Behavior therapy is a combination of the systematic application of principles of learning theory to to the analysis and treatment of behavior. It involves more than principles of learning and conditioning, however, and uses the empirical findings of social and experimental psychology. The emphasis is placed upon the observable and confrontable and not inferred mental states or constructs. The doctors seeks to relate problematic behaviors (symptoms) to other observable physiological and environmental events. This involves behavioral analysis of what is occurring (and has occurred) and means of altering the behavior. 

The early development of behavior therapies occurred in the 1960s and 1970s and at that time, this mode of psychological care was defined as the systematic application of learning theory to the analysis and treatment of behavioral disorders. This is too narrow of a definition and today, behavior therapy draws not only upon principles of learning theory and conditioning but upon empirical findings from experimental and social psychology. The doctor relates that patients and their disorders to to observable events from physiological or environmental factors rather than inferring that they arise as a result of unseen/unrecognized/unconscious conflicts or trauma. Behavioral analysis, noting the events which lead to motor or verbal behaviors, is used to assist the patient in understanding cause-effect relationships and means of disrupting/discontinuing the maladaptive or counterproductive behaviors. Behavior Therapies have a wide range of application in phobic, maladaptive habit, and compulsive behaviors.

In systematic desensitization, the patient can overcome maladaptive anticipatory anxiety that is evoked by situations or objects by approaching the feared situations gradually and in a psychophysiologic state that inhibits the experience of anxiety. A variety of deep muscle relaxation procedures induces a psychophysiological state that counterconditions the anxiety response. A graded list or hierarchy of anxiety-provoking scenes which are associated with the patient fears is prepared. The patient then approaches the deconditioning of anxiety by beginning, in fantasy (mental imagery), with the least anxiety provoking scene and progressing up the hierarchy. The clinical goal is for the patient to be able to vividly imagine the previously most anxiety-evoking scene with equanimity. This capacity translates to real life situations but is most successful when real life situations are also used during the course of resolving each scene in the hierarchy.

Clinical Hypnosis is an attentive, receptive, focal concentration while the individual has a concurrent awareness but a constriction of peripheral events. It is very similar to visual focus and peripheral vision. Those items in the center are sharp, detailed and colorful while those in the periphery are less noticeable. It is very similar to being so absorbed in that which a person is reading that they enter the world of the book and often fail to note things occurring around them. There are psychological, sensory, and motor/behavioral changes during hypnosis. The individual may have the ability to alter perceptions, dissociate from events and have amnesia for part of the hypnotic experience. The patient has the tendency to comply with the doctor, but this suggestibility and willingness has limitations. EEG (electroencephalographic) studies suggest that the brain is experiencing resting arousal and that they are not asleep. Unfortunately, clinical hypnosis as performed by your doctor can become confused with mythology and stage performers who use similar approaches to entertain an audience.

Group psychotherapy is effective and appeals to many patients and doctors. The same number of doctors can treat more patients, and it may be combined with individual psychotherapy. In some countries, the group psychotherapeutic approach has exceeded the individual approach. As the nuclear family and religion has become diverse, and in some instances, fragmented, the psychotherapy group may meet the strong need to belong, affiliate and assist others. Many doctors see a group size of 8 to 10 patients as optimal, but groups may vary in size from 3 to 15. Weekly or twice monthly sessions of 1-2 (1½ most common) hours seems to be the average. Groups of differing ("heterogenous") patient needs may be helpful, but there are some group psychotherapy where all share the same expressed need or disorder. In some instances the group is thought of as a doctor who is expressed through other group members: as each group member grows stronger, he/she provides assistance in interpretation, insight and decision making to other group members.

Clinical biofeedback instrumentation provides information (data) to a patient about normally involuntary physical processes that are below threshold (outside of awareness). The patient, with these data, can adjust behavioral, cognitive (mental) and affective (emotional) processes and learn to control these physical processes. The term was first employed during WWII and the term behavioral medicine was first utilized in 1973 to describe integration of behavioral and biomedical sciences for the diagnosis, treatment, rehabilitation and prevention of illness as well as promotion of health. Not only can biobehavioral methods be effective in the management of specific symptoms and rehabilitation, but these approaches are often useful for patients who are resistant to other forms of treatment.

Psychopharmacotherapies are based upon the realization that the brain is not chemically responding in a functional fashion. This has to do with chemicals within the brain and central nervous system called neurotransmitters which must not only exist but exist in balance for thought, emotion and behavior to have regulation. Vigorous research on these chemical agents have existed since the mid 1950s. As a result of this research, we better understand how the brain's function is regulated and how best to assist those who suffer from dysregulation of these neurotransmitters. Acetylcholine and norepinephrine were among the first investigated followed by dopamine (dihydoxyphenylethylamine) and indoleamine serotonin. Quantitatively, these are only minor transmitters in the brian but they serve major roles in emotional behavior. The anticonvulsants, neuroleptics, antidepressants and anxiolytic agents are ever being refined. They are not addictive agents although some patients become dependent upon the anti-anxiety (anxiolytic agents) when they are not prescribed in an appropriate schedule. Non-medical abuse of the anti-anxiety drugs is actually uncommon. These anxiolytic agents were excessively prescribed in the past, and some clinicians became hesitant to prescribe them. Appropriately used, the drugs are both safe and beneficial.

