Because cognitions
are internal events they are less accessible to measurement and study than are
overt behaviors. We have to study them indirectly via the person’s overt
behaviors. We generally do not know what people are thinking except by way of
some behavior such as what they say they are thinking. Thus we are always
dealing with behaviors, whether or not we make inferences about cognitions.
This is basically the position of behaviorism. Some researchers and theorists
argue that the best approach is to restrict our studies and discussions to what
we can observe and measure and not make unnecessary inferences to such
constructs as cognitions. We should restrict ourselves to people’s verbal
behavior rather than extrapolate to their thoughts. Although this is a
reasonable scientific strategy, it
has created the impression that
such theorists are somehow denying the existence or importance of cognitions.
Other theorists, including many behaviorists, readily incorporate cognitions
into their models and discussions. This is particularly true of the cognitive
and information-processing approaches in the psychology of learning and in the
behavior modification approaches discussed later in this chapter. For
simplicity I will freely talk about cognitions in this chapter, but we must
remember they are usually inferences from observable behavior.
Most cognitions can
be treated, researched, and formulated as behaviors (Ullmann, 1970). That
is, most cognitions are covert behaviors that follow most of the same principles
as overt behaviors. Thus in a treatment program people may learn how to operantly
or respondently condition their thoughts in ways similar to conditioning other
behaviors. At this point behavior modification overlaps other approaches,
such as meditation, which deal with quieting or controlling the mind.
Many of the procedures
already discussed in this book are basically cognitive procedures. This includes
covert sensitization, covert reinforcement, covert punishment, covert extinction,
covert modeling, covert rehearsal, and the use of imagined scenes in such
practices as desensitization and implosion. All of these procedures are based
on having the client imagine different events, for humans are imagers, and
images are often mediating links in behavior chains. Thus people often do
not respond directly to a situation, but rather respond to the image they
have of the situation. Similarly, people’s behavior is often governed by what
they imagine will happen if they act in different ways. Thus we can often
affect behavior by procedures geared toward what people imagine. This is a
very old approach that underlies a wide diversity of practices, including
psychocybernetics, some yoga meditations, and perhaps some or all of modeling.
Because we cannot
directly measure cognitions, there is great difficulty in evaluating and researching
the various covert procedures. Hence the research in this area is currently
inadequate and the procedures lend themselves for many different explanations.
Similarly on a practical level a client may imagine something different from
what you think he is imagining or told him to imagine (Kazdin, 1975a; Weitzman,
1967). For example, in desensitization a client may imagine a scene that is
more or less anxiety-producing than the suggested scene. In such situations
it is often desirable to have the client verbalize, during or after, what
he is imagining.
Before considering
other cognitive change approaches, I wish to review two important questions: To what extent does changing cognitions affect a
range of behaviors other than those used to measure the cognitions? To what
extent does changing overt behaviors affect related cognitions?
COGNITIONS
AFFECTING OTHER BEHAVIORS
Most people,
including most teachers, parents, and therapists, try to influence others’
behavior by what they say to them. That is, their approach is basically geared
toward the person’s cognitions. And this often results in changes in the
person’s behavior. For example, the cognitive change may basically consist of
acquiring new information that guides behavior. A student may be instructed in
strategies to improve study habits. Or a couple in therapy may require
substantial sexual education. Masters and Johnson (1970) report that a major
fallacy in our culture is assuming that a man naturally knows what is pleasing
to a woman and the best sexual approach with his partner. In
other situations the cognitive change may involve altering a person’s
misconceptions or faulty assumptions.
On the other hand,
many cognitive approaches are basically our behavior modification procedures
mediated by language. Thus by talking with a client we may produce respondent
conditioning through the pairing of concepts and their related images, alter
a person’s incentives and affect related operant behavior, allow certain emotions
to be expressed and extinguished, verbally reinforce the person for talking
in certain ways, provide discrimination training so the person’s behavior
becomes tied to more specific stimulus situations, and act as a model for
a wide range of behaviors. Thus a practitioner may believe the changes he
produces by talking with the client are due to cognitive changes, such as
insight or attitude change; when in fact it
might be more profitable to view the changes
in terms of learning and motivational constructs such as those above.
So cognitive changes
may result in general behavior changes, but often they do not. In some cases
the client simply does not have the
desired behavior in his repertoire.
