Behavior Therapy Methods: 12 Best Techniques & Worksheets

Behavior therapy originates from attempts by science and psychology to understand, predict, and control human behavior (Sommers-Flanagan & Sommers-Flanagan, 2015).

Attention is focused on observable behavior, unlike the subjective focus of psychoanalysis on “inner dynamics or mental concepts” (Sommers-Flanagan & Sommers-Flanagan, 2015, p. 225).

It has proven highly successful. Behavior therapy has helped treat diverse client populations across a range of psychological disorders and continues to evolve into a new range of treatments (Corey, 2013).

This article explores several of the best behavior therapy methods and introduces valuable techniques, worksheets, and exercises for work in-session or at home.

Before you continue, we thought you might like to download our three Positive CBT Exercises for free. These science-based exercises will provide you with detailed insight into positive Cognitive-Behavioral Therapy (CBT) and give you the tools to apply it in your therapy or coaching.

Best Behavior Therapy Methods

Traditionally, “behaviorists strictly focus on observable behavior or materialistic concepts,” using scientifically derived therapeutic techniques (Corey, 2013, p. 225). Based on the view that all behavior is learned, the behavioral approach to human change has passed through three historical stages (Corey, 2013):

1. Behaviorism as a scientific endeavor
2. Behavior therapy
3. Cognitive-Behavioral Therapy

Having evolved over time, the third wave of the behavioral approach to therapy now includes Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), mindfulness-based stress reduction (MBSR), and Mindfulness-Based Cognitive Therapy (MBCT; Corey, 2013).

These newer behavioral therapy methods center on five overlapping core themes (modified from Corey, 2013, p. 269):

• A more far-reaching, expanded view of psychological wellness
• A broader view of acceptable outcomes from treatment
• The role and importance of acceptance
• The value and benefits of mindfulness
• The importance of creating a life worth living

Mindfulness encourages nonjudgmental engagement and awareness during an activity. Clients develop an attitude of curiosity, intentionally focusing on the present experience.

Closely aligned with mindfulness, “acceptance is a process involving receiving one’s present experience without judgment or preference, but with curiosity and kindness” (Corey, 2013, p. 269).

Below is a brief description of five of the best (more recent) behavior therapy methods (Corey, 2013; Sommers-Flanagan & Sommers-Flanagan, 2015).

Acceptance and Commitment Therapy (ACT)

In contrast to many Cognitive-Behavioral Therapy approaches, ACT involves fully accepting the present while mindfully letting go of obstacles that stand in our way.

Rather than attempting to challenge and change thinking, clients are helped to become more aware and change how they relate to their thoughts. The client is then encouraged to commit to act in a way that promotes meaningful and valued living (Forsyth & Eifert, 2016; Corey, 2013).

Dialectical Behavior Therapy (DBT)

DBT blends behavioral and psychoanalytic techniques to treat borderline personality disorders. Acceptance and change-oriented strategies help clients transform their behavior and environment while adopting a state of acceptance.

Critically, the client learns the dialectical relationships between ongoing and opposing forces in their lives and how to regulate their emotions and behaviors (Corey, 2013).

Mindfulness-based stress reduction (MBSR)

MBSR recognizes that much of our stress comes from our ongoing wish that things are different from how they are, whatever our environment or situation.

While initially used with groups, it has since been practiced with various specific diagnoses and conditions in individuals, including people with cancer, eating disorders, and in medical, educational, and prison settings (Crane, 2009).

The approach helps people live in the present rather than maintain an ongoing focus on the past or future. Mindfulness is brought into multiple aspects of the client’s life to relate to both internal and external stressors in a more positive way (Corey, 2013).

Mindfulness-Based Cognitive Therapy (MBCT)

Mindfulness is a powerful tool for managing depression (Brown-Iannuzzi et al., 2014), especially when teamed with CBT. CBT offers a valuable framework that informs teaching.

MBCT integrates MBSR to inform its content, structure, and teaching style with CBT interventions in an eight-session program “to change clients’ awareness of and relation to their negative thoughts” (Corey, 2013, p. 272; Crane, 2009).

6 Valuable Techniques for Your Sessions

Modern behavior therapy requires a strong therapeutic alliance throughout treatment.

The therapist works with the client to formulate specific, clear, and measurable goals and subgoals alongside associated behaviors (Corey, 2013).

Behavioral analysis is a crucial aspect of therapy. The ABC model, in particular, includes identifying and gathering (Corey, 2013):

A – situational antecedents (what elicits the behavior)
B – dimensions of the problem behavior
C – the consequences of the behavior

Helpful techniques used across the various behavior therapy methods are wide and varied, offering powerful tools to encourage and evoke client change (Sommers-Flanagan & Sommers-Flanagan, 2015; Corey, 2013).

