Behavioral Interventions 257
When initiating a behavioral change intervention, the therapist begins with didac-
tic instruction aimed at preparing the client for behavioral rehearsal. Goldfried and
Davison (1976) comment that this didactic introduction is necessary for ensuring that
the client recognizes that behavioral change is needed, to accept behavioral rehearsal
as an important step in learning new behaviors, and to overcome any anxiety about
role playing. In addition, the therapist provides specific information that helps clients
learn the difference between their maladaptive behaviors and more effective prosocial
behaviors.
In cognitive therapy a rationale should be given for shifting therapy from a focus
on the cognitive basis of anxiety to this more behavioral orientation. Clients should be
informed that these interventions are not intended as a direct anxiety- reduction strat-
egy, but rather their aim is to improve one’s functioning and confidence in social situa-
tions. Improved social functioning might have an indirect anxiolytic effect by increasing
the frequency of positive responses from others, which in turn would increase a person’s
motivation to expose himself to anxiety- provoking encounters with others.
Modeling plays an important role in teaching anxious clients how to engage in
more effective interpersonal behavior. The therapist demonstrates the skill that is to
be learned and then discusses with the client how to perform the behavior in question.
Even though didactic explanations of new behaviors are important, nothing can sub-
stitute for actually showing a client how to respond. For example, a person with social
anxiety had a tendency to talk too quickly when conversing at work. Even though it
ensured quicker escape from an anxious social interaction, it interfered in the quality of
her communication and actually intensified her subjective anxiety. This acceleration of
her speech actually occurred in the therapy session. The therapist was able to interrupt
the conversation, point out that her speech was accelerating, and then demonstrate a
more appropriate rate of speech. This modeling led naturally into the next phase of the
behavioral change intervention.
Behavioral rehearsal is really the core therapeutic ingredient of direct behavioral
change interventions. Within- session role plays are conducted in which the client prac-
tices executing the new behavior in a variety of possible situations. The therapist might
begin by modeling in the role play the target behavior such as initiating a conversation
with a stranger, making a request, maintaining eye contact, refusing an unreasonable
request, or the like. The client is then asked to practice the behavior within the role
play. Throughout the role play the therapist provides coaching in the form of correc-
tive feedback as well as reinforcement and encouragement for attempts to perform the
target behavior. Since many individuals are uncomfortable with acting and may find
these behavioral practice sessions tedious, it is important to keep the atmosphere light
or informal and use humor to put individuals at ease. In the treatment of social phobia
videotaped in- session role plays with therapist and client or with additional “actors” can
be used to enhance behavioral rehearsal (e.g., Antony & Swinson, 2000a; D. M. Clark,
2001). In such cases the therapist provides feedback and correction while reviewing the
tape with the client.
Beck at al. (1985, 2005) also notes that important dysfunctional thoughts and
beliefs may become apparent in the course of behavioral rehearsal. Once identified these
automatic thoughts and beliefs would be addressed with cognitive restructuring strate-
gies. For example, during behavioral rehearsal that targeted eye contact with a person
suffering from chronic social phobia, the therapist noticed that the client had great