Convincing a client to be more assertive may be inadequate. He may not know
what do to and could go to the other extreme and act too aggressive. It is
better to provide assertive training. In some cases cognitive changes are
inadequate to overcome strong behaviors. For example, it is common for a person
with a strong fear to understand the nature and cause of the fear, consider
the fear undesirable and irrational, and know how a non-fearful person would
act in these situations; but this seldom helps reduce the fear. Rather the
client needs some behavioral treatment such as desensitization. And in other
cases, such as with some small children, retardates, and severely mentally
ill, cognitive approaches are impractical or inefficient.
A common cognitive
approach is to change people’s attitudes as a way to change their behavior.
However, after considerable social psychological research, it turns out that
this is not an effective approach (Festinger, 1964; Wicker, 1969). After people’s
attitudes have been changed, there may be a slight change in behavior to match
the attitudes. But if the behavior is not independently changed or supported
in its change, the attitudes will drift back toward their original position.
Thus someone may go into a high school and show the students horror films
about not brushing their teeth. As a result, the students’ attitudes may dramatically
change in favor of more brushing. But although there may be an immediate change
in actual brushing, over time the students will probably return to their previous
brushing frequencies.
When the Surgeon
General’s report came out relating cigarette smoking to health problems, there
was a dramatic reduction in cigarette sales. But soon the sales were greater
than before. Ludwig (1968) has suggested that constructive attitude change
with alcoholics might merely produce a more insightful drunk. The point is
that attitude change is often inadequate to produce general behavior changes;
the behaviors should be independently altered as with behavior modification.
Many social psychologists (e.g., Zimbardo & Ebbesen, 1970) now combine
attitude change techniques with behavior change techniques.
Another common cognitive
approach is insight-oriented therapy. Here the assumption is that providing
the client insight into the nature and/or etiology of his problem will produce
general therapeutic change across many behaviors. In many cases insight often
involves the client being able to view his behavior from a particular theoretical
position. For reasons such as those already discussed, this approach has not
proved effective; understanding a problem does not necessarily provide the
person with the skills to overcome the problem. London (1969, p. 53) concluded
that “Insight therapy is clearly a poor means of symptom control; after almost
70 years of use, there are still few indications that uncovering motives and
expanding self-understanding confer much therapeutic power over most troubling
symptoms.” And Hobbs (1962) suggested that insight is not a cause of therapeutic
change, but rather is a consequence of such change. Insight- oriented approaches
dominated psychotherapy for many years, and many therapists still see insight
as their major therapeutic goal. Other therapists recognize that insight is
often inadequate and needs to be coupled with or replaced by other approaches,
such as behavior modification.
Thus cognitive approaches
may be effective ways to change cognitions. But we have to be careful about
assuming that the cognitive changes will produce lasting or significant changes
in behaviors (other than the behaviors used to measure the cognitions). Sometimes
we will get behavior changes, often we will not. If we wish behavior changes,
we should generally use procedures that directly change or support change
in the behaviors, rather than getting at them indirectly through cognitions.
As will be seen next, changes in behavior often result in changes in cognitions.
BEHAVIORS
AFFECTING COGNITIONS
Often following a
behavior change program the person’s cognitions (e.g., attitudes, thoughts,
self-concept) alter, even though no attempt was made to directly change them.
This is not surprising since people are observers of themselves. So if a person
sees himself acting differently, handling problems he could not handle before,
being more successful in some area, feeling more relaxed, or some other
important change, it is not uncommon for the person to think and feel
differently about himself and related people and situations. The human mind
also has a tendency to justify whatever the person does; so changing the
behaviors changes the justifications. And it is common, perhaps the rule, for
attitude change to follow behavior change (Bern, 1967). For example, in
assertive training, it is usually easier and more effective to work with
behaviors than attitudes, which then usually results in attitude change
(Alberti & Emmons, 1 974, p. 33—35).
Cautela (1965) described
three cases in which he used desensitization to treat phobias. Although no
attempt was made to make the clients aware of the etiology of their anxiety,
the clients made “insightful-like” statements as the treatment became effective.
That is, they came to understand their fear more as the anxiety was reduced,
although no attempt was made to determine if their insights were “correct.”