Marital and Sexual Psychotherapies deal with not only environmental, situational and phase of life problems which confront relationships but deal with concurrent problems in communication and conflict. Problems that occur within a relationship often emerge from interactional problems, the nature of feedback which couples provide each other, the difficulties in maintaining functional balance within the relationship, and the struggles for power and control which emerge. While interactional problems within a marital system may result in, and sometimes from, sexual conflicts, these are not the sole causes, nor even necessarily the primary causes. It is quite possible for a couple to have a functional sexual relationship and a dysfunctional emotional relationship. Relationship problems may emerge or worsen as a result of sexual dysfunction. By the time the couple consults a doctors, it is questionable as to whether sole resolution of the sexual problem, via medication for example, will make the marriage again functional unless other intervention (e.g. marital psychotherapy) is concurrently provided.  

Short-term dynamic psychotherapies (STDP) work well for nonresistant patients whose resolution of problems do not become steeped in long term transferential problems relating to the doctor and for whom problems are significant but not overwhelmingly complex. Such patients often have some beginning insight or awareness of potential causes of their problems. Treatment begins with a comprehensive diagnostic examination which determines whether the problems/disorder can be appropriately treated by a particular psychotherapeutic technique. The doctor also determines whether the patient has the strength to confront the underlying causes for their problems and that there is the potential for positive response to short term intervention. As in psychoanalysis or psychoanalytic psychotherapies, STDP does involve examination of of the means by which unconscious needs and drives influence a patient's behavior and functional capacity.

Client-centered psychotherapy arose during the period of 1938-1950 and broadened the scope of patients treated by this approach in the 60s and 70s. The characteristics that distinguished this form of patient care included the belief that specific characteristics of the doctor were necessary and sufficient for effective treatment; rejection of the medical/disease model and focus upon the growth model of patient change; the immediate (rather than emotionally distant) accessibility of the doctor; focus upon the experiences of the patient; focus upon the patient's ability to live within the moment; concern for personality change rather than personality structure; and belief that the process applies to all patients rather than a select group; application of all knowledge of the impact of psychotherapy upon the interpersonal process. Many patients reported significant gains after only brief treatment exposure in contrast to the greater time period perceived required by other modes of treatment.

Cognitive Behavioral Psychotherapy is based upon a theory of psychopathology, set of psychotherapeutic principles,  and knowledge based upon empirical investigation. It is based upon information-processing theory and social psychology. Aside from being effective with a wide range of disorders, it appears to enhance the impact of medications used to treat such disorders and has appeal in that it is active, structured and time-limited. Pain, phobias, and mood disorders as well as psychophysiologic (psychosomatic) disorders have been treated successfully with this treatment approach. Errors in our thinking leading to self-defeating assumptions, incorrect interpretation of information, and lack of adequate problem solving planning are believed to be at the heart of our problems. Treatment assist the patient in identifying, testing the reality of, and correcting dysfunctional beliefs underlying our thinking and to assist the patient in modifying the thoughts and behaviors which emerge.

Drug Therapies:

·         The benzodiazepines, and their derivatives, are use mainly in the treatment of anxiety, insomnia and panic disorder. They are also used for acute stress (an emotional upheaval) and often pre-surgically. They are safe and effective, and their likelihood of causing dependence is based upon dosage and length of time for treatment. Those with past histories of other drug or alcohol dependence may be more vulnerable to dependence upon the benzodiazepines. Some studies indicate that patients have taken the benzodiazepines for months or years, usually maintaining or actually reducing intake.

When dependence occurs it is due to the action of the drug at nerve receptors alongside receptors for the inhibitory neurotransmitter called gamma-aminobutyric acid (GABA). With repeated use, the benzodiazepines receptors can adapt to the drug's presence, and the sensitivity of the receptors change. Then if the drug is abruptly withdrawn, the patient can become anxious, agitated or have difficulty sleeping. This is uncomfortable but not life threatening. There are, however, rare instances of withdrawal seizures, depression or psychotic states.

There is no proof, but some clinicians believe that potent benzodiazepines with short half lives (Xanax or Ativan) create faster dependence (in comparison to Valium, Librium or Serax which have longer half-lives in the system).

Patients hear these tales, become fearful of what the patient calls "addiction" and those prescribing often become equally concerned about long term use. Interestingly, abuse of these drugs is uncommon, most are prescribed for short term treatment, but, as noted, there are data to indicate that even long term monitored use can be entirely safe. It is always best to discuss these fears, beliefs and concerns with who is prescribing the benzodiazapine.