critical. Psychoanalytic theory holds that a client’s insight into these experiences is of curative value (Masters, Burish, Hollon & Rimm, 1987).
The next therapy to be discussed is a combination of behaviour and cognitive therapy, which was actually used in this study to facilitate behaviour change.
COGNITIVE BEHAVIOUR THERAPY (CBT)
behaviour therapy (Bea & Tesar, 2002; Bush, 2003; Möller & Van Tonder, 1999; Wiser et al., 1996). CBT has become a leading psychotherapy in most parts of the world, partly due to the close link between science and practice characteristic of the movement, and the demonstrated effectiveness of the treatment (Möller & Van Tonder, 1999). Cognitive and behaviour therapies provide very powerful tools for stopping symptoms and getting one’s life on a more satisfying track. In CBT, the therapist takes an active part in solving the client’s difficulties. The therapist does not settle for just nodding wisely while the client carry the whole burden of finding the answers he or she came to therapy for. The client receives a thorough diagnostic workup at the beginning of treatment – to make sure that the client’s needs and problems have been pinpointed as well as possible. This crucial step – which is often, omitted altogether in traditional kinds of therapy – results in an explicit, understandable and flexible treatment plan that accurately reflects the client’s individual needs. CBT has shown in many ways to resemble education, coaching or tutoring. Under the expert guidance, a client will share in setting treatment goals and in deciding which techniques work well for the client personally (Bush, 2003).
CBT provides clear structure and focus to treatment. Unlike therapies that easily drift off into interesting but unproductive side trips, CBT sticks to the point and changes course only when there are sound reasons for doing so. A CBT client will take on valuable “homework” projects to speed progress in therapy. These homework assignments – which are developed as much as possible with the client’s own active participation – extend and multiply the results of the work done in therapy. The client may also receive take-home readings and other materials tailored to the client’s own individual needs to help the person continue to forge ahead between sessions (Bush, 2003).
Most clients coming for therapy need to change something in their lives – whether it’s the way they feel, the way they act or how other people treat them, for example, being discriminated against now that a person is living with HIV/AIDS. CBT focuses on finding out what needs to be changed and what doesn’t – and then works for those targeted changes. Some exploration of people’s life histories is necessary and desirable – if their current problems are closely tied to “unfinished emotional business” from the past, or if they grow out of a repeating pattern of difficulty. Focusing on the past (and on dreams) can at times assist to explain a client’s difficulties. But these activities all too often do little to actually overcome them. Instead, CBT aims at rapid improvement in the person’s feelings and moods, and early changes in any self-defeating behaviour the client may be caught up in. In other words, CBT is more present-centered and forward-looking than traditional therapies (Bush, 2003).
The Use and Limitations of Cognitive Behaviour Therapy
anxiety. CBT has been shown to be better than drugs in avoiding treatment failures and in preventing relapse after the end of treatment. Other symptoms for which CBT has demonstrated its effectiveness include mood swings; problems with establishing or staying in relationships; problems with marriage or other relationships an individual is already in; work, career or school difficulties; insomnia and other sleep problems; insufficient self-esteem; obsessions and compulsions; substance abuse; trouble keeping feelings such as anger, sadness, fear, guilt, shame, eagerness, excitement and so on, within bounds. CBT is usually the preferred treatment for shyness, headaches, panic attacks, phobias, posttraumatic stress, eating disorders and obesity, loneliness and procrastinations (Bush, 2003).
The disadvantages of CBT are that it requires patients to participate actively in their own treatment by monitoring themselves and doing homework. Patients who are unmotivated, suffering from inertia caused by depression or otherwise resistant may not be able to exert the required energy. CBT also requires therapists to be robust in their efforts and energy. Psychodynamic theorists criticise CBT for neglecting underlying psychic conflict and other critics suggest that patients may experience symptom substitution, that is, manifest new symptoms after suppressing old ones (Bea & Tesar, 2002). As a long standing clinical treatment for adult disorders, nevertheless, CBT has come under some recent challenges. For instance, Graham and Parker (2000) suggest that it has high “treatment principle credibility” for both clients and practitioners but that its benefits are not necessarily derived from treatment-specific factors – how then does it hold up for children when, for instance children may not be matured enough to undergo CBT in the same way as adults.
CHAPTER 1 : INTRODUCTION
1.1 ORIENTATION TO THE STUDY
1.2 MOTIVATION FOR THE STUDY
1.3 AIM OF THE STUDY
1.4 THE OUTLINE OF THE STUDY
CHAPTER 2 : REVIEW OF THE LITERATURE ON HIV/AIDS, STIGMA AND DISCRIMINATION
2.1 INTRODUCTION
2.2 HIV TRANSMISSION
2.3 THE IMPACT OF HIV ON THE BODY
2.4 EMOTIONAL EXPERIENCES OF BEING HIV-POSITIVE
2.5 HIV/AIDS STIGMA AND DISCRIMINATION
2.6 INTERVENTIONS TO ADDRESS STIGMA AND DISCRIMINATION
CHAPTER 3 : THEORETICAL PERSPECTIVES ON HOW TO FACILITATE CHANGE THROUGH PSYCHOTHERAPY
3.1 INTRODUCTION
3.2 COGNITIVE THERAPY
3.3 BEHAVIOUR THERAPY
3.4 COGNITIVE BEHAVIOUR THERAPY (CBT
3.5 A GUIDELINE OF THE INTERVENTION MODEL
CHAPTER 4: RESEARCH METHODS
4.1 INTRODUCTION
4.2 QUALITATIVE AND QUANTITATIVE METHODS
4.3 RESEARCH DESIGN
4.4 ACCURACY AND RELIABILITY OF DATA
4.5 THE RESEARCHER’S ROLE
CHAPTER 5: RESULTS
5.1 INTRODUCTION
5.2 PHASE 1: PRESENTATION OF THE RESULTS
5.3 PHASE 2: PRESENTATION OF THE RESULTS
5.4 THE VALUE OF EACH THERAPEUTIC TECHNIQUE USED
CHAPTER 6: DISCUSSION OF THE RESULTS
6.1 INTRODUCTION
6.2 DISCUSSION OF WOMEN’S EXPERIENCES OF HIV AND AIDS-RELATED STIGMA
6.3 DISCUSSION OF THE IMPLEMENTATION AND EVALUATION OF THE INTERVENTION MODEL
6.4 THE QUANTITATIVE RESULTS
6.5 THE COGNITIVE BEHAVIOURAL THERAPY TECHNIQUES THAT DID NOT FUNCTION WELL
6.6 SUGGESTIONS FOR FUTURE IMPLEMENTATION
6.7 LIMITATIONS OF THE STUDY
6.8 CONCLUSION
REFERENCES