Bandura, Blanchard, and Ritter (1969) used various combinations of desensitization
and modeling to reduce snake phobias. Although no attempt was made to change
attitudes toward snakes, clients’ attitudes about snakes became more favorable
as treatment progressed. Similarly, Shaw and Thoresen (1974) reduced fear
of dentists by modeling and counterconditioning and found that this produced
a change in clients’ attitudes toward dentists and dental work. Ryan and his
associates (1976) desensitized test anxiety in college students and found
this produced a change in the students’ self-concepts. Dua (1970) worked with
female students with anxiety concerning the ability to relate in interpersonal
situations. The “action program” treatment emphasized establishing specific
actions to expand the behavioral repertoire, while the “reeducation program”
treatment emphasized changing attitudes, cognitive processes, and verbal interactions
involved in relating to others. Both programs reduced emotionality, but the
action program was more effective than the reeducation program in terms of
improvement in social extraversion and increasing the sense of internal control
versus external control.
Desensitization of
specific concepts has also been an effective way of reducing nightmares (Shorkey
& Himle, 1974; Silverman & Geer, 1968). Bergin (1970) worked with
a client whose dreams often had conflict situations with authority figures.
The conflicts elicited much anxiety and woke him up. Following the second
session of desensitization related to authority figures, there was a shift
in the dreams so that the conflicts continued without anxiety to a more satisfactory
conclusion. Later this subject matter no longer occurred in his dreams. Ayllon
and Michael (1959) worked with a female patient who refused to eat and made
“delusional” statements that the food was poisoned. Although no attempt was
made to deal with her delusions, they disappeared as she was encouraged to
feed herself and found the food was not poisoned.
Eitzen (1975) studied
the changes in attitudes in the boys living in the token economy, residential
home Achievement Place (see Chapter 7). Compared to boys of a similar age
in a junior high school, the boys in Achievement Place showed a greater shift
from an external to internal sense of control (they were becoming masters
of their own fate) and more improved self-concept, in both cases ending up
better than the control group. The Achievement Place boys also improved in
achievement orientation, but stayed below the control group. Grzesiak and
Locke (1975) studied a token economy program with psychiatric patients. Although
the program was geared toward overt behaviors, they found changes in many
independent cognitive measures—such as improved adjustment, increased ego
strength, and decreased impulse responses. They also found significant changes
on scales for a variety of attributes, including mood, cooperation, communication,
and social contact.
Thus changing behaviors
often results in cognitive changes. It seems that behaviors are often “stronger”
than cognitions, so that changing the behaviors draws the cognitions along,
while changing the cognitions produces a temporary change with the cognitions
often changing back to match the behaviors. In practice most treatments are
affecting both cognitions and other behaviors; it is more a question of emphasis.
It is probably best to simply consider the whole range of the client’s behaviors,
some of which might be called cognitive, and how they interrelate. Then a
comprehensive treatment program can be developed. The rest of this chapter
deals with treatment approaches that are basically cognitive.
Cognitive therapy, as developed by Beck (1970, 1971, 1976) and
others, emphasizes changing clients’ internal processing. The assumption is
that people often distort their perceptions (which may lead to
psychopathological responses), distort information they are processing, work from
faulty assumptions, and use faulty thinking. Treatment involves such practices
as delineating and testing the validity and reasonableness of the clients’
misconceptions, distortions, and maladaptive assumptions. Practitioners may
help clients formulate their experiences more realistically, process
information more veridically, and alter faulty thinking and statements clients
tell themselves. For example, the treatment of depression might involve getting
clients to engage in more activities and helping them to evaluate themselves
and their behavior more realistically by focusing on negative self-judgments
(Rush et al., 1975).
Although cognitive
therapy is currently not a formal part of behavior modification, the two share
many commonalities. Both focus more on overt symptoms than assumed dynamic
causes, both emphasize current behavior over historical experiences, and in
both the therapist actively participates in setting up a specific treatment
program. Beck (1976) has suggested that behavior therapy is a subset of cognitive
therapy and primarily works by changing cognitions. In the current behavior
modification literature the types of change approaches of cognitive therapy
are discussed under terms such as “cognitive restructuring” and “rational
restructuring.”
