Behavioural therapies mainly emerged in the 1950s. The main assumption of the behavioural view is that abnormal behaviour is learned in the same way as normal behaviour, through the principles of
classical and operant conditioning, and social learning theory. Therefore, just as it is learned, it can equally be unlearned. The first stage in behavioural therapy is to identify the problem and to
decide upon the most appropriate treatment techniques. Techniques are derived from classical conditioning and operant conditioning.
Behavioural therapies based on classical conditioning are considered to be very appropriate methods of treatment for anxiety disorders, such as phobias, post-traumatic stress disorder and for
addictions, although they are not regarded as suitable for psychotic disorders, such as schizophrenia. These methods are widely used by clinical psychologists within the NHS and are relatively
quick, usually taking just a few months, by contrast to psychodynamic therapies that usually last several years. They are also very effective in group therapy. The treatment is structured, the goals
are clear, and clinical progress is measurable.
Treatment
Classical Conditioning
Techniques
Systematic desensitisation
(SD)
Flooding/Implosion
Use of treatment
Mode of action
This technique, devised by
The principle behind this
Wolpe (1958), was developed
technique is to make the person
specifically to deal with fears,
feel relaxed rather than feel
phobias and anxieties. It is
fear. It is the pairing of
based on the idea that it is not
relaxation with the feared
possible to experience two
stimulus that causes the
opposite emotions at the same
desensitisation (this is to
time. The therapist works with
reduce the sensitivity of
the client to make a list of
something, in this case, for
feared situations, starting with
example, a spider will have less
those that arouse least anxiety,
effect). This technique can be
progressing to those that are
conducted in vitro (through
the most frightening. The
imagined imagery) or in vivo
person is first encouraged to
(real-life).
relax and then to progress from
the least fearful situation to
the more difficult
situations over a number of
sessions
- Quicker and often thought to be more effective than SD, the
idea is that if someone refused to face up to their fear, that fear
will never be overcome and may even grow in strength. Flooding is a
technique whereby the person, instead of taking careful steps
towards the object of fear, goes straight to their most feared
situation, usually contact with the object. Physiologically it is not
possible to maintain a state of high anxiety for a very long period,
and so eventually it should decrease. The person realises that they
are still safe and that nothing dreadful has happened to them. Thus
the fear should be extinguished (or ‘implode’). For ethical reasons,
this technique is conducted mainly in vitro and the therapist should
first ensure that the person is in good physical health.
- Comer (1995) discusses an interesting study on ‘flooding’,
conducted by Hogen and Kirchner (1967). Twenty-one people with
a phobia for rats were asked to imagine themselves having their
Appropriateness
- All behavioural therapies have
their roots in learning theory.
- Marks (1973) suggests that
SD works because of exposure
to the feared stimulus, not
the relaxation. The technique
can be explained in terms of
cognitive restructuring rather
than classic learning theory.
Effectiveness
- McGrath et al (1990) claim
that SD is effective for around
75% of people with specific
phobias.
- SD has also been used with
patients who suffer from OCD.
60% of patients improved if
they used this technique
(Comer, 2002)
Ethics
Teaches the client that there is
no objective basis for their
fear. Simple elimination of
symptoms does not mean that
the condition is cured. If there
is an underlying problem this
may lead to symptom
substitution. Behaviourists
argue that the symptoms are all
that matter – observable
behaviour.
Ost (1989) found 90%
improvement after one session
of flooding with patients with
specific phobias, and this was
maintained for an average of
four years. Van Oppen et al
(1995) reported much less
success with obsessivecompulsive disorder
Induces a high level
of anxiety in the
client, which could be
considered unethical.
fingers nibbled and being clawed by rats. After treatment, twenty
were able to open a rat’s cage and fourteen could actually pick up
the rat. In vivo techniques are found to be more effective for
specific phobias than in vitro (Menzies and Clarke 1993).
- Wolpe (1973) describes a case in which an adolescent girl who
had a fear of cars was forced into the back of a car and driven
around for four hours. Initially, she was hysterical but eventually
she began to calm down and by the end of the journey the fear had
disappeared completely.
- Dobson (1996) says that virtual reality software has been used
to treat people with phobias, e.g. acrophobia - fear of heights.
Footbridges, outdoor balconies and glass lifts are used. Barbara
Rothbaum, a leader for a research team, reports 100%
improvement in 12 participants after two months of treatment.
Treatment
Aversion Therapy
Use of treatment
Aversion therapy was developed
from studies with animals that
showed that giving an electric
shock when a neutral object is
present makes them learn an
aversion to or a dislike of the
neutral object. This has formed
the basis of aversion therapy,
which was developed to deal
with habits and addictions, such
as eating disorders, drinking
problems, and sexual deviations
such as ‘flashers’. Here the
therapist attempts to attach
negative feelings to things that
are considered inappropriate.
An example of this is smoking.
This is achieved through pairing
the taste of tobacco with a
feeling of nausea, for example
by inserting a nausea-inducing
substance into cigarettes.
Think about the vomiting
inducing drugs given to George
Best in his fight for survival
against alcoholism
Mode of action
Aversion therapy is based on
CC. The individual is repeatedly
presented with an aversive
(unpleasant) stimulus, e.g.,
electric shocks. In aversion
therapy applied to alcohol
abuse, a drug is used that
induces nausea and vomiting.
