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The principle theory of the behaviourist approach to psychotherapy is that all
behaviour is learned and that these laws apply to animals as well as human beings.
All individuals respond and behave naturally in accordance with the environment.
Instead of seeking unconscious reasons that motivate people, behaviourists take the
approach of changing the problem and reaction to the external stimulus – i.e. if we
react to something that rouses us in a way that is inappropriate and continues to upset
us or society, then we have learned a faulty behavioural pattern. This now
conditioned  response, automatically produced by the repeated stimulus, can,
according to behaviourists, be re-conditioned to the person‘s benefit.

The philosopher John Locke (1632 – 1704) believed that all infants are born tabula
rasa (blank slate) and said ”If your child shrieks and runs away at the sight of a frog,
let another catch it and lay it down ay a good distance from him; at first accustom
him to look upon it; when he can do that to come nearer to it and see it leap without
emotion; then to touch it lightly, when it it held fast in another‘s hand; and so on,
until he can come to handle it as confidently as a butterfly or sparrow.• (Individual
Therapy, p52, Geraldine O‘Sullivan.)

The father of behaviourism, American John Broadus watson (1878 – 1958), insisted
that psychology should study only objective, observable behaviour, this view rose as
a reaction to introspection – the subjective workings of the mind through self-
reporting  ‘doing rather than viewing’. “Behaviorism claims that consciousness is
neither a definite nor a useable concept. The behaviorist, who has been trained
always as an experimentalist, holds, further, that belief in the existence of
consciousness goes back to the ancient days of superstition and magic.”
(Behaviourism, p11, The Open University). To this present day behaviourism is
practised widely by clinical psychologists and is seen as an effective intervention for
phobias, obsessive compulsive disorders and appetitive problems.

Classical conditioning or respondent conditioning was used by Russian physiologist
and Nobel prizewinner Ivan Pavlov (1849 – 1936). He made discoveries of
conditioned reflexes while investigating the digestive system using dogs. Pavlov
noted that the presentation of food – unconditioned stimulus – was enough to make
the dogs salivate – unconditioned response. He then rang a bell – a conditioned
stimulus – and gave them food. The salivation illicited by the bell was now a
conditioned response. During these ”trials• when ”reinforcement• of the bell and
food occurs it will eventually produce ”a conditioned reflex• where the sound of the
bell alone was sufficient to induce salivation.  However this process is finite and after
a while extinction occurs when the unconditioned stimulus is not re-introduced. The
conditioned stimulus will then then return to neutral stimulus. Spontaneous recovery
may occur but to a far less intensity – ie the bell ringing may alert the dogs to salivate
but if no food was forthcoming salivation would cease. ”Generalisation• may occur
when a similar sound is heard and the same conditioned response occurs, but further
conditioning can result in ”discrimination• from the unwanted stimulus. Pavlov
defined learning as a behaviour change produced by biological conditioning.
Behaviourists believe that human beings do not differ in any important way (other
than in their complexity) from other animals.

Watson was of the opinion that many human problems are the result of inappropriate
patterns of behaviour and if these could be altered the world could be a far better
place. He believed that neurotic disorders were caused by learned behaviour and that
this behaviour could be un-learned. In trying to prove this in 1920 he conditioned a
11 month old boy, named Albert, to be fearful of white rats. Watson, and his
colleague Raynor, hammered on a steel bar whenever Albert was shown a white rat,
thereby scaring him. This process was repeated whenever Albert tried to touch the
rat. Needless to say the very sight of the rat would cause him to cry. Generalisation
occurred when he became fearful of dogs, rabbits fur coats and a Santa Claus mask.

Operant conditioning is where behaviour is largely determined by its consequences.
Edward Lee Thorndike (1874 – 1949) believed that we all learn by trial and error. He
put cats in a box with food on the outside. As the cats tried to escape they would
usually find the correct string to pull to open the door. After each experiment the cat
would take less time to find the way out. Thorndike developed a law of effect saying
that a response followed by satisfaction is more firmly implanted in the mind –
positive re-enforcement – than one followed by disappointment. Similarly if a
particular behaviour is met with punishment negative reinforcement occurs. B F
Skinner (1904 – 1990) used the term operant conditioning to describe how human
beings and animals function trying to control their environment to meet their needs.
Driving a car, for example, is learned by acquiring knowledge in a step by step
manner. This is known as chaining‘ or shaping‘. Skinner used pigeons and rats
placed in a ”Skinner Box.• When they pressed a bar, food – he primary enforcer – was
released from a dish thus establishing their primary behaviour. Skinner did not like
theorising about the internal workings of the organism and called this “spurious
physiologizing.” His approach was known as “Black Box Psychology” which looked
at stimulus and responses.