Cognitive
restructuring is basically
cognitive therapy facilitated by behavioral strategies. For example, Goldfried
and Goldfried (1975) outline an approach to help clients modify their internal
sentences, what they say to themselves. First the client learns how his
internal sentences have been causing his emotional problems. Then the client
imagines problematic situations (perhaps in hierarchial order), learns to catch
undesired self-statements he makes in these situations, and practices desirable
self-statements in place of the undesirable ones. This whole approach might be
coupled with modeling by the practitioner, behavioral rehearsal, or simulation
in groups.
Goldfried and associates
(1974) have described a program of self- control of anxiety based on teaching
clients to modify how they approach situations: First the client is exposed
to anxiety-provoking situations in imagination or by role playing. Then the
client learns how to evaluate how anxious he is. The client learns to use
the anxiety as a cue to determine self-defeating anxiety-provoking attitudes
and expectations he has about the situation and specifically what he is telling
himself. Next these self- statements are reevaluated rationally. Finally,
the practitioner suggests or models change strategies, as for faulty self-statements
or irrational assu mptions.
Note the importance
given to the clients’ self-statements and assumptions in the examples above.
This represents the influence of Rational- Emotive Therapy and researchers
such as Meichenbaum, discussed next. Cognitive restructuring, by definition,
includes a wider range of cognitive approaches.
Rational-Emotive
Therapy (RET), developed by
Ellis (1962, 1970), is a cognitive therapy whose major approach is modifying
the client’s thinking and related assumptions and attitudes. Many psychological
problems and much emotional suffering are seen as due to irrational ways of
perceiving the environment, irrational thinking, and related self-statements.
Part of therapy consists of identifying and correcting irrational beliefs—such
as the belief that it is necessary to be loved or approved by everyone or the
belief that one should be thoroughly competent in all that he does if he is
worthwhile. Another part of therapy consists of helping clients correct
undesired self-statements, on the assumption that what people say to themselves
affects the way they feel and act.
RET is seen by some
as part of modern behavior modification and by others as closely related to
behavior modification. It certainly has influenced the interest of the last
few years in cognitive behavior modification. The addition of behavioral techniques
to RET, as in cognitive restructuring, has made it more powerful. A good example
of this is the research by Meichenbaum (1974a, 1974b). While RET relies heavily
on logical self-examination, Meichenbaum incorporates such behavioral components
as modeling, graduated tasks, specific training, and self-reinforcement. Through
his approach to altering self-statements Meichenbaum has been able to produce
desirable changes in hyperactive and impulsive children, and in people wishing
help with creativity, worrying, stress, and snake- and test-related anxiety.
The following is
a typical sequence of training Meichenbaum might employ: First the model (e.g.,
the therapist) performs the task while talking out loud to himself, modeling
self-statements. Then the client performs the task with instructions from
the model. Next the client performs while instructing himself out loud. Then
the client performs while whispering. Finally, the client performs while giving
himself the self-instructions covertly. The verbalizations and related images
that are rehearsed are specific to the problem or task, but may include questions
(and answers) about the nature of the task; instructions guiding the performance;
self-reinforcement; or coping self-statements to deal with frustration, uncertainty,
or anxiety. A hyperactive child may tell himself to “Go slowly” or “Stop and
think before I answer.” A college student trying to be more creative may tell
himself to “Defer judgments” or “Use different analogies.”
Meichenbaum and Cameron
(1973) used such an approach to give institutionalized schizophrenics extended
trai fling in self-instructions. Via Operant conditioning the patients learned
to pause and think before responding and use self-statements such as pay attention,
listen, repeat instructions, and disregard distraction. The patients also
learned to be sensitive to others’ cues about their behavior and use this
information to act more “appropriately.” This involved self-statements such
as be relevant, be coherent, and make oneself understood. The result of this
training was that the patients showed an increase in “healthy talk” in a structured
interview and showed improvement in several cognitive and attention tasks.
Another study involved
the treatment of speech anxiety (Meichenbaum et al., 1971). Here the subjects
were taught to identify maladaptive self-statements and encouraged to produce
more adaptive self-statements. This approach and desensitization were both
done in groups and both significantly reduced speech anxiety. The researchers
suggest the possibility that subjects who experience anxiety in many situations
profit more from self-statement approaches, while desensitization may be better
for subjects whose anxiety is more specific.
