Psychology intervention therapies and techniques

Although we have already made a main review of the history of the Psychotherapy and main psychological currents, Behavioral therapy and modification is fundamentally linked to behavioral assumptions, and its academic research and subsequent application to the population is the one that has generated a greater number of techniques for the treatment of disorders, although it is true that other currents perhaps without so much Variability of techniques introduce equally effective therapies and treatments (mainly cognitive and systemic orientations).

1. The first attempts: Paulov and experimental neuroses
2. Yale's group
3. Breathing control techniques
4. Exposure techniques
5. Systematic desensitization technique
6. Aversive techniques
7. Biofeedback techniques
8. Implosion and flood techniques

The first attempts: Paulov and experimental neuroses

Paulov's theoretical explanations about the underlying mechanisms to experimental neuroses represent one of the first attempts to understand psychopathology in terms of psychophysiological vulnerability (Vila and Fernández, 2004).

For Paulov, the key to behavior was in the creation of neuronal connections of an excitatory or inhibitory nature between stimuli and physical responses (first signal system) or symbolic (second signal system). Abnormal behavior arose when there was a conflict between processes excitatory physiological and inhibitory. This conflict could have its origin in concrete learning experiences, both of the aversive and appetitive type. But experiences were not enough for themselves to explain the disorder. Extreme temperaments, according to Paulov, were vulnerable to manifest neurotic behaviors if individuals suffered conflicting or traumatic experiences (Vila and Fernández, 2004).

Part of this research has been reflected in various subsequent studies on different studies Psychopathological observed in the context of learning with animals (learned helplessness, psychosomatic ulcers, superstitious behavior); And it was retaken by Yale's group, constituting the most immediate antecedent of behavior therapy.

Yale's group

Yale's group It was constituted by a set of experimental psychologists, clinical psychologists, psychiatrists, sociologists and anthropologists who worked at the Institute of Human Relations of Yale University under the scientific leadership of Clark Hull. Among the most outstanding members of the group, apart from Hull himself, was Hobart Mower. Mower was one of the first to translate Freudian concepts into the language of learning theory in order to facilitate its Empirical verification. The operationalization of concepts such as instinct, anxiety or conflict were key to definitively establishing the basis of experimental research on motivational processes.

In this context, Hull's theoretical approaches (1943) had a decisive importance, in particular their ideas about impulses as fountain Energy of behavior with internal physiological stimuli, which can be innate (biological) or acquired by conditioning (psychological), and that in addition to pushing the behavior, facilitate the learning of those responses that are followed by the reduction of the impulse (the reinforcement source). There are innumerable experimental studies that were carried out on the impulse from this perspective and that ended with the proposal, years later, of two sources of motivational energy, one of an internal character or of the physiological spring-and another of an external nature or of attraction (the incentive). Experimental studies on the anxiety and conflict conducted by Mowrer, Miller and Brown (1939) and the rest of YAL School researchers are indisputable classics that they had and continue to have a decisive influence on current research.

The treatment of experimental neuroses was studied, the work of J and should be mentioned.H. Maserman (1943) by establishing experimental models of neurotic anxiety with cats that would significantly influence Wolpe. The study of hypnosis was initiated in the Paulov laboratory (considering hypnosis an analogue of sleep), and retaken by Hull (who considered the hypnotist an EC).In 1932, Dunlap developed the technique called negative practice, which was originally used for the treatment of enuresis, homosexuality and masturbation.

At the end of the thirties MOWER and MOWER (1938) created the technique of the grid and the bell for the treatment of enuresis from their theoretical analysis (in terms of classical conditioning) of the problem. The forty decade began with the use of drug -induced aversive states in the treatment of alcoholism by Voeggtlin and its associates (Lemere and Voeggtlin, 1940).

On the other hand, Andrew Salter highlighted the importance of assertive behavior for the treatment of any psychological disorder in conditioned reflex therapy (1949). In 1941, Estes and Skinner designed a procedure called conditioned emotional response, better known as conditioned suppression, to measure the state of anxiety through its effect on a behavior.

