An alternative approach to therapy, known as behaviorism, emerged in the early 1900s in part due to concerns about the inability of psychoanalytic theory to make predictions that could be tested experimentally. Behavior therapy is much more straight-forward in its approach.
It is based in the assumption that problematic behaviors are learned, in the same way we learn any other behavior.
Changing behavior is, therefore, not about understanding the root causes of present-day problems, but rather just replacing maladaptive behaviors (and associated thoughts) with more constructive behaviors. How? By using techniques based on well-established principles of behavioral learning, going back to the classical conditioning of Pavlov and operant conditioning of Skinner.
Counter Conditioning Technique
The technique known as counter-conditioning involves associating problematic feelings and behaviors with something counter to what you’d expect. For example, let’s say that one is terrified about getting into an elevator because they have a fear of being stuck in small places, or a fear that it will malfunction and they will plunge to their death.
In such cases, they’ve associated the elevator stimulus with a fear response. A behavioral therapist would work to pair the elevator stimulus with a new emotion, such as feeling calm or relaxed. With repeated pairings of elevator-relaxation, the fear response will gradually be eliminated.
Systematic Desensitization Technique
The most common technique for creating this new association is known as systematic desensitization. You start by creating a fear hierarchy, or exposure hierarchy, listing out a series of different steps that gradually increase in the degree of fear they cause.
So, if you have a fear of snakes, the first step on your list might be seeing a picture of a snake, then being in a room with a snake in a cage across the room, then actually being next to that cage, and finally, being able to touch the snake.
Next, after creating your fear hierarchy list, the therapist trains you in progressive muscle relaxation, meaning an ability to relax one muscle group after the other so that you can completely relax your whole body.
The therapist then asks you to imagine the first step on your fear hierarchy, seeing a picture of a snake in this example. If you feel any anxiety, you return in your mind to your state of deep relaxation. You then work up over time the steps in your fear hierarchy, so that eventually you are able to pair even the most intense version of your previously feared object with a new feeling of relaxation, instead of anxiety.
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Systematic desensitization is a slow and gradual approach to creating a new association. But counter-conditioning can also be more abrupt. A more risky, but more direct, approach to creating a new association is known as flooding.
This technique is very fast, but it can also be traumatizing, as it involves forcing the person to face the feared stimulus. So, this is a more extreme choice, even though it’s done in a safe way, and goes on for several hours where the goal is, after an initial period of fear, to understand that something actually isn’t as terrifying as they had believed.
So, a person with a phobia about dogs might be brought into a small pen with three or four friendly dogs, where they would experience a burst of fear, but then experience that not all dogs are necessarily vicious killers. Of course, someone unable to endure the initial fear long enough to complete the treatment will have a stronger phobia and may even suffer additional trauma.
The counter-conditioning techniques described thus far are rooted in principles of classical conditioning, just like how Pavlov’s dogs learned the association between a bell and food. Other behavior therapy techniques are rooted in the rewards and punishments of operant conditioning.
For example, autistic children who are socially withdrawn may be given certain rewards, such as special snack or small toy, for engaging in prosocial behaviors, like hugging someone or engaging in eye contact. People who are in treatment centers for anorexia nervosa and gain weight may be given special privileges, like a day pass to go shopping.
Concerns With Behavior Therapy
Behavior therapy approaches can be quite effective at changing people’s behavior in desired ways. But there are also some concerns about this approach to treating problems. One concern is what happens when the reinforcement ends? People with anorexia may successfully gain weight in order to receive rewards in a hospital setting, but in the real world, they aren’t going to get those same rewards for gaining weight and that can lead them to return to their prior maladaptive behavior.
A broader concern is that behavior therapy’s focus on just treating a specific behavior may leave an underlying cause of their fear or behavior to show up in some other way. For example, if a person smokes to reduce anxiety, perhaps counter-conditioning techniques can help them quit smoking, but now they turn to drinking alcohol, or engaging in obsessive exercise, or overeating. So, this approach might address one type of maladaptive behavior, yet do nothing to forestall another.
Common Questions about Behavior Therapy and Counter Conditioning
Behavior therapy is based in the assumption that problematic behaviors are learned, in the same way we learn any other behavior. Changing behavior is therefore not about understanding the root causes of present-day problems, but rather just replacing maladaptive behaviors (and associated thoughts) with more constructive behaviors.
In systematic desensitization, you start by creating a fear hierarchy, or exposure hierarchy, listing out a series of different steps that gradually increase in the degree of fear they cause.
The flooding technique is used for counter conditioning. It is very fast, but it can also be traumatizing, as it involves forcing the person to face the feared stimulus. So, this is a more extreme choice, even though it’s done in a safe way, and goes on for several hours where the goal is, after an initial period of fear, to understand that something actually isn’t as terrifying as they had believed.