Goodwin and Mahoney
(1975) coupled modeling with a self- instruction approach to teach hyperactive
impulsive boys to cope with verbal aggression in a verbal taunting game. The
boys observed a videotape of a boy in the game remaining calm. The model was
portrayed as coping via a series of covert self-instructions (e.g., “I won’t
get mad”), which were dubbed in on the tape. The modeling was followed by
coaching and practice of the boys using these coping self-statements. This
treatment resulted in increased coping in the game and an increase in non-disruptive
classroom behavior.
Next I turn to behavioral
approaches that apply conditioning principles to words and thoughts. This
includes thought stopping to disrupt unwanted thoughts, coverant control to
operantly condition desired thoughts, and respondent verbal conditioning to
change the affect associated with words and related thoughts. Coupling these
with the cognitive approaches already discussed gives the practitioner a more
powerful treatment package. Such techniques strengthen cognitive therapies.
For example, rather than simply telling the client to use certain positive
self-statements, coverant control provides a way of shaping and reinforcing
these statements.
Thought stopping,
a procedure suggested by
Bain (1928) and popularized by Wolpe (1958, 1969), is a simple but effective
way to disrupt unwanted thoughts. Consider a client who is continually bothered
by thoughts related to an unpleasant past event. The thoughts come into his
mind with some regularity, he has little control over the thoughts, and the
thoughts trigger undesired reactions such as unpleasant emotions. Treatment
would involve the client being instructed to close his eyes and think the
thoughts. Then the practitioner would shout “STOP!” and point out to the
startled client how this caused the thought to stop. The practitioner does this
a couple of times and then has the client do it himself, shouting out loud. The
client practices this at home, first shouting out loud and gradually “shouting”
covertly. Very quickly the client learns to be able to disrupt unwanted
thoughts simply by telling them to stop. With time the process becomes more
automatic and the client can simply “will” the thoughts away.
As simple as thought
stopping sounds, it is quite effective and can be learned quickly
to stop such thoughts as those that interfere with studying (Mikulas, 1 976a).
It is particularly effective when used to disrupt irrational, perhaps obsessive,
thoughts or thoughts in a behavior chain leading to fear. The disruptive effect
of the “STOP” can be enhanced by pairing it with such things as electric shock
or pounding a fist on the table. But thought stopping is merely a disruptive
tool and is thus best when coupled with other procedures such as coverant
control.
Anthony and Edelstein
(1975) worked with a client with a fear of epileptic seizures, although because
of anti-seizure medication there had not been any seizures for two years.
Excessive thoughts about seizures led to severe anxiety attacks four to five
times a week, accompanied by nausea and vomiting. Thought stopping eliminated
these problems in three weeks and there were no anxiety attacks during the
six month follow-up.
Samaan (1975) worked
with a 42-year-old woman, one of whose problems was auditory and visual hallucinations
of her mother. For example, whenever she took a shower she saw the water change
into blood while an image of her mother watched at the shower door and shouted
threats. Thought stopping effectively stopped her hallucinations. Other parts
of her treatment program for other problems included flooding, relaxation
training, and working with the family.
Rosen and Schnapp
(1974) used thought stopping as part of marriage counseling. The husband had
obsessional thoughts regarding his wife’s affair. Both the husband and wife
were trained to yell “STOP” whenever the husband’s thinking or speaking ran
out of control on this topic.
Rimm and associates
(Rimm, 1973; Rimm et al., 1975) have found that thought stopping coupled with
covert assertion is an effective way to treat some phobias. Covert assertion
consists of the client saying forceful and assertive things to himself,
perhaps contradicting the problem. Thus in phobic situations the client uses
covert assertion, following thought stopping, as a way to reduce anxiety.
For example, a woman fearing men hiding in the closet may tell herself, “There
is nobody in that stupid closet.” Covert assertion is similar to the self-statements
discussed earlier and coverant control discussed next.
It is often useful
to consider thoughts as covert responses that can be altered by operant
conditioning. Homme (1965) suggested the term coverant as a contraction
of “covert operant” and coverant control as an approach to operantly
condition thoughts. In its simplest form coverant control consists in first
identifying thoughts or self-statements we wish to increase in the client in
different situations. Then the client is taught to emit these coverants when in
the appropriate situation and reinforce himself for doing this. The coverants
should generally be short believable statements. Johnson (1971) had his client
put the statements on separate 3 x 5 index cards and carry them along. Todd
(1972) used coverant control as part of his treatment of a 49-year-old
depressed female whose description of herself was all negative. They found six
positive statements about her and put these on a card in her cigarette pack.