From these experiments it was concluded that punishment can lead to the elimination of the execution of a behavior but not to their unfortunateness. However, the most important contribution of the YAL group regarding treatments was the theoretical proposal to address therapy from a perspective consistent with experimental models consistent with research in the laboratory on animal psychology (Vila and Fernández, 2004).

Breathing control techniques

Proper control of our breathing is one of the strategies simpler to deal with stress situations and handle increases in physiological activation caused by these. Correct breathing habits are very important because they contribute to organism enough oxygen for our brain.

The current life rhythm favors incomplete breathing that does not use the total capacity of the lungs. The objective of techniques of breathing It is to facilitate voluntary breathing control and automate it so that it can be maintained in stress situations. Breathing exercises series:

• Exercise 1: Abdominal inspiration The objective of this exercise is that the person directs the inspired air to the lower part of the lungs. For which one hand must be placed in the belly and another on top of the stomach. In the exercise you must perceive movement when breathing in your hand located in the belly, but not in the stomach on the stomach. At first it may seem difficult, but it is a technique that is controlled in about 15-20 minutes.
• Exercise 2: Abdominal and ventral inspiration The goal is to learn to direct the inspired air to the lower and middle zone of the lungs. It is equal to the previous exercise, however, once the lower part is filled, the middle zone must also be filled. Movement first in the hand of the abdomen must be noticed and then in the belly.
• Exercise 3: Abdominal, ventral and costal inspiration The objective of this exercise is to achieve a complete inspiration. The person, placed in the position of the previous exercise, must first fill the abdomen with air, then the stomach and finally the chest.
• Exercise 4: Expiration This exercise is a continuation of the 3rd, the same steps must be performed and then, when exhaling, the lips must be closed so that when leaving the air there is a brief snort. The exhalation should be paused and controlled.
• Exercise 5: Inspiration rhythm - Expiration This exercise is similar to the previous one but now the inspiration is done continuously, linking the three steps (abdomen, stomach and chest). Expiration is similar to the previous exercise, but you must try to make it more and more silent.
• EXERCISE 6: Overgenerization This is the crucial step. Here you must use these exercises in everyday situations (sitting, standing, walking, working, etc.). You have to practice in different situations: with noise, with great light, in the dark, with many people around, color, etc.

Exposure techniques

Live exhibition of phobic stimuli Without escape behavior until anxiety remites. The key to the treatment is to prevent avoiding or escape from becoming a "security signal" explanatory mechanisms of the reduction of fear during exposure: habituation, from a psychophysiological perspective

Change of expectations, from a cognitive perspective, from a behavioral perspective

Exhibition paradigm:

• Classical conditioning theory (CC) that partially explains the extinction of the phobias but does not explain its acquisition.
• Operating Conditioning Theory (Co) that does not explain its acquisition and only explains its extinction particularly

Exposure modalities:

• Live exposure is the method of choice for phobias and relaxation by itself does not have therapeutic effects on phobias disorders
• The exposure in imagination poses the problem that the anxious stimuli in lives arouse fear of the patient despite the habitation to them in the imagination, but it is of interest in cases not that the live exposure is difficult to apply and supposes motivation Additional for patients who do not dare to start treatment with live exposure.

Group Exhibition:

• With individual and group exposure, comparable results are obtained

Imagination exposure is especially indicated when:

• The patient lives only the patient lacks social skills
• The patient maintains a conflicting couple relationship
• Self -exposition is another modality of exposure that is proposed due to the high percentage of dependency presented by phobic patients.

The objectives of the exposure is to reduce the dependence of the patient, shorten the time of professional dedication and facilitate the maintenance of the results.

It is much more powerful than the patient -directed exposure. The success of the Self -exposition It lies in the prominence of the patient and the attribution of success to their own efforts. The main problem of exposure is persistence in its practice. Virtual reality is another exposure technique in which it is intended to generate an interactive and three -dimensional environment in which to submerge the patient.