Joseph Wolpe viewed behaviour as being controlled by the upsetting stimulus and
believed that incorporating relaxation with a gradual exposure to the feared stimulus
would reduce the link between stimulus and anxiety. He called the technique
systematic desensitization.‘

Albert Bandura believed that we learn by experience and observing others’ behaviour
(modelling) and take from it that which will bring us rewards and which is acceptable
to society. Bandura used more of a cognitive approach where thoughts, belief,
irrational ideas and assumptions were important. In experiments nursery children
witnessed an adult assaulting an inflatable ”bobo• doll. The children were more
likely to engage in that behaviour than other children who witnessed a non-
aggressive role model. This may explain why some phobias run in families.

Allied with systematic desensitization a subjective units of discomfort scale
(S.U.D.S.) can be used so that the client is able to systematically state the least
anxiety provoking stimulus on the hierarchal scale and move up one step at a time
through other anxiety provoking stimuli to the most provoking situation. This can be
done on a scale from zero to one hundred. Twenty to thirty would represent a fairly
comfortable level; as relaxation is paired with visualization the client can
successfully master the feared situation. He is then encouraged to face this in vivo.

A phobia is a conditioned response producing anxiety kept alive in behavioural terms
as the law of effect, eg if a child does a task around the house without being asked it
is likely that he will repeat the task again if he is rewarded by his parent – fixed
response. If the parents were to delay rewarding the child it would be less likely that
he would do the chore again, so it is not the size of the reward which is important but
the amount of time which passes between doing something and receiving the reward.
Money and praise are very important. Occasional rewards can be likened to someone
playing a fruit machine; the player does not know when his rewards will come but
there is always just the chance that it will; and when it does come it is fed back into
the machine as the gambler has become conditioned to play. Instant but randomly
dispensed rewards have been the lure – positive reinforcement / variable response.

If an individual is doing a job which makes him unhappy, then anything which stops
him doing it will bring him short term relief, but giving in to it produces negative
reinforcement – i.e the greater the reward the more likely he would avoid the
discomfort, but the worse it will be in the long run. Stimulus, anxiety, avoidance,
reward – S.A.A.R. “The individual who continuously retires in the face of discomfort
will not recognize a relationship between his or her actions and environmental
circumstances which are amenable to change. In contrast the individual who
manipulates the environment will illicit favourable responses leading to a high rate of
reinforcement.” (Individual Therapy, p256,  Geraldine O’Sullivan.)

As stated systematic desensitization can go a considerable way in helping the client
overcome a phobia, but should, in the writer’s opinion, be backed up with explanation
of the “feelings” which are aroused within the person: hands trembling, difficulty in
expanding his chest, lump in the throat, headaches, giddiness, weak legs,
palpitations, and heart racing are the body’s natural responses to fear. Apart from the
anxiety attack the sufferer may have feelings of unreality personality disintegration,
strange thoughts, obsession and depression, The perpetuating force is fear, adrenalin
and second fear. It is the second fear which the sufferer consciously adds that
sensitizes his body. it is all the “what ifs” which add adrenalin to adrenalin, thus
keeping the body aroused, particularly in the case of agoraphobia and “free floating
anxiety.” The sufferer does not know what is happening to him so he adds
bewilderment to fear which in turn leads to despair, depletion and then depression.
He is afraid of the state that he is in. In a calm relaxed body, sympathetic and para-
sympathetic hold each other in check, but when afraid the sympathetic part of the
nervous system dominated thus causing panic.

Sympathetic nerves act in this way through the release of adrenalin, thus in turn
causing the “feeling.” The natural reaction for the sufferer is to fight; this in turn
creates more adrenalin and more panic. If knows what is happening to him and is
taught how to take panic correctly and not avoid it he will recover. “The patients
treated by behaviourism who has not learned how to pass through fear may find fear
lurking in the shadows ready to come forward in the future perhaps in some new
guise.” (Peace From Nervous Suffering, p106, Dr Claire Weeks.)

The writer believes the client must be helped to handle the panic as well as getting
used to the place. If the client does not receive the support and the explanation to
take the panic, what would he do if panic were to strike again in a different place? It
should be emphasised that memory, sight, sound or smell can bring a debilitating
attack of panic. The client who accepts what his body does to him, and does not try to
“run from it”, will find cure not remission.

Flooding, or implosive, therapy is used when it is time for the client to go to a place
that he fears most: the reasoning behind this being extinction of the conditioned
anxiety. In implosive therapy the same processes are used, but this time in the client’s
imagination with the therapist introducing fearful “triggers” and visualisation. These
techniques have their merits for some, but will not be applicable for others – for
example, the client with cardiac problems.