She then read one or two statements before smoking a cigarette and gradually
added new statements to the list. This led to a general increase in positive
thoughts and a decrease in depression.
If the coverants
to be increased are fairly general, not tied to specific situations, then
the client’s life is filled with reinforcers that can be used. For example,
the client might require himself to emit the coverant “I am in charge of my
own behavior” before eating an apple, calling a friend, or opening the magazine
that came in the mail. If the coverant needs to be tied into specific situations,
we need more “portable” reinforcers—such as cigarettes or self-reinforcing
thoughts or images. Historically, many people (e.g., Homme) involved in coverant
control have used Premack’s theory of reinforcement (see Chapter 7). The assumption
here is that any high probability behavior can reinforce any lower-probability
behavior. In this case low-probability coverants are reinforced by high-probability
responses such as answering a telephone when it rings or opening a door you
have your hand on. Johnson (1971) used urination as the high probability behavior
with his client.
Homme (1 965) suggested
the use of coverants in favor of some behavior coupled with coverants opposed
to other behavior. Thus to reduce undesired behaviors we would identify the
stimuli for these behaviors. In the presence of these stimuli the client would
emit a coverant against the undesired behavior, followed by a coverant for
some desired behavior, followed by reinforcement. For example, to reduce smoking
a client in the presence of cigarettes may say to himself “Smoking causes
cancer,” followed by “My health will be better if I don’t smoke,” followed
by drinking some juice.
Although coverant
control seems logical from an operant orientation and has been reported to
be a useful therapeutic tool, several problems exist in evaluating it (Knapp,
1976; Mahoney, 1970, 1972). Most of the literature is case studies with little
good controlled research. Homme’s more complex approach, described in the
preceding paragraph, has not been investigated. And there is a lack of research
on the Premack principle with humans, particularly as it is being applied
here. It may be that much of the effect of coverant control is simply getting
the client to practice self-statements, but this is worthwhile in itself.
RESPONDENT
VERBAL CONDITIONING
While operant
conditioning may be used to increase or decrease the probability of certain
thoughts, words, or verbalizations, respondent conditioning may be used to
change their affect, such as the emotional reactions elicited by specific
words. Studies below suggest that changing the affect of certain words produces
changes in related behaviors. We need much more research to determine when and
how this happens. Perhaps words are part of complex behavior chains, so that
changing the words alters the chain. perhaps conditioning based on words
generalizes to or results in conditioning of images or other constructs that
affect behavior. Research in these areas will help us understand part of what
goes on in talk therapies and how to make them more effective.
Hekmat and Vanian
(1971) suggested a procedure they called semantic desensitization, which
consists of counterconditioning the negative affect of phobic-related words.
They had college students with snake phobias associate the word “snake” with
a pleasant word (e.g., “beautiful”) by creating an image combining the two
words (e.g., imagining a beautiful snake). They report that this procedure
resulted in the word “snake” being evaluated less negatively (on a semantic
differential), less fear of snakes reported on the Fear Survey Schedule, as
well as greater behavioral approach to a live snake. Hekmat and Vanian also
call their procedure “semantic counter- conditioning,” which may be more accurate.
They suggest that their results are due to counterconditioning of meaning
and suggest that other behavior modification procedures may reduce to semantic
desensitization. However, their use of images allows other interpretations
of their results, such as counterconditioning of mediating images. In a later
study Hekmat (1973) found that semantic desensitization and systematic desensitization
were equally effective in reducing phobias; and both were more effective than
implosive therapy. However, semantic desensitization required less time than
systematic desensitization to achieve the same results.
DiCaprio (1970) suggested
an implosion approach, called verbal satiation therapy, to reduce the
effects of specific words as an approach to deal with behaviors in which the
words may be part of the behavior chain. Treatment consists of continued repetition
(satiation) of the words in various forms, primarily verbal. Treatment possibilities
include the client repeating the word, repeating syllables of the words or
words resembling the word, repeating synonyms of the word, writing the word
repeatedly, or repetitively perceiving the word presented visually or orally.
For a person with a fear the repeated words would be those that elicit anxiety.