Self-monitoring

Being unable to observe the client’s behavior outside the session, therapists must rely on their self-reporting. Clients are trained to keep track of how they behave, such as when they get angry or how many cigarettes they smoke. Emotion and thought logs are used to record (Sommers-Flanagan & Sommers-Flanagan, 2015):

• Disturbing or upsetting emotional states
• The exact nature of the behavior at the time
• Thoughts that emerged alongside the emotions

Self-monitoring benefits from a lack of expensive equipment yet risks being inaccurate or incomplete.

Behavioral interviews

Within sessions, therapists may use behavioral interviews to (Sommers-Flanagan & Sommers-Flanagan, 2015):

• Observe client behavior
• Ask about antecedents
• Question problem behavior
• Agree on and define treatment targets and goals

The behavioral interview inquires beyond client statements such as, “I’m depressed,” digging into specific behavioral needs. For example, the therapist may ask, “What happens during the day when you are feeling depressed?” (Sommers-Flanagan & Sommers-Flanagan, 2015, p. 235).

Operant conditioning

In the tradition of Skinner, behaviorists attempt to modify behavior by manipulating the environment, rather than the mind or cognition (Sommers-Flanagan & Sommers-Flanagan, 2015).

The therapist usually begins by operationalizing target behaviors or objectives (for example, decreasing profanity, overeating, or smoking). Once the environment has been modified, it is necessary to perform ongoing monitoring to test the behavior.

Systematic desensitization

Based on classical conditioning, clients imagine increased “anxiety-arousing situations at the same time that they engage in a behavior that competes with anxiety” (Corey, 2013, p. 258). While time-consuming, systematic desensitization can successfully reduce maladaptive anxiety, anxiety-related disorders, and phobias, but also requires self-monitoring.

Progressive muscle relaxation (PMR)

PMR teaches people how to deal with stress through mental and muscle relaxation skills. The client lets go by contracting muscles (and feeling the intense pressure building up) then releasing them while performing deep and regular breathing. Once learned, the client must practice the skills to achieve maximum benefits (Corey, 2013).

Interoceptive exposure

Interoceptive exposure teaches clients to handle the physical aspects of intense anxiety and panic. The client focuses on internal physical cues using interoceptive exposure tasks, such as (Sommers-Flanagan & Sommers-Flanagan, 2015):

• Hyperventilating
• Holding their breath
• Shaking their head
• Spinning in circles
• Breathing in the chest
• Breathing through a straw

With practice, clients become desensitized to physical triggers associated with anxiety and panic attacks.

6 Worksheets to Download Today

The following worksheets are taken from various theoretical standpoints under the term ‘behavior therapy,’ including its more recent variations.

While they differ considerably, each worksheet helps change behavior; achieve a better understanding of thoughts, emotions, or behaviors; or helps implement coping skills.

Challenging Emotional Myths

Emotional myths may impede helpful thinking and cause us to hold irrational beliefs.

Use the Challenging Emotional Myths worksheet to challenge your client’s thinking about feelings by considering a set of statements, including:

There is only one way to feel in any given situation.
Letting others know how I feel will show my weaknesses.
Painful emotions are just the result of having the wrong attitude.
Painful emotions are not helpful and should be ignored.
Extreme emotions get you much further in life than trying to regulate them.

Once completed, talk through each challenged statement and explore how all emotions can be valuable, helping us in different ways and times.

Checking Emotional Facts

Sometimes our emotions don’t represent what is really happening, but are influenced by other thoughts, assumptions, and beliefs.

Use the Checking Emotional Facts worksheet with clients to better understand their emotions and what else could be impacting them.

Clients are asked a series of questions, including:

What emotion would you like to change? (perhaps it is causing you problems elsewhere in your life, for example, envy, anger, or jealousy)
What event triggered/prompted the emotion?
Are you assuming a threat?
Is there really a threat?
If the threat comes true, what will really happen?
Do your feelings (angry, sad, reluctant, suspicious, etc.) really fit the situation?

Once completed, talk through the client’s answers without judgment. Work with them to see that some emotions could be causing them unnecessary pain and may not be appropriate to the situation.

STOP – Distress Tolerance

Sometimes it is not possible to make things better right away; it is helpful to develop skills to handle strong emotions and tolerate painful events.

Use the STOP – Distress Tolerance worksheet to learn how to use the STOP acronym to handle difficult situations:

• Stop
  Stop! Don’t just react; freeze. You may be about to act without thinking.
• Take a step back
  Take a deep breath and step back from the situation. Don’t let how you feel make you act impulsively.
• Observe
  Become aware of how you feel and your environment. What is the situation? What are you thinking? What are you feeling? What are others saying and doing?
• Proceed mindfully
  Move forward and act mindfully. Consider what actions will make things better or worse.

Remembering to STOP can be a valuable way to avoid an emotional response that worsens the situation and subsequent feelings of regret.

Resisting rather than acting on crisis urges

At times, we react poorly to unexpected or emotionally upsetting situations.

Use the Resisting Acting on Crisis Urges worksheet with clients to help them compare the pros and cons of acting on impulsive urges or resisting them.

Ask the client to think of a real situation that could have been handled better or an imagined one in the future.

