What are behavioral experiments in therapy?

Therapists can use these techniques in certain cases.

In this article we are going to talk about one of the fundamental components of the well-known Cognitive Restructuring technique: behavioral experiments.

Why do we say that these experiments are fundamental? Very simple: in the context of therapy it is relatively "easy" for the patient to test some beliefs verbally, but the ultimate challenge comes when the therapist proposes to perform an activity outside, on his own, to test behaviorally those distorted or dysfunctional beliefs or thoughts.

Usually, it is at that moment when the reluctance that had not arisen so far in therapy appears. Moving from the abstract to action (from verbal to behavioral) is a challenge for anyone.

What is a behavioral experiment?

Relax, it is not about doing unethical experiments with patients, but they are "exercises" or activities that the patient carries out, voluntarily and consciously, on a daily basis to overcome a problem or a difficult situation.

A behavioral experiment can consist of doing (in cases of social phobia, for example) or not doing something (especially in cases of obsessive compulsive disorder), observing the behavior of others, daring to ask other people about what they think, feel or do (especially interesting in cases of social phobia), obtaining information from other sources such as books....

The aim of these experiments is to test the distorted beliefs/cognitions of the patients, which have to be specific (e.g., "the patient's own beliefs/cognitions").The aim of these experiments is to test the distorted beliefs/cognitions of the patients, which have to be specific (p. e.g., "I will be criticized", "I will draw a blank and not know what to say") rather than too general ("I am worthless", "I am no good").

To ensure the usefulness of behavioral experiments it is very important that the patient does not focus his attention on himself when performing them, but on the task. In addition, it is essential that they stop using their defensive behaviors, as they contribute to the maintenance of the dysfunctional beliefs and thoughts that we want to modify.

Types and examples

There are 2 basic types of experiments:

Active experiments.

These are the most frequent and the ones we have explained. They consist of the patient doing or not doing something.

• Doing somethingLet us imagine a person who is very anxious when speaking in public, and believes that this anxiety is perceived by the listeners. You are asked in therapy to videotape yourself, we ask you to watch the recording after the fact and check what the signs of anxiety are and the degree to which they are appreciated.
• Stopping doing somethingObsessive Compulsive Disorder: a person with Obsessive Compulsive Disorder who believes that if he has a sharp object nearby he will not be able to resist the urge to use it. Then, the experiment would consist of him/her remaining in the consultation room with a kitchen knife on the table and with the tip pointing towards the therapist for a while.

Observational experiments

In these cases the patient is only an observer who is dedicated to collecting data; he/she does not have an active role as in the previous type. They will be useful in cases where the patient is too afraid to carry out an active experiment, or when more information is needed to do an active one. Examples: direct observation (modeling), conducting surveys or information from other sources.

When to use them?

We will prepare together with the patient and we will use the behavioral experiments when we are applying the technique of cognitive restructuring, in parallel. That is to say, when we want to make the person's beliefs more flexible and modify them, behavioral experiments are a good ally.

Some authors recommend introducing behavioral experiments as soon as possible, since it is understood that therapeutic advances go hand in hand with behavioral changes. Psychologists are interested in the achievement by the patient of broad and prolonged changes over time (affective, cognitive and behavioral changes), which almost always require behavioral questioning.

In this sense, the verbal questioning that we perform in the Cognitive Restructuring technique when looking for evidence for and against certain thoughts is very useful to "pave" the ground and make it easier for the patient, but if small "nudges" are not introduced to make the person do or stop doing things, the therapy can be prolonged indefinitely (e.g., always moving in the abstract and verbal, in our "comfort zone"). This entails a high economic cost for the patient, the non-achievement of therapeutic objectives and a possible professional frustration for the psychotherapist.

How to prepare them?

Behavioral experiments are prepared in therapy together with the psychotherapist, who will be an important guide to achieve the expected changes.. They will never be predetermined experiments, but will vary greatly depending on the patient and the problem.

It is convenient that in session a self-record of the experiment is prepared, in which the following should be recorded:

• Date
• Patient's prediction (usually specific anticipated consequences, their severity or intensity, and degree of belief in such prediction). For example: "when I go out to make the oral presentation I will turn red as a tomato, I will sweat a lot, my voice will tremble, I will go blank and panic, I will have to run out of the place and I will have made a fool of myself".
• Alternative perspective and degree of belief in it.
• Experiment (detail what will be done and what the patient will look for -before doing it-, write down what has actually been done, including all defensive behaviors -after having carried it out-).
• Results (consequences that have actually occurred, their severity, and the extent to which the patient's prediction has been fulfilled).
• Conclusion (what he/she has learned in relation to his/her anxious prediction and the alternative, degree of belief in them).
• What to do from now on and what to look out for in similar situations from now on.