For an obese person the word “cake” may be a critical word. Presently there
is little evidence on the effectiveness of verbal satiation therapy.
To finish this discussion
of covert procedures, consider the following case report by Wisocki (1 973),
which combines several covert approaches of this and previous chapters. The
client was a 26-year-old man with a three- year addiction to heroin and negative
feelings toward himself and society. Covert reinforcement was used for imagining
refusing drugs and for thoughts antagonistic to heroin use. Thought stopping
disrupted positive thoughts about heroin use. Covert sensitization associated
imagining scenes related to getting or using heroin with aversive scenes,
including being attacked by Spiders or immersed in sewage. Vomiting could
not be used as an aversive scene since it was positively associated
with a good grade of heroin. To deal with the client’s poor “self-concept”
thought stopping was used to disrupt undesired thoughts (e.g., that he looked
“ugly and nasty”), while covert reinforcement was used to reinforce desired
thoughts in their place. Thought stopping and covert reinforcement were also
used to deal with social anxieties. Therapy lasted four months. At an 1 8-month
follow-up the client was drug free, had a new job, and had an active social
life.
An important
contribution to behavior modification from social psychology is the concept of attribution,
the perception and explanation of causes of events. People perceive various
factors affecting their lives; and this perceived causality (attribution) may
affect their behavior. Essentially everyone, in varying degrees, misperceives
himself and his environment in complex ways. Such misperceptions can lead a
person to attribute causes to minor or irrelevant factors and thus overlook
more significant variables. For example, a person who has trouble getting along
with his neighbors may attribute this to religious differences, when in fact it
may be because of inadequacies in his general interpersonal behaviors. Thus an
important part of many counseling therapy programs is to identify and perhaps
“correct” the client’s attributions. This is generally done at a fairly basic
level, for following misperceptions and faulty attributions to their extremes
leads into the subtlest domains of consciousness.
One implication of
attribution research relates to the importance of emphasizing self-control
approaches in behavior modification. It appears that you often get greater
behavior and attitude change in a client if he attributes the changes to himself
rather than to an external agent, such as a drug or some treatment done to
him (Davison & Valins, 1969; Winett, 1970).
In an early study
Davison and Valins (1969) gave subjects a placebo drug and told them it was
a “fast-acting vitamin compound” that would increase their ability to withstand
painful electric shocks. In fact the experimenters simply reduced the amperage
of the shock after giving the subjects the drug. Later half of the subjects
were told the drug was a placebo, thus the subjects themselves were responsible
for any tolerance change. On a final test, the half that knew the drug was
a placebo withstood shock better than the half that attributed changes to
the drug.
Another study investigated
the effects of drug attribution on being able to fall asleep (Davison et al.,
1973). All subjects were helped to fall asleep faster via self-produced relaxation,
scheduling procedures (e.g., going to sleep at about the same time each night),
and taking the drug chloral hydrate. Half the subjects were told they had
been given the maximum dose of the drug; half were told they had the minimum
dose. All subjects were then taken off the drug, but continued relaxing and
scheduling. There was a greater maintenance of therapeutic gain for those
subjects who did not attribute most of the effect to the drug (i.e., minimum
dose subjects).
Thus when drugs are
used as part of a treatment program, it is important that clients not attribute
most of the effects to the drug, although treatment procedures, such as desensitization,
have been successfully accomplished even when clients attribute effects, such
as relaxation, to drugs (e.g., Wilson & Thomas, 1973). Generally, clients
should view the use of a drug as an aid to acquiring self-control skills and/or
as a transient tool which will produce long-term effects (e.g., counterconditioning)
that will last after the drug is withdrawn.
A change procedure which has come from the attribution literature is the approach of misattribution, getting the client to believe the source of his anxiety is one that is not affectively charged (Ross et al., 1969). A client with a specific phobia may be exposed simultaneously to the phobic object and some other stimulus, such as a loud noise. Misattribution therapy would consist of getting the client to believe his feeling of anxiety was because of the tone rather than the phobic object. There is some evidence (e.g., Loftis & Ross, 1974) that misattribution procedures actually affect physiological responses to a conditioned source of arousal, rather than just affecting subjective feelings, reports, misperceiving, and denial of internal states. However, current research on the effectiveness and parameters of misattribution is mixed (e.g., Calvert-Boyanowsky
& Leventhal,
1 975).