The main activation field has been the phobia to fly (North and North, 1994), Agarophobia, the phobia and the TEP in ex -combatants. Long exposure sessions are more effective than short, because they facilitate habituation instead of awareness. The effect is enhanced with a short interval between sessions.

The differentiating factors On a sensitizing exposure in front of an accustoming exposure depend on the duration of the exposure, the time interval between trials and perhaps on the change of meaning of the anxious stimulus. The exposure gradient should be as fast as the patient can tolerate it. The potentiation of the exposure can be achieved by: modeling by the therapist, contingent reinforcement to the progress of treatment, biofeedback techniques, breathing training or cognitive or extension techniques of exposure to external stimuli.

Exposure success factors: Show clearly defined avoidative behaviors have a normal mood following therapeutic prescriptions not to submit to exposure under the effect of anxiolytic alcohol that the patient improves after a few weeks of treatment. social, compulsive rituals (live exposure with response prevention is the most effective treatment.

Systematic desensitization technique

With systematic desensitization a person can learn to face objects and to situations that are particularly threatening, exposing themselves in a real or imaginary way to the stimuli that produce an anxious response. It's about learning to relax while imagining scenes that progressively causes greater anxiety. "The repeated presentation of the stimulus makes it progressively lose its ability to evoke anxiety and consequent.

It is essential to be exposed in a real or imaginary to the stimuli that produce anxious emotions and the more times the better. It's about never avoiding, facing but armed with resources that were not previously learned but that can be learned. That is why it is very important to repeat, repeat and repeat. Conducting systematic and progressive approaches (Slowly but without pause, little by little until the anxious element is losing strength) which will be reinforced promptly, so that the answer loses power in this situation.

We can do so by reviewing with the imagination the exposure to stimulus that generates anxiety (for example. how to respond to a situation or thought to which we feel uncontrolla. to ourselves responding controlledly and in a much more positive and adaptive way) later to practice with direct exposure. It is about undoing conditions that cause anxiety and learning others more positive and adaptive. This serves any situation that can cause us anxiety.

The steps are:

• Relax the muscles at will (differential or progressive relaxation).
• Make a list with all fears or anxious situations.
• Build a hierarchy of anxious scenes from least to greater anxiety intensity.
• Advance, through imagination or by confrontation, with the feared situations of the hierarchy. It is important that visualization be practiced so that the situation is lived as very real. It will not go to a new anxious situation until the previous situation of the hierarchy is totally resolved in terms of lived anxiety.

Aversive techniques

The formal development of aversive techniques has developed in parallel to the development of learning theory and behavior therapy.

Main milestones in the development of aversive therapy

• 1920: Watson and Rayner generate a child phobia in a controlled way
• 1927: Paulov and Bechterev announce the conditioning of aversive responses to previously neutral stimuli.
• 1924: Jones controlled a child phobia controlled
• 1930: Kantarovich applies aversive procedures in the treatment of alcohol addiction
• 1938: Skinner presents a theoretical alternative (operant conditioning) to classic conditioning.
• 1944: They propose that aversive techniques suppress the problem responses but do not generate their unfortunateness. 1950: LEMERE AND VOEGTLIN provide data on 4096 cases of alcohol treated with chemical stimuli.
• 1964: Solomon recapitulates his research on learning responses and avoidance to the study of aversive techniques as an alternative or complement to the CC.
• 1966: Azrin and Hold review and evaluate the effectiveness of punishment from the operant perspective
• 1966: caution applies aversion with imaginary stimuli (undercover punishment)

Some clinical and ethical reasons that justify their use:

• When maladaptive behavior is so serious that it could cause harm to others and itself
• When maladaptive behavior is extreme and durable and has not responded to other programs
• When some patient does not have any type of attention to develop positive behaviors that give access to later reinforcers, given the extreme severity of their actions.
• When preventive, custodial programs or absolute recruitment are developed to avoid the appearance of maladaptive behavior.