This is paired with alcohol so
patients begin to feel sick when
they drink.
Appropriateness
Back to the question of who
decides if an individual needs
treatment? Controversially,
aversion therapy has been used
to ‘cure’ homosexuals. Changes
in behaviour were reported for
up to two years. Marks (1968)
treated 19 homosexual males,
and after 1 year found 50%
‘improved’.It’s also been found
that there is a 50% chance of
patients dropping out from the
therapy.
- In contrast, McConaghly
(1999) found that trying to
change homosexuals and
paedophiles was ineffective.
Effectiveness
The major problem with this
technique is that it is doubtful
that aversion will continue after
the treatment has been
discontinued. 50% of alcoholics
did abstain but only for a year
after this treatment. Meter
and Chesser (1970) found that
at least half their patients
abstained for a year after
therapy. However, the dropout
rate tends to be high and there
are doubts about its long-term
effectiveness. It may work in
the therapist’s office but not
generalise to other situations.
Ethics
Serious, long term
psychological effects
(Harris, 1988). Lang
et al (1969) claims
that the cost and
benefits need to be
weighed up- e.g., the
benefits to society
for curing
paedophiles.
Operant Conditioning Therapies:
Token Economies
Token economy is a behaviour
modification or behaviour
changing programme based on
Skinner’s principle of changing
behaviour by rewards
In exchange for desirable
- Allyon and Azrin (1968) used - Woods et al. (1984) found
Corrigan (1995)
behaviour, the person will
TE to control the behaviour of
that short-term changes did
claims that behaviour
receive rewards in the form of
45 chronic schizophrenics who
lead on to more fundamental
modification
tokens, which can be exchanged
had been institutionalised for
long-term ones possibly because
programmes are
for goods, outings or privileges.
an average 16 years. They were
newly acquired behaviours are
abusive and
Token economy has been applied given tokens for making their
‘trapped’ by social reinforcers.
humiliating.
extensively in institutions,
beds or combing their hair. The
- But, the effectiveness of
Withholding basic
mainly with psychotic patients,
number of chores the patients
tokens may be due to other
rights has been rules
and with people who have severe performed each day increased
factors, such as being positively
unethical; in USA.
learning difficulties. Although it from about 5 to over 40.
reinforcing for the nursing
has been claimed that it is
- The drawback to this therapy
staff, who feel they are making
difficult for the modified
is that it often fails to transfer positive gains and therefore are
behaviour to continue after
to life outside the institution
stimulated to persist. They also
they have left the institution,
because of context-dependent
help to structure the situation
the hope is that outside the
learning.
and ensure consistent rewards.
reward will be acceptance of
the person by others.
Modelling
For example, a patient first
According to social learning
Modelling has been most
Bandura et al. (1969) found
watches the therapist
theory, phobias can develop
successfully used to help people
that this therapy was most
experiencing the phobic
through observing those fears
cope better in social situations
effective when working with a
situation calmly, then the
in significant others and
and situation that they find
live example of the feared
patient does the same. This is
modelling behaviour upon those
fearful. Clients watch other
object (such as a real snake)
based on social learning theory.
observations. Bandura has
people coping well with such
rather than a symbolic
supported the effectiveness of
situations and then imitate
representation.
using ‘modelling’ in the
their behaviour.
treatment of phobias in a
clinical study of 48 nursery
children with dog phobias
(Bandura and Menlove 1968)
and with adults with snake
phobias (Bandura et al. 1969),
claiming a 90% success rate.
General Evaluation of Behavioural Therapy There are three persistent criticisms of behavioural therapy: - Kendall and Hammen (1998) critics have described behavioural therapy as mechanical in
its applications and as limiting the benefits of treatment to changes in observable behaviour. - The focus of behavioural therapists on eliminating symptoms is very limited. The failure to consider
the underlying causes of mental illness leads to the danger of symptom substitution.
- The problem of generalisation. The application of behavioural therapy may serve to produce the desired behaviour by the patient in the therapist’s room. But it does not necessarily follow that
the same behaviour will be produced in other situations. Yet, the effectiveness of behavioural techniques has been shown to be quite high. Agoraphobia is one of the most difficult phobias to treat;
yet systematic desensitisation has resulted in improvement for between 60 and 80% of cases (Craske and Barlow, 1993). However, improvements are shown to be only partial and in 50% of cases
relapses occur.
The most serious criticism of behaviour therapy and modification is ethical. Techniques involving punishment, in particular, have been criticised for controlling people. Another criticism is that
behaviour therapists manipulate people and deprive them of freedom. It is the therapist, rather than the person, who controls the reinforcer, and therapists do not encourage people to look inside
them self for the problem. - Psychoanalytic theorists claim that this is because the phobia is merely a symptom, an observable problem in the conscious which is a signal from the unconscious that
something is wrong. Bandura (1969) argues that if ‘underlying’ is defined as ‘not immediately obvious’ then behaviour therapists indeed do look for underlying causes. The task is for the therapist to
work with the client to find the most significant causes.