Misattribution by
itself is probably not an effective way to deal with problems such as strong
or long-standing fears, for outside of laboratory experiments people’s personal
experiences probably force them to attribute the cause of their fear to at
least the general categories of situations that elicit the fear. Hence attribution
effects are probably more significant in more ambiguous situations, such as
those involving drugs.
Overall then, cognitive
approaches, such as those discussed in this chapter, are often useful adjuncts
to a complete behavior modification program. The recent interest in this general
area has brought behavior modification closer to other change models that
emphasize cognitive variables.
Cognitions refer to a
wide range of internal events and processes, including aspects of perceptions,
images, assumptions, beliefs, attributions, attitudes, thoughts, self-statements,
insights, and understanding. Cognitions are not directly measurable, but can only be inferred from overt behavior, causing practical problems in
research, Interpretation, and application. Cognitive therapy is an approach
geared primarily at changing cognitions. Rational-Emotive Therapy is a form of
cognitive therapy that emphasizes changing thoughts, self-statements, and
related assumptions. Cognitive restructuring is the combination of cognitive
therapy with behavioral procedures. Although changing cognitions may result in
changes in many related behaviors, often the cognitive changes are insufficient
and need to be coupled with more direct behavioral approaches. This is
particularly true when the client does not have the desired behaviors in his
repertoire. On the other hand, changing behaviors often results in changes in
cognitions such as attitudes and self-concept. In practice almost all change
procedures affect both cognitions and behaviors; differences among approaches
are usually more of emphasis on one or the other. Also many cognitive
approaches can be viewed as behavioral strategies mediated by language. Many
covert behavior modification procedures, such as covert modeling, covert
reinforcement, covert sensitization, and the use of imagined scenes in
desensitization are basically cognitive procedures. Other behavior modification
practices dealing with cognitions include thought stopping to disrupt unwanted
thoughts, coverant control to operantly condition desired thoughts, and
respondent verbal conditioning to change the emotional affect elicited by
specific words and thoughts.
|
1.
|
Give
a general definition of cognition. Discuss this definition from a behaviorist
position. How can a person be both a behaviorist and concerned with cognitions?
Give a definition of cognitive behavior modification. |
|
2.
|
Discuss
the idea that all cognitions are covert behaviors. |
|
3.
|
Give
three different situations, other than those in the text, in which a change
in cognitions results in widespread behavioral changes. |
|
4.
|
Give
three different situations, other than those in the text, in which cognitive
changes would be inadequate to deal with the major behavioral problem. |
|
5.
|
When would you expect changes in overt behavior to produce changes in cognitions? |
|
6.
|
Give
two different theoretical explanations for the effects of thought stopping.
Describe an experiment that would help decide between these two theories. |
|
7.
|
Give
a different hypothetical case example for how coverant control might be
coupled with each of the following: desensitization, assertive training,
and covert sensitization. |
|
8.
|
When
would you use semantic desensitization as opposed to standard desensitization
described in Chapter 5? Why? |
|
9.
|
Outline
a cognitive therapy program for a hypothetical case of paranoia in which
the client feels people are out to ruin him because he is so much smarter
than everyone else. How does the idea of attribution relate to this case?
How may thought stopping and coverant control be used with this client? |
|
10.
|
Combining
cognitive restructuring, RET, the work of Meichenbaum, and coverant control,
outline a general self-control approach a person can use to identify and
change self-statements that are causing trouble. |
|
11.
|
Discuss
the interrelationships among attribution, self-control, and self-concept.
What are the implications for general assessment procedures? |
Beck, A. T. Cognitive therapy and the emotional
disorders. New York: International Universities Press 1976. Goldfried,
M. R. & Lavison, G. C. Clinical behavior therapy. New York: Holt, Rinehart,
& Winston, 1976. Chapter 8.
Mahoney, M. J. Cognition and behavior modification. Cambridge, Mass.: Ballinger Publishing Co., 1 974.
Meichenbaum, D. Cognitive
behavior modification. Morristown, N.J.: General Learning Press, 1974.
Meichen baum, D. Cognitive-behavior
modification: An integrative approach. New York: Plenum, 1977.
Rimm, D. C. & Masters, J. C. Behavior therapy: Techniques and empirical findings. New York: Academic Press, 1974. Chapter 10.