Models that explain the development of aversive therapies:

1. Classical conditioning
2. Operant conditioning
3. Feldman and Macculloch avoidance learning
4. Paradigm of punishment
5. Central theories

Attitudinal changes, cognitive dissonance, cognitive essays

Biofeedback techniques

They are defined as any technique that uses instrumentation to provide immediate, precise and direct information to a person, about the activity of their physiological functions.It can be considered as a self -control procedure.

BF training objective: that the person achieves the voluntary control of a physiological response related to a specific problem quickly and adequately and that is able to put into practice this control in the usual conditions in which it is useful.

BF training is a molding case in which the activity to be carried out is the control of a specific physiological response.

Electromyographic BF

Provides information on the activity of the muscular group or muscle on which the electrodes (surface) are placed

To learn to control a specific muscle response by increasing or decreasing muscle tension.

It is indicated for problems and disorders that involve excess muscle tension or a muscle tension deficit (low back pain, headaches, scoliosis, bruxism, cerebral palsy, muscle hypotonies, hemiplegia, fallen foot, etc.)

Electrodermic BF

Provides information on the conductance response of the skin area where the electrodes are placed. Values ​​depend on the level of sympathetic nervous system activation: it allows identifying the general level of activation and training to control it.

It is indicated for disorders associated with a high level of sympathetic activation or those in which the reduction of the activity will have beneficial effects (asthma, insomnia, sexual dysfunctions, headaches, tachycardia), or anxiety and hypertension disorders .

It is also used as a relaxation treatment.

Temperature BF

Informs the peripheral temperature of the body area in which the sensor is located. The skin temperature depends on the blood irrigation of the underlying area, so it has been used as an indirect estimation of peripheral circulation applying to the control of circulatory problems.

Indications: Vasomotor disorders, migraine headaches, impotence, raynaud, dermatitis, asthma.

Electroencephalographic BF

Informs about the electrical activity of the cerebral cortex.It is a questioned method, except in the case of epilepsy

BF of heart rate

Informs the number of heartbeat per unit of time allowing to identify both the frequency and the regularity of the beat.

Indications: Tachycardia control.

BF of blood volume

Informs the amount of blood that passes through a glass or, alternatively, the expansion that this reaches.

The person can learn to reduce or increase blood flow in the area.

Indications: vascular disorders such as headaches, raynaud, hypertension.

BREETING BF

One of the most used. Its results are modest, and it has different subtypes:

a) BF of systolic pressure measured by sphygmomanometer: the subject must train to reduce blood pressure.

b) BF of pulse wave speed: informs the time it takes to travel each blood pulse the space between two pressure sensors placed in the humeral artery the first and in the radial the second.

c) BF of pulse transit time: measures the speed of blood pulse. The first measure is the r wave of the electrocardiogram and the second the pulse pressure in the radial artery.

Electrokinesiological BF

Informs about a certain movement.It is useful in muscle rehabilitation procedures, constituting an alternative or a complement to the BF EMG.Its use has increased to sports and work environment.

Indications: Disorders in which some movement is affected.

Pressure BF

Informs the pressure exerted by a certain area of ​​the body on a gadget prepared for this purpose.

In the field of health it is used as information exerted by the anal sphincter (fecal incontinence) or muscles of the cervix of the vagina. In the sports field: movements improvement.

Pletismograph

Informs change in penis size.

Implosion and flood techniques

These are two procedures for the treatment of anxiety disorders:

• The implosion technique was created by Stampfl (1961) following Mower's ideas, his theoretical bases are psychoanalysis and experimental psychology.The exhibition is made in imagination, without escape response and the contents of the stimuli are dynamic.
• The flooding technique was created by Baum (1968), its theoretical bases are experimental psychology. The exhibition is made live and imagination, and the contents of the stimuli are non -dynamic.

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