In the nineteenth century a captain in the Royal Navy controlled the behaviour of
prisoners on an island in the Pacific by using the technique of ‘contingency rewards’.
Today the ‘token economy’ system is used in psychiatric hospitals. Patients are given
tokens for achieving “target” behaviours. The tokens can be exchanged for privileges.
For example the patient who keeps himself clean and tidy and speaks to others will
benefit by being allowed to watch television. The writer would hope that this is
morally and judicially applied by the staff.

With obsessive compulsive disorders ritual prevention may be used, therefore by
preventing the act anxiety is no longer an habitual response. The writer would be
very surprised indeed if the client on his own had not tried to prevent himself from
engaging in the futile act, and is of the opinion that for some OCD’s the client would
benefit greatly by being taught that it is a strange thought in a tired mind; and that a
tired mind is an inflexible mind; and that thoughts stick. If the client was actively
encouraged to engage in the repetitive act willingly, the anxiety that accompanies the
ritual would be greatly reduced, and therefore left with only a thought – and who
need be bluffed by a thought? This procedure could be described as “glimpsing” the
truth, and, with continual support and encouragement from the therapist, it could
eventually be successful.

The therapist may also use ‘thought stopping’ where he encourages the client to think
the destructive thought, but tells him to “stop” just as thought enters the client’s mind.
The client is then asked to re-frame the negative thought into a positive thought. This
technique however may only have a short term gain.

In appetitive disorders the positive reinforcement gained from the behaviour leads to
its continuation. Self-monitoring, diary-keeping and recording of internal and
external cues which instigate the eating disorder, and confining the eating to one
room, may help bulimia and obesity. “These behavioural techniques are frequently
used in conjunction with a cognitive approach during which the individuals attitude
and thoughts about the problematic behaviour are explored.” (Individual Therapy,
p266, Geraldine O’Sullivan).

Sexual deviations were treated with aversion therapy where the noxious stimulant –
electric shock – was paired with an imagined deviant behaviour. Covert sensitization
however is in more frequent use, where the client moves towards arousal but is then
paired with a ‘normal’ fantasy.

Depression can be treated with assertiveness training and self-evaluation. Again the
writer is of the opinion that a depression arising from an anxiety state would be best
treated with explanation and encouragement not to fight the depression, but instead
to work with it at a steady pace.

The therapist should be directive, understanding and empathic and may use
contingency contracting to establish which behaviours the client should produce in
order for rewards to be received. An attitudes and feelings test may be used in order
for the therapist to gauge the initial problem and the results from the continuing
therapeutic encounter. The questions asked are framed in such a way as to illicit
whether psychosis, anxiety, agoraphobia, bulimia, anorexia, insomnia,  depression or
other disorders are present. The therapist should be aware of dealing with any
disorders beyond his experience.

The writer is of the belief that a great many behavioural therapies have their place
and can be successfully and easily used – ie incorporating systematic desensitization
with reciprocal inhibition for clients suffering from mono-symptomatic phobias. If
the client has a fear of spiders, it may be useful to visualise the spider having a red
nose. Comedy and relaxation, being the opposite of anxiety and fear, will greatly
dissolve the connection between the unconditioned stimulus and the response.

To use behavioural therapies alone for the betterment of the client would be wrong.
The writer advocates an eclectic approach. There would be very little point in using
systematic desensitization on a client suffering from apiphobia (fear of bees) if the
underlying cause was sexual abuse and that the bees were a displacement for his
anxieties. Systematic desensitization would be more effectual after release of the
repression. The writer notes that a case history presented in the book Individual
Therapy (pp270/271) tells of a client being helped with panic attacks using self
exposure, and that she is “progressing along the hierarchy of feared situations…The
quality of her life had improved substantially. She experienced some discomfort in
certain situations but able to endure this…”  Unfortunately six months into therapy
anxiety and panic returned after a holiday: the sight sound and smell of the previous
suffering were recalled – the principle of contiguity. It seems that she had been helped
how to deal with the places, but not how to deal with the panic. By teaching the
client how to accept the panic she will be able to deal with the places, and therefore
will be able to take the cure with her, wherever she goes.

The writer is of the belief that behaviourism is an extremely powerful tool which
should be used with caution. It has the potential to infringe the rights of individuals
and should therefore only be used to meet the specific needs of the clients. It does
however tend to over simplify the complex workings of a human being,  dealing only
with the presenting problems and ignoring the underlying issues of the client. The
positive attributes of behaviourism are already an integral part of most other
therapies, and should not be used in isolation but as an adjunct with these other
therapies. “The real complication with behaviour therapy, then, is not that it is the
wrong therapy but that, unless scrupulously controlled and limited, it is wrong, full
stop.” (A complete Guide to Therapy, p282, Joel Kovel).

 

Robin Thorburn