Describe the pros and cons of acting on urges (those immediate, reactive, and often strong emotions).
Describe the pros and cons of resisting urges.

Read through the pros and cons and consider how resisting urges could help them maintain control, reacting more in line with their values in future.

Value and Goals

Goal setting is a helpful way of living in line with values and overcoming obstacles along the journey.

Use the Value and Goals worksheet to help clients set a goal in line with their values and identify obstacles that might get in the way.

What important value does this goal work toward?
What goals do I want to achieve?
What are the obstacles and which strategies could help?

Getting to Know Yourself

We often spend more time on what is wrong with us than what is right. This can mean we lose track of important aspects of ourselves and our lives (Forsyth & Eifert, 2016).

Use the Getting to Know Yourself worksheet with your clients to help them remind themselves of who they are.

Fun Games and Exercises for Your Clients

Games and exercises can be a fun way to learn valuable cognitive behavior principles.

Dropping the anchor

This mindfulness exercise helps center clients and connect with the world around them.

Ask them to carry out the following steps:

1. Close your eyes and take a few slow, deep breaths.
2. Place your feet flat on the floor.
3. Push down and notice the floor supporting your feet.
4. Notice the tension in the muscles in your legs.
5. Feel the weight of gravity flowing through your head, down through your body to your feet.
6. Open your eyes and become aware of where you are through your eyes, ears, and bodily sensations.

Morning mindfulness

Ask your client to repeat the following mindfulness activity daily for maximum benefit:

Pick any activity or task from your daily morning routine, for example, taking a shower, brushing your teeth, or making a cup of coffee. Totally focus on what you are doing: the smells, sounds, and movement. As thoughts arise, acknowledge them but bring your attention back to the activity.

Drawing activities

Drawing can be a valuable exercise at any age but is particularly valuable with children.

Ask your client to:

• Think of an important person in your life and draw them performing a typical activity.
• Close your eyes and imagine sending them friendliness. Perhaps they are having a nice breakfast or doing something fun for the day.
• Next, draw a picture either of you sending them kindness and friendliness or the activity they may be doing.

PositivePsychology.com’s Resources

We have many resources available for therapists to help clients modify behaviors or manage unwanted and unhelpful thoughts.

Why not download our free CBT pack and try out the powerful exercises contained within? Some examples include:

• Solution-Focused Guided Imagery
  This exercise emphasizes people’s strengths and how they can be applied to the change process. Clients can rely on them to cope with a problem or obstacle they face.
• Reframing Critical Self-Talk
  Self-criticism is the opposite of self-compassion, taking many forms and often resulting in negative emotions (such as fear, shame, and guilt) that can underpin psychopathology.

Other free resources include:

• Progressive Muscle Relaxation
  This script outlines the basics of PMR and its value for helping clients relax and unwind, while keeping it simple for younger audiences.
• Problem-Solving Self-Monitoring Form
  The answers to a series of questions provide the therapist with details of the client’s overall and specific problem-solving approaches and reactions.
• Reactions to Stress
  This helpful form can be used as homework to capture stressful events and the client’s reactions. By recording feelings, behaviors, and thoughts, repeating patterns can be recognized.

More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit©, but they are described briefly below:

• Acting Opposite to Urges
  Emotions are associated with urges; for example, anger often leads to an urge to strike out, whether verbally or physically. Teaching clients the skill of acting contrary to their urges teaches them to regulate maladaptive habitual reactions and initiate adaptive reactions.
  • Step one – Understand usual responses to emotions.
  • Step two – Consider the opposite response and its potential impact.

Afterward, reflect on how successful the exercise was and how it could be helpful to choose the opposite of the usual response going forward.

• Wise Mind Chair Work
  In DBT, clients learn that there are three states of mind in which we operate: the reasonable mind, the emotional mind, and the wise mind.

The exercise begins by introducing each of the mind states, before performing an exercise that helps the client adopt each one in turn and understand its benefits and costs.

17 Positive CBT Exercises
If you’re looking for more science-based ways to help others through CBT, check out this collection of 17 validated positive CBT tools for practitioners. Use them to help others overcome unhelpful thoughts and feelings and develop more positive behaviors.

A Take-Home Message

Behavior therapy is a powerful tool for treating clients with unhelpful behaviors they wish to stop or replace.

If we assume that all behavior is learned, then we can accept that given the right conditions, we can adopt new skills and strategies and change how we act.

Over time, behavior therapy has adopted the latest psychological techniques based on scientific research, including mindfulness and acceptance. They expand our view of what psychological wellness truly means and what represents a positive outcome from treatment.

Mindfulness and acceptance approaches can change how we see the present, whether difficult or effortless. They help us accept our situation while exploring how to set goals and move toward a more valued and meaningful life.

Why not explore the newer, third-wave behavior therapy approaches – DBT, MBSR, MBCT, and ACT – and consider how you can use them to help your clients achieve their best lives? Each technique and worksheet included in this article is a valuable tool that can help address behavioral concerns that led to clients seeking help.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free.